Accepted Manuscript

Prevalence and Correlates of DSM-5 Eating Disorders in Nationally Representative

Sample of United States Adults

Tomoko Udo, Ph.D., Carlos M. Grilo, Ph.D.

PII: S0006-3223(18)31440-9
DOI: 10.1016/j.biopsych.2018.03.014
Reference: BPS 13513

To appear in: Biological Psychiatry

Received Date: 7 December 2017

Revised Date: 20 March 2018
Accepted Date: 31 March 2018

Please cite this article as: Udo T. & Grilo C.M., Prevalence and Correlates of DSM-5 Eating Disorders
in Nationally Representative Sample of United States Adults, Biological Psychiatry (2018), doi: 10.1016/
j.biopsych.2018.03.014.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to
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 ACCEPTED MANUSCRIPT
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Prevalence and Correlates of DSM-5 Eating Disorders in Nationally Representative Sample of

United States Adults

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Tomoko Udo, Ph.D. 1 and Carlos M. Grilo, Ph.D. 2

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1
Department of Health Policy, Management, and Behavior, School of Public Health, University

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at Albany, State University of New York, 12144, USA
2
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510

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Corresponding Author: Tomoko Udo, Ph.D.; 1 University Place, Rensselaer, NY 12144; Phone:

518-486-5572; Fax: 518-402-0414; Email: tschaller@albany.edu.

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KEY WORDS: anorexia nervosa; bulimia nervosa; binge-eating disorder; obesity; prevalence;

impairment
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RUNNING HEAD: PREVALENCE DSM-5 EATING DISORDERS

Word count (abstract): 248

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Word count (text): 4,000

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Figures: 0

Tables: 7

Supplemental information: 3 Tables

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Abstract

Background: There exist few population-based data on the prevalence of eating disorders (EDs)

and this is especially needed because of changes to diagnoses in the DSM-5. This study aimed to

provide lifetime and 12-month prevalence estimates of DSM-5 anorexia nervosa (AN), bulimia

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nervosa (BN), and binge-eating disorder (BED) from the 2012-2013 National Epidemiologic

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Survey Alcohol and Related Conditions (NESARC-III).

Methods: A national sample of 36,306 U.S. adults completed structured diagnostic interviews

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(AUDADIS-5).

Results: Prevalence (standard error) estimates of lifetime AN, BN, and BED were 0.80%

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(0.07%), 0.28% (0.03%), and 0.85% (0.05%). 12-month estimates for AN, BN, and BED were
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0.05% (0.02%), 0.14% (0.02%), and 0.44% (0.04%). Adjusting for age, race/ethnicity, education,

and income, odds of lifetime and 12-month diagnoses of all three EDs were significantly greater
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for women than men. Adjusted odds ratios (AORs) of lifetime AN were significantly lower for
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non-Hispanic Black and Hispanic than for White respondents. AORs of lifetime and 12-month
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BN did not differ significantly by race/ethnicity. AOR of lifetime BED, but not 12-month, was

significantly lower for non-Hispanic Black relative to non-Hispanic White respondents; AORs of
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BED for Hispanic and non-Hispanic White respondents did not differ significantly. AN, BN, and

BED were characterized by significant differences in ages of onset, persistence and duration of
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episodes, and rates of current obesity and psychosocial impairment.

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Conclusions: These findings for DSM-5-defined EDs, based on the largest national sample of

U.S. adults studied to date, indicate some important similarities and differences to earlier smaller

nationally representative studies.

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There exist few nationally representative population-based data on the prevalence of

eating disorders (EDs) (1). In the United States, the National Institutes of Mental Health

Collaborative Psychiatric Epidemiological Studies (CPES; 2) comprised three nationally

representative samples of adults assessed with diagnostic interviews: National Comorbidity

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Survey-Replication (NCS-R; 3), National Survey American Life (NSAL; 4), and National Latino

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and Asian American Study (NLAAS; 5). NCS-R used structured lay-administered diagnostic

interviews (Composite International Diagnostic Interview; CIDI) to generate DSM-IV-based

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psychiatric diagnoses, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating

disorder (BED; which was not a “formal” diagnosis but included as a provisional diagnosis

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category and criteria set). Hudson and colleagues (6) analyzed data from a subset of N=2980
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respondents (randomly selected from larger NCS-R pool of N=5692), and reported lifetime

prevalence estimates for AN, BN, and BED as 0.6%, 1.0%, and 2.8% (0.9%, 1.5%, and 3.5%
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among women, and 0.3%, 0.5%, and 2.0% among men). Marques and colleagues (7) compared
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ED prevalence rates across ethnic/racial groups by pooling CPES data, including NCS-R (6)
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aggregated with N=3750 African-American from NSAL and N=2554 Latinos and N=2095

Asian-Americans from NLAAS. Similar prevalence estimates for AN and BED across
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ethnic/racial groups but higher estimates for BN among Latino and African-American than

White respondents were reported (7).

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Data from large-scale nationally-representative samples assessed with diagnostic

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interviews is required to update prevalence estimates of EDs in the U.S. Expert reviews of

worldwide ED epidemiology have emphasized the need for larger rigorous studies to produce a

better understanding of prevalence and distribution of EDs (1). This is especially needed because

of recent changes in diagnoses and criteria of EDs in DSM-5 (8), which could impact prevalence
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estimates. In DSM-5, AN diagnosis no longer requires amenorrhea and now defines low-weight

as less than minimally normal/expected. The BN diagnosis now has a frequency requirement of

once-weekly for binge-eating and weight-compensatory behaviors, a lower frequency than twice-

weekly in the DSM-IV. BED, now a “formal” diagnosis, is also defined with a lower frequency

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requirement of once-weekly binge-eating for 3-months to parallel the BN diagnosis.

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Research on the impact of changes between DSM-IV and DSM-5 on prevalence of EDs

has been limited. One study from Switzerland, which used diagnostic interviews to assess a

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nationally representative sample of 10,038 residents, examined differences between DSM-IV and

DSM-5 for AN (9). A Swedish Twin Study re-analyzed data from diagnostic interviews with

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13,295 female twins to estimate impact of reduced frequency/duration criteria for binge-eating
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on estimates for BN and BED (10). One U.S.-based internet survey study of 22,397 respondents

used self-reports to estimate prevalence of BED based on DSM-IV and DSM-5 (11). These
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studies suggested DSM-5-based criteria yielded higher estimates for AN (9), BN (10), and BED
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(11). To date, however, no study has estimated the DSM-5-defined prevalence of EDs using
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diagnostic interviews with a large-scale nationally representative U.S. sample.

This study aimed to provide lifetime and 12-month prevalence estimates of DSM-5 AN,
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BN, and BED in a nationally-representative sample of U.S. adults using data from 2012-2013

National Epidemiologic Survey Alcohol and Related Conditions (NESARC-III). NESARC-III,

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which included 36,309 respondents assessed with lay-administered diagnostic interviews, is by

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far the largest nationally-representative sample of U.S. adults to allow for estimating prevalence

of AN, BN, and BED following the DSM-5 (8).

Methods and Materials

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Sample

NESARC-III included 36,309 non-institutionalized U.S. civilians 18 years and older (12,

13). Respondents completed computer-assisted face-to-face personal interviews between April

2012 and June 2013. NESARC employed multi-stage probabilistic sampling with counties or

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groups of contiguous counties as primary sampling units, groups of Census-defined blocks as

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secondary sampling units, and households within secondary sampling units as tertiary sampling

units. Within each household, eligible adults were randomly selected but with Hispanic, Black,

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and Asian household members oversampled (i.e., two respondents from households with more

than four eligible minority members) relative to White household members. Household response

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rate was 72% and person-level response rate was 84%, yielding an overall response rate of
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60.1% (13). Data were adjusted for non-response and weighted to represent the U.S. population

based on Bureau of the Census 2012 American Community Survey. NESARC-III was approved
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by the NIH IRB and respondents provided oral informed-consent which was electronically
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recorded (13). The authors obtained IRB exempt approval from SUNY-Albany to perform
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analyses.

Measurement
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Sociodemographic Characteristics. Respondents provided sociodemographic

information including age, sex, ethnicity/race (non-Hispanic White, non-Hispanic Black,

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Hispanic, non-Hispanic Asian/Pacific Islander, and non-Hispanic American-Indian/Alaska

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Native, and Hispanic [any race]), education (categorized as less than H.S., H.S./GED, at least

some college), and income (categorized as <$25,000, $25,000-39,999, $40,000-69,999,

≤$70,000).

Body mass index (BMI). Self-reported height and weight were used to calculate BMI.
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Diagnostic Assessment. NESARC-III used the NIAAA Alcohol Use Disorder and

Associated Disabilities Interview Schedule-5 (AUDADIS-5; 14) to assess DSM-5-defined

psychiatric disorders and their criteria, including AN, BN, and BED. The AUDADIS-5 assessed

age at onset and age for most recent episode in order to calculate 12-month and lifetime

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prevalence estimates and assessed for impairment in social function due to EDs, including: (1)

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interference with normal daily activities, (2) serious problems getting along with others, and (3)

serious problems fulfilling responsibilities.

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AUDADIS-5 was administered by 970 trained lay assessors who had an average of five

years of experience with health-related surveys (13). Good test-retest reliability and fair-to-

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moderate concordance levels for the AUDADIS-5 with a semi-structured diagnostic interview
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administered by independent/blinded research-clinicians have been reported for substance use

and psychiatric disorders (15, 16). Reliability for NESARC-III ED diagnoses has not been
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reported.
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Creation of Eating Disorder Diagnoses1

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We created specific ED diagnostic groups (AN, BN, BED) based on DSM-5 criteria using

NESARC-III respondents’ responses to relevant AUDADIS-5 items2. We did not utilize

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NESARC-III-generated ED diagnosis variables because inspection of the dataset revealed

various errors3. Thus, it seemed clearly indicated to re-score NESARC-III variable data to create
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DSM-5-based ED categories for our analysis4, 5.

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For AN, respondents were required to meet the following: (1) Self-reported lowest BMI

less than 18.5; (2) Tried not to gain weight or restrict food intake despite low weight; (3) Afraid

of gaining weight or “getting fat” despite low weight; and (4) Reported at least one of the

following while their BMI was lowest: (a) thought they “looked fat”; (b) thought their weight or
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shape was one of the most important things about them; (c) did not think they might have been

unhealthy; (d) did not believe others who thought their weight was unhealthy; or (e) constantly

weighing themselves or measuring body parts.

For BN and BED, respondents were required to report recurrent binge-eating, determined

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based on three questions: (1) Ever eaten an unusually large amount of food within 2-hour period,

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not including the holidays; (2) Ever eating unusually large amounts of food on average at least

once weekly for at least 3 months; and (3) While eating an unusually large amount of food, felt

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unable to stop eating or control how much/what eating.

For BN, in addition to meeting criteria for recurrent binge-eating, respondents were

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required to report that during any of those times that they were binge-eating they: (1) Tried to
AN
keep from gaining weight by vomiting, using enemas, laxatives, diuretics/other medicines,

fasting, or exercising excessively; (2) Engaged in the weight-compensatory behaviors at least

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once weekly for at least 3 months; and (3) Thought their weight/shape was one of the most
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important things about them.

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For BED, in addition to meeting criteria for recurrent binge-eating, respondents were

required to report: (1) Eating an unusually large amount of food made them very upset, and (2)
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At least three of the following five features during the times they ate unusually large amounts of

food: (a) Eating much more quickly than usual; (b) Eating until uncomfortably full; (c) Eating
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despite not being hungry; (d) Eating alone because embarrassed by how much they were eating;
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and (e) Felt disgusted, depressed, or very guilty about the overeating.

Statistical Analysis

Analyses were performed using Statistical Analysis System (SAS) (release 9.4, 2002-

2012) and accounted for NESARC-III survey design by using Proc Survey procedures with
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Taylor series-variance-estimation method. Weighted means, frequencies, and cross-tabulations

were computed for 12-month and lifetime DSM-5-based diagnosis for the three specific EDs

overall (total sample) and separately for specific sociodemographic groups (sex, ethnicity/race,

age, education, income).

