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Eating disorders comorbidities prevalent among girls

Purging and binge eating were common among young females and predicted a range of adverse outcomes, including overweight or obesity, high depressive symptoms, drug use and binge drinking, according to recent study results.

Alison E. Field, ScD, a staff scientist at Children’s Hospital in Boston, and colleagues conducted a prospective analysis of 8,594 girls aged 9 to 15 years to evaluate the prevalence of full and sub-threshold bulimia nervosa, binge eating disorder, purging disorder and eating disorders not otherwise specified (EDNOS), as well as the mental and physical health outcomes of the disorders. Participants were part of the ongoing Growing Up Today Study.

Eating disorders, weight status, binge drinking, drug use and depressive symptoms were assessed through questionnaires mailed to participants. The researchers created the following classifications, with cutoffs for binge eating reflecting proposed changes in the upcoming DSM-5:

• Girls who reported that they engaged in binge eating at least once a week and did not engage in purging or purged less than monthly were classified as having binge eating disorder.
• Girls who reported at least weekly use of vomiting or laxatives to control their weight and did not binge eat or binged less than monthly were classified as having purging disorder.
• Girls who engaged weekly in both binge eating and purging were classified as having bulimia nervosa.
• Girls who engaged in monthly binge eating and/or purging and those who engaged in overeating episodes but did not experience a loss of control were classified as having EDNOS.
• Girls without eating disorders.

The researchers also accounted for the effect of lowering the frequency threshold of bulimic behaviors from weekly to monthly occurrences.

Bulimia nervosa affected approximately 1% of participants, and 2% to 3% had purging disorder. Another 2% to 3% had binge eating disorder. Participants with binge eating disorder were almost twice as likely as participants without the disorder to become overweight or obese (OR=1.9; 95% CI, 1.0-3.5) or develop high depressive symptoms (OR=2.3; 95% CI, 1.0-5.0). Participants with purging disorder were twice as likely (OR=1.72; 95% CI, 0.97-3.06) and those with bulimia nervosa were four times as likely (OR=3.91; 95% CI, 1.83-8.37) to start using drugs, compared with non-disordered peers. Participants with purging disorder also had a significantly increased risk of starting to binge drink frequently (OR=1.8).

“There is a need for both [binge eating disorder] and [purging disorder] to be recognized as distinct eating disorders or for [purging disorder] to be combined with [bulimia nervosa], rather than including one of these common and serous disorders in the large, heterogeneous, and often overlooked EDNOS group,” the researchers wrote.

Field and colleagues added that few people with psychiatric illnesses receive treatment, and clinicians should be aware of these disorders so that adolescents in need of treatment will be identified.

Disclosure: The researchers report no relevant financial disclosures.