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Eating disorders: Overview of epidemiology, clinical features, and diagnosis

Sara F Forman, MD
Section Editor
Joel Yager, MD
Deputy Editor
David Solomon, MD


Eating disorders are characterized by a persistent disturbance of eating that impairs health or psychosocial functioning [1]. The disorders include anorexia nervosa, avoidant/restrictive food intake disorder, binge eating disorder, bulimia nervosa, pica, and rumination disorder. Diagnoses are based upon the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which divides eating disorders into mutually exclusive categories that are based upon observed symptoms [1]. Some diagnoses include a dimensional component that allows clinicians to specify the severity of illness [2-4].

Many aspects of the United States culture display an obsession with weight loss. Women's magazines often include stories about weight management, dieting, or how to tighten specific muscle groups. Models and actors often display a level of thinness that is difficult to attain, computer programs are used to alter photographs to make models look thinner, and some athletes relentlessly pursue a leaner body to enhance performance. This preoccupation to lose weight and tying self-esteem to a thin body type often extends to maturing adolescents.

This topic reviews the epidemiology, pathogenesis, and diagnosis of eating disorders, as well as their course of illness. Treatment of eating disorders, medical complications of eating disorders and their management, evaluation for medical complications and criteria for hospitalization, and the refeeding syndrome in anorexia nervosa are discussed separately.    

(See "Eating disorders: Overview of prevention and treatment".)

(See "Anorexia nervosa in adults and adolescents: Medical complications and their management".)

