26/04/17 Outline Ea+ng Disorders and related • ED and DSM-5 behaviours in adolescence: results • Epidemiology from popula+on-based studies -ED -ED behaviours Nadia Micali Dept. of Psychiatry • Three studies: Icahn School of Medicine at Mount Sinai New York, NY -prevalence of ED US & -Correlates and adverse outcomes Ins+tute of Child Health University College London London UK The Incidence of ED amongst females ED: the old and the new aged 10-49 in the UK • Anorexia Nervosa amenorrhea • Bulimia Nervosa Minimum frequency: once a week • Ea+ng Disorders not Otherwise specified OSFED -Binge Ea+ng Disorder Minimum frequency: once a week Micali et al., 2013 1
26/04/17 Incidence rates of ED in females by The Incidence of ED amongst males age-bands in 2009 aged 10-49 in the UK 180" IR=1.7/1,000 160" 140" 120" AN" 100" IR per 100,000 BN" 80" EDNOS" 60" ALL"ED" 40" 20" 0" 10(14" 15(19" 20(29" 30(39" 40(49" Age bands Micali et al., 2013 Prevalence of adolescent AN Prevalence of adolescent BN l US Na+onal Comorbidity Survey US adolescents aged 13-18 years: l US: life+me 0.9%; M= 0.5%; F=1.3% life+me prevalence: 0.3%, 12-mo prevalence 0.2% (M=F) l Portugal: 0.3% in adolescent girls (aged 12-23) l Portugal: 0.4% in adolescent females (aged 12-23) l Finland: 1.7% in females aged 15-19 l Finland: 2.2% adolescent girls aged 15-19 (life+me) l Overall ~ 1-2% l Overall about 0.4-2% Swanson et al., 2011; Keski-Rakhonen et al., 2009, Machado et al., 2007 Swanson et al., 2011; Keski-Rakhonen et al., 2007, Machado et al., 2007 2
26/04/17 Prevalence of adolescent EDNOS Ea+ng disorders behaviours in US adolescents l Portugal: 2.4% in adolescent females l US: -BED: life+me 1.6%; M=0.8, F=2.3% l EDNOS most common ED: BED Swanson et al., 2011; Machado et al., 2007 Ackard et al., 2007 ED and ED behaviours in adolescence: prevalence, correlates and adverse outcomes ALSPAC and GUTS Field et al, Pediatrics, 2012 Field et al. JAMA Pediatrics, 2013 Micali et al, JAACAP, 2015 3
26/04/17 Growing Up Today Study (GUTS) Follow-up • Ques+onnaires were mailed annually un+l 2001, • Established in 1996 then biennially • Par+cipants are the offspring of women in the • Non-responders are sent a reminder e-mail and/ Nurses Health Study II (NHS II) or postcard, followed by a another ques+onnaire • 9039 girls and 7843 boys • Children who do not respond aher these – 9-15 years at baseline measures have been taken are sent an abbreviated survey Weight & Weight Concerns Binge Ea+ng • Binge ea+ng: • Self-reported weight and height collected on all – at least monthly/weekly episodes of ea+ng a large surveys amount of food AND feeling out of control during the episodes (LOC) • Overea&ng: • Weight concerns measured with the McKnight – at least monthly/weekly episodes of ea&ng a Risk Factor Survey (MRFS) large amount of food, but NOT feeling out of control during the episodes (no LOC) 4
26/04/17 Ea+ng Disorder Classifica+on Purging • During the past year, did you make yourself • AN throw up to lose weight or keep from gaining – Underweight weight? • < 18 years • During the past year, did you take laxa+ves to Age-specific cut-off predic+ng BMI < 18.5 at age 18 lose weight or keep from gaining weight? • > 18 years BMI < 18.5 – High concerns with weight and shape Ea+ng Disorder Classifica+on Ea+ng Disorder Classifica+on • BN • AN – Binge eat with loss of control • BN > weekly (DSM-5) • BED >monthly – Binge eat with LOC > weekly – Purging > weekly (DSM-5) > weekly (DSM-5) > monthly >monthly – No or infrequent purging 5
26/04/17 Ea+ng Disorder Classifica+on Ea+ng Disorder Classifica+on • AN • AN • BN • BN • BED • BED • Purging Disorder (PD) • Purging Disorder (PD) – Purge > weekly • EDNOS > weekly (DSM-5) – Overeat, but no loss of control > monthly – Binge weekly (DSM-IV)/monthly (DSM-5) – No or infrequent binge ea+ng – Purge weekly (DSM-IV)/monthly (DSM-5) Age-specific prevalence of ea+ng disorders Age-specific prevalence of ea+ng disorders among girls in GUTS among girls in GUTS 5% 10% 9% 4% 8% 7% 3% 6% 5% 2% 4% 3% 1% 2% 1% 0% 0% 9-12 yrs 13-15 yrs 16-18 yrs 19-22 yrs 23-26 yrs 9-12 yrs 13-15 yrs 16-18 yrs 19-22 yrs 23-26 yrs AN BN AN BN BED 6
