Cited by 415Eating Disorders and BehaviorsNutrition, Health and Food BehaviorChild Nutrition and Feeding Issues

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Prevalence and severity of DSM‐5 eating disorders in a community cohort of adolescents

Smink, Frédérique R.E., van Hoeken, Daphne, Oldehinkel, Albertine J., Hoek, Hans W.·2014·International Journal of Eating Disorders

DOI 10.1002/eat.22316

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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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Influential
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Background
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Diagnostic Categories for Eating Disorders
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“Similar studies have recruited relatively small samples of individuals diagnosed with BN (e.g., Smink et al., 2014, n = 8), making wider inferences difficult and there have been no studies of BN recruited from clinical (treatment-seeking) samples.”
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MethodInfluentialSelf-citation
Testing the DSM-5 severity indicator for bulimia nervosa in a treatment-seeking sample
Dakanalis, A., Clerici, M., Riva, G., & Carrà, G. (2016) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-016-0324-2 · Cited by 16
“disorder- than a severity-dependent variable [17].”
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“The first peak of prevalence occurs in adolescence [3], at 1–3% in children and adolescents [3], and 3% for subclinical presentations [4].”
Background
Prevalence of Eating Disorder Symptoms in Transgender and Gender Diverse Adolescents Presenting for Gender-Affirming Care
Kerr, J. A., Paine, J., Thrower, E., Hoq, M., Mollica, C. M., Sawyer, S. M., Azzopardi, P. S., & Pang, K. C. (2024) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2023.11.396 · Cited by 16
The Influence of Family Dynamics On Eating Disorders and Their Consequence On Resilience: A Mediation Model
Leys, C., Kotsou, I., Goemanne, M., & Fossion, P. (2017) · American Journal of Family Therapy · doi:10.1080/01926187.2017.1303654 · Cited by 16
Anorexia nervosa and bone
Haines, M. S., & Klibanski, A. (2018) · Current Opinion in Endocrine and Metabolic Research · doi:10.1016/j.coemr.2018.01.002 · Cited by 19
Age- and Sex-Specific Plasticity in Dopamine Transporter Function Revealed by Food Restriction and Exercise in a Rat Activity-Based Anorexia Paradigm
Gilman, T. L., Owens, W. A., George, C. M., Metzel, L., Vitela, M., Ferreira, L., Bowman, M. A., Gould, G. G., Toney, G. M., & Daws, L. C. (2019) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1124/jpet.119.260794 · Cited by 16
Binge eating-related concerns and depressive symptoms in young adulthood: Seven-year longitudinal associations and differences by race/ethnicity
Hazzard, V. M., Hahn, S. L., Bauer, K. W., & Sonneville, K. R. (2019) · Eating Behaviors · doi:10.1016/j.eatbeh.2019.01.004 · Cited by 16
“6% for other specified feeding and eating disorders (Allen et al., 2013; Smink et al., 2014).”
Background
Normal variations in personality predict eating behavior, oral health, and partial syndrome bulimia nervosa in adolescent girls
Allen, M. S., Robson, D. A., & Laborde, S. (2020) · Food Science & Nutrition · doi:10.1002/fsn3.1425 · Cited by 17
“Only adolescent girls were used in this study given the low frequency of eating disorders among adolescent boys (O’Connor, Warren, & Daraganova, 2018; Smink et al., 2014).”
Method
Ketamine ameliorates activity-based anorexia of adolescent female mice through changes in GluN2B-containing NMDA receptors at postsynaptic cytoplasmic locations of pyramidal neurons and interneurons of medial prefrontal cortex
Li, J., Temizer, R., Chen, Y.-W., & Aoki, C. J. (2024) · Brain Structure and Function · doi:10.1007/s00429-023-02740-w · Cited by 13
“AN is experienced by approximately 1% of females, and is reported to occur once or more in a lifetime of as many as 3.6% of females (Hudson et al. 2007; Keski-Rahkonen et al. 2007; Smink et al. 2014; van Eeden et al. 2021).”
Influential
Effortful control as a moderator in the association between punishment and reward sensitivity and eating styles in adolescent boys and girls
Matton, A., Goossens, L., Vervaet, M., & Braet, C. (2017) · Appetite · doi:10.1016/j.appet.2017.01.002 · Cited by 15
Prevalence and correlates of eating disorders in greek-cypriot adolescents and young adults
Koushiou, M., Nikolaou, P., & Karekla, M. (2020) · The European Journal of Counselling Psychology · doi:10.5964/ejcop.v8i1.170 · Cited by 15
