It is always hard to give precise prevalence figures because the figures known are for those seeking/receiving treatment and it is estimated by the Dept of health that the true figure for those affected is more like 4 million as so many who struggle do not seek help and therefore do not enter the figures.
Over 1.6 million people in the UK are estimated to be directly affected by eating disorders. This is likely to be an underestimate as we know there is a huge level of unmet need in the community. Good quality comprehensive services for people with eating disorders are not yet available in many parts of England. (1)
Who is affected?
Anorexia most commonly affects girls and women, although it has become more common in boys and men in recent years. On average, the condition first develops at around the age of 16 to 17. (2)
Recent studies suggest that as many as 8% of women have bulimia at some stage in their life. The condition can occur at any age, but mainly affects women aged between 16 and 40 (on average, it starts around the age of 18 or 19. Bulimia nervosa can affect children, but this is extremely rare. Reports estimate that up to 25% of Britons struggling with eating disorders may be male. (3)
In 2007 the NHS information centre stated that up to 6.4% of adults displayed signs of an eating disorder. This research also suggested that up to 25% of those showing signs of an eating disorder were male. (4)
The age at which most boys were admitted to hospital for an eating disorder was 13 years in the 12 months to October 2013. (5)
The increase in the number of people diagnosed with eating disorders was more pronounced in males with incidences rising 27 per cent. The number of people diagnosed with eating disorders has increased by 15 per cent since 2000 (6)
Figures for 2007 found 1.9% of women and 0.2% of men experience anorexia in any year. Usually, the condition lasts for about 6 years. Between 0.5% and 1% of young women experience bulimia at any one time. (7)
About 40% of people referred to eating disorder clinics are classified ‘Eating Disorder Not Otherwise Specified’ (8) with symptoms that don’t fit neatly into either the anorexia or bulimia classifications.
In 2013 the EDNOS category was removed and Binge Eating Disorder became a recognised disorder in a distinct category in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). (9)
Eating disorders have the highest mortality rates among psychiatric disorders. (10)
Anorexia Nervosa has the highest mortality rate of any psychiatric disorder in adolescence. (11)
Of those surviving, 50% recover, whereas 30% improve and 20% remain chronically ill. (12)
Only 46.9% of AN patients were classified as ‘cured.’ Early intervention results in the best possible recovery outcome (NICE). Not providing children and young people with the resources to recover means that their illness may not be cured and that they go into adulthood with enduring Anorexia Nervosa.
Links with Suicide
In anorexia nervosa (AN), this excess mortality is explained in part by the physical complications and in part by an increased rate of suicide. Across studies, approximately 20 to 40% of deaths in AN are thought to result from suicide. The mean crude mortality rate was 5.0% (t1). In the surviving patients, on average, full recovery was found in only 46.9% of the patients, while 33.5% improved, and 20.8% developed a chronic course of the disorder. First, crude mortality rates were high and increased significantly with length of follow-up. (13)
Even stronger evidence comes from a series of studies that calculated standard mortality rates. A review of the standard mortality rate in 10 cohort studies (134) found standard mortality rates between 1.36 and 17.80, indicating a slight to an almost 18-fold increase in mortality in patients with anorexia nervosa, with a maximal standard mortality rate of 30 for female patients in the first year after presentation and a statistically significant increase for up to 15 years after presentation. The data suggest that there are more deaths from suicide and other and unknown causes and fewer deaths related to the eating disorder than have been previously reported. (14)
Most recent figures January 2014 reveal that there was a national rise of 8 per cent in the number of admissions to hospital for an eating disorder in the 12 months previous to October 2013.
Most of the 2,560 who went to hospital for inpatient treatment were very young – 15 was the most common age of admission for girls and 13 for boys. But children aged five to nine and the under-fives were also admitted.
In the 12 months to October 2013 hospitals dealt with 2,560 eating disorder admissions, 8 per cent more than in the previous 12 months (2,370 admissions). (15)
Healthcare Costs for Eating Disorders
Health care costs for eating disorders in England have been estimated as £80-100m with overall economic cost likely to be more than £1.26 bn per year. (16)
Are the pressures of 24/7 social media fuelling disordered eating and eating disorders?
A recent two part study looking at Social media sites, such as Facebook, researched influence and risk for eating disorders.
In Study 1, 960 women completed self-report surveys regarding Facebook use and disordered eating. In Study 2, 84 women were randomly assigned to use Facebook or to use an alternate internet site for 20 min.
More frequent Facebook use was associated with greater disordered eating in a cross-sectional survey. Facebook use was associated with the maintenance of weight/shape concerns and state anxiety compared to an alternate internet activity. (17)
What is the link between eating disorders and self-harming?
[Now referred to as Non Suicidal Self Injury (NSSI)]
Eating disorders and NSSI fall along the continuum of self-harm, and up to 72 % of people with an ED also engaging in NSSI and up to 54 % of people who engage in NSSI report comorbid eating pathology. The likelihood of engaging in NSSI is greater among patients with purging-type EDs than those with non-purging-type EDs, suggesting an etiological link between purging and NSSI. (18)
Where are young people turning to for help?
Only around one in ten young people feel comfortable seeking advice from teachers, parents, GPs or the school/health systems in general, whereas around half feel these groups are where they should be able to turn.
Conversely, half are comfortable going online (Google or forums where other young people talk about self-harm), but only one in five feel that’s where they should be going.
Conversations with friends are the most common source of information on self-harm for young people (45% of young people say that’s what informs their views). Information online, from websites, social media sites, blogs etc, is second most common (33% of young people say these inform their opinions about self-harm). (19)
(1) Joint Commissioning Panel For Mental Health (www.jcpmh.info/wp-content/uploads/10keymsgs-eatingdisorders.pdf)
(4) Adult Psychiatric Morbidity Survey, 2007
(5) Health and Social Care Information Centre (www.hscic.gov.uk/article/3880/Eating-disorders-Hospital-admissions-up-by-8-per-cent-in-a-year
(6) Micali, N. et al “The incidence of eating disorders in the UK in 200-2009: findings from the General Practice Research Database” BMJ Opendoi:10.1136/bmjopen-2013-002646
(7) "Eating Disorders: Core Interventions In The Treatment And Management Of Anorexia Nervosa, Bulimia Nervosa And Other Eating Disorders, National Collaborating Centre for Mental Health, London: The British Psychological Society/ Royal College Of Psychiatrists p23- 24, (2004)
(8) Button E. et al (2005), "Don’t forget EDNOS (eating disorder not otherwise specified): Patterns of Service Use in an Eating Disorders Service", Psychiatric Bulletin, 29: 134- 136, (2005)
(9) The Diagnostic and Statistical Manual of Mental Disorders (www.dsm5.org)
(10) Arcelus J, Mitchell AJ, Wales J. et al, "Mortality Rates in Patients with Anorexia Nervosa and Other Eating Disorders: A Meta Analysis of 36 Studies." Arch Gen Psychiatry 2011, 68: 724-31. Sonnenville K, Micali N et al., "Common Eating Disorders Predictive of Adverse Outcomes are Missed by the DSM-IV and DSM-5 Classifications." Paediatrics 2012; 130:e289-95
(11) NICE Guidelines 2004 page 7. "Eating Disorders Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa, and Related Eating Disorders"
(12) Steinhausen, H.C. (2002). "The Outcome of Anorexia Nervosa in the 20th Century." American Journal of Psychiatry, 159, 1284-1293
(13) Papadopoulos FC, Ekbom A, Brandt L, Ekselius L (2009) "Excess mortality, Causes of Death and Prognostic Factors in Anorexia Nervosa." Br J Psychiatry 194: 10–17 Harris EC, Barraclough B (1998) Excess mortality of mental disorder. Br J Psychiatry 173: 11–53
(14) Steinhausen, H.C. (2002). The Outcome of Anorexia Nervosa in the 20th Century. American Journal of Psychiatry, 159, 1284-1293
(15) Health and Social Care Information Centre (www.hscic.gov.uk/article/3880/Eating-disorders-Hospital-admissions-up-by-8-per-cent-in-a-year)
(16) Joint Commissioning Panel For Mental Health (www.jcpmh.info/wp-content/uploads/10keymsgs-eatingdisorders.pdf)
(17) Mabe AG, Forney KJ, Keel PK. Int J Eat Disord. 2014 Jul;47(5):516-23 Do you "like" my photo?
(18) Colleen M. Jacobson and Cynthia C. Luik, Epidemiology and Sociocultural Aspects of Non-suicidal Self-Injury and Eating Disorders 2014
(19) Talking Self-harm, p.33 (www.selfharmorganisation.org.uk/wp-content/uploads/2013/08/Talking-Self-Harm.pdf)