OJEpi  Vol.3 No.2 , May 2013
Epidemiology of anorexia nervosa in a French community-based sample of 39,542 adolescents
Abstract: Purpose: To assess the prevalence of DSM-IV anorexia nervosa criteria, anorexia nervosa and subthreshold subgroups, and their incidence between the ages of 12 and 17 years using Cole’s international thinness cut-offs, and to characterize these anorexic adolescents by parental socioeconomic status and whether or not they reported receiving treatment. Method: In all, a representative sample of 39,542 French adolescents (19,658 girls and 19,884 boys) was recruited in a cross-sectional study in 2008. Anorexia nervosa DSM-IV diagnosis was determined by a self-administered questionnaire. Results: Among females, 0.5% (n = 105) met criteria for anorexia nervosa between the ages of 12 and 17 years, whereas among males, the prevalence was 0.03% (n = 6). In females, the prevalence of sub-threshold anorexia nervosa was found to be between 1.2% (n = 216) and 3.3% (n = 618); more than 75% were of the restrictive subtype. The highest incidence of anorexia nervosa was at 16 years. There was also a greater prevalence of sub-threshold anorexia nervosa subgroups among subjects with high parental socioeconomic status. More than half of the female adolescents who met the anorexia nervosa criteria reported receiving treatment for their disorder, versus 23% to 40% of the adolescents in the sub-threshold subgroups (P < 0.0001). Conclusions: This study is the first to report the prevalence of AN on such a large community sample of adolescents. Using Cole’s international thinness cut-off could improve international comparability among studies. Adolescents from the higher socioeconomic categories were more likely to be anorexic.
Cite this paper: Godart, N. , Legleye, S. , Huas, C. , Coté, S. , Choquet, M. , Falissard, B. and Touchette, E. (2013) Epidemiology of anorexia nervosa in a French community-based sample of 39,542 adolescents. Open Journal of Epidemiology, 3, 53-61. doi: 10.4236/ojepi.2013.32009.

[1]   Huas, C., Caille, A., Godart, N., Foulon, C., Pham-Scottez, A., Divac, S., Dechartres, A., Lavoisy, G., Guelfi, J.D., Rouillon, F. and Falissard B. (2011) Factors predictive of ten-year mortality in severe anorexia nervosa patients. Acta Psychiatrica Scandinavica, 123, 62-70. doi:10.1111/j.1600-0447.2010.01627.x

[2]   Papadopoulos, F.C., Ekbom, A., Brandt, L. and Ekselius, L. (2009) Excess mortality, causes of death and prognostic factors in anorexia nervosa. British Journal of Psychiatry, 194, 10-17. doi:10.1192/bjp.bp.108.054742

[3]   Ackard, D.M., Fulkerson, J.A. and Neumark-Sztainer, D. (2007) Prevalence and utility of DSM-IV eating disorder diagnostic criteria among youth. International Journal of Eating Disorders, 40, 409-417. doi:10.1002/eat.20389

[4]   Swanson, S.A., Crow, S.J., Le Grange, D., Swendsen, J. and Merikangas, K.R. (2011) Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68, 714-723. doi:10.1001/archgenpsychiatry.2011.22

[5]   Preti, A., Girolamo, G., Vilagut, G., Alonso, J., de Graaf, R., Bruffaerts, R., Demyttenaere, K., Pinto-Meza, A., Haro, J.M., Morosini, P. and ESEMeD-WMH Investigators (2009) The epidemiology of eating disorders in six European countries: Results of the ESEMeD-WMH project. Journal of Psychiatric Research, 43, 1125-1132. doi:10.1016/j.jpsychires.2009.04.003

[6]   Hudson, J.I., Hiripi, E., Pope Jr., H.G. and Kessler, R.C. (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348-358. doi:10.1016/j.biopsych.2006.03.040

[7]   Keski-Rahkonen, A., Hoek H.W., Susser, E.S., Linna, M.S., Sihvola, E., Raevuori, A., Bulik, C.M., Kaprio, J., and Rissanen, A. (2007) Epidemiology and course of anorexia nervosa in the community. American Journal of Psychiatry, 164, 1259-1265. doi:10.1176/appi.ajp.2007.06081388

[8]   Hoek, H.W. and van Hoeken, D. (2003) Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34, 383-396. doi:10.1002/eat.10222

[9]   World Health Organisation (1992) The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. WHO, Geneva.

