A new study from the University of Copenhagen suggests that eating disorders are not necessarily more common among families with a high level of education - but that young people from these families are more likely to be identified, assessed and treated.
Eating disorders are often associated with teenage girls from socioeconomically advantaged families. However, a new study from the University of Copenhagen challenges this perception, suggesting that eating disorders are just as likely to affect young people from less advantaged backgrounds.
The researchers analysed data on eating disorder diagnoses from more than 500,000 people born in Denmark between 1996 and 2003. For a subgroup of 44,000 young people, they also had information on self-reported symptoms of eating disorders.
The findings show that children and adolescents from highly educated families are more likely to receive a formal diagnosis of an eating disorder. At the same time, young people from families with lower levels of educational attainment are more likely to report symptoms of an eating disorder without ever having received a diagnosis.
The results suggest that social inequalities do not only influence illness itself, but also who is identified and receives help.
"Eating disorders, particularly anorexia, have traditionally been viewed as conditions that primarily affect young people from highly educated families. Our study suggests that the picture is more complex. It may largely be a question of who is recognised, referred and diagnosed," says Andrea Joensen, Postdoc at the Department of Public Health, University of Copenhagen, and lead author of the study.
It may be the diagnosis - not the illness - that is socially patterned
The researchers found that young people whose parents had completed a long-cycle higher education degree were 35% more likely to receive an eating disorder diagnosis than the reference group. The reference group consisted of young people whose parents had an educational level equivalent to upper secondary education.
By contrast, young people whose parents had only completed compulsory schooling were 30% less likely to receive a diagnosis than the reference group.
However, when the researchers examined self-reported symptoms of anorexia, bulimia and binge eating disorder among 44,000 young people, the pattern was reversed. Young people from families with the lowest educational attainment were more than twice as likely to report symptoms of an eating disorder compared with the reference group.
"Our findings suggest that eating disorders may resemble the pattern seen for many other mental health conditions, where social vulnerability also plays a role," says Else Marie Olsen, Consultant Psychiatrist at the Psychotherapeutic Outpatient Clinic for Eating Disorders, Psychiatric Centre Ballerup, and co-author of the study.
Although the study is observational and cannot determine causality, the researchers point to several possible explanations for why some young people remain undiagnosed. Parents may have fewer resources to navigate the healthcare system, less awareness of symptoms, or greater mistrust of whether the system can provide effective support.
The consequences of living with an eating disorder without receiving help can be severe.
"These young people often cope with the illness on their own, and it is associated with considerable shame, guilt and psychological distress. Many withdraw from social relationships because food is at the centre of so many social activities," says Else Marie Olsen.
Risk of overlooking certain groups
The researchers stress that the findings do not mean that young people from advantaged families are not affected by eating disorders. Rather, the study suggests that the healthcare system and society in general may be better at identifying and supporting some groups than others.
The researchers hope that the results will contribute to a broader discussion about early identification, prevention and equitable access to support for children and young people with eating disorders.
"The key message is that eating disorders are not only a problem among affluent families. We risk overlooking young people who have just as much need for support but, for various reasons, never find their way into treatment," says Andrea Joensen.
