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Prevalence, comorbidities and outpatient treatment of anorexia and bulimia nervosa in German children and adolescents

  • Charlotte JaiteEmail author
  • Falk Hoffmann
  • Gerd Glaeske
  • Christian J. Bachmann
Original Article

Abstract

Objective

This study aimed at investigating the prevalence, psychiatric comorbidity and outpatient treatment in a sample of German children and adolescents with eating disorders (EDs).

Method

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.

Results

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.

Discussion

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.

Keywords

Adolescents Anorexia nervosa Bulimia nervosa Children Statutory health insurance 

Notes

Acknowledgments

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.

References

  1. 1.
    Hoek HW (2006) Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry 19:389–394PubMedCrossRefGoogle Scholar
  2. 2.
    Smink FR, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414PubMedCrossRefGoogle Scholar
  3. 3.
    Neumark-Sztainer D, Hannan PJ (2000) Weight-related behaviours among adolescent girls and boys: results from a national survey. Arch Pediatr Adolesc Med 154:569–577PubMedCrossRefGoogle Scholar
  4. 4.
    Currin L, Schmidt U, Treasure J et al (2005) Time trends in eating disorder incidence. Br J Psychiatry 186:132–135PubMedCrossRefGoogle Scholar
  5. 5.
    Nicholls DE, Lynn R, Viner RM (2011) Childhood ea-ting disorders: British national surveillance study. Br J Psychiatry 198:295–301PubMedCrossRefGoogle Scholar
  6. 6.
    Herpertz-Dahlmann B (2009) Adolescent eating disorders: definitions, symptomatology, epidemiology and comorbidity. Child Adolesc Psychiatr Clin N Am 18:31–47PubMedCrossRefGoogle Scholar
  7. 7.
    Godart NT, Perdereau F, Rein Z et al (2007) Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J Affect Disord 97:37–49PubMedCrossRefGoogle Scholar
  8. 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
  9. 9.
    Casper RC (1998) Depression and eating disorders. Depression Anxiety 8:96–104CrossRefGoogle Scholar
  10. 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
  11. 11.
    Milos GF, Spindler AM, Buddeberg C et al (2003) Axes I and II comorbidity and treatment experiences in eating disorder subjects. Psychother Psychosom 72:276–285PubMedCrossRefGoogle Scholar
  12. 12.
    Kaye W, Bulik C, Thornton L et al (2004) Comorbidity if anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry 161:2215–2221PubMedCrossRefGoogle Scholar
  13. 13.
    Godart NT, Flament MF, Lecrubier Y et al (2000) Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance. Eur Psychiatry J Assoc Eur Psychiatr 15:38–45CrossRefGoogle Scholar
  14. 14.
    Lewinsohn P, Hops R, Seeley J et al (1993) Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. J Abnorm Psychol 102:133–144PubMedCrossRefGoogle Scholar
  15. 15.
    Salbach-Andrae H, Lenz K, Simmendinger N et al (2008) Psychiatric comorbidities among female adolescents with anorexia nervosa. Child Psychiatry Hum Dev 39:261–272PubMedCrossRefGoogle Scholar
  16. 16.
    Stein D, Meged S, Bar-Hanin T et al (1997) Partial eating disorders in a community sample of female adolescents. J Am Acad Child Adolesc Psychiatry 36:1116–1123PubMedCrossRefGoogle Scholar
  17. 17.
    Zaider TI, Johnson JG, Cockell SJ (2000) Psychiatric comorbidity associated with eating disorder symptomatology among adolescents in the community. Int J Eat Disord 28:58–67PubMedCrossRefGoogle Scholar
  18. 18.
    Bulik CM, Klump KL, Thornton L et al (2004) Alcohol use disorder comorbidity in eating disorders: a multicenter study. J Clin Psychiatry 65:1000–1006PubMedCrossRefGoogle Scholar
  19. 19.
    Westen D, Harnden-Fischer J (2001) Personality profiles in eating disorders: rethinking the distinction between axis I and axis II. Am J Psychiatry 158:547–562PubMedCrossRefGoogle Scholar
