Billman Miller Marley G, Gioia Ayla N, Essayli Jamal H, Forrest Lauren N
Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA.
Department of Psychology, Hofstra University, Hempstead, New York, USA.
Int J Eat Disord. 2024 Apr;57(4):809-818. doi: 10.1002/eat.24046. Epub 2023 Sep 22.
Little is known about how individuals with atypical anorexia nervosa (AN) respond to eating disorder (ED) treatment in a partial hospitalization program (PHP), nor how certain factors such as trauma, childhood abuse, psychiatric comorbidity, and suicidal thoughts and behaviors might contribute to poor treatment outcomes. Thus, the current study (1) compares prevalence of these factors between individuals with AN and atypical AN upon admission to an ED PHP, (2) compares PHP treatment response between groups, and (3) investigates whether experiencing these factors impacts treatment outcomes.
We conducted a retrospective chart review of young adults admitted to a PHP with AN (n = 95) and atypical AN (n = 59). Histories of psychiatric comorbidities and adverse childhood experiences were obtained from initial psychiatric evaluations. ED symptoms were assessed at intake and discharge with the Eating Disorder Examination-Questionnaire (EDE-Q).
No significant differences were found at intake in ED symptom severity or prevalence of lifetime trauma, childhood abuse, number of psychiatric diagnoses, or suicidal thoughts and behavior. Symptomatology at discharge also did not differ between groups. Emotional abuse was significantly related to discharge shape and weight overvaluation. No other intake characteristics were significantly related to discharge symptomatology.
To our knowledge, this is the first study to compare the prevalence of comorbidities for both AN and atypical AN, as well as differential treatment outcomes for these individuals in a PHP. Results add to growing literature suggesting that, other than weight, AN and atypical AN have few properties that reliably distinguish them from one another.
This study adds to a growing body of literature that raises questions about whether anorexia nervosa (AN) and atypical AN are truly different diagnoses. Our findings suggest these two groups present to treatment in a partial hospitalization program (PHP) with similar ED symptoms, as well as prevalence of lifetime trauma, childhood abuse, suicidal thoughts and behavior, and number of psychiatric comorbidities, and demonstrate similar treatment trajectories in PHP.
对于神经性厌食症（AN）非典型型患者在部分住院治疗项目（PHP）中如何应对进食障碍（ED）治疗，以及诸如创伤、童年期虐待、精神共病、自杀想法和行为等特定因素如何导致治疗效果不佳，人们了解甚少。因此，本研究（1）比较了AN患者和非典型AN患者在进入ED的PHP时这些因素的发生率，（2）比较了两组之间的PHP治疗反应，（3）调查了经历这些因素是否会影响治疗结果。
我们对进入PHP的AN患者（n = 95）和非典型AN患者（n = 59）进行了回顾性病历审查。从初始精神评估中获取精神共病和不良童年经历的病史。在入院时和出院时使用进食障碍检查问卷（EDE-Q）评估ED症状。
在入院时，ED症状严重程度、终生创伤发生率、童年期虐待、精神诊断数量或自杀想法及行为方面未发现显著差异。两组出院时的症状学也无差异。情感虐待与出院时的体型观念和体重超重视显著相关。没有其他入院特征与出院时的症状学显著相关。
据我们所知，这是第一项比较AN和非典型AN共病发生率以及这些个体在PHP中的不同治疗结果的研究。结果进一步证明，除了体重之外，AN和非典型AN几乎没有可靠区分彼此的特征。
本研究进一步增加了关于神经性厌食症（AN）和非典型AN是否真的是不同诊断的文献数量。我们的研究结果表明，这两组患者在部分住院治疗项目（PHP）中的ED症状、终生创伤发生率、童年期虐待、自杀想法和行为以及精神共病数量相似，并在PHP中表现出相似的治疗轨迹。
