EPIDEMIOLOGY OF THE EATING DISORDERS
Psychiatric Clinics of North AmericaPublished 1 December 1996
L. K. George Hsu
Citations251
SJR quartileQ2
SJR score0.88
SNIP0.86
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
It is concluded that anorexia and bulimia nervosa are uncommon disorders but probably have increased in incidence in recent years and are one of the most common psychiatric disorders to affect young women in the west.
Abstract
Recent studies on the epidemiology of anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorders in special populations and in other cultures are reviewed. In addition, studies on the epidemiology of dieting behavior and longitudinal studies of the outcome of dieting behavior are reviewed. It is concluded that anorexia and bulimia nervosa are uncommon disorders but probably have increased in incidence in recent years. However, they are one of the most common psychiatric disorders to affect young women in the west. Dieting behavior is a major risk factor in the pathogenesis of the eating disorders. The prevalence of the eating disorders in a given community is, therefore, correlated with the prevalence of dieting behavior in the community.
Keywords
PsychologyMedicine
Archives of General PsychiatryDiagnostic Criteria for Use in Psychiatric Research
5,714 Citations1972John P. Feighner
Diagnostic criteria for 14 psychiatric illnesses along with the validating evidence for these diagnostic categories comes from workers outside the authors' group as well as from those within; it consists of studies of both outpatients and inpatients, of family studies, and of follow-up studies.
Psychological MedicineThe Eating Attitudes Test: psychometric features and clinical correlates
4,957 Citations1982David M. Garner, Marion P. Olmsted +2 more
International Journal of Eating DisordersDevelopment and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia
4,535 Citations1983David M. Garner, Marion P. Olmstead +1 more
Psychological MedicineThe Eating Attitudes Test: an index of the symptoms of anorexia nervosa
3,551 Citations1979David M. Garner, Paul E. Garfinkel
The EAT was validated using 2 groups of female anorexia nervosa patients and female control subjects and total EAT score was significantly correlated with criterion group membership, suggesting a high level of concurrent validity.
Psychological ReportsCultural Expectations of Thinness in Women
1,184 Citations1980David M. Garner, Paul E. Garfinkel +2 more
This study attempts to document and quantify the shift toward a thinner ideal shape for females in the authors' culture over the last 20 years, including data from Playboy centerfolds and Miss America Pageant contestants and a significant increase in diet articles in six popular women's magazines.
The British Journal of PsychiatryA Self-rating Scale for Bulimia the ‘BITE’
821 Citations1987Max Henderson, C. P. Freeman
A new brief questionnaire, the Bulimic Investigatory Test, Edinburgh (BITE), for the detection and description of binge-eating is described, which has measures of both symptoms and severity.
International Journal of Eating DisordersBinge eating disorder: A multisite field trial of the diagnostic criteria
780 Citations1992Robert L. Spitzer, Michael J. Devlin +10 more
The results of a multisite field trial indicate that the binge eating disorder is common among subjects attending hospital-affiliated weight control programs, but is relatively rare in the community.
Psychological MedicineSocio-cultural factors in the development of anorexia nervosa
767 Citations1980David M. Garner, Paul E. Garfinkel
The data suggest that both pressures to be slim and achievement expectations are risk factors in the development of anorexia nervosa.
International Journal of Eating DisordersCultural expectations of thinness in women: An update
717 Citations1992Claire V. Wiseman, James J. Gray +2 more
American Journal of PsychiatryStudies of the epidemiology of bulimia nervosa
638 Citations1990Christopher G. Fairburn, Sarah J. Beglin
A shift in emphasis is recommended away from studies of the distribution of the disorder toward studies ofThe determinants of the whole spectrum of the disturbance that exists in the community.
American Journal of PsychiatryThe genetic epidemiology of bulimia nervosa
637 Citations1991Kenneth S. Kendler, Charles Maclean +4 more
The liability to fully syndromal bulimia nervosa, which affects around one in 25 women at some point in their lives, is substantially influenced by both epidemiologic and genetic risk factors.
American Journal of Psychiatry50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study
603 Citations1991Alexander R. Lucas, C. Mary Beard +2 more
Anorexia nervosa is more common among girls 15-19 years old it is a very common chronic illness and its incidence has increased among females 15-24 years old but not among older women or among males.
