title: Three decades of eating disorders in Dutch primary care: decreasing incidence of bulimia nervosa but not of anorexia nervosa.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The incidence rate of BN decreased significantly over the past three decades, while the overall incidence rate of AN remained stable.
authors.affiliation: Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: F R E
authors.initials: FR
authors.lastname: Smink
authors.affiliation: Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: van Hoeken
authors.affiliation: NIVEL Primary Care Database, Sentinel Practices,Utrecht,The Netherlands.
authors.forename: G A
authors.initials: GA
authors.lastname: Donker
authors.affiliation: Department of Epidemiology,Columbia University,Mailman School of Public Health,New York,USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Susser
authors.affiliation: Department of Psychiatry,University Medical Center Groningen,University of Groningen,Groningen,The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Oldehinkel
authors.affiliation: Parnassia Psychiatric Institute,The Hague,The Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: Hoek
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000856:Anorexia Nervosa / Q000453:epidemiology*; D052018:Bulimia Nervosa / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care; D012017:Referral and Consultation; D017678:Sex Distribution; D055815:Young Adult
keywords: Anorexia nervosa; bulimia nervosa; eating disorders; epidemiology; incidence; primary care; time trends