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Literature review current through: Nov 2017. | This topic last updated: Oct 25, 2017.
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  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  2. Wildes JE, Marcus MD. Incorporating dimensions into the classification of eating disorders: three models and their implications for research and clinical practice. Int J Eat Disord 2013; 46:396.
  3. Lavender JM, Crosby RD, Wonderlich SA. Dimensions in the eating disorders: past, present, and future. Commentary on Wildes and Marcus: Incorporating dimensions into the classification of eating disorders. Int J Eat Disord 2013; 46:404.
  4. Pike KM. Classification, culture, and complexity: a global look at the diagnosis of eating disorders: Commentary on Wildes and Marcus: Incorporating dimensions into the classification of eating disorders. Int J Eat Disord 2013; 46:408.
  5. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 1999; 319:1467.
  6. Cotton MA, Ball C, Robinson P. Four simple questions can help screen for eating disorders. J Gen Intern Med 2003; 18:53.
  7. Hill LS, Reid F, Morgan JF, Lacey JH. SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord 2010; 43:344.
  8. Mintz LB, O'Halloran MS. The Eating Attitudes Test: validation with DSM-IV eating disorder criteria. J Pers Assess 2000; 74:489.
  9. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999; 282:1737.
  10. 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; 61:348.
  11. Keski-Rahkonen A, Hoek HW, Susser ES, et al. Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 2007; 164:1259.
  12. Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord 2003; 34:383.
  13. Brown TA, Holland LA, Keel PK. Comparing operational definitions of DSM-5 anorexia nervosa for research contexts. Int J Eat Disord 2014; 47:76.
  14. Micali N, Hagberg KW, Petersen I, Treasure JL. The incidence of eating disorders in the UK in 2000-2009: findings from the General Practice Research Database. BMJ Open 2013; 3.
  15. Pedersen CB, Mors O, Bertelsen A, et al. A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders. JAMA Psychiatry 2014; 71:573.
  16. Swanson SA, Crow SJ, Le Grange D, et al. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry 2011; 68:714.
  17. Steinhausen HC, Jakobsen H, Helenius D, et al. A nation-wide study of the family aggregation and risk factors in anorexia nervosa over three generations. Int J Eat Disord 2015; 48:1.
  18. Duncan L, Yilmaz Z, Gaspar H, et al. Significant Locus and Metabolic Genetic Correlations Revealed in Genome-Wide Association Study of Anorexia Nervosa. Am J Psychiatry 2017; 174:850.
  19. Phillipou A, Rossell SL, Castle DJ. The neurobiology of anorexia nervosa: a systematic review. Aust N Z J Psychiatry 2014; 48:128.
  20. Oberndorfer TA, Frank GK, Simmons AN, et al. Altered insula response to sweet taste processing after recovery from anorexia and bulimia nervosa. Am J Psychiatry 2013; 170:1143.
  21. Foerde K, Steinglass JE, Shohamy D, Walsh BT. Neural mechanisms supporting maladaptive food choices in anorexia nervosa. Nat Neurosci 2015; 18:1571.
  22. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, American Psychiatric Association, Washington DC 2000.
  23. Attia E, Becker AE, Bryant-Waugh R, et al. Feeding and eating disorders in DSM-5. Am J Psychiatry 2013; 170:1237.
  24. American Psychiatric Association. Treatment of patients with eating disorders,third edition. American Psychiatric Association. Am J Psychiatry 2006; 163:4.
  25. Mehler PS, Birmingham LC, Crow SJ, Jahraus JP. Medical complications of eating disorders. In: The Treatment of Eating Disorders: A Clinical Handbook, Grilo CM, Mitchell JE (Eds), The Guilford Press, New York 2010. p.66.
  26. Halmi, K. Eating disorders: Anorexia nervosa, bulimia nervosa, and obesity. In: The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition, Hales, RE, Yudofsky, SC, Gabbard GO (Eds), American Psychiatric Publishing, Inc., Washington, DC 2008. p.971.
  27. Eating Disorders: Core Interventions in the Treatment of and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. National Institute for Clinical Excellence, Clinical Guideline 9. http://guidance.nice.org.uk (Accessed on December 22, 2010).
  28. Kurz S, van Dyck Z, Dremmel D, et al. Early-onset restrictive eating disturbances in primary school boys and girls. Eur Child Adolesc Psychiatry 2015; 24:779.
  29. Ornstein RM, Rosen DS, Mammel KA, et al. Distribution of eating disorders in children and adolescents using the proposed DSM-5 criteria for feeding and eating disorders. J Adolesc Health 2013; 53:303.
  30. Fisher MM, Rosen DS, Ornstein RM, et al. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a "new disorder" in DSM-5. J Adolesc Health 2014; 55:49.
  31. Norris ML, Robinson A, Obeid N, et al. Exploring avoidant/restrictive food intake disorder in eating disordered patients: a descriptive study. Int J Eat Disord 2014; 47:495.
  32. Forman SF, McKenzie N, Hehn R, et al. Predictors of outcome at 1 year in adolescents with DSM-5 restrictive eating disorders: report of the national eating disorders quality improvement collaborative. J Adolesc Health 2014; 55:750.
  33. Eddy KT, Thomas JJ, Hastings E, et al. Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. Int J Eat Disord 2015; 48:464.
  34. Kessler RC, Berglund PA, Chiu WT, et al. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiatry 2013; 73:904.
  35. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:593.
  36. Devlin MJ. Binge-Eating Disorder Comes of Age. Ann Intern Med 2016; 165:445.
  37. Devlin, MJ. Binge-eating disorder and obesity. In: Binge-Eating Disorder: Clinical Foundations and Treatment, Mitchell, JE, de Zwaan, M, Peterson, CB, et al. (Eds) (Eds), Guilford Press, New York 2007. p.23.
  38. Didie ER, Fitzgibbon M. Binge eating and psychological distress: is the degree of obesity a factor? Eat Behav 2005; 6:35.
  39. Bodell, LP, Devlin, MJ. Pharmacotherapy for binge-eating disorder. In: The Treatment of Eating Disorders, Grilo, CM, Mitchell, JE (Eds), Guilford Press, New York 2009. p.402.
  40. de Zwaan, M. Obesity treatment for binge-eating disorder in the obese. In: Treatment of Eating Disorders, Grilo, CM, Mitchell, JE (Eds), Guilford Press, New York 2009. p.428.
  41. Wilson GT. Treatment of binge eating disorder. Psychiatr Clin North Am 2011; 34:773.
  42. Friborg O, Martinussen M, Kaiser S, et al. Personality disorders in eating disorder not otherwise specified and binge eating disorder: a meta-analysis of comorbidity studies. J Nerv Ment Dis 2014; 202:119.
  43. Raevuori A, Suokas J, Haukka J, et al. Highly increased risk of type 2 diabetes in patients with binge eating disorder and bulimia nervosa. Int J Eat Disord 2015; 48:555.
  44. Reas DL, Grilo CM. Timing and sequence of the onset of overweight, dieting, and binge eating in overweight patients with binge eating disorder. Int J Eat Disord 2007; 40:165.
  45. Pope HG Jr, Lalonde JK, Pindyck LJ, et al. Binge eating disorder: a stable syndrome. Am J Psychiatry 2006; 163:2181.
  46. Fichter MM, Quadflieg N, Hedlund S. Long-term course of binge eating disorder and bulimia nervosa: relevance for nosology and diagnostic criteria. Int J Eat Disord 2008; 41:577.
  47. Grilo CM, White MA, Gueorguieva R, et al. Predictive significance of the overvaluation of shape/weight in obese patients with binge eating disorder: findings from a randomized controlled trial with 12-month follow-up. Psychol Med 2013; 43:1335.
  48. Allen KL, Byrne SM, Oddy WH, Crosby RD. 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. J Abnorm Psychol 2013; 122:720.
  49. Frank GK, Shott ME, Hagman JO, Mittal VA. Alterations in brain structures related to taste reward circuitry in ill and recovered anorexia nervosa and in bulimia nervosa. Am J Psychiatry 2013; 170:1152.
  50. Marsh R, Stefan M, Bansal R, et al. Anatomical characteristics of the cerebral surface in bulimia nervosa. Biol Psychiatry 2015; 77:616.
  51. 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; 68:724.
  52. Crow SJ, Peterson CB, Swanson SA, et al. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry 2009; 166:1342.
  53. Mazzeo SE, Mitchell KS, Bulik CM, et al. Assessing the heritability of anorexia nervosa symptoms using a marginal maximal likelihood approach. Psychol Med 2009; 39:463.
  54. Mazzeo SE, Mitchell KS, Bulik CM, et al. A twin study of specific bulimia nervosa symptoms. Psychol Med 2010; 40:1203.
  55. Mitchell KS, Neale MC, Bulik CM, et al. Binge eating disorder: a symptom-level investigation of genetic and environmental influences on liability. Psychol Med 2010; 40:1899.
  56. Fairburn CG, Harrison PJ. Eating disorders. Lancet 2003; 361:407.
  57. Sanci L, Coffey C, Olsson C, et al. Childhood sexual abuse and eating disorders in females: findings from the Victorian Adolescent Health Cohort Study. Arch Pediatr Adolesc Med 2008; 162:261.
  58. Patton GC, Selzer R, Coffey C, et al. Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ 1999; 318:765.
  59. McKnight Investigators. Risk factors for the onset of eating disorders in adolescent girls: results of the McKnight longitudinal risk factor study. Am J Psychiatry 2003; 160:248.
  60. Nattiv A, Agostini R, Drinkwater B, Yeager KK. The female athlete triad. The inter-relatedness of disordered eating, amenorrhea, and osteoporosis. Clin Sports Med 1994; 13:405.