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More than 8 million Americans suffer from eating disorders. Approximately 90% of them are young women; however, middle-aged women, children, and men are also affected. The prevalence of eating disorders appears to vary by the population being studied. Recently, binge eating disorder (BED), previously considered a putative diagnosis subsumed under the category “eating disorder not otherwise specified,” was included as its own category of eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Its inclusion has changed the face of eating disorders. While anorexia (AN) and bulimia nervosa (BN) appear to primarily affect women, the ratio of women to men with BED is approximately 3:2. There are also significant cross-cultural differences in the prevalence and presentation of AN, BN, and BED.

Eating disorders are more prevalent in industrialized societies (where food is abundant and thinness is valued as attractive) than in developing countries. Women in Western countries traditionally have exhibited greater concern for body habitus than those in developing countries, who appear to be more accepting of and comfortable with a fuller body shape. In many of the latter societies, a fuller figure has been considered the cultural stereotype of attractiveness, although this ideal appears to change when individuals from these societies integrate into Western culture.

Westernization has affected many countries, and individuals from other cultures should not be excluded from consideration of an eating disorder diagnosis. Immigration from non-Western to Western cultures appears to place individuals at greater risk for eating disorders. Indeed, degree of acculturation into American society is associated with eating disorder risk, likely due to the adoption of Western body image ideals. As individuals (particularly girls and women) from cultures in which AN is unknown or extremely rare immigrate to Westernized societies with higher rates of AN, they tend to develop disorders as they attempt to acculturate.

Two core features are common across all eating disorders: (1) severe disturbance in eating habits, and (2) excessive concern and/or dissatisfaction with body shape and weight. However, on the surface, individuals with AN and BED present quite differently. Further, AN, BN, and BED differ in terms of prevalence, demographic correlates, and medical ramifications. Classification of both overeating and undereating disorders into a single category poses difficulties for the conceptualization and treatment of these conditions.

Dalle Grave  R Eating disorders: progress and challenges. Eur J Intern Med. 2011;22:2:153.
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Hudson  JI  et al.. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61:348.
[PubMed: [PMID: 1892232]]


Before detailing the clinical characteristics of various eating disorders, it is necessary to identify what is meant by “normative eating.” In so doing, it becomes apparent that a great deal of dieting occurs in Western culture as part ...

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