[10]   Hebebrand, J., Himmelmann, G.W., Heseker, H., Schafer, H. and Remschmidt, H. (1996) Use of percentiles for the body mass index in anorexia nervosa: Diagnostic, epidemiological, and therapeutic considerations. International Journal of Eating Disorders, 19, 359-369.

[11]   Rolland-Cachera, M.F., Cole, T.J., Sempé, M., Tichet, J., Rossignol, C. and Charraud, A. (1991) Body Mass Index variations: Centiles from birth to 87 years. European Journal of Clinical Nutrition, 45, 13-21.

[12]   Cole, T.J., Flegal, K.M., Nicholls, D. and Jackson, A.A. (2007) Body mass index cut offs to define thinness in children and adolescents: International survey. British Medical Journal, 335, 194. doi:10.1136/bmj.39238.399444.55

[13]   Beck, F., Legleye, S. and Peretti-Watel, P. (2000) Les usages de substances psychoactives à la fin de l’adolescence: Mise en place d’une enquête annuelle [The use of psychoactive substances among adolescents in their late teens—Setting up an annual survey]. Tendances, 10, pp. 1-4.

[14]   INSEE (2011) Bulletin statistique.

[15]   Beck, F., Costes, J.-M., Legleye, S., Peretti-Watel, P. and Spilka, S. (2006) ESCAPAD survey on the use of Drugs: An original collection device on a sensitive topic, In: Lavallée, P. and Rivest, L-P., Eds. Survey Methods: European and North American practices, Dunod, Paris, 56-59.

[16]   American Psychiatric Association (1994) Statistical manual of mental disorder. 4th Edition, American Psychiatric Press, Washington DC.

[17]   Attia, E. and Roberto, C.A. (2009) Should amenorrhea be a diagnostic criterion for anorexia nervosa? International Journal of Eating Disorders, 42, 581-589. doi:10.1002/eat.20720

[18]   National Institute of Statistics and Economic Studies (INSEE) (2003) Classification of occupations and socio-professional categories (OSC): List of aggregated socio-professional categories.

[19]   Billewicz, W.Z., Fellowes, H.M. and Thomson, A.M. (1980) Post-menarcheal menstrual cycle in British (Newcastle upon Tyne) girls. Annals of Human Biology, 7, 177-180. doi:10.1080/03014468000004201

[20]   Klump, K.L., Burt, S.A., McGue, M. and Iacono, W.G. (2007) Changes in genetic and environmental influences on disordered eating across adolescence: A longitudinal twin study. Archives of General Psychiatry, 64, 1409-1415. doi:10.1001/archpsyc.64.12.1409

[21]   de la Rochebrochard, é. (1999) Age of puberty onset among French girls and boys. Measures based on a survey on adolescent sexuality. Population, 54, 933-962. doi:10.2307/1534716

[22]   Forman-Hoffman, V.L., Watson, T.L. and Andersen, A.E. (2008) Eating disorder age of onset in males: distribution and associated characteristics. Eating and Weight Disorders, 13, e28-e31.

