Prevalence and severity of DSM‐5 eating disorders in a community cohort of adolescents
Abstract
Objective: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) includes a considerably revised eating disorder section. The aim of this study was to establish the prevalence and severity of eating disorders based on the new DSM‐5 criteria in a community cohort of adolescents. Method: This study is part of TRAILS (TRacking Adolescents' Individual Lives Survey), a Dutch cohort study on mental health and social development from preadolescence into young adulthood. At baseline, the participants (n = 2,230) were about 11 years old. Body mass index was measured at all four assessment waves. At age 19, the Composite International Diagnostic Interview was administered to 1,584 of the participants. A two‐stage screening approach was used to estimate the prevalence of DSM‐5 eating disorders. Adolescents at high risk for eating disorders (n = 312) were selected for an additional interview administered by eating disorder experts. Results: Of the high‐risk group n = 296 (95%) could be interviewed. Among the women, the lifetime prevalence of DSM‐5 anorexia nervosa was 1.7%, of bulimia nervosa 0.8% and of binge eating disorder 2.3%. Eating disorders were relatively rare among the men. The severity of most cases was mild to moderate and detection and treatment rates depended on the level of severity. Discussion: The most common DSM‐5 eating disorder diagnoses in adolescents in the community are anorexia nervosa and binge eating disorder. Severity ratings for eating disorders seem valid in terms of both the distribution in the community and the correlation with detection and treatment by health care services. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:610–619)
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Most research in LOC relies on female participants, even though males are more often affected with BED and LOC than in other EDs.
“Up to now, most of the research in LOC relies on female participants, even though males are more often affected with BED and LOC than in other EDs [11].”
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Bakalar, J. L., Shank, L. M., Vannucci, A., Radin, R. M., & Tanofsky‐Kraff, M. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-015-0585-x · Cited by 90 · see citing works
“Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD 20814, USA Curr Psychiatry Rep (2015) 17:42”
BackgroundInfluentialSmink, F. R. E., van Hoeken, D., Donker, G., Susser, E., Oldehinkel, A. J., & Hoek, H. W. (2015) · Psychological Medicine · doi:10.1017/s003329171500272x · Cited by 88 · see citing works
“3%).(39) A related but different perspective on the relationship between increased BMI of the population and binge eating is provided by a South-Australian community study(40) in which the point prevalence of disordered eating behaviors, including binge eating, doubled between 1995 and 2005, in parallel with a higher…”
BackgroundInfluentialSelf-citationHerpertz‐Dahlmann, B., Elburg, A. A. V., Castro‐Fornieles, J., & Schmidt, U. H. (2015) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-015-0748-7 · Cited by 88 · see citing works
“1 in the Dutch community study delineated above [29] and were thus very similar to those of a former investigation described by van Son et al.”
ResultBinge Eating Disorder in Children and Adolescents
Bohon, C. (2019) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2019.05.003 · Cited by 76 · see citing works
Hübel, C., Abdulkadir, M., Herle, M., Loos, R. J. F., Breen, G. D., Bulik, C. M., & Micali, N. (2021) · International Journal of Eating Disorders · doi:10.1002/eat.23481 · Cited by 86 · see citing works
Nutrition in Middle Childhood and Adolescence
Lassi, Z. S., Moin, A., & Bhutta, Z. A. (2017) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0423-6_ch11 · Cited by 84 · see citing works
Appolinário, J. C., Sichieri, R., Lopes, C. D. S., de Moraes, C. E. F., da Veiga, G. V., de Freitas, S. R., Nunes, M. A., Wang, Y., & Hay, P. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02223-z · Cited by 81 · see citing works
“7% for BN observed in this study are in line with the figures reported in other community-based surveys [54, 55].”
ResultSchmidt, U. H., Claudino, A. M., Fernández‐Aranda, F., Giel, K. E., Griffiths, J., Hay, P., Kim, Y., Marshall, J., Micali, N., Monteleone, A. M., et al. (2025) · World Psychiatry · doi:10.1002/wps.21263 · Cited by 85 · see citing works
“For BED, a meta-analysis of five studies found higher ED psychopathology in more severe categories 111 , while varied results were reported for other measures, such as general psychopathology, cognitive functioning, and quality of life 111,113,114 .”
