Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample – characteristics and treatment outcome

Abstract

BackgroundAnorexia Nervosa (AN) destroys developmentally important early years of many young people and knowledge is insufficient regarding course, treatment outcome and prognosis. Only a few naturalistic studies have been conducted within the field of eating disorder (ED) research. In this naturalistic study we included adolescents with AN or subthreshold AN treated in outpatient care, and the overall aim was to examine sample characteristics and treatment outcome. Additional aims were to examine potential factors associated with remission as an outcome variable, and possible differences between three time periods for treatment onset.MethodsParticipants were identified through the Swedish national quality register for eating disorder treatment (SwEat), in which patients are registered at treatment onset and followed up once a year until end of treatment (EOT). Inclusion criteria were: medical or self-referral to one of the participating treatment units between 1999 and 2014, 13–19 years of age at initial entry into SwEat and diagnosed with AN or subthreshold AN. The total sample consisted of 3997 patient from 83 different treatment units.ResultsThe results show that 55% of the participants were in remission and approximately 85% were within a healthy weight range at EOT. Of those who ended treatment according to plan, 70% were in remission and 90% within a healthy weight range. The average treatment duration was approximately 15 months. About one third of the patients terminated treatment prematurely, which was associated with a decreased chance of achieving remission. Remission rates and weight recovery increased over time, while treatment duration decreased. Considering treatment outcome, the results did not show any differences between patients with AN or subthreshold AN.ConclusionsThe present study shows a relatively good prognosis for adolescent patients with AN or subthreshold AN in routine care and the results indicate that treatment for adolescents with ED in Sweden has become more effective over the past 15 years. The results of the present study contribute to the scope of treatment research and the large-scale naturalistic setting secures the generalizability to a clinical environment. However, more research is needed into different forms of evidence, new research strategies and diversity of treatment approaches.Trial registrationRegistered in FOU in Sweden (Researchweb.org) 2014-04-14, ID nr 147301.

The role of self‐esteem in the treatment of patients with anorexia nervosa – A systematic review and meta‐analysis

“…influence of weight or shape on self-evaluation, or persistent denial of the seriousness of the low weight (APA, 2013). For affected individuals and their relatives, AN appears as a malign developmental influence (Lindstedt, Kjellin, & Gustafsson, 2017). Adolescent girls and young adult women are most commonly affected by the disorder, and the estimates for the lifetime prevalence among females vary between 1% and 4% (Keski-Rahkonen & Mustelin, 2016;Smink, van Hoeken, & Hoek, 2013).…”

“…Adolescent girls and young adult women are most commonly affected by the disorder, and the estimates for the lifetime prevalence among females vary between 1% and 4% (Keski-Rahkonen & Mustelin, 2016;Smink, van Hoeken, & Hoek, 2013). In recent years, the outcome of AN treatments (e.g., remission rates and weight recovery) has improved, particularly for adolescent patients (Lindstedt et al, 2017;Zipfel, Giel, Bulik, Hay, & Schmidt, 2015). On a societal level, the disorder has been reported to produce direct costs comparable to that of schizophrenia (Stuhldreher et al, 2015).…”

“…For affected individuals and their relatives, AN appears as a malign developmental influence (Lindstedt, Kjellin, & Gustafsson, 2017). However, the rates of dropout from treatment lie between 20% and 50% (Dejong, Broadbent, & Schmidt, 2012;Huas et al, 2011;Lindstedt et al, 2017) and the rates of relapses within 1 year after treatment range between 20% and 40% (Carter et al, 2012;Herpertz-Dahlmann et al, 2014). In recent years, the outcome of AN treatments (e.g., remission rates and weight recovery) has improved, particularly for adolescent patients (Lindstedt et al, 2017;Zipfel, Giel, Bulik, Hay, & Schmidt, 2015).…”

“…In recent years, the outcome of AN treatments (e.g., remission rates and weight recovery) has improved, particularly for adolescent patients (Lindstedt et al, 2017;Zipfel, Giel, Bulik, Hay, & Schmidt, 2015). However, the rates of dropout from treatment lie between 20% and 50% (Dejong, Broadbent, & Schmidt, 2012;Huas et al, 2011;Lindstedt et al, 2017) and the rates of relapses within 1 year after treatment range between 20% and 40% (Carter et al, 2012;Herpertz-Dahlmann et al, 2014). Above all, the mortality rates for younger and for older patients with AN continue to exceed that of other mental disorders (Hoang, Goldacre, & James, 2014).…”

Family-Based Treatment for Anorexia Nervosa Symptoms in High-Risk Youth: A Partially-Randomized Preference-Design Study

“…In the case of incipient AN, both research and expert consensus support taking action (19). The literature has long since characterized sub-diagnostic cases and argued that they are not markedly distinct from their full-AN counterparts in medical complications, comorbidities, and outcomes (2,(27)(28)(29)(30)(31). While these sub-diagnostic samples are generally heterogeneous with regard to course, they collectively include a portion of individuals who have not yet met the diagnosis and are at risk for progression to AN.…”