Why might EDs be increasing?

Question

BlackTom AI · Accepted Answer

Improved detection and diagnostic changes have expanded the pool of recognized eating disorders, so the apparent rise in EDs is largely driven by better identification of disorders beyond anorexia nervosa (AN) and bulimia nervosa (BN).

1) Relevant knowledge points and concepts
- Diagnostic categories: historically many cases were labeled EDNOS (eating disorder not otherwise specified); DSM-5 (2013) introduced clearer categories (e.g., binge-eating disorder, OSFED) and relaxed some thresholds.  
- Surveillance and awareness: increased screening in primary care, schools, and mental health services raises case-finding.  
- Measurement effect: prevalence estimates depend on diagnostic definitions and detection, not only true incidence.

2) Step-by-step reasoning
- Previously, only the most severe AN and BN cases were routinely recognized and coded.  
- With DSM-5 and clinical training, clinicians now diagnose BED and OSFED more reliably.  
- Public health surveillance and use of standardized screening tools (e.g., SCOFF, EDE-Q) increase reported cases.

3) Illustrative calculation (intermediate steps)
- Suppose a community previously identified 10 AN + 10 BN = 20 diagnosed cases per 10,000.  
- After DSM-5 and better screening, clinicians now also identify 30 BED/OSFED cases previously missed.  
- New total = 20 + 30 = 50 per 10,000. That is a 150% increase in reported prevalence, driven by detection, not necessarily a true rise in underlying incidence.

4) Why the correct answer is correct
- The increase in reported ED prevalence aligns with methodological changes (diagnostic expansion, screening), which inflates measured rates even if underlying incidence is stable.

5) Why other options are incorrect
- Option a ("people are more self-conscious") is speculative, lacks empirical support as the primary driver, and conflates broad social trends with diagnostic data.  
- Option b (link to obesity) is partly relevant for BED but overstates the connection as the main reason for overall ED increases; obesity trends do not fully explain higher detection of diverse ED categories.

6) Conclusion
- Therefore, improved detection and diagnosis—especially of EDs other than AN and BN—is the best explanation. This confirms option c as the correct answer.

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