MONTREAL - While the typical image of an anorexic is that of a young, overachieving female, these sufferers make up just a fifth of those who eventually die from the disease, according to research presented here.
Speaking at the 16th International Congress of Psychology here recently, discussing mortality in anorexia nervosa, Dr. Paul Hewitt (PhD), associate professor of psychology at the University of British Columbia, said research has revealed the disease overwhelmingly proves fatal in those aged 70 years or more.
Almost four out of every five deaths (78.6%) that involved anorexia nervosa occurred in those more than 45 years of age.
"What we are talking about is potentially two lethal forms of anorexia nervosa," said Dr. Hewitt.
"One appears to have an early onset. It is predominantly women who are affected and follows the classical model, in terms of prevalence rates, etc. The other is a form of anorexia that affects people in the latter half of life.
"Probably the most surprising thing is the age distribution of deaths," he continued. "It shows that if you look at people aged less than 45, you see what you would expect based on prevalence rates. If you stopped there, you would say it is consistent with what we know about anorexia nervosa, that it is a young person's disease."
Researchers examined data from the National Centre for Health Statistics in the U.S. of over 10 million death records in a five-year period (1986-1990) to see if anorexia nervosa was cited as either a primary cause or contributing cause of death. Equivalent Canadian data were not available.
They found a total of 724 deaths fell into either of those two categories. That figure averaged out 149 annual deaths, representing a rate of 6.67 per 100,000 deaths.
Analysis of the data indicated that there was a "bi-modal" distribution of deaths among women with peaks at age 35 and in the late 80s. The median age of death for women was 69.
Interestingly, gender also differentiates the incidence of deaths. In the early onset form, women comprised 89.6% of deaths while they made up 75.6% of deaths among sufferers of presbyanorexia nervosa.
"It appears that men are in greater proportion of people who die of the disease later in life," Dr. Hewitt said. "Probably one of the most interesting things is the gender and age association. What happens is among everybody under 45, about 10% of the deaths are in males. That dramatically increases after age 45."
The prevalence, associated symptoms, and individual predispositions leading to anorexia nervosa have been well documented. Mortality, however, is a subject that has not been investigated, according to Dr. Hewitt.
"There is very little we know about people who actually die from anorexia nervosa," Dr. Hewitt said. "When you look at some of the long-term, follow-up studies, you find estimated rates of fatality vary from 5% to 10%. Other people, in writing about lethality, will make estimates as high as 50% of people with anorexia nervosa dying from the disorder."
Dr. Hewitt said the findings will force psychologists to rethink their preconceptions of who the victims are of anorexia nervosa, as well as other conditions.
"There has been a real bias in psychiatry and psychology, in terms of looking at people between the ages of 18 and 65," he said. "The phenomenon of disorders in our seniors is coming to people as a surprise."
The belief is that anorexia nervosa originates with pubertal issues, which has led researchers to focus on young people as its target, Dr. Hewitt explained. However, life events can affect an individual's identity and lead to anorexia nervosa.
"One of the things from the case studies is that interpersonal loss is a continuing event in the lives of many of these people," he said. "That loss could be children leaving home, a spouse dying or retiring from a job. It could be anything that impinges on their identity."
Copyright © 1996 Maclean Hunter Publishing Limited
Reprinted with permission.
Internet Mental Health (www.mentalhealth.com) copyright © 1995-2011 by Phillip W. Long, M.D.