Identifying duration criteria for eating‐disorder remission and recovery through intensive modeling of longitudinal data

Abstract

ObjectiveOutcome states, such as remission and recovery, include specific duration criteria for which individuals must be asymptomatic. Ideally, duration criteria provide predictive validity to outcome states by reducing symptom‐return risk. However, available research is insufficient for deriving specific recommendations for remission or recovery duration criteria for eating disorders.MethodWe intensively modeled the relation between duration criteria length and rates of remission, recovery, and subsequent symptom return in longitudinal data from a treatment‐seeking sample of women with anorexia nervosa (AN) and bulimia nervosa (BN). We hypothesized that the length of the duration criterion would be inversely associated with both rates of remission and recovery and with subsequent rates of symptom return.ResultsGeneralized estimating equations supported our hypotheses for all investigated eating‐disorder features except for symptom return when using the Psychiatric Status Rating for AN.DiscussionWe recommend that 6 months be used for remission definitions applied to binge eating, purging, and BN symptom composite measures, whereas no duration criteria be used for low weight and AN symptom composites. We further recommend that 6 months be used for recovery definitions applied to BN symptom composites and AN symptom composites, whereas 18 months be used for individual symptoms of binge eating, purging, and low weight. The adoption of these duration criteria into comprehensive definitions of remission and recovery will increase their predictive validity, which in turn, maximizes their utility.

Gastric Necrosis After Binge Eating in Bulimia: Recovery From Eating Disorder After Total Gastrectomy

“…There is currently no consensus on the definition of recovery of eating disorders. De Young et al recently recommended that 6 months be used for recovery definitions of bulimia ( 17 ), whereas DSM-V classification provides unspecific guidance, i.e., « criteria not met for a sustained period of time » ( 1 ). Richmond et al reported four items for eating disorders recovery definition according to patients, parents and clinicians: (a) psychological well-being, (b) eating-related behaviors/attitudes, (c) physical markers, and (d) self-acceptance of body image ( 18 ).…”

The impact of duration of illness on treatment nonresponse and drop‐out: Exploring the relevance of enduring eating disorder concept

“…Numerous definitions of therapy-resistant eating disorders (EDs) can be found in the literature, and the terms "chronic", "long-lasting ED" and "Severe and Enduring ED" (SE-ED), have been used interchangeably (Young et al, 2020). However, the precise parameters of severity and duration are uncertain (Robinson, 2009;Touyz et al, 2013), for example, what are the markers of severity (specific-general psychopathological symptomatology, frequency of abnormal eating behaviours in the case of bulimia nervosa (BN) and binge eating disorder [BED]) or weight (in the case of anorexia nervosa [AN], although applied in Diagnostic and Statistical Manual of Mental Highlights � Almost a half of people with anorexia nervosa (AN) and binge eating disorder (BED) had a good response to treatment, whereas for bulimia nervosa (BN) and other specified feeding and eating disorder (OSFED) only a quarter attained this outcome.…”

What are we aiming for? Exploring tensions in healthcare provider perspectives on and communications about eating disorder recovery

“…In addition to the primacy of symptom remission and increasing emphasis on social and interpersonal factors, the clinical literature on eating disorders offers definitions of recovery that indicate particular timeframes during which behaviours must remit before “recovery” can be said to occur. Common timeframes range from six to eighteen months depending on whether one is looking at symptom composites (assessment across a collection of symptoms) or individual symptoms (such as bingeing, purging, or restriction, assessed individually) (De Young et al, 2020). Many of the clinical definitions of recovery, including Bardone-Cone et al's (2010) definition, offer transdiagnostic 3 conceptualizations of recovery, arguing that that is both more practical (as people may experience diagnostic crossover and different symptoms at different points in time) and clearer to communicate (Bardone-Cone et al, 2018).…”

“…Bardone-Cone et al (2010) in particular have developed a clear and thorough set of criteria for recovery that take into account physical (e.g., weight restoration, nutritional stabilization), behavioural (e.g., restricting, binge, and purge behaviour), cognitive (e.g., disruptive, obsessive, and intrusive thoughts), and psychological (e.g., mood, anxiety) factors. Often, definitions of recovery from eating disorders begin with the requirement of symptom remission (De Young et al, 2020), though this alone is often seen as insufficient for determining recovery (Wade & Lock, 2020). Recovery definitions can also integrate social factors, attending to how people interact with others (Bachner-Melman et al, 2006) and to their overall quality of life (de Vos et al, 2017).…”