Mental Health 527late adolescence to early adulthood (Pike &
Striegel-Moore, 1997). The incidence of buli-
mia has increased over the past several decades,
whereas the rate of anorexia has stabilized.Binge Eating Disorder. Binge eating dis-
orderis characterized by recurrent binge eat-
ing without purging or fasting. Binge eating
is accompanied by eating rapidly, eating large
amounts of food in the absence of hunger, eat-
ing in isolation from others, and feelings of
guilt and disgust with oneself for eating. Unlike
anorexia and bulimia, binge eating does not in-
clude purging, fasting, or exercise, which means
that people with binge eating disorder are
likely to be overweight or obese. Of the three,
binge eating disorder is the most prevalent, af-
fecting 3.5% of women and 2% of men over
their lifetimes (Hudson et al., 2007). Although
binge eating disorder is more common among
women than men, there is some evidence that
binge eating behavior is more common among
men than women (Saules et al., 2009). Unlike
anorexia and bulimia, which typically occur
during adolescence, the typical onset of binge
eating disorder is young adulthood.Disturbed Eating Behavior. Because
the prevalence rate of eating disorders in
the general population is so small, investi-
gators often study symptoms of bulimia or
anorexia. These symptoms are referred to as
disturbed eating behavior.One of the most
frequently used instruments to assess dis-
turbed eating is the Eating Disorder Inven-
tory (Garner, Olmstead, & Polivy, 1983).
Three subscales of this inventory have been
linked to eating disorders: drive for thinness,
symptoms of bulimia, and body dissatisfac-
tion. The items from each of these scales are
shown in Table 13.6. Many of the studies re-
viewed in this section have used this instru-
ment or a similar one.The anorexic person has a distorted body
image and refuses to maintain a normal
weight. One of the diagnostic features is that
the anorexic person weighs less than 85% of
what is considered normal for that person’s
age and height. A common symptom of an-
orexia in women is amenorrhea (cessation of
menstrual cycling).
Ironically, anorexia is more common
in industrialized societies, where food is
plentiful (American Psychiatric Association,
2000). A majority of cases of anorexia (90%)
are found in women, and the lifetime inci-
dence in the female population is 0.5%. The
onset of anorexia typically occurs between
the ages of 14 and 18.Bulimia Nervosa. Bulimia nervosais char-
acterized by recurrent binge eating followed by
inappropriate methods to prevent weight gain,
such as vomiting, intense exercising, or the use
of laxatives, diuretics, and enemas. By far the
most common method of purging is vomiting.
Although any food can be consumed during
a binge, foods typically consist of sweets and
fats. During the binge, the person usually feels
a loss of control. This person constantly thinks
about food and weight control. The typical
person with bulimia is of average weight but
may have been overweight prior to the onset
of the disorder. The low weight of an anorexic
person is a feature that distinguishes her or
him from the bulimic.
There are two types of bulimia: (1) pur-
ging, which involves vomiting and using
laxatives, diuretics, and enemas, and (2) non-
purging, which involves dieting and exercise
and not the other, more extreme methods.
As with anorexia, about 90% of bulimia
cases are found among women, and between
1% and 3% of women have bulimia (Pike &
Striegel-Moore, 1997). The onset of buli-
mia is somewhat later than anorexia, duringM13_HELG0185_04_SE_C13.indd 527 6/21/11 12:55 PM