Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4

Eating disorders include a range of serious mental health conditions characterised by disturbances in eating and food-related behaviours, as well as disturbances in the experience of weight and shape.

In the phase one interview, eating disorder features were screened for using the SCOFF questionnaire, a brief self-report screening tool designed to screen for possible cases of anorexia nervosa and bulimia nervosa. In the phase two interview, examinations were carried out with a subset of participants by clinically trained interviewers using the Eating Disorders module of the Schedule for Clinical Assessment in Neuropsychiatry (SCAN ED), designed to assess ICD-11 eating disorder diagnoses, including avoidant restrictive food intake disorder (ARFID). The SCAN examination results were weighted to estimate the prevalence of eating disorders meeting diagnostic criteria in the adult population.

This chapter presents two outcomes: (1) the proportion of adults screening positive on the SCOFF in 2007 and 2023/4, and (2) the proportion of adults in 2023/4 both screening positive on the SCOFF and identified with a diagnosable eating disorder based on the SCAN ED examination.

• The proportion of adults screening positive on the SCOFF increased from 6.4% in 2007 to 9.1% in 2023/4, indicative of possible eating disorder. A rise was evident in both males and females, and in most age groups.
• Screening positive on the SCOFF was more common in women (11.8%) than men (6.1%), and in younger adults compared with older age groups.
• Based on those with a positive SCOFF screen and a positive clinical examination on the SCAN ED, 1.3% of adults (95% CI 0.8, 2.2) met the diagnostic criteria for an eating disorder in the past year. Because just 26 participants both scored 2+ on the SCOFF and were identified by the SCAN with an eating disorder, confidence intervals around estimates are wide, and the sample is underpowered for examining subgroup differences. A further 13 participants were identified with an eating disorder by the SCAN ED but did not screen positive on the SCOFF and were therefore excluded from the analysis. This prevalence may be an underestimate for several reasons, which are described in the chapter.
• Eating disorder (SCOFF+SCAN ED) prevalence varied by age. It was highest in 16 to 24 year olds (2.5%, CI 0.8, 7.4) and lowest in those aged 65 and over (0.2%, CI 0.0, 0.7).
• Prevalence of eating disorder (SCOFF+SCAN ED) varied by employment status, with a higher proportion of unemployed adults (11.4%) having an eating disorder, compared with those who were employed (1.0%) or economically inactive (2.8%).
• Eating disorder prevalence was strongly associated with common mental health conditions such as anxiety and depression. Adults with a common mental health condition were more likely to have an eating disorder (4.5%) than those without (0.5%).

Eating disorders are described in the World Health Organization’s (WHO) 11th edition of the International Classification of Diseases (ICD-11) as psychiatric conditions involving abnormal eating behaviour and preoccupation with food accompanied in most instances by body weight or shape concerns (WHO 2019). Eating disorders include anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), avoidant restrictive food intake disorder (ARFID), pica, rumination disorder, and other specified feeding or eating disorder (OSFED) all of which have a significant impact on the quality of life of affected individuals and are associated with increased healthcare utilisation and costs (Ágh et al. 2016; Hay et al. 2023; Liu et al. 2025; Santomauro et al. 2021; Wang et al. 2024).

Eating disorders are more common in women (Udo and Grillo 2018), though under recognition may be an issue among men and nonbinary people, who may present with different symptomatology and have been historically overlooked in eating disorders research (Murray et al. 2017; Rasmussen et al. 2025). The vast majority of first episodes of eating disorders occur in adolescence or early adulthood (Solmi et al. 2022), though many people go on to experience recurrent episodes later in life (Ward et al. 2019). Minoritised ethnic groups are underrepresented in eating disorders research. As such, there is limited understanding of prevalence and treatment outcomes in these populations (Williams-Ridgway et al. 2025; Barakat et al. 2023). Eating disorders are associated with other health problems, both related to mental health (e.g., anxiety disorders, mood disorders, substance abuse disorders, and post-traumatic stress disorder) and physical health (e.g., involving the skeletal, neuroendocrine, gastrointestinal, and dental systems) (Hambleton et al. 2022; Barakat et al. 2023). Eating disorders are also associated with a substantially increased risk of mortality. A recent large meta-analysis by Solmi and colleagues (2024) found that people with anorexia nervosa have around five times higher mortality rates than the general population, while standardised mortality ratios for other eating disorders are approximately double that of the general population (Solmi et al. 2024). Additionally, eating disorders can have wider impacts, such as on fertility (Tabler et al. 2018), work participation and performance (Ubhi et al. 2025).

