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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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“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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“This suggests that, despite efforts in DSM-5 to reduce the prevalence of the ‘unspecified’ category (a goal of the revisions to DSM-IV), as previously shown [4, 6, 9], many individuals in the community experience EDs other than AN, BN, and BED.”
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“In a community cohort study of adolescents [28], the lifetime prevalence of any DSM-5 eating disorder was 1.”
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“The criteria for anorexia nervosa and bulimia nervosa were broadened in the DSM-5 criteria (Smink et al., 2014).”
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“Using DSM-5 criteria (APA, 2013), the lifetime prevalence of AN is 1.7%, whilst for BN it is 0.8% (Smink et al., 2014).”
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“In the British surveillance study, the male to female ratio was approximately 1:9 (12% boys) [14] in comparison to 1:10 to20 in adolescence [17].”
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Tanofsky‐Kraff, M., Schvey, N. A., & Grilo, C. M. (2020) · American Psychologist · doi:10.1037/amp0000592 · Cited by 118
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Epidemiology of binge eating disorder
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Recent Advances in Developmental and Risk Factor Research on Eating Disorders
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“The ratio of males to females with BED is estimated to be between 1:2 and 1:6 (Smink et al., 2014; Hoek, 2017).”
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Variability in eating disorder risk and diagnosis in transgender and gender diverse college students
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Brown, T. A., & Keel, P. K. (2023) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-080921-074125 · Cited by 71
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 65
“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
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 59
“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
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 56
“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 56
Krug, I., Giles, S., & Paganini, C. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s168944 · Cited by 50
“The few studies reported in the literature have so far shown a prevalence of OSFED of approximately 3–6% in community samples.(22) Binge eating is associated with difficulties managing weight, including weight gain,(23) obesity onset,(24) and unsuccessful attempts to lose weight.”
BackgroundUpdates 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
Escrivá‐Martínez, T., Galiana, L., Rodríguez‐Arias, M., & Baños, R. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00530 · Cited by 50
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
“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
“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 53
“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
“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
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
“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
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
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
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
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
“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 43
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 38
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
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
“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 45
Self-citation
Metadata
- 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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