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For each ED, weighted means, medians, and frequencies were computed for age, BMI,

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age of onset, years with episode, persistence of ED, and ED-related impairment; Analysis of

covariance (ANCOVA) was used to examine whether current age, current BMI, age of onset,

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and years with episode differed between AN, BN, and BED, adjusting for sociodemographic

variables. Rao-Scott Chi-Square test was used to compare the proportion reporting persistence of

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ED and ED-related impairment across ED groups. Significant omnibus chi-square tests were
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probed by comparing cells to identify significant differences between ED groups (17, 18). For

these inferential statistics comparing lifetime ED groups, we followed well-established

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diagnostic “hierarchy” of AN>BN>BED (i.e., lifetime BN excluded those with lifetime AN,
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lifetime BED excluded those with lifetime AN/BN). Multiple logistic regression was used to
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calculate adjusted odds ratios (AORs) comparing risk of lifetime and 12-month diagnoses of EDs

by sociodemographic variables, adjusting for the other sociodemographic variables not being
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tested. Cox proportional hazardous models were used to test for differences in age-cohort effects

on ED, adjusting for sociodemographic variables. Multiple logistic regression was used to
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examine whether the likelihoods of having BMI<18.5 (underweight), 18.5≤BMI< 25 (normal

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weight), 25≤BMI< 30 (overweight), 30≤BMI< 40 (obese), and 40≤ BMI (extremely obese)

differed significantly between EDs (12-month and lifetime), relative to respondents without

lifetime history of any ED; these analyses adjusted for a sociodemographic variables (except for

12-month AN diagnosis which required BMI<18.5).

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Results

Prevalence Estimates of Eating Disorders: Lifetime and 12-month Rates: Overall and by

Sociodemographic Characteristics

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Prevalence (standard error [SE]) estimates of lifetime AN, BN, and BED were 0.80%

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(0.07%), 0.28% (0.03%), and 0.85% (0.05%), respectively (Table 1). Prevalence (SE) estimates

of 12-month AN, BN, and BED were 0.05% (0.02%), 0.14% (0.02%), and 0.44% (0.04%),

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respectively (Table 2). Supplemental Table S3 summarizes sensitivity analyses showing the

impact of discrepancies between our coding with that of the NESARC-III (listed in

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Supplemental Table S2) as well as to exploring the impacts of “broadening” various specific
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criteria on the prevalence estimates for EDs.

Lifetime prevalence estimate for “comorbid” EDs (i.e., having lifetime diagnoses of two
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or more specific EDs) was 0.22% (0.03%). Of those, 0.01% (0.01%) reported lifetime
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“comorbidity” between AN and BN, 0.02% (0.01%) between AN and BED, 0.13% (0.02%)
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between BN and BED, and 0.05% (0.02%) amongst all three EDs. Tables 1 and 2 also show

(unadjusted) prevalence estimates of lifetime and 12-month diagnoses, respectively, of AN, BN,
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and BED by sex, ethnicity/race, age, education, and income categories.

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Adjusted Prevalence Estimate of Eating Disorders by Sex, Race/Ethnicity, Education, and

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Income

Table 3 shows AORs and 95% CIs by sex, ethnicity/race (non-Hispanic White, non-

Hispanic Black, and Hispanic respondents), education, and income groups. AORs of lifetime and

12-month diagnoses of all three EDs were significantly greater for women than men (Tables 1
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and 2 show unadjusted estimates). AORs of lifetime AN were significantly lower for non-

Hispanic Black and Hispanic than non-Hispanic White respondents. AORs of 12-month AN

were significantly lower for Hispanic than non-Hispanic White respondents. There were no cases

of 12-month AN in non-Hispanic Black respondents; thus, it was not possible to generate valid

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estimates of AORs for non-Hispanic Black vs. non-Hispanic White groups. AORs of lifetime

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and 12-month BN did not differ significantly by race/ethnicity. AOR of lifetime BED was

significantly lower for non-Hispanic Black than non-Hispanic White; AORs of BED for

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Hispanic and non-Hispanic White did not differ significantly. There were no racial differences in

AORs of 12-month BED. Education level was not significantly associated with any ED

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prevalence. Higher income categories were associated with significantly increased odds of
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lifetime AN.
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Age of Onset, Duration, and Persistence of Eating Disorders

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Table 4 summarizes mean and median age of onset across the EDs (current age at
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interview is shown to provide context). Compared with lifetime AN or BN, those with lifetime

BED had later age of onset of ED and longer duration of ED episodes. 12-month persistence,
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defined as the proportion of those with 12-month diagnosis among those with the lifetime

diagnosis, was 63.5% for BED and 54.7% for BN which were significantly higher than for AN
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(9.4 %)5.
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Cohort Effects

Cox proportional hazard models revealed an inverse association between age cohort (age

at interview) and lifetime risk for EDs (Table 5). Adjusting for age, sex, ethnicity/race, and
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educational level, hazard ratios (HR) of AN and BED in younger age groups (ages 18-29, 30-44,

45-59) were significantly higher relative to older group (ages 60+); AHRs increased as age

decreased. AHRs of BN were significantly higher in ages 18-20 and 30-44, relative to 60+, but

not in ages 45-59.

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Impairment in Psychosocial Functioning Associated with Disordered Eating
Table 6 summarizes rates of impairment in psychosocial functioning in three domains

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and overall (“any”) associated with disordered eating reported by respondents categorized with

the EDs shown separately for lifetime and 12-month diagnoses. For lifetime diagnoses, rates of

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any impairment in social function were significantly greater for BN (61.4%) and BED (53.7%)
AN
than AN (30.7%). Rates of reporting interference with normal daily activities was significantly

greater for BED (52.5%) and BN (49.5%) than AN (23.5%). For 12-month diagnoses, the three
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EDs differed little; only significant difference observed was BN reporting greater rate of
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difficulties setting along with others than BED.

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Associations with Current BMI

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Table 7 shows current mean (SE) and median (IQR) BMI and current BMI categories

(prevalence rates and AORs with 95% CIs) across the ED groups for both lifetime and 12-month
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diagnoses. For both lifetime and 12-month diagnoses, AN had significantly lower current BMI
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than BN and BED (for 12-month diagnosis this was as expected given the required criterion of

BMI less than 18.5 for AN). For both lifetime and 12-month diagnoses, BN had significantly

lower current BMI than BED.

Relative to no history of ED, lifetime AN had significantly greater odds of being

categorized currently with underweight and normal weight, and significantly reduced odds of
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currently having overweight, obesity, and extreme obesity; AORs reduced as BMI increased.

Relative to no history of ED, lifetime BED was associated with significantly reduced odds of

being categorized as currently having normal weight and overweight, but significantly increased

odds of currently having obesity and extreme obesity. Similarly, 12-month BED was associated

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with significantly reduced odds of being categorized as currently having normal weight and

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overweight, but significantly increased odds of currently having obesity and extreme obesity. For

both lifetime and 12-month BED, AORs increased as BMI increased. Relative to no lifetime

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history of ED, BN (lifetime and 12-month diagnoses) did not differ significantly in odds of any

weight/obesity categories

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Discussion

This study, with a nationally-representative sample of U.S. 36,309 adults assessed with
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lay-administered diagnostic interviews, provides new prevalence estimates of EDs based on

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DSM-5. Prevalence estimates of lifetime AN, BN, and BED were 0.80%, 0.28%, and 0.85%,
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respectively, and 12-month estimates were 0.05%, 0.14%, and 0.44%. These prevalence

estimates are based on our re-coding of NESARC-III ED data because inspection of the original
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NESARC-III data revealed errors; Supplemental Tables summarize coding discrepancies and

sensitivity analyses exploring impacts of discrepancies on prevalence estimates. Findings for

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DSM-5-defined EDs, which included several changes from the DSM-IV, are based on the largest
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national sample of U.S. adults studied to date, and suggest some important similarities and

differences to earlier smaller nationally-representative studies.

Our prevalence estimates of DSM-5-defined BN and BED are lower than reported by

Hudson and colleagues (6) from the NCS-R based on a subset of N=2,980 respondents for DSM-
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IV-defined BN and BED (1.0% and 2.8%, for lifetime and 0.3% and 1.2%, for 12-month). Our

lifetime prevalence estimate of DSM-5-defined AN (0.8%) is slightly higher than that of DSM-

IV-defined AN in the NCS-R (0.6%; 6); for 12-month AN, we observed 0.05% whereas NCS-R

(6) found no cases. Our lower prevalence estimates for BN and BED relative to NCS-R (6)

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estimates are surprising given the changes in criteria from DSM-IV to DSM-5 which would be

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expected to yield higher rates, as found in a population-based Swiss sample of 10,028 adults (9).

Lifetime prevalence was higher for AN than BN while the pattern was opposite for 12-month.

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Both the current and NCS-R studies used lay-administered structured interviews, albeit

different ones, and used rigorous sampling methods; thus, exact reasons for the varied findings

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are uncertain. Much larger sampling in our study, roughly 12 times more respondents than the
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NCS-R, may allow for more stable estimation. Kessler and colleagues (19), in comparing

differences across DSM-IV-based studies, addressed important methodological considerations

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such as how even different versions of the same interview can yield differences. Moreover,
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different structured interviews for psychiatric disorders vary in how diagnostic criteria are asked,
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strictness of wording, the survey administration order (e.g., NCS-R assesses EDs mid-way

whereas NESARC-III assesses EDs at the end, which conceivably lead to lower responding
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because of fatigue), and in how diagnostic hierarchies are applied. We explored impacts of

“broadening” several specific criteria (i.e., “marked distress” about binge-eating for BED and
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overvaluation of shape/weight for BN) because of differences in the structured interviews in

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NCS-R and NESARC-III. Our sensitivity analyses (detailed in Supplemental Tables) revealed

slight increases in lifetime estimates for BED, but not BN; however, even with broadened

definitions, our prevalence estimates remained lower than the NCS-R (6). Sensitivity analyses

performed for NCS-R (6) testing stricter definitions of overvaluation revealed little effect on
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reducing BN prevalence estimates. Thus, neither our present analyses nor the NCS-R (6)

suggested much impact based on either overly broad/stringent measures of overvaluation on BN

prevalence estimates. Our prevalence estimates are at odds with critics’ views of the DSM-5 who

used BED as an illustration of over-pathologizing. Discrepancies in prevalence estimates

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underscore the need of more population-based studies with large samples using diagnostic

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interviews.

Our findings extend knowledge regarding the distribution and sociodemographic

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correlates of EDs. Adjusting for age, ethnicity/race, education, and income categories, odds of

lifetime and 12-month diagnoses of all three EDs were significantly greater for women than men,

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particularly for AN and BN. We also found that risk of: (1) lifetime AN was significantly lower
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for Hispanic and non-Hispanic Black than for non-Hispanic White respondents; (2) lifetime and

12-month BN did not differ significantly by ethnicity/race; (3) lifetime BED, but not 12-month
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BED, was significantly lower for non-Hispanic Black than non-Hispanic White respondents; (4)
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lifetime and 12-month BED for Hispanic and non-Hispanic White respondents did not differ
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significantly; and (5) lifetime AN was associated with higher income. Overall, it is important to

recognize that EDs occur across all ethnic/racial groups and that the rates for some diagnoses
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(e.g., BN and BED to a lesser extent) are comparable across groups. However, 12-month AN

was most prevalent among non-Hispanic White, women, and 18-29 years old. The findings are
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broadly consistent with previous DSM-IV-defined EDs (6, 7). Kessler and colleagues (19) - in
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their analysis of 24,124 adult respondents from the WHO World Mental Health Survey –

reported roughly comparable prevalence estimates for BN and BED across 14 countries.

Collectively, such findings highlight the importance of actively considering all forms of diversity

across prevention and intervention clinical/research work, which to date, appears to be at odds
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with our findings (e.g., 20).

Findings regarding the mean ages of onset for AN, BN, and BED were nearly identical to

the NCR-S (6): ages 19.3, 20.0, and 24.5, respectively versus 18.9, 19.7, and 25.4. The chronic

nature of EDs was suggested by long illness durations and rates of 12-month persistence, which

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highlight the importance of early recognition and intervention. Percentage of 12-month

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persistence in AN was significantly lower than BN or BED, which is at odds with NCR-S (6)

findings and reports on the course of AN (21). We found some support for the view that EDs

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might be increasing in incidence. We observed an inverse association between age cohort (age at

interview) and lifetime risk particularly for BN and BED, echoing earlier findings for BN (1, 6,

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22) and BED (6). Odds of AN showed slight increase with cohort, adding to the mixed literature,
AN
primarily case register data. As noted by Hudson and colleagues (6), cohort effects overlaps with

age effects,and thus prospective studies should investigate whether incidence of EDs is on
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increasing trend.
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Impairment in psychosocial functioning associated with disordered eating was common.

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The majority of lifetime BN (61.4%) and BED (53.7%) groups reported “any” impairment; these

rates were significantly higher than reported by lifetime AN (30.7%). However, the rates of
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reporting “any” impairment were not significantly different for 12-month diagnoses (AN=47.1%,

BN=64.6%, and BED=54.7%). Comparison with the NCS-R (6) is difficult due to different
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measurement of impairment and because their smaller study precluded analysis of AN.
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Nonetheless, these two studies converge in suggesting that roughly half of persons with BN and

BED suffer from impaired functioning associated with their disordered eating. Our findings for

AN, might seem surprising given the established seriousness and even life-threatening nature of

this disorder. Alternatively, it is possible that the findings for AN reflect, in part, under-reporting
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associated with the well-known minimization of severity and ego-syntonic nature of the

underweight state in persons with AN.

