Prevalence and utility of DSM-IV eating disorder diagnostic criteria among youth

Objective: To examine the prevalence and utility of DSM-IV eating disorder (ED) criteria and anorexia (AN), bulimia (BN), and binge eating disorder (BED) among adolescents. Method: An ethnically diverse population-based sample of 4,746 public middle and high school students completed anthropometric measures and Project EAT survey items. Results: Many youth endorsed body shape perception disturbance (41.5% female; 24.9% male), undue influence of body shape/weight on self-esteem (36.4% female; 23.9% male), and compensatory behavior (9.4% female; 13.5% male). Prevalence among females and males, respectively, was: AN = 0.04%, 0%; BN = 0.3%, 0.2%; BED = 1.9%, 0.3%. Analyses of individual criteria showed high sensitivity and negative predictive values for each disorder and corresponding criteria, low specificity for several AN (27.8%) and BN (32.0%) criteria, and low positive predictive values (0.06-40.2%). Conclusion: Body disparagement and compensatory behaviors indicate eating disturbance, despite low prevalence of EDs. Diagnostic classification may be clinically useful, but is complicated for use in epidemiological populations.