Hagan Kelsey E, Johnson Adanya, Venables Kira, Makara Amanda, Haynos Ann F
Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA.
Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA.
Int J Eat Disord. 2024 Apr;57(4):924-936. doi: 10.1002/eat.24152. Epub 2024 Feb 2.
Research on the natural course of symptoms of atypical anorexia nervosa (AN) relative to AN and bulimia nervosa (BN) is limited yet needed to inform nosology and improve understanding of atypical AN. This study aimed to 1) characterize trajectories of eating disorder and internalizing (anxiety, depression) symptoms in college students with and without a history of atypical AN, AN, and BN; and 2) compare sex and race/ethnicity distributions across groups.
United States college students who participated in Spit for Science™, a prospective cohort study, were classified as having a history of atypical AN (n = 125), AN (n = 160), BN (n = 617), or as non-eating-disorder controls (NCs, n = 5876). Generalized and linear mixed-effects models assessed group differences in eating and internalizing symptom trajectories, and logistic regression compared groups on sex and race/ethnicity distributions.
Atypical AN participants demonstrated elevated eating disorder and internalizing symptoms compared to NCs during college, but less severe symptoms than AN and BN participants. Although all eating disorder groups showed signs of improvement in fasting and driven exercise, purging and depression remained elevated. Atypical AN participants showed increasing anxiety and stable binge-eating trajectories compared to AN and/or BN participants. The atypical AN group comprised significantly more people of color than the AN group.
Findings underscore that atypical AN is a severe psychiatric disorder. As atypical AN may present as less severe than AN and BN and disproportionately affects people of color, clinicians should be mindful of biases that could delay diagnosis and care.
College students with histories of atypical AN, AN, and BN demonstrated improvements in fasting and driven exercise and stable purging and depression levels. Atypical AN students showed worsening anxiety and stable binge-eating trajectories compared to favorable changes among AN and BN students. A higher percentage of atypical AN (vs. AN) students were people of color. Findings may improve the detection of atypical AN in college students.
关于非典型神经性厌食症（AN）相对于神经性厌食症和神经性贪食症（BN）症状自然病程的研究有限，但对于完善疾病分类学以及增进对非典型AN的理解是必要的。本研究旨在：1）描述有和没有非典型AN、AN和BN病史的大学生饮食失调及内化（焦虑、抑郁）症状的轨迹；2）比较各群体的性别和种族/民族分布。
参与前瞻性队列研究“为科学而吐”（Spit for Science™）的美国大学生被分类为有非典型AN病史（n = 125）、AN病史（n = 160）、BN病史（n = 617）或作为非饮食失调对照组（NCs，n = 5876）。广义线性混合效应模型评估饮食和内化症状轨迹的组间差异，逻辑回归比较各群体的性别和种族/民族分布。
与NCs相比，非典型AN参与者在大学期间饮食失调和内化症状有所升高，但症状严重程度低于AN和BN参与者。尽管所有饮食失调组在禁食和强迫性运动方面都有改善迹象，但清除行为和抑郁水平仍然较高。与AN和/或BN参与者相比，非典型AN参与者的焦虑症状呈上升趋势，暴饮暴食轨迹保持稳定。非典型AN组中的有色人种比AN组显著更多。
研究结果强调非典型AN是一种严重的精神疾病。由于非典型AN可能表现得不如AN和BN严重，且对有色人种影响更大，临床医生应注意可能导致诊断和治疗延迟的偏见。
有非典型AN、AN和BN病史的大学生在禁食和强迫性运动方面有所改善，清除行为和抑郁水平保持稳定。与AN和BN学生的有利变化相比，非典型AN学生的焦虑症状恶化，暴饮暴食轨迹保持稳定。非典型AN（相对于AN）学生中有色人种的比例更高。研究结果可能有助于提高对大学生中非典型AN的检测。
