Incidence, prevalence and mortality of anorexia nervosa and
other eating disorders
Hans Wijbrand Hoeka,b,c
Purpose of review
with eating disorders.
General-practice studies show that the overall incidence
compared with the 1980s. Some evidence suggests that
the occurrence of bulimia nervosa is decreasing. Anorexia
nervosa is a common disorder among young white females,
but is extremely rare among black females. Recent studies
confirmprevious findingsofthehigh mortalityratewithinthe
anorexia nervosa population.
The incidence of anorexia nervosa is around eight per
100 000 persons per year. An upward trend has been
observed in the incidence of anorexia nervosa in the past
century till the 1970s. The most substantial increase was
among females aged 15–24 years, for whom a significant
increase was observed from 1935 to 1999. The average
prevalence rates for anorexia nervosa and bulimia nervosa
among young females are 0.3 and 1%, respectively. Only a
minority of people with eating disorders, especially with
bulimia nervosa, are treated in mental healthcare.
anorexia nervosa, eating disorder, epidemiology, mortality
Curr Opin Psychiatry 19:389–394. ? 2006 Lippincott Williams & Wilkins.
aParnassia Psychiatric Institute, The Hague, The Netherlands,bDepartment of
Epidemiology, Columbia University, New York, USA andcDepartment of Psychiatry,
University Medical Center Groningen, University of Groningen, Groningen, The
Correspondence to Professor Hans Wijbrand Hoek MD PhD, Parnassia Psychiatric
Institute, Mangostraat 15, 2552 KS The Hague, The Netherlands
Tel: +31 70 391 7344; fax: +31 70 391 7088; e-mail: firstname.lastname@example.org
Current Opinion in Psychiatry 2006, 19:389–394
crude mortality rate
Diagnostic and Statistical Manual of Mental Disorders
Eating Disorder Not Otherwise Specified
standardized mortality rate
? 2006 Lippincott Williams & Wilkins
Incidence and prevalence rates are the basic measures of
disease frequency. Incidence is the number of new cases
in the population over a specified period. The incidence
of eating disorders is commonly expressed in terms of per
differences between groups are better clues to the etiol-
ogy than are prevalence rate differences because they
relate to fairly new cases of an eating disorder.
Prevalence is the total number of cases in the population.
The point prevalence is the prevalence at a specific point
of time. The 1-year period prevalence rate is the point
prevalence rate plus the annual incidence rate. The
prevalence rate is the most useful rate for planning
facilities as it indicates the demand for care.
Mortality rates are often used as an indicator of the
severity of anorexia nervosa. In a meta-analysis of excess
mortality in the 1990s, anorexia nervosa was associated
with the highest rate of mortality among all mental
disorders . The standard measures for mortality are
the crude mortality rate (CMR) and the standardized
mortality rate (SMR). The CMR is the proportion of
deaths within the study population. The SMR is the
fraction of the observed mortality rate (CMR) compared
with the expected mortality rate in the population of
origin, for example, all young females.
This article is based on a selection from the literature,
of eating disorders and updates and incorporates our
previous reviews [2–4].
The validity of many epidemiological studies of eating
disorders is called into question because of a number of
methodological problems related to the selection of
populations under study and the identification of cases
[3,5]. Problems that are specific to eating disorders are
their low prevalence in the general population and the
tendency of the people with eating disorders to conceal
their illness and to avoid professional help.
Most incidence studies of anorexia nervosa have used
psychiatric case registers or medical records of hospitals
in a circumscribed area. All record-based studies will
grossly underestimate the incidence in the community
because not all cases will be referred to (mental) health-
care or become hospitalized. Therefore, it is unclear
whether the reported increase in the number of cases
in healthcare facilities reflects an actual increase in the
incidence in the community; the increase might also be
due to improved methods of case detection or the wider
availability of services. Findings from case registers and
hospital records are of restricted value for generating
hypotheses on the etiology of the disease because there
is no direct access to the patients and the additional
information that is available is usually limited and of a
demographic nature only.
