Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study

Trafford, Alex M; Carr, Matthew; Ashcroft, Darren M.; Chew‐Graham, Carolyn; Cockcroft, Emma; Cybulski, Łukasz; Garavini, Emma; Garg, Shruti; Kabir, Thomas; Kapur, Navneet; Temple, Rachel; Webb, Roger T.; Mok, Pearl L. H.

doi:10.1016/s2352-4642(23)00126-8

Cited by 22 publications

(10 citation statements)

References 23 publications

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“…Additionally, the data are $10 years old, predating COVID-19. Given the increasing prevalence of atypical AN and other eating disorders since COVID-19 (Trafford et al, 2023), more recent data may reveal different symptom trajectories.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students

Hagan,

Johnson,

Venables

et al. 2024

Intl J Eating Disorders

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ObjectiveResearch on the natural course of symptoms of atypical anorexia nervosa (AN) relative to AN and bulimia nervosa (BN) is limited yet needed to inform nosology and improve understanding of atypical AN. This study aimed to 1) characterize trajectories of eating disorder and internalizing (anxiety, depression) symptoms in college students with and without a history of atypical AN, AN, and BN; and 2) compare sex and race/ethnicity distributions across groups.MethodUnited States college students who participated in Spit for Science™, a prospective cohort study, were classified as having a history of atypical AN (n = 125), AN (n = 160), BN (n = 617), or as non‐eating‐disorder controls (NCs, n = 5876). Generalized and linear mixed‐effects models assessed group differences in eating and internalizing symptom trajectories, and logistic regression compared groups on sex and race/ethnicity distributions.ResultsAtypical AN participants demonstrated elevated eating disorder and internalizing symptoms compared to NCs during college, but less severe symptoms than AN and BN participants. Although all eating disorder groups showed signs of improvement in fasting and driven exercise, purging and depression remained elevated. Atypical AN participants showed increasing anxiety and stable binge‐eating trajectories compared to AN and/or BN participants. The atypical AN group comprised significantly more people of color than the AN group.DiscussionFindings underscore that atypical AN is a severe psychiatric disorder. As atypical AN may present as less severe than AN and BN and disproportionately affects people of color, clinicians should be mindful of biases that could delay diagnosis and care.Public SignificanceCollege students with histories of atypical AN, AN, and BN demonstrated improvements in fasting and driven exercise and stable purging and depression levels. Atypical AN students showed worsening anxiety and stable binge‐eating trajectories compared to favorable changes among AN and BN students. A higher percentage of atypical AN (vs. AN) students were people of color. Findings may improve the detection of atypical AN in college students.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students

Hagan,

Johnson,

Venables

et al. 2024

Intl J Eating Disorders

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“…Notably, a large-scale population-based study in the UK noted that the prevalence of both EDs and self-injury increased among females aged 13-19 since the COVID-19 pandemic (Trafford et al, 2023). Specifically, EDs and selfinjury were found to have 42.4% and 32.0% higher incidence rates than anticipated, respectively (Trafford et al, 2023).…”

Section: Introductionmentioning

confidence: 98%

“…The prevalence of an ED has previously been found to be 9%, while a prevalence of self‐injury has been reported as 22% (Arcelus et al, 2011; Xiao et al, 2022). Notably, a large‐scale population‐based study in the UK noted that the prevalence of both EDs and self‐injury increased among females aged 13–19 since the COVID‐19 pandemic (Trafford et al, 2023). Specifically, EDs and self‐injury were found to have 42.4% and 32.0% higher incidence rates than anticipated, respectively (Trafford et al, 2023).…”

Section: Introductionmentioning

confidence: 99%

Non‐suicidal self‐injury among individuals with an eating disorder: A systematic review and prevalence meta‐analysis

