Skip to main content

Advertisement

Log in

Recognition and therapy of eating disorders in young women in primary care

  • Original Article
  • Published:
Journal of Public Health Aims and scope Submit manuscript

Abstract

Objective

To evaluate the prevalence of eating disorders (ED) in a general population sample of young German women, compare those to primary care diagnoses, and investigate their medical treatments.

Methods

In a prospective epidemiological study, a representative sample of young women (n=1555, between 18 and 25 years of age) was questioned twice during a structured psychological interview (F-DIPS) for mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). At the same time, personal health insurance data were recorded and primary care physicians’ diagnoses and payments for services rendered were analyzed.

Results

The lifetime prevalence of eating disorders was 3.3% (2.3% anorexia nervosa, 1.1% bulimia nervosa). The primary care physicians diagnosed eating disorders in only about 20% of the women concerned. Eating disorders were often overlooked, although physicians detected physical and mental complaints (e.g., menstrual cycle disorders, abnormal weight loss, flatulence, depression, anxiety disorders), which are closely related to eating disorders. If the primary care physicians had diagnosed eating disorders, they mostly recommended psychotherapeutic treatment as the only measure, or in combination with pharmacological therapy.

Conclusion

The study indicates that primary care physicians need better training, particularly in diagnostic procedures for eating disorders. Screening methods and systematic assessment might be helpful in improving the detection of eating disorders in primary care

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. APA, Washington, DC

  • Becker ES, Margraf J, Turke V, Soeder U, Neumer S (2001) Obesity and mental illness in a representative sample of young women. Int J Obes Relat Metab Disord 25:5–9

    Google Scholar 

  • Boule CJ, McSherry JA (2002) Patients with eating disorders. How well are family physicians managing them? Can Fam Physician 48:1807–1813

    Google Scholar 

  • Braun DL, Sundy R, Halmi KA (1994) Psychiatric comorbidity in patients with eating disorders. Psychol Med 24:859–864

    Google Scholar 

  • Brown TA, DiNardo PA, Barlow DH (1994) Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). Graywind, Albany

  • Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) (2000) Praxisleitlinien in Psychiatrie und Psychotherapie, vol 4: Behandlungsleitlinie Essstörungen. Steinkopff, Darmstadt

  • Devlin MJ, Walsh TB, Kral JG, Heymsfield SB, Pi-Sunjer FX, Dantzic S (1990) Metabolic abnormalities in bulimia nervosa. Arch Gen Psychiatry 47:144–148

    Google Scholar 

  • Dilling H, Mombour W, Schmidt MH (1991) Internationale Klassifikation für psychiatrische Störungen: ICD-10, Chap V (F). Hans Huber, Göttingen

  • Fairburn CG, Harrison PJ (2003) Eating disorders. Lancet 361:407-416

    Article  PubMed  Google Scholar 

  • Favaro A, Santonastaso P (1997) Suicidality in eating disorders: clinical and psychological correlates. Acta Psychiatr Scand 95:508–514

    Google Scholar 

  • Favaro A, Ferrara S, Santonastaso P (2003) The spectrum of eating disorders in young women: a prevalence study in a general population sample. Psychosom Med 65:701–708

    Google Scholar 

  • Godart NT, Flament MF, Perdereau F, Jeammet P (2002) Comorbidity between eating disorders and anxiety disorders. Int J Eat Disord 32:253–270

    Google Scholar 

  • Hach I, Rentsch A, Ruhl U, Becker E, Türke V, Margraf J, Krappweis J, Kirch W (2003) Validität von Krankenscheindiagnosen psychischer Störungen (validity of diagnoses of mental disorders by primary care physicians). Gesundheitswesen 65:1–6

    Google Scholar 

  • Halmi KA (2002) Eating disorders in females: genetics, pathophysiology, and treatment. J Pediatr Endocrinol Metab 15:1379–1386

    Google Scholar 

  • Hayaki J, Friedman MA, Brownell KD (2002) Shame and severity of bulimic symptoms. Eat Behav 3:73–83

    Google Scholar 

  • Herzog DB, Greenwood DN, Dorer DJ, Flores AT, Ekeblad ER, Richards A, Blais MA, Keller MB (2000) Mortality in eating disorders: a descriptive study. Int J Eat Disord 28:20-26