26/04/17 Age-specific prevalence of ea+ng disorders Age-specific prevalence of ea+ng disorders among girls in GUTS among girls in GUTS 10% 25% 9% 8% 20% 7% 15% 6% 5% 10% 4% 3% 5% 2% 1% 0% 0% 9-12 yrs 13-15 yrs 16-18 yrs 19-22 yrs 23-26 yrs 9-12 yrs 13-15 yrs 16-18 yrs 19-22 yrs 23-26 yrs AN BN BED Purging Disorder EDNOS AN BN BED Purging Disorder Methods Methods • Becoming overweight • All analyses restricted to 8594 females with – Age, BMI, die+ng follow-up data • Lagged analysis • Star+ng to use drugs other than marijuana • Generalized es+ma+ng equa+ons with an independence working covariance • Star+ng to binge drink frequently • Developing high depressive symptoms 7
26/04/17 Methods Methods • Becoming overweight • Becoming overweight • Star+ng to use drugs • Star+ng to use drugs – Age, sib who used drugs, sib who was drinking < 21, friends who use drugs, adult who drinks, • Star+ng to binge drink region – Age, sibling who used was drinking < 21, friends who use drugs, adult who drinks, region • Star+ng to binge drink • Developing high depressive symptoms • Developing high depressive symptoms Methods Ea+ng disorder subtypes predic+ng star+ng to use drugs • Becoming overweight OR (95% CI) • Star+ng to use drugs Non-disordered 1.0 (referent) BN 3.9 (1.8-8.4) 1 • Star+ng to binge drink BED 0.5 (0.2-1.5) • Developing high depressive symptoms PD 1.7 (1.0-3.1) 1 – Age, BMI, depressive symptoms EDNOS 1.5 (1.2-1.9) 1: no change when using monthly cut-off 8
26/04/17 Ea+ng disorder subtypes predic+ng Ea+ng disorder subtypes predic+ng star+ng to binge drinking frequently becoming overweight or obese OR (95% CI) OR (95% CI) Non-disordered 1.0 (referent) Non-disordered 1.0 (referent) BN 1.7 (1.0-3.1) BN 0.8 (0.2-2.8) (monthly cut-off) 2.59 (1.76–3.81) BED 1.8 (1.1-2.9) BED 1.1 (0.7-1.7) (monthly cut-off) 1.42 (1.13–1.79) PD 1.0 (0.5-1.9) PD 1.8 (1.3-2.7) (monthly cut-off) 1.49 (1.00–2.21) (monthly cut-off) 1.75 (1.34–2.27) EDNOS 1.1 (0.9-1.5) EDNOS 1.6 (1.4-1.9) (monthly cut-off) 1.40 (1.09–1.79) Ea+ng disorder subtypes predic+ng Conclusions developing high depressive symptoms • Fewer EDNOS cases with DSM-5, but s+ll the largest group OR (95% CI) Non-disordered 1.0 (referent) • AN and BN are the least common disorders BN 0.4 (0.1-3.4) • BED looks different than other ea+ng disorders: prospec+ve associa+on with depressive sx, BED 2.3 (1.0-5.0) overweight/obesity (monthly cut-off) 1.77 (1.23–2.46) PD 1.2 (0.6-2.2) • PD looks like BN, should it be combined? EDNOS 1.3 (1.0-1.7) 9
26/04/17 Sample-Avon Longitudinal Study of Parents and Children (ALSPAC) -General popula+on sample of ~14,000 women recruited in pregnancy and their children -Cohort members have been followed up regularly Qs sent • 6,140 (58%) adolescents responded at age 14 years • 5,069 (52%) at age 16 years Sample ED symptoms Age 14/16 yrs • Weight & shape concern: • Qs have also been regularly mailed to parents 3 Qs from the McKnight Risk Factor Survey • ED behaviours: Ques+ons about purging, binge ea+ng, fas+ng, excessive exercise derived from the Youth Risk Behavior Surveillance System ques+onnaire enquiring about the previous year • BMI (age- and gender-adjusted) Objec+ve weight and height 10
26/04/17 ED diagnoses ED symptoms Age 14/16 yrs-parental AN: report Objec+ve underweight and food restric+on/ • Parents completed the Developmental and fas+ng/excessive exercise and shape and weight Well-being Assessment (DAWBA)-ED sec+on concern • Sensi+vity analyses showed binge ea+ng and BN: purging not overlapping with youth report Binge ea+ng and purging ≥once/week • Parental report used for AN diagnosis BED: Binge ea+ng ≥once/week and at least 3 cogni+ve symptoms (ea+ng fast or faster than normal; ea+ng un+l stomach hurt or they felt sick, ea+ng large amounts when not hungry, ea+ng alone, feeling guilty about amount eaten) ED behaviours ED diagnoses-OSFED Any frequency: PD : -Excessive exercise: exercising for weight loss or to avoid Purging ≥once/week weight gain AND exercising even when injured or sick Subthreshold BN ( S-BN ): or impact on school work due to the amount of +me Binge ea+ng and purging ≥once/month spent exercising; Subthreshold BED ( S-BED ): -Purging: self-induced vomi+ng, laxa+ve use or other Binge ea+ng ≥once/month and cogni+ve symptoms medicines for weight loss or to avoid weight gain OSFED-other1 : -Fas+ng for weight loss or to avoid weight-gain Monthly binge ea+ng/ purging/ excessive exercising or fas+ng OSFED-other2 : < Monthly binge ea+ng/ purging/ excessive exercise or fas+ng 11
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