Kirkpatrick,

Breton,

Biorac

et al. 2023

Intl J Eating Disorders

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ObjectiveThis study aimed to quantify the prevalence of non‐suicidal self‐injury across eating disorders (EDs) and within diagnostic categories through systematic review and proportional, or so‐called prevalence, meta‐analysis.MethodIncluded studies had to contain individuals with a verified diagnosis of an ED. The last literature search was conducted on September 11, 2023, for studies published on or before September 2023 without a restriction on earliest publication year. Results were synthesized and analyzed using the “metaprop” package in R and presented using forest plots. Bias was assessed by a Peters' regression test and funnel plot.Results79 studies published between 1985 and 2023 were included encompassing 32,334 individuals with an ED. Importantly, 42 studies were not included in any other meta‐analyses on self‐injury in EDs to date. Overall prevalence of non‐suicidal self‐injury was 34.59% (95%CI = 30.49–38.81). Prevalence in anorexia nervosa restrictive type, binge/purge type, bulimia nervosa, binge eating disorder and other specified feeding/eating disorder were 23.19% (95%CI = 16.96–30.03%), 41.98% (95%CI = 32.35–51.91%), 36.97% (95%CI = 30.69–43.46%), 21.21% (95%CI = 14.93–28.12%) and 37.65% (95%CI = 28.59–47.09%), respectively. Prevalence estimations could not be estimated for other ED categories due to lack of a sufficient number of studies.DiscussionNon‐suicidal self‐injury is prevalent across both binge/purge and restrictive EDs. Considering the transdiagnostic nature of self‐injurious behaviors in ED, the results highlight the importance of assessment and monitoring of self‐injury in people with ED, irrespective of specific diagnoses. The method of determining self‐injury varied across studies and may limit this study.Public SignificanceThis study highlights the prevalence of self‐injury across eating disorders irrespective of diagnosis and within specific EDs. While diagnoses known to exhibit self‐injurious behaviors (e.g., bulimia nervosa, anorexia nervosa binge/purge subtype) demonstrated the highest prevalence of self‐injury, all diagnoses were found to have a prevalence greater than 20%. These findings suggest the importance of assessing and monitoring all individuals with an eating disorder for the presence of self‐injury.

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“…Eating disorders (EDs) collectively share cardinal features, including dysregulated eating patterns and body image distortion, and too often, they are characterized by a chronic, costly, and disabling illness course (Demmler et al, 2020;Streatfeild et al, 2021). The prevalence rates of EDs, encompassing Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED), range from 0.3-4% (Udo & Grilo, 2018), and they are continuing to increase (Trafford et al, 2023). EDs disproportionately impact females compared to males, with lifetime prevalence rates of AN reported to be ~4% for females and 0.3% for males, and rates of BN reported to be 3% for females and 1% for males (van Eeden et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic correlates of parent and youth-reported eating disorder symptoms in the Adolescent Brain Cognitive Development Study

Makowski,

Westwater,

Rhee

et al. 2023

Preprint

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ObjectiveEating Disorders (EDs) often start in adolescence, though the prevalence, trajectory of symptom onset and predictors of illness are poorly understood, especially across sociodemographically diverse youth. Here, we leverage data from the Adolescent Brain Cognitive Development℠ (ABCD) Study, a large demographically representative longitudinal sample of youth in the US, to characterize the prevalence of parent- and youth-reported ED symptoms and their sociodemographic characteristics at baseline (ages 9-11) and two-years later (2-year; ages 11-14).MethodA tetrachoric factor analysis summarized clusters of ED symptoms, which were compared between parent and youth reports. Cognitive, mental and physical health variables at baseline were used to predict youth-reported symptoms at 2-year using a mixed-effects logistic regression.ResultsThree factors emerged reflecting “weight distress”, “weight control”, and “bingeing”, with prevalence rates ranging from 1.5 to 7.3%. All symptoms loaded on similar factors between reporters. Rates of symptom endorsement were similar for males and females, with disproportionately higher rates across factors for youth who self-identified as sexual minority, Hispanic, Black, or Mixed race participants, and those from a disadvantaged socioeconomic background, compared to the full ABCD sample. Youth and parent reports at 2-year showed ∼17% overlap. A distinct pattern of cognitive variables emerged as significant predictors of later youth-reported ED concerns, whereas mental health symptoms and traits were non-specific and associated with all ED factors.ConclusionIdentifying the landscape of ED symptoms across demographic groups, reporters and their premorbid factors in late childhood is critical to inform prevention and early intervention efforts, with particularly important implications for historically understudied racial and sexual minority groups.

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Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study

Cited by 22 publications

References 23 publications

Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students

Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students

Non‐suicidal self‐injury among individuals with an eating disorder: A systematic review and prevalence meta‐analysis

Sociodemographic correlates of parent and youth-reported eating disorder symptoms in the Adolescent Brain Cognitive Development Study

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