Incidence Of Anorexia Nervosa Research Articles

A1Interactive simulation training course for professionals working with children and adolescents with eating disorders

Research suggests that eating disorders (ED) in children and adolescents are on the rise [1]. One study found that the incidence of anorexia nervosa in young girls aged 10–14 years increased by 50% between 1980 and 2000 [2]. Another study reported a 119% increase in the number of hospitalizations for eating disorders in children aged 12 and under between 1999 and 2006 [3]. These statistics highlight the urgent need for improved prevention, early intervention and treatment of eating disorders in young people. This 1-day interactive simulation training course is designed to enhance the knowledge, confidence and skills of medical doctors, psychiatrists, RMNs, physical health nurses, dieticians, general practitioners and family therapists who are working with children and young people (CYP) with eating disorders. This 1-day simulation course was delivered online. The course focuses on the assessment and management of CYP with ED, understanding the challenges faced by professionals in engaging CYP with ED in different settings, thinking about dynamics within family systems and in wider systems, and gaining a better understanding of capacity, consent and other conundrums. The course includes simulated scenarios played by trained actors to support the development of effective communication skills and Maudsley debrief model is employed to give participants feedback on their contributions and assist them in learning positively and constructively from their experience. Participants completed a pre- and post-course questionnaire measuring their confidence in course-specific skills and human factors skills, as well as collecting qualitative feedback on their experience of the course and intention to apply the learning. Participants were asked to complete a pre-course and post-course questionnaire rating their knowledge, confidence and skills related to working with patients with eating disorders. Paired samples The course was effective at improving participants’ knowledge, confidence and skills in working with CYP with ED. The participants found the course useful for their clinical practice. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Increase in incidence of anorexia nervosa among 10- to 14-year-old girls: A nationwide study in the Netherlands over four decades.

This primary care study examined time trends in the incidence of anorexia nervosa (AN) and bulimia nervosa (BN) in the Netherlands across four decades. A nationwide network of general practitioners, serving approximately 1% of the total Dutch population, recorded newly diagnosed patients with AN and BN in their practices from 1985 to 2019 (2,890,978 person-years). DSM-IV diagnostic criteria were consistently used and the same psychiatrist was responsible for the final diagnostic decision. Incidence rates (IRs) were calculated for: the total population (all ages), females overall, and females per 5-year age category. Time trends in IRs were analyzed using JoinPoint regression analyses. In four decades, the incidence of AN among 10- to 14-year-old females increased significantly from 8.6 to 38.6 per 100,000 person-years (average period percentage change [APPC] = 56.7; 95% confidence interval [CI] = 6.5-130.6. The overall incidence of AN was stable, with IRs ranging from 6.0 (95% CI = 4.3-8.1) to 8.4 (95% CI = 6.4-10.8). The IR of BN decreased significantly from 8.7 (95% CI = 6.7-11.0) to 3.2 (95% CI = 2.0-4.9) in the 2000s, before leveling off in the 2010s (IR 3.2; 95% CI = 2.0-4.8). The incidence of AN among 10- to 14-year-old girls increased significantly over four decades. Both biological and sociocultural factors, for example, early pubertal timing and the impact of social media, might explain this. In other age groups and overall, the incidence of AN remained stable. The significant decrease of the incidence of BN in the previous decades halted in the last decade. An important finding of the present study is that for 10- to 14-year-old girls, the risk for developing anorexia nervosa has increased significantly over 40 years. More healthcare facilities for younger people are needed, and prevention programs could include social media use. For bulimia nervosa, the general decrease in the occurrence of new cases has halted in the 2010s.

Sleep and emotionality in adolescents with anorexia nervosa during the Covid-19 pandemic.

The recent Covid-19 pandemic and its lockdown measures raised concerns about people's mental health, leading to an increased interest in identifying vulnerable groups especially at risk for mental distress. This cross-sectional study investigated the impact of this unprecedented situation on sleeping patterns and emotionality in adolescents with anorexia nervosa (AN). Variations in sleeping patterns and emotionality of two groups of adolescents with AN, assessed before (N=50) and during (N=51) the Covid-19 lockdown were analysed. We further investigated these variations over time, considering the two lockdown periods in France. Adolescents self-reported significantly more sleep difficulties and lower rates of positive emotions during lockdown, compared to those evaluated before it. Furthermore, present findings overall suggest that as the lockdown progresses, adolescents with AN show an increased deterioration of sleep quality, as indicated by greater insomnia severity levels. They also show a significant decrease in the subjective experience of positive emotionality, in particular in feelings of tenderness. These sleep and emotionality alterations may have amplified the severity and the incidence of AN in adolescents during the Covid-19 pandemic. These features may therefore represent therapeutic targets to optimise care of adolescents with AN. This is particularly urgent, considering kinetics of the deterioration. Tools such as those provided by cognitive behavioural therapy for insomnia and by the positive psychology framework seem appropriate to guide clinicians in this context. Level V, descriptive study (evaluation data retrospectively studied).