At present, a two-stage screening approach is the most
widely accepted procedure for the identification of preva-
lent cases. First, a large population is screened for the
likelihood of an eating disorder by means of a screening
questionnaire that identifies an at-risk population (first
stage). Then definite cases are established on the basis of
a personal interview of both the persons from this at-risk
population and those from a randomly selected sample of
people not at risk (second stage). Methodological pro-
rates, sensitivity and specificity of the screening instru-
ment and often the restricted size of the groups inter-
viewed, particularly of those not at risk.
Incidence of anorexia nervosa
The highest reported age-adjusted and sex-adjusted
incidence rate of anorexia nervosa was 8.3 per 100 000
person years in Rochester, MN, USA, during 1935–1989
. Lucas and colleagues used an extensive case-finding
method, which included all medical records of healthcare
providers, general practitioners and specialists in the
community of Rochester. They screened records that
mentioned diagnostic terms that could refer to nonde-
tected cases. They included probable as well as possible
cases, and definite cases constituted only 39% (82 out of
208) of all incident cases identified during 1935–1989.
Incidence rates derived from general practices gener-
ally represent eating disorders that started more
recently than those based on other medical records.
Two recent studies of this type examined the inci-
dence of anorexia nervosa in primary care in the UK
and the Netherlands during the second half of the
1990s. Currin and colleagues [7??] searched the General
Practice Research Database in the UK for new cases of
anorexia nervosa between 1994 and 2000. They com-
pared their data with the findings of a similar study for
1988–1993 . The incidence of anorexia nervosa
remained remarkably consistent over the two study
periods. The age-adjusted and sex-adjusted incidence
rate of anorexia nervosa in 2000 was 4.7 [95% confidence
interval (CI): 3.6–5.8] compared with 4.2 (95% CI: 3.4–
5.0) per 100 000 persons in 1993.
In two studies in the Netherlands [9,10], general prac-
titioners studied the incidence of eating disorders in a
large representative sample of the Dutch population.
The overall incidence of anorexia nervosa was 7.7
(95% CI: 5.9–10.0) per 100 000 persons per year during
1995–1999. It was comparable to the rate of 7.4 during
1985–1989 . Incidence rates for anorexia nervosa
are highest for females aged 15–19 years. They con-
stitute approximately 40% of all identified cases . In
Rochester, MN, USA, the incidence rate was 74 per
100 000 person years for 15–19-year-old females during
1935–1989 . In Switzerland the incidence rate of
cases admitted for anorexia nervosa was 20 per 100 000
person years for females between 12 and 25 years of
age during 1993–1995 .
The question of whether the incidence of anorexia ner-
vosa is on the rise has been considerably debated. Long-
term epidemiological studies are sensitive to minor
changes in the absolute incidence numbers and in the
methods used, for example, variations in registration
policy, demographic differences between the popu-
lations, faulty inclusion of readmissions, the specific
methods of detection used or the availability of services
In a meta-analysis  of the incidence of anorexia ner-
vosa in mental healthcare, various studies in northern
east Scotland, 1960–1969 ; and the Netherlands,
1970–1999 [9,10,16] (Fig. 1). Until the 1970s, there
was an increase of the registered incidence of anorexia
nervosa in Europe.Since 1970, the incidence of anorexia
nervosa in Europe seems to have been rather stable .
Only two studies have used the same methods during a
prolonged study period, inthe United States from 1935 to
1989  and in Switzerland from 1956 to 1995 . In
Rochester, MN, USA the age-adjusted incidence rates of
Services research and outcomes
Figure 1 Registered yearly incidence of anorexia nervosa in
mental healthcare in northern Europe in the 20th century
1931–19401941–19501951–1960 1961–1970 1971–1980 1981–19901991–2000
per 100 000 population
Hospital records, Sweden;
mental healthcare, the Netherlands.
case register, north-east Scotland;
anorexia nervosa showed a significant linear increasing
trend only in females aged 15–24 years from 1935 to
1989. This increase in young females continued pro-
bably during the 1990s according to the findings in the
Netherlands (G.E. van Son, D. van Hoeken, A.I.M.
Bartelds et al., unpublished data).
