ABSTRACT

Objective

In adults, low-weight restrictive eating disorders, including anorexia nervosa (AN), are marked by chronicity and diagnostic crossover from restricting to binge-eating/purging. Less is known about the naturalistic course of these eating disorders in adolescents, particularly atypical AN (atyp-AN) and avoidant/restrictive food intake disorder (ARFID). To inform nosology of low-weight restrictive eating disorders in adolescents, we examined outcomes including persistence, crossover, and recovery in an 18-month observational study.

Method

We assessed 82 women (ages 10–23 years) with low-weight eating disorders including AN (n = 40; 29 restricting, 11 binge-eating/purging), atyp-AN (n = 26; 19 restricting, seven binge-eating/purging), and ARFID (n = 16) at baseline, nine months (9 M; 75% retention), and 18 months (18 M; 73% retention) via semi-structured interviews. First-order Markov modeling was used to determine diagnostic persistence, crossover, and recovery occurring at 9 M or 18 M.

Results

Among all diagnoses, the likelihood of remaining stable within a given diagnosis was greater than that of transitioning, with the greatest probability among ARFID (0.84) and AN-R (0.62). Persistence of BP and atypical presentations at follow-up periods was less stable (AN-BP probability 0.40; atyp-AN-R probability 0.48; atyp-AN-BP probability, 0.50). Crossover from binge-eating/purging to restricting occurred 72% of the time; crossover from restricting to binge-eating/purging occurred 23% of the time. The likelihood of stable recovery (e.g., recovery at both 9 M and 18 M) was between 0.00 and 0.36.

Conclusion

Across groups, intake diagnosis persisted in about two-thirds, and recovery was infrequent, underscoring the urgent need for innovative treatment approaches to these illnesses. Frequent crossover between AN and atyp-AN supports continuity between typical and atypical presentations, whereas no crossover to ARFID supports its distinction.

中文翻译：

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青少年限制性饮食失调十八个月的过程和结果：持续、交叉和恢复

 抽象的

 客观的

在成人中，低体重限制性饮食失调，包括神经性厌食症（AN），其特点是慢性和从限制到暴食/清除的诊断交叉。人们对青少年饮食失调的自然过程知之甚少，特别是非典型AN（atyp-AN）和回避/限制性食物摄入障碍（ARFID）。为了了解青少年低体重限制性饮食失调的分类学，我们在一项为期 18 个月的观察性研究中检查了结果，包括持续性、交叉和恢复。

 方法

我们评估了 82 名患有低体重饮食失调的女性（年龄 10-23 岁），包括 AN（ n = 40；29 名限制性饮食，11 名暴食/清除）、atyp-AN（ n = 26；19 名限制性饮食，7 名暴食） /purging）和 ARFID（ n = 16）在基线、9 个月（9 M；75% 保留率）和 18 个月（18 M；73% 保留率）通过半结构化访谈进行。使用一阶马尔可夫模型来确定 9 M 或 18 M 时发生的诊断持续性、交叉和恢复。

 结果

在所有诊断中，在给定诊断范围内保持稳定的可能性大于转变的可能性，其中 ARFID (0.84) 和 AN-R (0.62) 的可能性最大。随访期间血压持续存在和非典型表现不太稳定（AN-BP 概率 0.40；atyp-AN-R 概率 0.48；atyp-AN-BP 概率 0.50）。 72% 的时间发生从暴饮暴食/清除暴饮暴食到限制饮食的交叉情况；从限制饮食到暴饮暴食的交叉发生率为 23%。稳定恢复的可能性（例如，在9 M 和18 M 处恢复）在0.00 和0.36 之间。

 结论

在各组中，大约三分之二的人坚持摄入诊断，并且康复的情况很少见，这突显了迫切需要针对这些疾病的创新治疗方法。 AN 和 atyp-AN 之间的频繁交叉支持典型和非典型表示之间的连续性，而与 ARFID 的没有交叉支持其区别。