The evolving epidemiology and differential etiopathogenesis of eating disorders: implications for prevention and treatment.

The evolving epidemiology and differential etiopathogenesis of eating disorders: implications for prevention and treatment.

Review Nutritional interventions during adolescence and their possible effects.

Nutrition is one of the most important factors affecting pubertal development. Increasing demands for energy proteins and micronutrients are necessary to cope with the rapid linear pubertal growth and development, change in body composition, and increased physical activity. Adequate nutrition is a key permissive factor for the normal timing and tempo of pubertal development. Severe primary or secondary malnutrition also can adversely delay the onset and progression of puberty. The higher incidence of anorexia nervosa and bulimia in adolescents imposes a nutritional risk on pubertal development. Here we provide an overview of nutritional requirements (macronutrients and micronutrients) necessary to cope with these changes. In addition, we discuss possible nutritional interventions trials and their effects on several aspects of growth and development in undernourished and stunted adolescents, in low- and middle-income countries (LMIC), who require nutritional rehabilitation. This mini review sums up some important findings in this important complex that link between nutrition, nutritional interventions, and pubertal development. (www.actabiomedica.it)

The effect of group cognitive behavior therapy on Chinese patients with anorexia nervosa: an open label trial

BackgroundThe high cost of treatment for anorexia nervosa (AN) and lack of trained specialists have resulted in limited accessibility of effective treatment to patients with AN, which is particularly problematic in China. To increase the accessibility of evidence-based treatment and reduce the cost of treatment, this study aimed to explore the feasibility and efficacy of group cognitive behavior therapy (G-CBT) adapted from enhanced cognitive behavior therapy for eating disorders (CBT-E) in Chinese AN patients.MethodA total of 78 patients with AN were assigned to G-CBT or individual outpatient treatment (IOT) and received three months of treatment for AN in each condition. Measures of eating pathology, depression and anxiety were administrated to both intervention groups at three time points: baseline, one month of treatment, and end of treatment; results were compared between groups and over time.ResultsThere were 70 participants included in the final analysis. Both G-CBT and IOT groups showed significant improvement in eating pathology and associated psychopathology (ps < .001) over the course of treatment, but no significant difference in symptom improvement was found between the two groups (ps > .05). G-CBT resulted in additional significant improvement in ED psychopathology over the last two months of treatment, and its overall therapeutic effect was influenced by baseline weight and early symptom improvement.ConclusionPreliminary findings from this open label trial suggest that G-CBT adapted from CBT-E is feasible in an outpatient setting and as effective as IOT in facilitating weight regain and reducing psychopathology in Chinese AN patients with little evidence for the superiority of either intervention.Trial registration: The current study was registered at clinical trials.gov on September 23, 2018 (registration number NCT03684239).Plain English summaryPeople with anorexia nervosa (AN) are known to be unmotivated for treatment and prone to relapse. Recovery from AN often needs intensive, long-term treatment from a specialized multidisciplinary team, which is not accessible for most people in China. Given the increasing incidence of AN and lack of eating disorder (ED) specialists in China, it is important to develop short-term cost-effective treatments for AN. In this study, we explored the feasibility and efficacy of group cognitive behavior therapy (G-CBT) adapted from enhanced cognitive behavior therapy (CBT-E) for people with AN from China. We found that G-CBT was as effective as individual outpatient treatment (IOT) typically provided to AN patients at the research site in facilitating weight regain, improving eating behaviors, and reducing ED and other symptoms. We also found that patients receiving G-CBT made more improvements in cognitive symptoms of the ED, which might help maintain treatment gains and prevent relapse in the long run. This potential long-term advantage of G-CBT needs to be verified in long-term follow-up.

