Elsevier

Biological Psychiatry

Volume 61, Issue 3, 1 February 2007, Pages 348-358
Biological Psychiatry

Original article
The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication

https://doi.org/10.1016/j.biopsych.2006.03.040Get rights and content

Background

Little population-based data exist on the prevalence or correlates of eating disorders.

Methods

Prevalence and correlates of eating disorders from the National Comorbidity Replication, a nationally representative face-to-face household survey (n = 9282), conducted in 2001–2003, were assessed using the WHO Composite International Diagnostic Interview.

Results

Lifetime prevalence estimates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder are .9%, 1.5%, and 3.5% among women, and .3% .5%, and 2.0% among men. Survival analysis based on retrospective age-of-onset reports suggests that risk of bulimia nervosa and binge eating disorder increased with successive birth cohorts. All 3 disorders are significantly comorbid with many other DSM-IV disorders. Lifetime anorexia nervosa is significantly associated with low current weight (body-mass index <18.5), whereas lifetime binge eating disorder is associated with current severe obesity (body-mass index ≥40). Although most respondents with 12-month bulimia nervosa and binge eating disorder report some role impairment (data unavailable for anorexia nervosa since no respondents met criteria for 12-month prevalence), only a minority of cases ever sought treatment.

Conclusions

Eating disorders, although relatively uncommon, represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently under-treated.

Section snippets

Sample

The NCS-R is a nationally representative survey of the US household population that was administered face-to-face to a sample of 9282 English-speaking adults ages 18 and older between February 2001 and December 2003 (Kessler and Merikangas 2004). The response rate was 70.9%. The sample was based on a multi-stage clustered area probability design. Recruitment featured an advance letter and Study Fact Brochure followed by in-person interviewer visits to obtain informed consent. Consent was verbal

Prevalence

Lifetime prevalence estimates of anorexia nervosa, bulimia nervosa, binge eating disorder, subthreshold binge eating disorder, and any binge eating were .6%, 1.0%, 2.8%, 1.2%, and 4.5% (Table 1). Lifetime prevalence was consistently 1¾ to 3 times as high among women as men for the 3 eating disorders (z = 2.2–2.8, P = .029–.005), 3 times as high among men as women for subthreshold binge eating disorder (z = 3.3, P = .001), and approximately equal among women and men for any binge eating (z =

Discussion

In a population-based survey of American households—the first nationally representative study of eating disorders in the United States—we found estimates of lifetime prevalence for eating disorders that are broadly consistent with earlier data. However, we found a surprisingly high proportion of men with anorexia nervosa and bulimia nervosa (representing approximately one-fourth of cases of each of these disorders). By contrast, clinical and case registry studies (Fairburn and Beglin 1990, Hoek

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