Introduction

Prevalence of eating disorders

The reported prevalence of eating disorders has risen exponentially over the last 30 years and continues to rise. Some have questioned whether this is due to a true change in incidence or merely a reflection of greater public and professional awareness of the disorders. It may also be that the total sum of neurotic disorder within a given population is constant, but the type of problem presented varies with time, ethnicity and gender.

Changing patterns of neurosis

Regarding women and neurosis generally, hysterical symptoms are not the everyday occurrence they once were. One view is that the recognition of eating disorders parallels their evolution. Vomiting was not part of the original descriptions of anorexia nervosa. As the condition evolved, vomiting may have made the condition more visible. Restrictive anorexia nervosa was the standard form in the 1960s, the bulimic variant was recognised in the 1970s, before normal weight bulimia nervosa firmly established itself as a separate entity in the 1980s (Box 12.1). Although they are still in the minority, the number of women with the multi-impulsive form of bulimia nervosa is increasing through the 1990s.

It is most likely that a combination of explanations is relevant. As methods of epidemiological research have improved a consensus has been reached that the prevalence of disorder among women according to the strict American Diagnostic and Statistical Manual (DSM-III-R) diagnostic criteria is between 1% and 2% for bulimia nervosa (Fairburn & Beglin, 1990) and between 0.02% and 0.04% (Rooney et al., 1995; Hoek, 1991) for anorexia nervosa. Box 12.1 gives DSM-IV diagnostic criteria.