In Switzerland, the development of the incidence of
severe anorexia nervosa was studied in a geographically
defined region by means of five sampling periods and the
same methodology from 1956 to 1995. The medical
records of all hospitals of the canton of Zurich were
screened for first-time hospitalizations of female anorexia
nervosa patients. The incidence of severe anorexia ner-
vosa in the canton of Zurich rose significantly during the
1960s and 1970s. Since then the incidence of severe
anorexia nervosa appears to have reached a plateau of
around 1.2 per 100 000 persons per year .
Although anorexia nervosa occurs in males as well as in
females, few studies report incidence rates for males.
From incidence studies that report on males, one can
conclude that the incidence of anorexia nervosa among
males is below 1.0 per 100 000 persons per year
Prevalence of anorexia nervosa
The current standard for the assessment of the preva-
lence of eating disorders is the process employing a two-
stage selection of cases. Prevalence rates of anorexia
nervosa varied between 0 and 0.9%, with an average
point prevalence rate of 0.29% in young females, accord-
ing to Diagnostic and Statistical Manual of Mental Dis-
orders, Fourth Edition (DSM-IV) criteria . Most
studies found higher prevalence rates for partial syn-
dromes of anorexia nervosa.
In a recent nationwide study in Portugal, the point
prevalence of anorexia nervosa among adolescent girls
was 0.39% .
In Sweden, the lifetime prevalence was 1.2% for rigor-
of women from the 1935–1958 birth cohorts [18??]. In an
Australian study of female twins, aged 28–39 years, the
lifetime prevalence of anorexia nervosa was 1.9% with an
additional 2.4% for partial anorexia nervosa (absence of
amenorrhea) [19?]. The lifetime prevalence was 2.2% for
anorexia nervosa according to DSM-IV criteria in a large
sample of women from the 1975–1979 birth cohorts of
In a meta-analysis , the 1-year prevalence rates per
100 000 young females were computed by point preva-
lence plus annual incidence rate at different levels of care
(Table 1).Usingtwo-stage studies ofcommunity samples
and estimates of theincidence, the 1-year prevalence rate
of anorexia nervosa in the community was calculated as
370 per 100 000 young females. One can conclude from
Table 1 that the majority of the patients with anorexia
nervosa in the community do not enter the mental
Mortality associated with anorexia nervosa
The few very long-term follow-up studies indicate a high
mortality associated with anorexia nervosa. In an oldest
long-term follow-up study in Sweden, a CMR of 18% was
found among 94 patients with anorexia nervosa, 24 years
after onset . In a meta-analysis in 1995 of 42 pub-
lished studies , the CMR was 5.9% (178 deaths in
3006 patients), translating into 0.56% per year or 5.6% per
decade. In the studies specifying the cause of death, 54%
of the patients died as a result of eating-disorder com-
plications, 27% committed suicide and the remaining
19% died of unknown or other causes. In a meta-analysis
of SMRs in 2001, the overall aggregate SMR of anorexia
nervosa in studies with 6–12 years of follow-up was 9.6
(95% CI: 7.8–11.5) and in studies with 20–40 years of
follow-up 3.7 (95% CI: 2.8–4.7) . Only one study
suggested that the overall mortality of anorexia nervosa
was not increased among the spectrum of cases repre-
208 patients with anorexia nervosa in Rochester from
1935 to 1989 did not differ from the expected rate .
Recent studies confirm the high mortality rate within the
anorexia nervosa population, for example, in Canada
[25??], northeast Scotland [26??] and Germany [27?]. In
Canada, 326 patients diagnosed with anorexia nervosa
completed an assessment over a 20-year period; the SMR
was 10.5 (95% CI: 5.5–15.5) [25??]. In northeast Scotland,
23 of 524 patients with anorexia nervosa seen in specialist
services died; the median length of time between diag-
nosis and death was 11 years [26??]. The CMR in this
study was 4.4% and the SMR 3.3 (95% CI: 2.2–4.9). In
only one-third of the cases, anorexia nervosa was men-
tioned in the death certificate, but an eating disorder or
other psychiatric pathology probably contributed to sev-
eral of the other deaths. In a 12-year follow-up study of
103 patients with anorexia nervosa in Germany, the CMR
was 7.7% and another 40% had a poor outcome [27?].
