Eating disorders in a multi-ethnic inner-city UK sample: prevalence, comorbidity and service use

  • F. SolmiEmail author
  • M. Hotopf
  • S. L. Hatch
  • J. Treasure
  • N. Micali
Original Paper



No studies have investigated the prevalence of eating disorders (ED) according to DSM-5 criteria and few have explored their comorbidity and service use in the general population in the UK. We aimed to estimate the prevalence, comorbidity, and service use in individuals with ED in a multi-ethnic inner city sample.


A total of 1698 individuals (age 16/90) were screened for ED in the first phase of the South East London Community Health Study and 145 were followed up with a diagnostic interview. Data was weighed for survey design and Chi Square tests were used to investigate socio-demographic distribution, comorbidity and service use in participants with ED.


The point prevalence of ED was 4.4 % (Binge Eating Disorder (BED) 3.6 %; Bulimia Nervosa (BN) 0.8 %) and 7.4 % when including sub-threshold diagnoses (Purging Disorder (PD) 0.6 %; Other Specified Feeding and Eating Disorders (OSFED) 2.4 %). No cases of AN were identified. Purging Disorder was the ED with the highest proportion of comorbid disorders. A minority of participants with ED had accessed specialist care services.


ED are common, the comorbidity of ED was in line with previous studies and no ethnic differences were identified. Although PD is not a full diagnosis in DSM-5, we found some evidence of high comorbidity with other disorders, that needs to be replicated using larger samples. Service use was low across ED diagnoses, despite high levels of comorbidity.


Eating disorders Comorbidity Prevalence Health services SELCoHII 



The authors are grateful to all SELCoH participants. The authors would also like to thank the SELCoH data manager, Mr. David Pernet, for his invaluable help throughout the project.

Compliance with ethical standards

Conflicts of interest

The authors do not report any conflicts of interest.

Financial support

SLH and MH receive salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College London.

This research was supported by the Biomedical Research Nucleus data management and informatics facility at South London and Maudsley NHS Foundation Trust, which is funded by the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and a joint infrastructure grant from Guy’s and St Thomas’ Charity and the Maudsley Charity. This research was also funded by a National Institute of Health Research (NIHR) clinician scientist award to Dr N Micali and by a grant received by the British Academy. These funders had no involvement in study design, data collection, analysis or the decision to submit for publication. The authors have no financial involvement (including employment, fees, share ownership) or affiliation with any organisation whose financial interests may be affected by material in the manuscript, or which might potentially bias it. This publication is the work of the authors and Nadia Micali will serve as guarantors for the contents of this paper.

Supplementary material

127_2015_1146_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 kb)


