How many people will struggle with an eating disorder during their lifetime?

It sounds like an obvious, easy-to-answer question, but it’s more complicated than you might think. Since the vast majority of people with eating disorders either never seek formal treatment for their disorder or are never formally diagnosed (Hart et al., 2011), researchers can’t just search medical records. Still, scientists in the US and around the world are trying to gather data to give sufferers, loved ones, and the general community more information about how many people have eating disorders.

Researchers calculate the frequency of eating disorders using two main measurements:

• Incidence – the number of people who first develop an eating disorder during a specific period of time (usually one year)
• Prevalence – the total number of people who have an eating disorder during a specific period of time

Population-Wide Statistics

NEDA has gathered data on the prevalence of eating disorders from the US, UK, and Europe to get a better idea of exactly how common eating disorders are. Older data from other countries that use more strict definitions of anorexia and bulimia give lower prevalence estimates:

• In a study of 31,406 Swedish twins born from 1935-1958, 1.2% of the women had strictly defined anorexia nervosa during their lifetime, which increased to 2.4% when a looser definition of anorexia was used (Bulik et al., 2006).
• For twins born between 1975 and 1979 in Finland, 2.2-4.2% of women (Keski-Rahkonen et al., 2007) and 0.24% of men (Raevuori et al., 2009) had experienced anorexia during their lifetime.
• At any given point in time between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa, 1.0% of young women and 0.1% of young men will suffer from bulimia, with similar rates for binge eating disorder (Hoek & van Hoeken, 2003).

Several more recent studies in the US have used broader definitions of eating disorders that more accurately reflect the range of disorders that occur, resulting in a higher prevalence of eating disorders.

• A 2007 study asked 9,282 English-speaking Americans about a variety of mental health conditions, including eating disorders. The results, published in Biological Psychiatry, found that:
• ƒ0.9% of women and 0.3% of men had anorexia during their life
• ƒ1.5% of women and 0.5% of men had bulimia during their life
• ƒ3.5% of women and 2.0% of men had binge eating disorder during their life (Hudson et al., 2007).
• When researchers followed a group of 496 adolescent girls for 8 years (Stice et al., 2010), until they were 20, they found:
• ƒ5.2% of the girls met criteria for DSM-5 anorexia, bulimia, or binge eating disorder.
• ƒWhen the researchers included nonspecific eating disorder symptoms, a total of 13.2% of the girls had suffered from a DSM-5 eating disorder by age 20.
• Combining information from several sources, Eric Stice and Cara Bohon (2012) found that
• ƒBetween 0.9% and 2.0% of females and 0.1% to 0.3% of males will develop anorexia
• Subthreshold anorexia occurs in 1.1% to 3.0% of adolescent females
• Between 1.1% and 4.6% of females and 0.1% to 0.5% of males will develop bulimia
• Subthreshold bulimia occurs in 2.0% to 5.4% of adolescent females
• Between 0.2% and 3.5% of females and 0.9% and 2.0% of males will develop binge eating disorder
• Subthreshold binge eating disorder occurs in 1.6% of adolescent females

Based on the Hudson et al., 2007 study of 9,282 people, approximately 20 million females and 10 million males in the US have a clinically significant eating disorder at some point in their lifetime.

Eating Disorder Diagnosis Over Time

Have these numbers changed over time? The answer isn’t clear. It does appear that, at least for the last two decades, the rates of new diagnoses of anorexia and bulimia have remained relatively stable.

• An ongoing study in Minnesota has found incidence of anorexia increasing over the last 50 years only in females aged 15 to 24. Incidence remained stable in other age groups and in males (Lucas et al., 1999).
• A Dutch study published in the International Journal of Eating Disorders found that new diagnoses of anorexia and bulimia remained relatively steady in the Netherlands from 1985-1989 to 1995-1999 (van Son et al., 2006).
• An analysis of many studies from Europe and North America revealed that rates of anorexia increased sharply until the 1970s, when they stabilized.
• Rates of bulimia increased during the 1980s and early 1990s, and they have since remained the same or decreased slightly (Smink, van Hoeken, & van Hoek, 2012).
• A British study also found stability in new anorexia and bulimia diagnoses in both males and females, although rates of EDNOS diagnoses increased in both groups (Micali et al., 2013). (Please note that in the new DSM-5, EDNOS is no longer recognized and a new term of OSFED has been added, meaning Other Specified Feeding or Eating Disorder).
• Eating disorder symptoms are beginning earlier in both males and females, which agrees with both formal research (Favaro et al., 2009) and clinical reports.

References:

Bulik CM, Sullivan PF, Tozzi F, Furberg H, Lichtenstein P, and Pedersen NL. (2006). Prevalence, heritability, and prospective risk factors for anorexia nervosa. Archives of General Psychiatry, 63(3):305-12. doi:10.1001/archpsyc.63.3.305.

Favaro A, Caregaro L, Tenconi E, Bosello R, and Santonastaso P. (2009). Time trends in age at onset of anorexia nervosa and bulimia nervosa. Journal of Clinical Psychiatry, 70(12):1715-21. doi: 10.4088/JCP.09m05176blu.

Hart LM, Granillo MT, Jorm AF, and Paxton SJ. (2011). Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clinical Psychology Reviews, 31(5):727-35. doi: 10.1016/j.cpr.2011.03.004.

Hoek HW and van Hoeken D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34(4):383-96. doi: 10.1002/eat.10222.

Hudson JI, Hiripi E, Pope HG Jr, and Kessler RC. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3):348-58. doi:10.1016/j.biopsych.2006.03.040.

Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, …, and Rissanen A. (2007). Epidemiology and course of anorexia nervosa in the community. American Journal of Psychiatry, 164(8):1259-65. doi: 10.1176/appi. ajp.2007.06081388.

Lucas AR, Crowson CS, O’Fallon WM, Melton LJ 3rd. (1999). The ups and downs of anorexia nervosa. International Journal of Eating Disorders, 26(4):397-405. DOI: 10.1002/(SICI)1098-108X(199912)26:4<397::AID-EAT5>3.0.CO;2-0.

Micali N, Hagberg KW, Petersen I, and Treasure JL. (2013). The incidence of eating disorders in the UK in 2000–2009: findings from the General Practice Research Database. BMJ Open, 3(5): e002646. doi: 10.1136/bmjopen-2013-002646.

Raevuori A, Hoek HW, Susser E, Kaprio J, Rissanen A, and Keski-Rahkonen A. (2009). Epidemiology of anorexia nervosa in men: a nationwide study of Finnish twins. PLoS ONE, doi: 10.1371/journal.pone.0004402.

Smink FR, van Hoeken D, and Hoek HW. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4):406-14. doi: 10.1007/s11920-012-0282-y.

Stice E & Bohon C. (2012). Eating Disorders. In Child and Adolescent Psychopathology, 2nd Edition, Theodore Beauchaine & Stephen Linshaw, eds. New York: Wiley.

Stice E, Marti CN, Shaw H, and Jaconis M. (2010). An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. Journal of Abnormal Psychology, 118(3):587-97. doi: 10.1037/a0016481.

van Son GE, van Hoeken D, Bartelds AI, van Furth EF, and Hoek HW. (2012). Time trends in the incidence of eating disorders: a primary care study in the Netherlands. International Journal of Eating Disorders, 39(7):565-9. doi: 10.1002/eat.20316.