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Early Course of Symptom Development in Anorexia Nervosa
Journal of Adolescent Health ( IF 7.6 ) Pub Date : 2022-08-13 , DOI: 10.1016/j.jadohealth.2022.06.010
Lisa M Ranzenhofer 1 , Monica Jablonski 2 , Lauren Davis 3 , Jonathan Posner 4 , B Timothy Walsh 1 , Joanna E Steinglass 1
Affiliation  

Purpose

Anorexia nervosa (AN) commonly begins in adolescence; however, detailed knowledge of symptom trajectories, including their temporal sequence, is less well elucidated. The purpose of the present study is to describe the onset and duration of disordered eating behaviors prior to a diagnosis of AN, examine concordance between child and parent report, and examine the relationships between timing of symptom onset and illness severity.

Methods

Seventy-one adolescents (ages 12–18 years) and their parents were interviewed about dieting, restriction, loss of control/binge eating, purging, excessive/compulsive exercise, weight history, and amenorrhea. Body mass index percentiles were calculated, and adolescents completed the Eating Disorder Examination-Questionnaire.

Results

Restriction, being underweight, dieting, and excessive exercise were reported by most of the sample; purging, loss-of-control eating, and having been overweight were reported by less than a third. Dieting typically emerged first, on average around age 14; the remainder of behaviors tended to emerge between ages 14 and 14½; and average age of formal diagnosis was slightly over 15 years. Dyads had good agreement regarding presence and timing of all behaviors except for dieting, for which children reported about 6 months earlier onset/longer duration, compared to parents. Although older age at interview was associated with lower body mass index percentile and higher EDE-Q score, neither age of onset nor duration was associated with severity when controlling for current age.

Discussion

Teens and parents describe a similar sequence of behavior changes leading up to a diagnosis of AN that typically begins with dieting and occurs over an approximate 1- to 1½-year period. Querying teens and parents about eating behavior changes may aid in identification and early intervention in AN; adolescents with normal weight who engage in persistent dieting or restrictive eating may warrant more frequent weight monitoring.



中文翻译:

神经性厌食症症状发展的早期过程

目的

神经性厌食症 (AN) 通常始于青春期;然而,对症状轨迹(包括其时间顺序)的详细了解尚不清楚。本研究的目的是描述诊断 AN 之前饮食失调行为的发作和持续时间,检查儿童和家长报告之间的一致性,并检查症状发作时间和疾病严重程度之间的关系。

方法

71 名青少年(12-18 岁)及其父母接受了有关节食、限制、失控/暴饮暴食、净化、过度/强迫性运动、体重史和闭经的采访。计算体重指数百分位数,并让青少年完成饮食失调检查问卷。

结果

大多数样本都报告了限制、体重不足、节食和过度运动;不到三分之一的人报告有排便、饮食失控和体重超重的情况。节食通常首先出现,平均在 14 岁左右;其余行为往往在 14 岁至 14.5 岁之间出现;正式诊断的平均年龄略高于15岁。除节食外,二人组对于所有行为的出现和发生时间都有很好的一致性,与父母相比,儿童报告节食行为的发生时间早约 6 个月/持续时间更长。尽管访谈时年龄较大与较低的体重指数百分位和较高的 EDE-Q 评分相关,但在控制当前年龄时,发病年龄和持续时间均与严重程度无关。

讨论

青少年和家长描述了导致 AN 诊断的一系列类似的行为变化,通常从节食开始,并在大约 1 至 1.5 年的时间内发生。询问青少年和家长有关饮食行为变化的信息可能有助于识别和早期干预 AN;体重正常的青少年如果持续节食或限制饮食,可能需要更频繁的体重监测。

更新日期:2022-08-13
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