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Statistics¶
Every row retains population, period and method. Conflicting or non-equivalent estimates are not averaged. All figures were re-verified against the source abstract during the independent audit on 2026-09-02.
Prevalence and incidence¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| Lifetime AN, US adults | 0.80% (SE 0.07%) | NESARC-III; 36,306 adults; AUDADIS-5 structured interview; 2012–13 | Udo 2018, PMID 29859631 |
| 12-month AN, US adults | 0.05% (SE 0.02%) | Same | Udo 2018, PMID 29859631 |
| Lifetime AN, young women | 0.8–6.3% | Range across DSM-5 studies of young people, 2013–22, mostly Western settings | Silén 2022, PMID 36125216 |
| Lifetime AN, young men | 0.1–0.3% | Same | Silén 2022, PMID 36125216 |
| Any DSM-5 eating disorder by early adulthood | 5.5–17.9% of young women; 0.6–2.4% of young men | Same | Silén 2022, PMID 36125216 |
| Lifetime AN prevalence, review estimate | Up to 4% of females; 0.3% of males | Narrative review of recent epidemiology | van Eeden 2021, PMID 34419970 |
| Incidence trend | Overall rate stable over decades; increased among those aged <15 | Review; earlier detection vs earlier onset not separable | van Eeden 2021, PMID 34419970 |
| Incidence trend, earlier review | Overall rate stable; increase among 15–19-year-old girls | Review | Smink 2012, PMID 22644309 |
| Peak age at onset, feeding/eating disorders | 15.5 years; median 18 (IQR 15–23) | 192-study meta-analysis, n=708,561; ICD-11 diagnostic block, not AN-specific; k=11 | Solmi 2022, PMID 34079068 |
| Onset before 14 / 18 / 25, feeding/eating disorders | 15.8% / 48.1% / 82.4% | Same | Solmi 2022, PMID 34079068 |
| Eating-disorder years of life lost, global | 17,361.5 (95% UI 15,518.5–21,459.8) | GBD 2019; AN and BN were the only mental disorders modelled as underlying causes of death; authors call the YLL estimate "extremely low" and not reflective of premature mortality | GBD 2019 Mental Disorders Collaborators 2022, PMID 35026139 |
| Sex of AN patients | 5–15% of patients with AN are men | Endocrine review; limited data in adolescent boys and men | Schorr 2017, PMID 27811940 |
| Lifetime AN prevalence, population twins | 1.20% women; 0.29% men | Swedish Twin Registry; 31,406 twins born 1935–1958; interview, hospital-discharge or death-certificate ascertainment | Bulik 2006, PMID 16520436 |
| Register-diagnosed AN incidence, Denmark | 6.4 → 12.6 per 100,000 person-years, 1995–2010 | Danish Psychiatric Central Research Registry, ages 4–65; N=5,902 incident AN. A sizeable part of the rise is attributed by the authors to a general increase in first-time psychiatric diagnosis (249,607 over the same period) | Steinhausen 2015, PMID 25809026 |
| Register-diagnosed BN incidence, Denmark | 6.3 → 7.2 per 100,000 person-years, 1995–2010 | Same; N=5,113 | Steinhausen 2015, PMID 25809026 |
| Male-to-female ratio, Denmark 2010 | 1:8 for AN; 1:20 for BN | Same | Steinhausen 2015, PMID 25809026 |
| Diagnosed eating disorder, US transgender claims | 2.43% (95% CI 2.14–2.74); AN 0.84% | 10,415 people identifiable as transgender via gender-affirming-care codes, 2018 MarketScan Commercial Database. Authors note this is lower than self-report estimates | Ferrucci 2022, PMID 35524487 |
| Same, by age | 5.60% (ages 12–15); 0.52% (ages 45–64) | Same | Ferrucci 2022, PMID 35524487 |
| Eating-disorder hospital admissions, pandemic | +48% on average (591 → 876 across 10 studies) | Systematic review of 53 studies, 36,485 individuals, Nov 2019–Oct 2021 | Devoe 2023, PMID 35384016 |
| Admissions vs public-health stringency | Per 10% stringency increase: aRR 1.05 (Quebec), 1.05 (Ontario), 1.08 (Prairies), 1.11 (British Columbia) | 11,289 Canadian eating-disorder hospitalizations, Apr 2016–Mar 2023; 77% female aged 12–17; interrupted time series | Roumeliotis 2024, PMID 38976259 |