  1. 1.
    Smink FRE, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Eddy KT, Celio Doyle A, Hoste RR et al (2008) Eating disorder not otherwise specified in adolescents. J Am Acad Child Adolesc Psychiatry 47:156–164CrossRefPubMedGoogle Scholar
  3. 3.
    Le Grange D, Swanson SA, Crow SJ, Merikangas KR (2012) Eating disorder not otherwise specified presentation in the US population. Int J Eat Disord 45:711–718CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Author, Washington, DCGoogle Scholar
  5. 5.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5™), 5th ed. Washington, DCGoogle Scholar
  6. 6.
    Mancuso SG, Newton JR, Bosanac P et al (2015) Classification of eating disorders: comparison of relative prevalence rates using DSM-IV and DSM-5 criteria. Br J Psychiatry. doi: 10.1192/bjp.bp.113.143461 PubMedGoogle Scholar
  7. 7.
    Flament MF, Buchholz A, Henderson K et al (2015) Comparative distribution and validity of DSM-IV and DSM-5 diagnoses of eating disorders in adolescents from the community. Eur Eat Disord Rev 23:100–110. doi: 10.1002/erv.2339 CrossRefPubMedGoogle Scholar
  8. 8.
    Hudson JI, Hiripi E, Pope HG Jr, Kessler RC (2007) The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biol Psychiatry 61:348–358CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Preti A, de 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 43:1125–1132CrossRefPubMedGoogle Scholar
  10. 10.
    Field AE, Sonneville KR, Micali N et al (2012) Prospective association of common eating disorders and adverse outcomes. Pediatrics 130:e289–e295CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Flament MF, Henderson K, Buchholz A et al (2015) Weight status and DSM-5 diagnoses of eating disorders in adolescents from the community. J Am Acad Child Adolesc Psychiatry 54(403–411):e2. doi: 10.1016/j.jaac.2015.01.020 PubMedGoogle Scholar
  12. 12.
    Hay P, Girosi F, Mond J (2015) Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Disord 3:19. doi: 10.1186/s40337-015-0056-0 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Tareen A, Hodes M, Rangel L (2005) Non-fat-phobic anorexia nervosa in British South Asian adolescents. Int J Eat Disord 37:161–165CrossRefPubMedGoogle Scholar
  14. 14.
    Lee H-Y, Lock J (2007) Anorexia nervosa in Asian-American adolescents: do they differ from their non-Asian peers. Int J Eat Disord 40:227–231. doi: 10.1002/eat.20364 CrossRefPubMedGoogle Scholar
  15. 15.
    Quick VM, Byrd-Bredbenner C (2014) Disordered eating, socio-cultural media influencers, body image, and psychological factors among a racially/ethnically diverse population of college women. Eat Behav 15:37–41. doi: 10.1016/j.eatbeh.2013.10.005 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Grabe S, Hyde JS (2006) Ethnicity and body dissatisfaction among women in the United States: a Meta-analysis. Psychol Bull 132:622–640CrossRefPubMedGoogle Scholar
  17. 17.
    Becker AE, Burwell RA, Gilman SE et al (2002) Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. Br J Psychiatry 180:509–514CrossRefPubMedGoogle Scholar
  18. 18.
    Chisuwa N, O’Dea JA (2010) Body image and eating disorders amongst Japanese adolescents. A review of the literature. Appetite 54:5–15CrossRefPubMedGoogle Scholar
  19. 19.
    Chandra PS, Abbas S, Palmer R (2012) Are eating disorders a significant clinical issue in urban India? A survey among psychiatrists in Bangalore. Int J Eat Disord 45:443–446. doi: 10.1002/eat.20952 CrossRefPubMedGoogle Scholar
  20. 20.
    Szabo CP, Allwood CW (2004) A cross-cultural study of eating attitudes in adolescent South African females. World Psychiatry 3:41–44PubMedPubMedCentralGoogle Scholar
  21. 21.
    Shaw H, Ramirez L, Trost A et al (2003) Body image and eating disturbances across ethnic groups: more similarities than differences. Psychol Addict Behav 18:12–18CrossRefGoogle Scholar
  22. 22.
    Becker AE, Franko DL, Speck A, Herzog DB (2003) Ethnicity and differential access to care for eating disorder symptoms. Int J Eat Disord 33:205–212CrossRefPubMedGoogle Scholar
  23. 23.
    Cachelin FM, Striegel-Moore RH (2006) Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders. Int J Eat Disord 39:154–161CrossRefPubMedGoogle Scholar
  24. 24.
    Waller G, Schmidt U, Treasure J et al (2009) Ethnic origins of patients attending specialist eating disorders services in a multiethnic urban catchment area in the United Kingdom. Int J Eat Disord 42:459–463CrossRefPubMedGoogle Scholar
  25. 25.