A comparison of eating disorder symptomatology, psychological distress and psychosocial function between early, typical and later onset anorexia nervosa

ObjectiveEpidemiological studies suggest that the incidence of anorexia nervosa (AN) is increasing in younger populations, with some evidence that clinical differences occur according to age of onset (AOO), which may impact prognostic outcomes. The current study sought to compare eating disorder (ED) symptomatology, psychological distress and psychosocial function between early onset (EO), typical onset (TO) and later onset (LO) AN in a large sample of treatment-seeking patients with a diagnosis of AN.MethodsParticipants included 249 individuals with a diagnosis of AN who were assessed at an outpatient ED service. The sample was divided into three groups based on AOO; those with an AOO ≤14 years (N = 58) were termed ‘EO-AN’, those with an AOO between 15 and 18 years (N = 113) were termed ‘TO-AN’ and those with an AOO of > 18 years (N = 78) were termed ‘LO-AN’. Comparisons were made between AOO groups on assessments of ED symptomatology, psychological distress and psychosocial function.ResultsEO-AN patients reported a significantly longer illness duration than both TO-AN and LO-AN groups. After controlling for effect of illness duration, the EO-AN group demonstrated significantly higher ED symptomatology and dysmorphic concern compared to the LO-AN group. The EO-AN group demonstrated significantly decreased cognitive flexibility compared to both the TO-AN and LO-AN groups.DiscussionThese findings suggest that clinical differences do occur according to AOO in AN whereby EO-AN may represent a more severe form of illness that is not attributable to increased illness duration. Treatment strategies which specifically address patients with EO-AN may improve long term health outcomes and recovery.

Incidence of Anorexia Nervosa in Women: A Systematic Review and Meta-Analysis.

Background: Anorexia nervosa (AN) among the general population is a rare but often fatal illness. Objective: To summarize the incidence of AN using a systematic review and meta-analysis. Methods: Four online databases (PubMed, Scopus, WoS and Embase) were consulted. The review was conducted according to with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was limited to women. The methodological quality of the studies was assessed by the Newcastle–Ottawa Scale (NOS). Results: A total of 31 articles were included in the study. The incidence rate of AN ranged from 0.5 to 318.0 cases per 100,000 women–years. The incidence in studies based on outpatient healthcare services (OHS) was higher than those based on hospital admissions (HA) (8.8 95% CI: 7.83–9.80 vs. 5.0 95% CI: 4.87–5.05). In young women, the incidence in OHS was higher than HA (63.7, 95% CI 61.21–66.12 vs. 8.1 95% CI 7.60–8.53). The linear trend in the incidence of AN was increasing in all ages of women and young women, both in studies with hospital admission records, and in those based on outpatient healthcare services. Conclusion: The incidence of AN depends on the methodology, the type of population and the diagnostic criteria used.

Features of the clinical manifestation of generalized parodontal diseases in patients with anorexia nervosa

Generalized parodontal diseases (GPD) are one of the most common dental diseases, which occupy a significant place in the structure of human diseases, reaching 60–90%. This is due to the complexity of understanding the etio-pathogenetic mechanisms of the development GPD and the high association of them with a number of diseases of the internal organs and systems with common points of contact between interdependence and mutual influence, in particular with anorexia nervosa (AN). Recently, the incidence of AN has increased significantly and poses a serious state, social, psychological and medical problem. There are serious changes on the axis hypothalamus — pituitary — amygdala, genital and thyroid glands, which cause a decrease in thyroid hormone metabolism, cause hypoestrogenia, hypogonadism, secondary hyperparathyroidism due to AN. Objective. To establish the features of the configuration of generalized pаrodontal diseases and their clinical manifestations in the format of basic characteristics of anorexia nervosa statistical methods were used. Objects were 75 patients with GPD, with AN, aged 18–36 years (average age 26 ± 3.8) — the main group (M), and 60 patients with GPD without signs of anorexia of the same age — comparison group (C). For a detailed analysis of the clinical manifestations of GPD in patients with AN, all patients in the main (M) and comparative (C) groups were divided into several subgroups. M1 subgroup — patients with various forms of gingivitis. The M2 subgroup was presented with patients with generalized parodontitis (GP) with AN as the basic pathology. The comparative (C) group consisted of two subgroups (C1), (C2) with different forms of gingivitis and GP, respectively. Results. A high incidence of GPD up to 100% was diagnosed, including both independent parodontal soft tissue disease and all components of the parodontal complex, which had characteristic of all age groups and varied with patient age, duration of AN and its stages. Among the independent forms of gingivitis, the most common was chronic catarrhal marginal gingivitis (86.7 ± 8.8%), with some cases of exacerbation on the background of the overwhelming absence of complaints with single manifestations of aggravation, complexity of psychological alliance. GP was predominantly I–II degree, with chronic course prevailing over other forms of GPD (80 ± 4.6%). Radiographically, in all patients, regardless of the severity of GP, there was an extension of the parodontal cleft and osteoporosis of the bone component of the parodontal complex, horizontal type of resorption. Advantages and priorities of different segments of parodontal complex lesions in patients with AN were not observed. For all patients with GP, a high degree of tissue sensitization to the bone antigen, characterizing significant changes in the bone component of the parodontal complex with AN, was finalized. Conclusion. Thus, direct correlation and interdependence of generalized parodontal diseases in the format of basic characteristics of anorexia nervosa were established.