To date, no population-level study has provided a comprehensive assessment of the full diagnostic spectrum of eating disorders in the UK. Current understanding relies heavily on global prevalence estimates and screening tools that fail to encompass the entire range of disorders. Epidemiological studies have typically focused on anorexia nervosa and bulimia nervosa, with eating disorders such as binge eating disorder and OFSED often excluded (Santomauro et al. 2021). No prevalence studies for ARFID have yet been conducted in UK adults, and good quality data in children and adolescents are sparse (Sanchez-Cerezo et al. 2023). A systematic analysis for the Global Burden of Disease (GBD) Study 2019 estimated an age-standardised prevalence of 174.0 per 100,000 people (GBD 2019 Mental Disorders Collaborators 2022). While the GBD figures included just anorexia nervosa and bulimia nervosa, a subsequent further analysis was carried out by Santomauro et al. (2021) to make the case for inclusion of binge eating disorder and OFSED in GBD. They estimated that this wider definition of eating disorders would increase the GBD 2019 global prevalence from 0.2% of the population to 0.7%. A systematic review describing the prevalence of eating disorders reported lifetime prevalence estimates of 8.4% for women and 2.2% for men, and 12-month prevalence estimates of 2.2% for women and 0.7% for men (Galmiche et al. 2019).

An upward trend in the prevalence of eating disorders over time is evident from analyses of general population surveys of children and adults living in England. Although no increase was evident between the 2004 and 2017 Mental Health of Children and Young People surveys (Marcheselli et al. 2018), the prevalence of eating disorders according to screening items increased from 0.5% in 2017 to 2.6% in the 2023 follow-up survey among 11 to 16 year olds. A more marked rise was reported for the 17 to 19 year age group (Newlove-Delgado et al. 2023). In APMS 2007, 6.4% of adults in England screened positive for a possible eating disorder using the SCOFF questionnaire (McManus et al. 2009), compared with 16% in 2019 in the Health Survey for England (NHS Digital 2020). Alongside this survey evidence of rising prevalence, the number of hospital admissions where the main reason for admission was an eating disorder diagnosis also increased, by about 50%, between 2013/14 and 2023/4 (NHS England 2024).

Various reasons have been proposed as contributing to a rising prevalence of eating disorders and disordered eating in England. The rising rate of obesity has been cited as a factor contributing to the increased rate of disordered eating, though there is currently very limited guidance for clinicians and researchers relating to effective identification and risk monitoring of eating disorders among the higher weight groups (McMaster et al. 2023). Additionally, social media usage may contribute to eating disorders through multiple pathways, including engaging in social comparison, internalising thin/fit ideals and experiencing self-objectification (Dane and Bhatia 2023). The COVID-19 pandemic was associated with an increase in referrals to eating disorders services as well as longer waiting times (Ayton et al. 2022), though the more recent post-pandemic period has shown a subsequent decline in referrals (Gallagher et al. 2025). Additionally, the diagnostic concept of eating disorders has broadened in recent years, to include newly formally recognised conditions such as binge-eating disorder and ARFID, in addition to broadening the criteria for pre-existing conditions, including anorexia nervosa and bulimia nervosa (Hay 2020).

A report by the All-Party Parliamentary Group on Eating Disorders called for a national eating disorders strategy to address the rise in eating disorders in the UK (All-Party Parliamentary Group on Eating Disorders 2025). The report recommended that the strategy have several key components, including mandatory eating disorder training for all front-line staff, investment in public health messaging around obesity and eating disorders, funding for the implementation and integration of evidence-based treatment practices, mandatory health screening for high risk groups and training for carers.

