During the years 1988-1993 the incidence of anorexia nervosa
detected in primary care remained stable, but rates of bulimia
nervosa increased threefold. Since then, they have been
falling.
This study, published in the February 2005 issue of the
British Journal of Psychiatry, set out to determine whether the
incidence of anorexia remained stable, and that of bulimia nervosa
continued to increase, in the years 1994-2000.
The General Practice Research Database was screened for new
cases of anorexia and bulimia nervosa for those years. Annual
incidence rates were calculated for females aged 10-39, and
compared with rates for the previous five years.
It was found that annual incidence rates of anorexia nervosa
remained remarkably stable over the period studied. Overall there
was an increase in the incidence of bulimia, but rates declined
after a peak in 1996.
The incidence rate for anorexia varied dramatically according
to the age-gender group. In 2000 the incidence of anorexia
diagnosed in primary care was 4.7 per 100,000 population. The
relative risk for females to males was 12:1; and the highest
incidence, 34.6 per 100,000, was found in females aged 10-19.
The results for bulimia were very different. The early 1990s
showed a marked increase in women aged 10-39, which continued until
1996. Although there was an overall increase in reported cases of
bulimia from 1988-2000, the incidence rate has fallen by 38.9%
since this peak.
The relative risk of bulimia for females to males was about
18:1. The highest incidence, 35.8 per 100,000, was in females aged
10-19.
The authors of the study comment that there are several
possible explanations for the peak in incidence of bulimia seen in
the 1990s and its subsequent decline. Patients may now seek help
from sources other than general practice.
During the period studied, the UK-based Eating Disorders
Association has experienced a dramatic increase in demand for its
web-based messaging and e-mail service.
Another possible explanation relates to changes in
professional or public attention to eating disorder symptoms. The
earlier period of rising incidence might have been the result of
increased recognition and detection efforts given to a new and
'fashionable'; diagnosis.
Intense press coverage of bulimia during the 1990s might also
have contributed to the apparent rise in incidence. For example,
the first reports of Princess Diana';s battle with bulimia appeared
in Andrew Morton';s 1992 book, and subsequent media interest might
have focused attention on bulimic symptoms and improved public
awareness of the disorder.
It is notable that the Princess';s death in 1997 coincided
with the beginning of the decline in bulimia incidence.
The authors of the study suggest that special detection and
treatment efforts should be aimed at young women aged 10-19, as
this is the group with the highest risk of both anorexia and
bulimia nervosa.
General practitioners need more information about the
presentation of eating disorder symptoms and the treatments
available, to allow early and effective intervention.
For further information, please contact Liz Fox or Deborah
Hart in the Communications Department.
Telephone: 020 7235 2351 Extensions. 6298 or 6127