Anorexia nervosa and other eating disorders Hoek 391
Table 1 One-year period prevalence rates per 100 000 young
females at different levels of care
Level of morbidity
Anorexia nervosa in Blacks and Asians
Hardly any epidemiological studies of anorexia nervosa
were conducted outside Western countries. Transcul-
tural studies conducted in the 1970s and 1980s showed
that anorexia nervosa was rare in non-Western countries
that anorexia nervosa does occur in non-Western
countries [32,33]. Abnormal eating attitudes and beha-
vior do occur frequently in traditional as well as in
Blacks and Asians [34–38,39?–41?].
In a recent comprehensive study [42??] conducted on the
Caribbean island Curac ¸ao, the full spectrum of com-
munity health and service providers was contacted.
Persons constituting probable incident cases were
interviewed. The overall incidence of anorexia nervosa
of 1.82 (95% CI: 0.74–2.89) per 100 000 persons per year
on Curac ¸ao is much lower than in the United States and
Western Europe. No cases were found among the
majority black population. The incidence of 9.1 (95%
CI: 3.71–14.45) among the minority mixed and white
population on Curac ¸ao, however, was similar to the
incidence in the Netherlands and the United States.
The results obtained on Curac ¸ao are consistent with
findings in a US prevalence study, in which anorexia
nervosa was not found in black women, in contrast to a
lifetime prevalence rate of 1.5% for anorexia nervosa
among white women. Bulimia nervosa and binge-eating
disorder (BED) occur frequently among black women,
but might be also more common among white women
Epidemiology of other eating disorders
Bulimia nervosa was first distinguished as a disorder
separate from anorexia nervosa by Russell in 1979 
and Diagnostic and Statistical Manual of Mental Dis-
orders, Third Edition (DSM-III) in 1980. Before 1980,
the term ‘bulimia’ in medical records denoted symptoms
of heterogeneous conditions manifested by overeating,
but not the syndrome as it is known today. Only a few
incidence studies of bulimia nervosa have been con-
ducted. An annual incidence of bulimia nervosa of 13.5
per 100 000 person years was found in Rochester, MN,
USA, during 1980–1990  and of 11.5 in the Nether-
lands during 1985–1989 . In a study of the General
Practice Research Database in the UK for new cases of
bulimia nervosa, the age-adjusted and sex-adjusted inci-
dence of bulimia nervosa decreased during the second
half of the 1990s to 6.6 per 100 000 persons in 2000 (95%
CI: 5.3–7.9) [7??]. This possible decrease in the occur-
rence of bulimia nervosa is supported by some recent
evidence provided by a US study, suggesting that the
prevalence of bulimia nervosa has decreased during
1982–2002 [46?]. The generally accepted prevalence rate
of bulimia nervosa from two-stage studies is about 1%
among young females [3,47]. Table 1 shows a meta-
analysis of the 1-year prevalence rates of bulimia nervosa
per 100 000 young females at different levels of care .
One can conclude from this table that only a very small
minority (6%) of the patients with bulimia nervosa in
the community enters the mental healthcare system.
Mortality associated with bulimia nervosa is considerably
lower than that associated with anorexia nervosa  but
has been less examined. A meta-analysis encompassing
43 follow-up studies of bulimia nervosa cohorts gave an
overall aggregate SMR of 1.6 (95% CI: 0.8–2.7) for
bulimia nervosa .
Nowadays the majority of cases suffering from an eating
disorder can only be classified in the DSM-IV category
Eating Disorder Not Otherwise Specified (EDNOS),
including partial syndromes of anorexia nervosa or buli-
mia nervosa and BED, a proposed new category in DSM-
IV for research purposes. BED is often seen in obese
individuals, but in a recent study [50?], BED aggregated
strongly in families independently of obesity. Using
DSM-IV criteria, the prevalence of BED was 1% in a
large general population sample in Australia; using a
broader definition, the prevalence was estimated to be
2.5% . In the United States, a rate of 2.6% was found
among a large sample of 18–40-year-old white women for
recurrent binge eating (two episodes per week during the
previous 3 months) and a higher rate of 4.5% in black
women of the same age group [52,53].
