Empirically Derived Subtypes of Full and Subthreshold Anorexia Nervosa in Adolescent Females: Understanding General Psychopathology and Treatment Implications

Abstract

The aim of this study was to derive clinically relevant subtypes of anorexia nervosa (AN) and subthreshold AN using general psychopathology variables and to determine how they differ on eating pathology. Participants were 39 adolescent females aged 13 to 18 years, diagnosed with AN or subthreshold AN. Cluster analysis revealed two subtypes that differed significantly in eating pathology. Cluster 1 patients were typically underweight with no clinical elevations on eating or psychopathology measures. Cluster 2 patients were mostly of healthy weight with greater eating and psychological problems. Findings allow clinicians to classify and understand AN beyond diagnostic criteria, and implement interventions that consider presentation beyond eating pathology.

Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature

“…As shown in Table 2, approximately 79% ( n = 46) of studies reported more consecutively referred or admitted patients to have AN compared with AAN, with AN rates ranging from 1.5 to 17 times as common as AAN referrals and admissions. However, in 17% ( n = 10) of studies, AAN exceeded AN referrals and admissions, and sometimes by a factor of three or more (Bayes & Madden, 2011; Damiano et al, 2015; Månsson et al, 2016; Swenne, 2016; Swenne et al, 2017; Swenne & Ros, 2017; Welch et al, 2015).…”

“…However, despite higher rates of prevalence in population studies, AAN appears to be undertreated in clinical settings, with more AN patients receiving referrals and treatment. A notable exception to this finding was that within studies conducted in countries with universal healthcare systems, rates of AAN patients admitted to treatment centers exceeded those of AN patients (Damiano et al, 2015; Månsson et al, 2016; Swenne, 2016; Welch et al, 2015). This suggests that healthcare systems with greater focus on prevention and early intervention strategies (and healthcare systems with more universal coverage) may increase the likelihood of screening and referring patients with AAN.…”

“…(n = 10) of studies, AAN exceeded AN referrals and admissions, and sometimes by a factor of three or more (Bayes & Madden, 2011;Damiano et al, 2015;Månsson et al, 2016;Swenne, 2016;Welch et al, 2015).…”

Exploring neuropsychological and socio-emotional performance in anorexia nervosa: A cluster analytic approach

“…Past research using cluster analysis in those with eating disorders has mostly focussed on characterising comorbidity (Van Alsten & Duncan, 2020), clinical presentation (Damiano et al, 2015;Errichiello et al, 2016), or personality types (Claes et al, 2006;Hopwood et al, 2010), however very few have performed clustering based on neuropsychological or socialcognitive performance. Most notably, Renwick et al (2015) included a comprehensive assessment of neuropsychological and social function as cluster variables, including setshifting, central coherence, and ToM tasks.…”

Exploring neuropsychological and socio‐emotional task performance in anorexia nervosa: A cluster analytic approach

“…Past research using cluster analysis in those with eating disorders has mostly focussed on characterising comorbidity (Van Alsten & Duncan, 2020), clinical presentation (Damiano et al, 2015;Errichiello et al, 2016) or personality types (Claes et al, 2006;Hopwood et al, 2010), however, very few have performed clustering based on neuropsychological or social-cognitive performance. Most notably, Renwick et al (2015) included a comprehensive assessment of neuropsychological and social function as cluster variables, including set-shifting, central coherence and ToM tasks.…”