Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
Similar content being viewed by others
Notes
SCOFF questions: Do you make yourself table because you feel uncomfortably full?; Do you worry you have lost control over how much you eat?; Have you recently lost more than one stone in a 3 month period?; Do you believe yourself to be Fat even when other say you are too thin?; Would you say that Food dominates your life?
The following procedures were employed to measure participants’ height and weight: Height: participants’ height was measured having them standing with their scapula, buttocks and heels resting against a wall, the neck held in a natural non-stretched position, the heels touching each other, the toe tips form a 45° angle and the head held straight with the inferior orbital border in the same horizontal plane as the external auditive conduct (Frankfort's plane). Weight: a portable scale with a 125 kg maximum capacity and a ± 100 g error margin was used. Individuals were asked to remove shoes and heavy cloths prior to weighing.
References
Smink FRE, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414
Eddy KT, Celio Doyle A, Hoste RR et al (2008) Eating disorder not otherwise specified in adolescents. J Am Acad Child Adolesc Psychiatry 47:156–164
Le Grange D, Swanson SA, Crow SJ, Merikangas KR (2012) Eating disorder not otherwise specified presentation in the US population. Int J Eat Disord 45:711–718
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Author, Washington, DC
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5™), 5th ed. Washington, DC
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
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
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 61:348–358
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 43:1125–1132
Field AE, Sonneville KR, Micali N et al (2012) Prospective association of common eating disorders and adverse outcomes. Pediatrics 130:e289–e295
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
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
Tareen A, Hodes M, Rangel L (2005) Non-fat-phobic anorexia nervosa in British South Asian adolescents. Int J Eat Disord 37:161–165
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
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
Grabe S, Hyde JS (2006) Ethnicity and body dissatisfaction among women in the United States: a Meta-analysis. Psychol Bull 132:622–640
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 180:509–514
Chisuwa N, O’Dea JA (2010) Body image and eating disorders amongst Japanese adolescents. A review of the literature. Appetite 54:5–15
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
Szabo CP, Allwood CW (2004) A cross-cultural study of eating attitudes in adolescent South African females. World Psychiatry 3:41–44
Shaw H, Ramirez L, Trost A et al (2003) Body image and eating disturbances across ethnic groups: more similarities than differences. Psychol Addict Behav 18:12–18
Becker AE, Franko DL, Speck A, Herzog DB (2003) Ethnicity and differential access to care for eating disorder symptoms. Int J Eat Disord 33:205–212
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 39:154–161
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 42:459–463
Striegel-Moore RH, DeBar L, Wilson GT et al (2008) Health services use in eating disorders. Psychol Med 38:1465–1474
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 39:1284–1292
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 40:399–408
Reid M, Williams S, Hammersley R (2009) Managing eating disorder patients in primary care in the UK: a qualitative study. Eat Disord 18:1–9
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
Morgan JF, Reid F, Lacey JH (1999) The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 319:1467–1468
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 22:465–486
Moran P (2003) Standardised Assessment of Personality—abbreviated scale (SAPAS): preliminary validation of a brief screen for personality disorder. Br J Psychiatry 183:228–232
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 12:94
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 6:61–68
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 9:6
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 76:272–281
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 48:1199–1209
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, Geneva
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 68:714–723
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 42:369–374
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 14:291–299
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 18:75–79
Keel PK, Haedt A, Edler C (2005) Purging disorder: an ominous variant of bulimia nervosa? Int J Eat Disord 38:191–199
Dunn G, Pickles A, Tansella M, Vazquez-Barquero L (1999) Two-phase epidemiological surveys in psychiatric research. Br J Psychiatry 174:95–100
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 49:1335–1346
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:e48012
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, Disord
Pope HG, Lalonde JK, Pindyck LJ et al (2006) Binge eating disorder: a stable syndrome. Am J Psychiatry 163:2181–2183
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
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
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
Fairburn CG, Beglin SJ (1990) Studies of the epidemiology of bulimia nervosa. Am J Psychiatry 147:401–408
Weltzin TE, Weisensel N, Franczyk D et al (2005) Eating disorders in men: update. J Men’s Heal Gend 2:186–193
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 53:963–974
Franko DL, Becker AE, Thomas JJ, Herzog DB (2007) Cross-ethnic differences in eating disorder symptoms and related distress. Int J Eat Disord 40:156–164
Regan PC, Cachelin FM (2006) Binge eating and purging in a multi-ethnic community sample. Int J Eat Disord 39:523–526
Grucza RA, Przybeck TR, Cloninger CR (2007) Prevalence and correlates of binge eating disorder in a community sample. Compr Psychiatry 48:124–131
Favaro A, Santanastaso P (1998) Impulsive and compulsive self-injurious behavior in bulimia nervosa: prevalence and psychological correlates. J Nerv Ment Dis 186:157–165
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 37:65–68
Franko DL, Keel PK (2006) Suicidality in eating disorders: occurrence, correlates, and clinical implications. Clin Psychol Rev 26:769–782
Keel PK, Wolfe B, Gravener J, Jimerson D (2008) Co-morbidity and disorder-related distress and impairment in purging disorder. Psychol Med 38:1435–1442
Araujo DMR, da Santos GF, Nardi AE (2010) Binge eating disorder and depression: a systematic review. World J Biol Psychiatry 11:199–207
Cassin SE, von Ranson KM (2005) Personality and eating disorders: a decade in review. Clin Psychol Rev 25:895–916
Swinbourne JM, Touyz SW (2007) The co-morbidity of eating disorders and anxiety disorders: a review. Eur Eat Disord Rev 15:253–274
Sim LA, McAlpine DE, Grothe KB et al (2010) Identification and treatment of eating disorders in the primary care setting. Mayo Clin Proc 85:746–751
White JE (1982) A two stage design for the study of the relationship between a rare exposure and a rare disease. Am J Epidemiol 115:119–128
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
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 167:149–155
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Solmi, F., Hotopf, M., Hatch, S.L. et al. Eating disorders in a multi-ethnic inner-city UK sample: prevalence, comorbidity and service use. Soc Psychiatry Psychiatr Epidemiol 51, 369–381 (2016). https://doi.org/10.1007/s00127-015-1146-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-015-1146-7