  20. 20.
    Mitchell JE, Crow S (2006) Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry 19:438–443PubMedCrossRefGoogle Scholar
  21. 21.
    Hudson JI, Hiripi E, Pope HG Jr et al (2007) The prevalence and correlates of eating disorders of National Comorbidity Survey Replication. Biol Psychiatry 61:348–358PubMedCrossRefGoogle Scholar
  22. 22.
    Preti A, Girolamo G, Vilagut G et al (2009) The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. J Psychiatr Res 43:1125–1132PubMedCrossRefGoogle Scholar
  23. 23.
    Steinhausen HC, Weber S (2009) The outcome of bulimia nervosa: findings from one-quarter century of research. Am J Psychiatry 166:1331–1341PubMedCrossRefGoogle Scholar
  24. 24.
    Steinhausen HC (2002) The outcome of anore-xia nervosa in the 20th century. Am J Psychiatry 159:1284–1293PubMedCrossRefGoogle Scholar
  25. 25.
    Crow SJ, Peterson CB, Swanson SA et al (2009) Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry 166:1342–1346PubMedCrossRefGoogle Scholar
  26. 26.
    Papadopoulos FC, Ekbom A, Brandt L et al (2009) Excess mortality, causes of death of prognostic factors in anorexia nervosa. Br J Psychiatry 194:10–17PubMedCrossRefGoogle Scholar
  27. 27.
    Sullivan PF (1995) Mortality in anorexia nervosa. Am J Psychiatry 152:1073–1074PubMedGoogle Scholar
  28. 28.
    Bulik CM, Thornton L, Pinheiro AP et al (2008) Suicide attempts in anorexia nervosa. Psychosom Med 70:378–383PubMedCrossRefGoogle Scholar
  29. 29.
    Byford S, Barrett B, Roberts C et al (2007) Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents. Br J Psychiatry 191:436–440PubMedCrossRefGoogle Scholar
  30. 30.
    Haas L, Stargardt T, Schreyoegg J et al (2012) Inpatient costs and predictors of costs in the psychosomatic treatment of anorexia nervosa. Int J Eat Disord 45:214–221PubMedCrossRefGoogle Scholar
  31. 31.
    Krauth C, Buser K, Vogel H (2002) How high are the costs of eating disorders—anorexia nervosa and bulimia nervosa—for German society? Eur J Health Econ 3:244–250PubMedCrossRefGoogle Scholar
  32. 32.
    Striegel-Moore RH, Leslie D, Petrill SA et al (2000) One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. Int J Eat Disord 27:381–389PubMedCrossRefGoogle Scholar
  33. 33.
    World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. WHO, GenevaGoogle Scholar
  34. 34.
    Turner H, Bryant-Waugh R (2004) Eating disorder not otherwise specified (EDNOS): profiles of clients presenting at a community eating disorder service. Eur Eating Disord Rev 12:18–26CrossRefGoogle Scholar
  35. 35.
    Fairburn CG, Cooper Z, O′Connor ME et al (2007) The severity and status of eating disorders NOS: implications for DSM-V. Behav Res Ther 45:1705–1715PubMedCrossRefGoogle Scholar
  36. 36.
    Herpertz S, Hagenah U, Vocks S et al (2011) Clinical practice guideline: the diagnosis and treatment of eating disorders. Deutsches Ärzteblatt International 108:678–685PubMedGoogle Scholar
  37. 37.
    Turnbull S, Ward A, Treasure J et al (1996) The demand for eating disorder care. An epidemiological study using the general practice research database. Br J Psychiatry 169:705–712PubMedCrossRefGoogle Scholar
  38. 38.
    Madden S, Morris A, Zurynski YA et al (2009) Burden of eating disorders in 5–13-year-old children in Australia. Med J Aust 190:410–414PubMedGoogle Scholar
  39. 39.
    Dansky BS, Brewerton TD, Kilpatrick DG (2000) Comorbidity of bulimia nervosa and alcohol use disorders: results from the National Women’s Study. Int J Eat Disord 27:180–190PubMedCrossRefGoogle Scholar
  40. 40.
    Swanson SA, Crow SJ, Le Grange D et al (2011) Prevalence and correlates of eating disorders in adolescents. Arch Gen Psychiatry 68:714–723PubMedCrossRefGoogle Scholar
  41. 41.
