Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population

Abstract

BackgroundLittle is known about the epidemiology and health related quality of life (HRQoL) of the new DSM-5 diagnoses, Binge Eating Disorder (BED) and Avoidant/Restrictive Food Intake Disorder (ARFID) in the Australian population. We aimed to investigate the prevalance and burden of these disorders.MethodsWe conducted two sequential population-based surveys including individuals aged over 15 years who were interviewed in 2014 (n = 2732) and 2015 (n =3005). Demographic information and diagnostic features of DSM-5 eating disorders were asked including the occurrence of regular (at least weekly over the past 3 months) objective binge eating with levels of distress, extreme dietary restriction/fasting for weight/shape control, purging behaviors, overvaluation of shape and/or weight, and the presence of an avoidant/restrictive food intake without overvaluation of shape and/or weight. In 2014 functional impact or role performance was measured with the ‘days out of role’ question and in 2015, Health Related Quality of Life (HRQoL) was assessed with the Short Form −12 item questionnaire (SF-12v1).ResultsThe 2014 and 2015 3-month prevalence of eating disorders were: anorexia nervosa-broad 0.4% (95% CI 0.2–0.7) and 0.5% (0.3–0.9); bulimia nervosa 1.1% (0.7–1.5) and 1.2% (0.9–1.7); ARFID 0.3% (0.1–0.5) and 0.3% (0.2–0.6). The 2015 3-month prevalence rates were: BED-broad 1.5% (1.1–2.0); Other Specified Feeding or Eating Disorder (OSFED) 3.2 (2.6–3.9); and Unspecified Feeding or Eating Disorder (UFED) 10.4% (0.9–11.5). Most people with OSFED had atypical anorexia nervosa and majority with UFED were characterised by having recurrent binge eating without marked distress. Eating disorders were represented throughout sociodemographic groups and those with bulimia nervosa and BED-broad had mean weight (BMI, kg/m2) in the obese range. Mental HRQoL was poor in all eating disorder groups but particularly poor for those with BED-broad and ARFID. Individuals with bulimia nervosa, BED-broad and OSFED-Purging Disorder also had poor physical HRQoL. ARFID and bulimia nervosa groups had lower role performance than those without an eating disorder.ConclusionsWhilst full spectrum eating disorders, including ARFID, were less common than OSFED or UFED, they were associated with poor mental HRQoL and significant functional impairment. The present study supports the movement of eating disorders in to broader socio demographic groups including men, socio-economic disadvantaged groups and those with obesity.

Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students

“…Second, we used an elevated EDE‐Q global score as a marker of elevated eating disorder psychopathology, but this is not a specific indicator of the psychopathology needed for diagnosis. Furthermore, because the EDE‐Q fails to capture the associated features of binge‐eating episodes, the prevalence of clinically significant binge eating would likely be overestimated in our study (Binford, Le Grange, & Jellar, ; Goldfein, Devlin, & Kamenetz, ; Hay et al, ; Mitchison, Touyz, Gonzalez‐Chica, Stocks, & Hay, ), although not all studies find that the EDE‐Q over identifies objective binge‐eating episodes (Grilo, Masheb, & Wilson, ; Mond et al, ). Overall, false positives included in our sample would have resulted in exaggerated estimates of under‐diagnosis and under‐treatment.…”

Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents

“…Since ARFID is a relatively new diagnosis, there have only been two population-based prevalence studies. An Australian interview-based study of males and females ages 15 and older reported a 3-month point prevalence of ARFID of 0.3% in 2013 and in 2014 (7). A study of schoolchildren ages 8–13 in Switzerland reported a point prevalence of 3.2% measured via self-report questionnaire (8).…”

Development of the Pica, ARFID, and Rumination Disorder Interview, a multi‐informant, semi‐structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22

“…Several measures assessing picky or selective eating in population samples are also available (e.g.,Wardle, Guthrie, Sanderson, & Rapoport, ; Pliner & Hobden, —see Table for additional measures) but all are too broad to measure ARFID psychopathology specifically. Whereas selective or picky eating is common in community samples (Wildes, Zucker, & Marcus, ), the psychiatric disorder ARFID has been shown to be far less common (Hay et al, ; Kurz, Van Dyck, Dremmel, Munsch, & Hilbert, ). However, prevalence studies of ARFID have to date relied on self‐report measures (Kurz et al, ) or unvalidated clinical interviews (Hay et al, ), making it challenging to ascertain the frequency of ARFID in the general population.…”

“…Whereas selective or picky eating is common in community samples (Wildes, Zucker, & Marcus, ), the psychiatric disorder ARFID has been shown to be far less common (Hay et al, ; Kurz, Van Dyck, Dremmel, Munsch, & Hilbert, ). However, prevalence studies of ARFID have to date relied on self‐report measures (Kurz et al, ) or unvalidated clinical interviews (Hay et al, ), making it challenging to ascertain the frequency of ARFID in the general population. Indeed, available estimates range widely, from 0.3% by clinical interview in an epidemiological study of Australian adults (Hay et al, ), to 3.2% by self‐report survey among Swiss schoolchildren ages 8–13 years old (Kurz et al, ).…”