Time trends in healthcare-detected incidence of anorexia nervosa and bulimia nervosa in the Norwegian National Patient Register (2010-2016).

Few studies have investigated temporal trends in the incidence of eating disorders (EDs). This study investigated time trends in the age- and sex-specific incidence of healthcare-detected anorexia nervosa (AN) and bulimia nervosa (BN) from 2010 to 2016. Data were retrieved from the Norwegian National Patient Register as defined by the International Classification of Diseases (ICD-10): narrowly defined AN (F50.0), broadly defined AN (F50.0 + 50.1), narrowly defined BN (F50.2), and broadly defined BN (F50.2 + 50.3). The average annual percent changes (AAPCs) in incidence rates (IRs) were examined by Joinpoint regression analyses. The overall (i.e., both genders, ages 10-49) rates of AN were stable across the 7-year period, with IRs ranging from 18.8 to 20.4 per 100,000 for narrowly defined AN and 33.2 to 39.5 per 100,000 for broadly defined AN, whereas overall rates of BN declined. Age- and gender-stratification revealed a significant average annual increase in AN (narrow and broad) among 10- to 14-year-old girls. The incidence of broadly defined AN also increased significantly among females aged 15-19 years between 2010 and 2012, before leveling off. Nearly universal declines in the incidence of narrowly and broadly defined BN among females occurred. IRs among males were stable and comparatively low, with no significant trends toward increasing or decreasing rates of AN or BN over time. Although register-based studies provide an underestimate of the true incidence and may not accurately reflect population-level changes in true ED occurrence, this study extends our knowledge regarding trends in the detected incidence of EDs into the second decade of the 21st century.

Eating disorders-Related hospitalizations in Portugal: A nationwide study from 2000 to 2014.

Recent evidence suggests that incidence of Anorexia nervosa (AN) has remained stable over the last decades in Western Europe, while decreasing for Bulimia nervosa (BN). It is well-known that most individuals with an ED (Eating disorder) do not seek medical treatment. The present study analyses hospitalizations related with EDs held in mainland Portuguese public hospitals between 2000 and 2014. A retrospective observational study was performed gathering all inpatient episodes with primary or secondary diagnosis of ED. Number of patients, gender, mean age at discharge, suicide-attempts related hospitalizations, in-hospital mortality, length of stay, and mean charges were analyzed. There were a total of 4,485 hospitalizations with an associated ED. AN was the most frequent ED (n = 2,806). Suicide attempt-related hospitalizations were most common among patients with BN (10.1% of BN hospitalizations) or AN (5.2% of AN hospitalizations). AN has higher in-hospital mortality than BN. We observed a higher proportion of suicide related hospitalizations in BN when compared to AN. Although pica, rumination disorder, and psychogenic vomiting represent a smaller portion of all EDs, this study was the first to describe hospitalization trends for this set of EDs for a 15-year period, to the best of our knowledge.