The National Institute for Health and Care Excellence (NICE) guidelines covering eating disorders recommend that initial assessments should not be based solely on screening tools (such as the SCOFF) and a range of factors should be taken into account, for example unusually low or high body mass index (BMI), rapid weight loss, comorbidity with physical or mental health conditions and social withdrawal, especially around food. If an eating disorder is suspected, people should be referred immediately to a community-based, age-appropriate eating disorder service for further assessment or treatment. NICE also recommends encouraging family members, carers, teachers, and peers of children to provide support during treatment. Treatment varies by the type of eating disorder, with a range of psychological treatments recommended, as well as collaboration to support physical and mental health comorbidities (NICE 2017, updated 2020).

This chapter aims to provide further insight into the distribution of eating disorders among community-based adults living in England, as well as associations with key demographic characteristics, including age, gender, ethnicity, employment status, problem debt, area-level deprivation, region, physical and mental health comorbidity, and BMI.

Eating disorders

There are two primary sets of diagnostic criteria in current use: the ICD-11 (WHO 2019) and the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5, American Psychiatric Association 2013). The ICD-11 lists eight categories of feeding and eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID, pica, rumination-regurgitation disorder, OSFED, and unspecified feeding or eating disorders. These correspond closely to the DSM-5 categories.

Features of an eating disorder

SCOFF questionnaire

The SCOFF screening tool was used in both the 2007 and 2023/4 APMS to screen for possible eating problems. The letters included in SCOFF represent the first letter of the words; Sick, Control, One stone, Fat, and Food. The SCOFF questions were developed and validated in the UK as a short and simple tool to raise the suspicion that an eating disorder might exist among non-specialists, rather than to make a diagnosis (Morgan et al. 1999). A recent systematic review of two decades of research (Coop et al. 2024) found that the SCOFF has often been used inappropriately as a diagnostic or prevalence measure rather than as a brief screening tool. The authors, including the original developers, emphasised that a full clinical assessment is required to confirm any diagnosis and that results should be interpreted with caution. Consistent with this, the National Institute for Health and Care Excellence (NICE 2024; NICE 2017, updated 2020) recognises the SCOFF as a useful short screening instrument for identifying possible eating disorders in community settings, but advises that it should not be used in isolation to determine whether a person has an eating disorder.

The SCOFF questionnaire was administered to all APMS 2023/4 participants in the self-completion part of the interview. The tool uses five questions from which the word SCOFF was devised, with yes/no response codes, as outlined in the table below. The word SCOFF is intended to act as a memory prompt for the screening items. Responding yes to two or more items indicates a case of possible eating problems, warranting further clinical assessment.

The table below lists the questions used. The APMS 2023/4 adopted that same approach used in the 2007 survey and the 2019 Health Survey for England (HSE) (McManus et al. 2009; NHS Digital 2020). The original SCOFF wording was amended slightly to relate the questions to a specified time frame: the last year. The order of presentation was also amended. These changes mean that the APMS 2023/4 data is comparable to the 2007 data and the HSE 2019 data but may not be directly comparable with other studies that have used the scale.

An additional question was asked of participants scoring two or more on the SCOFF: ‘Did your feelings about food interfere with your ability to work, meet personal responsibilities and/or enjoy a social life?’ This question was asked to get an indication of whether the presence of attitudes and behaviours associated with eating disorders were having an impact on social participation and integration.

In this chapter, a positive screen for features of an eating disorder is a SCOFF score of two or more. The proportion of participants screening positive and reporting that feelings about food interfere with life (with significant impact) is also presented in the tables.

Eating disorder in the past year

Eating disorders module of the Schedule for Clinical Assessment in Neuropsychiatry (SCAN ED)

The Eating disorders module was a new addition to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) 3.0 (WHO unpublished), administered in the phase two examination, and has not been used in the APMS-series before. It covers DSM-5 criteria and ICD-11 clinical descriptions for eating disorders and subtypes in the past year. The SCAN (SCAN ED) was designed to cover probable anorexia nervosa, bulimia nervosa, and binge eating disorder, possible ARFID, and other specified feeding or eating disorders (OFSED), but did not detect pica or rumination-regurgitation disorder. For the purposes of this chapter, these identified eating disorder types were considered collectively in the analysis. SCAN ED was included in the existing phase two examination, which already used SCAN to assess psychosis in the APMS.

