Classification of childhood onset eating disorders: A latent class analysis

Abstract

This study tested the hypothesis that latent class analysis (LCA) would successfully classify eating disorder (ED) symptoms in children into categories that mapped onto DSM-5 diagnoses and that these categories would be consistent across countries. Childhood onset ED cases were ascertained through prospective active surveillance by the Australian Paediatric Surveillance Unit, the Canadian Paediatric Surveillance Program, and the British Paediatric Surveillance Unit for 36, 24, and 14 months, respectively. Pediatricians and child psychiatrists reported symptoms of any child aged ≤ 12 years with a newly diagnosed restrictive ED. Descriptive analyses and LCA were performed separately for all three countries and compared. Four hundred and thirty-six children were included in the analysis (Australia n = 70; Canada n = 160; United Kingdom n = 206). In each country, LCA revealed two distinct clusters, both of which presented with food avoidance. Cluster 1 (75%, 71%, 66% of the Australian, Canadian, and United Kingdom populations, respectively) presented with symptoms of greater weight preoccupation, fear of being fat, body image distortion, and over exercising, while Cluster 2 did not (all p < .05). Cluster 1 was older, had greater mean weight loss and was more likely to have been admitted to an inpatient unit and have unstable vital signs (all p < .01). Cluster 2 was more likely to present with a comorbid psychiatric disorder (p < .01). Clusters 1 and 2 closely resembled the DSM-5 criteria for anorexia nervosa and avoidant/restrictive food intake disorder, respectively. Symptomatology and distribution were remarkably similar among countries, which lends support to two separate and distinct restrictive ED diagnoses.

A systematic scoping review of diagnostic validity in avoidant/restrictive food intake disorder

“…From the studies that report illness duration at baseline a pattern emerges, although not altogether consistent. The finding that ARFID patients have ususally been ill for a longer time at presentation is supported by several studies (Fisher et al, ; Pinhas et al, ); however, the opposite tendency (Nakai et al, ) or no differences have also been found (Nicely et al, ; Strandjord et al, ) (Table ).…”

“…The literature review identified only one study utilizing a latent class analysis approach in differentiating between clinical entities (Pinhas et al, ), lending support to a differentiation between ARFID and AN in pediatrics patients. The studies on ARFID and AN epidemiology summarized above also support the distinction between these two diagnostic entities, although they do not apply a latent class analysis approach.…”

Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment

“…9 A recent latent class analysis of three pediatric surveillance studies (in which pediatricians and child psychiatrists were asked to report on any children < 12 years with a newly diagnosed restrictive type eating disorder) performed across Canada, the United Kingdom, and Australia suggested that one of two identified clusters representing between 25–34% of children with incident restrictive type eating disorders mapped onto symptoms consistent with ARFID. 10 These studies suggest that despite variation in estimates, ARFID is commonly seen in clinical settings and might be common among children in the general population. Further studies are needed to investigate the epidemiology of ARFID in children, adults, and the elderly.…”

Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa

“…Generally, previous studies have reported that those with ARFID present for treatment at a younger age than those with AN (Bryson, Scipioni, Essayli, Mahoney, & Ornstein, ; Cooney et al, ; Fisher et al, ; Forman et al, ; Nakai, Nin, Noma, Teramukai, & Wonderlich, ; Nicely et al, ; Norris et al, ; Ornstein, Nicely, Lane‐Loney, Masciulli, & Hollenbeak, ) and, in outpatient settings, have a longer duration of illness than patients with AN (Fisher et al, ; Forman et al, ). A recent latent class analysis of children between the ages of 5 and 13 presenting to pediatric clinics or general psychological clinics reported that restrictive eating could be separated into two distinct classes: (1) a class similar to AN characterized by body dissatisfaction, fear of gaining weight, and over exercising; and (2) a class similar to ARFID characterized by somatic concerns and low levels of weight and shape concerns (Pinhas et al, ). Consistent across three samples from English‐speaking countries (United Kingdom, Australia, and Canada), the class similar to ARFID was younger with elevated levels of anxiety and, though not statistically significant, a longer duration of illness (Pinhas et al, ).…”

“…A recent latent class analysis of children between the ages of 5 and 13 presenting to pediatric clinics or general psychological clinics reported that restrictive eating could be separated into two distinct classes: (1) a class similar to AN characterized by body dissatisfaction, fear of gaining weight, and over exercising; and (2) a class similar to ARFID characterized by somatic concerns and low levels of weight and shape concerns (Pinhas et al, ). Consistent across three samples from English‐speaking countries (United Kingdom, Australia, and Canada), the class similar to ARFID was younger with elevated levels of anxiety and, though not statistically significant, a longer duration of illness (Pinhas et al, ). Interestingly, at higher levels of care, child and adolescent patients with ARFID have often shown similar illness duration to patients with AN (Nicely et al, ; Ornstein, Essayli, Nicely, Masciulli, & Lane‐Loney, ; Strandjord, Sieke, Richmond, & Rome, ).…”