Prevalence of anorexia nervosa among adolescent girls

Background: Girls tend to be more concerned about their physical appearance than boys during adolescent period. Adolescent girls are more likely to care for losing weight with the fear of being “fat”. Anorexia nervosa (AN), a form of self-starvation, is an eating disorder characterized by a distorted body image that leads to restricted eating and other behavior that prevents a person from gaining weight. It commonly occurs in teenage girls, although boys are also affected, especially in the prepubertal age group. Hence the researcher would like to assess the prevalence of anorexia nervosa among the adolescent nursing students.Objectives: 1. Determine the prevalence of anorexia nervosa among adolescent girls. 2. Find out the association between prevalence and selected demographic variables.Materials and Methods: The study was conducted among 100 B.Sc Nursing 1st year students at selected nursing colleges of Mangalore. The samples were selected by convenience sampling method. After obtaining informed consent and ethical clearance the data was collected by assessing the baseline proforma and Eating attitude Test.Findings: It was found that 31% of the adolescent girls were having high risk to anorexia nervosa and 69% were of no risk, whereas none of them were found consistent with anorexia nervosa. It was noted that all the 31 high risk girls were hostel residents. There was no association found between the risk of anorexia nervosa and the selected demographic variables.Conclusion: Some perceive anorexia as a simple case of vanity taken too far, but rather it is a complex psychological problem. So it is the responsibility of the teachers to create awareness among students by educating about the ill effects of anorexia nervosa which help us to prevent the incidence of anorexia nervosa and lead to healthy adolescents to the society.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.466-470

One-year outcome and incidence of anorexia nervosa and restrictive eating disorders among adolescent girls treated as out-patients in a family-based setting

Aims To study the 1-year outcome and to analyse predictors of outcome of a cohort of adolescent girls with anorexia nervosa (AN) or restrictive eating disorders not otherwise specified (EDNOSr) treated as out-patients in a family-based programme at a specialized eating disorder service. To calculate the incidence of anorexia nervosa among treatment-seeking girls younger than 18 in Uppsala County from 2004 to 2006.Methods A total of 168 female patients were offered treatment, and 141 were followed-up 1 year after starting treatment, 29 with AN and 112 with EDNOSr.Results Of the 29 girls who initially had AN, 6 (20%) had a good outcome and were free of any form of eating disorder at follow-up; only 1 (3%) had AN. Of the patients with EDNOSr, 54 (48%) had a good outcome and were free of eating disorders. Three (3%) had a poor outcome and had developed AN. The incidence of AN was 18/100,000 person-years in girls younger than 12 and 63/100,000 in girls younger than 18.Conclusion Restrictive eating disorders, including AN, in children and adolescents can be successfully treated in a family-based specialized out-patient service without in-patient care.

Three decades of eating disorders in Dutch primary care: decreasing incidence of bulimia nervosa but not of anorexia nervosa.

Whether the incidence of eating disorders in Western, industrialized countries has changed over time has been the subject of much debate. The purpose of this primary-care study was to examine changes in the incidence of eating disorders in The Netherlands during the 1980s, 1990s and 2000s. A nationwide network of general practitioners (GPs), serving a representative sample (~1%) of the total Dutch population, recorded newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) in their practice during 1985-1989, 1995-1999, and 2005-2009. GPs are key players in the Dutch healthcare system, as their written referral is mandatory in order to get access to specialized (mental) healthcare, covered by health insurance. Health insurance is virtually universal in The Netherlands (99% of the population). A substantial number of GPs participated in all three study periods, during which the same case identification criteria were used and the same psychiatrist was responsible for making the final diagnoses. Incidence rates were calculated and for comparison between periods, incidence rate ratios. The overall incidence rate of BN decreased significantly in the past three decades (from 8.6 per 100,000 person-years in 1985-1989 to 6.1 in 1995-1999, and 3.2 in 2005-2009). The overall incidence of AN remained fairly stable during three decades, i.e. 7.4 per 100,000 person-years in 1985-1989, 7.8 in 1995-1999, and 6.0 in 2005-2009. The incidence rate of BN decreased significantly over the past three decades, while the overall incidence rate of AN remained stable.

Sex- and age-specific incidence of healthcare-register-recorded eating disorders in the complete swedish 1979-2001 birth cohort.

To investigate the sex- and age-specific incidence of healthcare-register-recorded anorexia nervosa (AN) and other eating disorders (OED) in a complete birth cohort, and assess whether incidence varies by diagnostic period and (sub-) birth cohort. We used the actuarial method and Poisson models to examine the incidence of AN and OED from 1987 to 2009 (when individuals were 8-30 years old) for a cohort of 2.3 million individuals (48.7% female) born from 1979 to 2001 in Sweden, identified using Swedish registers. For both sexes, incidences of AN and OED increased considerably for diagnostic periods after 2000, but differed little by birth cohort. In 2009, AN incidence in the peak age category was 205.9 cases/100,000 persons (95% CI: 178.2, 233.5) for females (14-15 years), versus 12.8 cases/100,000 (95% CI: 5.6, 20.1) for males (12-13 years). OED incidence in the peak age category was 372.1 cases/100,000 (95% CI: 336.4, 407.9) for females (16-17 years), versus 22.2 cases/100,000 (95% CI: 13.3, 31.1) for males (14-15 years). Our finding of an increase in healthcare-register-recorded eating disorders for diagnostic periods after 2000 likely reflects improved detection and expanded register coverage in Sweden. The peak of eating disorder incidence in adolescence, which began unexpectedly early for AN in males, suggests the importance of vigilance for signs of AN in young boys and early primary prevention efforts. Waiting until later could miss critical windows for intervention that could prevent disorders from taking root.

Time trends in lifetime incidence rates of first-time diagnosed anorexia nervosa and bulimia nervosa across 16 years in a Danish nationwide psychiatric registry study.

To study recent time trends in the incidence of diagnosed anorexia nervosa (AN) and bulimia nervosa (BN) based on nationwide psychiatric register data. The Danish Psychiatric Central Research Registry was used to identify the incidence of diagnosed cases with AN and BN at the ages of 4-65 years from 1995 to 2010. Age- and sex-adjusted incidence rates per 100,000 person-years were calculated and were adjusted for time trends in the total number of people diagnosed in psychiatry. Time trends were analyzed using JoinPoint regression analysis. A total of N = 5,902 persons had a first-time incidence of AN, and a total of N = 5,113 had first-time incidence of BN. Incidence rates increased for AN from 6.4 to 12.6 per 100,000 person-years, and for BN from 6.3 to 7.2 per 100,000 person-years. In 2010, the male-to-female ratio was 1:8 for AN, and 1:20 for BN. There was an earlier onset for AN than for BN, and age at incidence decreased during the observation period for AN but not for BN. A sizeable part of the increasing incidence rates for AN and in particular, the younger AN age groups, could be attributed to an increase in the total number of N = 249,607 persons with first-time diagnoses in psychiatry. Incidence rates had increased slightly for AN, but were stable for BN across 16 years in this nationwide study and to a large extent were reflective of a general increase in diagnosed mental disorders.

Girls Growing Up: A Feasibility and Acceptability Study to Explore the Antecedents of Anorexia Nervosa in Girls Aged 7 to 17

Abstract Objective: Prospective longitudinal research into the antecedents of anorexia nervosa (AN) is required to identify targets for prevention, early detection and treatment. Such research is hampered by the low natural incidence of AN, and the ethical complexities of research with children. A number of risk factors have been identified, but the relationship between these and the development and maintenance of AN remains unclear. To date, prospective studies have had insufficient power to differentiate risk factors from consequences of AN. The proposed “Girls Growing Up: The Antecedents of Anorexia Nervosa” study aims to identify predictors of AN and protective factors by prospectively tracking the progress of healthy genetically high risk individuals and controls. A proposed pilot study will first discover whether a series of likely physical and psychometric measures are acceptable to subjects and their families and will additionally assess whether high risk and control subjects differ at baseline on any of these measures. The present study assesses the feasibility and acceptability of the proposed research protocol by use of buzz-groups to ascertain perceptions, opinions and ideas of potential recruits. Method: Seven buzz-groups (focus groups) were held with schoolgirls aged seven to 17, parents and teachers recruited from a co-educational school. The proposed protocol was presented as a narrated storyboard demonstrating an example research day of a fictional study participant. Group discussions were audio-recorded, transcribed and analysed in terms of study location, acceptability of measurements, recruitment and retention. Results: The proposed protocol was broadly acceptable to all participants. Participants provided collaborative input to the study design, including: a strong preference for female researchers; discussion about the acceptability of proposed physical and psychosocial measures; a preference for a choice of study location; the suggestion of provision of a detailed timetable to reduce anxiety; and agreement that it is appropriate to advertise to parents of under-12s, but to 12 to 17 year olds in their own right. They also renamed the study and suggested means of recruitment. Conclusion: The proposed methodology was deemed acceptable to the target group. Buzz-groups proved invaluable in exploring opinions, influencing the proposed research protocol and highlighting the value of involvement of potential participants in preparatory stages of research, particularly into the sensitive field of eating disorders.

The incidence of eating disorders in the UK in 2000–2009: findings from the General Practice Research Database

ObjectivesFew studies have investigated the incidence of eating disorders (EDs). Important questions about changes in the incidence of diagnosed disorders in recent years, disorder and gender-specific onset and case detection...