In outpatient settings, EDNOS cases account for an
average of 60% of all cases, compared with 14.5% for
anorexia nervosa and 25.5% for bulimia nervosa [54?].
Although these patients are characterized by similar core
cognitive psychopathology, they represent the least
studied group of patients with eating disorders.
The registered incidence rates of anorexia nervosa and
bulimia nervosa are up to 8 per 100 000 persons per year
and 13 per 100 000 persons per year, respectively. It must
be assumed that even the studies with the most complete
case-finding methods yield an underestimate of the true
larly in females 15–24 years old, increased during the past
in the general population, they are relatively common
among adolescent girls and young women. For anorexia
nervosa and bulimia nervosa average prevalence rates of
0.3 and 1%, respectively were found for young females.
One-third of the people who meet stringent diagnostic
criteria for anorexia nervosa and only 6% of those with
bulimia nervosa are treated in mental healthcare.
Future epidemiological research should move toward
Services research and outcomes
characteristics of negative self-evaluation and perfection-
. As in the case of other psychiatric disorders, genetic
stances [57,58??] are probably important in the develop-
make an effort to control them.
References and recommended reading
Papers of particular interest, published within the annual period of review, have
been highlighted as:
Additional references related to this topic can also be found in the Current
World Literature section in this issue (pp. 453–454).
of special interest
of outstanding interest
Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry
Hoek HW. Review of the epidemiological studies of eating disorders. Int Rev
Psychiatry 1993; 5:61–74.
Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating
disorders. Int J Eat Disord 2003; 34:383–396.
Hoek HW, van Hoeken D, Katzman MA. Epidemiology and cultural aspects of
eating disorders: a review. In: Maj M, Halmi K, Lo ´pez-Ibor JJ, Sartorius N,
editors. Eating disorders. Chichester: John Wiley & Sons; 2003. pp.75–104.
Hsu LKG. Epidemiology of the eating disorders. Psychiatr Clin North Am
Lucas AR, Crowson CS, O’Fallon WM, Melton LJ 3rd. The ups and downs of
anorexia nervosa. Int J Eat Disord 1999; 26:397–405.
A study examining time trends in eating disorders at primary care level.
Currin L, Schmidt U, Treasure J, Jick H. Time trends in eating disorder
incidence. Br J Psychiatry 2005; 186:132–135.
Turnbull S, Ward A, Treasure J, et al. The demand for eating disorder care. An
epidemiological study using the General Practice Research Database. Br J
Psychiatry 1996; 169:705–712.
Hoek HW, van Son GE, van Hoeken D, et al. Changes in the incidence of
eating disorders. International Conference on Eating Disorders; 27–30 April
2005; Montre ´al. p. 10.
10 Hoek HW, Bartelds AIM, Bosveld JJF, et al. Impact of urbanization on
detection rates of eating disorders. Am J Psychiatry 1995; 152:1272–1278.
11 MilosG,Spindler A,Schnyder U,etal.Incidence ofsevereanorexianervosain
Switzerland: 40 years of development. Int J Eat Disord 2004; 35:250–258.
12 Williams P, King M. The ‘epidemic’ of anorexia nervosa: another medical
myth? Lancet 1987; 1:205–207.
13 Fombonne E. Anorexia nervosa. No evidence of an increase. Br J Psychiatry
14 Theander S. Outcome and prognosis in anorexia nervosa and bulimia: some
results of previous investigations, compared with those of a Swedish long-
term study. J Psychiatr Res 1985; 19:493–508.
15 Kendell RE, Hall DJ, Hailey A, Babigian HM. The epidemiology of anorexia
nervosa. Psychol Med 1973; 3:200–203.
16 Hoek HW, Brook FG. Patterns of care of anorexia nervosa. J Psychiatr Res
17 Machado PP, Gonc ¸alves S, Machado BC, et al. Risk factors for bulimia
nervosa inPortugal. Eating DisordersResearch Society 11th Annual Meeting;
29 September–1 October 2005; Toronto. p. 180.
Provides prevalence rates for anorexia nervosa in the largest twin study of women
from the 1935-1958 birth cohorts in Sweden.
