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Epidemiology and Natural Course of Eating Disorders in Young Women From Adolescence to Young Adulthood

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ABSTRACT

Objectives

To describe the epidemiology of eating disorders (ED) in a community sample of adolescent girls; to compare the clinical characteristics of full-syndrome (FS) and partial-syndrome (PS) ED cases; and to provide information about the continuity between adolescent ED and young adult psychopathology.

Method

A randomly selected sample of high school girls were assessed during adolescence (n = 891) and a year later (n = 810), and a stratified subset (n = 538) was assessed during their 24th year. The assessments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children, the Longitudinal Interval Follow-up Evaluation, level of functioning, mental health treatment utilization, history of suicide attempt, and physical symptoms.

Results

The incidence of ED was less than 2.8% by age 18, and 1.3% for ages 19 through 23. Comorbidity with other psychopathology (89.5%), but especially depression, was very high. FS- and PS-ED groups differed significantly from a no-disorder comparison group on most outcome measures, and more than 70% of the adolescent FS- and PS-ED cases met criteria for an Axis I disorder in young adulthood.

Conclusions

FS- and PS-ED are associated with substantial comorbidity, treatment seeking, impaired functioning, and risk for psychopathology in young adulthood.

Section snippets

Participants

Participants were randomly selected from 9 senior high schools in western Oregon who completed initial assessments (T1; n = 1,709) between 1987 and 1989. Approximately 1 year later, 1,507 of the participants (88%) returned for the readministration of the interview and questionnaire. Statistically significant differences between participants and those who declined to participate and those who dropped out of the study before T2 were small (additional details are provided by Lewinsohn et al., 1993

Prevalence and Incidence of Eating Disorders During Adolescence and Young Adulthood

The lifetime prevalence rates for AN and BN at each of the 3 assessments are shown in Table 1. The lifetime prevalence rates of AN and BN are very low, ranging from 0.6% for AN at T1 to 2.8% for BN at T3 (weighted); the PS-AN and PS-BN prevalence rates range from 0.8% at T1 to 2.5% at T3 (weighted). No current cases of AN were observed at any of the assessments, and the rates for current BN did not exceed 0.5%.

First incidence was determined for disorders occurring during childhood/adolescence

DISCUSSION

Consistent with previous major epidemiological studies conducted in North America (e.g., Garfinkel et al., 1995b), the lifetime prevalence of AN and BN was low and these disorders were found to be disorders of adolescence. The relatively younger age of onset in AN compared with BN is consistent with reports in the literature. For example, Turnbull et al. (1996) found the highest incidence of AN was for females aged 10 through 19 years, whereas the highest incidence of BN was among females aged

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    This research was supported in part by NIMH awards MH40501 and MH50522.

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