    Striegel-Moore RH, DeBar L, Wilson GT et al (2008) Health services use in eating disorders. Psychol Med 38:1465–1474CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Lewinsohn PM, Striegel-Moore RH, Seeley JR (2000) Epidemiology and natural course of eating disorders in young women from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatry 39:1284–1292CrossRefPubMedGoogle Scholar
  27. 27.
    Mond JM, Hay PJ, Rodgers B, Owen C (2007) Health service utilization for eating disorders: findings from a community-based study. Int J Eat Disord 40:399–408CrossRefPubMedGoogle Scholar
  28. 28.
    Reid M, Williams S, Hammersley R (2009) Managing eating disorder patients in primary care in the UK: a qualitative study. Eat Disord 18:1–9CrossRefGoogle Scholar
  29. 29.
    Hatch SL, Frissa S, Verdecchia M et al (2011) Identifying socio-demographic and socioeconomic determinants of health inequalities in a diverse London community: the South East London Community Health (SELCoH) study. BMC Public Health. doi: 10.1186/1471-2458-11-861 PubMedPubMedCentralGoogle Scholar
  30. 30.
    Morgan JF, Reid F, Lacey JH (1999) The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 319:1467–1468CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Lewis G, Pelosi AJ, Araya R, Dunn G (1992) Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med 22:465–486CrossRefPubMedGoogle Scholar
  32. 32.
    Moran P (2003) Standardised Assessment of Personality—abbreviated scale (SAPAS): preliminary validation of a brief screen for personality disorder. Br J Psychiatry 183:228–232CrossRefPubMedGoogle Scholar
  33. 33.
    Kongerslev M, Moran P, Bo S, Simonsen E (2012) Screening for personality disorder in incarcerated adolescent boys: preliminary validation of an adolescent version of the standardised assessment of personality—abbreviated scale (SAPAS-AV). BMC Psychiatry 12:94CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Pluck G, Sirdifield C, Brooker C, Moran P (2012) Screening for personality disorder in probationers: validation of the standardised assessment of personality—abbreviated scale (SAPAS). Personal Ment Health 6:61–68CrossRefGoogle Scholar
  35. 35.
    Prins A, Ouimette P, Kimerling R et al (2004) The primary care PTSD screen (PC–PTSD): development and operating characteristics. Int J Psychiatry Clin Pract 9:6Google Scholar
  36. 36.
    Bliese PD, Wright KM, Adler AB et al (2008) Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. J Consult Clin Psychol 76:272–281CrossRefPubMedGoogle Scholar
  37. 37.
    Frissa S, Hatch SL, Gazard B et al (2013) Trauma and current symptoms of PTSD in a South East London community. Soc Psychiatry Psychiatr Epidemiol 48:1199–1209CrossRefPubMedGoogle Scholar
  38. 38.
    Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG (2001) AUDIT—the alcohol use disorders identification test: guidelines for use in primary care, 2nd edn. World Health Organization, GenevaGoogle Scholar
  39. 39.
    Swanson SA, Crow SJ, Le Grange D et al (2011) Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry 68:714–723CrossRefPubMedGoogle Scholar
  40. 40.
    Zanarini MC, Frankenburg FR (2001) Attainment and maintenance of reliability of axis I and II disorders over the course of a longitudinal study. Compr Psychiatry 42:369–374CrossRefPubMedGoogle Scholar
  41. 41.
    Zanarini MC, Skodol AE, Bender D et al (2000) The Collaborative Longitudinal Personality Disorders Study: reliability of axis I and II diagnoses. J Pers Disord 14:291–299CrossRefPubMedGoogle Scholar
  42. 42.
    Lobbestael J, Leurgans M, Arntz A (2011) Inter-rater reliability of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II Disorders (SCID II). Clin Psychol Psychother 18:75–79CrossRefPubMedGoogle Scholar
  43. 43.
    Keel PK, Haedt A, Edler C (2005) Purging disorder: an ominous variant of bulimia nervosa? Int J Eat Disord 38:191–199CrossRefPubMedGoogle Scholar
  44. 44.
    Dunn G, Pickles A, Tansella M, Vazquez-Barquero L (1999) Two-phase epidemiological surveys in psychiatric research. Br J Psychiatry 174:95–100CrossRefPubMedGoogle Scholar
  45. 45.
    Solmi F, Hatch SL, Hotopf M et al (2014) Prevalence and correlates of disordered eating in a general population sample: the South East London Community Health (SELCoH) study. Soc Psychiatry Psychiatr Epidemiol 49:1335–1346CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Hatch SL, Woodhead C, Frissa S et al. (2012) Importance of thinking locally for mental health: data from cross-sectional surveys representing South East London and England. PLoS One 7:e48012CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Solmi F, Hatch SL, Hotopf M et al (2015) Validation of the SCOFF questionnaire for eating disorders in a multi-ethnic general population sample. Int J Eat, DisordGoogle Scholar
  48. 48.