Bulik CM, Sullivan PF, Tozzi F, et al. Prevalence, heritability, and prospective
risk factors for anorexia nervosa. Arch Gen Psychiatry 2006; 63:305–312.
Wade TD, Bergin JL, Tiggemann M, et al. Prevalence and long-term course of
lifetime eating disorders in an adult Australian twin cohort. Aust N Z J
Psychiatry 2006; 40:121–128.
Provides prevalence rates for anorexia nervosa and partial anorexia nervosa in a
sample of female twins in Australia.
20 Keski-Rahkonen A, Hoek HW, Bulik CM, et al. Recovery from DSM-IV
anorexia and bulimia in a population sample of young women. Eating Dis-
orders Research Society 11th Annual Meeting; 29 September–1 October
2005; Toronto. p. 174.
21 Keski-Rahkonen A, Sihvola E, Raevuori A, et al. Reliability of self-reported
eating disorders: optimizing population screening. Int J Eat Disord
22 Sullivan PF. Mortality in anorexia nervosa. Am J Psychiatry 1995; 152:1073–
23 Nielsen S. Epidemiology and mortality of eating disorders. Psychiatr Clin
North Am 2001; 24:201–214.
24 Korndorfer SR, Lucas AR, Suman VJ, et al. Long-term survival of patients with
anorexia nervosa: a population-based study in Rochester, Minn. Mayo Clin
Proc 2003; 78:278–284.
anorexia nervosa in Canada.
Birmingham CL, Su J, Hlynsky JA, et al. The mortality rate from anorexia
nervosa. Int J Eat Disord 2005; 38:143–146.
This study provides CMRs and SMRs in a large sample of patients with anorexia
nervosa and examines the causes of death.
Millar HR, Wardell F, Vyvyan JP, et al. Anorexia nervosa mortality in Northeast
Scotland. Am J Psychiatry 2005; 162:753–757.
A 12-year follow-up study on the outcome of anorexia nervosa in Germany.
Fichter MM, Quadflieg N, Hedlund S. Twelve-year course and outcome
predictors of anorexia nervosa. Int J Eat Disord 2006; 39:87–100.
28 Ballot NS, Delaney NE, Erskine PJ, et al. Anorexia nervosa – a prevalence
study. S Afr Med J 1981; 59:992–993.
29 Buhrich N. Frequency of presentation of anorexia nervosa in Malaysia. Aust N
Z J Psychiatry 1981; 15:153–155.
30 King MB, Bhugra D. Eating disorders: lessons from a cross-cultural study.
Psychol Med 1989; 19:955–958.
31 Lee S, Chiu HF, Chen CN. Anorexia nervosa in Hong Kong. Why not more in
Chinese? Br J Psychiatry 1989; 154:683–688.
32 Hoek HW, van Harten PN, van Hoeken D, Susser E. Lack of relation between
culture and anorexia nervosa – results of an incidence study on Curac ¸ao.
N Engl J Med 1998; 338:1231–1232.
33 Lee HY, Lee EL, Pathy P, Chan YH. Anorexia nervosa in Singapore: an eight-
year retrospective study. Singapore Med J 2005; 46:275–281.
34 Nakamura K, Yamamoto M, Yamazaki O, et al. Prevalence of anorexia nervosa
and bulimia nervosa in a geographically defined area in Japan. Int J Eat Disord
35 Nobakht M, Dezhkam M. An epidemiological study of eating disorders in Iran.
Int J Eat Disord 2000; 28:265–271.
36 Ghazal N, Agoub M, Moussaoui D, Battas O. Prevalence of bulimia among
secondary school students in Casablanca. Encephale 2001; 27:338–
37 Huon GF, Mingyi Q, Oliver K, Xiao G. A large-scale survey of eating disorder
symptomatology among female adolescents in the People’s Republic of
China. Int J Eat Disord 2002; 32:192–205.
38 Tong J, Miao SJ, Wang J, et al. Five cases of male eating disorders in Central
China. Int J Eat Disord 2005; 37:72–75.
