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DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance

Published online by Cambridge University Press:  02 May 2019

Deborah Mitchison Open the ORCID record for Deborah Mitchison [Opens in a new window] ,
Jonathan Mond ,
Kay Bussey ,
Scott Griffiths ,
Nora Trompeter ,
Alexandra Lonergan ,
Kathleen M. Pike ,
Stuart B. Murray  and
Phillipa Hay
Deborah Mitchison*
Affiliation:
Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia Department of Psychology, Macquarie University, Sydney, Australia
Jonathan Mond
Affiliation:
Centre for Rural Health, University of Tasmania, Launceston, Australia School of Medicine, Western Sydney University, Sydney, Australia
Kay Bussey
Affiliation:
Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
Scott Griffiths
Affiliation:
School for Psychological Sciences, University of Melbourne, Sydney, Australia
Nora Trompeter
Affiliation:
Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
Alexandra Lonergan
Affiliation:
Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
Kathleen M. Pike
Affiliation:
Departments of Psychiatry and Epidemiology, Columbia University, New York, USA
Stuart B. Murray
Affiliation:
Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
Phillipa Hay
Affiliation:
Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
*
Author for correspondence: Deborah Mitchison, E-mail: debbie.mitchison@gmail.com
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Abstract

Background

Little information is available on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 eating disorders in adolescence, and eating disorders remain unique in the DSM for not systematically including a criterion for clinical significance. This study aimed to provide the first prevalence report of the full suite of DSM-5 eating disorders in adolescence, and to examine the impact of applying a criterion for clinical significance.

Methods

In total, 5191 (participation rate: 70%) Australian adolescents completed a survey measuring 1-month prevalence of eating disorder symptoms for all criterial, ‘other specified’ and unspecified eating disorders, as well as health-related quality of life and psychological distress.

Results

The point prevalence of any eating disorder was 22.2% (12.8% in boys, 32.9% in girls), and ‘other specified’ disorders (11.2%) were more common than full criterial disorders (6.2%). Probable bulimia nervosa and binge eating disorder, but not anorexia nervosa (AN), were more likely to be experienced by older adolescents. Most disorders were associated with an increased odds for being at a higher weight. The prevalence of eating disorders was reduced by 40% (to 13.6%) when a criterion for clinical significance was applied.

Conclusions

Eating disorders, particularly ‘other specified’ syndromes, are common in adolescence, and are experienced across age, weight, socioeconomic and migrant status. The merit of adding a criterion for clinical significance to the eating disorders, similar to other DSM-5 disorders, warrants consideration. At the least, screening tools should measure distress and impairment associated with eating disorder symptoms in order to capture adolescents in greatest need for intervention.

Keywords

Adolescencediagnosiseating disordersOSFEDprevalence

Information

Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 6 , April 2020 , pp. 981 - 990
Copyright
Copyright © Cambridge University Press 2019

