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Anorexia Rates May Be Increasing Among Young People

New research documents an increase in cases of anorexia among 8-12 year-olds.

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Anorexia Nervosa, a life-threatening mental disorder marked by self-starvation, is not a recent phenomenon. Descriptions of anorexia were included in medical texts as far back as the 17th century, though the disorder was not widely recognized in medical literature until the 20th century. With the highest mortality rate of any disorder in the DSM 5 (the widely-used guidebook for psychiatric diagnosis), anorexia continues to be the focus of much scientific research. A recent study conducted in the UK and Ireland found disturbing evidence that rates of anorexia among children may be increasing.

Researchers and activists have long been interested in tracking rates of anorexia over time. However, there is often little agreement about whether (or to what extent) prevalence rates are changing. Some argue that we are facing an epidemic of anorexia, while others suggest that rates have been relatively steady since the 1970s. Though subclinical eating disordered behaviors that border on anorexia are common, especially among women, full-blown anorexia remains a relatively rare condition. Two other eating disorders — binge eating disorder and bulimia nervosa — are much more frequently diagnosed.

Scientists in the UK recently conducted an eight-month study to estimate how common new cases of anorexia were among young people aged 8-17. Over the eight months, child and adolescent psychiatrists (along with other relevant clinicians working in mental health services in the UK and Ireland) completed monthly reporting forms, which the researchers analyzed. Only first-episode cases of anorexia were the focus of this study. Researchers counted any young person who met at least one of the symptom criteria in each of three areas — restriction of food/low body weight; fear of weight gain/behavior that interferes with weight gain; and body image disturbance/failure to recognize the seriousness of current low body weight. These criteria were based on the diagnostic guidelines for anorexia provided by the DSM 5. Consistent with DSM guidelines, only patients who were underweight were included.

The authors summarized their results in the form of incident rates. These rates indicate the estimated number of new cases of anorexia per 100,000 population members. Consistent with previous research, their findings showed a large gender gap in rates of anorexia: 91 percent of reported new cases were young women. For young women, around 26 per 100,000 met the criteria for a first episode of anorexia; for young men, around 2 cases per 100,000 met the criteria. The risk for anorexia peaked at around age 15 for young women and age 16 for young men. On average, the bodyweight of patients in this study would classify them as experiencing “moderately severe” cases of anorexia.

The researchers also found that the overwhelming majority of new cases of anorexia (92%) were diagnosed in white patients. Though consistent with previous studies of anorexia, it’s important to note that eating disorders affect all races and ethnicities.

The most concerning finding was that rates of anorexia among children aged 12 and under seem to have increased over the past decade. This trend is consistent with findings from other Western European countries and in line with other studies suggesting the average age of onset for anorexia may be decreasing.

Epidemiological research like this is difficult to conduct and all methodologies used have significant limitations. In this study, one limitation was that the researchers only got reports from specific mental health care providers. Some young people might be treated by primary care physicians alone; these cases would not have shown up in the data set. Additionally, as with any study using these methods, there can be issues with non-reporting by some clinicians. However, the authors used statistical methods to attempt to correct for non-reporting bias.

One study is never enough to firmly establish an important scientific claim. However, in conjunction with other recent studies of rates of anorexia, these results do point toward a worrying trend. If you have concerns about a child’s body image or eating, talk with a health-care provider. Eating disorders are serious, and early intervention can make a positive difference.