Pike KM, Mizushima H. The clinical presentation of Japanese women with
anorexia nervosa and bulimia nervosa: a study of the Eating Disorders
Inventory-2. Int J Eat Disord 2005; 37:26–31.
A study on cultural differences in eating disorder profiles between Japanese and
North American groups of eating disorder cases.
Striegel-Moore RH, Fairburn CG, Wilfley DE, et al. Toward an understanding
of risk factors for binge-eating disorder in black and white women: a com-
munity-based case–control study. Psychol Med 2005; 35:907–917.
A community-based study of differences between black and white women in the
Becker AE, Gilman SE, Burwell RA. Changes in prevalence of overweight and
in body image among Fijian women between 1989 and 1998. Obes Res
A study of eating attitudes and body image in atraditional community undergoing a
rapid social change.
A comprehensive epidemiological study on a Caribbean island with mainly black
Hoek HW, van Harten PN, Hermans KME, et al. The incidence of anorexia
nervosa on Curac ¸ao. Am J Psychiatry 2005; 162:748–752.
43 Striegel-Moore RH, Dohm FA, Kraemer HC, et al. Eating disorders in white
and black women. Am J Psychiatry 2003; 160:1326–1331.
44 Russell G. Bulimia nervosa: an ominous variant of anorexia nervosa. Psychol
Med 1979; 9:429–448.
45 Soundy TJ,Lucas AR,SumanVJ,Melton LJ3rd. Bulimia nervosa inRochester,
Minnesota from 1980 to 1990. Psychol Med 1995; 25:1065–1071.
Anorexia nervosa and other eating disorders Hoek393
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This study reports a decline in the prevalence rate of bulimia nervosa during a 20-
Keel PK, Heatherton TF, Dorer DJ, et al. Point prevalence of bulimia nervosa in
1982, 1992, and 2002. Psychol Med 2006; 36:119–127.
47 Fairburn CG, Beglin SJ. Studies of the epidemiology of bulimia nervosa. Am J
Psychiatry 1990; 147:401–408.
48 Quadflieg N, Fichter MM. The course and outcome of bulimia nervosa.
Eur Child Adolesc Psychiatry 2003; 12 (Suppl 1):I99–I109.
49 Nielsen S. Standardized mortality ratio in bulimia nervosa. Arch Gen
Psychiatry 2003; 60:851.
Hudson JI, Lalonde JK, Berry JM, et al. Binge-eating disorder as a distinct
familial phenotype in obese individuals. Arch Gen Psychiatry 2006; 63:313–
While BED is often seen in obese individuals, this study shows that BED
aggregates strongly in families independently of obesity.
51 Hay P. The epidemiology of eating disorder behaviors: an Australian com-
munity-based survey. Int J Eat Disord 1998; 23:371–382.
52 Pike KM, Dohm FA, Striegel-Moore RH, et al. A comparison of black and
53 Striegel-Moore RH, Wilfley DE, Pike KM, et al. Recurrent binge eating in black
American women. Arch Fam Med 2000; 9:83–87.
Fairburn CG, Bohn K. Eating disorder NOS (EDNOS): an example of the
troublesome ‘not otherwise specified’ (NOS) category in DSM-IV. Behav Res
Ther 2005; 43:691–701.
An analysis of four well diagnosed adult samples of patients with eating disorders
showing that EDNOS is the most common eating disorder in outpatient settings.
55 Fairburn CG, Cooper Z, Doll HA, Welch SL. Risk factors for anorexia nervosa:
three integrated case–control comparisons. Arch Gen Psychiatry 1999;
56 Bulik CM. Exploring the gene–environment nexus in eating disorders.
J Psychiatry Neurosci 2005; 30:335–339.
57 Cnattingius S, Hultman CM, Dahl M, Sparen P. Very preterm birth, birth
trauma, and the risk of anorexia nervosa among girls. Arch Gen Psychiatry
Favaro A, Tenconi E, Santonastaso P. Perinatal factors and the risk of
developing anorexia nervosa and bulimia nervosa. Arch Gen Psychiatry
This study shows that the risk of developing anorexia nervosa increases with the
number of perinatal complications.
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