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References

Allen, KL, Byrne, SM, Oddy, WH and Crosby, RD (2013) DSM-IV-TR and DSM-5 eating disorders in adolescents: Prevalence, stability, and psychosocial correlates in a population-based sample of male and female adolescents. Journal of Abnormal Psychology 122, 720–732.10.1037/a0034004CrossRefGoogle Scholar
Allison, KC, Lundgren, JD, O'reardon, JP, Martino, NS, Sarwer, DB, Wadden, TA, Crosby, RD, Engel, SG and Stunkard, AJ (2008) The Night Eating Questionnaire (NEQ): psychometric properties of a measure of severity of the Night Eating Syndrome. Eating Behaviors 9, 62–72.10.1016/j.eatbeh.2007.03.007CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington, American Psychiatric Publishing Inc.Google Scholar
Andersen, SB, Lindgreen, P, Rokkedal, K and Clausen, L (2018) Grasping the weight cut-off for anorexia nervosa in children and adolescents. The International Journal of Eating Disorders 51, 1346–1351.Google ScholarPubMed
Andrews, G and Slade, T (2001) Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health 25, 494–497.10.1111/j.1467-842X.2001.tb00310.xCrossRefGoogle Scholar
Australian Bureau of Statistics (2017) Population by Age and Sex, Regions of Australia, 2016: Population Estimates by Age and Sex, Regions of New South Wales (ASGS 2016), 2006 and 2016.Google Scholar
Beals, J, Novins, DK, Spicer, P, Orton, HD, Mitchell, CM, Baron, AE, Manson, SM and AI-SUPERPFP Team (2004) Challenges in operationalizing the DSM-IV clinical significance criterion. Archives of General Psychiatry 61, 1197–1207.10.1001/archpsyc.61.12.1197CrossRefGoogle ScholarPubMed
Da Luz, F, Sainsbury, A, Mannan, H, Touyz, S, Mitchison, D and Hay, P (2017) Prevalence of obesity and comorbid eating disorder behaviors in South Australia from 1995 to 2015. International Journal of Obesity 41, 1148–1153.10.1038/ijo.2017.79CrossRefGoogle ScholarPubMed
Diemer, EW, Grant, JD, Munn-Chernoff, MA, Patterson, DA and Duncan, AE (2015) Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health 57, 144–149.10.1016/j.jadohealth.2015.03.003CrossRefGoogle Scholar
Eddy, KT, Thomas, JJ, Hastings, E, Edkins, K, Lamont, E, Nevins, CM, Patterson, RM, Murray, HB, Bryant-Waugh, R and Becker, AE (2015) Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. International Journal of Eating Disorders 48, 464–470.10.1002/eat.22350CrossRefGoogle Scholar
Fairburn, CG and Beglin, SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders 16, 363–370.Google ScholarPubMed
Fairburn, CG and Beglin, SJ (2008) Eating disorder examination questionnaire (EDE-Q 6.0). In Fairburn, CG (ed.), Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press, pp. 309–313.Google ScholarPubMed
Fairburn, CG, Cooper, Z and Shafran, R (2003) Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy 41, 509–528.10.1016/S0005-7967(02)00088-8CrossRefGoogle ScholarPubMed
Flament, MF, Buchholz, A, Henderson, K, Obeid, N, Maras, D, Schubert, N, Paterniti, S and Goldfield, G (2015) Comparative distribution and validity of DSM-IV and DSM-5 diagnoses of eating disorders in adolescents from the community. European Eating Disorders Review 23, 100–110.10.1002/erv.2339CrossRefGoogle ScholarPubMed
Frances, A (2013) The past, present and future of psychiatric diagnosis. World Psychiatry 12, 111–112.10.1002/wps.20027CrossRefGoogle ScholarPubMed
Frances, AJ and Widiger, T (2012) Psychiatric diagnosis: lessons from the DSM-IV past and cautions for the DSM-5 future. Annual Review of Clinical Psychology 8, 109–130.10.1146/annurev-clinpsy-032511-143102CrossRefGoogle ScholarPubMed
Gallant, AR, Lundgren, J, Allison, K, Stunkard, AJ, Lambert, M, O'loughlin, J, Lemieux, S, Tremblay, A and Drapeau, V (2012 a) Validity of the night eating questionnaire in children. International Journal of Eating Disorders 45, 861–865.10.1002/eat.22021CrossRefGoogle ScholarPubMed
Gallant, AR, Lundgren, J and Drapeau, V (2012 b) The night-eating syndrome and obesity. Obesity Reviews 13, 528–536.10.1111/j.1467-789X.2011.00975.xCrossRefGoogle ScholarPubMed
Glazer, KB, Sonneville, KR, Micali, N, Swanson, SA, Crosby, R, Horton, NJ, Eddy, KT and Field, AE (2019) The course of eating disorders involving bingeing and purging Among adolescent girls: prevalence, stability, and transitions. Journal of Adolescent Health 64, 165–171.10.1016/j.jadohealth.2018.09.023CrossRefGoogle ScholarPubMed
Halfon, N, Larson, K and Slusser, W (2013) Associations between obesity and comorbid mental health, developmental, and physical health conditions in a nationally representative sample of US children aged 10 to 17. Academic Pediatrics 13, 6–13.10.1016/j.acap.2012.10.007CrossRefGoogle Scholar
Hammerle, F, Huss, M, Ernst, V and Bürger, A (2016) Thinking dimensional: prevalence of DSM-5 early adolescent full syndrome, partial and subthreshold eating disorders in a cross-sectional survey in German schools. BMJ Open 6, e010843.10.1136/bmjopen-2015-010843CrossRefGoogle Scholar
Hay, P, Mitchison, D, Collado, AEL, González-Chica, DA, Stocks, N and Touyz, S (2017) Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. Journal of Eating Disorders 5, 21.10.1186/s40337-017-0149-zCrossRefGoogle Scholar
Huang, I-C, Thompson, LA, Chi, Y-Y, Knapp, CA, Revicki, DA, Seid, M and Shenkman, EA (2009) The linkage between pediatric quality of life and health conditions: Establishing clinically meaningful cutoff scores for the PedsQL. Value in Health 12, 773–781.10.1111/j.1524-4733.2008.00487.xCrossRefGoogle ScholarPubMed
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, 348–358.10.1016/j.biopsych.2006.03.040CrossRefGoogle ScholarPubMed
Jenkins, PE, Hoste, RR, Meyer, C and Blissett, JM (2011) Eating disorders and quality of life: a review of the literature. Clinical Psychology Review 31, 113–121.10.1016/j.cpr.2010.08.003CrossRefGoogle ScholarPubMed
Keel, PK and Striegel-Moore, RH (2009) The validity and clinical utility of purging disorder. International Journal of Eating Disorders 42, 706–719.10.1002/eat.20718CrossRefGoogle ScholarPubMed
Kessler, RC, Andrews, G, Colpe, LJ, Hiripi, E, Mroczek, DK, Normand, S-L, Walters, EE and Zaslavsky, AM (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine 32, 959–976.10.1017/S0033291702006074CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, PA, Chiu, WT, Deitz, AC, Hudson, JI, Shahly, V, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC and Benjet, C (2013) The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biological Psychiatry 73, 904–914.10.1016/j.biopsych.2012.11.020CrossRefGoogle ScholarPubMed
Le Grange, D, Swanson, SA, Crow, SJ and Merikangas, KR (2012) Eating disorder not otherwise specified presentation in the US population. International Journal of Eating Disorders 45, 711–718.10.1002/eat.22006CrossRefGoogle Scholar
Micali, N, Solmi, F, Horton, NJ, Crosby, RD, Eddy, KT, Calzo, JP, Sonneville, KR, Swanson, SA and Field, AE (2015) Adolescent eating disorders predict psychiatric, high-risk behaviors and weight outcomes in young adulthood. Journal of the American Academy of Child and Adolescent Psychiatry 54, 652–659, e1.10.1016/j.jaac.2015.05.009CrossRefGoogle ScholarPubMed
Mitchison, D, Hay, P, Engel, S, Crosby, R, Le Grange, D, Lacey, H, Mond, J, Slewa-Younan, S and Touyz, S (2013) Assessment of quality of life in people with severe and enduring anorexia nervosa: a comparison of generic and specific instruments. BMC Psychiatry 13, 284.10.1186/1471-244X-13-284CrossRefGoogle ScholarPubMed
Mitchison, D, Hay, P, Slewa-Younan, S and Mond, J (2014) The changing demographic profile of eating disorder behaviors in the community. BMC Public Health 14.10.1186/1471-2458-14-943CrossRefGoogle Scholar
Mitchison, D, Touyz, S, González-Chica, DA, Stocks, N and Hay, P (2017) How abnormal is binge eating? 18-Year time trends in population prevalence and burden. Acta Psychiatrica Scandinavica 136, 147–155.10.1111/acps.12735CrossRefGoogle ScholarPubMed
Mond, JM, Hay, PJ, Darby, A, Paxton, SJ, Quirk, F, Buttner, P, Owen, C and Rodgers, B (2009) Women with bulimic eating disorders: when do they receive treatment for an eating problem? Journal of Consulting and Clinical Psychology 77, 835.10.1037/a0015336CrossRefGoogle ScholarPubMed
Mond, J, Hall, A, Bentley, C, Harrison, C, Gratwick-Sarll, K and Lewis, V (2014) Eating-disordered behavior in adolescent boys: eating disorder examination questionnaire norms. International Journal of Eating Disorders 47, 335–341.10.1002/eat.22237CrossRefGoogle ScholarPubMed
Moynihan, R, Barratt, AL, Buchbinder, R, Carter, SM, Dakin, T, Donovan, J, Elshaug, AG, Glasziou, PP, Maher, CG, Mccaffery, KJ and Scott, IA (2018) Australia is responding to the complex challenge of overdiagnosis. Medical Journal of Australia 209, 332–334.10.5694/mja17.01138CrossRefGoogle ScholarPubMed
Mulders-Jones, B, Mitchison, D, Girosi, F and Hay, P (2017) Socioeconomic correlates of eating disorder symptoms in an Australian population-based sample. PLOS ONE 12, e0170603.10.1371/journal.pone.0170603CrossRefGoogle Scholar
Murray, SB, Nagata, JM, Griffiths, S, Calzo, JP, Brown, TA, Mitchison, D, Blashill, AJ and Mond, JM (2017) The enigma of male eating disorders: a critical review and synthesis. Clinical Psychology Review 57, 1–11.10.1016/j.cpr.2017.08.001CrossRefGoogle ScholarPubMed
Nagl, M, Jacobi, C, Paul, M, Beesdo-Baum, K, Hofler, M, Lieb, R and Wittchen, HU (2016) Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. European Child & Adolescent Psychiatry 25, 903–918.10.1007/s00787-015-0808-zCrossRefGoogle ScholarPubMed
Nolan, LJ and Geliebter, A (2012) Night eating is associated with emotional and external eating in college students. Eating Behaviors 13, 202–206.10.1016/j.eatbeh.2012.02.002CrossRefGoogle ScholarPubMed
Patton, GC, Coffey, C, Carlin, JB, Sanci, L and Sawyer, S (2008) Prognosis of adolescent partial syndromes of eating disorder. The British Journal of Psychiatry 192, 294–299.10.1192/bjp.bp.106.031112CrossRefGoogle ScholarPubMed
Rojo-Moreno, L, Arribas, P, Plumed, J, Gimeno, N, Garcia-Blanco, A, Vaz-Leal, F, Luisa Vila, M and Livianos, L (2015) Prevalence and comorbidity of eating disorders among a community sample of adolescents: 2-year follow-up. Psychiatry Research 227, 52–57.10.1016/j.psychres.2015.02.015CrossRefGoogle ScholarPubMed
Runfola, CD, Allison, KC, Hardy, KK, Lock, J and Peebles, R (2014) Prevalence and clinical significance of night eating syndrome in university students. Journal of Adolescent Health 55, 41–48.10.1016/j.jadohealth.2013.11.012CrossRefGoogle ScholarPubMed
Schmidt, U, Adan, R, Böhm, I, Campbell, IC, Dingemans, A, Ehrlich, S, Elzakkers, I, Favaro, A, Giel, K, Harrison, A, Himmerich, H, Hoek, HW, Herpertz-Dahlmann, B, Kas, MJ, Seitz, J, Smeets, P, Sternheim, L, Tenconi, E, Van Elburg, A, Van Furth, E and Zipfel, S (2016) Eating disorders: the big issue. The Lancet Psychiatry 3, 313–315.10.1016/S2215-0366(16)00081-XCrossRefGoogle ScholarPubMed
Spitzer, RL (1998) Diagnosis and need for treatment are not the same. Archives of General Psychiatry 55, 120–120.10.1001/archpsyc.55.2.120CrossRefGoogle Scholar
Stice, E, Marti, CN and Rohde, P (2013) Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology 122, 445.10.1037/a0030679CrossRefGoogle Scholar
Striegel-Moore, RH, Dohm, FA, Hook, JM, Schreiber, GB, Crawford, PB and Daniels, SR (2005) Night eating syndrome in young adult women: prevalence and correlates. International Journal of Eating Disorders 37, 200–206.10.1002/eat.20128CrossRefGoogle ScholarPubMed
Stunkard, AJ, Grace, WJ and Wolff, HG (1955) The night-eating syndrome. The American Journal of Medicine 19, 78–86.10.1016/0002-9343(55)90276-XCrossRefGoogle ScholarPubMed
Trace, SE, Thornton, LM, Root, TL, Mazzeo, SE, Lichtenstein, P, Pedersen, NL and Bulik, CM (2012) Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: implications for DSM-5. International Journal of Eating Disorders 45, 531–536.10.1002/eat.20955CrossRefGoogle ScholarPubMed
Trompeter, N, Bussey, K, Hay, P, Mond, J, Murray, SB, Lonergan, A, Griffiths, S, Pike, K and Mitchison, D (2018) Fear of negative evaluation and weight/shape concerns among adolescents: the moderating effects of gender and weight status. Journal of Youth and Adolescence 47, 1398–1408.10.1007/s10964-018-0872-zCrossRefGoogle ScholarPubMed
Udo, T and Grilo, CM (2018) Prevalence and correlates of DSM-5-defined eating disorders in a nationally representative sample of U.S. adults. Biological Psychiatry 84, 345–354.10.1016/j.biopsych.2018.03.014CrossRefGoogle Scholar
Varni, JW, Seid, M and Kurtin, PS (2001) PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Medical Care 39, 800–812.10.1097/00005650-200108000-00006CrossRefGoogle ScholarPubMed
Varni, JW, Burwinkle, TM, Seid, M and Skarr, D (2003) The PedsQL 4.0 as a pediatric population health measure: Feasibility, reliability, and validity. Ambulatory Pediatrics 3, 329–341.10.1367/1539-4409(2003)003<0329:TPAAPP>2.0.CO;22.0.CO;2>CrossRefGoogle ScholarPubMed
Volpe, U, Tortorella, A, Manchia, M, Monteleone, AM, Albert, U and Monteleone, P (2016) Eating disorders: What age at onset? Psychiatry Research 238, 225–227.10.1016/j.psychres.2016.02.048CrossRefGoogle ScholarPubMed
Wade, TD and O'shea, A (2015) DSM-5 unspecified feeding and eating disorders in adolescents: What do they look like and are they clinically significant? International Journal of Eating Disorders 48, 367–374.10.1002/eat.22303CrossRefGoogle ScholarPubMed