http://www.mentalhealth.com/mag1/p5m-et01.html

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."

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