438 CHAPTER 10
Table 10.2 • Anorexia Nervosa Facts at a Glance
Prevalence- In the course of a lifetime, about 1% of females and up to 0.3% of males will develop anorexia (Hoek & van Hoeken,
2003; Hudson et al., 2007).
Comorbidity- Most studies fi nd that at least half—but as high as 90%—of patients with anorexia have at least one comorbid
psychological disorder. The most common types of comorbid disorders are depression, anxiety disorders, and per-
sonality disorders (Agras, 2001; Blinder, Cumella, & Sanathara, 2006; Cassin & van Ranson, 2005; Godart et al.,
2003; Lucka, 2006).
Onset- Anorexia typically emerges between the ages of 14 and 18 (American Psychiatric Association, 2000), although the disor-
der can make its fi rst appearance at an earlier or a later age (Beck, Casper, & Anderson, 1996; Keith & Midlarsky, 2004).
Course- Anorexia has the highest mortality rate of any psychological disorder—up to 15% (Zipfel et al., 2000). Half of the
deaths are from suicide, and the others are from medical complications of the disorder. People with anorexia who
also abuse substances have an even higher risk of death (Keel et al., 2003). - According to some studies, fewer than 50% of those who survive fully recover (Keel et al., 2005; Von Holle et al.,
2008), about 33% improve but do not recover, and 20% develop chronic anorexia (Fichter, Quadfl ieg, & Hedlund,
2006; Steinhausen, 2002); other studies have found higher rates of full recovery (Johnson, Lund, & Yates, 2003;
Keski-Rahkonen et al., 2007). Some people with anorexia gain enough weight that they no longer meet the
criteria for the disorder, but meet the criteria for bulimia nervosa (Keel et al., 2005).
Gender Differences- Approximately 75–90% of those with anorexia nervosa are female (Hoek & van Hoeken, 2003; Hudson et al., 2007).
Cultural Differences- The specifi c diagnostic criteria stated in DSM-IV-TR do not necessarily apply to all cultures. Many Chinese girls and
women with anorexia have not reported the fear of becoming fat that is typical among people with anorexia in Western
cultures. Rather, the reasons they give for their minimal food intake are discomfort when eating or the poor taste
of the food (Lee & Lee, 1996). - In the United States, females of black, Hispanic, or Asian background are less likely to be diagnosed with anorexia
nervosa than are white females (Alegria et al., 2007; Nicdao, Hong, & Takeuchi, 2007; Striegel-Moore et al., 2003;
Taylor et al., 2007).
CASE 10.1 • FROM THE INSIDE: Anorexia Nervosa
Caroline Knapp suffered from both anorexia and alcohol dependence (see the excerpt
from her book, Drinking: A Love Story, in Chapter 9, Case 9.5). In describing her rela-
tionship with food, she noted that people with anorexia nervosa develop bizarre eating
habits and a kind of tunnel vision—focusing on food, on eating, and on not eating:
When you’re starving... it’s hard to think about anything else [except eating or not eating.
It’s] very hard to see the larger picture of options that is your life, very hard to consider what
else you might need or want or fear were you not so intently focused on one crushing pas-
sion. I sat in my room every night, with rare exceptions, for three-and-a-half years. In secret,
and with painstaking deliberation, I carved an apple and one-inch square of cheddar cheese
into tiny bits, sixteen individual slivers, each one so translucently thin you could see the light
shine through it if you held it up to a lamp. Then I lined up the apple slices on a tiny china sau-
cer and placed a square of cheese on each. And then I ate them one by one, nibbled at them
like a rabbit, edge by tiny edge, so slowly and with such concentrated precision the meal took
two hours to consume. I planned for this ritual all day, yearned for it, carried it out with the
utmost focus and care.
(Knapp, 2003, pp. 48–49)