Because SCAN involves interviewer judgement of whether symptoms are present (hence an ‘examination’ as opposed to reliance on self-reports or on a fixed set of interview questions), the assessments were conducted by clinically trained interviewers from the University of Leicester (Brugha et al. 1999). The presence of an eating disorder in the year before examination was established by applying ICD-11 diagnostic algorithms to the SCAN generated symptom ratings. As SCAN ED is a new module, a separate validation study was carried out with adults seen by an eating disorder specialist at two NHS sites specialising in eating disorders. The results from the validation study were used to set a threshold for the SCAN algorithm to identify any eating disorder. More detailed results from the validation study will be published separately.

Participants were eligible for the SCAN ED module if they answered ‘yes’ to at least two SCOFF questions in the phase one questionnaire. Overall, 468 participants scored at least two on the SCOFF questionnaire in the in-person phase one self-completion part of the interview and were therefore eligible for a phase two assessment. Of these, 87 participants (19%) did not consent to be contacted for a phase two interview. In total, 187 (40%) participants who scored at least two on the SCOFF questionnaire in phase one and agreed to be contacted about phase two took part in the phase two examination. The remainder either later declined to participate (37%) or could not be contacted (23%). Of those selected for phase two based on a score of two or more on the SCOFF questionnaire and who completed a phase two interview, 26 participants were classified as having an eating disorder in the past year based on their SCAN ED results.

The full SCAN questionnaire was administered to all participants who took part in the phase two examination, regardless of the condition(s) they were selected for. 13 participants with a SCOFF score of less than 2, who had been selected for phase two interview based on screening positive for autism and/or psychosis, were identified as having an eating disorder. Thus, while 39 participants were identified as having an eating disorder based on SCAN ED, 13 cases are counted as negative for the purposes of the prevalence estimates presented in this chapter due to their low SCOFF score. The fact that a third of them were identified from a group of participants who scored less than 2 on SCOFF indicates that SCOFF has low sensitivity and may not perform well in identifying people with the full range of ICD-11 eating disorders. For example, the SCOFF would not detect ARFID cases, which may be particularly overrepresented in those with autism (Bourne et al. 2022).

It is possible that other participants who scored less than 2 on SCOFF but were not selected for a phase two examination may have had an eating disorder but are not included in the probable eating disorder prevalence. It was decided to limit the eating disorder cases used in analysis in this chapter to the 26 that were identified based on the initially agreed study protocol (i.e., only those who had additionally scored two or more on the SCOFF). The estimates presented in this chapter are thus conservative. Because much was known about the characteristics of non-responders to phase two, a nuanced eating disorders specific weighting strategy was developed to address non-response. See the APMS 2023/4 Methods documentation for more information.

Results using the SCOFF screening questionnaire should be treated with caution, as they class at least some participants with a probable eating disorder (as identified by SCAN ED), as not having eating problems. Our results cannot evaluate the specificity and sensitivity of SCOFF, i.e., how many participants were incorrectly identified as having or not having an eating disorder.

Estimation of body mass index (BMI)

In the face-to-face part of the interview, participants were asked about their height and weight. Where provided, this information has been used to estimate each participant’s body mass index (BMI). BMI is defined as body weight in kilograms divided by the square of height in metres (kg/m²).

Self-reported height and weight is recognised to be less accurate than direct measurement, with men likely to overestimate their height and women underestimate their weight (Merrill and Richardson 2009). To account for this, prediction equations developed using Health Survey for England data were used to adjust for possible inaccuracies in height and weight (Scholes et al. 2023). In this chapter, participants were grouped into the following five BMI categories; less than 18.5 (underweight), 18.5 to less than 25 (healthy weight), 25 to less than 30 (overweight), 30 to less than 40 (obese, excluding severe obesity), and 40 or more (severe obesity).

The upper threshold of the underweight category used in APMS was 18.5 kg/m² as defined in the ICD-11 (WHO 2019) and the DSM-5 (APA 2013).

