Prevalence, comorbidities and outpatient treatment of anorexia and bulimia nervosa in German children and adolescents
- 923 Downloads
This study aimed at investigating the prevalence, psychiatric comorbidity and outpatient treatment in a sample of German children and adolescents with eating disorders (EDs).
Data of a large German statutory health insurance company were analysed and outpatients aged between 10 and 21 years with an ED diagnosis in 2009 were identified.
Of 248,558 insured children and adolescents, 1,404 patients (79.9 % females, mean age: 16.7; SD: 3.3 years) matched the inclusion criteria. The large majority of patients with anorexia nervosa (AN) and bulimia nervosa (BN) were females (94.7 and 92.7 %), on which we focus in the following analyses. The prevalence in females was 0.28 % (AN) and 0.20 % (BN). Psychiatric comorbidity was diagnosed in 59.8 % (AN) and 64.1 % (BN) of patients, respectively. Most patients were treated with psychotherapy (AN: 75.7 %, BN: 78.5 %), 16.4 % (AN) and 20.2 % (BN) of our patients received pharmacotherapy with either antidepressants or antipsychotics. 23.5 % (AN) and 21.1 % (BN) received no treatment with psychotherapy, antidepressants or antipsychotics.
This naturalistic study suggests that in young ED outpatients, EDs seem to be underdiagnosed and treatment does not necessarily comply with current guidelines. Therefore, dissemination of state-of-the-art knowledge on diagnosis and treatment in children and adolescents with EDs constitutes an important educational goal.
KeywordsAdolescents Anorexia nervosa Bulimia nervosa Children Statutory health insurance
We thank the Gmünder Ersatzkasse (GEK) for providing the data and for supporting us in data management. We also thank Ernst Pfeiffer, MD, for comments on the manuscript.
Conflict of interest
CB has received consultant or speaker honoraria from Actelion, Medice, Novartis and Ferring and has acted as investigator in pharmaceutical trials sponsored by Shire. FH, CJ and GG declare that they have no conflicts of interest.
- 8.O′Brien KM, Vincent NK (2003) Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and casual relationships. Clin Psychol Rev 23:57–74Google Scholar
- 10.Fischer S, Le Grange D (2007) Comorbidity and high-risk behaviors in treatment-seeking adolescents with bulimia nervosa. Int J Eating Disord 40:751–753Google Scholar
- 33.World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. WHO, GenevaGoogle Scholar
- 43.American Psychiatric Association (2006) Treatment of patients with eating disorders, third edition. Am J Psychiatry 163:4–54Google Scholar
- 44.Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie (2007) Leitlinien zu Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter. Deutscher Ärzteverlag, KölnGoogle Scholar
- 45.National Institute for Health and Clinical Excellence (2004) Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Clinical guideline 9. http://www.nice.org.uk/CG009NICEguideline 2004 January, Updated 2010 March
- 52.Karwautz A, de Zwaan M, Wöber-Bingöl C et al (1997) Awareness of early-onset anorexia nervosa. Eating Weight Disord 2:138–143Google Scholar
- 54.Evans-Lacko SE, Dosreis S, Kastelic EA et al (2010) Evaluation of guideline-concordant care for bipolar disorder among privately insured youth. Prim Care Companion J Clin Psychiatry 12:e1–e8Google Scholar
- 59.Hoffmann F, Icks A (2012) Unterschiede in der Versichertenstruktur von Krankenkassen und deren Auswirkungen für die Versorgungsforschung: Ergebnisse des Bertelsmann-Gesundheitsmonitors [structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor]. Gesundheitswesen 74:291–297PubMedCrossRefGoogle Scholar
- 60.Huber J, Lampert T, Mielck A (2012) Unterschiede bei Gesundheitsrisiken, Morbidität und gesundheitlicher Versorgung zwischen Kindern GKV- bzw. PKV-versicherter Eltern: Ergebnisse aus dem Kinder- und Jugendgesundheitssurvey (KiGGS) [Inequalities in Health Risks, Morbidity and Health Care of Children by Health Insurance of Their Parents (Statutory vs. Private Health Insurance): Results of the German KiGGS Study]. Gesundheitswesen 74:627–638Google Scholar
- 61.Godart NT, Perdereau F, Curt F et al (2004) Predictive factors of social disability in anorexic and bulimic patients. Eating Weight Disord 9:249–257Google Scholar