Three decades of eating disorders in Dutch primary care: decreasing incidence of bulimia nervosa but not of anorexia nervosa.
Level 3 - non-randomized controlled study
Longitudinal population-based primary care surveillance study across multiple time intervals.
PubMed 26671456 · doi:10.1017/S003329171500272X
What was done
A nationwide network of general practitioners (GPs) covering a representative sample (~1%) of the total Dutch population recorded newly diagnosed cases of anorexia nervosa (AN) and bulimia nervosa (BN) across three distinct time intervals: 1985–1989, 1995–1999, and 2005–2009. The same case identification criteria and the same psychiatrist for final diagnostic confirmation were maintained across all three periods. Incidence rates and incidence rate ratios were calculated to track trends across decades within a healthcare system where GP referral is mandatory for insurance-covered specialized care.
What was found
The overall incidence rate of bulimia nervosa decreased significantly over three decades, dropping from 8.6 per 100,000 person-years in 1985–1989 to 6.1 in 1995–1999, and down to 3.2 in 2005–2009. The overall incidence rate of anorexia nervosa remained relatively stable across the same periods, recorded at 7.4 per 100,000 person-years in 1985–1989, 7.8 in 1995–1999, and 6.0 in 2005–2009.
Why it matters
This study provides long-term primary care epidemiological surveillance showing a distinct divergence in eating disorder trends: bulimia nervosa incidence fell by more than half between the late 1980s and late 2000s, whereas anorexia nervosa incidence rates remained stable.
Limits
The abstract does not report total participant counts, specific case numbers, confidence intervals, or exact p-values for the incidence rate ratios. Data are limited to individuals presenting to primary care and receiving a diagnosis, potentially missing community cases that do not seek medical care.
Cited by
- supports The population frequency of anorexia nervosa has remained steady over time rather than increasing in response to modern media or social media.