Features of an eating disorder (SCOFF 2+), by age and gender

9.1% of adults scored 2+ on the SCOFF, and 2.2% of adults scored 2+ on the SCOFF and also reported that their feelings about food had interfered with their ability to work, meet personal responsibilities or enjoy a social life. If all adults in the population had been assessed, it is likely that the proportion scoring 2+ on the SCOFF would be between 8.1% and 10.2% (95% CI). This equates to approximately 4.2 million adults living in England.

Women (11.8%, 95% CI 10.4, 13.4) were more likely than men (6.1%, CI 4.9, 7.5) to score 2+ on the SCOFF. 3.2% of women (CI 2.4, 4.2) and 1.2% of men (CI 0.7, 2.0) scored 2+ on the SCOFF and reported that their feelings about food had a significant impact on their life. Among both men and women, prevalence of screening positive on the SCOFF was highest in 16 to 24 year olds (20.1%, CI 15.4, 25.7) and declined with increasing age to 2.2% (CI 1.2, 3.9) in those aged 75 and over.

For more information: Table 13.1 and Table A1 for confidence intervals

Features of an eating disorder (SCOFF 2+) in 2007 and 2023/4

Note that the trends in this chapter are analysed by sex (male and female) rather than gender (men and women) to allow for comparison with 2007. See How to interpret the findings for information on how changes over time were assessed.

The proportion of adults scoring 2+ on the SCOFF rose from 6.4% (95% CI 5.8, 7.1) in 2007 to 9.1% (CI 8.1, 10.1) in 2023/4. This rise was observed in both males and females, increasing in males from 3.5% in 2007 (CI 2.9, 4.3) to 6.1% (CI 4.9, 7.5) in 2023/4, and in females from 9.2% in 2007 (CI 8.2, 10.3) to 11.9% (CI 10.5, 13.5) in 2023/4. Apparent rises in age and sex subgroups over time have wide and overlapping confidence intervals.

For more information: Table 13.2 and Table B1 for confidence intervals

Prevalence of eating disorders in the past year (SCOFF+SCAN ED), by age and gender

The prevalence of eating disorders in the past year in England was 1.3%, as indicated by both a positive SCOFF screen combined with a positive eating disorder examination using the SCAN ED. Prevalence in the wider adult population is likely to be between 0.8% and 2.2%, referred to as the 95% confidence interval (95% CI). This equates to about 600 thousand adults living in England. The size of this confidence interval is similar to that of some of the other lower prevalence disorders considered on APMS.

Because just 26 participants both scored 2+ on the SCOFF and were identified by the SCAN with an eating disorder, confidence intervals around estimates are wide, and the sample is underpowered for examining subgroup differences. A further 13 participants were identified with an eating disorder by the SCAN ED but did not screen positive on the SCOFF and are therefore excluded from the analysis, which should be taken into consideration when interpreting the results in this chapter.

The prevalence of eating disorder appeared to be higher in women (1.9%, CI 1.1, 3.5) than men (0.5%, CI 0.2, 1.6) although confidence intervals were wide and overlapped. Some variation in prevalence of eating disorder by age was evident, with prevalence highest in those aged 16 to 24 (2.5%, CI 0.8, 7.4) and lowest in those aged 65 and over (0.2%, CI 0.0, 0.7). 

For more information: Table 13.3 and Table A2 for confidence intervals

Variations in prevalence of eating disorders (SCOFF+SCAN ED) by other characteristics

Ethnic group

Eating disorder prevalence (based on SCOFF+SCAN ED) did not vary significantly between ethnic groups in age-standardised analyses. However, the number of adults with eating disorders in some groups was very small and the confidence intervals around estimates were wide.

For more information: Table 13.4 and Table A3 for confidence intervals

Employment status

Eating disorder prevalence (based on SCOFF+SCAN ED) varied by employment status (age-standardised) among working age adults (16 to 64). It was highest in unemployed (11.4%) and lower in employed (1.0%) and economically inactive (2.8%) adults.

