European Child & Adolescent Psychiatry

, Volume 25, Issue 8, pp 903–918 | Cite as

Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults

  • Michaela Nagl
  • Corinna Jacobi
  • Martin Paul
  • Katja Beesdo-Baum
  • Michael Höfler
  • Roselind Lieb
  • Hans-Ulrich Wittchen
Original Contribution


We aimed to assess the prevalence, incidence, age-of-onset and diagnostic stability of threshold and subthreshold anorexia nervosa (AN) and bulimia nervosa (BN) in the community. Data come from a prospective-longitudinal community study of 3021 subjects aged 14–24 at baseline, who were followed up at three assessment waves over 10 years. Eating disorder (ED) symptomatology was assessed with the DSM-IV/M-CIDI at each wave. Diagnostic stability was defined as the proportion of individuals still affected with at least symptomatic eating disorders (EDs) at follow-ups. Baseline lifetime prevalence for any threshold ED were 2.9 % among females and 0.1 % among males. For any subthreshold ED lifetime prevalence were 2.2 % for females and 0.7 % for males. Symptomatic expressions of EDs (including core symptoms of the respective disorder) were most common with a lifetime prevalence of 11.5 % among females and 1.8 % among males. Symptomatic AN showed the earliest onset with a considerable proportion of cases emerging in childhood. 47 % of initial threshold AN cases and 42 % of initial threshold BN cases showed at least symptomatic expressions of any ED at any follow-up assessment. Stability for subthreshold EDs and symptomatic expressions was 14–36 %. While threshold EDs are rare, ED symptomatology is common particularly in female adolescents and young women. Especially threshold EDs are associated with a substantial risk for stability. A considerable degree of symptom fluctuation is characteristic especially for subthreshold EDs.


Anorexia nervosa Bulimia nervosa Prevalence Stability Epidemiology 



This work is part of the Early Developmental Stages of Psychopathology (EDSP) Study and is funded by the German Federal Ministry of Education and Research (BMBF) Project No. 01EB9405/6, 01 EB 9901/6, EB01016200, 01EB0140 and 01EB0440. Part of the field work and analyses were also additionally supported by grants of the Deutsche Forschungsgemeinschaft (DFG) LA1148/1-1, WI2246/1-1, WI 709/7-1 and WI 709/8-1. Furthermore, the research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under Grant Agreement No. 245009. Principal investigators are Dr. Hans-Ulrich Wittchen and Dr. Roselind Lieb. Core staff members of the EDSP group are Dr. Kirsten von Sydow, Dr. Gabriele Lachner, Dr. Axel Perkonigg, Dr. Peter Schuster, Dr. Michael Höfler, Dipl.-Psych. Holger Sonntag, Dr. Tanja Brückl, Dipl.-Psych. Elzbieta Garczynski, Dr. Barbara Isensee, Dr. Agnes Nocon, Dr. Chris Nelson, Dipl.-Inf. Hildegard Pfister, Dr. Victoria Reed, Dipl.-Soz. Barbara Spiegel, Dr. Andrea Schreier, Dr. Ursula Wunderlich, Dr. Petra Zimmermann, Dr. Katja Beesdo-Baum, Dr. Antje Bittner, Dr. Silke Behrendt and Dr. Susanne Knappe. Scientific advisors are Dr. Jules Angst (Zurich), Dr. Jürgen Margraf (Basel), Dr. Günther Esser (Potsdam), Dr. Kathleen Merikangas (NIMH, Bethesda), Dr. Ron Kessler (Harvard, Boston) and Dr. Jim van Os (Maastricht).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

787_2015_808_MOESM1_ESM.pdf (169 kb)
Supplementary material 1 (PDF 169 kb) ESM_1: Table ST1.1. Operationalization in the DSM-IV/M-CIDI criteria for eating disorders
787_2015_808_MOESM2_ESM.pdf (428 kb)
Supplementary material 2 (PDF 428 kb) ESM_2: Tables ST2.1 to 2.7. Dropout analyses
787_2015_808_MOESM3_ESM.pdf (261 kb)
Supplementary material 3 (PDF 261 kb) ESM_3: Tables ST3.1 to 3.3. Sensitivity analyses


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
  2. 2.Department of Psychology, Division of Clinical Psychology and EpidemiologyUniversity of BaselBaselSwitzerland
  3. 3.Max Planck Institute of PsychiatryMunichGermany

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