We observed significant but varied associations between EDs and obesity. Lifetime AN

had significantly lower current BMI than lifetime BN and BED and lifetime BN had significantly

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lower BMI than lifetime BED. Consistent with the NCS-R (6) and clinical studies (19, 21), we

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found lifetime AN had significantly greater odds of currently having underweight/normal weight

and lower odds of having overweight/obesity/extreme-obesity, with AORs increasing with

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increasing BMI. Conversely, lifetime and 12-month BED was associated with significantly

reduced odds of currently being categorized as normal weight/overweight, but increased odds of

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being currently categorized with obesity/extreme obesity. Substantially elevated odds of having
AN
current extreme obesity in those with lifetime BED (AOR=4.67) and 12-month BED

(AOR=5.42) echo previous NCS-R (6) and WHO (19) findings and clinical reports regarding
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steep weight-gains among persons with BED prior to seeking treatment (23). Finally, in contrast
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to significant, albeit opposite, associations with weight for AN versus BED, BN (lifetime and 12-
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month) did not differ significantly in associations with different weight/obesity categories.

We note strengths and limitations as context for our findings. A major strength is the
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large epidemiological data-set with a representative sample of U.S. adults assessed with trained

interviewers using structured interviews. A relative weakness is the use of lay interviewers,
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rather than clinicians; standardized training and structured assessments may offset this limitation
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to some extent. The AUDADIS-5 has not been evaluated for reliability/validity for ED diagnoses,

although it has been validated for other psychiatric conditions. We note that even different

diagnostic interviews or even versions of the same interview can produce different diagnostic

estimates (24). EDs are thought to be associated with shame and secrecy, and some specific
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17

types such as AN are ego-syntonic and these factors might result in under-reporting and lower

estimates. Different reference time points used to define lowest BMI across studies may also

result in different prevalence estimates of AN. The use of telephone interviews might have offset

this to some degree by allowing for greater honesty when reporting sensitive or embarrassing

PT
issues. The AUDADIS-5 does not assess EDs using the exact wording of the DSM-5; as we

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detailed in the methods, we re-scored specific AUDADIS-5 items to map very closely to criteria

and performed sensitivity analyses which revealed relatively limited impacts of loosening criteria

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on prevalence estimates. BMI was calculated based on self-reported height and weight, which

may be biased (25)6.

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Conclusions

Our findings for DSM-5-defined EDs, based on the largest national sample of U.S. adults
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studied to date, indicate these are prevalent disorders distributed across age groups, both men and
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women, and across different ethnic/racial groups. Although substantial differences between EDs
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exist, overall, they appear to be persistent and associated with substantial rates of impairment in

psychosocial functioning. EDs show differential associations with obesity and our findings
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highlight substantial associations between BED and extreme obesity. Thus, our findings indicate

that DSM-5 EDs represent an important public health problem.

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Acknowledgements and Disclosure

Dr. Grilo was supported, in part, by National Institutes of Health grant K24 DK070052. This

manuscript was prepared using a limited access dataset obtained from the National Institute on

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Alcohol Abuse and Alcoholism (NIAAA). This manuscript does not reflect the opinions or views

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of the NIDDK, NIAAA, or the U.S. government.

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Although Dr. Grilo reports no relevant direct or indirect conflicts of interest with respect to this

study, he reports the following: For the past 12-months, Dr. Grilo reports receiving honoraria for

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lectures delivered for CME-related activities and plenaries and lectures at professional academic
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conferences and reports royalties from academic books published by Guilford Press and Taylor

& Francis Publishers. Beyond 12-months, Dr. Grilo reports having received consultant fees from
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Shire and Sunovion, and honoraria for CME-related lectures and for lectures delivered at grand
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rounds and professional academic conferences nationally and internationally. All other authors
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report no biomedical financial interests or potential conflicts of interest.

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FOOTNOTES

1. The NESARC III was the first wave of this nationally-representative survey study that

included eating disorders (EDs). To our knowledge, reliability and validity of the

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AUDADIS-5 for specific EDs have not been reported.

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2. Supplemental Table S1 lists DSM-5 criteria for AN, BN, and BED, alongside the exact

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AUDADIS-5 items in the NESARC-III dataset used to create each specific ED criterion

including how each item was scored. The Supplemental Table 1 footnotes describe the

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clinical/empirical rationale for scoring decisions.
AN
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3. During our preliminary analyses, we found errors in how the NESARC-III co shows

every “marked distress” regarding binge-eating, which is required for the BED diagnosis,
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and categorized many respondents with 12-month AN despite having current BMIs in the
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obese range, among other errors. Thus, for this study, we re-created lifetime and 12-
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month diagnosis variables for AN, BN, and BED based on the criteria described in the

method section (and elaborated further in Supplemental Table S1).

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4. Supplemental Table S2 shows every coding discrepancy between the ED diagnosis

variables in our study and the NESARC-III data set.

5. It is possible that the 12-month persistence finding could be influenced by age of onset.

For example, for two individuals with the same length (or total years) of an ED episode,
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one individual having an earlier onset of that ED would have different persistence

relative to a second individual having a later onset. Thus, it might be possible for

increased “persistence” to reflect not only the ED persisting longer but also partly

confounded by later onset. Thus, we performed multiple logistic regression analyses to

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compare the risk for reporting 12-months diagnosis among those with lifetime diagnosis

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by age of onset, with current age, sex, education, race, and income as covariates. For AN,

due to the small number of positive cases, the model was not valid. For both BN and

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BED, however, later age of onset was associated with significantly greater likelihoods of

meeting 12-month diagnosis (for BN: AOR = 1.12, 95% CI = 1.03-1.21, p < .05; for

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BED: AOR = 1.03, 95% CI = 1.01-1.06, p < .05).
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6. When errors in self-report of weight/height occur, they tend to be in the direction of
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under-reporting weight and over-reporting height (25); in community-based studies, for

example, this can produce on average a BMI estimate of 1.3 units lower than based on
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measured values (26). Nonetheless, large-scale studies generally report high correlations
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between self-reported and measured height and weight (28) and studies with patients with
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EDs have found that errors in self-reported height and weight tend to be very slight (27,

29) and the discrepancies between self-report and measured values are not associated
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with eating-disorder psychopathology or psychological features (29).

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Table 1. Lifetime Prevalence of DSM-5 AN, BN, and BED by Sociodemographic Characteristics
AN BN BED
n % (SE) n % (SE) n % (SE)

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Total 276 0.80 (.07) 92 0.28 (.03) 318 0.85 (.05)
Sex

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Men 23 0.12 (.04) 12 0.08 (.03) 68 0.42 (.06)

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Women 253 1.42 (.12) 80 0.46 (.06) 250 1.25 (.10)
Race or ethnicity

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Non-Hispanic White 206 0.96 (.08) 54 0.31 (.05) 206 0.94 (.08)

AN
Non-Hispanic Black 17 0.19 (.05) 14 0.20 (.07) 41 0.62 (.14)
Hispanic 36 0.46 (.08) 19 0.24 (.07) 56 0.75 (.13)

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Other 1 17 1.05 (.32) 5 0.17 (.08) 15 0.59 (.16)
Age (years)

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18-29 66 0.86 (.13) 26 0.40 (.10) 75 0.89 (.12)
30-44
45-59
89
89 TE
1.02 (.14)
0.96 (.12)
43
17
0.42 (.07)
0.21 (.07)
97
97
0.96 (0.12)
1.00 (0.13)
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≥ 60 32 0.34 (.07) 6 0.10 (.05) 49 0.54 (.10)
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Education level
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Less than high school 22 0.47 (.09) 14 0.22 (.07) 43 0.79 (.12)
High school or GED 48 0.48 (.09) 18 0.20 (.07) 67 0.72 (.11)
Some college or higher 206 1.00 (.09) 60 0.32 (.05) 208 0.92 (.08)
Income level
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<$25,000 62 0.58 (0.09) 28 0.34 (0.90) 100 0.98 (0.05)

$25,000-39,999 47 0.55 (0.10) 21 0.21 (0.05) 62 0.78 (0.11)
$40,000-69,999 74 0.88 (0.13) 23 0.30 (0.07) 86 0.80 (0.10)

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≥$70,000 93 1.04 (0.13) 20 0.25 (0.06) 70 0.85 (0.12)
Notes. AN = anorexia nervosa; BN = bulimia nervosa; BED = binge eating disorder. Calculations of prevalence and standard errors

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were adjusted for survey weights. 1 = Other included Asian, Native Hawaiian, or other Pacific Islander, and Native American.

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AN
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Table 2. 12-Month Prevalence of DSM-5 AN, BN, and BED by Sociodemographic Characteristics
AN BN BED
n % (SE) n % (SE) n % (SE)

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Total 13 0.05 (.02) 44 0.14 (.02) 166 0.44 (.04)
Sex

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Men 2 0.01 (.01) 6 0.05 (.02) 41 0.26 (.05)

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Women 11 0.08 (.03) 38 0.22 (.05) 125 0.60 (.07)
Race or ethnicity

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Non-Hispanic White 11 0.07 (.02) 24 0.15 (.04) 107 0.48 (.06)

AN
Non-Hispanic Black 0 0.00 (.00) 7 0.09 (.04) 20 0.28 (.09)
Hispanic 1 0.01 (.01) 10 0.14 (.05) 31 0.40 (.09)

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Other 1 0.03 (.03) 3 0.11 (.06) 8 0.39 (.16)
Age (years)

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18-29 4 0.08 (.05) 13 0.23 (.08) 43 0.46 (.08)
30-44
45-59
3
5 TE
0.04 (.03)
0.06 (.03)
23
4
0.23 (.06)
0.03 (.02)
46
48
0.46 (.09)
0.50 (.09)
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≥ 60 1 0.01 (.01) 4 0.08 (.05) 29 0.33 (.07)
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Education level
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Less than high school 0 0.00 (.00) 10 0.17 (.07) 25 0.51 (.12)
High school or GED 3 0.05 (.04) 11 0.15 (.06) 36 0.38 (.07)
Some college or higher 10 0.06 (.02) 23 0.13 (.03) 105 0.45 (.05)
Income level
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<$25,000 4 0.08 (0.05) 14 0.19 (0.07) 51 0.48 (0.09)

$25,000-39,999 1 0.01 (0.01) 10 0.10 (0.03) 34 0.42 (0.10)
$40,000-69,999 3 0.02 (0.02) 12 0.12 (0.04) 46 0.38 (0.06)

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≥$70,000 5 0.07 (0.03) 8 0.14 (0.05) 35 0.47 (0.09)
Notes. AN = anorexia nervosa; BN = bulimia nervosa; BED = binge eating disorder. Calculations of prevalence and standard errors

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were adjusted for survey weights.

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Table 3. Adjusted Odds Ratios (AOR) and 95% Confidence Interval (95% CI) of DSM-5 AN, BN, and BED by gender, by
race/ethnicity, and by educational level
AN BN BED

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AOR (95% CI) AOR (95% CI) AOR (95% CI)
Lifetime diagnosis

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Women vs. Men 12.00 (6.45-22.34) ‡ 5.80 (2.82-11.92) ‡ 3.01 (2.17-4.16) ‡

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Race
Hispanic vs. non-Hispanic White 0.48 (0.33-0.72) ‡ 0.65 (0.33-1.29) 0.75 (0.38-0.92)

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Non-Hispanic Black vs. non-Hispanic White 0.19 (0.11-0.33) ‡ 0.54(0.25-1.19) 0.60 (0.38-0.92) †

AN
Education
High school/GED vs. less than HS 0.82 (0.50-1.36) 0.83 (0.34-2.12) 0.87 (0.59-1.29)

M
Some college or higher vs. less than HS 1.31 (0.87-1.97) 1. 25 (0.64-2.44) 1.05 (0.72-1.53)
Income

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$25,000-39,999 vs. <$25,000 0.97 (0.60-1.57) 0.68 (0.34-1.34) 0.82 (0.56-1.20)

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†
$40,000-69,999 vs. <$25,000 1.47 (1.01-2.15) 0.94 (0.49-1.84) 0.83 (0.58-1.21)
†
≥$70,000 vs, <$25,000 1.60 (1.07-2.38) 0.76 (0.39-1.48) 0.87 (0.59-1.25)
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12 months diagnosis
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Women vs. Men 6.48 (1.72-24.45) † 5.16 (1.83-14.56) ‡ 2.37 (1.57-3.59) ‡

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Race
Hispanic vs. non-Hispanic White 0.11 (0.01-1.00) † 0.64 (0.27-1.56) 0.76 (0.45-1.27)
1
Non-Hispanic Black vs. non-Hispanic White --- 0.47 (0.16-1.41) 0.55 (0.28-1.06)
Education
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High school/GED vs. less than HS1 --- 0.77 (0.24-2.46) 0.70 (0.39-1.28)
1
Some college or higher vs. less than HS --- 0.57 (0.26-1.27) 0.76 (0.44-1.31)
Income

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$25,000-39,999 vs. <$25,000 0.06 (0.01-0.56) † 0.63 (0.23-1.72) 0.92 (0.51-1.65)
$40,000-69,999 vs. <$25,000 0.26 (0.06-1.23) 0.83 (0.29-2.37) 0.84 (0.52-1.35)

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≥$70,000 vs, <$25,000 0.67 (0.21-2.15) 1.05 (0.40-2.57) 1.04 (0.58-1.89)

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Notes. AN = anorexia nervosa; BN = bulimia nervosa; BED = binge eating disorder. Adjusted for age and other sociodemographic
variables. † = significant at p < .05; ‡ = significant at p < .01. Calculations of ORs and 95% CIs were adjusted for survey weights. 1 =

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Estimate was not valid due to no case in non-Hispanic Black and high school/GED.

AN
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Table 4. Age of Onset, Duration, and Persistence of DSM-5 Eating Disorders

AN BN BED
Current age

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Mean (SE) 41.8 (0.96) 39.1 (2.45) 45.2 (1.21) a
Median (IQR) 42.2 (29.5-51.7) 38.3 (27.3-46.8) 46.0 (31.8-56.8)

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Age of onset of ED

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Mean (SE) 19.3 (0.06) 20.0 (0.55) 24.5 (0.31) a, b
Median (IQR) 17.4 (15.2-20.5) 16.0 (13.9-21.5) 21.1 (14.6-30.4)

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Years with episode

AN
Mean (SE) 11.4 (0.40) 12.2 (0.67) 15.9 (0.36) a, b
Median (IQR) 4.9 (1.6-16.3) 8.0 (3.6-18.3) 10.6 (3.5-24.4)

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% 12-month persistence (SE) 9.4 (2.41) 54.7 (6.79) a 63.5 (3.87) a
Notes. ED = eating disorder; AN = anorexia nervosa; BN = bulimia nervosa; BED = binge eating disorder. SE = standard error; IQR =

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interquartile range. The analysis included those with lifetime diagnosis of AN, BN without lifetime AN, or BED without lifetime AN

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or BN; a = significantly different from anorexia nervosa at p < .05 based on Tukey-Kramer post-hoc test or comparison of cells (17); b
= significantly different from bulimia nervosa at p < .05 based on Tukey-Kramer post-hoc test. Calculations of means, medians, and
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standard errors were adjusted for survey weights.
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Table 5. Inter-Cohort Differences in Lifetime Risk (Adjusted Hazard Ratios) of DSM-5 Eating Disorders
AN BN BED
Age (years) AHR (95% CI) AHR (95% CI) AHR (95% CI)

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18-29 3.86 (2.21-6.74) ‡ 5.81 (1.83-18.42) ‡ 3.86 (2.21-6.74) ‡
30-44 2.77 (1.60-4.78) ‡ 5.45 (1.63-18.24) ‡ 2.77 (1.61-4.78) ‡

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45-59 2.52 (1.57-4.02) ‡ 2.37 (0.65-11.55) 2.52 (1.63-3.32) ‡

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60+ Reference Reference Reference
Notes. AN = anorexia nervosa; BN = bulimia nervosa; BED = binge eating disorder. AHR = adjusted hazard ratios, adjusting for age,

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sex, race/ethnicity, education and income. CI = confidence interval. † = significant at p < .05; ‡ = significant at p < .01.

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Table 6. Report of Clinical Impairment in Psychosocial Functioning Associated with Disordered Eating (% [SE]) by DSM-5 Eating
Disorders
AN BN BED

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Lifetime
Interfere with normal daily activities 23.5 (3.34) 49.5 (7.23) a 52.5 (3.88) a

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Serious problems getting along with others 21.2 (3.04) 32.9 (6.57) 20.9 (3.10)

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Serious problems fulfilling responsibilities 17.5 (2.81) 25.1 (4.63) 28.2 (3.55)
Any Form 30.7 (3.49) 61.4 (7.54) a 53.7 (3.99) a

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12 months

AN
Interfere with normal daily activities 47.1 (14.10) 46.8 (9.56) 54.7 (4.35)
Serious problems getting along with others 43.9 (14.00) 41.8 (10.50) 19.8 (3.29) b

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Serious problems fulfilling responsibilities 45.4 (14.39) 32.9 (7.28) 25.6 (4.01)
Any Form 47.1 (14.10) 64.6 (10.12) 54.7 (4.35)

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Notes. ED = eating disorder; AN = anorexia nervosa; BN = bulimia nervosa; BED = binge eating disorder. SE = standard error; The

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analysis included those with lifetime diagnosis of AN, BN without lifetime AN, or BED without lifetime AN or BN; a = significantly
different from anorexia nervosa at p < .05 based on comparison of cells (17). All analyses were adjusted for the NESARC complex
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survey design. 1 = no standard error was computed due to small sample size.
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Table 7. Differences in Current BMI and BMI Categories in Lifetime and 12-month ED Groups
AN BN BED
Current BMI by Lifetime ED diagnosis

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Mean (SE) 24.1 (0.42) 27.7 (0.75) a 33.9 (0.64) a, b
Median (IQR) 22.2 (20.0-26.7) 27.2 (22.9-30.8) 32.6 (27.3-38.4)

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Current BMI Group by % AOR (95% CI) % AOR (95% CI) % AOR (95% CI)

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Lifetime ED diagnosis
< 18.5 3.19 (1.03) 2.71 (1.57-4.68) ‡ 0.40 --- 1 0.52 0.22 (0.03-1.58)

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15 (0.40) (0.41)

AN
1 2
18.5-24.9 1.40 (0.14) 2.29 (1.80-2.92) ‡ 0.36 0.94 (0.59-1.49) 0.53 0.29 (0.20-0.41) ‡

M
161 (0.07) (0.08)
38 63

D
25-29.9 0.42 (0.06) 0.61 (0.45-0.82) ‡ 0.23 0.87 (0.52-1.46) 0.55 0.70 (0.52-0.95) †
55
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22
(0.08)
74
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30-39.9 0.43 (0.09) 0.49 (0.35-0.70) ‡ 0.25 1.31 (0.82-2.08) 1.38 2.09 (1.61-2.70) ‡
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37 (0.06) (0.16)
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28 125
† 2
≥ 40 0.31 (0.21) 0.28 (0.10-0.74) 0.10 ---- 2.82 4.61 (3.34-6.37) ‡
4 (0.06) (0.47)
3 51
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Current BMI by 12 months ED diagnosis

Mean (SE) 17.4 (0.39) 27.1 (0.82) a 34.9 (0.84) a, b
Median (IQR) 18.0 (16.6-18.1) 26.8 (22.8-29.1) 34.3 (29.0-39.0)

PT
Current BMI Group by % AOR (95% CI) % AOR (95% CI) % AOR (95% CI)
12-month ED diagnosis

RI
SC
< 18.5 2.91 (1.02) --- 3 0.40 (0.40) ---1 0.12 (0.12) ---1
13 1 1

U
18.5-24.9 --- --- 0.15 (0.15) 0.88 (0.49-1.60) 0.10 (0.03) 0.15 (0.09-0.26) ‡

AN
16 14
25-29.9 --- --- 0.15 (0.05) 1.24 (0.65-2.40) 0.28 (0.06) 0.65 (0.45-0.95) †

M
14 37
30-39.9 --- --- 0.12 (0.04) 0.99 (0.52-1.88) 0.86 (0.12) 2.58 (1.88-3.54) ‡

D
12 76

TE
≥ 40 --- --- 0.03 (0.03) ---2 1.95 (0.43) 5.36 (3.67-7.83) ‡
1 36
EP
Notes. AN = anorexia nervosa; BN = bulimia nervosa; BED = binge eating disorder; SE = standard error; IQR = interquartile range.
AOR = adjusted odds ratios, adjusting for sociodemographic variables. 1 = collapsed with BMI=18.5-24.5; 2 = collapsed with
C

BMI=30-39.9; 3 = the model was not valid due to low positive response frequencies. In all analyses, a reference group was individuals
AC

without lifetime history of any ED. All analyses were adjusted for the NESARC complex survey design. † = significant at p < .05; ‡ =
significant at p < .01.
 ACCEPTED MANUSCRIPT

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Prevalence and Correlates of DSM-5 Eating Disorders in Nationally

Representative Sample of United States Adults

Supplemental Information

PT
RI
Supplemental Table S1. Operationalization of criteria for DSM-5 eating disorders and related entities in the AUDADIS-5 in the
NESARC-III.

SC
DSM-5 Criteria Item number The AUDADIS-5 questions and operationalization in our study
Current BMI Weight (in pounds) / Height (inches)2 x 703

U
Current weight & height NFEET, NINCHES, Please tell me your height (feet & inches) and weight in pounds as these are
& NPOUNDS important factors for this survey.

AN
Anorexia Nervosa

M
Lowest weight N17Q1 What has been your LOWEST weight in pounds since your weight reached
your current height, not counting times when you were ill?

D
N17CK1711 Is lowest weight in N17Q1 less than 85% of that expected (refer to norms for
(question for the men and women)? If “NO”, skip to the next section with “Eating and
TE
interviewer) Overeating.”

Operationalization in our study

• Lowest BMI calculated based on the current height
EP

• Cut-off for significantly low weight: BMI < 18.52 (lowest BMI for
lifetime and additionally current BMI for 12-months diagnosis)
C

A. Restriction of energy intake relative to N17Q4A3 When your weight was (weight in 1), did you restrict the amount of food you
requirements leading to a significantly ate in order not to gain any weight even though other people thought you
AC

low body weight in the context of age, should?

sex, developmental trajectory, and
physical health. Significantly low weight • Respond “YES”
is defined as a weight that is less than
minimally normal or, for children and
adolescents, less than that minimally
expected.

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DSM-5 Criteria Item number The AUDADIS-5 questions and operationalization in our study
B. Intense fear of gaining weight or N17Q5 During that time when your weight was (N17Q1), were you afraid of gaining
becoming fat, or persistent behavior that weight or getting fat?
interferes with weight gain, even though

PT
at a significantly low weight. • Respond “YES”

C. Disturbance in the way in which one's When your weight was (weight in N17Q1), …

RI
body weight or shape is experienced,
undue influence of body weight or shape N17Q6A Did you think that you looked fat?
on self-evaluation, or persistent lack of

SC
recognition of the seriousness of the N17Q6B Did you think your weight or body shape was one of the most important things
current low body weight. about you?

N17Q6C Did you think that your weight might have been unhealthy?

U
AN
N17Q6D Did you believe other people who thought your weight was unhealthy?

N17Q6E Were you constantly weighing yourself or taking measurements of various

parts of your body?

M
• Report positive response to one of the response. Positive response is
defined as “YES” for N17Q6A, N17Q6B, & N17Q6E, and “NO” for

D
N17Q6C & N17Q6D.4

Age of onset
TE
N17Q9 About how old were you when you FIRST weighed less than (85% of
expected weight) and had SOME of the other experiences you mentioned at
the same time?
EP

Age at the most recent episode N17Q12R About how old were you the MOST RECENT time when you weighed less
than (85% of expected weight) and you also had SOME of these other
C

experiences?
AC

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DSM-5 Criteria Item number The AUDADIS-5 questions and operationalization in our study
Duration of the most recent episode N17Q14R How long did (this/your) MOST RECENT time last when you weighed less
than (85% of expected weight) (in weeks)?

PT
Our operationalization of “12-months” diagnosis5
• Difference between age of onset and current age is 1 year or less.
• Difference between current age and age at the most recent episode

RI
plus duration of the most recent episode is 1 year or less.
• If we cannot calculate one of these variables, it was treated as no 12-
months diagnosis

SC
Associated impairments Now, I’d like to ask you about some other things that might have happened to
you during that time when you weighed (weight in N17Q1) and you had some

U
of the other experiences we just talked about. During that time did your low
weight…

AN
N17Q8A Make you very upset?

N17Q8B Interfere with your normal daily activities?

M
N17Q8C Cause any serious problems getting along with other people – like arguing
with your friends, family, people at work or anyone else?

D
N17Q8D
TE Cause any serious problems doing the things you were supposed to do – like
working, doing your schoolwork, or taking care of your home or family?

Recurrent Binge Eating

EP

A. Eating in a discrete amount of time (e.g., N18Q1 Have you EVER eaten an UNUSUALLY LARGE AMOUNT of food within any
within a 2 hour period) an amount of food 2-hour period, not including the holidays? That is, eating more food than most
that is definitely larger than what most people would eat during a 2-hour period under similar circumstances?
C

individuals would eat in a similar period

of time under similar circumstances. • Respond “YES”
AC

B. Sense of lack of control over eating N18Q3a During ANY time like this when you ate an UNUSUALLY LARGE AMOUNT of
during an episode. food, did you feel that you couldn’t stop eating or control how much or what
you were eating?