| Excess pandemic admissions at 1 year | RR 2.02–2.44 across regions | Same | Roumeliotis 2024, PMID 38976259 |
| Lifetime prevalence, any eating disorder | 2–5% worldwide | Narrative review | Attia 2025, PMID 40048192 |
| Lifetime depression in AN | 49.5% (vs 76.3% BN, 65.5% BED) | Same | Attia 2025, PMID 40048192 |
Mortality and outcomes¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| Mortality rate | 5.1 deaths per 1,000 person-years | AN; 36-study meta-analysis, literature through 2010; 166,642 person-years | Arcelus 2011, PMID 21727255 |
| Standardized mortality ratio | 5.86 | AN versus population expectation; meta-analysis | Arcelus 2011, PMID 21727255 |
| Suicide among deaths | 20% | Proportion of deaths in AN cohorts, not patient cumulative risk | Arcelus 2011, PMID 21727255 |
| All-cause mortality risk ratio, AN | 5.52 (95% CI 4.47–6.82) | 83 studies; 307,710 ED patients vs 15,719,076 general-population controls; mean follow-up 11.96 yr; 94.35% female | Semchishen 2026, PMID 41536100 |
| All-cause mortality risk ratio, any ED | 4.92 (95% CI 4.03–6.00) | Same; ranges from AN down to a non-significant difference for BED | Semchishen 2026, PMID 41536100 |
| Suicide mortality risk ratio, AN | 9.86 (95% CI 5.63–17.27) | Same; BN 6.15 (2.52–15.04) | Semchishen 2026, PMID 41536100 |
| Natural- vs non-natural-cause RR, any ED | 3.47 (2.29–5.25) and 6.46 (4.62–9.04) | Same | Semchishen 2026, PMID 41536100 |
| Standardized mortality ratio, AN (2026 update) | 5.06 (95% CI 3.47–7.38) | 30 studies, 33,176 patients, 22 pooled; searched to May 2025; studies with zero deaths excluded | Lai 2026, PMID 41277145 |
| SMR by sex | Male samples 3.47 (1.60–7.52); female 3.86 (1.82–8.20) | Same; overlapping intervals, few male samples | Lai 2026, PMID 41277145 |
| Cause of death, AN | Suicide 21%; cardiac 19% | Same | Lai 2026, PMID 41277145 |
| Overall ED mortality, pooled proportion | 0.4% (95% CI 0.2–0.7) | 214 studies; mean follow-up 72.2±117.7 months | Solmi 2024, PMID 38214616 |
| Observational-study mortality rate, all EDs | 5.2 deaths/1,000 person-years (95% CI 4.4–6.1) | 167 studies; mean follow-up 88.7 months; range 8.2 (mixed ED) to 3.4 (BN) | Solmi 2024, PMID 38214616 |
| Mortality after involuntary treatment | All-cause HR 2.21 (1.54–3.17); external causes 3.88 (1.94–7.77); suicide 5.30 (2.07–13.54) | Danish register cohort; 4,425 people with AN diagnosed 2000–2016, 93.3% female, mean age 22; 821 (18.5%) received involuntary treatment, 206 (4.7%) died; adjusted. Confounded by indication | Bager 2026, PMID 42383339 |
| All-cause SMR, methodological re-analysis | 5.2 (95% CI 3.7–7.5) | 41 cohorts from 40 studies, 1966–2010; double data extraction, over-dispersed Poisson log-linear regression; 10% lower than previously reported | Keshaviah 2014, PMID 25214371 |
| Suicide SMR, same re-analysis | 18.1 (95% CI 11.5–28.7) vs 15–34-year-old females | Same; 49% lower than previously reported suicide SMRs | Keshaviah 2014, PMID 25214371 |
| Weighted SMR, any eating disorder (2010–2024) | 3.39 (95% CI 2.90–3.95); I²=95.1%, k=74 | Four databases, studies 2010 to Oct 2024 | Krug 2025, PMID 39889307 |
| SMR by diagnosis (same) | AN 5.21 (k=30); EDNOS 2.51 (k=8); BN 2.20 (k=18); BED 1.46 (k=3) | Same | Krug 2025, PMID 39889307 |
| SMR, treatment-seeking cohort | 4.37 (95% CI 2.4–7.3) lifetime AN; 7.7 (3.7–14.2) within first 10 years of follow-up | 246 women interviewed 6-monthly for median 9.5 years; vital status to median 20 years; 16 deaths (6.5%) | Franko 2013, PMID 23771148 |
| SMR by illness duration | 3.2 (0.9–8.3) for 0–15 years lifetime AN (4/119 died); 6.6 (3.2–12.1) for >15–30 years (10/67) | Same | Franko 2013, PMID 23771148 |
| Recovery, 22-year follow-up | AN 62.8% at 22 years vs 31.4% at 9 years; BN 68.2% at both | 228 women, DSM-III-R/DSM-IV; 77% re-interviewed, multiple imputation; mean follow-up 22.10 (SD 1.10) years | Eddy 2017, PMID 28002660 |