American Journal of PsychiatryBulimia nervosa in a Canadian community sample: prevalence and comparison of subgroups
496 Citations1995
Psychological MedicineAbnormal eating attitudes in London schoolgirls — a prospective epidemiological study: outcome at twelve month follow-up
468 Citations1990George Patton, Eric Johnson‐Sabine +3 more
Dieting was in the great majority of girls found to be a benign practice without progression to more extreme concerns about food and weight, however, a small proportion of dieters did become cases and formed the majority of new cases found at follow-up.
Journal of the American Academy of Child & Adolescent PsychiatryEarly Childhood Eating Behaviors and Adolescent Eating Disorders
451 Citations1990MARGARET L. MARCHI, Patricia Cohen
Findings regarding prospective risks implicate pica and problem meals in early childhood for later bulimia nervosa and anorexia nervosa; suggesting problems in self-control of eating behavior as well as eating-related family struggles.
PEDIATRICSTrends in Fatness and the Origins of Obesity
424 Citations1976Stanley M. Garn, D. Cecil Clark +9 more
The TSNS has provided nine-decade triceps or subscapular fatfold data on more than 40,000 individuals, showing both an economic-related fatness increase in the male at all ages and an economic "reversal" of fatness in the female at adolescence and beyond.
Archives of General PsychiatryUncommon Troubles in Young People:
405 Citations1990Agnes H. Whitaker
While rates of mental health service utilization varied greatly by diagnosis, only 41% of students who were assigned both a diagnosis and a rating of impairment had received any kind of clinical attention.
American Journal of PsychiatryAnorexia nervosa and anorexic-like syndromes in a population-based female twin sample
334 Citations1995Ellen E. Walters, K S Kendler
Both the pattern of comorbidity and the relationship to epidemiologic risk factors suggested an etiologic continuity between narrowly and broadly defined anorexic syndromes, which support the hypothesis of a spectrum of anoreXic-like Syndromes in women.
Archives of General PsychiatryThe Shatin Community Mental Health Survey in Hong Kong
300 Citations1993Char-Nie Chen
A large-scale community survey in Shatin, Hong Kong, is presented with a modified two-phase design using flagged and nonflagged subsamples and lifetime rates for 19 Diagnostic Interview Schedule/DSM-III diagnoses are presented.
Psychosomatic MedicineComparison Between Weight-Preoccupied Women and Anorexia Nervosa
282 Citations1984David M. Garner, Marion P. Olmsted +2 more
Findings were interpreted as indicating that, although there are some highly weight‐preoccupied females who display psychopathology quite similar to anorexia nervosa, others only superficially resemble patients suffering from serious eating disorders.
American Journal of Clinical NutritionA Longitudinal Study of Gross Body Composition and Body Conformation and Their Association with Food and Activity in a Teen-Age Population
241 Citations1966Ruth L. Huenemann, Leona R. Shapiro +2 more
PEDIATRICSNutrition, Growth, Development, and Maturation: Findings From the Ten-State Nutrition Survey of 1968-1970
221 Citations1975Stanley M. Garn, D. Cecil Clark +9 more
The Ten-State Nutrition Survey of 1968-1970 contributed far more information on nutrition and growth than was originally anticipated and pointed out major gaps in knowledge and provided a new body of substantive important information.
Psychological Medicine Monograph SupplementEating disorders in a general practice population. Prevalence, characteristics and follow-up at 12 to 18 months
207 Citations1989Michael King
There was some change along a spectrum of normal dieting to the full syndrome, although only one subject with bulimia nervosa recovered significantly over the follow-up period, although the GPs were unaware of the eating pathology and their intervention was minimal.
Psychological MedicineAbnormal eating attitudes in London schoolgirls — a prospective epidemiological study: factors associated with abnormal response on screening questionnaires
191 Citations1988Eric Johnson‐Sabine, Kathryn Wood +3 more
Some commonly accepted risk factors for eating disorders were discovered to be associations with general psychiatric morbidity and perceived parental pressure to eat more, taking exercise to lose weight, perceived stress at home and reporting a family history of anxiety or depression were discovered.
The British Journal of PsychiatryAnorexia Nervosa in a Swedish Urban Region
186 Citations1989Maria Råstam, Christopher Gillberg +1 more
The total population of 15-year-olds in Göteborg, Sweden, were screened in 1985 for anorexia nervosa using brief questionnaires, growth charts and individual school nurse reports, with 85% of the cases fulfilling DSM–III–R criteria.
Journal of Psychosomatic ResearchAdolescent concerns about weight and eating; A social-developmental perspective
174 Citations1990Jane Wardle, Louise Marsland
The results suggested that weight concern was high in the girls, with more than 50% feeling too fat and wanting to lose weight, which suggests that weight concerns are beginning earlier than in the past.
Psychotherapy and PsychosomaticsA Prospective Study of Eating Disturbances in the Ballet
167 Citations2010David M. Garner, Paul E. Garfinkel +2 more
Findings indicate that vulnerable adolescents may be identified early using economical self-report measures as the initial step in a two-stage screening process and that most cases of anorexia nervosa gained weight at follow-up.
JAMABulimia vs Bulimic Behaviors on a College Campus
163 Citations1987David E. Schotte
An inflection point was found in the rates of binge eating, self-induced vomiting, and their combination at a frequency of about twice per month in a self-report survey of bulimic behaviors conducted with 1965 students.
Psychological MedicineHow abnormal is the desire for slimness? A survey of eating attitudes and behaviour among Chinese undergraduates in Hong Kong
144 Citations1993Sing Lee
A two-stage screening survey of Chinese bilingual university students in Hong Kong showed that although female students were 'underweight' by Western standard, the majority of them and nearly all female students above a body mass index of 20.5 kg/m2 were cognitively inclined to diet and weigh less, albeit without being driven to actual weight control behaviour.
The British Journal of PsychiatryAnorexia Nervosa
141 Citations1995Éric Fombonne
There is no evidence of a secular increase in the incidence of anorexia nervosa and prevalence estimates are higher in the most recent studies.
Psychological MedicineAnorexia nervosa: a psychiatric case register study from Aberdeen
141 Citations1986George Szmukler, C. McCance +2 more
An examination of the 238 cases of anorexia nervosa on the Aberdeen Psychiatric Case Register for the period 1965–82 found a highly significant increase in the number of cases over time and a social class bias was found.
The British Journal of PsychiatryAnorexia Nervosa in a Swedish Urban Region
116 Citations1989Maria Råstam, Christopher Gillberg +1 more
American Journal of PsychiatryIncreasing incidence of anorexia nervosa in the female population of northeast Scotland
114 Citations1995John Eagles, M I Johnston +3 more
Rates of referral for female subjects with anorexia nervosa have greatly increased since the 1960s, and rates likely reflect a genuine increase in incidence, but the data suggest that less severely ill patients are now being referred.
American Journal of PsychiatryBulimia in college women: incidence and recovery rates
113 Citations1988
In a longitudinal survey of college freshmen, the incidence of bulimia nervosa was 4.2 cases per 100 women per year, and some women continued bulimic behaviors without meeting the DSM-III-R criteria.
American Journal of Public HealthThe prevalence of bulimia nervosa in the US college student population.
106 Citations1988A. Drewnowski, Shakita Hopkins +1 more
A phone survey to determine the prevalence of bulimia nervosa was conducted with a national probability sample of 1,007 male and female students from a stratified sample of 53 universities and colleges in the continental United States.
Psychological MedicineDetection of eating disorders in a small rural town: an epidemiological study
105 Citations1993G Rathner, Klara Messner
This study shows that early case detection can be improved by using multiple risk indices, and in this rural area the prevalence was as high as in metropolitan or urban areas.
Psychological MedicineThe problem of screening for uncommon disorders – a comment on the Eating Attitudes Test
102 Citations1982Paul Williams, David J. Hand +1 more
The Eating Attitudes Test is used as a screening tool for uncommon disorders and one of the problems is identified and discussed within the context of the Eating Att attitudes Test.
Journal of Developmental & Behavioral PediatricsSexual Maturation, Social Class, and the Desire to Be Thin Among Adolescent Females
100 Citations1984Sanford M. Dornbusch, J. Merrill Carlsmith +5 more
Veblen's 1899 hypothesis that associated a female desire for thinness with the higher social classes was tested with data from a representative national sample of adolescents, 12 to 17 years of age, in the National Health Examination Survey.
