Prevalence and Correlates of Eating Disorders in Adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement
Swanson SA, Crow SJ, Grange DL, Swendsen J, Merikangas KR.  Archives of General Psychiatry. Published online March 7, 2011. doi:10.1001/archgenpsychiatry.2011.22
Many clinicians in sports medicine have dealt with eating disorders and eating problems that fall below the diagnostic thresholds for eating disorders. Surprisingly, the prevalence of patients with eating problems below the diagnostic threshold is not well known among adolescents. Therefore, the purpose of this study was to explore the prevalence and correlates of eating disorders in a large nationally (United States)-representative group of adolescents 13 to 18 years of age (10,123 adolescents). During a face-to-face interview the lifetime prevalence (experience of an eating disorder thus far in life) was determined for anorexia nervosa (0.3%), bulimia nervosa (0.9%), binge-eating disorder (1.6%), subthreshold anorexia nervosa (0.9%), and subthreshold binge-eating disorder (2.5%). Surprisingly (to me at least), there were no or small sex differences in the prevalence of anorexia nervosa (males = 0.3%, females = 0.3%), bulimia nervosa (males = 0.5%, females = 1.3%), binge-eating disorder (males = 0.8%, females = 2.3%), and subthreshold binge-eating disorder (males = 2.6%, females = 2.3%).  Subthreshold anorexia nervosa was more common in girls (males = 0.1%, females = 1.5%). The median age of onset was between 12 and 13 years of age. A majority of adolescents (55% to 88%) with an eating disorder also met criteria for at least 1 other DSM-IV (Diagnostic and Statistical Manual of Mental Disorders IV) disorder. Furthermore, eating disorders were associated with suicidality. The majority of adolescents with eating disorders (64 to 88%) sought some form of treatment, but only a few (3 to 28%) sought treatments specifically for their eating or weight problems. The study also indicated that adolescents with eating problems below the diagnostic threshold were clinically important; which suggests that this may be a population we need to pay more attention to.

I think there is valuable information in this epidemiology study for sports medicine clinicians regardless of their clinical setting. It helps further raise awareness about eating disorders and the comorbidities associated with them (for example, other DSM-IV disorders). The study is also an important reminder that we need to be aware of adolescent males with signs of potential eating disorders. What are your experiences with eating disorders in this population? I would be interested to hear from clinicians and/or researchers with experience in how we can better serve this population. Post a comment and let us know.
Written by: Jeffrey Driban
Reviewed by: Stephen Thomas