Sex Differences in Adolescent Anorexia and Bulimia Nervosa: Beyond the Signs and Symptoms
Timko, C. A., DeFilipp, L., & Dakanalis, A. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-0988-1 · Cited by 77 · see citing works
Evidence Based Update on Psychosocial Treatments for Eating Disorders in Children and Adolescents
Datta, N., Matheson, B. E., Citron, K. E., Wye, E. M. V., & Lock, J. (2022) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2022.2109650 · Cited by 77 · see citing works
“7% in adolescent females (Hoek & van Hoeken, 2003; Lucas et al., 1991; Pinhas et al., 2011; Smink et al., 2014; Van Son et al., 2006), and the prevalence of bulimia nervosa (BN) is approximately 1–2% in females (Ahs et al.”
BackgroundInfluentialHammerle, F., Huß, M., Ernst, V., & Bürger, A. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-010843 · Cited by 78 · see citing works
“In contrast to other studies, this adds some evidence against the bias hypothesis.(5) However, specific body image disturbances in male participants, possibly leading to different body weight/body fat distributions, could have been neglected to some extent due to lack of instruments.”
ResultPrevalence and correlates of binge eating disorder related features in the community
Mustelin, L., Bulik, C. M., Kaprio, J. A., & Keski‐Rahkonen, A. (2016) · Appetite · doi:10.1016/j.appet.2016.11.032 · Cited by 77 · see citing works
“Despite being the most common eating disorder in many settings (Hudson et al., 2007; Smink et al., 2014), interview-ascertained DSM-5 BED only affected 0.”
BackgroundResultInfluentialLimbers, C. A., Cohen, L. A., & Gray, B. A. (2018) · Adolescent Health Medicine and Therapeutics · doi:10.2147/ahmt.s147480 · Cited by 75 · see citing works
“2%.(7) Similarly, the prevalence of DSM-5 EDs was 1.”
BackgroundEating Disorders in Adolescent and Young Adult Males: Presenting Characteristics
Vo, M., Lau, J. S., & Rubinstein, M. L. (2016) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2016.04.005 · Cited by 75 · see citing works
Flament, M. F., Buchholz, A., Henderson, K. A., Obeid, N., Maras, D., Schubert, N., Paterniti, S., & Goldfield, G. S. (2014) · European Eating Disorders Review · doi:10.1002/erv.2339 · Cited by 74 · see citing works
Overlap in Eating Disorders and Obesity in Adolescence
Rancourt, D., & McCullough, M. B. (2015) · Current Diabetes Reports · doi:10.1007/s11892-015-0645-y · Cited by 74 · see citing works
Does Sex Matter in the Clinical Presentation of Eating Disorders in Youth?
Kinasz, K. R., Accurso, E. C., Kass, A. E., & Grange, D. L. (2016) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2015.11.005 · Cited by 74 · see citing works
Evaluation of the DSM-5 severity indicator for binge eating disorder in a community sample
Grilo, C. M., Ivezaj, V., & White, M. A. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.01.004 · Cited by 67 · see citing works
Bartholdy, S., Allen, K. L., Hodsoll, J. P., O’Daly, O., Campbell, I. C., Banaschewski, T., Bokde, A. L. W., Bromberg, U., Büchel, C., Quinlan, E. B., et al. (2017) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-016-0935-1 · Cited by 68 · see citing works
“Although the magnitude of the sex differences observed in this study is smaller than that reported in treatment-seeking samples, it is of similar magnitude to population-based studies in adolescents [5, 17, 27, 28].”
ResultMasheb, R. M., Ramsey, C. M., Marsh, A. G., Decker, S. E., Maguen, S., Brandt, C., & Haskell, S. G. (2021) · International Journal of Eating Disorders · doi:10.1002/eat.23501 · Cited by 67 · see citing works
Incidence of Anorexia Nervosa in Women: A Systematic Review and Meta-Analysis
González, L. M., Fernández‐Villa, T., Molina, A. J., Delgado‐Rodríguez, M., & Martín, V. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17113824 · Cited by 64 · see citing works
“Among the causes that could explain this, there is a greater effort in the search for cases among adolescents [3,4,73] and a worse prognosis than in adult cases [75–77].”
