Eating Disorders: Anorexia and Bulimia

• "Possible eating problem" refers to broader difficulties with eating.

Prevalence of Eating Problems (2023)

• 11-16 year olds: 12.3%
• 17-19 year olds: 60%
• 20-25 year olds: 57%

Prevalence of Eating Disorders (Anorexia or Bulimia) (2023)

• 11-16 year olds: 2.6%
• 17-19 year olds: 12.5%
• 20-25 year olds: 5.9%

Eating Disorders in DSM-5

• Includes anorexia, bulimia, binge-eating disorder, other specified feeding & eating disorders (OSFED), and avoidant/restrictive food intake disorder (ARFID).

Anorexia

• Characterized by an intense fear of gaining weight.
• Body shape and weight unduly influence self-evaluation.
• Involves persistent restriction of energy intake, leading to significantly low body weight.
• There may be a disturbance in how one's body is perceived.
• There is a lack of recognition of the severity of low body weight.

Bulimia

• Involves binge-eating episodes (eating large amounts of food in a short period of time with a sense of loss of control) occurring once/week for at least 3 months.
• Body shape and weight unduly influence self-evaluation.
• Includes compensatory behaviors.

Binge-Eating Disorder

• Characterized by binge-eating episodes.
• There is an absence of recurrent compensatory behaviors.
• Marked distress is experienced regarding binge-eating.

Other Specified Feeding & Eating Disorders (OSFED)

• Includes atypical anorexia (no underweight BMI).
• Includes sub-threshold bulimia nervosa (BN) or binge-eating disorder (BED) where frequency criteria are not met.
• Includes purging disorder (purging in the absence of binge-eating).
• Includes night eating syndrome (eating after awakening from sleep or excessive food consumption after evening meal).
• Includes ARFID and PICA.

Avoidant/Restrictive Food Intake Disorder (ARFID)

• Involves eating or feeding disturbance, such as lack of interest in eating or food, avoidance based on sensory characteristics of food, or concern about aversive consequences of eating.
• Can result in significant weight loss.
• Can result in nutritional deficiency.
• May cause dependence on enteral feeding or supplements.
• Characterized by marked impairment.
• Not explained by another medical condition (anorexia or bulimia), cultural practices, or food availability.

Age of Onset

• Eating disorders (EDs) generally start in early adolescence.
• Anorexia has the earliest age of onset.

Incidence vs. Prevalence

• Incidence refers to how many new cases there are.
• Prevalence refers to how many adolescents have had an eating disorder in adolescence.
• Lifetime prevalence refers to the proportion of individuals who, at some point during their life, have experienced the condition.
• Point prevalence refers to the proportion of individuals who have the condition at a specific point in time.

"Possible Eating Problems"

• Identified via Development and Wellbeing Assessment (DAWBA).
• Scoring above the threshold on the DAWBA indicates a "screening positive" for a possible eating problem.
• Does not necessarily mean the child has a clinically impairing ED but increases the likelihood of broader problems or difficulties with eating.

"Eating Disorders"

• Characterized by disturbances in eating behaviors, appetite, or food intake.
• Usually start in teenage years.
• Can cause heart and kidney problems, and even death.

Validity of Screening Instruments

• Issues exist with the validity of instruments used for screening eating disorders, which can lead to varying prevalence percentages.
• Even when using the same measure, an increase in eating disorders has been observed over the past 6 years.

Incidence Changes Over Time

• Children = 0.3-3.1%.
• Children & young people = 3% to 15%.
• There is a lack of data on incidence from the general population.
• There are no validated questionnaires for general population use.
• Existing questionnaires do not include 'exclusion criteria' and don't cover ARFID.

Groups at Greater Risk

• Male-to-female ratio varies.
• Unclear reasons regarding ethnicity & immigration status.
• Differences in symptoms/diagnoses might reflect biases in healthcare, barriers, or stigma.
• Socio-economic status appears to have an affect.
• Differences defined regarding sexual orientation.

BMI

• There are huge debates around using BMI in services, which can prevent people from accessing treatment.
• There are gaps in identification and treatment provision.
• Increase in population presentations may point to environmental risk factors.

Conclusions

• Different profiles of young people with eating disorders and those presenting with symptoms in the population
• There are gaps in identification and treatment provisions.
• There is a need to identify barriers to diagnosis.
• Increase in population presentations points to environmental risk factors.

Transitions Between Disorders

• Diagnoses are separate, but people move between them.

Mortality Rate

• Suicide attempts are more common in bulimia nervosa (BN) and anorexia nervosa with binge-purge type (AN-BP).

Limitations of Data

• Secondary care samples may include more severe cases.
• Samples may be unrepresentative as a minority are referred to ED services.

Primary Care Data Sources

• Clinical practice records (60m patients, 2000 primary care practices).
• Hospital episode statistics (HES) including hospital admissions and reasons for admission.
• Office for National Statistics (ONS) data on causes of death.
• Data includes patients with incident diagnosis of eating disorder, ages 11-60, diagnosed between January 1st and December 31st.

Conclusions from Data

• Eating disorders have severe outcomes in terms of mortality, admissions, and emergency admissions.
• There are inequalities in outcomes and access to treatment.
• Improved guidance is needed on providing care and health monitoring at the primary care level.

Hospital Admission Statistics

• Eating disorders have severe outcomes.
• There are inequalities in outcomes of ED and access to treatment.

Impact of Social Media

• "The Instagram effect," internalization of thin ideal, and social comparison theory are potential risk factors.
• Observational evidence shows an association between time spent, selfie feedback/behavior/comments/updates, and eating disorder-related cognitions.
• Experimental evidence shows higher concerns with body image in experimental groups assigned to view images of thin/muscular bodies.
• Some RCT evidence exists regarding media literacy in schools, but with short follow-ups.

Conclusions on Social Media

• Evidence is still mixed.
• Interactions on social media and usage patterns need to be better understood.
• Long-term outcomes need to be assessed.
• Understanding is needed to determine the most suitable interventions.