| Early recovery predicting long-term recovery | AN OR 10.5 (95% CI 3.77–29.28); BN OR 1.0 (0.49–2.05) | Same | Eddy 2017, PMID 28002660 |
| Remission, large inpatient cohort | 30% total sample; 40% in the 20-year subsample | 1,693 consecutive inpatients of a specialized hospital over 25 years (mean 10-year follow-up); 112 with 20-year follow-up | Fichter 2017, PMID 28644530 |
| 20th-century outcome baseline | <50% of survivors recovered; ~33% improved; 20% chronically ill | 119 study series, 5,590 patients; "no convincing evidence that outcome improved over the second half of the last century" | Steinhausen 2002, PMID 12153817 |
| Deaths in Danish AN severity cohort | 132/9,167 (17 from AN, 30 suicide, 85 other) | Danish register; born 1963–2007, diagnosed 1969–2013; AN-RSI scored 5 years after first diagnosis | Larsen 2025, PMID 40670905 |
| Hospitalization, any ED | 26% (95% CI 18–36); AN 32%, BN 4% | 18 studies; mean follow-up 43.2 months | Solmi 2024, PMID 38214616 |
| ANTOP 5-year global outcome | Full recovery 41% (33–49); partial 41% (33–49); full-syndrome AN 18% (12–24) | 154/242 (64%) reassessed at mean 5.96 years; observed data | Herzog 2022, PMID 35294860 |
| Overall ED recovery | 46% (95% CI 44–49) | 415 studies, 88,372 participants; transdiagnostic | Solmi 2024, PMID 38214616 |
| Overall ED chronicity | 25% (95% CI 23–29) | 170 contributing studies; mean follow-up 59.3 months | Solmi 2024, PMID 38214616 |
| Recovery <2 years | 42% | Transdiagnostic studies grouped by follow-up | Solmi 2024, PMID 38214616 |
| Recovery 2–<4 years | 43% | Same | Solmi 2024, PMID 38214616 |
| Recovery 4–<6 years | 54% | Same | Solmi 2024, PMID 38214616 |
| Recovery 6–<8 years | 59% | Same | Solmi 2024, PMID 38214616 |
| Recovery 8–<10 years | 64% | Same | Solmi 2024, PMID 38214616 |
| Recovery ≥10 years | 67% | Same | Solmi 2024, PMID 38214616 |
| Relapse after one-year remission | 2/33 (6.1%) | Selected 79-person long-term follow-up of adolescent RCT | Le Grange 2014, PMID 25440306 |
| New remission after one-year follow-up | 10/44 (22.7%) | Same selected follow-up | Le Grange 2014, PMID 25440306 |
Genetics¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| GWAS cases | 16,992 | ANGI + PGC-ED | Watson 2019, PMID 31308545 |
| GWAS controls | 55,525 | Same | Watson 2019, PMID 31308545 |
| Significant loci | 8 | Genome-wide significant | Watson 2019, PMID 31308545 |
| Twin-based heritability | 50–60% | Range summarized in GWAS background | Watson 2019, PMID 31308545 |
| Twin/family heritability, alternative range | 33–84% | Review of twin and family studies — shown side by side with the 50–60% figure, not reconciled | Donato 2022, PMID 36479493 |
| Additional GWAS locus (2026) | 1 novel genome-wide significant locus near SOX5 | Meta-analysis of European and Finnish AN GWAS data | Song 2026, PMID 41927769 |
| MTAG loci (2026) | 86 significant, of which 25 novel (incl. VAMP2, LPL, BDNF) | Multi-trait analysis borrowing power from correlated traits — not equivalent to loci discovered in AN cases | Song 2026, PMID 41927769 |
| Local genetic-correlation regions | 185 significant; 100 with pleiotropy across multiple traits | Same | Song 2026, PMID 41927769 |
Comorbidity, familial risk and heritability¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| Population-register heritability | AN 36%; BN 39%; other EDs 30% | Danish and Swedish registers 1972–2016; >67,000 people with EDs, first-degree relatives and matched controls from populations of 17 million | Meijsen 2025, PMID 40615413 |
| Genetic correlation, AN–OCD | rg = 0.65 | Same | Meijsen 2025, PMID 40615413 |
| Genetic correlation, AN–autism | rg = 0.36 | Same | Meijsen 2025, PMID 40615413 |
| Twin heritability, narrow DSM-IV AN | a² = 0.56 (95% CI 0.00–0.87); c² = 0.05 (0.00–0.64); e² = 0.38 (0.13–0.84) | Swedish Twin Registry, 31,406 twins | Bulik 2006, PMID 16520436 |
