Johnson-Munguia Sarah, Bottera Angeline R, Vanzhula Irina, Forbush Kelsie T, Gould Sara R, Negi Sonakshi, Thomeczek Marianna L, L'Insalata Alexa M, Like Emily E, Sharma Anjali R, Morgan R William, Rasheed Samiya
Department of Psychology, University of Kansas, Lawrence, Kansas, USA.
Department of Pediatrics, Children's Mercy, Kansas City, Missouri, USA.
Int J Eat Disord. 2024 Apr;57(4):892-902. doi: 10.1002/eat.24125. Epub 2024 Jan 18.
There is a lack of consensus in defining "significant weight loss" when diagnosing atypical anorexia nervosa (atypical AN) and no guidelines exist for setting target weight (TW). The current study aimed to identify community providers' practices related to the diagnosis of atypical AN and the determination of TW. A secondary aim was to evaluate whether professional discipline impacted "significant weight loss" definitions.
A variety of providers (N = 141; 96.4% female) completed an online survey pertaining to diagnostic and treatment practices with atypical AN. Descriptive statistics were computed to characterize provider-based practices and Fisher's exact tests were used to test for differences in diagnostic practices by professional discipline. Thematic analysis was used to examine open-ended questions.
Most (63.97%) providers diagnosed atypical AN in the absence of any weight loss if other AN criteria were met, but doctoral-level psychologists and medical professionals were less likely to do so compared to nutritional or other mental health professionals. Most providers found weight gain was only sometimes necessary for atypical AN recovery. Qualitative responses revealed providers found atypical AN to be a stigmatizing label that was not taken seriously. Providers preferred to use an individualized approach focused on behaviors, rather than weight when diagnosing and treating atypical AN.
Lack of diagnostic clarity and concrete treatment guidelines for atypical AN may result in substantial deviations from the DSM-5-TR criteria in real-world practice. Clinically useful diagnostic definitions for restrictive eating disorders and evidence-based treatment guidelines for TW and/or other relevant recovery metrics are needed.
The current study found variability in how community providers diagnose and determine target recovery weight for atypical anorexia nervosa (atypical AN). Many providers viewed the diagnosis of atypical AN as stigmatizing and preferred to focus on behaviors, rather than weight. This study underscores the importance of creating a clinically useful diagnostic definition and guidelines for recovery for atypical AN backed by empirical evidence that providers may implement in practice.
在诊断非典型神经性厌食症（非典型AN）时，对于“显著体重减轻”的定义缺乏共识，且不存在设定目标体重（TW）的指南。本研究旨在确定社区医疗服务提供者在非典型AN诊断及TW确定方面的做法。次要目的是评估专业学科是否会影响“显著体重减轻”的定义。
各类医疗服务提供者（N = 141；96.4%为女性）完成了一项关于非典型AN诊断和治疗实践的在线调查。计算描述性统计数据以描述基于医疗服务提供者的做法，并使用Fisher精确检验来检验不同专业学科在诊断实践上的差异。采用主题分析法来研究开放式问题。
如果满足其他AN标准，大多数（63.97%）医疗服务提供者在没有任何体重减轻的情况下诊断为非典型AN，但与营养或其他心理健康专业人员相比，博士水平的心理学家和医学专业人员这样做的可能性较小。大多数医疗服务提供者发现，体重增加对于非典型AN的康复只是有时必要。定性回答显示，医疗服务提供者发现非典型AN是一个带有污名化的标签，未被重视。在诊断和治疗非典型AN时，医疗服务提供者更倾向于采用关注行为而非体重的个体化方法。
非典型AN缺乏明确的诊断标准和具体的治疗指南，可能导致在实际临床实践中与《精神疾病诊断与统计手册》第5版修订版（DSM-5-TR）标准存在重大偏差。需要针对限制性饮食失调制定临床有用的诊断定义以及针对TW和/或其他相关康复指标的循证治疗指南。
本研究发现，社区医疗服务提供者在诊断非典型神经性厌食症（非典型AN）以及确定目标康复体重方面存在差异。许多医疗服务提供者认为非典型AN的诊断带有污名化，更倾向于关注行为而非体重。本研究强调了创建一个基于实证证据、临床有用的非典型AN诊断定义和康复指南的重要性，以便医疗服务提供者能够在实践中应用。