    Herzog DB, Keller MB, Sacks NR et al (1992) Psychiatric comorbidity in treatment-seeking anorexics and bulimics. J Am Acad Child Adolesc Psychiatry 31:810–818PubMedCrossRefGoogle Scholar
  42. 42.
    Thornton C, Russell J (1997) Obsessive-compulsive comorbidity in eating disorders. Int J Eat Disord 21:83–87PubMedCrossRefGoogle Scholar
  43. 43.
    American Psychiatric Association (2006) Treatment of patients with eating disorders, third edition. Am J Psychiatry 163:4–54Google Scholar
  44. 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. 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
  46. 46.
    Hagman J, Gralla J, Sigel E et al (2011) A double-blind, placebo-controlled study of risperidone for the treatment of adolescents and young adults with anorexia nervosa: a pilot study. J Am Acad Child Adolesc Psychiatry 50:915–924PubMedCrossRefGoogle Scholar
  47. 47.
    Hebebrand J (2011) Pharmacotherapy of anorexia nervosa: more questions than answers. J Am Acad Child Adolesc Psychiatry 50:854–856PubMedCrossRefGoogle Scholar
  48. 48.
    Darby AM, Hay PJ, Mond JM et al (2012) Community recognition and beliefs about anorexia nervosa and its treatment. Int J Eat Disord 45:120–124PubMedCrossRefGoogle Scholar
  49. 49.
    Ogg EC, Millar HR, Pusztai EE et al (1997) General practice consultation patterns preceding diagnosis of eating disorders. Int J Eat Disord 22:89–93PubMedCrossRefGoogle Scholar
  50. 50.
    Walsh JM, Wheat ME, Freund K (2000) Detection, evaluation, and treatment of eating disorders: the role of the primary care physician. J Gen Intern Med 15:577–590PubMedCrossRefGoogle Scholar
  51. 51.
    Bryant-Waugh R, Lask B, Shafran R et al (1992) Do doctors recognise eating disorders in children? Arch Dis Child 67:103–105PubMedCrossRefGoogle Scholar
  52. 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
  53. 53.
    Bartholomew T, Carvalho T (2007) Medical practitioners’ competence and confidentiality decisions with a minor: an anorexia nervosa case study. Psychol Health Med 12:495–508PubMedCrossRefGoogle Scholar
  54. 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
  55. 55.
    Wilson GT, Shafran R (2005) Eating disorders guidelines from NICE. Lancet 365:79–81PubMedCrossRefGoogle Scholar
  56. 56.
    Alonso-Coello P, Irfan A, Solà I et al (2010) The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Quality Saf Health Care 19:e58CrossRefGoogle Scholar
  57. 57.
    Schneeweiss S (2007) Developments in post-marketing comparative effectiveness research. Clin Pharmacol Ther 82:143–156PubMedCrossRefGoogle Scholar
  58. 58.
    Hoffmann F, Icks A (2011) Diabetes prevalence based on health insurance claims: large differences between companies. Diabet Med 28:919–923PubMedCrossRefGoogle Scholar
  59. 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. 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. 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
  62. 62.
    Fontanella CA, Bridge JA, Marcus SC et al (2011) Factors associated with antidepressant adherence for medicaid-enrolled children and adolescents. Annals Pharmacother 45:898–909CrossRefGoogle Scholar
  63. 63.
    Woldu H, Porta G, Goldstein T et al (2011) Pharmacokinetically and clinician-determined adherence to an antidepressant regimen and clinical outcome in the TORDIA trial. J Am Acad Child Adolesc Psychiatry 50:490–498PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Charlotte Jaite
    • 1
    Email author
  • Falk Hoffmann
    • 2
  • Gerd Glaeske
    • 2
  • Christian J. Bachmann
    • 3
  1. 1.Department of Child and Adolescent PsychiatryCharité – Universitätsmedizin BerlinBerlinGermany
  2. 2.Division Health Economics, Health Policy and Outcomes Research, Centre for Social Policy ResearchUniversity of BremenBremenGermany
  3. 3.Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Human MedicinePhilipps-University MarburgMarburgGermany

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