| Heritability of continuous disordered-eating score | 0.65 (95% CI 0.61–0.68) | 1,481 female Swedish twin pairs at age 18, EDI-2 | Dinkler 2021, PMID 31843035 |
| Twin genetic correlation, EDI-2 score with AN diagnosis | 0.26 (95% CI 0.08–0.42) — vs 0.52 (0.39–0.65) for other ED diagnoses | Same | Dinkler 2021, PMID 31843035 |
| Autistic traits in AN | Hedge's g = 0.88 (95% CI 0.65–1.12) | 22 studies; 1,172 AN vs 2,747 controls | Inal-Kaleli 2025, PMID 39530423 |
| Screening above ADOS cut-off in AN | 29% (95% CI 19–38) | Same; screening instruments, not diagnostic assessment | Inal-Kaleli 2025, PMID 39530423 |
| Set-shifting deficit, AN vs controls | Hedge's g = −0.38 (95% CI −0.50 to −0.26) | 38 studies, 3,505 participants; BN g = −0.55, not significantly different from AN | Keegan 2021, PMID 33305366 |
| Central coherence deficit, AN vs controls | Hedge's g = −0.53 (95% CI −0.80 to −0.27) | 16 studies, 1,112 participants; BN g = −0.70, not significantly different from AN | Keegan 2021, PMID 33305366 |
| Childhood maltreatment and ED odds | ORs 1.71–3.29 across four maltreatment types | Up to 63,989 women, Norwegian MoBa cohort; no multiplicative interaction with polygenic score | Bjørndal 2026, PMID 42471970 |
| ED polygenic score and ED odds | ORs 1.05–1.31 | Same | Bjørndal 2026, PMID 42471970 |
Medical complications at extreme malnutrition¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| Anaemia | 79% | 354 consecutive adults admitted to a French clinical-nutrition ED referral unit 1997–2014; mean admission BMI 12.2 ± 1.6 kg/m² | Guinhut 2021, PMID 33023762 |
| Neutropenia | 53.9% | Same | Guinhut 2021, PMID 33023762 |
| Hypertransaminasaemia | 53.7% | Same | Guinhut 2021, PMID 33023762 |
| Osteoporosis | 46.3% | Same | Guinhut 2021, PMID 33023762 |
| Hypokalaemia | 39.5% | Same; more frequent in binge/purge subtype | Guinhut 2021, PMID 33023762 |
| Hypophosphataemia | 26% | Same | Guinhut 2021, PMID 33023762 |
| Infectious complications | 24.3% | Same | Guinhut 2021, PMID 33023762 |
| Hypoglycaemia | 13.8% | Same | Guinhut 2021, PMID 33023762 |
| Cardiac dysfunction | 7.1% | Same | Guinhut 2021, PMID 33023762 |
| Gelatinous bone-marrow transformation (biopsy-proven) | 6.5% | Same | Guinhut 2021, PMID 33023762 |
| ICU transfer / deaths | 10% transferred; 5 deaths | Same | Guinhut 2021, PMID 33023762 |
| Hypoglycaemia at admission, very low BMI | 50% detected on point-of-care testing; 20.6% severe (<50 mg/dL) | 34 patients, BMI <14.5 kg/m², meal-based rapid weight-gain protocol | Fischer 2022, PMID 35994205 |
| Blood glucose <55 mg/dL, BMI <13 | 32 of 48 patients | Median admission BMI 10.51; all patients with poor prognosis were in the hypoglycaemic group | Matsunaga 2024, PMID 38702806 |
| Renal impairment at admission (eGFR <90) | 33% of 111 | StRONG secondary analysis, ages 12–24, AN or atypical AN | Downey 2022, PMID 35705423 |
| Pericardial effusion, adults | 9/48 vs 0/44 controls (p = 0.003) | Prospective consecutive AN adults vs matched controls | Scheggi 2022, PMID 35597626 |
| Left-ventricular mass, adults | 63 ± 15 g vs 99 ± 30 g controls (p < 0.001) | Same | Scheggi 2022, PMID 35597626 |
| "AN cardiopathy" at paediatric admission | 63% (24/38); effusion + bradycardia + mitral regurgitation together in 26% | Children admitted for physical instability, 2015–2019 | Borgia 2021, PMID 34050378 |
| QTc prolongation, very-low-BMI inpatients | 21% (4/19); 10.5% >500 ms; not correlated with LV mass, BMI or REE | Mean BMI 12.3; blinded digital ECG, Fridericia correction; 68% on QT-prolonging drugs | Krantz 2012, PMID 21917317 |
| Seizure prevalence, eating disorders | 4.5% (75/1,664 charts); PNES 29.3%, substance withdrawal 18.7%, primary seizure disorder 12%, electrolytes/hypoglycaemia 10.7%, presumed Wernicke's 4% | Retrospective chart study | Gibson 2023, PMID 37092766 |
| Full Wernicke's triad at presentation in AN | 8 of 12 published cases (vs ~16% in alcohol-related Wernicke's) | Systematic review of case reports | Oudman 2018, PMID 29984541 |
