Psychological Medicine

Original Articles

Health services use in eating disorders

R. H. Striegel-Moorea1 c1, L. DeBara2, G. T. Wilsona3, J. Dickersona2, F. Rossellia4, N. Perrina2, F. Lyncha2 and H. C. Kraemera5

a1 Department of Psychology, Wesleyan University, Middletown, CT, USA

a2 Center for Health Research, Kaiser Permanente NorthWest, Portland, OR, USA

a3 Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA

a4 Department of Psychology, Manchester Community College, Manchester, CT, USA

a5 Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA


Background This study examined healthcare services used by adults diagnosed with an eating disorder (ED) in a large health maintenance organization in the Pacific Northwest.

Method Electronic medical records were used to collect information on all out-patient and in-patient visits and medication dispenses, from 2002 to 2004, for adults aged 18–55 years who received an ED diagnosis during 2003. Healthcare services received the year prior to, and following, the receipt of an ED diagnosis were examined. Cases were matched to five comparison health plan members who had a health plan visit close to the date of the matched case's ED diagnosis.

Results Incidence of EDs (0.32% of the 104 130 females, and 0.02% of the 93 628 males) was consistent with prior research employing treatment-based databases, though less than community-based samples. Most cases (50%) were first identified during a primary-care visit and psychiatric co-morbidity was high. Health services use was significantly elevated in all service sectors among those with an ED when compared with matched controls both in the year preceding and that following the receipt of the incident ED diagnosis. Contrary to expectations, healthcare utilization was found to be similarly high across the spectrum of EDs (anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified).

Conclusions The elevation in health service use among women both before and after diagnosis suggests that EDs merit identification and treatment efforts commensurate with other mental health disorders (e.g. depression) which have similar healthcare impact.

(Received March 26 2007)

(Revised August 13 2007)

(Accepted August 20 2007)

(Online publication November 02 2007)


c1 Address for correspondence: R. H. Striegel-Moore, Ph.D., Department of Psychology, Wesleyan University, 207 High Street, Middletown, CT 06459-0408, USA. (Email: