By Sarah O’Neil, MD (bio)
There are several reasons why I think it is important for all mental health clinicians to screen our patients for a possible eating disorder even if we ourselves don’t treat patients with eating disorders.
On this page, I will discuss some of the reasons why.
Eating disorders and subthreshold disordered eating are very common. The lifetime prevalence of various eating disorders are as follows (Hudson et al., 2007):
– Anorexia nervosa: women 1%, men 0.3%
– Bulimia nervosa: women 1.5%, men 0.5%
– Binge eating disorder: women 3.5%, men 2%
These numbers show that a LOT of people suffer from an eating disorder at some time in their lives.
Also, along with these full diagnoses, even subthreshold disordered eating can be associated with considerable suffering.
Associated with a significantly increased risk of death
Eating disorders are complex medical-psychiatric illnesses with a high mortality rate (Arcelus et al., 2011). Here are some facts that indicate how serious eating disorders are:
1. When eating disorders are taken as a whole, among psychiatric disorders, only opioid use disorder has a higher mortality rate (Chesney et al., 2014).
2. Every hour, someone in this country dies due to the direct result of an eating disorder (Eating Disorders Coalition, 2019).
3. And, among the eating disorders, the mortality rate associated with anorexia nervosa is among the highest associated with any psychiatric diagnosis. After adjusting for age, the risk of premature death in women with anorexia nervosa is 6 to 12 times higher than in the general population.
Challenging but treatable
We know that eating disorders can often be difficult to treat and that many patients show only partial or no improvement (Steinhausen, 2002, 2009).
But, eating disorders don’t have to be life-long, intractable illnesses. If detected and treated early (see below), eating disorders are treatable and complete recovery is possible for many patients.
Only about one-third of persons with an eating disorder ever receive treatment (Hudson et al., 2007).
And, for adolescents, the numbers are even worse. Fewer than 1 in 5 adolescents with an eating disorder have received treatment (Swanson et al., 2011).
“The sooner the better”*
The likelihood of successful treatment of eating disorders is greater the sooner:
– The eating disorder is detected
– Weight restoration and nutritional rehabilitation is established, and
– Behavioral and psychological recovery begins.
For example, one study found that for both family and individual therapy, the prognosis was poor unless effective treatment was provided within three years of onset of the illness onset (Treasure and Russell, 2011).
(* “The sooner the better” is the slogan of a campaign by the Multiservice Eating Disorders Association.)
At the link below, I explain exactly how busy mental health professionals who do not themselves treat eating disorders can screen all their patients for eating disorders as part of their overall evaluation.
References used in this article
Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry. 2011 Jul;68(7):724-31. doi: 10.1001/archgenpsychiatry.2011.74. PubMed PMID: 21727255.
Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014 Jun;13(2):153-60. doi: 10.1002/wps.20128. PubMed PMID: 24890068; PubMed Central PMCID: PMC4102288.
Eating Disorders Coalition. Facts About Eating Disorders: What The Research Shows (2019). Available at http://eatingdisorderscoalition.org.s208556.gridserver.com/couch/uploads/file/edc-fact-sheet-revised.pdf
Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 1;61(3):348-58. Epub 2006 Jul 3. Erratum in: Biol Psychiatry. 2012 Jul 15;72(2):164. PubMed PMID: 16815322; PubMed Central PMCID: PMC1892232.
Steinhausen HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002 Aug;159(8):1284-93. Review. PubMed PMID: 12153817.
Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry. 2011 Jul;68(7):714-23. doi: 10.1001/archgenpsychiatry.2011.22. Epub 2011 Mar 7. PubMed PMID: 21383252; PubMed Central PMCID: PMC5546800.
Steinhausen HC. Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am. 2009 Jan;18(1):225-42. doi: 10.1016/j.chc.2008.07.013. PubMed PMID: 19014869.
Treasure J, Russell G. The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. Br J Psychiatry. 2011 Jul;199(1):5-7. doi: 10.1192/bjp.bp.110.087585. PubMed PMID: 21719874.
Fichter MM, Quadflieg N. Mortality in eating disorders – results of a large prospective clinical longitudinal study. Int J Eat Disord. 2016 Apr;49(4):391-401. doi: 10.1002/eat.22501. Epub 2016 Jan 15. PubMed PMID: 26767344.
Quadflieg N, Strobel C, Naab S, Voderholzer U, Fichter MM. Mortality in males treated for an eating disorder-A large prospective study. Int J Eat Disord. 2019 Jul 10. doi: 10.1002/eat.23135. [Epub ahead of print] PubMed PMID: 31291032.
Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry. 2013 Nov;26(6):543-8. doi: 10.1097/YCO.0b013e328365a24f. Review. PubMed PMID: 24060914.
Stice E, Bohon C. Eating Disorders. In Child and Adolescent Psychopathology, 2nd Edition (2012), Theodore Beauchaine & Stephen Linshaw, eds. New York: Wiley.
Stice E, Marti CN, Shaw H, Jaconis M. An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. J Abnorm Psychol. 2009 Aug;118(3):587-97. doi: 10.1037/a0016481. PubMed PMID: 19685955; PubMed Central PMCID: PMC2849679.
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