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Who develops bulimia nervosa?

The disorder affects females and males, and people as young as 8 years old and as old as 60 years, people who appear thin and people who appear overweight. Research has shown that bulimia nervosa is most common in females—about 90% of diagnoses are made in females. Recent studies suggest that up to 7% of females in the United States have had bulimia nervosa at some time in their life. An estimated 1% of young women in the United States are believed to be affected at any given time.

Yet, many myths exist about who develops bulimia nervosa and why, and what a person with the disorder looks like. While people with the disorder have several traits in common, it does not discriminate by race, socioeconomic, or education level. In Westernized cultures, bulimia nervosa has been diagnosed in Asians, blacks, Latinos, whites, and other ethnic and racial groups, and in all socioeconomic classes. However, high-quality studies are not available to tell us for sure how many cases occur each year in a given group or people, or how many bulimic people there are overall. The reasons that it's hard to find out, according to researchers, is that people with eating disorders are less likely to admit to having a problem than people without the disorder. They are also less likely to respond openly to questions a doctor asks about it and are less likely to fill out an eating disorder symptom survey than people without the disorder. However, researchers believe that a two-stage process is the best approach to try to determine how many people have an eating disorder. The process involves screening people by using a questionnaire first and then using those results to follow up and confirm suspected cases through personal interviews.

One myth about who develops the disorder is the stereotype of thin young white women from higher socio-economic classes. Older published studies of bulimia nervosa reported that this group was more likely than any other group to develop the disorder. Now researchers think these older data are inaccurate because the people in those studies did not reflect the general population. These studies came from universities and clinics where white women in higher socio-economic classes were overrepresented. One result of this stereotype was that doctors generally did not believe that bulimia nervosa occurred in other types of people, such as those described above. So, doctors did not consider a diagnosis of bulimia nervosa in such people even when the signs and symptoms suggested a person might have the disorder.

More recent published studies that include these other groups have found a higher incidence of eating disorders in males and minority females than has previously been reported. Bulimia nervosa is thought to be increasing among males in Westernized societies as more pressure comes to bear on boys and men to achieve and maintain a trim and fit body.

Bulimia nervosa is also more common than previously thought among women in their 40s and 50s in Western cultures. Some reasons given for this are pressures that in combination can create high stress levels. These pressures include career, family, children growing up, changes in personal health and body size and shape with aging, and divorce. With age, a woman's body can also look less like the idealized women seen in much product advertising. Changing metabolisms and weight gain are changes that women face with aging. Today women have generally become more conscious about appearance over a longer time span than women from previous generations—in part because more women are out in the work force and are living longer. Thus the expectation is to maintain a youthful body and appearance for a longer time.

Athletes comprise another group affected by bulimia nervosa. As expectations for peak performance rise in top male and female athletes, so does the pressure to maintain that level of performance. This can lead to compulsive exercising and dieting. Some sports like gymnastics, wrestling, ice skating, and diving promote a certain body image. Some believe that participants in these sports may be at higher risk of developing disordered eating as a coping mechanism to try to maintain their performance level and appearance. Maintaining weight limits is important in many of these sports. For example, wrestlers may use drastic means to stay in their wrestling weight class—means that are similar to the compensatory practices used by people with bulimia nervosa. However, study results on whether certain groups of athletes are actually at higher risk of developing bulimia nervosa are mixed.

The National College Athletic Association (NCAA) carried out studies on the incidence of eating-disordered behavior among athletes in the 1990s. NCAA reported that of those athletes who were reported to have an eating disorder, 93% were female. Women's sports reporting the highest rates of eating disorders were cross country running, gymnastics, swimming, and track and field. Male sports reporting the highest rates of eating disorders were wrestling and cross country running. However, a later NCAA study reported that the rate of eating disorders among college athletes was no higher than the rates reported for the general population.

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Bulimia nervosa is an eating disorder in which a person engages in binge eating (eating a lot of food in a short time) followed by some type of behavior to prevent weight gain from the food that was eaten. This behavior can take two forms: self-induced vomiting, misuse of enemas, laxatives, diet pills (called purging) and excessive exercise, fasting, or diabetic omission of insulin (called non-purging). Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again. Bulimia nervosa has important mental, emotional, and physical aspects that require consideration during treatment.

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