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Adolescent Eating Disorders Predict Psychiatric, High-Risk Behaviors and Weight Outcomes in Young Adulthood

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Objective

To investigate whether anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorders (OSFED), including purging disorder (PD), subthreshold BN, and BED at ages 14 and 16 years, are prospectively associated with later depression, anxiety disorders, alcohol and substance use, and self-harm.

Method

Eating disorders were ascertained at ages 14 and 16 years in 6,140 youth at age 14 (58% of those eligible) and 5,069 at age 16 (52% of those eligible) as part of the prospective Avon Longitudinal Study of Parents and Children (ALSPAC). Outcomes (depression, anxiety disorders, binge drinking, drug use, deliberate self-harm, weight status) were measured using interviews and questionnaires about 2 years after predictors. Generalized estimating equation models adjusting for gender, socio-demographic variables, and prior outcome were used to examine prospective associations between eating disorders and each outcome.

Results

All eating disorders were predictive of later anxiety disorders. AN, BN, BED, PD, and OSFED were prospectively associated with depression (respectively AN: odds ratio [OR] = 1.39, 95% CI = 1.00–1.94; BN: OR = 3.39, 95% CI = 1.25–9.20; BED: OR = 2.00, 95% CI = 1.06–3.75; and PD: OR = 2.56, 95% CI = 1.38–4.74). All eating disorders but AN predicted drug use and deliberate self-harm (BN: OR = 5.72, 95% CI = 2.22–14.72; PD: OR = 4.88, 95% CI = 2.78–8.57; subthreshold BN: OR = 3.97, 95% CI = 1.44–10.98; and subthreshold BED: OR = 2.32, 95% CI = 1.43–3.75). Although BED and BN predicted obesity (respectively OR = 3.58, 95% CI = 1.06–12.14 and OR = 6.42, 95% CI = 1.69–24.30), AN was prospectively associated with underweight.

Conclusions

Adolescent eating disorders, including subthreshold presentations, predict negative outcomes, including mental health disorders, substance use, deliberate self-harm, and weight outcomes. This study highlights the high public health and clinical burden of eating disorders among adolescents.

Section snippets

Participants

The Avon Longitudinal Study of Parents and Children (ALSPAC) is a longitudinal, population-based, prospective study of women and their children.11 All pregnant women living in the geographical area of Avon, UK, who were expected to deliver between April 1, 1991, and December 31, 1992, were invited to participate in the study. Children from 14,541 pregnancies were enrolled; 13,988 children were alive at 1 year. An additional 713 children were enrolled at age 7 years (Phases 2 and 3).11 All women

Results

Socio-demographic data of adolescents included in the study are shown in Table 2.

Discussion

EDs were common in this large UK population–based study and almost doubled in prevalence between ages 14 and 16 years. EDs that did not reach full DSM-5 diagnostic thresholds were the most common. It is difficult to compare prevalence estimates in this study with our US study because of differences in study design (birth cohort in whom all youth have a similar age in ALSPAC versus a wider age gap in the Growing Up Today Study [GUTS]), and of criteria used for diagnoses (binge eating once a week

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    The UK Medical Research Council (ref:74882), Wellcome Trust (ref:076467, 102215/2/13/2), and University of Bristol provide core support for the Avon Longitudinal Study of Parents and Children (ALSPAC). This research was funded by a National Institute of Health grant to Drs. Field and Micali (MH087786), and a National Institute of Health Research clinician scientist award to Dr. Micali (DHCS/08/08/012).

    Dr. Horton served as the statistical expert for this research.

    The authors are grateful to all of the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, including interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists, and nurses.

    Disclosure: Drs. Micali, Solmi, Horton, Crosby, Eddy, Calzo, Sonneville, Swanson, and Field report no biomedical financial interests or potential conflicts of interest.

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