BackgroundResultAoki, C. J., Chowdhury, T. G., Wable, G. S., & Chen, Y.-W. (2016) · Brain Research · doi:10.1016/j.brainres.2016.01.019 · Cited by 62 · see citing works
Systematic review of the effects of acute stress in binge eating disorder
Naish, K. R., Laliberte, M. M., MacKillop, J. M., & Balodis, I. M. (2018) · European Journal of Neuroscience · doi:10.1111/ejn.14110 · Cited by 63 · see citing works
“The ratio of males to females with BED is estimated to be between 1:2 and 1:6 (Smink et al., 2014; Hoek, 2017).”
BackgroundRiesco, N., Agüera, Z., Granero, R., Jiménez‐Múrcia, S., Menchón, J. M., & Fernández‐Aranda, F. (2018) · European Psychiatry · doi:10.1016/j.eurpsy.2018.08.001 · Cited by 62 · see citing works
“Due to the vast majority of diagnoses in clinical practice fall within the atypical/subthreshold ED umbrella [8], this diagnosis has been reported as the most prevalent ED [9–13], but often not less severe and enduring than full syndromes [8,14,15].”
BackgroundDopamine D2/3 receptor antagonism reduces activity-based anorexia
Klenotich, S. J., Ho, E. V., McMurray, M. S., Server, C. H., & Dulawa, S. C. (2015) · Translational Psychiatry · doi:10.1038/tp.2015.109 · Cited by 60 · see citing works
Smith, K. E., Ellison, J. M., Crosby, R. D., Engel, S. G., Mitchell, J. E., Crow, S. J., Peterson, C. B., Le Grange, D., & Wonderlich, S. A. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22739 · Cited by 59 · see citing works
Hazzard, V. M., Bauer, K. W., Mukherjee, B., Miller, A. L., & Sonneville, K. R. (2019) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2019.104171 · Cited by 59 · see citing works
Haines, M. S., Thomas, J. J., Eddy, K. T., Dichtel, L. E., Lawson, E. A., Meenaghan, E. M., Paskal, M. L., Fazeli, P. K., Faje, A. T., Misra, M., et al. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22603 · Cited by 58 · see citing works
Gonzales, M., & Blashill, A. J. (2021) · Body Image · doi:10.1016/j.bodyim.2020.10.007 · Cited by 57 · see citing works
Variability in eating disorder risk and diagnosis in transgender and gender diverse college students
Simone, M., Hazzard, V. M., Askew, A. J., Tebbe, E. A., Lipson, S. K., & Pisetsky, E. M. (2022) · Annals of Epidemiology · doi:10.1016/j.annepidem.2022.04.007 · Cited by 57 · see citing works
Eating Disorders in Boys and Men
Brown, T. A., & Keel, P. K. (2023) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-080921-074125 · Cited by 65 · see citing works
de Jong, M., Spinhoven, P., Korrelboom, K., Deen, M. L., van der Meer, I., Danner, U. N., van der Schuur, S., Schoorl, M., & Hoek, H. W. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23239 · Cited by 51 · see citing works
“Participants were randomized into two groups (CBT-E vs. TAU), stratified by type of ED (AN, BN, BED, OSFED), gender (male/female), BMI range (17.5 – 20, 20 – 25, 25 – 30, 30 – 40), and psychotropic medication (yes/no).”
InfluentialSelf-citationHazzard, V. M., Simone, M., Borg, S. L., Borton, K. A., Sonneville, K. R., Calzo, J. P., & Lipson, S. K. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23304 · Cited by 52 · see citing works
The influence of school on whether girls develop eating disorders
Bould, H., Stavola, B. L. D., Magnusson, C., Micali, N., Dal, H., Evans, J., Dalman, C., & Lewis, G. (2016) · International Journal of Epidemiology · doi:10.1093/ije/dyw037 · Cited by 52 · see citing works
“7%.(3) They have high mortality, with meta-analysis finding a standardised mortality ratio (SMR) of 5.”