For more information: Table 13.5

Problem debt

Problem debt was defined as being seriously behind on at least one debt repayment or having utilities cut off. See the APMS 2023/4 Methods documentation for more information on how problem debt was derived.

Eating disorder prevalence (based on SCOFF+SCAN ED) was not significantly associated with problem debt in age-standardised analyses. However, the number of adults with eating disorders in some groups was very small and the confidence intervals around estimates were wide.

For more information: Table 13.6

Area-level deprivation

Eating disorder prevalence (based on SCOFF+SCAN ED) was not significantly associated with area-level deprivation in age-standardised analyses.

For more information: Table 13.7

Region

Regions were grouped into four areas (North, Midlands and East, South, and London) for this analysis due to the small number of participants identified with an eating disorder. Eating disorder prevalence (based on SCOFF+SCAN ED) varied by region (age-standardised) and was highest in the South of England (2.3%) and lowest in the North of England (0.2%). However, the number of adults with eating disorders in some groups was very small and the confidence intervals around estimates were wide.

For more information: Table 13.8

Comorbidity

Physical health conditions

In age-standardised analyses, adults with a limiting physical health condition (2.7%) were more likely than those without (0.6%) to have an eating disorder (based on SCOFF+SCAN ED).

For more information: Table 13.9

Common mental health conditions

In age-standardised analyses, adults with a common mental health condition (CMHC) were more likely to have an eating disorder (4.5%) according to SCOFF+SCAN ED than those without a CMHC (0.5%).

For more information: Table 13.9

Body mass index (BMI)

BMI was estimated based on participants’ self-reported height and weight at phase one, and adjusted for possible inaccuracies in self-reported height and weight. For more information Section 13.2 Definitions and assessments.

In age-standardised analyses, the prevalence of eating disorder (SCOFF+SCAN ED) did not vary between BMI groups. No APMS participants identified with an eating disorder (SCAN ED) met the criteria for the ‘underweight’ category.

For more information: Table 13.10

1.3% of adults in England had a diagnosable eating disorder in the past year (95% CI 0.8, 2.2). This estimate required both a positive screen using the SCOFF and a positive examination using the Eating Disorders module of the Schedule for Clinical Assessment in Neuropsychiatry (SCAN ED). APMS 2023/4 is the first national survey to include a two stage ascertainment like this. Prevalence appeared to be higher in women (1.9%) than men (0.5%), and higher in younger than older adults. However, the small number of identified cases limits the statistical power of this analysis, the confidence intervals were wide and overlapping. This apparent higher prevalence of eating disorders in women is consistent with the majority of prior evidence, though the sex ratios for individual eating disorders likely vary (Qian et al. 2022). Further research is needed to better understand the differences in sex ratio across different eating disorder diagnoses.

The SCOFF screening questionnaire may miss some eating disorder cases. The SCOFF was originally designed to screen just for anorexia nervosa and bulimia nervosa (Morgan et al. 1999), and thus it may be less effective with other eating disorders, especially ARFID. A meta-analysis of 25 SCOFF validation studies (Kutz et al. 2020) found it was most sensitive in studies of young women with anorexia nervosa or bulimia nervosa, and less sensitive in studies with more men, participants with binge-eating disorder, and with large community samples. These findings are consistent with a study validating the SCOFF in a multiethnic general population sample of adults (Solmi et al. 2015). This found that most validation studies relied on young, mostly female, and ethnically homogeneous samples, with limited generalisability to more diverse populations. The study concluded that specificity of the SCOFF was higher than its sensitivity, and that its sensitivity was lower than previously found in other studies (Solmi et al. 2015; Kutz et al. 2020). APMS 2023/4 drew on a large and heterogeneous community sample, it is possible that the SCOFF had poor sensitivity.

The approach taken to identify eating disorder cases - requiring both a positive SCOFF screen and a positive SCAN ED examination - may underestimate prevalence. APMS 2023/4 comprised a large and heterogeneous community sample. If the sensitivity of the SCOFF was poor, some participants with an eating disorder may have screened negative on the SCOFF and not been selected for a phase two SCAN ED examination. This is evidenced by participants who underwent a SCAN examination for reasons other than screening positive on the SCOFF questionnaire (i.e., based on screening positive on psychosis and/or autism measures), and who were found to have an eating disorder following a SCAN examination. In this chapter all SCOFF negative participants were classified as not having an eating disorder, even if they had a positive SCAN ED examination. Thus, the prevalence estimate reported in this chapter is likely an underestimate. A detailed analysis of all the eating disorder cases identified by SCAN ED will be undertaken in due course.