International Journal of Eating DisordersEpidemiology of bulimia and symptoms in a general population: Sex, age, race, and socioeconomic status
96 Citations1992Colleen S. W. Rand, John M. Kuldau
Bulimic behaviors and symptoms were more common among women than men, younger than older respondents, and, on some items, lower socioeconomic status (SES) than higher SES respondents.
Psychological MedicineAnorexia nervosa in Hong Kong: a Chinese perspective
95 Citations1991Sing Lee
A prospective study of sixteen Chinese anorexic patients in Hong Kong indicates that they were single young females who came from lower social class, exhibited severe self-induced weight loss, rigid maintenance of low body weight and amenorrhea, and only partially fulfilled current criteria for diagnosis.
The British Journal of PsychiatryAnorexia Nervosa in Hong Kong
93 Citations1989Sing Lee, Helen F.K. Chiu +1 more
The rarity of the disorder in the East could be related to protective biological and sociocultural factors specific to the Chinese, and while it may become more common, anorexia nervosa is unlikely to reach Western proportions.
Mayo Clinic ProceedingsAnorexia Nervosa in Rochester, Minnesota: A 45-Year Study
87 Citations1988Alexander R. Lucas, C. Mary Beard +2 more
The incidence of anorexia nervosa during a 45-year period (1935 through 1979) was determined for the population of Rochester, Minnesota, from the epidemiology archives at the Mayo Clinic, using medical records of local residents with the diagnosis of the disease as the primary source for case ascertainment.
Acta Psychiatrica ScandinavicaThe epidemiology of anorexia nervosa in Denmark from 1973 to 1987: a nationwide register study of psychiatric admission
80 Citations1990Søren Nielsen
Age‐period and age‐cohort analysis of the 10‐ to 24‐year‐old females showed that only age exerted a significant independent influence on first‐admission rates, whereas all 3 factors exerted significant independent Influence on readmission rates.
Journal of Psychiatric ResearchThe implications of anorexia nervosa in a ballet school
76 Citations1985George Szmukler, Ivan Eisler +2 more
Features important in the diagnosis of anorexia nervosa were common in a sample of 100 ballet students and follow-up one year later showed that seven girls who were designated "possible cases" had continued to dance and were considerably improved in their physical status without medical intervention.
Journal of Nutrition EducationAdolescent attitudes toward weight and appearance
75 Citations1969Johanna Dwyer, Jacob J. Feldman +2 more
The goal of this study was to obtain information for the construction of weight control programs at the high school level by assessing the degree to which accuracy in reporting of weight varied with differences in body fatness.
International Journal of Eating DisordersApplication of the eating disorders inventory to a sample of black, white, and mixed race schoolgirls in zimbabwe
69 Citations1986Malcolm S. H. Hooper, David M. Garner
American Journal of PsychiatryUpdate on the epidemiology of anorexia nervosa in a defined region of Switzerland
68 Citations1990J Willi, G. Giacometti +1 more
The more frequent use of vomiting and abuse of laxatives in 1983-1985 may indicate an increase in cases with mixed features of anorexia nervosa and bulimia.
Acta Psychiatrica ScandinavicaEpidemiology of anorexia nervosa and bulimia nervosa in Bornholm County, Denmark, 1970–1989
60 Citations1994Anne Katrine Pagsberg, A.‐R. Wang
In a retrospective study of anorexia nervosa and bulimia nervosa, potential cases were traced, studied, and diagnosed according to ICD‐10, and a significant increase occurred during the last 5 years.
Journal of the American Dietetic AssociationEating habits and nutrient intakes of college women over a thirty-year period
60 Citations1977Carol Jakobovits, Peggy Halstead +3 more
American Journal of PsychiatryIs weight phobia always necessary for a diagnosis of anorexia nervosa?
60 Citations1993L. K. George Hsu, Seunghyun Lee
The authors conclude that a change in the core features of anorexia nervosa in Western cultures since 1930 can be demonstrated and recommend that because the desire for thinness appears to be culture-bound, anorexic nervosa is the best disorder to use in examining the influence of culture on psychopathology.
Psychological MedicineEating behaviour of male racing jockeys
60 Citations1987Michael King, Gillian Mezey
Jockeys based in racing stables in the Newmarket and Epsom areas of England were screened using the 26-item Eating Attitudes Test, and the majority of jockeys interviewed reported food avoidance, the use of saunas and the abuse of laxatives.
