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Abstract
Mayo Clin Proc. 2019;94(8):1415-1426 According to the most recent estimates based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),1 the prevalence rates of lifetime anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) in US adults are 0.80%, 0.28%, and 0.85%, respectively.2 Eating disorders (EDs) are associated with numerous medical complications, impaired health-related quality of life, and severe psychosocial functional impairment.3-5 Frequently, AN, BN, and BED are also comorbid with other psychiatric disorders, particularly with anxiety disorders, major depressive disorder, and substance use disorders.3,6-10 Available research suggests that EDs are associated with decreased quality of life and increased economic costs compared with other psychiatric conditions.4 Despite these possible disease burdens, there is a dearth of epidemiologic research on EDs,2,6,11,12 particularly regarding prevalence and patterns of seeking help or treatment for ED symptoms. Studies have long recognized treatment barriers among ethnically diverse populations, including financial difficulties, lack of insurance, fears of being labeled, beliefs that others cannot help, and ED symptoms not being screened by health care providers.17,18,35 Emerging research suggests important differences in presenting clinical characteristics by sex24 and ethnicity/race.27 The present findings reinforce the importance of raising awareness of ED symptoms among ethnic/racial minorities and engaging them in treatment through nontraditional, possibly nonclinical community settings.1 The present findings seem to contrast somewhat with those of the study by Marques et al5 that examined ethnic/racial differences in mental health service utilization by individuals with EDs using the CPES data set. In the NESARC-III, the help-seeking questions were specific to the ED-related symptoms (eg, low weight for AN, binge eating and weight compensation behaviors for BN, and binge eating for BED), whereas the CPES defined it more broadly as 1 or more visits to a specialty mental health or mental health provider for mental health care. Because all EDs are associated with elevated rates of other psychiatric disorders, individuals with EDs may use treatment for other mental health problems, which likely accounts for the higher rates reported in the study by Marques etal.12 The strengths of the present study include the analysis of the most recent large epidemiologic study on DSM-5 psychiatric disorders in US adults that included information on EDs and treatment utilization. [...]some of the categories for help-seeking are broad (ie, counselor, therapist, doctor, or psychologist), and it is difficult to characterize the exact services that were used within each individual category. [...]broad categories might obscure important disparities around, for example, whether participants sought generalist care (eg, primary care internal medicine) vs specialist care (eg, psychiatrist or psychologist), or specialized ED treatment (eg, evidence-based ED specific).
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1 Department of Psychology, University at Albany, State University of New York, Albany; and Department of Psychiatry, Yale School of Medicine, New Haven, CT
2 Department of Health Policy, Management, and Behavior, School of Public Health
3 University at Albany, State University of New York, Albany; and Department of Psychiatry, Yale School of Medicine, New Haven, CT