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The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication

      Background

      Little population-based data exist on the prevalence or correlates of eating disorders.

      Methods

      Prevalence and correlates of eating disorders from the National Comorbidity Replication, a nationally representative face-to-face household survey (n = 9282), conducted in 2001–2003, were assessed using the WHO Composite International Diagnostic Interview.

      Results

      Lifetime prevalence estimates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder are .9%, 1.5%, and 3.5% among women, and .3% .5%, and 2.0% among men. Survival analysis based on retrospective age-of-onset reports suggests that risk of bulimia nervosa and binge eating disorder increased with successive birth cohorts. All 3 disorders are significantly comorbid with many other DSM-IV disorders. Lifetime anorexia nervosa is significantly associated with low current weight (body-mass index <18.5), whereas lifetime binge eating disorder is associated with current severe obesity (body-mass index ≥40). Although most respondents with 12-month bulimia nervosa and binge eating disorder report some role impairment (data unavailable for anorexia nervosa since no respondents met criteria for 12-month prevalence), only a minority of cases ever sought treatment.

      Conclusions

      Eating disorders, although relatively uncommon, represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently under-treated.

      Key Words

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      References

        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV). American Psychiatric Association, Washington, DC1994
        • Angst J.
        The emerging epidemiology of hypomania and bipolar II disorder.
        J Affect Disord. 1998; 50: 143-151
        • Bulik C.M.
        • Sullivan P.F.
        • Kendler K.S.
        Heritability of binge-eating and broadly defined bulimia nervosa.
        Biol Psychiatry. 1998; 44: 1210-1218
        • Bulik C.M.
        • Sullivan P.F.
        • Kendler K.S.
        Medical and psychiatric morbidity in obese women with and without binge eating.
        Int J Eat Disord. 2002; 32: 72-78
        • Bushnell J.A.
        • Wells J.E.
        • Hornblow A.R.
        • Oakley-Browne M.A.
        • Joyce P.
        Prevalence of three bulimia syndromes in the general population.
        Psychol Med. 1990; 20: 671-680
        • Bushnell J.A.
        • Wells J.E.
        • McKenzie J.M.
        • Hornblow A.R.
        • Oakley-Browne M.A.
        • Joyce P.R.
        Bulimia comorbidity in the general population and in the clinic.
        Psychol Med. 1994; 24: 605-611
        • Cachelin F.M.
        • Striegel-Moore R.H.
        • Elder K.A.
        • Pike K.M.
        • Wilfley D.E.
        • Fairburn C.G.
        Natural course of a community sample of women with binge eating disorder.
        Int J Eat Disord. 1999; 25: 45-54
        • Crow S.J.
        • Agras W.S.
        • Halmi K.
        • Mitchell J.E.
        • Kraemer H.C.
        Full syndromal versus subthreshold anorexia nervosa, bulimia nervosa, and binge eating disorder: a multicenter study.
        Int J Eat Disord. 2002; 32: 309-318
        • Crow S.J.
        • Peterson C.B.
        • Levine A.S.
        • Thuras P.
        • Mitchell J.E.
        A survey of binge eating and obesity treatment practices among primary care providers.
        Int J Eat Disord. 2004; 35: 348-353
        • Currin L.
        • Schmidt U.
        • Treasure J.
        • Jick H.
        Time trends in eating disorder incidence.
        Br J Psychiatry. 2005; 186: 132-135
        • de Zwaan M.
        Binge eating disorder and obesity.