• Respond “YES”

3
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DSM-5 Criteria Item number The AUDADIS-5 questions and operationalization in our study
C. Binge eating occurs, on average, at N18Q2 Was there EVER a time when you ate an UNUSUALLY LARGE AMOUNT of
least once a week for 3 months food on average at least once a week for at least 3 months?

PT
• Respond “YES”

Bulimia Nervosa

RI
A. Report recurrent binge eating See above section

B. Recurrent inappropriate compensatory N18Q4A During ANY of those times when you were eating an UNUSUALLY LARGE

SC
behavior in order to prevent weight gain AMOUNT of food, did you try to keep from gaining weight by vomiting, using
such as self-induced vomiting; misuse of enemas, laxatives, diuretics or other medicines, or by fasting, that is having
laxatives, diuretics, or other medications; no solid food, or exercising a lot?

U
fasting; or excessive exercise
• Respond “YES”

AN
C. The binge eating and inappropriate N18Q5 Did you EVER eat an UNUSUALLY LARGE AMOUNT of food within a 2-hour
compensatory behaviors both occur, on period AND do SOME of the other things we talked about to keep from

M
average, at least once a week for 3 gaining weight on average at least once a week for at least 3 months?
months
• Respond “YES”

D
D. Self-evaluation is unduly influenced by N18Q3B
TE During ANY time like this when you ate an UNUSUALLY LARGE AMOUNT of
body shape and weight food, did you feel that your weight or body shape was one of the most
important things about you
EP
N18Q6 When you were eating an UNUSUALLY LARGE AMOUNT of food AND doing
some of the things we talked about to keep from gaining weight around the
same time, was your weight or body shape the most important thing about
you?
C

•
AC

Respond “YES” to one of the questions

E. The disturbance does not occur ***This question was not considered in this study as in many epidemiological
exclusively during episodes of anorexia studies with lifetime and 12-months-estimate, accurately determining whether
nervosa. one disorder overlap with another is not possible.

4
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DSM-5 Criteria Item number The AUDADIS-5 questions and operationalization in our study
Age of onset N18Q8A About how old were you the FIRST time you BEGAN to eat LARGE
AMOUNTS of food (AND do some things to keep from gaining weight) on
average at least once a week for at least 3 months?

PT
Age at the most recent episode N18Q10R How old were you the MOST RECENT time you BEGAN to eat LARGE
AMOUNTS of food (AND do some things to keep from gaining weight)?

RI
Duration of the most recent episode N18Q12AR How long did (this/your) MOST RECENT time last when you ate LARGE
AMOUNTS of food (AND did OR some things to keep from gaining weight)?

SC
Our operationalization of “12-months” diagnosis3
• Difference between age of onset and current age is 1 year or less.
• Difference between current age and age at the most recent episode

U
plus duration of the most recent episode is 1 year or less.

AN
• If we cannot calculate one of these variables, it was treated as no 12-
months diagnosis

Associated impairments Now I’d like to ask you about some other things that might have happened to

M
you when you were eating an UNUSUALLY LARGE AMOUNT of food (AND
doing some of the things we talked about to keep from gaining weight around

D
the same time). During ANY of these times, did eating LARGE AMOUNTS of
food (AND doing some of the things we talked about to keep from gaining
TE weight) . . .

N18Q7A Make you very upset?

EP

N18Q7B Interfere with your normal daily activities?

N18Q7C Cause any serious problems getting along with other people – like arguing
C

with your friends, family, people at work or anyone else?

AC

N18Q7D Cause any serious problems doing the things you were supposed to do – like
working, doing your schoolwork, or taking care of your home or family?

Binge Eating Disorder

A. Report recurrent binge eating See above section

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DSM-5 Criteria Item number The AUDADIS-5 questions and operationalization in our study
B. Episodes associated with three or more During ANY time like this when you ate an UNUSUALLY LARGE AMOUNT of
of the following: food, did you . . .

PT
1. Eating much more rapidly than usual N18Q3C Find that you ate much more quickly than usual?
2. Eating until feeling uncomfortably full N18Q3D Find that you ate until you felt uncomfortably full?
3. Eating large amounts of food when no N18Q3E Eat an UNUSUALLY LARGE AMOUNT of food even though you weren’t

RI
feeling physically hungry hungry?
4. Eating alone because of being N18Q3F Eat alone because you might be embarrassed by how much you were eating?
embarrassed by how much one is

SC
eating
5. Feeling disgusted with oneself, N18Q3G Feel disgusted with yourself, depressed or very guilty about eating so much?
depressed, or very guilty after
overeating • Respond “YES” to three out of the five questions

U
AN
C. Marked distress regarding binge eating N18Q27A6 During ANY of those times when you ate an UNUSUALLY LARGE AMOUNT
is present of food did this make you upset?

• Respond “YES”

M
D. Binge eating is not associated with N18Q26 Were there EVER ANY OTHER times lasting at least 3 months when you ate
regular use of inappropriate LARGE AMOUNTS of food at least once a week WITHOUT doing any of the

D
compensatory behaviors (e.g., laxative things you mentioned to keep from gaining weight?
use, purging, fasting, excessive exercise) TE
and does not occur exclusively during the • Respond “YES” or missing response7
course of anorexia or bulimia nervosa
Age of onset N18Q28B About how old were you the FIRST time you BEGAN to eat LARGE
EP

AMOUNTS of food on average at least once a week for at least 3 months?

Age at the most recent episode N18Q31R How old were you the MOST RECENT time you BEGAN to eat LARGE
C

AMOUNTS of food?
AC

6
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DSM-5 Criteria Item number The AUDADIS-5 questions and operationalization in our study
Duration of the most recent episode N18Q33AR How long did (this/your) MOST RECENT time last when you ate LARGE
AMOUNTS of food (in months)?

PT
Our operationalization of “12-months” diagnosis3
• Difference between age of onset and current age is 1 year or less.
• Difference between current age and age at the most recent episode

RI
plus duration of the most recent episode is 1 year or less.
• If we cannot calculate one of these variables, it was treated as no12-
months diagnosis

SC
Associated impairments Now I’d like to ask you about some other things that might have happened to
you when you were eating an UNUSUALLY LARGE AMOUNT of food. During

U
ANY of these times, did eating LARGE AMOUNTS of food . . .

AN
N18Q27A Make you very upset?

N18Q27B Interfere with your normal daily activities?

M
N18Q27C Cause any serious problems getting along with other people – like arguing
with your friends, family, people at work or anyone else?

D
N18Q27D Cause any serious problems doing the things you were supposed to do – like
TE working, doing your schoolwork, or taking care of your home or family?

Notes:
1 The answer to this question was not included in the NESARC-III database. This is likely because the “lower than 85% weight” criterion is no
EP

longer used for AN in the DSM-5.

2 We selected BMI < 18.5 as a cut-off as it is a widely used convention for “normal” BMI.
3 There was also an additional question, “Did you restrict the amount of food that you ate in order to lose weight BEFORE you weighed (weight in
C

N17Q1)?” (N17Q4B). We did not use this variable to categorize AN due to potential ambiguities (for example, a person might have lost weight due
to a medical reason and then started to restrict once they achieved low weight). Clinically and diagnostically, we interpret the AN criterion A to
AC

capture or focus on restriction of food intake during the time of low weight.
4 N17Q6C & N17Q6D required reverse coding to reflect AN pathology.
5 NESARC-III included a question about whether the onset of EDs was in the past 12 months or whether the most recent episode began to occur

in the past 12 months. We note that this variable alone cannot not indicate whether an individual had ED in the past 12 months as the most recent
episode could begin to occur prior to the past 12 months and he/she still was experiencing the symptoms at the time of interview. We therefore
took the categorization approach described above.

7
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6 For one individual, we used N18Q7A instead of N18Q27A. This case responded “YES” to N18Q7A but “NO” to N18Q27A, but did not meet
criteria for BN.
7 Our close inspection of the data indicated that close to 90% of individuals who were categorized as having lifetime BED either by the NESARC-III

or by our coding are missing this variable. Of those with this response coded, 25 answered “NO” or “UNKNOWN”. These individuals were also
missing information such as age of onset, the most recent episode, and associated impairment (because a “NO” or “UNKNOWN” response led to

PT
skipping the rest of BED-related questions). Although these individuals reported positive responses to all other BED criteria, we chose to take a
conservative approach, and therefore did not categorize these individuals as meeting BED criteria, resulting in N = 318 (see Supplemental Table
S3 for a sensitivity analysis on the impact of this and other coding decisions).

RI
*** Link to the actual survey question: https://www.niaaa.nih.gov/research/nesarc-iii/questionnaire (Sections 17 & 18 are related with EDs).

U SC
AN
M
D
TE
C EP
AC

8
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Supplemental Table S2. Discrepancies between diagnostic codes between the NESARC-III and Udo & Grilo
Current age Current age
Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX

PT
AN DX episode of most recent AN DX
(years) episodes (years)
Anorexia Nervosa

RI
NHAS00001230 17.940 1 1 1 1 1 24.325 33.987 37 0 0 0
NHAS00001270 17.940 1 1 1 1 1 21.741 29.004 31 0 0 0

SC
NHAS00002830 18.092 0 1 1 1 0 28.126 0 1 0
NHAS00003280 14.143 1 1 1 0 1 35.608 0.925 32 1 0 0
NHAS00003380 18.879 1 1 1 1 0 22.312 0.983 2 1 1 0

U
NHAS00008290 17.948 1 1 1 1 1 37.786 39.501 40 0 0 0

AN
NHAS00008970 18.837 1 1 1 1 0 33.467 0.954 17 1 1 0
NHAS00009640 16.991 1 1 1 1 1 22.312 9.002 10 0 0 0
NHAS00013710 18.782 1 1 1 1 0 20.397 0.983 2 1 1 0

M
NHAS00013880 18.303 1 1 1 1 1 19.135 1 1 1 0
NHAS00013990 18.303 1 1 1 1 1 23.960 7 0 0 0

D
NHAS00014720 17.712 1 1 1 1 1 20.192 2.004 4 0 0 0
NHAS00015190 17.181 1 1 1 TE
1 1 32.768 7.985 20 0 0 0
NHAS00015640 18.303 1 1 1 0 1 25.125 0.891 54 1 0 0
NHAS00017200 18.479 1 1 1 1 1 38.055 46.002 47 0 0 0
EP

NHAS00017750 16.827 1 1 1 0 1 21.963 0 0 0

NHAS00018830 18.075 1 1 1 1 1 30.018 25.992 32 0 0 0
C

NHAS00020610 16.139 1 1 1 1 1 18.559 6.827 7 0 0 0

NHAS00020780 16.140 1 1 1 1 1 20.799 5.503 7 0 0 0
AC

NHAS00021170 16.650 0 1 1 1 0 25.683 0.937 28 1 1 0

NHAS00021790 15.622 1 1 1 0 1 21.481 9.962 10 0 0 0
NHAS00023110 18.244 1 1 1 1 1 25.683 17.002 18 0 0 0
NHAS00023160 18.193 1 1 1 1 1 21.111 0.933 26 1 1 0
NHAS00023830 18.010 1 1 1 1 1 19.576 12.992 19 0 0 0

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Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00025640 16.133 1 1 1 0 1 25.401 0 0 0
NHAS00026390 16.755 1 1 1 0 1 32.931 0.894 56 1 0 0

RI
NHAS00028610 18.559 1 1 1 1 0 24.047 6.004 8 0 0 0
NHAS00029280 17.753 1 1 1 1 1 24.208 0.964 12 1 1 0

SC
NHAS00030490 19.993 1 1 1 1 0 28.677 0.960 10 1 1 0
NHAS00031940 17.970 1 1 1 1 1 24.959 26.004 28 0 0 0
NHAS00032810 16.437 1 1 1 1 1 30.228 0.956 18 1 1 0

U
NHAS00038470 17.535 1 1 1 1 1 42.332 0.944 22 1 1 0

AN
NHAS00038750 18.303 1 1 1 1 1 22.463 -0.033 23 1 1 0
NHAS00038900 17.934 1 1 1 1 1 50.214 0.952 16 1 1 0
NHAS00040460 18.021 1 1 1 0 1 25.745 0.935 27 1 0 0

M
NHAS00044840 17.484 1 1 1 0 1 17.636 0 0 0
NHAS00046480 15.332 1 1 1 1 1 21.787 -0.008 6 1 1 0

D
NHAS00046690 17.381 1 1 1 1 1 21.160 32.987 36 0 0 0
NHAS00046800
NHAS00047730
18.882
14.094
1
1
1
1
1
1
TE
1
1
0
1
21.464
15.191
0.827
0.939
1
29
1
1
1
1
0
1
NHAS00048440 17.424 1 1 1 1 1 19.196 0 1 0
EP

