Eating Disorder Severity and Psychological Morbidity in Adolescents with Anorexia Nervosa or Atypical Anorexia Nervosa and Premorbid Overweight/Obesity

Abstract PurposeA significant proportion of adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) experience premorbid overweight/obesity, yet distinct characteristics among this subset of patients remain unclear. This study examined eating disorder (ED) symptom severity, psychological morbidity, and weight stigma in patients with premorbid overweight/obesity as compared to patients with premorbid normal weights.MethodsParticipants included adolescents with AN or AAN (aged 12-18) who received multidisciplinary treatment at a pediatric medical center in the United States. ED symptoms, anxiety, and depression were compared among patients with premorbid overweight/obesity (n = 43) and premorbid normal weights (n = 63). Associations between weight stigma, ED severity, and psychological morbidity were also examined. ResultsPatients with premorbid overweight/obesity reported greater ED severity (p = .04), anxiety (p < .003), depression (p = .02), and a higher frequency of weight-based teasing by peers (p = .003) and parent weight talk about their own weights (p < .001). Weight-based teasing was positively associated with ED symptoms, anxiety, and depression for all patients, regardless of premorbid weight status.ConclusionsAdolescents with AN or AAN and a history of overweight/obesity may present with greater ED symptom severity and psychological morbidity than patients with normal weight histories. Distinct prevention and treatment interventions for adolescents with AN or AAN and premorbid overweight/obesity may be warranted. Level of EvidenceLevel III, case-control analytic study

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Eating disorder severity and psychological morbidity in adolescents with anorexia nervosa or atypical anorexia nervosa and premorbid overweight/obesity

Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity ◽

10.1007/s40519-021-01168-7 ◽

2021 ◽

Author(s):

Abigail Matthews ◽

Rachel A. Kramer ◽

Laurie Mitan

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Psychological Morbidity ◽

Atypical Anorexia Nervosa

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Exploring the experience of being viewed as “not sick enough”: a qualitative study of women recovered from anorexia nervosa or atypical anorexia nervosa

Journal of Eating Disorders ◽

10.1186/s40337-021-00495-5 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Kari Eiring ◽

Trine Wiig Hage ◽

Deborah Lynn Reas

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Qualitative Study ◽

Help Seeking ◽

Severity Of Illness ◽

Physical Sign ◽

Structured Interviews ◽

Restrictive Eating ◽

Eating Disorder Symptoms ◽

Atypical Anorexia Nervosa

Abstract Background Despite common misconceptions, an individual may be seriously ill with a restrictive eating disorder without an outwardly recognizable physical sign of the illness. The aim of this qualitative study was to investigate the perspectives of individuals who have previously battled a restrictive eating disorder who were considered “not sick enough” by others (e.g., peers, families, healthcare professionals) at some point during their illness, and to understand the perceived impact on the illness and recovery. Such misconceptions are potentially damaging, and have been previously linked with delayed help-seeking and poorer clinical outcomes. Methods Seven women who had recovered from anorexia nervosa or atypical anorexia nervosa participated in semi-structured interviews. Interviews were transcribed and interpretive phenomenological analysis was used. Results Three main themes emerged: (1) dealing with the focus upon one’s physical appearance while battling a mental illness, (2) “project perfect”: feeling pressure to prove oneself, and (3) the importance of being seen and understood. Participants reported that their symptoms were occasionally met with trivialization or disbelief, leading to shame, confusion, despair, and for some, deterioration in eating disorder symptoms which drove further weight loss. In contrast, social support and being understood were viewed as essential for recovery. Conclusion To facilitate treatment seeking and engagement, and to optimize chances of recovery, greater awareness of diverse, non-stereotypical presentations of restrictive eating disorders is needed which challenge the myth that weight is the sole indicator of the presence or severity of illness.

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Worry and Rumination in Anorexia Nervosa

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465812000847 ◽

2012 ◽

Vol 41 (3) ◽

pp. 301-316 ◽

Cited By ~ 45

Author(s):

Helen Startup ◽

Anna Lavender ◽

Anna Oldershaw ◽

Richard Stott ◽

Kate Tchanturia ◽

...

