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James Hudson & Ron Kessler talks with and answer a few questions about this month's New Hot Paper in the field of Neuroscience & Behavior.
Hudson Article Title: The prevalence and correlates of eating disorders in the national comorbidity survey replication
Authors: Hudson, JI;Hiripi, E;Pope, HG;Kessler, RC
Volume: 61
Issue: 3
Page: 348-358
Year: FEB 1 2007
* McLean Hosp, Biol Psychiat Lab, 115 Mill St, Belmont, MA 02478 USA.
* McLean Hosp, Biol Psychiat Lab, Belmont, MA 02478 USA.
* Harvard Univ, Sch Med, Dept Psychiat, Belmont, MA 02178 USA.
(addresses have been truncated)

 Why do you think your paper is highly cited?

The paper reports the first nationally representative population-based data on the prevalence and correlates of eating disorders in the United States. The data come from the National Comorbidity Survey Replication (NCS-R), a nationally representative psychiatric epidemiological survey of the US household population that gathered data on the prevalence and correlates of a wide range of mental disorders.

Because the data in our paper are unique, many subsequently published papers covering a variety of aspects of eating disorders and disturbed eating have cited our paper as an authoritative source for estimates of the prevalence and demographic features of eating disorders.


Ronald Kessler

National Comorbidity Survey Replication team

National Comorbidity Survey Replication team

In addition, our paper reports the first population-based epidemiological data on the prevalence and correlates of binge eating disorder. Binge eating disorder is characterized by recurrent eating binges during which an individual eats an unusually large amount of food in a short period of time, associated with a feeling of loss of control over the eating, but without the "purging behaviors," such as self-induced vomiting or laxative abuse, seen in bulimia nervosa.

We showed both that binge eating disorder is relatively common in comparison with bulimia nervosa and also that binge eating disorder is associated with very similar chronicity and impairment as bulimia nervosa. The latter finding is of special importance in light of the fact that the current diagnostic system used in the US, the Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), does not include binge eating disorder as a definite disorder but rather as a condition of possible interest that might at some future date be upgraded to be considered a definite disorder.

As the DSM system is currently in the process of being revised, a great deal has been written recently about various proposed changes in the next edition. Many of the papers that have cited our paper focus on binge eating disorder and cite our evidence of chronicity, substantial impairment, high levels of psychiatric comorbidity, and risk for obesity as evidence that binge eating disorder should be upgraded to a definite disorder in the next edition of the DSM system.

 Does it describe a new discovery, methodology, or synthesis of knowledge?

As noted above, the paper reports new findings in two principal areas. First, it provides the first nationally representative data on the prevalence and correlates of eating disorders in the United States. For anorexia nervosa and bulimia nervosa, these data largely provide confirmation of the results of previous smaller or less representative studies. Second, the study provides the first general population data on binge eating disorder, including data on prevalence and correlates.

We found that binge eating disorder is more common than anorexia nervosa and bulimia nervosa combined (affecting 3.5% of women and 2.0% of men over the course of their lifetime), is often a chronic condition, is associated with the presence of other mental disorders, is associated with obesity (particularly severe obesity), and has increased in prevalence in recent cohorts. These findings suggest that binge eating disorder contributes to the obesity epidemic and that it represents a major and underrecognized public health problem.

As noted above, binge eating disorder is currently classified as a provisional entity (i.e. a "proposed diagnosis," rather than an "official" diagnosis) in the DSM-IV, the official classification of mental disorders in the United States. As work begins on the fifth edition (DSM-V), there is much interest in the question of whether binge eating disorder merits inclusion as an official diagnosis. The results of our paper provide important new data on this issue, and weigh in favor of elevating binge eating disorder to an official diagnosis.

 Would you summarize the significance of your paper in layman's terms?

Many people, both laymen and scientists, have questioned whether binge eating disorder represents a genuine psychiatric disorder, or whether it might be simply a particular pattern of eating that occurs from time to time in people who are obese. In the past, lacking national epidemiologic data, it has been difficult to answer this question. Our study now suggests that binge eating disorder is a common, relatively stable condition that's associated with both psychiatric morbidity and medical morbidity. These findings weigh in favor of binge eating disorder being a genuine psychiatric disorder rather than merely an idiosyncratic pattern of eating.

 How did you become involved in this research, and were there any problems along the way?

As noted above, this paper was prepared as part of the work of the National Comorbidity Survey Replication (NCS-R), a nationally representative survey of the prevalence and correlates of mental disorders in the US household population. The NCS-R was carried out in 2001-3. The NCS-R is a replication and expansion of the earlier National Comorbdity Survey (NCS), a national survey that was carried out a decade before the NCS-R. Comparisons of results in the NCS and NCS-R have been used to monitor trends in the prevalence of mental disorders in the US and to study changes in patterns of treatment for these disorders.

One of the expansions in the NCS-R was the inclusion of information about eating disorders, which were not included in the earlier NCS. Once a decision was made to include eating disorders in the NCS-R, the NCS-R survey team, which is led by Ron Kessler, established collaboration with James Hudson and Harrison Pope, who are experts in the study of eating disorders, to work on this part of the NCS-R data. No major problems were encountered once the decision was made to include an assessment of eating disorders in the survey. Data collection and subsequent data analysis went smoothly.

 Where do you see your research leading in the future?

Finding as we did that eating disorders are common and often chronic, it will become important to expand investigation of the public health implications of this disorder in future epidemiological surveys. To that end, the NCS-R assessment of eating disorders has now been included in the nationally representative surveys carried out in the World Health Organization’s World Mental Health Survey Initiative.

WMH surveys are being administered in 28 countries around the world. With regard to binge eating disorder, a new long-term follow-up study has now been initiated by Hudson and colleagues to examine the extent to which binge eating disorder is a risk factor for obesity and cardiometabolic disorders.

 Do you foresee any social or political implications for your research?

We expect that the results of this study will be considered in the deliberations regarding whether to add binge eating disorder as an official diagnosis in DSM-V. Inclusion of binge eating disorder would result in greater coverage for treatment by insurance plans and thus would increase access to treatment for individuals suffering from this condition.

More broadly, if binge eating disorder represents a cause of obesity stemming from an underlying neuropsychiatric dysregulation, identification and potential treatment of this dysregulation might reduce the risk of obesity and other adverse psychological and physical consequences of binge eating.  

James I. Hudson, M.D., Sc.D.
Professor of Psychiatry
Harvard Medical School
Director, Biological Psychiatry Laboratory
Director, Psychiatric Epidemiology Research Program
McLean Hospital
Belmont, MA, USA

Ronald C. Kessler, Ph.D.
Professor of Health Care Policy
Harvard Medical School
Principal Investigator, National Comorbidity Survey
Boston, MA, USA

Related information:


Keywords: national comorbidity survey replication, ncs-r, psychiatric epidemiological survey, eating disorders, binge eating disorder, severe obesity, obesity epidemic, population-based epidemiological data, bulimia nervosa, diagnostic and statistical manual of mental disorders, dsm-iv, dsm-v, anorexia nervosa, psychiatric disorder, psychiatric morbidity, medical morbidity, world health organization’s world mental health survey initiative, cardiometabolic disorders, neuropsychiatric dysregulation


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