Epidemiology
Section Learning Objectives
Describe the epidemiology of anorexia nervosa.
Describe the epidemiology of bulimia nervosa.
Describe the epidemiology of binge eating disorder.
10.2.1. Anorexia Nervosa207
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According to the National Eating Disorder Alliance (NEDA) website, at any point in time more women
(0.3-0.4%) than men (0.1%) will be diagnosed with anorexia. Anorexia nervosa is most prevalent in
postindustrialized, high-income countries such as the United States, Australia, New Zealand, Japan, and
many European countries. In the U.S., prevalence is lower among Latinx and non-Latinx Black
Americans than non-Latinx Whites (APA, 2022).
10.2.2. Bulimia Nervosa
According to the NEDA website, at any point in time, 1.0% of women and 0.1% of men will meet the
diagnostic criteria for bulimia nervosa. A study by Stice and Bohon (2012) found that between 1.1% and
4.6% of females and 0.1% to 0.5% of males will develop bulimia and that subthreshold bulimia occurs in
2.0% to 5.4% of adolescent females. The DSM reports that the 12-month prevalence ranges from 0.14%
to 0.3% with higher rates in females and high-income countries. Rates are similar across ethnoracial
groups across the U.S. (APA, 2022).
10.2.3. Binge Eating Disorder
Hudson et al. (2007) reports that BED is three times more common than anorexia and bulimia and is
more common than breast cancer, HIV, and schizophrenia. It has also been found that between 0.2%
and 3.5% of females and 0.9% and 2.0% of males will develop binge eating disorder with subthreshold
binge eating disorder occurring in 1.6% of adolescent females (Stice & Bohon, 2012). The DSM reports
a 12-month prevalence of 0.44% to 1.2% with rates 2-3 times higher in women, similar rates across
ethnoracial groups in the United States and between most high-income industrialized countries (APA,
2022).
For more on statistics and research related to feeding and eating disorders, please visit the National
Eating Disorders Association website below:
https://www.nationaleatingdisorders.org/statistics-research-eating-disorders
Key Takeaways
You should have learned the following in this section:
BED is three times more common than anorexia and bulimia.
All feeding and eating disorders are more common in women and high-income, industrialized
countries.
Only anorexia shows differences across ethnoracial groups in the United States.208
Fundamentals of Psychological Disorders
Section 10.2 Review Questions
1. Which feeding and eating disorder is most common?
2. What gender differences occur with regards to the eating disorders?
3. Are there any other noteworthy similarities or differences in the prevalence rates of the three
disorders?
10.3. Comorbidity
Section Learning Objectives
Describe the comorbidity of anorexia nervosa.
Describe the comorbidity of bulimia nervosa.
Describe the comorbidity of BED.
10.3.1. Anorexia Nervosa
Anorexia is rarely a single diagnosis. High rates of bipolar, depressive, and anxiety disorders are
common among individuals with anorexia nervosa. Obsessive-compulsive disorder is more often seen in
those with the restricting type of anorexia nervosa, whereas alcohol use disorder and other substance
use disorders are more commonly seen in those with anorexia who engage in binge-eating/purging
behaviors. Unfortunately, there is also a high rate of suicidality, with rates reported to be 18 times
greater than in an age- and gender-matched comparison group. It is also estimated that between 9%
and 25% of individuals with anorexia have attempted suicide (APA, 2022).
10.3.2. Bulimia Nervosa
The majority of individuals diagnosed with bulimia nervosa also present with at least one other mental
disorder. Similar to anorexia nervosa, there is a high frequency of depressive symptoms (i.e., low selfesteem), as well as bipolar and depressive disorders. While some experience mood fluctuations because
of their eating pattern (occurring at the same time or following the development of bulimia), some
individuals will identify mood symptoms prior to the onset of bulimia nervosa (APA, 2022).
Anxiety, particularly social anxiety, is often present in those with bulimia nervosa. However, most mood
and anxiety symptoms resolve once an effective treatment of bulimia is established. Substance use
disorder, and in particular alcohol use disorder, is also prevalent in those with bulimia, with about a
30% prevalence among those with bulimia. The substance abuse begins as a compensatory behavior
(e.g., stimulant use is used to control appetite and weight) and over time, as the eating disorder209
Fundamentals of Psychological Disorders
progresses, so does the substance abuse. There is also a percentage of individuals with bulimia nervosa
who display personality features that meet the criteria for at least one personality disorder, most often
borderline personality disorder. Finally, about one-quarter to one-third of individuals with bulimia have
had suicidal ideation and a comparable amount have attempted suicide.
10.3.3. BED
Research shows that BED shares similar comorbidities with anorexia nervosa and bulimia nervosa.
Common comorbidities include major depressive disorder and alcohol use disorder. About 25% of those
with BED have shown suicidal ideation (APA, 2022).
Key Takeaways
You should have learned the following in this section:
Anorexia has a high comorbidity with bipolar, depressive, and anxiety disorders. OCD and alcohol
use disorder are also comorbid but depend on the type of anorexia (restricting or bingeeating/purging).
Bulimia has a high comorbidity with bipolar disorder, depressive symptoms and disorders, social
anxiety, and substance use disorder.
BED is highly comorbid with MDD and alcohol use disorder.
There is a high rate of suicidal ideation with all three disorders.
