Prevalence of DSM-5 eating disorders and associated impairment and service use among children and young people in England: analysis of a general population survey

Background: Eating disorders (EDs) typically emerge in adolescence and carry substantial morbidity. DSM-5 revised EDs classification, introducing Other Specified Feeding or Eating Disorder (OSFED) and Avoidant Restrictive Food Intake Disorder (ARFID). We estimated general population prevalence of EDs, including ARFID, in children and young people (CYP), and the associated impairment, which remains poorly characterised. Methods: We analysed the Mental Health of Children and Young People in England (MHCYP) 2023 survey, a nationally representative probability sample. All participants were screened for possible eating problems. Screen positives and a random sample of screen negatives were invited to a second-stage assessment; giving an analytic sample of 1,738 aged 11-25 years. Associations with impairment, mental health difficulties and service use were estimated using survey-weighted regression adjusted for age and sex. Results: Any ED affected 6.7% (95% CI 5.4-8.3) of 11-25-year-olds and was over three times more common in females (10.7%) than males (3.0%). OSFED was the commonest (3.5%), followed by bulimia nervosa (1.7%), anorexia nervosa (0.9%), binge eating disorder (0.6%) and ARFID (0.2%). Prevalence peaked at 17-19 years (13.9%). EDs were associated with lifetime self-harm (aOR 9.1 at 11-16; 4.4 at 17-25), SDQ-predicted probable disorder (aOR 14.7 at 11-16; 2.5 at 17-25), medication use (aOR 5.3) and mental health service contact (aOR 2.1). Conclusions: EDs are common among CYP in England and carry high levels of impairment, self-harm and comorbid mental health difficulties, particularly among 11-16-year-olds. Nonetheless, more than half of those meeting diagnostic criteria had no mental health service contact in the preceding year. Keywords: Eating disorders; prevalence; epidemiology; adolescence; ARFID; service use.