    Google Scholar 

  • Hickie IB, Davenport TA, Ricci CS (2002) Screening for depression in general practice and related medical settings. Med J Aust 177:111-116

    Google Scholar 

  • Johnson JG, Spitzer RL, Williams JB (2001) Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynaecology patients. Psychol Med 31:1455–1466

    Google Scholar 

  • Johnson JG, Cohen P, Kasen S, Brook J (2002) Eating disorders during adolescence and the risk for physical or mental disorders during early adulthood. Arch Gen Psychiatry 59:545-552

    Google Scholar 

  • Kessler D, Bennewith O, Lewis, G, Sharp D (2002) Detection of depression and anxiety in primary care: follow up study. BMJ 325:1016-1017

    Google Scholar 

  • Lewinsohn PM, Striegel-Moore RH, Seeley JR (2000) Epidemiology and natural course of eating disorders in young women from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatry 39:1284–1292

    Google Scholar 

  • Margraf J, Schneider S, Ehlers A (1991) DIPS: Diagnostisches Interview bei psychischen Störungen. Springer, Berlin

  • Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. (1999) Onset of adolescent eating disorders: population based cohort study over 3 years. BMJ 318:765-768

    Google Scholar 

  • Robinson PH (2000) Review article: recognition and treatment of eating disorders in primary and secondary care. Aliment Pharmacol Ther 14:367-377

    Google Scholar 

  • Schneider S, Margraf J, Spörkel H., Franzen U (1992) Therapiebezogene Diagnostik: Reliabilität des Diagnostischen Interviews bei Psychischen Störungen (DIPS). Diagnostica 38:209-227

    Google Scholar 

  • Schulte-Markwort M, Marutt K, Riedesser P (2002) Crosswalk ICD-10—DSM IV. Klassifikation psychischer Störungen: eine Synopsis. Hans Huber, Berlin

  • Schulze U, Mehler-Wex C, Remschmidt H, Herpertz-Dahlmann B, Warnke A (2002) Children in the drive for thinness. How early anorexia nervosa modifies development. MMWR Morb Mortal Wkly Rep 144:28–30

    Google Scholar 

  • Spitzer RL, Williams JB, Kroenke K, Linzer M, de Gruy FW 3rd, Hahn SR, Brody G, Johnson JG (1994) Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 Study. JAMA 272:1749–1756

    Article  CAS  PubMed  Google Scholar 

  • Steinhausen HC (2002) The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 159:1284-1293

    Article  PubMed  Google Scholar 

  • Strumia R, Varotti E, Manzato E, Gualandi M (2001) Skin signs in anorexia nervosa. Dermatology 203:314-317

    Google Scholar 

  • Turnbull S, Ward A, Treasure J, Jick H, Derby L (1996) The demand for eating disorder care: an epidemiological study using the General Practice research data base. Br J Psychiatry 169:705–712

    Google Scholar 

  • Vestergaard P, Emborg C, Stoving RK, Hagen C, Mosekilde L, Brixen K (2002) Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders—a nationwide register study. Int J Eat Disord 32:301–308

    Google Scholar 

  • Wittchen HU (2001) Bedarfsgerechte Versorgung psychischer Störungen” Abschätzungen aufgrund epidemiologischer, bevölkerungsbezogener Daten. Max Plank Institut für Psychiatrie, Munich

  • Wittchen HU, Nelson CB, Lachner G (1998) Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med 28:109–126

    Google Scholar 

  • Wonderlich SA, Mitchell JE (1997) Eating disorders and comorbidity: empirical, conceptual, and clinical implications. Psychopharmacol Bull 33:381–390

    Google Scholar 

  • Zhu AJ, Walsh BT (2002) Pharmacological treatment of eating disorders. Can J Psychiatry 47:227–234

    Google Scholar 

Download references

Acknowledgements

The research was supported by the grant DLR 01EG9410, Ministry of Science, Research and Education. We would like to thank the many people who helped with this study, especially Dr. Jutta Krappweis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Isabel Hach.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hach, I., Ruhl, U.E., Rentsch, A. et al. Recognition and therapy of eating disorders in young women in primary care. J Public Health 13, 160–165 (2005). https://doi.org/10.1007/s10389-005-0102-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10389-005-0102-5

Keywords

Navigation