Anorexia nervosa is an eating disorder characterized by unrealistic fear of weight gain, self-starvation, and conspicuous distortion of body image. The name comes from two Latin words that mean "nervous inability to eat." In females who have begun to menstruate, anorexia nervosa is usually marked by amenorrhea, or skipping at least three menstrual periods in a row. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV (1994), defines two subtypes of anorexia nervosa—a restricting type, characterized by strict dieting and exercise without binge eating—and a binge-eating/purging type, marked by episodes of compulsive eating with or without self-induced vomiting and the use of laxatives or enemas. DSM-IV defines a binge as a time-limited (usually under two hours) episode of compulsive eating in which the individual consumes a significantly larger amount of food than most people would eat in similar circumstances.
Anorexia nervosa was not officially classified as a psychiatric disorder until the third edition of DSM in 1980. It is, however, a growing problem among adolescent females and its incidence in the United States has doubled since 1970. The rise in the number of reported cases reflects a genuine increase in the number of persons affected by the disorder, not simply earlier or more accurate diagnosis. Estimates of the incidence of anorexia range between 0.5-1% of Caucasian female adolescents. Over 90% of patients diagnosed with the disorder as of 1998 were female. It was originally thought that only 5% of anorexics are male, but that estimate is being revised upward. The peak age range for onset of the disorder is 14-18 years, although there are patients who develop anorexia as late as their 40s. In the 1970s and 1980s, anorexia was regarded as a disorder of upper- and middle-class women, but that generalization is also changing. More recent studies indicate that anorexia is increasingly common among women of all races and social classes in the United States.
Anorexia nervosa is a serious public health problem not only because of its rising incidence, but also because it has one of the highest mortality rates of any psychiatric disorder. Moreover, the disorder may cause serious long-term health complications, including congestive heart failure, sudden death, growth retardation, dental problems, constipation, stomach rupture, swelling of the salivary glands, loss of kidney function, osteoporosis, anemia and other abnormalities of the blood.
Mai Tran, The Gale Group Inc., Gale, Detroit,