        Int J Obesity. 2001; 25: S51-S55
        • Fairburn C.G.
        • Beglin S.J.
        Studies of the epidemiology of bulimia nervosa.
        Am J Psychiatry. 1990; 147: 401-408
        • Fairburn C.G.
        • Bohn K.
        Eating disorder NOS (EDNOS): an example of the troublesome “not otherwise specified” (NOS) category in DSM-IV.
        Behav Res Ther. 2005; 43: 691-701
        • Fairburn C.G.
        • Cooper Z.
        • Doll H.A.
        • Norman P.
        • O’Connor M.
        The natural course of bulimia nervosa and binge-eating disorder in young women.
        Arch Gen Psychiatry. 2000; 57: 659-665
        • Favaro A.
        • Ferrara S.
        • Santonastaso P.
        The spectrum of eating disorders in young women: a prevalence study in a general population sample.
        Psychosom Med. 2004; 65: 701-708
        • First M.B.
        • Spitzer R.L.
        • Gibbon M.
        • Williams J.B.W.
        Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non–patient Edition (SCID–I/NP). Biometrics Research, New York State Psychiatric Institute, New York2002
        • Fombonne E.
        Anorexia nervosa: no evidence of an increase.
        Br J Psychiatry. 1995; 166: 462-471
        • Garfinkel P.E.
        • Lin E.
        • Goering C.
        • Spegg D.
        • Goldbloom D.
        • Kennedy S.
        Should amenorrhoea be necessary for the diagnosis of anorexia nervosa?.
        Br J Psychiatry. 1996; 168: 500-506
        • Garfinkel P.E.
        • Lin E.
        • Goering P.
        • Spegg C.
        • Goldbloom D.S.
        • Kennedy S.
        • et al.
        Bulimia nervosa in a Canadian community sample: prevalence and comparison subgroups.
        Am J Psychiatry. 1995; 152: 1052-1058
        • Giuffra L.A.
        • Risch N.
        Diminished recall and the cohort effect of major depression: a simulation study.
        Psychol Med. 1994; 24: 375-383
        • Godart N.T.
        • Flament M.F.
        • Perdereau F.
        • Jeammet P.
        Comorbidity between eating disorders and anxiety disorders: a review.
        Int J Eating Disord. 2002; 32: 253-270
        • Halmi K.A.
        • Eckert E.
        • Marchi P.
        • Sampugno V.
        • Apple R.
        • Cohen J.
        Comorbidity of psychiatric diagnoses in anorexia nervosa.
        Arch Gen Psychiatry. 1991; 48: 712-718
        • Hoek H.W.
        • van Hoeken D.
        Review of the prevalence and incidence of eating disorders.
        Int J Eat Disord. 2003; 34: 383-396
        • Hosmer D.W.
        • Lemeshow S.
        Applied Logistic Regression. 2nd ed. John Wiley & Sons, New York, NY2000
        • Hudson J.I.
        • Lalonde J.K.
        • Berry J.M.
        • Pindyck L.J.
        • Bulik C.M.
        • Crow S.J.
        • et al.
        Binge eating disorder as a distinct familial phenotype in obese individuals.
        Arch Gen Psychiatry. 2006; 63: 313-319
        • Hudson J.I.
        • Pope Jr, H.G.
        • Glynn R.J.
        The cross–sectional cohort study: an under-utilized design.
        Epidemiology. 2005; 16: 355-359
        • Hudson J.I.
        • Pope Jr, H.G.
        • Yurgelun-Todd D.
        • Jonas J.M.
        • Frankenburg F.R.
        A controlled study of lifetime prevalence of affective and other psychiatric disorders in bulimic outpatients.
        Am J Psychiatry. 1987; 144: 1283-1287
        • Iacovino J.R.
        Anorexia nervosa: a 63-year population-based survival study.
        J Insur Med. 2004; 36: 107-110
        • Johnson J.G.
        • Spitzer R.L.
        • Williams J.B.
        Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynaecology patients.
        Psychol Med. 2001; 31: 1455-1466
        • Kaye W.H.
        • Bulik C.M.
        • Thornton L.
