Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway.
Institute of Psychology, University of Oslo, Oslo, Norway.
Int J Eat Disord. 2024 Jan;57(1):81-92. doi: 10.1002/eat.24067. Epub 2023 Oct 27.
A large proportion of patients with eating disorders (ED) report experiences of childhood trauma. Latent trajectory analysis in ED samples reveals the complexities in course and outcome and can explore the long-term impact of adverse experiences in childhood.
A total of 84 patients with longstanding ED were included. ED symptoms were assessed by the Eating Disorder Examination interview at discharge from inpatient treatment, and at 1-, 2-, 5-, and 17-year follow-up, respectively. Change over time was examined using growth mixture modeling, allowing the number of trajectories to emerge through the data. Prevalence of childhood trauma was assessed, and its relation to class membership was tested.
We identified four distinct classes: patients with (a) a continuous improvement in the entire follow-up period, and scores within normal range at the end, "continuous improvement" (54.8%); (b) a high symptom level at baseline and moderate decrease over time, "high and declining" (22.6%); (c) initial ED scores below clinical cut-off and stable symptoms throughout the course, "consistently low" (14.3%); and (d) with high scores initially, and a significant increase in symptoms over time, "high and increasing" (8.3%). A history of childhood sexual abuse (CSA) was overrepresented in classes with persistently high symptom levels and poor long-term outcome DISCUSSION: Patients with longstanding ED displayed considerable diversity in trajectories of symptom change across 17 years. To improve long-term outcome, enhanced treatment of sequelae from CSA seems essential.
Patients with longstanding eating disorders displayed four different trajectories of change in a 17-year follow-up study. Although there were significant changes over time, the majority of patients remained within similar symptom levels as they presented with at discharge from inpatient treatment. Exposure to childhood maltreatment was common within the sample. Childhood sexual abuse predicted poor long-term outcome, which highlights the importance of trauma informed care.
很大一部分饮食失调（ED）患者报告有童年创伤经历。ED 样本中的潜在轨迹分析揭示了病程和结果的复杂性，并可以探索童年期不良经历的长期影响。
共纳入 84 例长期 ED 患者。在住院治疗出院时、分别在 1、2、5 和 17 年随访时，使用饮食障碍检查访谈评估 ED 症状。通过增长混合建模来检查随时间的变化，允许通过数据出现轨迹的数量。评估童年创伤的患病率，并测试其与类别的关系。
我们确定了四个不同的类别：（a）在整个随访期间持续改善，并且在结束时分数在正常范围内的患者，“持续改善”（54.8%）；（b）基线时症状水平高且随时间中度下降的患者，“高且下降”（22.6%）；（c）初始 ED 分数低于临床临界值且整个病程中症状稳定的患者，“持续低”（14.3%）；（d）初始分数高，随时间症状显著增加的患者，“高且增加”（8.3%）。童年期性虐待（CSA）史在持续高症状水平和不良长期结局的类别中更为常见。
长期 ED 患者在 17 年的随访中表现出症状变化轨迹的显著多样性。为了改善长期预后，增强对 CSA 后遗症的治疗似乎至关重要。
在 17 年的随访研究中，长期饮食失调患者的变化轨迹显示出四种不同的轨迹。尽管随时间发生了显著变化，但大多数患者仍保持与住院治疗出院时相似的症状水平。该样本中普遍存在童年期虐待经历。童年期性虐待预测预后不良，这凸显了创伤知情护理的重要性。