BackgroundEvaluation of the DSM‐5 Severity Indicator for Anorexia Nervosa
Machado, P. P. P., Grilo, C. M., & Crosby, R. D. (2017) · European Eating Disorders Review · doi:10.1002/erv.2508 · Cited by 51 · see citing works
Activity-based anorexia animal model: a review of the main neurobiological findings
Spadini, S., Ferro, M., Lamanna, J., & Malgaroli, A. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00481-x · Cited by 54 · see citing works
“According to DSM-5 criteria, incidence is around 1% with a mortality rate of 5–10% [1].”
BackgroundTransitioning from DSM‐IV to DSM‐5: A systematic review of eating disorder prevalence assessment
Dahlgren, C. L., & Wisting, L. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22596 · Cited by 50 · see citing works
Updates on Treatments for Adolescent Anorexia Nervosa
Lock, J. (2019) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2019.05.001 · Cited by 50 · see citing works
Escrivá‐Martínez, T., Galiana, L., Rodríguez‐Arias, M., & Baños, R. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00530 · Cited by 50 · see citing works
Silén, Y., Sipilä, P. N., Raevuori, A., Mustelin, L., MARTTUNEN, M. J., Kaprio, J. A., & Keski‐Rahkonen, A. (2021) · European Eating Disorders Review · doi:10.1002/erv.2838 · Cited by 50 · see citing works
“Supporting previous observations, we found that most adolescents and young adults who meet the diagnostic criteria for eating disorders are not detected by the healthcare system (Hart et al., 2011; Micali, N. et al., 2017; Mohler‐Kuo et al., 2016; Mustelin, Lehtokari et al., 2016; Mustelin, Silen, et al., 2016; Solmi…”
InfluentialFemale Adolescents with Eating Disorders, Parental Psychopathological Risk and Family Functioning
Tafà, M., Cimino, S., Ballarotto, G., Bracaglia, F., Bottone, C., & Cerniglia, L. (2016) · Journal of Child and Family Studies · doi:10.1007/s10826-016-0531-5 · Cited by 49 · see citing works
“With specific regard to the adolescent population, Smink et al. (2014) have demonstrated that 5.7 % of female and 1.2 % of male adolescents showed EDs in a community * Mimma Tafà mimma.tafa@uniroma1.it 1 Department of Dynamic and Clinical Psychology, Sapienza—University of Rome, Rome, Italy 2…”
BackgroundInfluentialChen, X., Luo, Y., & Chen, H. (2020) · Sex Roles · doi:10.1007/s11199-020-01122-4 · Cited by 48 · see citing works
“spread and typically emerge during adolescence (Smink et al. 2014).”
Impact of low‐weight severity and menstrual status on bone in adolescent girls with anorexia nervosa
Kandemir, N., Becker, K., Slattery, M., Tulsiani, S., Singhal, V., Thomas, J. J., Coniglio, K., Lee, H., Miller, K. K., Eddy, K. T., et al. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22681 · Cited by 47 · see citing works
“Following implementation of the revised criteria, lifetime prevalence of AN among female adolescents increased by 50%, ranging from 0.8 to 1.7% (Mustelin, Silen, Raevuori, et al., 2016; Nagl, Jacobi, Paul, et al., 2016; Smink et al., 2014).”
InfluentialLiu, K., Gao, R., Kuang, H., Ranbo, E., Zhang, C., & Xin, G. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119596 · Cited by 45 · see citing works
Targeting Neural Endophenotypes of Eating Disorders with Non-invasive Brain Stimulation
Dunlop, K., Woodside, D. B., & Downar, J. H. (2016) · Frontiers in Neuroscience · doi:10.3389/fnins.2016.00030 · Cited by 44 · see citing works
“According to recent studies, the lifetime prevalence of EDs is 5.7% for females, and 1.2% in males (Golden et al., 2003; Hudson et al., 2007; Smink et al., 2014).”
