1. ANOREXIA/BULIMIA Young adolescent women, 90% female Risk groups – higher social classes, models, athletes, dancers, students, hx sexual abuse Comorbid diagnoses depend on age incl – anxiety and affective disorders and substance misuse Predictors of poor outcome – low self esteem, childhood obesity, PD, long Hx, commencing later age

2. Epidemiology-AN Incidence is between 8 and 13 cases per 100,000 persons per year Average prevalence is 0.3% Largely affects young adolescent women and approximately 90% of people with anorexia are female 15 and 19 years old makes up 40% of all cases

3. BULIMIA 90% affected women Mostly prevalent in adolescents High risk groups as anorexia Co-morbidities -

4. Predisposing factors for AN Social –economic background Ethnicity-Western Indrustrialised nation,less among non european Gender Social pressures e.g Dancers,models Hx of sexual abuse Hereditary(twin studies)(ranges from 56-84%)

5. Onset Of Bulimia The average age of onset for bulimia is 18 years, but it occurs in children as young as 9 and adults into their mid-40s. Most bulimics go through a period of prolonged dieting or restricted eating before the cyclic binging-purging episodes begin. several events that can trigger the onset of bulimia, such as family problems, problems in relationships, and failure in school and work. The illness may pursue a long-term, fluctuating course over many years, or may be more episodic, precipitated by life events and crises. The diagnosis may not be stable over time. In the shorter term, some reports suggest a 50% improvement in binge eating and purging behavior among patients who are able to engage in treatment. In one of the study, patients with bulimia nervosa had a remission rate of approximately 74% and a relapse rate of approximately 47%. The natural course did not appear to be influenced by personality disorder psychopathology.

6. Associated Co-morbidity-BN Affective disorders : The rather common association of eating disorders with affective disorders suggests a possible relationship between them. Whether the association is causative (primary), secondary to the bulimia itself, or represents a common set of risk factor for bulimia and MDD. Anxiety disorders : Obsessive-compulsive disorder (OCD) is more common in persons with bulimia than in those without bulimia. Panic disorder, social phobia, specific phobias, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) significantly contribute to comorbidity.

7. Substance use disorders: Some evidence suggests a relationship between addictions and bulimia, including alcohol dependence, nicotine dependence and drug dependence. Impulse control disorders: impulse control disorders in patients with bulimia, were the most frequently reported disorders. Kleptomania, and trichotillomania have also been reported in patients with bulimia. Suicidal behaviors Borderline personality disorder is found frequently and these patients usually have histories of trauma and abuse and may represent a distinct subgroup. Attention deficit hyperactivity disorder may be associated with bulimia.

8. Demographics Bulimia nervosa affects between 1% and 3% of women in the developed countries; its prevalence is thought to have increased markedly since 1970. The rates are similar across cultures as otherwise different as the United States, Japan, the United Kingdom, Australia, South Africa, Canada, France, Germany, and Israel. About 90% of patients diagnosed with bulimia are female as of 2002, but some researchers believe that the rate of bulimia among males is rising faster than the rate among females. The average age at onset of bulimia nervosa appears to be dropping in the developed countries. A study of eating disorders in Rochester, Minnesota over the 50 years between 1935 and 1985 indicated that the incidence rates for women over 20 remained fairly constant, but there was a significant rise for women between 15 and 20 years of age. The average age at onset among women with bulimia was 14 and among men, 18.

9. In terms of sexual orientation, gay men appear to be as vulnerable to developing bulimia as heterosexual women, while lesbians are less vulnerable. Recent studies indicate that bulimia in the United States is no longer primarily a disorder of Caucasian women; the rates among African American and Hispanic women have risen faster than the rate of bulimia for the female population as a whole. One report indicates that the chief difference between African American and Caucasian bulimics in the United States is that the African American patients are less likely to eat restricted diets between episodes of binge eating. At-risk groups Risk factors for bulimia are similar to those of other eating disorders, such as anorexia nervosa: those of age 10 through to 25 athletes people who are active in dancing, modeling or gymnasticsdancingmodelinggymnastics students who are under heavy workloads students those who have suffered traumatic events in their lifetime such as child abuse and sexual abusetraumaticchild abuse sexual abuse those positioned in the higher echelons of the socioeconomic scalesocioeconomic the highly intelligent and/or high-achievers.[1]intelligent[1] perfectionists

10. Co-morbid diagnosis with AN Top three co-morbid Diagnoses are 1)affective disorder (depression) 2)anxiety disorder ( Incl. OCD) 3)substance abuse Also high association with personality disorder/ traits.