Eating Disorders Clinical and Research Program, Massachusetts General Hospital.
Department of Psychiatry, Harvard Medical School.
J Clin Child Adolesc Psychol. 2022 Sep-Oct;51(5):715-725. doi: 10.1080/15374416.2022.2034634. Epub 2022 Apr 27.
In adults, low-weight restrictive eating disorders, including anorexia nervosa (AN), are marked by chronicity and diagnostic crossover from restricting to binge-eating/purging. Less is known about the naturalistic course of these eating disorders in adolescents, particularly atypical AN (atyp-AN) and avoidant/restrictive food intake disorder (ARFID). To inform nosology of low-weight restrictive eating disorders in adolescents, we examined outcomes including persistence, crossover, and recovery in an 18-month observational study.
We assessed 82 women (ages 10-23 years) with low-weight eating disorders including AN ( = 40; 29 restricting, 11 binge-eating/purging), atyp-AN ( = 26; 19 restricting, seven binge-eating/purging), and ARFID ( = 16) at baseline, nine months (9 M; 75% retention), and 18 months (18 M; 73% retention) via semi-structured interviews. First-order Markov modeling was used to determine diagnostic persistence, crossover, and recovery occurring at 9 M or 18 M.
Among all diagnoses, the likelihood of remaining stable within a given diagnosis was greater than that of transitioning, with the greatest probability among ARFID (0.84) and AN-R (0.62). Persistence of BP and atypical presentations at follow-up periods was less stable (AN-BP probability 0.40; atyp-AN-R probability 0.48; atyp-AN-BP probability, 0.50). Crossover from binge-eating/purging to restricting occurred 72% of the time; crossover from restricting to binge-eating/purging occurred 23% of the time. The likelihood of stable recovery (e.g., recovery at both 9 M and 18 M) was between 0.00 and 0.36.
Across groups, intake diagnosis persisted in about two-thirds, and recovery was infrequent, underscoring the urgent need for innovative treatment approaches to these illnesses. Frequent crossover between AN and atyp-AN supports continuity between typical and atypical presentations, whereas no crossover to ARFID supports its distinction.
在成年人中，低体重限制型进食障碍，包括神经性厌食症（AN），以慢性和从限制型到暴食/清肠型的诊断交叉为特征。关于青少年中这些进食障碍的自然病程，我们知之甚少，特别是非典型 AN（atyp-AN）和回避/限制型食物摄入障碍（ARFID）。为了为青少年低体重限制型进食障碍提供分类学信息，我们在一项为期 18 个月的观察性研究中检查了包括持续性、交叉和恢复在内的结局。
我们在基线、9 个月（9M；75%保留率）和 18 个月（18M；73%保留率）时评估了 82 名患有低体重进食障碍的女性（年龄 10-23 岁），包括 AN（n=40；29 名限制型，11 名暴食/清肠型）、atyp-AN（n=26；19 名限制型，7 名暴食/清肠型）和 ARFID（n=16），通过半结构化访谈进行。使用一阶马尔可夫模型确定 9M 或 18M 时发生的诊断持续性、交叉和恢复。
在所有诊断中，在给定诊断内保持稳定的可能性大于转变的可能性，ARFID（0.84）和 AN-R（0.62）的概率最大。在随访期间，BP 和非典型表现的持续性不太稳定（AN-BP 概率为 0.40；atyp-AN-R 概率为 0.48；atyp-AN-BP 概率为 0.50）。从暴食/清肠型到限制型的交叉发生了 72%的时间；从限制型到暴食/清肠型的交叉发生了 23%的时间。稳定恢复（例如，在 9M 和 18M 时都恢复）的可能性在 0.00 到 0.36 之间。
在各组中，摄食诊断的持续性约为三分之二，恢复很少见，这突显了对这些疾病的创新治疗方法的迫切需求。AN 和 atyp-AN 之间频繁的交叉支持了典型和非典型表现之间的连续性，而没有交叉到 ARFID 则支持了它的区别。
