Identifying research priorities for the study of atypical anorexia nervosa: A Delphi study

Abstract

Objective: Individuals meeting all criteria for anorexia nervosa (AN) except that weight falls within or above the normal range despite significant weight loss are categorized as having atypical AN (AAN). Existing research has provided mixed evidence concerning the diagnostic demarcation of AN and AAN. The aim of the present study was to identify research priorities for furthering the understanding of AN and AAN as diagnostic entities. Method: Employing the Delphi methodology, experts in the field were invited to suggest research questions that need to be explored in the demarcation of AN from AAN. This yielded 24 research areas, that were presented in subsequent rounds where panelists were asked to prioritize areas of primary interest. Results: Fifty-three panelists completed all three Delphi rounds. Consensus was only reached on three items considered to be of primary interest: medical, neurobiological, and neurological factors; epidemiology and natural course; and treatment response in AAN compared to AN. In contrast, questions of premorbid weight and determining the need for and nature of a body mass index cutoff differentiating between AAN and AN were seen as being of low priority. Discussion: These findings reveal a relatively low degree of consensus on the demarcation of AN from AAN in the field of eating disorders. A reason could be that the definition and use of the AAN category vary in research and clinical practice. In order to achieve further diagnostic clarity, research on the demarcation of AAN and AN should focus on the identified prioritized research areas.

Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation

“…Data on participants’ self-admission episodes and number of participants in the program were retrieved from patient records. In sum, the cohort study on which the present analysis is based showed a statistically significant ( p = .001) 51.1 % reduction in time spent hospitalized (at SCÄ and all other Swedish health services) at one-year follow-up, compared to a statistically non-significant ( p = .259) 34.7 % increase in the TAU comparison group [ 13 ]. However, participants’ BMI or eating disorder morbidity was not affected in a clinically meaningful way during follow-up and HRQoL outcomes were inconclusive.…”

“…Available findings indicate that being offered self-admission as a tool in the treatment of eating disorders helped participants prevent deterioration and reduce their need for inpatient treatment, but that it did not aid in achieving symptom remission such as a normalized weight or reduced eating disorder cognitions [ 13 ]. Considering that the targeted participant group displayed a mean duration of illness of 13.4 years, self-admission certainly should not be expected to provide a “quick fix”.…”

“…Instead, these brief admissions are best thought of as booster opportunities or brief respites at times when the risk of deterioration is high. As we have discussed in more detail elsewhere [ 1 , 13 , 21 ], self-admission is therefore probably best understood within a recovery model framework. In this model, a distinction is made between recovery from and recovery in a disorder [ 22 ].…”

“…An overall 1:4 ratio of participants to comparison group patients was achieved, although for two participants a lower ratio had to be accepted due to a scarcity of patients with matching severity of illness in Stepwise. In total, the comparison group comprised 113 patients whose data were entered into the Stepwise register between 2013 and 2017 [ 13 ].…”

“…In a qualitative study, participants in the self-admission program at SCÄ reported a high level of satisfaction, increased agency, and strengthened motivation [ 12 ]. Moreover, in terms of quantitative outcomes, a 51 % reduction in time spent hospitalized at one-year follow-up (at SCÄ and all other Swedish health services) was seen among participants, compared to non-significant changes among comparison groups [ 13 ]. In contrast, participants’ body mass index (BMI) or eating disorder morbidity were not affected during their time in the self-admission program.…”