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Anxiety Disorder ◽

Anxiety And Depression ◽

Healthy Controls ◽

Regression Analyses ◽

Set Shifting ◽

Neuropsychological Measures ◽

Comparison Groups ◽

Core Features

Background: Difficulties with comprehending and managing emotions are core features of the pathology of anorexia nervosa (AN). Advancements in understanding aetiology and treatment have been made within other clinical domains by targeting worry and rumination. However, worry and rumination have been given minimal consideration in AN. Aims: This study is the largest to date of worry and rumination in AN. Method: Sixty-two outpatients with a diagnosis of AN took part. Measures of worry, rumination, core AN pathology and neuropsychological correlates were administered. Results: Findings suggest that worry and rumination are elevated in AN patients compared with both healthy controls and anxiety disorder comparison groups. Regression analyses indicated that worry and rumination were significant predictors of eating disorder symptomatology, over and above the effects of anxiety and depression. Worry and rumination were not associated with neuropsychological measures of set-shifting and focus on detail. Conclusions: The data suggest that worry and rumination are major concerns for this group and warrant further study.

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The Anorexia Nervosa Genetics Initiative: Overview and Methods

10.1101/234013 ◽

2017 ◽

Author(s):

Laura M Thornton ◽

Melissa A Munn-Chernoff ◽

Jessica H Baker ◽

Anders Juréus ◽

Richard Parker ◽

...

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Large Scale ◽

Eating Behaviors ◽

Clinical Information ◽

The United States ◽

Sample Collection ◽

Present Sample ◽

Link Type ◽

Dsm Iv

AbstractBackground:Genetic factors contribute to anorexia nervosa (AN); and the first genome-wide significant locus has been identified. We describe methods and procedures for the Anorexia Nervosa Genetics Initiative (ANGI), an international collaboration designed to rapidly recruit 13000 individuals with AN as well as ancestrally matched controls. We present sample characteristics and the utility of an online eating disorder diagnostic questionnaire suitable for large-scale genetic and population research.Methods:ANGI recruited from the United States (US), Australia/New Zealand (ANZ), Sweden (SE), and Denmark (DK). Recruitment was via national registers (SE, DK); treatment centers (US, ANZ, SE, DK); and social and traditional media (US, ANZ, SE). All cases had a lifetime AN diagnosis based on DSM-IV or ICD-10 criteria (excluding amenorrhea). Recruited controls had no lifetime history of disordered eating behaviors. To assess the positive and negative predictive validity of the online eating disorder questionnaire (ED100K-v1), 109 women also completed the Structured Clinical Interview for DSM-IV (SCID), Module H.Results:Blood samples and clinical information were collected from 13,364 individuals with lifetime AN and from controls. Online diagnostic phenotyping was effective and efficient; the validity of the questionnaire was acceptable.Conclusions:Our multipronged recruitment approach was highly effective for rapid recruitment and can be used as a model for efforts by other groups. High online presence of individuals with AN rendered the Internet/social media a remarkably effective recruitment tool in some countries. ANGI has substantially augmented Psychiatric Genomics Consortium AN sample collection. ANGI is a registered clinical trial: clinicaltrials.gov NCT01916538; https://clinicaltrials.gov/ct2/show/NCT01916538?cond=Anorexia+Nervosa&draw=1&rank=3.

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Androgen Deficiency: Association With Increased Anxiety and Depression Symptom Severity in Anorexia Nervosa

The Journal of Clinical Psychiatry ◽

10.4088/jcp.v68n0621 ◽

2007 ◽

Vol 68 (06) ◽

pp. 959-965 ◽

Cited By ~ 33

Author(s):

Karen K. Miller ◽

Tamara L. Wexler ◽

Alicia M. Zha ◽

Elizabeth A. Lawson ◽

Erinne M. Meenaghan ◽

...

Keyword(s):

Anorexia Nervosa ◽

Symptom Severity ◽

Anxiety And Depression ◽

Depression Symptom ◽

Androgen Deficiency

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New eating disorder service

Psychiatric Bulletin ◽

10.1192/pb.22.12.751 ◽

1998 ◽

Vol 22 (12) ◽

pp. 751-754 ◽

Cited By ~ 8

Author(s):

Harry R. Millar

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Clinical Care ◽

Unmet Need ◽

Referral Rate ◽

Clinical Implications ◽

Specialist Service ◽

Assessment And Treatment ◽

Atypical Anorexia Nervosa ◽

Training And Support

Aims and methodThe paper describes the first three years experience of a new out-patient eating disorder service for adults. Clinical data on referrals using standardised assessments are presented.ResultsThe referral rate rapidly rose to over 200 patients per annum. Forty-nine per cent of referrals were bulimic disorders and 26% had either anorexia nervosa or atypical anorexia nervosa. Seventy per cent were directly referred by general practitioners.Clinical implicationsThe creation of a specialist eating disorder service quickly leads to a high referral rate suggesting a previously unmet need. A service based on assessment and treatment by nurse therapists is acceptable and feasible with appropriate training and support from psychiatry, clinical psychology and dietetics. Expectations of a specialist service include teaching, consultation, research and audit as well as the provision of direct clinical care.

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