[23]   Swami, V., Frederick, D.A., Aavik, T., Alcalay, L., Allik, J., Anderson, D., Andrianto, S., Arora, A., Br?nnstr?m, A., Cunningham, J., Danel, D., Doroszewicz, K., Forbes, G.B., Furnham, A., Greven, C.U., Halberstadt, J., Hao, S., Haubner, T., Hwang, C.S., Inman, M., Jaafar, J.L., Johansson, J., Jung, J., Keser, A., Kretzschmar, U., Lachenicht, L., Li, N.P., Locke, K., L?nnqvist, J.E., Lopez, C., Loutzenhiser, L., Maisel, N.C., McCabe, M.P., McCreary, D.R., McKibbin, W.F., Mussap, A., Neto, F., Nowell, C., Alampay, L.P., Pillai, S.K., Pokrajac-Bulian, A., Proyer, R.T., Quintelier, K., Ricciardelli, L.A., Rozmus-Wrzesinska, M., Ruch, W., Russo, T., Schütz, A., Shackelford, T.K., Shashidharan, S., Simonetti, F., Sinniah, D., Swami, M., Vandermassen, G., van Duynslaeger, M., Verkasalo, M., Voracek, M., Yee, C.K., Zhang, E.X., Zhang, X. and Zivcic-Becirevic, I. (2010) The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: Results of the international body project I. Personality and Social Psychology Bulletin, 36, 309-325. doi:10.1177/0146167209359702

[24]   Fairburn, C.G. and Harrison, P.J. (2003) Eating disorders. Lancet, 361, 407-416. doi:10.1016/S0140-6736(03)12378-1

[25]   Halmi, K.A., Agras, W.S., Crow, S., Mitchell, J., Wilson, G.T., Bryson, S.W. and Kraemer, H.C. (2005) Predictors of treatment acceptance and completion in anorexia nervosa: Implications for future study designs. Archives of General Psychiatry, 62, 776-781. doi:10.1001/archpsyc.62.7.776

[26]   Hoek, H.W. (1991) The incidence and prevalence of anorexia nervosa and bulimia nervosa in primary care. Psychological Medicine, 21, 455-460. doi:10.1017/S0033291700020560

[27]   Johnson, J.G., Cohen, P., Kasen, S. and Brook, J.S. (2002) Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood. Archives of General Psychiatry, 59, 545-552. doi:10.1001/archpsyc.59.6.545

[28]   Patton, G.C., Coffey, C., Carlin, J.B., Sanci, L., Sawyer, S. (2008) Prognosis of adolescent partial syndromes of eating disorder. British Journal of Psychiatry, 192, 294-299. doi:10.1192/bjp.bp.106.031112

[29]   Thomas, J.J., Vartanian, L.R. and Brownell, K.D. (2009) The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: Meta-analysis and implications for DSM. Psychological Bulletin, 135, 407-433. doi:10.1037/a0015326

[30]   Jayasekera, H., Carter, G. and Clover, K. (2011) Comparison of the Composite International Diagnostic interview (CIDI-Auto) with clinical diagnosis in a suicidal population. Archives of Suicide Research, 15, 43-55. doi:10.1080/13811118.2011.540208

[31]   Kedzior, K.K. and Martin-Iverson, M.T. (2007) Concurrent validity of cannabis misuse diagnoses on CIDI-Auto 2.1 in low-level cannabis users from the general population. Australian Journal of Psychology, 59, 169-175.

[32]   Rosenman, S.J., Korten, A.E. and Levings, C.T. (1997) Computerised diagnosis in acute psychiatry: Validity of CIDI-Auto against routine clinical diagnosis. Journal of Psychiatric Research, 31, 581-592. doi:10.1016/S0022-3956(97)00032-0

[33]   Sunderland, M., Andrews, G., Slade, T. and Peters, L. (2011) Measuring the level of diagnostic concordance and discordance between modules of the CIDI-Short Form and the CIDI-Auto 2.1. Social Psychiatry and Psychiatric Epidemiology, 46, 775-785. doi:10.1007/s00127-010-0247-6

[34]   McFarlane, T., McCabe, R.E., Jarry, J., Olmsted, M.P., and Polivy, J. (2001) Weight-related and shape-related self-evaluation in eating-disordered and non-eating-disordered women. International Journal of Eating Disorders, 29, 328-335. doi:10.1002/eat.1026

[35]   McCabe, R.E., McFarlane, T., Polivy, J. and Olmsted, M.P. (2001) Eating disorders, dieting, and the accuracy of self-reported weight. International Journal of Eating Disorders, 29, 59-64. doi:10.1002/1098-108X(200101)29:1<59::AID-EAT9>3.0.CO;2-#