Presentation from the International Congress of the Royal College of Psychiatrists 24-27 June 2014, London

1. The
Epidemiology
of
Ea0ng
Disorders
Nadia
Micali,
MD,
PhD,
MRCPSych
Senior
Lecturer
Child
and
adolescent
Mental
Health,
Pallia0ve
care
and
Paediatrics
sec0on
Popula0on,
Policy
&
Prac0ce
Sec0on
Ins0tute
of
Child
Health
University
College
London
RCPsych
Interna0onal
Conference
2014

2. Outline
• The
changing
landscape
of
ED
• Quan0ta0ve
studies:
-­‐ The
incidence
of
ED
in
the
UK
-­‐Prevalence
of
ED
behaviours
and
ED
their
correlates
and
service
use
• Conclusions

3. ED prior to DSM5
• Anorexia Nervosa (AN)
• Bulimia nervosa (BN)
• Eating Disorders Not Otherwise Specified
(EDNOS)
• [Binge Eating Disorder (BED)]

4. ED:
and
DSM5
• Anorexia
Nervosa
amenorrhea
• Bulimia
Nervosa
Minimum
frequency:
once
a
week
-­‐Binge
Ea0ng
Disorder
Minimum
frequency:
once
a
week

5. ED
and
DSM5
• Ea0ng
Disorders
not
Otherwise
specified
• Avoidant
Restric0ve
Food
Intake
disorder
(ARFID)
• Purging
Disorder:
purging
in
the
absence
of
bingeing
OSFED

6. ED
are
common
disorders
• Prevalence
amongst
females
~7%,
males
~1-­‐2%
• Few
studies
available
in
the
UK
Swanson
et
al,
2011,
Keski-­‐Rakhonen
et
al.,
2009,
Smink
et
al,
2013

7. High
mortality
and
morbidity
• AN
has
an
SMR
of
5.85
• BN
and
EDNOS:
SMR
1.9
• Schizophrenia:
2.5-­‐2.8
• Bipolar:
1.9-­‐2.1
• Unipolar
depression:
1.5-­‐1.6
High
chronicity:
only
50%
recover
following
treatment
Arcelus
et
al.,
2011;
Steinhausen
et
al,
2009

8. The
Incidence
of
ED
in
the
UK
in
the
21st
century
Micali,
N.,
Hagberg,
KW.,
Petersen,
I.,
Treasure,
J.
The
Incidence
of
Ea0ng
Disorders
in
the
UK
in
2000-­‐2009:
findings
from
the
General
Prac0ce
Research
Database.
BMJ
Open.
2013;
3:e002646.
doi:10.1136/
bmjopen-­‐2013-­‐002646

9. Aims
• To
determine
gender
and
age
specific
incidence
rates
of
ED
between
2000-­‐2009
in
the
UK
in
primary
care
• To
inves0gate
changes
in
the
incidence
of
BN
and
AN

10. Methods
I
• General
Prac0ce
Research
database
(GPRD):
-­‐large
automated
UK
medical
record
database
-­‐contains
informa0on
from
about
400
general
prac0ces
(cumula0ve
follow-­‐up
0me
of
>
20
million
person-­‐years)
represents
~5-­‐8
%
of
the
UK
popula0on

11. Methods
II
• All
cases
aged
10-­‐49
receiving
a
new
diagnosis
of
AN,
BN,
EDNOS
(ED
NOS,
ED
unspecified)
were
extracted
• Diagnoses
were
validated
in
5-­‐10%
of
overall
sample
• Age
and
gender
specific
yearly
incidence
rates
were
calculated
for
AN,
BN,
EDNOS

12. The
Incidence
of
ED
amongst
females
aged
10-­‐49
in
the
UK

13. The
Incidence
of
ED
amongst
males
aged
10-­‐49
in
the
UK

14. Between
2000-­‐2009
ED
diagnoses
in
primary
care
increased
• In
females
age-­‐standardised
ED
diagnoses
increased
from51.8
(95%CI:
50.6-­‐52.9)
to
62.6
(95%CI:
61.4-­‐63.8)
per
100,000
• 20%
increase
• In
males
ED
diagnoses
increased
from
5.6
(95%CI:
5.3-­‐6.0)
to
7.1
(95%CI:
6.7-­‐7.5)
per
100,000
• 27%increase

15. Incidence
rates
of
ED
in
females
by
age-­‐bands
in
2009
0"
20"
40"
60"
80"
100"
120"
140"
160"
180"
10(14" 15(19" 20(29" 30(39" 40(49"
AN"
BN"
EDNOS"
ALL"ED"
IR
per
100,000
Age
bands
IR=1.7/1,000

16. Summary
• ED
have
increased
in
incidence
in
the
UK
• EDNOS
mainly
responsible
for
increase
• About
2
in
1,000
girls
aged
between
15-­‐19
in
the
UK
have
a
new
onset
ED
• Detec0on
of
ED
has
increased
• EDNOS
now
“on
the
map”

17. THE
PREVALENCE
OF
ED
Ea?ng
disorders
in
a
mul?-­‐ethnic
inner-­‐city
UK
sample:
prevalence,
comorbidity
and
service
use.
Solmi,
F.;
Hotopf,
M.;
Hatch,
S.L.;
Treasure,
J.;
Micali,
N.

18. • Community-­‐based
sample
of
adults
in
South
London

19. Two-­‐phase
prevalence
study-­‐
Methods
I
• The
small
user
postcode
address
file
was
used
as
sampling
frame
to
iden0fy
households.
• All
eligible
individuals
aged
16
years
and
over
living
within
selected
and
par0cipa0ng
households
were
invited
to
undertake
the
survey.

20. Methods
II
• ED
screening
in
~
1,600
individuals
using
the
SCOFF
• SCID
interviews
in
screen
posi0ve
(Scoring
above
cut-­‐off)
and
gender-­‐matched
screen
nega0ves
• A
large
banery
of
measures
on
comorbid
disorders
and
service
use
(CIS-­‐R
for
CMD,
SAPAS
for
personality
disorders,
primary
care
posnrauma0c
stress
disorder
scale,
AUDIT
for
alcohol
use,
ques0ons
on
suicidal
idea0on
and
drug
use)
• Objec0ve
BMI

21. Epidemiology
of
adult
ED
behaviours

22. Socio-­‐demographic-­‐Phase
1

23. Conclusions
• ED
are
common
in
a
mixed
gender
inner-­‐city
sample
• No
AN
iden0fied
• High
levels
of
comorbidity
• Poor
access
to
care,
especially
specialist
care

24. Overall
conclusions
• Evidence
that
new
onset
ED
are
increasing
in
primary
care
in
the
UK
• Adolescence
is
clearly
a
high
risk
period
• ED
are
common,
they
are
associated
with
high
comorbidity
and
low
service
use

25. Acknowledgements
Francesca
Solmi
Janet
Treasure
Manhew
Hotopf
Stephani
Hatch
Irene
Petersen
Katrina
Hagberg
• Bri0sh
Academy
small
grant
• NIHR
Clinician
Scien0st
award