    Pope HG, Lalonde JK, Pindyck LJ et al (2006) Binge eating disorder: a stable syndrome. Am J Psychiatry 163:2181–2183CrossRefPubMedGoogle Scholar
  49. 49.
    Solmi F, Sonneville KR, Easter A et al (2015) Purging behaviours at age 16: prevalence in three community-based international cohorts. J Child Psychol Psychiatry 56:87–96. doi: 10.1111/jcpp.12283 CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Micali N, Hagberg KW, Petersen I, Treasure J (2013) The incidence of eating disorders in the UK in 2000–2009: findings from the general practice research database. BMJ Open. doi: 10.1136/bmjopen-2013-002646 PubMedPubMedCentralGoogle Scholar
  51. 51.
    Knudsen AK, Hotopf M, Skogen JC et al (2010) The health status of nonparticipants in a population-based health study: the Hordaland Health Study. Am J Epidemiol 172:1306–1314. doi: 10.1093/aje/kwq257 CrossRefPubMedGoogle Scholar
  52. 52.
    Fairburn CG, Beglin SJ (1990) Studies of the epidemiology of bulimia nervosa. Am J Psychiatry 147:401–408CrossRefPubMedGoogle Scholar
  53. 53.
    Weltzin TE, Weisensel N, Franczyk D et al (2005) Eating disorders in men: update. J Men’s Heal Gend 2:186–193CrossRefGoogle Scholar
  54. 54.
    Neumark-Sztainer D, Croll J, Story M et al (2002) Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys. J Psychosom Res 53:963–974CrossRefPubMedGoogle Scholar
  55. 55.
    Franko DL, Becker AE, Thomas JJ, Herzog DB (2007) Cross-ethnic differences in eating disorder symptoms and related distress. Int J Eat Disord 40:156–164CrossRefPubMedGoogle Scholar
  56. 56.
    Regan PC, Cachelin FM (2006) Binge eating and purging in a multi-ethnic community sample. Int J Eat Disord 39:523–526CrossRefPubMedGoogle Scholar
  57. 57.
    Grucza RA, Przybeck TR, Cloninger CR (2007) Prevalence and correlates of binge eating disorder in a community sample. Compr Psychiatry 48:124–131CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Favaro A, Santanastaso P (1998) Impulsive and compulsive self-injurious behavior in bulimia nervosa: prevalence and psychological correlates. J Nerv Ment Dis 186:157–165CrossRefPubMedGoogle Scholar
  59. 59.
    Anderson DA, Martens MP, Cimini MD (2005) Do female college students who purge report greater alcohol use and negative alcohol-related consequences? Int J Eat Disord 37:65–68CrossRefPubMedGoogle Scholar
  60. 60.
    Franko DL, Keel PK (2006) Suicidality in eating disorders: occurrence, correlates, and clinical implications. Clin Psychol Rev 26:769–782CrossRefPubMedGoogle Scholar
  61. 61.
    Keel PK, Wolfe B, Gravener J, Jimerson D (2008) Co-morbidity and disorder-related distress and impairment in purging disorder. Psychol Med 38:1435–1442CrossRefPubMedGoogle Scholar
  62. 62.
    Araujo DMR, da Santos GF, Nardi AE (2010) Binge eating disorder and depression: a systematic review. World J Biol Psychiatry 11:199–207CrossRefPubMedGoogle Scholar
  63. 63.
    Cassin SE, von Ranson KM (2005) Personality and eating disorders: a decade in review. Clin Psychol Rev 25:895–916CrossRefPubMedGoogle Scholar
  64. 64.
    Swinbourne JM, Touyz SW (2007) The co-morbidity of eating disorders and anxiety disorders: a review. Eur Eat Disord Rev 15:253–274CrossRefPubMedGoogle Scholar
  65. 65.
    Sim LA, McAlpine DE, Grothe KB et al (2010) Identification and treatment of eating disorders in the primary care setting. Mayo Clin Proc 85:746–751CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    White JE (1982) A two stage design for the study of the relationship between a rare exposure and a rare disease. Am J Epidemiol 115:119–128PubMedGoogle Scholar
  67. 67.
    Micali N, Solmi F, Horton NJ et al (2015) Adolescent eating disorders predict psychiatric, high-risk behaviors and weight outcomes in young adulthood. J Am Acad Child Adolesc Psychiatry 54(652–659):e1. doi: 10.1016/j.jaac.2015.05.009 PubMedGoogle Scholar
  68. 68.
    Sonneville KR, Horton NJ, Micali N et al (2013) Longitudinal associations between binge eating and overeating and adverse outcomes among adolescents and young adults: does loss of control matter? JAMA Pediatr 167:149–155CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • F. Solmi
    • 1
    • 4
    Email author
  • M. Hotopf
    • 2
  • S. L. Hatch
    • 2
  • J. Treasure
    • 3
  • N. Micali
    • 1
    • 5
  1. 1.Behavioural and Brain Science Unit, Institute of Child HealthUniversity College LondonLondonUK
  2. 2.Psychological Medicine, Institute of PsychiatryKing’s College LondonLondonUK
  3. 3.Eating Disorders Department, Institute of PsychiatryKing’s College LondonLondonUK
  4. 4.Division of PsychiatryUniversity College LondonLondonUK
  5. 5.Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations