Through the looking glass: Epidemiologische studies naar eetstoornissen in de eerste lijn en de bevolking

Eating disorders, such as anorexia nervosa and bulimia nervosa, are severe mental health problems, which usually develop in adolescence. Their causes are relatively poorly understood; sociocultural factors are thought to play a major role. Research questions addressed in this thesis include: Has the number of new cases of anorexia nervosa and bulimia nervosa changed over time? What are the most common eating disorder diagnoses among Dutch adolescents? Furthermore, an attempt is made to improve our understanding of how eating pathology develops by examining the role of self-perceived and peer-perceived social status in early adolescence as a potential risk factor. This thesis shows that the number of new cases of bulimia nervosa decreased significantly over the past three decades, while the number of anorexia nervosa remained fairly stable. Bulimia nervosa is probably more sensitive than anorexia nervosa to sociocultural developments over the past 25 years, such as, for example, a long-term trend of increasing body mass index of the general population. This may normalize overweight and thus decrease the pressure to counteract the effects of binge eating by compensatory behaviors, which constitute the core of bulimia nervosa. The most common eating disorders in Dutch adolescents were anorexia nervosa and binge-eating disorder among the girls, and among the boys, binge-eating disorder. The majority of eating disorder cases are not detected by (mental) health care services. Furthermore, in early adolescence, looking good – either in one’s own eyes or in the eyes of peers – protects against eating pathology in young adulthood, while being liked by peers might surprisingly indicate a risk.