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An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents.
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The authors examined the natural history of threshold, subthreshold, and partial eating disorders in a community sample of 496 adolescent girls who completed annual diagnostic interviews over an 8-year period. Lifetime prevalence by age 20 years was 0.6% and 0.6% for threshold and subthreshold anorexia nervosa (AN), 1.6% and 6.1% for threshold and subthreshold bulimia nervosa (BN), 1.0% and 4.6% for threshold and subthreshold binge-eating disorder (BED), and 4.4% for purging disorder (PD). Overall, 12% of adolescents experienced some form of eating disorder. Subthreshold BN and BED and threshold PD were associated with elevated treatment, impairment, and distress. Peak age of onset was 17-18 years for BN and BED and 18-20 years for PD. Average episode duration in months was 3.9 for BN and BED and 5.1 for PD. One-year recovery rates ranged from 91% to 96%. Relapse rates were 41% for BN, 33% for BED, and 5% for PD. For BN and BED, subthreshold cases often progressed to threshold cases and diagnostic crossover was most likely for these disorders. Results suggest that subthreshold eating disorders are more prevalent than threshold eating disorders and are associated with marked impairment.
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“Threshold and subthreshold eating disorder diagnoses have shown 1-wk test–retest reliability ( .96) and inter-rater agreement ( .86) and are associated with elevated mental health treatment, distress, and functional impairment (Stice et al., 2009).”
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Disguised Distress in Children and Adolescents “Flying Under The Radar”
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MethodLoss of control eating in adolescents from the community
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“The literature on OBC in adults is robust; however, eating pathology typically emerges during adolescence (e.g., Allen et al., 2013; Stice et al., 2009; Striegel-Moore & Bulik, 2007).”
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“Gender Eating disorders and sub-clinical eating disturbances typically emerge in adolescence, affect up to 12 % of girls and young women (e.g., Machado et al. 2007; Smink et al. 2012; Stice et al. 2009), and carry substantial risks for morbidity, disability, and premature mortality (e.”
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“PD does not appear to differ in remission rates compared to other diagnoses [20-22], and studies of the persistence of symptoms present a varied picture [21-23].”
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“This is probably due to the fact that greater knowledge of the disease and its high mortality rate compared to other mental diseases [68–71] has generated a greater capacity for detection, changes in clinical practice with the appearance of specialized services [72], and the greater social relevance of the problem [3,…”
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“The fact that change in thin-ideal internalization partially mediated the effects of this intervention on change in eating disorder symptoms prompted Stice et al. (2007) to suggest that body dissatisfaction may also play a role in mediating the effects of the intervention on symptom reduction.”
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Stice, E. M., Rohde, P., Gau, J. M., & Shaw, H. E. (2011) · Prevention Science · doi:10.1007/s11121-011-0251-4 · Cited by 62
“Moderators Over 10% of young women experience an eating disorder, which are marked by functional impairment, health problems, health service utilization, and increased risk for obesity, psychiatric comorbidity, suicide, and mortality (Crow et al. 2009; Stice et al. 2009a; Wilson et al. 2003).”
BackgroundInfluentialSelf-citationRiesco, 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
“However, they are not in accordance with others presenting recovery rates of 91% for sub-BN and 95% for PD [41].”
ResultKusina, J. R., & Exline, J. J. (2019) · Adolescent Research Review · doi:10.1007/s40894-019-00121-1 · Cited by 73
Forbush, K. T., South, S. C., Krueger, R. F., Iacono, W. G., Clark, L. A., Keel, P. K., Legrand, L. N., & Watson, D. (2010) · Journal of Abnormal Psychology · doi:10.1037/a0019189 · Cited by 65
“(Favaro, Ferrara, & Santonastaso, 2003; Hudson et al., 2007; Isomaa, Isomaa, Marttunen, Kaltiala-Heino, & Björkqvist, 2009; Stice et al., 2009; Wade, Bergin, Tiggemann, Bulik, & Fairburn, 2006).”
The association between alexithymia and eating behavior in children and adolescents
Shank, L. M., Tanofsky‐Kraff, M., Kelly, N. R., Jaramillo, M., Rubin, A., Altman, D. R., Byrne, M. E., LeMay‐Russell, S., Schvey, N. A., Broadney, M. M., et al. (2019) · Appetite · doi:10.1016/j.appet.2019.104381 · Cited by 59
Philipp, J., Zeiler, M. D., Waldherr, K., Truttmann, S., Dür, W., Karwautz, A. F. K., & Wagner, G. (2018) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-018-1586-y · Cited by 58
Verschueren, M., Claes, L., Bogaerts, A., Palmeroni, N., Gandhi, A., Moons, P., & Luyckx, K. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00816 · Cited by 58
“These findings support previous research that found an increase in bulimic symptoms throughout mid- to late adolescence in high school girls and described late adolescence as the most at-risk age group for developing bulimia nervosa (Stice et al., 2009; Abebe et al., 2012).”
ResultMediators linking insecure attachment to eating symptoms: A systematic review and meta-analysis
Cortés-García, L., Takkouche, B., Seoane, G., & Senra, C. (2019) · PLoS ONE · doi:10.1371/journal.pone.0213099 · Cited by 50
Executive functioning and behavioral impulsivity of young women who binge eat
Kelly, N. R., Bulik, C. M., & Mazzeo, S. E. (2013) · International Journal of Eating Disorders · doi:10.1002/eat.22096 · Cited by 60
“It is also important for clinicians and researchers to be aware of the association between negative urgency and treatment dropout among patients with EDs.42 Finally, in consideration of the binge eating group’s average CES-D score, it is important that clinicians treating binge eating also assess and address clinicall…”
BackgroundInfluentialRichter, F., Strauss, B. M., Brähler, E., Altmann, U., & Berger, U. (2016) · Eating Behaviors · doi:10.1016/j.eatbeh.2016.03.006 · Cited by 57
Low Self-Esteem as a Risk Factor for Eating Disorders: A Meta-Analysis
Colmsee, I.-S. O., Hank, P., & Bošnjak, M. (2021) · Zeitschrift für Psychologie · doi:10.1027/2151-2604/a000433 · Cited by 68
The Economic Effect of Planet Health on Preventing Bulimia Nervosa
Wang, L. Y. (2011) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpediatrics.2011.105 · Cited by 56
Richter, F., Strauss, B. M., Brähler, E., Adametz, L., & Berger, U. (2016) · Eating Behaviors · doi:10.1016/j.eatbeh.2016.06.022 · Cited by 57
Body image and adolescence: A behavioral impairment model
Senín‐Calderón, C., Testal, J. F. R., Garcelán, S. P., & Perpiñá, C. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.12.003 · Cited by 68
Bryant‐Waugh, R., & Watkins, B. (2015) · Wiley eBooks · doi:10.1002/9781118381953.ch71 · Cited by 57
Grillot, C. L., & Keel, P. K. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22965 · Cited by 55
Eating disorder symptoms and comorbid psychopathology among male and female veterans
Litwack, S. D., Mitchell, K. S., Sloan, D. M., Reardon, A. F., & Miller, M. W. (2014) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2014.03.013 · Cited by 53
“, PTSD), have found significant contributions to overall impairment, even when controlling for the impact of comorbid conditions [36,37].”
BackgroundTurner, B. J., Yiu, A., Layden, B. K., Claes, L., Zaitsoff, S. L., & Chapman, A. L. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.09.002 · Cited by 53
Burger, K. S., Sanders, A. J., & Gilbert, J. R. (2016) · Journal of Nutrition · doi:10.3945/jn.116.231431 · Cited by 52
Treatment seeking for eating disorders: Results from a nationally representative study
Bohrer, B. K., Carroll, I. A., Forbush, K. T., & Chen, P. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22785 · Cited by 49
Ackard, D. M., Fulkerson, J. A., & Neumark‐Sztainer, D. (2011) · Eating Disorders · doi:10.1080/10640266.2011.584804 · Cited by 50
“The current study used data from a large, population-based study of male and female adolescents to evaluate the stability of eating disorder classifications over a peak period of eating disorder development (Stice et al., 2009).”
BackgroundMethodResultInfluentialDevelopmental antecedents of abnormal eating attitudes and behaviors in adolescence
Grange, D. L., O’Connor, M., Hughes, E. K., Macdonald, J. A., Little, K., & Olsson, C. A. (2014) · International Journal of Eating Disorders · doi:10.1002/eat.22331 · Cited by 50
“Abnormal eating attitudes and behaviors may indicate the presence of an eating disorder or be a precursor to the development of an eating disorder or, in some cases, another diagnosis.(1,9,10) To date, most etiologic research has focused on prediction of full threshold eating disorders.”
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
A review of the definitions of outcome used in the treatment of bulimia nervosa
Williams, S. E., Watts, T. K. O., & Wade, T. D. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.01.006 · Cited by 50
Metadata
- Authors
- Stice, E., Marti, C. N., Shaw, H., & Jaconis, M.
- Affiliations
- The University of Texas at Austin (US)
- Venue
- Journal of Abnormal Psychology
- Published
- 2009-08
- Volume
- 118
- Issue
- 3
- Pages
- 587-597
- ISSN
- 0021-843X (ISSN-L)
- 1939-1846
- PMC
- PMC2849679
- OpenAlex
- W2041413968
- Cited by
- 529
- References
- 60
- Citations by year
- 2026: 17 · 2025: 20 · 2024: 28 · 2023: 31 · 2022: 33 · 2021: 68 · 2020: 35 · 2019: 26 · 2018: 22 · 2017: 26 · 2016: 34 · 2015: 39 · 2014: 34 · 2013: 44 · 2012: 27
- FWCI
- 24.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Abnormal Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (MH01708; MH/DK61957)
- 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, subthreshold eating disorders, anorexia nervosa, bulimia nervosa, binge eating disorder, purging disorder, adolescents, natural history (disease), prevalence, age of onset, episode duration, relapse, recovery, community sample
- MeSH terms
- Adolescent, Anorexia Nervosa, Child, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Personality Inventory, Psychometrics, Recurrence, Remission, Spontaneous, United States, Incidence, Disease Progression, Bulimia Nervosa, Young Adult
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