g psychological maturity led to a desire to return to a prepubescent size, hormonal status and life experience.
Although historically, anorexia nervosa has been associated only with starvation, binge eating has also been associated with the clinical picture in some patients and so DaCosta and Halm divided anorexia nervosa into two forms: bulimia and nonbulimic subtypes (Levey, Williams-Wilson and Corfman, 2003). Patients exhibiting both anorexia nervosa and bulimia show greater impulsivity, social involvement, sexual activity, family dysfunction, depression, and conspicuous emotional disturbance than patients with anorexia nervosa alone. Purging after binge eating appears to be a better way to distinguish these two groups. Garner et al found that there is a different psychopathology in anorexia nervosa patients who engage in purging behavior and those who do not.
Although several reports have suggested anorexia nervosa is a disorder found only in Western civilizations, a recent review found that it was present in every non-Western region of the world as well (Keel and Klump, 2003, 747-769). However, the presence of weight concerns as a reason for food refusal does not seem to be universal in anorexia nervosa. The data suggested that Westernization and industrialization bring about certain aspects of anorexia nervosa such as weight concerns, but these are not necessary for the production of a self-starvation syndrome. A study in China predicted that Western influence in that country would lead to an increased presence of weight-phobia, and Lee and Lai have both found that there is an increasing prevalence of anorexia nervosa characterized by body dissatisfaction in the East which is stronger in Hong Kong, which is more Westernized, than in Hunan, which is less Westernized.
Epidemiology supports the existence of anorexia nervosa in non-Western countries and suggests its prevalence may be similar to that in Western na...