        • Barbarich N.
        • Master K.
        Comorbidity of anxiety disorders with anorexia and bulimia nervosa.
        Am J Psychiatry. 2004; 161: 2215-2221
        • Keel P.K.
        • Dorer D.J.
        • Eddy K.T.
        • Franko D.
        • Charatan D.L.
        • Herzog D.B.
        Predictors of mortality in eating disorders.
        Arch Gen Psychiatry. 2003; 60: 179-183
        • Keel P.K.
        • Haedt A.
        • Edler C.
        Purging disorder: an ominous variant of bulimia nervosa?.
        Inter J Eat Disord. 2005; 38: 191-199
        • Kendler K.S.
        • MacLean C.
        • Neale M.
        • Kessler R.
        • Heath A.
        • Eaves L.
        The genetic epidemiology of bulimia nervosa.
        Am J Psychiatry. 1991; 148: 1627-1637
        • Kessler R.C.
        • Abelson J.
        • Demler O.
        • Escobar J.I.
        • Gibbon M.
        • Guyer M.E.
        • et al.
        Clinical Calibration of DSM-IV Diagnoses in the World Mental Health (WMH) Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).
        Int J Methods Psychiatr Res. 2004; 13: 122-139
        • Kessler R.C.
        • Berglund P.
        • Chiu W.T.
        • Demler O.
        • Heeringa S.
        • Hiripi E.
        • et al.
        The US National Comorbidity Survey Replication (NCS-R): design and field procedures.
        Int J Methods Psychiatr Res. 2004; 13: 69-92
        • Kessler R.C.
        • Berglund P.B.
        • Demler O.
        • Jin R.
        • Merikangas K.R.
        • Walters E.E.
        Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.
        Arch Gen Psychiatry. 2005; 62: 593-602
        • Kessler R.C.
        • McGonagle K.A.
        • Zhao S.
        • Nelson C.B.
        • Hughes M.
        • Eschleman S.
        • et al.
        Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States.
        Arch Gen Psychiatry. 1994; 51: 8-19
        • Kessler R.C.
        • Merikangas K.R.
        The National Comorbidity Survey Replication (NCS-R).
        Int J Methods Psychiatr Res. 2004; 13: 60-68
        • Kessler R.C.
        • Ustun T.B.
        The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).
        Int J Methods Psychiatr Res. 2004; 13: 93-121
        • Kinzl J.F.
        • Traweger C.
        • Trefalt E.
        • Mangweth B.
        • Biebl W.
        Binge eating disorder in females: a population-based investigation.
        Int J Eating Disord. 1999; 25: 287-292
        • Kinzl J.F.
        • Traweger C.
        • Trefalt E.
        • Mangweth B.
        • Biebl W.
        Binge eating disorder in males: a population-based investigation.
        Eat Weight Disord. 1999; 4: 169-174
        • Leon A.C.
        • Olfson M.
        • Portera L.
        • Farber L.
        • Sheehan D.V.
        Assessing psychiatric impairment in primary care with the Sheehan Disability Scale.
        Int J Psychiatry Med. 1997; 27: 93-105
        • Lucas A.R.
        • Crowson C.S.
        • O’Fallon W.M.
        • Melton 3rd, L.J.
        The ups and downs of anorexia nervosa.
        Int J Eating Disord. 1999; 26: 397-405
        • Mangweth B.
        • Hudson J.I.
        • Pope Jr, H.G.
        • Hausmann A.
        • De Col C.
        • Laird N.M.
        • et al.
        Family study of the aggregation of eating disorders and mood disorders.
        Psychol Med. 2003; 33: 1319-1323
        • McElroy S.L.
        • Kotwal R.
        • Keck Jr, P.E.
        • Akiskal H.S.
        Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations?.
        J Affect Disord. 2005; 86: 107-127
      1. Pope HG Jr, Lalonde JK, Pindyck LJ, Walsh BT, Bulik CM, Crow SJ, McElroy SL, Rosenthal NR, Hudson JI (in press). Binge eating disorder: a stable syndrome. Am J Psychiatry.

