The Psychology of Eating: From Healthy to Disordered Behavior

Eating Disorders 217

after the age of 40, with two patients reporting onset at ages 75 and 77.
Furthermore, Mangweth-Matzek et al. (2006) reported that 3.8 percent of
a large community survey of 1,000 women aged 60–70 years met the criteria
for eating disorders (although most of these were eating disorders not specified
rather than AN or BN). Manejias Parke et al. (2008) described a case of a
72-year-old man who was referred with mild dementia thought to be caused
by nutritional neglect. The authors reported how on assessment he was found
to have many of the symptoms associated with an eating disorder.

Social class

It is mainly assumed that anorexics come from the higher classes. However,
the research examining the relationship between class and a clinical diagnosis
is contradictory. For example, Kendell et al. (1973) reported data from a
small-scale clinical register study and concluded that those individuals who
fulfilled the criteria for anorexia nervosa were of a higher class than those
who did not. However, a larger study found no such relationship (Szmukler
et al., 1986). This inconsistency may reflect problems with defining social
class, as definitions can include parental occupation, own occupation, educa-
tional status, and income, which are problematic due to an overreliance on
male data and the changing nature of the job market. This inconsistency
may also indicate that class per se is only a proxy measure for other factors
which relate to eating disorders. Gard and Freeman (1996) reviewed all papers
written between 1970 and 1994 which assessed socioeconomic status and
eating disorders. They concluded from their analysis that “the relationship
between anorexia nervosa and high socioeconomic status remains to be
proved” (p. 1), and suggested that clinical impression, referral bias, and
methodological bias had contributed to the perpetuation of this stereotype.

Ethnicity

Research has also addressed the extent to which the incidence of anorexia
is related to ethnicity within Western populations, and many clinical reports
show that the majority of patients with anorexia are white. However, a
number of UK patients are Asian or Arabic (Bryant-Waugh and Lask, 1991;
Mumford, Whitehouse, and Platts, 1991) or black (Holden and Robinson,
1988; Lacey and Dolan, 1988), and black patients have also been reported
in the US (Hsu, 1987). The prevalence of AN, however, is generally low in
Latinos (Alegria et al., 2008) and black African Americans and Caribbean