title: Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults.
abstract: We aimed to assess the prevalence, incidence, age-of-onset and diagnostic stability of threshold and subthreshold anorexia nervosa (AN) and bulimia nervosa (BN) in the community. Data come from a prospective-longitudinal community study of 3021 subjects aged 14-24 at baseline, who were followed up at three assessment waves over 10 years. Eating disorder (ED) symptomatology was assessed with the DSM-IV/M-CIDI at each wave. Diagnostic stability was defined as the proportion of individuals still affected with at least symptomatic eating disorders (EDs) at follow-ups. Baseline lifetime prevalence for any threshold ED were 2.9 % among females and 0.1 % among males. For any subthreshold ED lifetime prevalence were 2.2 % for females and 0.7 % for males. Symptomatic expressions of EDs (including core symptoms of the respective disorder) were most common with a lifetime prevalence of 11.5 % among females and 1.8 % among males. Symptomatic AN showed the earliest onset with a considerable proportion of cases emerging in childhood. 47 % of initial threshold AN cases and 42 % of initial threshold BN cases showed at least symptomatic expressions of any ED at any follow-up assessment. Stability for subthreshold EDs and symptomatic expressions was 14-36 %. While threshold EDs are rare, ED symptomatology is common particularly in female adolescents and young women. Especially threshold EDs are associated with a substantial risk for stability. A considerable degree of symptom fluctuation is characteristic especially for subthreshold EDs.
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187, Dresden, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Nagl
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187, Dresden, Germany. corinna.jacobi@tu-dresden.de.
authors.forename: Corinna
authors.identifier: http://orcid.org/0000-0002-0982-0596
authors.initials: C
authors.lastname: Jacobi
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187, Dresden, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Paul
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187, Dresden, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Beesdo-Baum
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187, Dresden, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Höfler
authors.affiliation: Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Missionsstrasse 60/62, 4055, Basel, Switzerland.|Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany.
authors.forename: Roselind
authors.initials: R
authors.lastname: Lieb
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187, Dresden, Germany.|Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000453:epidemiology*; D052018:Bulimia Nervosa / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D055815:Young Adult
keywords: Anorexia nervosa; Bulimia nervosa; Epidemiology; Prevalence; Stability