NHAS00049120 13.977 1 1 1 1 1 19.634 0.175 1 1 1 0

NHAS00051000 18.326 1 1 1 0 1 18.893 1.923 2 0 0 0
C

NHAS00051060 16.459 1 1 1 0 1 31.090 0.940 30 1 0 0

NHAS00051370 17.571 1 1 1 1 1 24.364 0.944 22 1 1 0
AC

NHAS00053160 16.444 1 1 1 1 1 26.936 0.956 18 1 1 0

NHAS00053270 19.135 1 1 1 1 0 23.295 0.952 16 1 1 0
NHAS00054640 12.802 1 1 1 1 1 32.919 0 1 0
NHAS00054830 14.094 1 1 1 1 1 18.793 0.894 56 1 1 0
NHAS00054880 16.444 1 1 1 1 1 22.551 18.987 22 0 0 0

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Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00055010 15.764 1 1 1 1 1 19.129 -0.979 0 1 1 0
NHAS00055290 17.227 1 1 1 1 1 21.142 0.948 14 1 1 0

RI
NHAS00055720 18.893 1 1 1 1 0 22.671 0.950 15 1 1 0
NHAS00056930 18.021 1 1 1 0 1 28.147 0 0 0

SC
NHAS00057260 20.202 0 1 1 1 0 22.238 0.967 4 1 1 0
NHAS00057810 17.184 1 1 1 1 1 26.167 15.002 16 0 0 0
NHAS00058100 18.244 1 1 1 1 1 21.255 12.990 18 0 0 0

U
NHAS00059500 14.470 1 1 1 1 1 18.900 0 0 0

AN
NHAS00059790 16.724 1 1 1 1 1 22.045 0.973 7 1 1 0
NHAS00060090 16.242 1 1 1 1 1 22.001 41 0 1 0
NHAS00060420 18.244 1 1 1 0 1 22.501 0.921 40 1 0 0

M
NHAS00061750 18.421 1 1 1 0 1 34.539 39.002 40 0 0 0
NHAS00062470 18.651 1 1 1 1 0 24.390 0.969 5 1 1 0

D
NHAS00063380 19.051 1 1 1 1 0 30.035 12.503 14 0 0 0
NHAS00063570
NHAS00064850
19.223
17.922
1
1
1
1
1
1
TE
1
1
0
1
24.028
21.946
0.965
-0.012
13
4
1
1
1
1
0
0
NHAS00065200 17.678 1 1 1 0 1 30.894 0.954 17 1 0 0
EP

NHAS00065550 18.166 1 1 1 0 1 22.708 0.956 18 1 0 0

NHAS00070620 17.753 1 1 1 1 1 32.277 0.889 53 1 1 0
C

NHAS00071060 18.010 1 1 1 1 1 19.576 0.956 18 1 1 0

NHAS00071370 18.515 1 1 1 1 0 28.339 8.501 9 0 0 0
AC

NHAS00071890 19.223 1 1 1 1 0 20.596 0.933 26 1 1 0

NHAS00072820 18.479 1 1 1 1 1 21.925 0.931 25 1 1 0
NHAS00073280 17.374 1 1 1 1 1 31.090 26.501 27 0 0 0
NHAS00073780 18.303 1 1 1 1 1 23.295 0.965 3 1 1 0
NHAS00074920 17.712 1 1 1 0 1 27.808 16.987 20 0 0 0

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Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00075670 17.740 1 1 1 1 1 28.530 0.923 41 1 1 0
NHAS00075910 18.244 1 1 1 1 1 20.524 0.983 2 1 1 0

RI
NHAS00075940 15.962 1 1 1 1 1 26.946 23.004 25 0 0 0
NHAS00077680 17.358 1 1 1 1 1 20.546 36.987 40 0 0 0

SC
NHAS00078210 15.114 0 1 1 1 0 23.994 39 0 0 0
NHAS00078430 16.156 1 1 1 1 1 20.195 0.973 7 1 1 0
NHAS00078590 18.457 1 1 1 1 1 35.438 0.940 20 1 1 0

U
NHAS00078710 18.457 1 1 1 1 1 34.404 0.929 34 1 1 0

AN
NHAS00080970 18.075 1 1 1 1 1 22.271 3.002 4 0 0 0
NHAS00081490 19.333 1 1 1 1 0 38.470 0.967 4 1 1 0
NHAS00083190 18.303 1 1 1 1 1 21.964 3 0 1 0

M
NHAS00086030 19.203 1 1 1 1 0 26.518 0.971 6 1 1 0
NHAS00086360 16.287 1 1 1 1 1 19.419 34.002 35 0 0 0

D
NHAS00086950 18.879 1 1 1 1 0 47.713 33.988 38 0 0 0
NHAS00087610
NHAS00087760
18.303
15.064
1
1
1
1
1
1
TE
1
1
1
1
23.128 0.946
21.004
23
23
1
0
1
0
0
0
NHAS00090210 17.753 1 1 1 1 1 27.436 3.990 9 0 0 0
EP

NHAS00090680 19.203 1 1 1 1 0 29.261 8.004 10 0 0 0

NHAS00090730 17.712 1 1 1 0 1 29.579 0.917 38 1 0 0
C

NHAS00093310 18.882 1 1 1 1 0 33.891 29.987 33 0 0 0

NHAS00093400 18.067 1 1 1 1 1 37.196 0.962 11 1 1 0
AC

NHAS00095000 17.184 1 1 1 0 1 26.753 41.987 45 0 0 0

NHAS00097250 19.648 1 1 1 1 0 37.974 49.002 50 0 0 0
NHAS00102950 17.163 1 1 1 0 1 19.738 0.004 2 1 0 0
NHAS00104180 18.010 1 1 1 1 1 20.359 0.002 1 1 1 0
NHAS00104210 18.092 0 1 1 1 0 19.612 0.917 38 1 1 0

12
 ACCEPTED MANUSCRIPT

Udo and Grilo Supplement

Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00105290 16.273 0 1 1 1 0 18.307 -0.077 0 1 1 0
NHAS00105600 19.223 1 1 1 1 0 31.752 0.929 34 1 1 0

RI
NHAS00106090 18.288 1 1 1 1 1 24.872 18.002 19 0 0 0
NHAS00106800 14.760 1 1 1 1 1 19.223 0.950 15 1 1 0

SC
NHAS00106890 16.444 1 1 1 1 1 19.732 7.002 8 0 0 0
NHAS00107360 15.974 1 1 1 0 1 19.106 0.983 2 1 0 0
NHAS00107950 17.850 1 1 1 0 1 28.834 17.501 18 0 0 0

U
NHAS00108980 17.163 1 1 1 1 1 23.513 0.931 35 1 1 0

AN
NHAS00109260 18.288 1 1 1 0 1 30.907 0.954 17 1 0 0
NHAS00109650 17.940 0 1 1 1 0 24.325 32.004 34 0 0 0
NHAS00109770 18.303 1 1 1 0 1 26.622 0 0 0

M
NHAS00110180 17.227 1 1 1 1 1 24.587 0.929 34 1 1 0
NHAS00111160 16.094 1 1 1 1 1 20.117 13.004 15 0 0 0

D
NHAS00111620 17.889 1 1 1 1 1 23.912 0.942 21 1 1 0
NHAS00111880
NHAS00112620
18.721
13.993
1
1
1
1
1
1
TE
1
1
0
1 17.712
0.948
-0.015
24
12
1
1
1
1
0
1
NHAS00118490 18.176 1 1 1 0 1 23.225 0 0 0
EP

NHAS00118970 15.816 1 1 1 1 1 19.689 10.002 11 0 0 0

NHAS00120220 16.130 1 1 1 1 1 22.708 0.942 21 1 1 0
C

NHAS00121140 14.203 1 1 1 1 1 19.081 0.950 15 1 1 0

NHAS00122070 19.967 1 1 1 1 0 23.295 3 0 0 0
AC

NHAS00123290 18.365 1 1 1 1 1 22.827 9.981 20 0 0 0

NHAS00123460 19.851 1 1 1 1 0 27.920 34.002 35 0 0 0
NHAS00123520 19.460 1 1 1 1 0 20.215 -0.038 0 1 1 0
NHAS00124520 18.021 1 1 1 0 1 21.625 0 0 0
NHAS00126240 16.757 1 1 1 1 1 26.310 0.958 9 1 1 0

13
 ACCEPTED MANUSCRIPT

Udo and Grilo Supplement

Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00127690 18.021 1 1 1 1 1 28.319 7.988 12 0 0 0
NHAS00127930 13.938 1 1 1 1 1 21.611 0.184 6 1 0 0

RI
NHAS00129290 17.192 1 1 1 0 1 17.948 0.328 1 1 0 1
NHAS00130030 17.948 1 1 1 1 1 21.727 5.002 6 0 0 0

SC
NHAS00132550 18.879 1 1 1 1 0 25.745 0.975 8 1 1 0
NHAS00134120 18.879 1 1 1 1 0 23.170 0.962 11 1 1 0
NHAS00135190 17.166 1 1 1 0 1 32.313 0.975 8 1 0 0

U
NHAS00135350 16.825 1 1 1 1 1 18.654 -0.019 0 1 1 0

AN
NHAS00135880 18.303 1 1 1 0 1 19.967 0.921 40 1 0 0
NHAS00136050 16.305 1 1 1 0 1 22.312 0.962 11 1 0 0
NHAS00139240 14.634 1 1 1 1 1 16.929 0 1 0

M
NHAS00139560 14.074 1 1 1 1 1 15.104 -0.979 0 1 1 1
NHAS00139790 17.753 1 1 1 1 1 19.044 1.002 2 0 0 0

D
NHAS00140120 17.374 1 1 1 0 1 32.553 36.002 37 0 0 0
NHAS00142100
NHAS00142210
18.479
18.879
1
1
1
1
1
1
TE
0
1
1
0
28.189
28.491
0.950
46.002
15
47
1
0
0
0
0
0
NHAS00142330 18.326 1 1 1 0 1 25.316 5.501 6 0 0 0
EP

NHAS00144170 17.413 0 1 1 1 0 25.065 0.923 41 1 1 0

NHAS00145450 18.288 1 1 1 0 1 21.031 0.983 2 1 0 0
C

NHAS00145650 18.636 1 1 1 1 0 20.672 0.900 49 1 1 0

NHAS00145810 19.203 1 1 1 1 0 21.031 0.956 18 1 1 0
AC

NHAS00146930 14.265 1 1 1 0 1 41.149 11.987 15 0 0 0

NHAS00147740 17.557 1 1 1 1 1 21.946 0.973 7 1 1 0
NHAS00147850 15.816 1 1 1 1 1 28.243 29.990 35 0 0 0
NHAS00149200 18.129 1 1 1 0 1 28.589 0.969 5 1 0 0
NHAS00149560 18.598 1 1 1 1 0 23.912 6 0 0 0

14
 ACCEPTED MANUSCRIPT

Udo and Grilo Supplement

Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00149630 15.191 1 1 1 1 1 19.576 32.992 39 0 0 0
NHAS00149740 18.244 1 1 1 1 1 24.325 0.969 5 1 1 0

RI
NHAS00150960 16.639 1 1 1 1 1 19.967 0 1 0
NHAS00153460 17.678 1 1 1 1 1 22.312 0.965 3 1 1 0

SC
NHAS00153690 16.305 1 1 1 1 1 28.319 8.002 9 0 0 0
NHAS00154410 18.879 1 1 1 1 0 21.969 8.002 9 0 0 0
NHAS00154490 14.524 1 1 1 1 1 29.225 5 0 0 0

U
NHAS00154510 18.879 1 1 1 1 0 21.111 0.971 6 1 1 0

AN
NHAS00157050 12.769 1 1 1 1 1 24.103 10.988 15 0 0 0
NHAS00158810 17.227 1 1 1 1 1 26.310 7.501 8 0 0 0
NHAS00158980 18.580 0 1 1 1 0 25.850 17.988 22 0 0 0

M
NHAS00159650 18.244 1 1 1 1 1 21.285 9.004 11 0 0 0
NHAS00160350 16.499 1 1 1 1 1 19.368 27.002 28 0 0 0

D
NHAS00161240 17.484 1 1 1 1 1 19.764 0 1 0
NHAS00161770
NHAS00165660
15.830
17.227
1
1
1
1
1
1
TE
0
0
1
1
25.065
26.779
0.948
-0.816
24
15
1
1
0
0
0
0
NHAS00166320 17.358 1 1 1 1 1 21.255 10.002 11 0 0 0
EP