Acta Psychiatrica ScandinavicaThe epidemiology of eating disorders in Fyn County, Denmark, 1977–1986
55 Citations1992Jan Stener Joergensen
Sixty percent of the anorexia nervosa patients, but only 30% of the bulimia patients, were admitted to hospital; this is an important difference in regard to estimation of occurrence from registers, and the prevalence was estimated at 1:780 (patient years/total population years), in the high‐risk population: females 15–19 years of age.
Acta Psychiatrica ScandinavicaPrevalence and incidence of eating disorders in a suburban area
49 Citations1988Johan Cullberg, M. Engström‐Lindberg
There has been no previous epidemiological study on anorexia nervosa (AN) and bulimia (BU) where non‐medical care givers have also been included in the case‐finding procedure and there seems to be no clear social class grouping.
Acta Psychiatrica ScandinavicaIncidence of anorexia nervosa in Denmark
45 Citations1992S. Møller‐Madsen, J Nystrup
During the time of this investigation, the number of discharges of patients with an eating disorder as the main diagnosis was constant from somatic hospitals, whereas discharges from psychiatric institutions increased.
Journal of Adolescent Health CareWeight control methods in high school wrestlers
43 Citations1988Elizabeth R. Woods, Claire D. Wilson +1 more
The methods of weight control practiced could potentially impair an adolescent's growth and development as well as increase the risk of dehydration or electrolyte imbalance during competition.
Acta PaediatricaDieting in Teenage Schoolgirls <i>A Longitudinal Prospective Study</i>
38 Citations1983Kari Schleimer
What far‐reaching consequences dieting may produce in teenage girls is demonstrated and whether there is a direct relation between dieting and the development of anorexia nervosa is determined.
American Psychiatric Press eBooksPsychiatric treatment : advances in outcome research
38 Citations1991Steven M. Mirin, John T. Gossett +1 more
The British Journal of PsychiatryBinge Eating and Weight Concerns among Young Adults
37 Citations1992Margarete Vollrath, Regula Koch +1 more
It is suggested that eating problems are persistent for the binge eaters, and, to a lesser extent, also for subjects with weight concerns, and long-term studies on eating problems in community samples are encouraged.
The British Journal of PsychiatryBulimia Nervosa in Hong Kong Chinese Patients
31 Citations1992Sing Lee, L. K. George Hsu +1 more
The case histories support the hypothesis that binge-eating is used to regulate unpleasant affect, and four female normal-weight bulimic patients with mostly typical clinical features and conspicuous morbidity are reported.
Acta Psychiatrica ScandinavicaAnorexia nervosa and bulimia: a prevalence study
31 Citations1992M.H. Azevedo, Cláudia Ferreira
The prevalence of anorexia nervosa and bulimia in a large sample of students attending a secondary school on the island of São Miguel (Azores) using the Diagnostic Interview for Children and Adolescents using the DSM‐III diagnoses was rather low.
Journal of Psychiatric ResearchPatterns of care of anorexia nervosa
29 Citations1985Hans W. Hoek, Frank G. Brook
Patients with anorexia nervosa only are younger, have a higher degree of education and more general education than patients with anoresis and another psychiatric disorder and the results suggest that in some cases they should be considered as a symptom, not as a disease entity by itself.
Australian & New Zealand Journal of PsychiatryThe Epidemiology of Anorexia Nervosa in South Australia
26 Citations1990David I. Ben-Tovim, Jacqueline Morton
A survey of 5,705 pupils in girls' schools in South Australia revealed that the one year prevalence of cases of anorexia nervosa, diagnosed according to DSM-Ill criteria, was 1.05 cases per thousand of the population studied.
Annals of Nutrition and MetabolismPrevalence of Obesity, Leanness and Anorexia nervosa in Japanese Boys and Girls Aged 12&ndash;14 Years
25 Citations1990Takehiko Ohzeki, Keiichi Hanaki +5 more
The results suggest that higher prevalence of obesity in certain subjects may be associated with increased numbers of leanness but not with anorexia nervosa.
The British Journal of PsychiatryThe BITE: Indices of Agreement
18 Citations1988Christopher P. Freeman, Michael Henderson