InfluentialPrevalence and clinical characterisation of pregnant women with eating disorders
Bye, A., Nath, S., Ryan, E., Bick, D., Easter, A., Howard, L. M., & Micali, N. (2020) · European Eating Disorders Review · doi:10.1002/erv.2719 · Cited by 45 · see citing works
Disordered eating behaviors among Christian and Muslim adolescents in Ceuta, a multicultural town
Ramón-Jarne, F. J., Jurado, D., Jiménez‐Fernández, S., Gutiérrez-Rojas, L., Martínez-Ortega, J. M., & Manuel Gurpegui, A. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.12.089 · Cited by 44 · see citing works
Other specified and unspecified feeding or eating disorders among women in the community
Mustelin, L., Lehtokari, V., & Keski‐Rahkonen, A. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22586 · Cited by 43 · see citing works
Gender differences in eating disorders
Capuano, E. I., Ruocco, A., Scazzocchio, B., Zanchi, G., Lombardo, C., Silenzi, A., Ortona, E., & Varı́, R. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1583672 · Cited by 42 · see citing works
Krug, I., Dang, A. B., Granero, R., Agüera, Z., Sánchez, I., Riesco, N., Jiménez‐Múrcia, S., Menchón, J. M., & Fernández‐Aranda, F. (2020) · European Eating Disorders Review · doi:10.1002/erv.2776 · Cited by 41 · see citing works
“Similar distributions have been found in previous community samples for BN (Grilo et al., 2015c; Smink et al., 2014), and BED (Grilo et al., 2015b).”
ResultMikhail, M. E., Carroll, S. L., Clark, D. A., O’Connor, S. M., Burt, S. A., & Klump, K. L. (2021) · Journal of Abnormal Psychology · doi:10.1037/abn0000719 · Cited by 41 · see citing works
Validity and utility of the DSM ‐5 severity specifier for binge‐eating disorder
Dakanalis, A., Colmegna, F., Riva, G., & Clerici, M. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22696 · Cited by 39 · see citing works
Autonomic Nervous System Function in Anorexia Nervosa: A Systematic Review
Jenkins, Z., Eikelis, N., Phillipou, A., Castle, D. J., Wilding, H., & Lambert, É. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.682208 · Cited by 42 · see citing works
Thomas, J. J., Eddy, K. T., Murray, H. B., Tromp, M. D. P., Hartmann, A. S., Stone, M. T., Levendusky, P. G., & Becker, A. E. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.06.017 · Cited by 39 · see citing works
“In a larger-scale epidemiological study, the lifetime prevalence of residual eating disorders decreased from 64% (DSM-IV) to just 16% (DSM-5) after retrospective application of DSM-5 criteria (Smink et al., 2014).”
BackgroundIncidence and weight trajectories of binge eating disorder among young women in the community
Mustelin, L., Raevuori, A., Hoek, H. W., Kaprio, J. A., & Keski‐Rahkonen, A. (2015) · International Journal of Eating Disorders · doi:10.1002/eat.22409 · Cited by 39 · see citing works
Self-citationBlume, M., Schmidt, R., & Hilbert, A. (2018) · European Eating Disorders Review · doi:10.1002/erv.2654 · Cited by 40 · see citing works
- Authors
- Smink, F. R. E., van Hoeken, D., Oldehinkel, A. J., & Hoek, H. W.
- Affiliations
- Parnassia Groep (NL)
- Parnassia Psychiatric Institute The Hague the Netherlands
- University Medical Center Groningen (NL)
- Corresponding author
- Smink, Frédérique R.E.
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2014-06-05
- Volume
- 47
- Issue
- 6
- Pages
- 610-619
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W2109585990
- Cited by
- 415
- References
- 44
- Citations by year
- 2026: 14 · 2025: 16 · 2024: 25 · 2023: 27 · 2022: 39 · 2021: 37 · 2020: 51 · 2019: 46 · 2018: 46 · 2017: 39 · 2016: 44 · 2015: 27 · 2014: 3
- FWCI
- 44.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek
- European Science Foundation
- University of Groningen
- Erasmus Medisch Centrum
- Radboud University Nijmegen
- Utrecht University
- Accare Center for Child and Adolescent Psychiatry
- BBMRI-NL
- Dutch Ministry of Justice
- Parnassia Psychiatric Institute The Hague
- ZonMW
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- eating disorders, DSM-5, adolescents, anorexia nervosa, bulimia nervosa, binge eating disorder, prevalence, severity, lifetime prevalence, TRAILS cohort, sex differences
- MeSH terms
- Adolescent, Feeding and Eating Disorders, Child, Female, Humans, Male, Mental Health, Netherlands, Severity of Illness Index, Cohort Studies, Body Mass Index, Prevalence, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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