The proportion of adults screening positive on the SCOFF has increased over time, from 6.4% (CI 5.8, 7.1) in 2007 to 9.1% in 2023/4 (CI 8.1, 10.1), indicating an upward trend. This increase in the proportion of adults reporting features of an eating disorder is consistent with results from the Mental Health of Children and Young People in England survey series, which found a rise between 2017 and 2023 among children and young people living in England (Newlove-Delgado et al. 2023). While there are signals that the COVID-19 pandemic has further intensified eating-disorder symptoms and related service demand (Devoe et al. 2023; Madigan et al. 2025), it remains uncertain whether these elevated levels will decline, underlining the need for targeted prevention and early-intervention strategies to reduce suffering and associated economic and societal costs.

Eating disorders were associated with co-occurring physical and mental health conditions. Adults with a limiting physical health condition were more likely than those without to have an eating disorder, consistent with previous research (Momen et al. 2022). Eating disorders can be life threatening and have significant implications for physical health including cardiovascular, gastrointestinal, reproductive and other issues (Rome and Ammerman 2003). Adults with a common mental health condition were also more likely than those without to have an eating disorder, reflecting established research highlighting a range of psychiatric comorbidities (Tan et al. 2023; Garcia et al. 2020; Swinbourne and Touyz 2007) as well as evidence of the substantial impact of having an eating disorder on a person’s quality of life (Jenkins et al. 2011).

Eating disorders were more common in adults who were unemployed, than among those in work or economically inactive. However, the number of unemployed adults with an eating disorder was small and confidence intervals were wide. Prior evidence exploring the relationship between eating disorders and employment status is relatively limited, but an exploratory analysis of US medical expenditures survey data also found an association between eating disorders and lower rates of employment, as well as lower earnings, though comorbid mental health problems contributed significantly to these differences (Samnaliev et al. 2015). Eating disorder prevalence was not found to vary significantly between ethnic groups, although small numbers limited this analysis. It is essential to collect ethnicity data when conducting eating disorders research, as little is known in relation to the prevalence and treatment experiences of members of minority ethnic groups (Williams-Ridgway et al. 2025; Barakat et al. 2023).

Although limited by sample size, the eating disorder prevalence data presented in this chapter represent a significant step forward in eating disorder research and provides valuable insights regarding the needs of the general population, informing health service resourcing. The inclusion of the SCAN examination in APMS 2023/4 provides the first clinically diagnosable eating disorder prevalence estimates. However, important limitations to this chapter should be noted. Firstly, the reliance on the SCOFF as a screening tool may have excluded a number of participants from a SCAN examination, therefore the eating disorder prevalence presented here is likely to be an underestimate. And as a screening tool, the SCOFF results in isolation will overestimate the prevalence of eating disorders. Secondly, subgroup comparisons within the chapter are based on just 26 participants who both screened positive on the SCOFF and were identified by the SCAN ED, resulting in a lack of statistical power and/or wide and overlapping confidence intervals. Thirdly, the number of participants in the underweight range was small, with none of the 26 positive SCOFF and SCAN cases in the underweight BMI category. Possible reasons for this could include that the screening approach resulted in small numbers of identified cases; or lower participation rates or willingness to provide self-reported height and weight among those with eating disorders often associated with an underweight BMI such as anorexia nervosa. Further methodological work is required to explore these limitations for future eating disorders general population studies.

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Please cite this chapter as: 

Ridout, K., Young, E., Morris, S., Morgan, Z., Ayton, A., Brugha, T., Nicholls, D., Solmi, F., McManus, S., & Tromans, S. (2025). Eating disorders. In Morris, S., Hill, S., Brugha, T., McManus, S. (Eds.). Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. NHS England.