Renal Function in Patients Hospitalized With Anorexia Nervosa Undergoing Refeeding: Findings From the Study of Refeeding to Optimize Inpatient Gains
Downey, A. E., Cheng, J., Adams, S. H., Buckelew, S. M., Kapphahn, C. J., Machen, V. I., Rosen, E. L., Moscicki, A., Golden, N. H., & Garber, A. K. (2022) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2022.04.017 · Cited by 16
Daily Laboratory Monitoring is of Poor Health Care Value in Adolescents Acutely Hospitalized for Eating Disorders
Ridout, K. K., Kole, J., Fitzgerald, K. L., Ridout, S. J., Donaldson, A. A., & Alverson, B. K. (2016) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2016.03.015 · Cited by 15
The Occurrence and Covariation of Binge Eating and Compensatory Behaviors Across Early to Mid-Adolescence
Davis, H. A., Ortiz, A. M. L., & Smith, G. T. (2018) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsx113 · Cited by 14
The Lifetime Prevalence of Non‐Suicidal Self‐Injury in Children and Adolescents With Eating Disorders—A Systematic Review and Meta‐Analysis
Meier, M., Jansen, K., Vertgewall, H., & Claes, L. (2024) · European Eating Disorders Review · doi:10.1002/erv.3158 · Cited by 16
“…of 19, 5.7% of girls and 1.2% of boys had met criteria for an ED diagnosis according to the fifth edition of the Diagnostic and Statistical Manual (DSM‐5; American Psychiatric Association 2013), such as anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED; Smink et al. 2014).”
Influential
Junior athletes’ nutritional demands: a narrative review of consumption and prevalence of eating disorders
Amawi, A. T., Khataybeh, B., Aqaili, R. A., Ababneh, N., Alnimer, L., Qoqazeh, A., Oukal, F., Jahrami, H., Ay, K. M., Saoud, H. A., et al. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1390204 · Cited by 26
“…and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11), anorexia nervosa (AN), bulimia nervosa (BN), restrictive eating disorder, and binge-eating disorder (BED) are some classifications of what are known as eating disorders (EDs) (132–134).”
Background
Group Qigong for Adolescent Inpatients with Anorexia Nervosa: Incentives and Barriers
Gueguen, J., Piot, M., Orri, M., Gutierre, A., Moan, J. L., Berthoz, S., Falissard, B., & Godart, N. T. (2017) · PLoS ONE · doi:10.1371/journal.pone.0170885 · Cited by 14
“Prevalence estimates among adolescents from the most recent epidemiological studies range from 0.3% [14] and 0.5% [15] to 1.7% [16].”
Influential
Activity-Based Anorexia, an Animal Model of Anorexia Nervosa for Investigating Brain Plasticity Underlying the Gain of Resilience
Aoki, C. J. (2020) · Neuromethods · doi:10.1007/978-1-0716-0924-8_15 · Cited by 13
Problem gambling during Covid-19
Frisone, F., Alibrandi, A., & Settineri, S. (2020) · Mediterranean Journal of Clinical Psychology · doi:10.6092/2282-1619/mjcp-2457 · Cited by 30
Temperament in preadolescence is associated with weight and eating pathology in young adulthood
van Eeden, A. E., Hoek, H. W., van Hoeken, D., Deen, M. L., & Oldehinkel, A. J. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23241 · Cited by 14
“For a detailed discussion of the cohort, see Smink et al. (2014).”
BackgroundSelf-citation
Disordered eating and self-harm as risk factors for poorer mental health during the COVID-19 pandemic: A UK-based birth cohort studyPreprint
Warne, N., Heron, J., Mars, B., Kwong, A. S. F., Solmi, F., Pearson, R. M., Moran, P., & Bould, H. (2021) · medRxiv · doi:10.1101/2021.04.30.21256377 · Cited by 14
GABAergic interneurons’ feedback inhibition of dorsal raphe-projecting pyramidal neurons of the medial prefrontal cortex suppresses feeding of adolescent female mice undergoing activity-based anorexia
Du, M., Santiago, A. N., Akiz, C., & Aoki, C. J. (2022) · Brain Structure and Function · doi:10.1007/s00429-022-02507-9 · Cited by 12
Childhood behavioral inhibition and overcontrol: Relationships with cognitive functioning, error monitoring, anxiety and obsessive-compulsive symptoms
Gilbert, K., Sudit, E. S., Fox, N. A., Barch, D. M., & Luby, J. L. (2022) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-022-00953-x · Cited by 16
“, 2019) and in psychiatric disorders of overcontrol (Smink et al., 2014; Taylor, 2011).”
BackgroundResult
The Relationship and Effects of Self-Esteem and Body Shape on Eating Disorder Behavior: A Cross-Sectional Survey of Chinese University Students
Gao, Z., Zhao, J., Peng, S., & Yuan, H. (2024) · Healthcare · doi:10.3390/healthcare12101034 · Cited by 19
“…prevalence of ED behaviors among individuals of different genders, and varying demographic characteristics pose a risk to physical and mental health in China [12,23,25,31]. different genders, and varying demographic characteristics pose a risk to physical and mental health in China [12,23,25,31].”
Background
Behavioural eating disorders
Lewis, B., & Nicholls, D. (2016) · Paediatrics and Child Health · doi:10.1016/j.paed.2016.08.005 · Cited by 13
A comparison of eating disorder symptomatology, psychological distress and psychosocial function between early, typical and later onset anorexia nervosa
Jenkins, Z., Chait, L. M., Cistullo, L. L., & Castle, D. J. (2020) · Journal of Eating Disorders · doi:10.1186/s40337-020-00337-w · Cited by 13
Effects of night eating and binge eating disorders on general health in university students in Lebanon
Ayoubi, L. M. E., Ltaif, D. A., Masri, J. E., & Salameh, P. (2022) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-021-02904-9 · Cited by 13
“This approves other studies where the same gender-based BED occurrence difference was seen [18].”
Result
Contribution of Hedonic Hunger and Binge Eating to Childhood Obesity
Fox, C. K., Northrop, E. F., Rudser, K. D., Ryder, J. R., Kelly, A. S., Bensignor, M. O., Bomberg, E. M., Bramante, C. T., & Gross, A. C. (2021) · Childhood Obesity · doi:10.1089/chi.2020.0177 · Cited by 19
“11,12 Among youth with high body weight, rates of binge eating disorder and subthreshold binge eating have been reported to be higher—at 7%.”
Antipsychotic effects on anthropometric outcomes in anorexia nervosa: a retrospective chart review of hospitalized children and adolescents
Frank, B., Arnold, S., Jaite, C., & Correll, C. U. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00862-4 · Cited by 13
“Anorexia nervosa (AN) is a severe mental illness that affects mostly females [1–3], has typically an adolescent-onset [2, 4], and has one of the highest mortality rates among psychiatric diseases [5, 6].”
Background
Autonomic nervous system function in women with anorexia nervosa
Jenkins, Z., Castle, D. J., Eikelis, N., Phillipou, A., Lambert, G. W., & Lambert, É. (2021) · Clinical Autonomic Research · doi:10.1007/s10286-021-00836-z · Cited by 13
Eating Disorders in Children and Adolescent Males: A Peculiar Psychopathological Profile
Riva, A., Pigni, M., Albanese, N. D., Falbo, M., Guardo, S. D., Brasola, E., Biso, F., & Nacinovich, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811449 · Cited by 13
“7% among females [26], with BED the most common diagnosis [26].”
Background
Cognitive flexibility and DSM-5 severity criteria for eating disorders: assessing drive for thinness and duration of illness as alternative severity variables
Mora‐Maltas, B., Lucas, I., Granero, R., Vintró‐Alcaraz, C., Miranda‐Olivos, R., Baenas, I., Sánchez, I., Toro, J. J., Sánchez‐González, J., Krug, I., et al. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00875-z · Cited by 14
Sub-threshold mental illness in adolescents: within and beyond DSM’s boundaries
Shah, J. L. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1015-4 · Cited by 11
Do emotion regulation difficulties when upset influence the association between dietary restraint and weight gain among college students?
Hunt, T. K., Forbush, K. T., Hagan, K. E., & Chapa, D. A. N. (2017) · Appetite · doi:10.1016/j.appet.2017.03.029 · Cited by 12
Disordered Eating: The Young Male Side
Ammann, S., Berchtold, A., Barrense‐Dias, Y., Akré, C., & Surı́s, J.-C. (2017) · Behavioral Medicine · doi:10.1080/08964289.2017.1341383 · Cited by 12
Deutschsprachige Präventionsprogramme für Essstörungen – Ein systematisches Review
Pickhardt, M., Adametz, L., Richter, F., Strauss, B. M., & Berger, U. (2018) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/s-0043-124766 · Cited by 12
“[2] Smink FRE, van Hoeken D, Oldehinkel AJ et al.”
Factors predicting disordered eating and the prevalence of eating disorders in adolescent elite athletes, trained athletes and a reference group: a prospective controlled two-step study
Sundgot-Borgen, C., Sundgot-Borgen, J. K., Sølvberg, N., Torstveit, M. K., Mountjoy, M. L., & Mathisen, T. F. (2025) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108808 · Cited by 14

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.
ORCID: Oldehinkel, Albertine J.
Hoek, Hans W.
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
DOI: 10.1002/eat.22316
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
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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Prevalence and severity of DSM‐5 eating disorders in a community cohort of adolescents

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