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

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Abstract

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.

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Notes

  1. Definitions of core symptoms for AN and BN were based on the structure of the DIA-X/M-CIDI and its skipping rules. Due to the implementation of skipping rules the DIA-X/M-CIDI does not allow for the assessment of other AN criteria (B–D) independently from AN criterion A. Furthermore, the M-DIA-X/M-CIDI does not allow for assessing other BN criteria (B–E) independently from BN criterion A. Symptomatic AN was defined as AN criterion A (underweight) plus one further AN criterion to ensure that weight loss was not only due to physical complications but also to fear of weight gain or other weight and shape concerns typical for AN.

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Acknowledgments

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).

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Authors and Affiliations

  1. Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187, Dresden, Germany

    Michaela Nagl, Corinna Jacobi, Martin Paul, Katja Beesdo-Baum, Michael Höfler & Hans-Ulrich Wittchen

  2. Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Missionsstrasse 60/62, 4055, Basel, Switzerland

    Roselind Lieb

  3. Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany

    Roselind Lieb & Hans-Ulrich Wittchen

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  1. Michaela Nagl
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787_2015_808_MOESM1_ESM.pdf

Supplementary material 1 (PDF 169 kb) ESM_1: Table ST1.1. Operationalization in the DSM-IV/M-CIDI criteria for eating disorders

Supplementary material 2 (PDF 428 kb) ESM_2: Tables ST2.1 to 2.7. Dropout analyses

Supplementary material 3 (PDF 261 kb) ESM_3: Tables ST3.1 to 3.3. Sensitivity analyses

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Nagl, M., Jacobi, C., Paul, M. et al. Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. Eur Child Adolesc Psychiatry 25, 903–918 (2016). https://doi.org/10.1007/s00787-015-0808-z

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