Épidémiologie de l’anorexie mentale : revue de la littérature

A critical review of the literature was conducted to provide answers to three questions: firstly, are we facing a national and/or international epidemic of anorexia nervosa (AN) as claimed in the media by certain professionals? Secondly, is AN simply an ordinary crisis of adolescence? Thirdly, is it a pathology that solely affects the higher socio-professional categories?A Medline search was conducted and backed up by a manual search to find all the studies or literature reviews published on prevalence, incidence rates, outcomes, morbidity and mortality in AN and its links with social class, covering the period 2000-2011.The differing methodologies of the studies on these themes have a considerable impact on the interpretation of results. For each indicator retained, the results observed in the different studies are detailed and commented in the light of these differences. The prevalence of AN in women aged 11 to 65 in non-clinical population ranges from 0 to 2.2 %. It varies in particular with the age of the studied subjects, the measurements used, and the definition criteria for AN. Among men, the lifetime prevalence is around 0.3%. The marked disparities in incidence rates observed are related to the nature of the samples considered: subjects consulting in hospital, whether in a specialised department or in any department, those consulting general practitioners (GPs), or subjects from general population samples recruited in different surveys (girls in schools for example). The incidence of female cases is low in general medicine or specialised consultation in town (whatever the speciality): from 4.2 and 8.3/100,000 individuals per year. It is much higher in the general population, ranging from 109 to 270/100,000 individuals per year. In fact, the studies reporting variations in the incidence of AN were conducted on samples from clinical populations in certain countries (United States and United Kingdom). They are probably more a reflection of variations in detection rates and use of healthcare, than of variations in the incidence in the general population. The mean duration of AN appears shorter in the general population than in clinical populations. On average, 47% of the individuals treated for AN recovered, 34% improved, 21% had a chronic eating disorder, and 5% died. The outcome is better for subjects treated during adolescence. Mortality is frequently expressed in crude mortality rate (CMR), which is not very informative on account of the heterogeneous natures of the cohorts followed; only the studies reporting standardised mortality rate (SMR) are informative. AN appears as having one of the highest mortality rates among psychiatric pathologies. Mortality varies according to the population considered. Rates observed are 6.2 to 10.6 times greater than that observed in the general population for a follow-up duration ranging respectively from 13 to 10 years. It is lower for longer follow-up periods, only 3.7 times more frequent than in the general population for follow-up periods of 20 to 40 years. It appears lower for subjects treated before the age of 20. The main causes of death are eating disorder complications, suicide and cancer. One review of the literature concluded in the absence of any significant link between this pathology and social class.There is nothing in the incidence and prevalence data to back up the notion of a recent "epidemic" of AN. AN is not simply a crisis of adolescence: morbidity and mortality are considerable in this pathology. The relationship between AN and social class is not established.

Anorexia nervosa, autoimmunity and the hygiene hypothesis

The hypothesis proposed is that anorexia nervosa (AN) is an autoimmune disease caused by delayed exposure to common micro-organisms in which auto-antibodies to regulatory peptides and hypothalamic neurons, which cross react with microbial antigens, disturb appetite and lead to decreased intake of food. IgG, IgA and IgM auto-antibodies to a range of regulatory peptides concerned with appetite and mood are found in patients with AN. The regulatory peptides show sequence homology with common micro-organisms of the microbial flora. Auto-antibodies to α melanocyte stimulating hormone (αMSH) are positively correlated with AN psychopathology. But patients with bulimia nervosa (BN) and normal healthy controls also have a similar range of auto-antibodies at comparable levels. The incidence of AN is rising in developed countries, the disease is more common in females than in males, the peak incidence is in the teenage years, there is seasonal variation in the month of birth and the disease is more common in higher socio-economic groups. These are all features which are consistent with the hygiene hypothesis. But there is no evidence that the disease is more common in first born than in later born children. There is a paucity of data on early life events such as attendance at nursery and exposure to pets. Genetic factors are important but the data on major histocompatibility complex (MHC) gene polymorphisms are contradictory. The epidemiological and serological data are consistent with the hypothesis under investigation but key questions in relation to the hygiene hypothesis have not been posed. A large case control study of AN epidemiology is indicated. MHC gene polymorphisms should be assessed. There is, however, sufficient evidence to justify a trial of pooled immunoglobulin therapy in patients with life threatening AN.