NHAS00169410 10.806 1 1 1 1 1 18.010 0.971 6 1 1 1

NHAS00171040 17.867 1 1 1 1 1 24.807 0 1 0
C

NHAS00171270 18.303 1 1 1 1 1 22.463 0.967 4 1 1 0

NHAS00171660 18.303 1 1 1 1 1 29.618 0.944 22 1 1 0
AC

NHAS00172680 18.469 1 1 1 0 1 31.115 0 0 0

NHAS00183020 19.853 1 1 1 1 0 27.167 0.965 3 1 1 0
NHAS00183990 18.479 1 1 1 1 1 23.491 8.004 10 0 0 0
NHAS00184590 16.305 1 1 1 0 1 19.738 0 0 0
NHAS00185280 15.728 1 1 1 0 1 23.592 0 0 0

15
 ACCEPTED MANUSCRIPT

Udo and Grilo Supplement

Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00185730 18.303 1 1 1 0 1 19.135 1.002 2 0 0 0
NHAS00189840 17.948 0 1 1 1 0 19.837 15.501 16 0 0 0

RI
NHAS00190850 16.820 1 1 1 0 1 21.454 17.002 18 0 0 0
NHAS00192270 16.685 1 1 1 0 1 27.907 41.987 45 0 0 0

SC
NHAS00192800 17.934 1 1 1 0 1 31.563 0.919 39 1 0 0
NHAS00193830 14.809 1 1 1 1 1 32.446 0.931 25 1 1 0
NHAS00193860 17.753 1 1 1 0 1 22.594 0.964 12 1 0 0

U
NHAS00194740 17.712 0 1 1 1 0 20.369 0.904 51 1 1 0

AN
NHAS00195610 18.244 1 1 1 1 1 20.829 11 0 1 0
NHAS00196300 15.191 1 1 1 1 1 23.491 0.940 30 1 1 0
NHAS00196680 16.139 1 1 1 1 1 20.980 0.960 10 1 1 0

M
NHAS00196960 17.850 1 1 1 0 1 28.319 0.923 41 1 0 0
NHAS00197430 18.288 1 1 1 0 1 38.771 0 0 0

D
NHAS00197900 18.872 1 1 1 1 0 26.189 0.948 14 1 1 0
NHAS00199500
NHAS00200590
15.545
16.059
1
1
1
1
1
1
TE
1
1
1
1
23.775
19.460
0
0
1
1
0
0
NHAS00203010 18.398 1 1 1 1 1 25.822 33 0 0 0
EP

NHAS00203380 15.816 1 1 1 1 1 30.179 16.002 17 0 0 0

NHAS00204120 14.848 1 1 1 1 1 20.335 0.958 19 1 1 0
C

NHAS00204170 18.014 1 1 1 1 1 19.934 2.002 3 0 0 0

NHAS00204520 13.977 1 1 1 1 1 15.973 -0.979 0 1 1 1
AC

NHAS00204690 16.094 1 1 1 1 1 19.568 38.987 42 0 0 0

NHAS00205060 19.386 1 1 1 1 0 23.775 0 0 0
NHAS00205170 18.479 0 1 1 1 0 20.828 0 1 0
NHAS00205380 15.203 1 1 1 0 1 28.886 0.902 50 1 0 0
NHAS00206510 17.374 1 1 1 1 1 19.203 0.975 8 1 1 0

16
 ACCEPTED MANUSCRIPT

Udo and Grilo Supplement

Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00207740 14.525 1 1 1 1 1 26.629 0.944 22 1 1 0
NHAS00207900 17.227 1 1 1 1 1 21.611 2.923 3 0 0 0

RI
NHAS00212710 18.021 1 1 1 1 1 18.879 -0.173 0 1 1 0
NHAS00213510 18.479 1 1 1 0 1 23.491 0.929 34 1 0 0

SC
NHAS00214230 18.303 1 1 1 1 1 21.631 0.973 7 1 1 0
NHAS00214280 18.067 1 1 1 1 1 30.642 -0.012 4 1 1 0
NHAS00217020 18.356 1 1 1 0 1 22.457 0 0 0

U
NHAS00218380 18.879 1 1 1 1 0 24.886 -0.017 1 1 1 0

AN
NHAS00222180 18.398 1 1 1 1 1 18.721 -0.979 0 1 1 0
NHAS00225180 18.479 1 1 1 0 1 19.576 0.973 7 1 0 0
NHAS00225480 18.067 1 1 1 1 1 19.838 -0.499 0 1 1 0

M
NHAS00226570 17.181 1 1 1 1 1 26.568 0.914 46 1 1 0
NHAS00232350 19.135 1 1 1 1 0 28.750 29 0 0 0

D
NHAS00233270 17.973 1 1 1 0 1 19.899 0.916 37 1 0 0
NHAS00233610
NHAS00235550
17.753
18.075
1
1
1
1
1
1
TE
1
1
1
1
24.208
20.173
5.971
30.002
21
31
0
0
0
0
0
0
NHAS00239340 18.237 1 1 1 1 1 29.857 0 1 0
EP

NHAS00239520 18.021 1 1 1 0 1 21.454 14.002 15 0 0 0

NHAS00240390 17.484 1 1 1 1 1 34.207 24.981 35 0 0 0
C

NHAS00241530 17.227 1 1 1 1 1 18.793 -0.019 0 1 1 0

NHAS00242190 17.484 1 1 1 1 1 21.741 0.948 24 1 1 0
AC

NHAS00242350 17.753 1 1 1 1 1 33.084 32.002 33 0 0 0

NHAS00242860 18.105 1 1 1 0 1 26.518 35.987 39 0 0 0
NHAS00244440 17.889 1 1 1 1 1 20.192 9.002 10 0 0 0
NHAS00244890 17.788 1 1 1 1 1 23.717 41.004 43 0 0 0
NHAS00246040 16.820 1 1 1 0 1 16.820 0.969 5 1 0 1

17
 ACCEPTED MANUSCRIPT

Udo and Grilo Supplement

Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00247910 18.010 1 1 1 1 1 8.808 9 0 0 0
NHAS00248400 19.528 1 1 1 1 0 23.433 0.952 16 1 1 0

RI
NHAS00248790 16.820 1 1 1 0 1 18.879 28.002 29 0 0 0
NHAS00248860 15.816 1 1 1 1 1 18.237 0.975 8 1 1 1

SC
NHAS00248960 16.981 1 1 1 0 1 22.149 0.910 44 1 0 0
NHAS00250010 16.094 1 1 1 1 1 21.031 0 1 0
NHAS00252450 18.793 1 1 1 1 0 21.925 12.977 31 0 0 0

U
NHAS00276240 19.388 1 1 1 1 0 21.407 2.501 3 0 0 0

AN
NHAS00276350 16.820 1 1 1 1 1 20.596 10.990 16 0 0 0
NHAS00280100 15.447 1 1 1 1 1 25.230 -0.996 11 1 1 0
NHAS00281030 16.757 1 1 1 1 1 21.142 0.965 3 1 1 0

M
NHAS00282430 17.305 1 1 1 1 1 20.799 0.965 3 1 1 0
NHAS00282820 16.786 1 1 1 1 1 21.807 22.004 24 0 0 0

D
NHAS00283100 18.879 1 1 1 1 0 25.745 0.931 25 1 1 0
NHAS00284980
NHAS00285590
18.636
19.368
1
1
1
1
1
1
TE
1
1
0
0
24.127
24.390 4.501 5
0
0
1
0
0
0
NHAS00285780 17.637 1 1 1 1 1 19.967 0.196 2 1 0 0
EP

NHAS00287920 17.571 1 1 1 1 1 24.807 0.944 22 1 1 0

NHAS00291350 17.922 1 1 1 1 1 27.432 0.935 27 1 1 0
C

NHAS00296790 18.398 1 1 1 1 1 22.594 6.002 7 0 0 0

NHAS00296820 18.021 1 1 1 1 1 32.267 37.503 39 0 0 0
AC

NHAS00297520 17.227 1 1 1 1 1 23.804 12.004 14 0 0 0

NHAS00298140 18.398 1 1 1 1 1 35.505 0.964 12 1 1 0
NHAS00302870 19.967 1 1 1 1 0 39.102 5.004 7 0 0 0
NHAS00303140 18.879 1 1 1 1 0 25.745 0.975 8 1 1 0
NHAS00303850 15.659 1 1 1 1 1 18.396 0.958 9 1 1 1

18
 ACCEPTED MANUSCRIPT

Udo and Grilo Supplement

Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00303980 16.991 1 1 1 0 1 20.596 -0.092 62 1 0 0
NHAS00305110 19.135 0 1 1 1 0 22.296 0.983 2 1 1 0

RI
NHAS00306950 18.021 1 1 1 1 1 26.260 0.916 37 1 1 0
NHAS00307050 17.712 1 1 1 1 1 20.369 0.196 2 1 0 0

SC
NHAS00310080 16.305 1 1 1 1 1 18.879 -0.012 4 1 1 0
NHAS00311650 17.948 1 1 1 1 1 20.404 7.004 9 0 0 0
NHAS00314500 19.366 1 1 1 1 0 21.303 0.973 7 1 1 0

U
NHAS00314540 17.335 1 1 1 1 1 21.454 0.940 30 1 1 0

AN
NHAS00315010 15.347 1 1 1 1 1 24.430 0 1 0
NHAS00315410 17.970 1 1 1 0 1 29.118 0.919 39 1 0 0
NHAS00315720 14.996 1 1 1 1 1 27.798 18.971 34 0 0 0

M
NHAS00316050 16.420 1 1 1 1 1 22.045 27.004 29 0 0 0
NHAS00316640 14.809 1 1 1 1 1 33.278 0.937 28 1 1 0

D
NHAS00317140 15.962 1 1 1 1 1 20.767 0.904 51 1 1 0
NHAS00318380
NHAS00318470
17.138
17.374
1
1
1
1
1
1
TE
0
1
1
1
20.300
26.518
26.004 28 0
0
0
1
0
0
NHAS00320200 18.793 1 1 1 1 0 28.189 32.002 33 0 0 0
EP

NHAS00320880 17.028 1 1 1 1 1 20.524 0.983 2 1 1 0

NHAS00320920 16.946 1 1 1 1 1 31.470 31.004 33 0 0 0
C

NHAS00325320 18.303 1 1 1 0 1 0 0 0
NHAS00325760 17.535 1 1 1 1 1 0.942 21 1 1 0
AC

NHAS00326360 17.471 1 1 1 1 1 20.799 1 1 1 0

NHAS00326460 17.471 1 1 1 1 1 32.446 21.750 22 0 0 0
NHAS00326630 17.227 1 1 1 0 1 19.576 0 0 0
NHAS00333510 18.479 1 1 1 0 1 20.359 0.940 30 1 0 0
NHAS00334390 15.816 1 1 1 1 1 17.753 -0.038 30 1 1 1

19
 ACCEPTED MANUSCRIPT

Udo and Grilo Supplement

Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00334890 16.805 1 1 1 0 1 23.295 0 0 0
NHAS00336330 15.308 1 1 1 0 1 25.624 13.750 14 0 0 0

RI
NHAS00336620 16.820 1 1 1 1 1 24.372 0.962 11 1 1 0
NHAS00337560 15.170 1 1 1 1 1 26.629 16.004 18 0 0 0

SC
NHAS00338330 19.128 0 1 1 1 0 21.107 0.965 3 1 1 0
NHAS00340540 18.879 1 1 1 1 0 29.177 0.937 28 1 1 0
NHAS00342840 18.129 1 1 1 1 1 30.680 0.956 18 1 1 0

U
NHAS00345230 17.940 1 1 1 0 1 27.062 0.931 25 1 0 0

AN
NHAS00345810 16.913 1 1 1 1 1 20.359 5.981 6 0 0 0
NHAS00346150 18.021 1 1 1 1 1 25.573 30 0 1 0
NHAS00347070 17.471 1 1 1 1 1 21.964 21.002 22 0 0 0

M
NHAS00349560 15.493 0 1 1 1 0 20.173 0.981 11 1 0 0
NHAS00349630 17.922 1 1 1 0 1 18.654 -0.250 0 1 0 0

D
NHAS00350800 16.639 1 1 1 0 1 21.631 0 0 0
NHAS00350980
NHAS00352940
18.879
17.712
1
1
1
1
1
1
TE
1
0
0
1
24.886
21.255
0.954
0.182
17
5
1
1
1
0
0
0
NHAS00353470 19.081 1 1 1 1 0 22.668 0.965 3 1 1 0
EP

NHAS00353570 18.021 1 1 1 0 1 28.319 9.002 10 0 0 0

NHAS00353630 19.791 1 1 1 1 0 23.831 0 0 0
C

NHAS00353750 18.879 1 1 1 1 0 22.655 -0.077 0 1 1 0

NHAS00354300 18.942 1 1 1 1 0 22.848 6.501 7 0 0 0
AC

NHAS00355510 19.528 1 1 1 1 0 28.901 0.942 21 1 1 0

NHAS00356270 17.940 1 1 1 1 1 25.846 0.933 26 1 1 0
NHAS00356320 16.946 1 1 1 1 1 20.012 6.004 8 0 0 0
NHAS00356740 19.589 1 1 1 1 0 56.143 0.940 20 1 1 0
NHAS00358100 18.244 1 1 1 1 1 19.129 -0.798 4 1 1 0

