Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, New York; Department of Psychiatry, Columbia University Irving Medical Center (CUIMC), New York, New York.
Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, New York.
J Adolesc Health. 2022 Nov;71(5):587-593. doi: 10.1016/j.jadohealth.2022.06.010. Epub 2022 Aug 13.
Anorexia nervosa (AN) commonly begins in adolescence; however, detailed knowledge of symptom trajectories, including their temporal sequence, is less well elucidated. The purpose of the present study is to describe the onset and duration of disordered eating behaviors prior to a diagnosis of AN, examine concordance between child and parent report, and examine the relationships between timing of symptom onset and illness severity.
Seventy-one adolescents (ages 12-18 years) and their parents were interviewed about dieting, restriction, loss of control/binge eating, purging, excessive/compulsive exercise, weight history, and amenorrhea. Body mass index percentiles were calculated, and adolescents completed the Eating Disorder Examination-Questionnaire.
Restriction, being underweight, dieting, and excessive exercise were reported by most of the sample; purging, loss-of-control eating, and having been overweight were reported by less than a third. Dieting typically emerged first, on average around age 14; the remainder of behaviors tended to emerge between ages 14 and 14½; and average age of formal diagnosis was slightly over 15 years. Dyads had good agreement regarding presence and timing of all behaviors except for dieting, for which children reported about 6 months earlier onset/longer duration, compared to parents. Although older age at interview was associated with lower body mass index percentile and higher EDE-Q score, neither age of onset nor duration was associated with severity when controlling for current age.
Teens and parents describe a similar sequence of behavior changes leading up to a diagnosis of AN that typically begins with dieting and occurs over an approximate 1- to 1½-year period. Querying teens and parents about eating behavior changes may aid in identification and early intervention in AN; adolescents with normal weight who engage in persistent dieting or restrictive eating may warrant more frequent weight monitoring.
神经性厌食症（AN）通常始于青春期；然而，对于症状轨迹的详细了解，包括其时间顺序，了解得还不够清楚。本研究的目的是描述 AN 诊断前饮食紊乱行为的发病和持续时间，检查儿童和父母报告的一致性，并研究症状发病时间与疾病严重程度之间的关系。
对 71 名青少年（12-18 岁）及其父母进行了关于节食、限制、失去控制/暴食、催吐、过度/强迫性运动、体重史和闭经的访谈。计算了体重指数百分位数，青少年完成了饮食障碍检查问卷。
大多数样本报告了限制、体重过轻、节食和过度运动；不到三分之一的人报告了催吐、失去控制的进食和超重。节食通常是最早出现的，平均年龄在 14 岁左右；其余行为倾向于在 14 到 14 岁半之间出现；正式诊断的平均年龄略高于 15 岁。除了节食，双生子在所有行为的存在和时间上都有很好的一致性，而儿童比父母报告的发病时间早约 6 个月，持续时间更长。虽然访谈时年龄较大与较低的体重指数百分位数和较高的 EDE-Q 评分相关，但在控制当前年龄后，发病年龄和持续时间与严重程度无关。
青少年和父母描述了导致 AN 诊断的类似行为变化序列，这些行为通常始于节食，持续约 1 到 1 年半的时间。询问青少年和父母有关饮食行为变化的情况可能有助于 AN 的识别和早期干预；体重正常但持续节食或限制饮食的青少年可能需要更频繁的体重监测。
