Epidemiology and course of anorexia nervosa in the community.
OBJECTIVE
Most previous studies of the prevalence, incidence, and outcome of anorexia nervosa have been limited to cases detected through the health care system, which may bias our understanding of the disorder's incidence and natural course. The authors sought to describe the onset and outcomes of anorexia nervosa in the general population.


METHODS
Lifetime prevalences, incidence rates, and 5-year recovery rates of anorexia nervosa were calculated on the basis of data from 2,881 women from the 1975-1979 birth cohorts of Finnish twins. Women who screened positive for eating disorder symptoms (N=292), their screen-negative female co-twins (N=134), and 210 randomly selected screen-negative women were assessed for lifetime eating disorders by telephone by experienced clinicians. To assess outcomes after clinical recovery and to detect residua of illness, women who had recovered were compared with their unaffected co-twins and healthy unrelated women on multiple outcome measures.


RESULTS
The lifetime prevalence of DSM-IV anorexia nervosa was 2.2%, and half of the cases had not been detected in the health care system. The incidence of anorexia nervosa in women between 15 and 19 years of age was 270 per 100,000 person-years. The 5-year clinical recovery rate was 66.8%. Outcomes did not differ between detected and undetected cases. After clinical recovery, the residua of illness steadily receded. By 5 years after clinical recovery, most probands had reached complete or nearly complete psychological recovery and closely resembled their unaffected co-twins and healthy women in weight and most psychological and social measures.


CONCLUSIONS
The authors found a substantially higher lifetime prevalence and incidence of anorexia nervosa than reported in previous studies, most of which were based on treated cases. Most women recovered clinically within 5 years, and thereafter usually progressed toward full recovery.
Department of Epidemiology, Columbia University, New York, NY, USA. anna.keski-rahkonen@helsinki.fi
Anna
A
Keski-Rahkonen
Hans W
HW
Hoek
Ezra S
ES
Susser
Milla S
MS
Linna
Elina
E
Sihvola
Anu
A
Raevuori
Cynthia M
CM
Bulik
Jaakko
J
Kaprio
Aila
A
Rissanen
D000223:Adaptation, Psychological; D000328:Adult; D017668:Age of Onset; D000856:Anorexia Nervosa / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D017281:Cost of Illness; D003625:Data Collection; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004200:Diseases in Twins / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011379:Prognosis; D012917:Social Adjustment; D011795:Surveys and Questionnaires; D016387:Women's Health