| Maladaptive exercise, lifetime | 88% pooled prevalence | 31,671 people with lifetime EDs across US, Australia, New Zealand and Sweden (EDGI, NCT04378101) | Watson 2026, PMID 41115789 |
| Maladaptive exercise, current | 40% any driven exercise; 35% compulsive exercise; 12% regular driven exercise | Same; prevalence varies substantially by instrument | Watson 2026, PMID 41115789 |
Pregnancy and neonatal outcomes¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| Preterm birth, maternal AN | RR 1.6 (95% CI 1.4–1.8) | Swedish Medical Birth Register 2003–2014; 2,769 women with AN vs 1,225,321 without; adjusted | Mantel 2020, PMID 31746972 |
| Preterm birth, maternal AN (independent cohort) | RR 1.32 (95% CI 1.13–1.55) | 2,134,945 Quebec pregnancies 1989–2016; AN requiring hospitalization | Ante 2020, PMID 32100355 |
| Microcephaly | RR 1.9 (95% CI 1.5–2.4) | Swedish cohort | Mantel 2020, PMID 31746972 |
| Hyperemesis | RR 2.1 (95% CI 1.8–2.5) | Same | Mantel 2020, PMID 31746972 |
| Antepartum haemorrhage | RR 1.6 (95% CI 1.2–2.1) | Same; stronger in active than previous disease | Mantel 2020, PMID 31746972 |
| Stillbirth | RR 1.99 (95% CI 1.20–3.30) | Quebec cohort | Ante 2020, PMID 32100355 |
| Low birth weight | RR 1.69 (95% CI 1.44–1.99) | Same | Ante 2020, PMID 32100355 |
| Small for gestational age | RR 1.52 (95% CI 1.35–1.72) | Same | Ante 2020, PMID 32100355 |
Economic burden¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| Nationwide annual financial cost of eating disorders | PPP-USD 70.5 billion | Systematic review of 26 studies (11 cost-of-illness), Aug 2013–Jun 2024; all figures converted to 2024 USD PPP; PROSPERO CRD42022358136 | Ahmed 2025, PMID 39542867 |
| Share of financial cost that is indirect | 70–93% | Same | Ahmed 2025, PMID 39542867 |
| Intangible costs (burden of disease) | PPP-USD 355.6 billion | Same | Ahmed 2025, PMID 39542867 |
| Five-year median total cost per patient | ~EUR 14,000–20,000 | German statutory-insurance claims; 1,242 women and 71 men with incident AN, 1,104 women and 64 men with incident BN; 2 years before to 3 years after index diagnosis | Bothe 2022, PMID 34599621 |
| Share of AN cost attributable to mental illness | ~two thirds (vs ~half in BN) | Same | Bothe 2022, PMID 34599621 |
| Inpatient / partial-hospitalization charge | $2,295 and $1,567 per day | 314 consecutive adult first admissions, US programme, 2003–2015 | Guarda 2017, PMID 28130794 |
| Cost per pound of weight gained | $4,089 (inpatient) and $7,050 (partial hospitalization); 70% reached discharge BMI ≥19 | Same | Guarda 2017, PMID 28130794 |
| Incremental cost-effectiveness, FBT vs no intervention | AUD 5,089 per DALY averted (95% UI dominant to 16,659); 100% likely cost-effective at AUD 50,000/DALY | Markov model, ages 11–18, Australian health-system perspective, 6-year horizon | Le 2017, PMID 29044637 |
| Incremental cost-effectiveness, adolescent-focused therapy | AUD 51,897 per DALY averted (21,591 to 1,712,491); 45% likely cost-effective | Same | Le 2017, PMID 29044637 |
Trial and registry landscape¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| Registered interventional AN studies | 337: 159 completed, 55 recruiting, 23 terminated, 22 not yet recruiting, 14 active-not-recruiting, 12 withdrawn, 8 enrolling by invitation, 44 unknown status | ClinicalTrials.gov v2 count queries, condition "anorexia nervosa", study type interventional | Live API query re-run by independent auditor, 2026-09-02 |
| Phase 2/3 interventional AN records, all time | 49 | Same API, phase filter | Live API query, 2026-09-02 |
| Registered AN trials 2000–2018 reaching publication | 201 registered → 101 completed → 41 published → 8 prospectively registered → 7 replicated | Systematic audit of ClinicalTrials.gov listings | Murray 2020, PMID 31638722 |
| Adult AN psychotherapy randomized evidence base | 14,003 reports screened → 16 trials → 13 in network → 1,047 patients (97.4% female) | Network meta-analysis | Solmi 2021, PMID 33600749 |
| Second-generation antipsychotic RCTs in AN | Olanzapine 7; quetiapine 2; risperidone 1; aripiprazole 0 | Systematic scoping review, articles 2000–2022 | Thorey 2023, PMID 36928656 |
Bone and fracture¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| Fracture hospitalization rate, women | 47.6 vs 21.0 per 10,000 person-years (AN vs control) | Quebec matched cohort; 7,332 AN inpatients vs 73,215 controls; 1989–2023 | Cyrenne-Dussault 2026, PMID 41109616 |
| Fracture hospitalization rate, men | 74.0 vs 39.9 per 10,000 person-years | Same | Cyrenne-Dussault 2026, PMID 41109616 |
| Adjusted fracture hazard ratio | Women 2.26 (2.02–2.51); men 1.86 (1.34–2.58) | Same; Cox regression stratified by sex | Cyrenne-Dussault 2026, PMID 41109616 |
| Osteoporotic-fracture hazard ratio | 7.50 (5.62–10.01) | Same | Cyrenne-Dussault 2026, PMID 41109616 |
| Bone pharmacotherapy evidence base | 19 studies, 1,119 participants, 10 double-blind RCTs | Systematic review; bisphosphonates raised BMD in adult women, transdermal oestrogen in mature adolescents, oral contraceptives did not | Robinson 2017, PMID 28554377 |
| Teriparatide trial | n=21 (10 vs 11), 6 months; no microarchitecture change; IT cortical thickness +13% (p=0.075) | Randomized placebo-controlled; women with AN and T-score ≤ −2.5 | Amorim 2026, PMID 41591404 |
| rhIGF-1 added to transdermal oestradiol | Negative: lumbar aBMD increased more without rhIGF-1 (p=0.004) | 75 women aged 14–22 randomized, 33 completed; 12 months | Singhal 2021, PMID 33693703 |
Treatment¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| Parent-focused remission at end of treatment | 43% | n=107 randomized adolescents; 18 sessions/6 months | Le Grange 2016, PMID 27453082 |
| FBT remission at end of treatment | 22% | Same | Le Grange 2016, PMID 27453082 |
| Parent-focused vs FBT odds ratio | 3.03 (95% CI 1.23–7.46) | End-of-treatment remission | Le Grange 2016, PMID 27453082 |
| 12-month remission, PFT vs FBT | 37% vs 29%; OR 1.39 (95% CI 0.60–3.21) | Difference not statistically significant | Le Grange 2016, PMID 27453082 |
| MOSAIC randomized | 142 | Adult broadly defined AN; MANTRA n=72, SSCM n=70 | Schmidt 2015, PMID 25984803 |
| ANTOP randomized | 242 | Adult female outpatients; 80 FPT, 80 CBT-E, 82 optimized TAU | Zipfel 2014, PMID 24131861 |
| ANTOP attrition, end of treatment | 54/242 (22%) | Multicentre adult RCT | Zipfel 2014, PMID 24131861 |
| ANTOP attrition, 12 months | 73/242 (30%) | Same | Zipfel 2014, PMID 24131861 |
| Refeeding RCT randomized | 120 | Age 12–24; AN or atypical AN; ≥60% median BMI | Garber 2021, PMID 33074282 |
| Higher-calorie start | 2,000 kcal/day; +200/day | Monitored inpatient arm | Garber 2021, PMID 33074282 |
| Lower-calorie start | 1,400 kcal/day; +200 every other day | Comparator | Garber 2021, PMID 33074282 |
| Acute pharmacotherapy RCTs | 19 eligible; 8 meta-analyzed; 5 reporting BMI | Systematic review; no significant olanzapine–placebo BMI difference | Cassioli 2020, PMID 32448045 |
| StRONG time to medical stability | HR 1.67 (95% CI 1.10–2.53), p=0.01, favouring higher-calorie | 111 in modified ITT of 120 enrolled | Garber 2021, PMID 33074282 |
| StRONG length of stay and cost | 4.0 days shorter (95% CI −6.1 to −1.9); $19,056 saved (−$28,819 to −$9,293) | Same | Garber 2021, PMID 33074282 |
| StRONG 1-year clinical remission | No group difference (p=0.42) | 111 mITT (60 higher-calorie, 51 lower); 12 months post-discharge | Golden 2021, PMID 33753542 |
| StRONG 1-year rehospitalization | 32.8% (19/58) vs 35.4% (17/48), p=0.84 | Same | Golden 2021, PMID 33753542 |
| StRONG atypical AN subgroup | 43% of 111; heart-rate restoration 8.7±4.0 vs 6.5±3.9 days (p=0.008); weight gain 3.1±5.9 vs 5.4±2.9 %mBMI (p<0.001); hypomagnesaemia 29% vs 11% (OR 3.29) | Atypical AN defined as %mBMI > 85 | Garber 2024, PMID 38179719 |
| StRONG caloric dose received | 32.4±6.9 kcal/kg (atypical AN) vs 43.4±9.8 (AN) | Same; per 10 kcal/kg, heart rate restored 1.7 days faster (1.0–2.5) | Garber 2024, PMID 38179719 |
| Refeeding-syndrome incidence in high-calorie reviews | 1 true clinical case across 20 studies, 2,191 participants | Systematic review of paediatric/adolescent refeeding, 2010–Feb 2023 | Mosuka 2023, PMID 37351245 |
| Olanzapine BMI trajectory | 0.259 (SD 0.051) vs 0.095 (SD 0.053) kg/m² per month | 152 adult outpatients (96% women, mean BMI 16.7), 5 North American sites, 16 weeks | Attia 2019, PMID 30654643 |
| Olanzapine obsessionality (Y-BOCS obsessions) | −0.325 vs −0.017 points/month; not significant | Same | Attia 2019, PMID 30654643 |
| Intranasal oxytocin phase II | No significant difference vs placebo on ED psychopathology or BMI at any timepoint | 61 female inpatients, 18 IU twice daily for 4 weeks, assessed to 6 months | Maguire 2024, PMID 38520886 |
| OPEN olanzapine feasibility (young people) | 52 pre-screened → 35 eligible → 20 recruited → 15 continued ≥16 weeks | Open-label, one-armed; target was 55; ages 12–24 | Filiz 2026, PMID 42116676 |
| Adult psychotherapy network | 14,003 reports screened → 16 RCTs → 13 in network, 1,047 patients (97.4% female) | None outperformed treatment as usual; CBT dropout lower than psychodynamic (OR 0.54, 0.31–0.93); confidence low to very low | Solmi 2021, PMID 33600749 |
| Family therapy vs treatment as usual (Cochrane) | Remission RR 3.50 (1.49–8.23) from 2 studies, 81 participants; not maintained at follow-up | 25 trials in review; low-quality evidence; 68% at high risk of selective reporting bias | Fisher 2019, PMID 31041816 |
| Family therapy vs other psychological interventions | RR 1.22 (0.89–1.67), 5 studies, n=252; long-term RR 1.08 (0.91–1.28), 4 studies, n=200 | Same | Fisher 2019, PMID 31041816 |
| ANDI day-patient non-inferiority | Mean BMI difference 0.46 kg/m² favouring day patient (95% CI −0.11 to 1.02); p_non-inferiority<0.0001, margin 0.75 | 172 female adolescents aged 11–18, below 10th BMI percentile, first admission; randomized after 3 weeks inpatient | Herpertz-Dahlmann 2014, PMID 24439238 |
| DSM-5 severity specifiers vs outcome | No significant difference across the four severity groups for weight recovery or good outcome | 128 adult women (64 outpatient, 64 inpatient) treated with CBT-E; EOT, 6- and 12-month follow-up | Dalle Grave 2018, PMID 30059831 |
| TIARA rTMS, real vs sham | BMI d=0.2 (−0.49 to 0.90); ED symptoms d=0.1 (−0.60 to 0.79); mood d=0.61–1.0 | 34 adults with severe/enduring AN, 20 sessions over 4 weeks; feasibility primary | McClelland 2018, PMID 30012789 |
| DBS evidence base, total | 36 patients across 11 studies; mean age 38.07, mean BMI at surgery 12.58 kg/m² | Patient-level network meta-analysis; subcallosal cingulate best-supported target (P-scores 0.94, 0.98) | Shaffer 2023, PMID 36724522 |
| Psilocybin phase 1 | n=10 adult females, single 25-mg dose; no clinically significant ECG, vital-sign or suicidality change; 2 asymptomatic hypoglycaemias | Open-label feasibility, single site; NCT04661514 | Peck 2023, PMID 37488291 |
| Treatment-refractory proportion, EDs | 20–30% fail to respond to best available treatments | Narrative review | Bryson 2024, PMID 38503683 |
| Adolescents needing intensive care | One fifth to one third over the illness course | Review of intensive treatment models | Herpertz-Dahlmann 2021, PMID 33924294 |
Diagnostic-spectrum evidence¶
| Statistic | Estimate | Population / method | Source |
|---|---|---|---|
| Comparative atypical-AN publications | 24 | PRISMA review, literature from 2013 to 17 July 2022 | Walsh 2023, PMID 36508318 |
| Comparative atypical-AN publications, 2026 update | 64 | Invited update by the same group; atypical AN shows greater ED psychopathology, comparable non-ED psychopathology, and menstrual disturbance and reduced BMD at lower frequency | Lee 2026, PMID 42557659 |
| Atypical-AN course/outcome studies | 0 identified | Both reviews state that longitudinal course and outcome evidence is absent | Walsh 2023, PMID 36508318; Lee 2026, PMID 42557659 |
| SF-36 quality of life across EDs | Significantly below population norms in every group; no difference established between diagnoses | 7 studies (AN: 5 studies, n=227; BN: 4, n=216; EDNOS: 2, n=166; BED: 4, n=148) | Winkler 2014, PMID 24857566 |
| Qualitative studies in patient-meaning synthesis | 24 | International studies, 1990–2005 | Espíndola 2009, PMID 19225241 |
Known conflicts and caveats¶
- Mortality rate, SMR and cumulative mortality are different estimands.
- The Solmi outcome percentages pool eating disorders and should not be relabelled AN-specific.
- Recovery rises with follow-up partly because delayed recovery is observed; cohort composition also changes.
- Trial remission definitions differ, so percentages are not directly rankable across studies.
- BMI and percentage median BMI are not interchangeable, especially during growth.
- Registry enrollment is planned for recruiting studies and actual for completed studies only if the record is updated; the clinical-trials table marks each value (E) or (A).
- The 2011 mortality rate (5.1/1,000 person-years, AN-specific) and the 2024 transdiagnostic rate (5.2/1,000 person-years, all EDs pooled) are numerically close but are not the same estimand: different populations, different eras, different diagnostic mixes. Their agreement is suggestive, not confirmatory.
- The three mortality meta-analyses (Arcelus 2011, Semchishen 2026, Lai 2026) share primary studies, so their agreement is not fully independent replication.
- Heritability estimates of 50–60% and 33–84% come from different study sets and assumptions and are listed side by side rather than averaged.
- Register-based hazard ratios for involuntary treatment measure the vulnerability of the exposed group, not the effect of compulsion; no comparator pathway exists.
- MTAG-derived loci borrow statistical power from genetically correlated traits and should not be counted alongside case-control GWAS loci.
- All bone-treatment evidence uses BMD, microarchitecture or bone-turnover surrogates; the fracture hazard ratios come from an observational cohort, not from any trial.
- The four AN all-cause SMR estimates (Arcelus 5.86; Keshaviah 5.2; Krug 5.21; Lai 5.06) are close, but the same methodological re-analysis that left all-cause SMR nearly unchanged lowered the suicide SMR by 49%. Suicide-specific figures are far more model-dependent than all-cause figures and should always be quoted with their source (Keshaviah 2014, PMID 25214371).
- Register-based heritability (36%) and twin-based heritability (50–60%) answer different questions on different ascertainment; the register figure is a lower bound because it counts only diagnosed cases.
- The extreme-malnutrition complication prevalences come from a single national referral unit and describe the most severely ill tail of the illness, not AN generally.
- Pandemic hospitalization increases are health-system measures. No population-incidence study has separated increased presentation from increased incidence.
- Economic cost figures are dominated by indirect costs estimated with varying methods; about half the underlying cost-of-illness studies met 60% or more of a standard quality checklist.
- ClinicalTrials.gov counts reflect records, not trials: registration practice varies by country and era, and mixed-diagnosis records appear under the AN condition query.
- Maladaptive-exercise prevalence varies from 12% to 40% within the same 31,671-person sample depending on instrument; no single figure should be quoted without naming the measure.