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Eighteen-month Course and Outcome of Adolescent Restrictive Eating Disorders: Persistence, Crossover, and Recovery
Journal of Clinical Child & Adolescent Psychology ( IF 4.2 ) Pub Date : 2022-04-27 , DOI: 10.1080/15374416.2022.2034634
Lauren Breithaupt 1, 2 , Danielle L Kahn 3 , Meghan Slattery 3 , Franziska Plessow 2, 3 , Christopher Mancuso 3 , Alyssa Izquierdo 3 , Melissa J Dreier 1 , Kendra Becker 1, 2 , Debra L Franko 4 , Jennifer J Thomas 1, 2 , Laura Holsen 2, 5 , Elizabeth A Lawson 2, 3 , Madhusmita Misra 2, 3, 6 , Kamryn T Eddy 1, 2
Affiliation  

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:


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。

更新日期:2022-04-27
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