20
 ACCEPTED MANUSCRIPT

Udo and Grilo Supplement

Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00358210 17.163 1 1 1 1 1 24.028 0.940 20 1 1 0
NHAS00358300 18.075 1 1 1 1 1 26.145 0.933 26 1 1 0

RI
NHAS00358910 17.850 1 1 1 1 1 32.075 17.990 23 0 0 0
NHAS00359360 16.277 1 1 1 0 1 20.849 0.965 3 1 0 0

SC
NHAS00359750 19.791 1 1 1 1 0 20.195 -0.019 0 1 1 0
NHAS00360220 13.716 1 1 1 1 1 21.946 25.981 36 0 0 0
NHAS00361090 19.129 1 1 1 1 0 22.140 0.251 1 1 1 0

U
NHAS00361650 14.932 1 1 1 1 1 27.461 0.933 26 1 1 0

AN
NHAS01000000 19.384 1 1 1 1 0 27.891 28.750 29 0 0 0
NHAS01000480 17.484 1 1 1 0 1 19.004 0.967 4 1 0 0
NHAS01000990 13.879 1 1 1 1 1 20.173 0.954 17 1 1 0

M
NHAS01001250 16.477 1 1 1 1 1 42.908 0.948 14 1 1 0
NHAS01001420 16.735 1 1 1 1 1 18.408 -0.825 0 1 1 1

D
NHAS01001630 14.605 1 1 1 0 1 21.299 0.969 5 1 0 0
NHAS01002410
NHAS01002810
20.173
17.535
1
1
1
1
1
1
TE
1
1
0
1
30.663
25.860
0.912
44.002
45
45
1
0
1
0
0
0
NHAS01003440 15.807 1 1 1 1 1 21.631 0.990 6 1 0 0
EP

NHAS01007380 18.536 1 1 1 1 0 21.454 0.973 7 1 1 0

NHAS01008440 15.332 1 1 1 0 1 20.980 0.948 14 1 0 0
C

NHAS01009800 16.130 1 1 1 1 1 18.010 -0.499 0 1 1 1

NHAS01010310 16.059 1 1 1 0 1 21.538 0.940 30 1 0 0
AC

NHAS01012020 18.879 1 1 1 1 0 29.177 0.921 40 1 1 0

NHAS01012030 18.515 1 1 1 1 0 27.206 6.827 7 0 0 0
NHAS01012070 17.216 1 1 1 1 1 21.520 1.503 3 0 0 0
NHAS01012390 19.366 1 1 1 1 0 26.629 4.750 5 0 0 0
NHAS01012850 18.166 1 1 1 1 1 21.768 48.251 49 0 0 0

21
 ACCEPTED MANUSCRIPT

Udo and Grilo Supplement

Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS01013250 18.605 1 1 1 1 0 39.129 0.904 51 1 1 0
NHAS01018440 16.825 1 1 1 0 1 31.822 21.004 23 0 0 0

RI
NHAS01021880 18.479 1 1 1 0 1 27.876 33.002 34 0 0 0
NHAS01021900 16.459 1 1 1 0 1 17.922 -0.787 0 1 0 1

SC
NHAS01022740 1 1 1 0 0 17.227 0 0 0
NHAS01023030 15.308 1 1 1 1 1 19.135 27.501 28 0 0 0
NHAS01023730 17.216 1 1 1 0 1 21.520 0.965 3 1 0 0

U
NHAS01025250 16.306 1 1 1 1 1 26.622 24.002 25 0 0 0

AN
NHAS01025560 15.963 1 1 1 1 1 26.606 25.827 26 0 0 0
NHAS01026220 17.712 1 1 1 0 1 19.483 0.965 3 1 0 0
NHAS01028660 16.827 1 1 1 1 1 21.255 0.950 15 1 1 0

M
NHAS01031550 17.374 1 1 1 1 1 32.919 4 0 1 0
NHAS01031650 18.288 1 1 1 1 1 22.312 0.186 7 1 0 0

D
NHAS01031940 18.515 1 1 1 1 0 32.118 7.987 11 0 0 0
NHAS01032750
NHAS01033590
16.623
18.303
1
1
1
1
1
1
TE
0
0
1
1
27.113
19.967
0.935 27 1
0
0
0
0
0
NHAS01033990 17.374 1 1 1 0 1 20.117 39.501 40 0 0 0
EP

NHAS01034290 18.075 1 1 1 1 1 36.151 0.946 23 1 1 0

NHAS01034920 16.316 0 1 1 1 0 18.129 10.988 15 0 0 0
C

NHAS01037830 18.288 1 1 1 1 1 24.689 22.002 23 0 0 0

NHAS01038860 18.075 1 1 1 1 1 25.015 8 0 0 0
AC

NHAS01040370 18.879 1 1 1 1 0 20.939 0.965 3 1 1 0

NHAS01041170 14.996 1 1 1 1 1 20.117 28.988 33 0 0 0
NHAS01042250 19.528 1 1 1 1 0 36.126 21.987 25 0 0 0
NHAS01002410 20.173 1 1 1 1 0 30.663 0.912 45 1 1 0
NHAS00070620 17.753 1 1 1 1 1 32.277 0.889 53 1 1 0

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Current age Current age

Udo & minus age minus age of Udo &
NESARC Meet NESARC
Lowest N17Q6a- Grilo Current of most most recent Grilo 12
CASEID N17Q4A N17Q5 Lifetime "Current" 12 mon
BMI N17Q6e Lifetime BMI recent episode + lengths mon
AN DX criteria AN DX
AN DX episode of most recent AN DX
(years) episodes (years)

PT
NHAS00078710 18.457 1 1 1 1 1 34.404 0.929 34 1 1 0
NHAS00356740 19.589 1 1 1 1 0 56.143 0.940 20 1 1 0

RI
NHAS00146930 14.265 1 1 1 0 1 41.149 11.987 15 0 0 0
NHAS00086950 18.879 1 1 1 0 0 47.713 33.988 38 0 1 0

SC
NHAS00038900 17.934 1 1 1 1 1 50.214 0.952 16 1 1 0
NHAS01001250 16.477 1 1 1 1 1 42.908 0.948 14 1 1 0
NHAS00038470 17.535 1 1 1 1 1 42.332 0.944 22 1 1 0

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AN
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Supplemental Table S3. Sensitivity analysis showing impact of discrepancies between our coding and NESARC-III coding and
impacts of broadening diagnostic criteria on prevalence estimates for AN, BN, and BED
Total Men Women
n % (SE) n % (SE) n % (SE)

PT
Lifetime
Anorexia Nervosa

RI
Udo & Grilo Current 276 0.80 (.07) 23 0.12 (.04) 253 1.42 (.12)
NESARC-III Original 276 0.81 (.07)a 36 0.19 (.04) 240 1.38 (.13)
Bulimia Nervosa

SC
Udo & Grilo Current 92 0.28 (.03) 12 0.08 (.03) 80 0.46 (.06)
NESARC-III Original 82 0.24 (.03) 11 0.07 (.02) 71 0.40 (.06)
Udo & Grilo Alternative 11 102 0.30 (.04) 12 0.08 (.03) 90 0.50 (.07)

U
Binge Eating Disorder

AN
Udo & Grilo Current 318 0.85 (.05) 68 0.42 (.06) 250 1.25 (.10)
NESARC-III Original 285 0.76 (.05) 82 0.50 (.06) 203 1.01 (.08)
Udo & Grilo Alternative 12 458 1.27 (.06) 131 0.87 (.09) 327 1.64 (.10)

M
Udo & Grilo Alternative 23 540 1.48 (.07) 180 1.14 (.10) 360 1.80 (.10)
Udo & Grilo Alternative 34 343 0.93 (.06) 73 0.45 (.06) 270 1.38 (.09)
12 month

D
Anorexia Nervosa
Udo & Grilo Current
NESARC-III Original
13
158
TE 0.05 (.02)
0.46 (.05)
2
22
0.01 (.01)
0.12 (.03)
11
136
0.08 (.03)
0.78 (.10)
Bulimia Nervosa
EP
Udo & Grilo Current 44 0.14 (.02) 6 0.05 (.02) 38 0.22 (.07)
NESARC-III Original 44 0.13 (.02)a 7 0.05 (.02) 37 0.21 (.04)
Udo & Grilo Alternative11 51 0.15 (.03) 6 0.05 (.02) 45 0.25 (.05)
C

Binge Eating Disorder

Udo & Grilo Current 166 0.44 (.04) 41 0.26 (.05) 125 0.60 (.07)
AC

NESARC-III Original 193 0.50 (.04) 56 0.33 (.05) 137 0.66 (.07)
Udo & Grilo Alternative 12 259 0.70 (.05) 91 0.60 (.07) 168 0.80 (.07)
Udo & Grilo Alternative 23 317 0.84 (.05) 128 0.78 (.07) 189 0.89 (.07)
Udo & Grilo Alternative 34 166 0.44 (.04) 41 0.26 (.05) 125 0.60 (.07)
Notes.

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a Although the raw numbers of those categorized as meeting the diagnostic criteria for AN are the same between our study and the NESARC-III
original coding, the prevalence estimates are slightly different due to differences in who actually met the criteria and the nature of the analyses
which take into account sampling design (see Supplemental Table 2 to see the exact discrepancies between our and NESARC-III diagnostic
codes).

PT
1 Denotes that this alternative diagnostic estimate did not require the NESARC-III item for “Self-Evaluation (N18Q3B or N18Q6).” Although over-

evaluation is a required criterion for BN, this analysis was performed to explore the potential impact of the AUDADIS-5 wording (i.e., weight/shape
being “the most important thing,” rather than one of the most important things used to judge oneself) which might be difficult to interpret (within the

RI
format of a structured assessment without follow-up) and also perhaps unduly stringent. The sensitivity analyses revealed little potential impact;
that is, eliminating this requirement did not result in much increase in prevalence estimate. These findings complement the sensitivity analyses
reported by Hudson et al. (1) for the NCS-R in their Supplemental Table 1. In the NCS-R, the coding based on the CIDI was thought to potentially

SC
be “too broad” but analyses using stricter definitions had little to no effects on reducing prevalence estimates for BN when stricter definitions were
used for overvaluation. Although neither the NCS-R (6) nor the present analyses with the NESARC-III data suggested much impact based on

U
either unduly broad/stringent measures of overvaluation on prevalence estimates for BN, research has suggested that structured assessments
without follow-up probing or anchoring do result in inflated responses by respondents (2).

AN
2 DSM-5 requires the criterion of “marked distress” about the binge-eating for the BED diagnosis, but not for the BN diagnosis. The importance and

validity of this criterion for BED, including its distinction from and its utility above and beyond general distress or depression, has been empirically
documented (3). Accordingly, sensitivity analyses were performed to explore the impacts of “broadening” this “marked distress” criterion on

M
prevalence estimates for BED. Specifically, these analyses tested three different “broadening” approaches to the DSM-5 Criterion C for BED; the
three alternatives are labeled Alternative1, Alternative2, and Alternative3 (denoted with footnotes 2-4). For this analysis, footnote # 2 denotes that
this alternative diagnostic estimate for was defined using BED Criterion C, “Marked distress regarding binge eating is present”, operationalized by

D
both “During ANY of those times when you ate an UNUSUALLY LARGE AMOUNT of food did this make you upset? (N18Q27A)” OR “Feel
TE
disgusted with yourself, depressed or very guilty about eating so much? (N18Q3G)”, which is consistent with Hudson et al. (1).
3 Denotes that this alternative diagnostic estimate did not require BED criterion C;

4 Denotes that this alternative diagnostic estimates included those who answered “NO” to Binge eating is not associated with regular use of
EP
inappropriate compensatory behaviors (e.g., laxative use, purging, fasting, excessive exercise) and does not occur exclusively during the course
of anorexia or bulimia nervosa (N18Q26)”. 12-month prevalence for this analysis was not different from our original analysis due to lack of
information about the “age of onset” and “most recent episode” for those who answered “NO” to this question.
C
AC

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Supplemental References

1. Hudson JI, Hiripi E, Pope HG, Jr., Kessler RC (2007): The prevalence and correlates of eating disorders in the National Comorbidity Survey
Replication. Biol Psychiatry 61:348-358.
2. Grilo CM, Masheb RM, White MA (2010): Significance of overvaluation of shape/weight in binge-eating disorder: Comparative study with

PT
overweight and bulimia nervosa. Obesity. 18:499-504.
3. Grilo CM, White MA (2011): A controlled evaluation of the distress criterion for binge eating disorder. Journal of Consulting and Clinical
Psychology. 79:509.

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