Establishing consensus for labeling and defining the later stage of anorexia nervosa: A Delphi study

Broomfield, Catherine; Noetel, Melissa; Stedal, Kristin; Hay, Phillipa; Touyz, Stephen

doi:10.1002/eat.23600

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…Usual stages of these processes include survey development based on literature review and core group input in which a core group develops potential consensus statements based on literature review and their own expertise, expert panel member recruitment, circulation of proposed statements to these larger groups of nominated experts, data collection and analyses for several rounds of survey votes and input, and ultimate consensus guideline development. [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Eating disorders and palliative care specialists require definitional consensus and clinical guidance regarding terminal anorexia nervosa: addressing concerns and moving forward

Yager

Gaudiani²,

Treem

2022

J Eat Disord

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Background and objectives Premature deaths are estimated to occur in 5–20% of patients with anorexia nervosa (AN). Among them, some patients with severe and enduring anorexia nervosa (SE-AN) will die due to the medical complications of malnutrition or to suicide. Almost no literature provides guidance to patients, clinicians, and loved ones regarding clinical characteristics of those with SE-AN who recognize and accept the fact that they will not be able to survive their disease. Consistent with general medical literature on terminal illness and based on the authors’ work with patients at this phase of life, we previously described four clinical characteristics of the small group of SE-AN patients who may be considered to have a terminal eating disorder. Following publication of this article, several opinions objecting to these formulations were published. The goals of this article are to respond to the key themes of concern posed by these objections, to extend our discussion of the palliative care and associated needs of these patients and their families, and to suggest ways in which the eating disorder and palliative care fields might develop more definitive criteria and consensus guidelines for the assessment and management of these patients. Methods Based on a selective narrative review of the literature, our combined experiences with these patients, and clinical reasoning, we address critiques grouped around five major themes: that (1) labels such as terminal AN are dangerous; (2) since AN is a treatable disorder, no SE-AN patients should be considered terminal; (3) a terminal psychiatric condition cannot be defined; (4) the proposed definition is not specific enough; and (5) considerations regarding mental capacity in the proposed criteria do not sufficiently account for the psycho-cognitive impairments in AN. Results Our analysis responds to the critiques of our original proposed clinical characteristics of those with terminal AN. While refuting many of these critiques, we also appreciate the opportunity to refine our discussion of this complex topic and identify that there are multiple stages of SE-AN that can result in good clinical outcomes. Only when all of these have failed to provide adequate amelioration of suffering do a low number of patients progress to terminal AN. Conclusions By further refining our discussion of terminal AN, we aim to encourage eating disorders and palliative care specialists to develop expert consensus definitions for terminal AN and to generate authoritative clinical guidance for management of this population. By validating terminal AN as a distinct condition, patients with this subcategory of SE-AN, their families, and their caregivers facing end-of-life concerns may be better able to access palliative and hospice care and related services to help improve their overall experiences at this phase of life.

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Section: Discussionmentioning

confidence: 99%

Eating disorders and palliative care specialists require definitional consensus and clinical guidance regarding terminal anorexia nervosa: addressing concerns and moving forward

Yager

Gaudiani²,

Treem

2022

J Eat Disord

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“…A total of 62.86% of statements reached consensus, representing an equal or higher amount of agreement amongst the expert panel compared to other Delphi studies in the field [ 38 , 45 ].…”

Section: Discussionmentioning

confidence: 89%

Measuring exercise in eating disorder patients: a Delphi study to aggregate clinical and research knowledge

et al. 2022

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Background Exercise is a prominent feature of most eating disorders, and has been shown to have a number of detrimental effects on treatment outcome. There is some disagreement in the literature regarding the construct of compulsive exercise, and assessment and treatment varies significantly. This study therefore aimed to aggregate expert clinicians’ and researchers’ views on how to define and measure compulsive exercise in eating disorder patients. The expert panel was also asked about questionnaire design, and possible problems when measuring compulsive exercise. Method This study used the Delphi method to establish consensus amongst an expert panel. Three successive rounds of questionnaires were distributed to the panel over a period of six months. The first round consisted of four open-ended questions regarding the definition and measurement of compulsive exercise in eating disorder patients. For Round 2, 70 statements were derived from the answers, and panelists were asked to rate each item on a Likert-based scale. An 85% consensus level was chosen. In Round 3, 44 statements were re-rated by the panel. Results Seventeen of 24 participants completed all three rounds of the study. Consensus was achieved for 63% of the items, while 18.5% reached near consensus, and 18.5% did not reach consensus after Round 3. The panel agreed on a number of important aspects of compulsive exercise. Several suggestions regarding the format of a questionnaire assessing this behavior were also endorsed. The panel further identified common difficulties when assessing compulsive exercise in eating disorder patients, notably a lack of consensus still apparent in the literature. Conclusion The current findings constitute a further step towards a unified definition of compulsive exercise, and contribute important suggestions to the measurement of this behavior.

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“…We also found that the child onset group had significantly higher rates of prior admissions to higher levels of care for their ED compared to both the adolescent and adult onset groups, a finding compatible with higher severity, chronicity and possibly poorer response to previous treatment. These results have implications for ‘severe and enduring’ AN and BN, although exact definitions, risk factors, and effective treatments remain elusive (Brewerton & Dennis, 2015; Broomfield et al., 2021; Kotilahti et al., 2020; Treasure et al., 2020; Westmoreland & Mehler, 2016; Wonderlich et al., 2020). Given that mean age of admission was not significantly different between the three groups, those with child onset ED have been living with an ED longer than those in the other two groups, although it is unknown to what extent remissions may have occurred in the interim.…”

Section: Discussionmentioning

confidence: 99%

Eating disorder onset during childhood is associated with higher trauma dose, provisional PTSD, and severity of illness in residential treatment

Brewerton

Gavidia²,

Suro³

et al. 2022

Euro Eating Disorders Rev

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Objective: Age of eating disorder (ED) onset has been of significant interest to both researchers and clinicians. The identification of factors associated with early or child onset has important prevention and treatment implications. The presence of prior trauma, resultant posttraumatic stress disorder (PTSD), ED severity, and comorbid psychopathology are of particular relevance to age of ED onset, but data are limited. Methods: Adults (≥18 years, 93% female, total n = 1283) admitted to residential ED treatment self-reported age of ED onset. Patients were divided into child onset (ages 5-10 years), adolescent onset (11-17 years), and adult onset (≥18 years) groups and compared on a number of clinical features and assessment measures. Results:The child onset group had significantly higher rates and doses of traumatic life events; higher current PTSD prevalence; higher BMIs, higher severity of ED, depression and state-trait anxiety symptoms; worse quality of life; and more prior inpatient and residential admissions for ED treatment, in comparison to both the adolescent and adult onset groups. Similarly, the adolescent onset group had significantly higher rates than the adult onset group. Conclusions: These results have important implications for prevention, treatment and long-term follow-up and highlight the need for early traumafocussed treatment of ED patients.

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Establishing consensus for labeling and defining the later stage of anorexia nervosa: A Delphi study

Cited by 14 publications

References 31 publications

Eating disorders and palliative care specialists require definitional consensus and clinical guidance regarding terminal anorexia nervosa: addressing concerns and moving forward

Eating disorders and palliative care specialists require definitional consensus and clinical guidance regarding terminal anorexia nervosa: addressing concerns and moving forward

Measuring exercise in eating disorder patients: a Delphi study to aggregate clinical and research knowledge

Eating disorder onset during childhood is associated with higher trauma dose, provisional PTSD, and severity of illness in residential treatment

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