Elsevier

Biological Psychiatry

Volume 73, Issue 9, 1 May 2013, Pages 904-914
Biological Psychiatry

Archival Report
The Prevalence and Correlates of Binge Eating Disorder in the World Health Organization World Mental Health Surveys

https://doi.org/10.1016/j.biopsych.2012.11.020Get rights and content

Background

Little population-based data exist outside the United States on the epidemiology of binge eating disorder (BED). Cross-national BED data are presented here and compared with bulimia nervosa (BN) data in the World Health Organization (WHO) World Mental Health Surveys.

Methods

Community surveys with 24,124 respondents (ages 18+) across 14 mostly upper-middle and high-income countries assessed lifetime and 12-month DSM-IV mental disorders with the WHO Composite International Diagnostic Interview. Physical disorders were assessed with a chronic conditions checklist.

Results

Country-specific lifetime prevalence estimates are consistently (median; interquartile range) higher for BED (1.4%; .8–1.9%) than BN (.8%; .4–1.0%). Median age of onset is in the late teens to early 20s for both disorders but slightly younger for BN. Persistence is slightly higher for BN (6.5 years; 2.2–15.4) than BED (4.3 years; 1.0–11.7). Lifetime risk of both disorders is elevated for women and recent cohorts. Retrospective reports suggest that comorbid DSM-IV disorders predict subsequent onset of BN somewhat more strongly than BED and that BN predicts subsequent comorbid disorders somewhat more strongly than does BED. Significant comorbidities with physical conditions are due almost entirely to BN and to a somewhat lesser degree BED predicting subsequent onset of these conditions. Role impairments are similar for BN and BED. Fewer than half of lifetime BN or BED cases receive treatment.

Conclusions

Binge eating disorder represents a public health problem at least equal to BN. Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.

Section snippets

Samples

Data come from the World Health Organization World Mental Health (WMH) Survey Initiative (7). The 14 countries in WMH that assessed BED include 1 with a World Bank (8) classification as lower-middle income (Colombia), 3 with a classification as upper-middle income (Brazil, Mexico, Romania), and 10 with a classification as high income (Belgium, France, Germany, Italy, The Netherlands, New Zealand, Northern Ireland, Portugal, Spain, and the United States). All surveys used adult household

Prevalence

Lifetime prevalence estimates average 1.0% for BN and 1.9% for BED across surveys. Range and interquartile range (IQR) (25th–75th percentiles) of lifetime prevalence estimates across surveys are .0% to 2.0% (.4% to 1.0%) for BN and .2% to 4.7% (.8% to 1.9%) for BED (Table 1). Twelve-month prevalence estimates (IQR) average .4% (.1% to .3%) for BN and .8% (.2% to 1.0%) for BED. Both lifetime and 12-month prevalence estimates are higher for BED than BN in virtually all countries.

Age of Onset and Persistence

Both mean and

Discussion

Results must be interpreted in the context of several study limitations. Response rates varied considerably across surveys. Sample sizes were too small to produce country-specific results other than for estimates of prevalence, AOO, and persistence. Because of confounding between country and sociodemographic variables, it was impossible to explore potentially important relationships of eating disorders with race/ethnicity or socioeconomic status 2, 33, except aggregate associations with

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