Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States

Int J Eat Disord. 2019 Jan;52(1):42-50. doi: 10.1002/eat.23004.


Objective: To examine psychiatric and somatic correlates of DSM-5 eating disorders (EDs)-anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED)-in a nationally representative sample of adults in the United States.

Method: A national sample of 36,309 adult participants in the national epidemiologic survey on alcohol and related conditions III (NESARC-III) completed structured diagnostic interviews (AUDADIS-5) to determine psychiatric disorders, including EDs, and reported 12-month diagnosis of chronic somatic conditions. Prevalence of lifetime psychiatric disorders and somatic conditions were calculated across the AN, BN, and BED groups and a fourth group without specific ED; multiple logistic regression models compared the likelihood of psychiatric/somatic conditions with each specific ED relative to the no-specific ED group.

Results: All three EDs were associated significantly with lifetime mood disorders, anxiety disorders, alcohol and drug use disorders, and personality disorders. In all three EDs, major depressive disorder was the most prevalent, followed by alcohol use disorder. AN was associated significantly with fibromyalgia, cancer, anemia, and osteoporosis, and BED with diabetes, hypertension, high cholesterol, and triglycerides. BN was not associated significantly with any somatic conditions.

Conclusions: This study examined lifetime psychiatric and somatic correlates of DSM-5 AN, BN, and BED in a large representative sample of U.S. adults. Our findings on significant associations with other psychiatric disorders and with current chronic somatic conditions indicate the serious burdens of EDs. Our findings suggest important differences across specific EDs and indicate some similarities and differences to previous smaller studies based on earlier diagnostic criteria.

Keywords: DSM-5; chronic somatic conditions; eating disorders; epidemiology; national representative sample; psychiatric comorbidity.

MeSH terms

  • Adolescent
  • Adult
  • Anorexia Nervosa / diagnosis*
  • Anorexia Nervosa / pathology
  • Binge-Eating Disorder / diagnosis*
  • Binge-Eating Disorder / pathology
  • Bulimia Nervosa / diagnosis*
  • Bulimia Nervosa / pathology
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Feeding and Eating Disorders / diagnosis*
  • Feeding and Eating Disorders / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • United States
  • Young Adult