        • Reichborn-Kjennerud T.
        • Bulik C.M.
        • Tambs K.
        • Harris J.R.
        Genetic and environmental influences on binge eating in the absence of compensatory behaviors: a population-based twin study.
        Int J Eating Disord. 2004; 36: 307-314
        • Reichborn-Kjennerud T.
        • Bulik C.M.
        • Tambs K.
        • Harris J.R.
        Psychiatric and medical symptoms in binge eating in the absence of compensatory behaviors.
        Obes Res. 2004; 12: 1445-1454
        • Research Triangle Institute
        SUDAAN: Professional Software for Survey Data Analysis. 8.01 ed. Research Triangle Institute, Research Triangle Park, NC2002
        • Rowe R.
        • Pickles A.
        • Simonoff E.
        • Bulik C.M.
        • Silberg J.L.
        Bulimic symptoms in the Virginia Twin Study of Adolescent Behavioral Development: correlates, comorbidity, and genetics.
        Biol Psychiatry. 2002; 51: 172-182
        • Steinhausen H.C.
        The outcome of anorexia nervosa in the 20th century.
        Am J Psychiatry. 2002; 159: 1284-1293
        • Striegel-Moore R.H.
        • Dohm F.A.
        • Solomon E.E.
        • Fairburn C.G.
        • Pike K.M.
        • Wilfley D.E.
        Subthreshold binge eating disorder.
        Int J Eating Disord. 2000; 27: 270-278
        • Streigel-Moore R.H.
        • Franko D.L.
        Epidemiology of binge eating disorder.
        Int J Eating Disord. 2003; 34: S19-S29
        • Strober M.
        • Freeman R.
        • Lampert C.
        • Diamond J.
        • Kaye W.
        Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmission of partial syndromes.
        Am J Psychiatry. 2000; 157: 393-401
        • Stunkard A.J.
        • Allison K.C.
        • O’Reardon J.P.
        The night eating syndrome: a progress report.
        Appetite. 2005; 2005: 182-966
        • Sullivan P.F.
        Mortality in anorexia nervosa.
        Am J Psychiatry. 1995; 152: 1073-1074
        • Thornton C.
        • Russell J.
        • Hudson J.
        Does the Composite International Diagnostic Interview underdiagnose the eating disorders?.
        Int J Eat Disord. 1998; 23: 341-345
        • Vollrath M.
        • Koch R.
        • Angst J.
        Binge eating and weight concerns among young adults.
        Br J Psychiatry. 1992; 160: 498-503
        • Wade T.D.
        • Bulik C.M.
        • Neale M.
        • Kendler K.S.
        Anorexia nervosa and major depression: shared genetic and environmental risk factors.
        Am J Psychiatry. 2000; 157: 469-471
        • Walters E.E.
        • Kendler K.S.
        Anorexia nervosa and anorexic-like syndromes in a population-based female twin sample.
        Am J Psychiatry. 1995; 152: 64-71
        • Walters E.E.
        • Neale M.C.
        • Eaves L.J.
        • Heath A.C.
        • Kessler R.C.
        • Kendler K.S.
        Bulimia nervosa and major depression: a study of common genetic and environmental factors.
        Psychol Med. 1992; 22: 617-622
        • Willett J.B.
        • Singer J.D.
        Investigating onset, cessation, relapse, and recovery: why you should, and how you can, use discrete-time survival analysis to examine event occurrence.
        J Consult Clin Psychol. 1993; 61: 952-965
        • Wolter K.M.
        Introduction to Variance Estimation. Springer-Verlag, New York1985

      Linked Article

      • Erratum to: The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication
        Biological PsychiatryVol. 72Issue 2
        • Preview
          Further analysis has documented two errors in the results reported in the article “The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication” by Hudson et al., which appeared in Biological Psychiatry (2007;61:348–358). First, the anorexia nervosa lifetime prevalence estimate (standard error) of .6% (.2) reported in Table 1 and the first sentence of the Results section should have been .5% (.2). Second, the results reported in the last row of Table 7 for 12-month treatment of eating disorders among 12-month cases were incorrect.
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