216 Eating Disorders
inpatient units, and is supported by both clinical and community studies,
with the male–female ratio currently standing at 1:10 (e.g., Beumont, Beard-
wood, and Russell, 1972; Rastam, Gillberg, and Garton, 1989; Hsu, 1990;
Touyz, Kopec-Schrader, and Beumont, 1993). Some research has indicated
that male anorexia may be on the increase, particularly within vulnerable
groups such as models, dancers, and jockeys, who are required to have a
lower body weight (Buckley, Freyne, and Walsh, 1991). Research has also
shown that gay men may be at higher risk than heterosexual men of eating
disturbances, with about one-third of men who present with eating disorders
being gay (Schneider and Agras, 1987). This has been supported by
community-based studies which have shown higher frequencies of disturbed
eating attitudes and behaviors among gay and bisexual participants
(Siever, 1994; Feldman and Meyer, 2007b). Several explanations have been
put forward for this phenomenon, including the internalization of social
homophobia; overidentification with a gay scene which emphasizes
youthfulness, slimness, and attractiveness; and an emphasis on healthiness
in the context of HIV (Williamson, 1999).
AgeClinical and register-based studies indicate that the age of onset for anorexia
nervosa peaks at mid- to late adolescence (Szmukler et al., 1986), with the
mean age of onset being 17. There has been some recent evidence, however,
that the incidence in younger girls may be increasing, with studies on girls
as young as 8 and 9 showing a concern about weight and shape (Hill,
Draper, and Stack, 1994). Clinical records also show that girls this young
are increasingly likely to report symptoms of full-scale anorexia (Lask and
Bryant-Waugh, 1992). This is reflected in the increase in inpatient units
specifically for younger sufferers. Nicholls and Bryant-Waugh (2009) also
describe a number of eating problems in infancy and childhood. Some of
these, they state, can be classified as “feeding disorder,” whilst some they
describe as “selective eating,” “food phobias,” and “food refusal.” Others,
however, in this age group can be considered an eating disorder. Not all
anorexics, however, are young. Anorexia also occurs in those of middle age
and the elderly, and is often associated with severe depression or obsessive-
compulsive disorder (Cosford and Arnold, 1992). For example, Beck, Casper,
and Anderson (1996) reviewed all cases of eating disorders who had been
admitted to three university hospital programs in the US. They reported
that 1 percent of all cases (n=11) showed first onset of the disorder