An 8-Year Longitudinal Study of the Natural History of Threshold, Subthreshold, and Partial Eating Disorders From a Community Sample of Adolescents

Department of Psychology, University of Texas at Austin, Texas, USA.
Journal of Abnormal Psychology (Impact Factor: 4.86). 09/2009; 118(3):587-97. DOI: 10.1037/a0016481
Source: PubMed


The authors examined the natural history of threshold, subthreshold, and partial eating disorders in a community sample of 496 adolescent girls who completed annual diagnostic interviews over an 8-year period. Lifetime prevalence by age 20 years was 0.6% and 0.6% for threshold and subthreshold anorexia nervosa (AN), 1.6% and 6.1% for threshold and subthreshold bulimia nervosa (BN), 1.0% and 4.6% for threshold and subthreshold binge-eating disorder (BED), and 4.4% for purging disorder (PD). Overall, 12% of adolescents experienced some form of eating disorder. Subthreshold BN and BED and threshold PD were associated with elevated treatment, impairment, and distress. Peak age of onset was 17-18 years for BN and BED and 18-20 years for PD. Average episode duration in months was 3.9 for BN and BED and 5.1 for PD. One-year recovery rates ranged from 91% to 96%. Relapse rates were 41% for BN, 33% for BED, and 5% for PD. For BN and BED, subthreshold cases often progressed to threshold cases and diagnostic crossover was most likely for these disorders. Results suggest that subthreshold eating disorders are more prevalent than threshold eating disorders and are associated with marked impairment.

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    • "Pediatric loss of control (LOC) eating, the subjective experience of being unable to control what or how much one eats, has been shown to predict excessive weight gain (Tanofsky-Kraff et al., 2009a; Sonneville et al., 2013a), exacerbated disordered eating (Tanofsky-Kraff et al., 2011; Hilbert et al., 2013), anxiety and depression (Sonneville et al., 2013a; Tanofsky-Kraff et al., 2011; Field et al., 2012; Skinner et al., 2012), and metabolic dysfunction (Tanofsky-Kraff et al., 2012). LOC eating often emerges during adolescence (Neumark-Sztainer et al., 2011; Stice et al., 2009) and is more commonly reported by girls (vs. boys) and overweight (vs. "
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    ABSTRACT: The interpersonal model of loss of control (LOC) eating proposes that socially distressing situations lead to anxious states that trigger excessive food consumption. Self-reports support these links, but the neurobiological underpinnings of these relationships remain unclear. We therefore examined brain regions associated with anxiety in relation to LOC eating and energy intake in the laboratory. Twenty-two overweight and obese (BMIz: 1.9±0.4) adolescent (15.8±1.6y) girls with LOC eating (LOC+, n=10) and without LOC eating (LOC-, n=12) underwent functional magnetic resonance imaging (fMRI) during a simulated peer interaction chatroom paradigm. Immediately after the fMRI scan, girls consumed lunch ad libitum from a 10,934-kcal laboratory buffet meal with the instruction to "let yourself go and eat as much as you want." Pre-specified hypotheses regarding activation of five regions of interest were tested. Analysis of fMRI data revealed a significant group by peer feedback interaction in the ventromedial prefrontal cortex (vmPFC), such that LOC+ had less activity following peer rejection (vs. acceptance), while LOC- had increased activity (p<.005). Moreover, functional coupling between vmPFC and striatum for peer rejection (vs. acceptance) interacted with LOC status: coupling was positive for LOC+, but negative in LOC- (p<.005). Activity of fusiform face area (FFA) during negative peer feedback from high-value peers also interacted with LOC status (p<.005). A positive association between FFA activation and intake during the meal was observed among only those with LOC eating. In conclusion, overweight and obese girls with LOC eating may be distinguished by a failure to engage regions of prefrontal cortex implicated in emotion regulation in response to social distress. The relationship between FFA activation and food intake supports the notion that heightened sensitivity to incoming interpersonal cues and perturbations in socio-emotional neural circuits may lead to overeating in order to cope with negative affect elicited by social discomfort in susceptible youth. Published by Elsevier Inc.
    NeuroImage 12/2014; 108. DOI:10.1016/j.neuroimage.2014.12.054 · 6.36 Impact Factor
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    • "As predicted, and consistent with the existing literature, BN was similar to both AN and BED in terms of developmental pathways (i.e., age of onset, trajectory of eating disturbance, patterns of symptom onset; Bulik et al., 1997; Haiman and Devlin, 1999; Stice et al., 2009). As previously reported, BN and BED tended to report a later age of onset than AN (Stice et al., 2009; Swanson et al., 2011), although the onset of clinically significant eating pathology was similar across groups, perhaps indicating that AN has a more aggressive onset reflected in the shorter lag time between the onset of disturbed eating and meeting full criteria for the disorder. As earlier studies have shown (Fichter and Quadflieg, 2007; Eddy et al., 2008; Stice et al., 2013), diagnostic crossover between AN and BN and between BN and BED, was more common than crossover between AN and BED, although notably, only a minority of individuals report crossover from one eating disorder to another. "
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    ABSTRACT: This study sought to examine risk and onset patterns in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Women with AN (n=71), BN (n=66), BED (n=160) and non-psychiatric controls (n=323) were compared retrospectively on risk factors, symptom onset, and diagnostic migration. Eating disorder groups reported greater risk exposure than non-psychiatric controls. AN and BED differed on premorbid personality/behavioral problems, childhood obesity, and family overeating. Risk factors for BN were shared with AN and BED. Dieting was the most common onset symptom in AN, whereas binge eating was most common in BN and BED. Migration between AN and BED was rare, but more frequent between AN and BN and between BN and BED. AN and BED have distinct risk factors and onset patterns, while BN shares similar risk factors and onset patterns with both AN and BED. Results should inform future classification schemes and prevention programs.
    Psychiatry Research 12/2014; 220(1-2). DOI:10.1016/j.psychres.2014.05.054 · 2.47 Impact Factor
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    • "oping AN is 1 . 4% . Furthermore , 17 - and 19 - year - olds females are at greater risk ( 2 . 4% and 3 . 1% respectively ) . Among males the 17 - and the 19 - year - old subjects are at a greater risk too ( 0 . 7% and 0 . 7% respectively ) . These data are consistent with other studies ( Isomaa et al . , 2009 ; Keski - Rahkonenet et al . , 2007 ; Stice et al . , 2009 ) . Data from this study show a probability of developing AN , which is four times higher for females . Although these results confirm that anorexia is a female - predominant disease , its impact on men should not be underestimated . In fact , the prevalence of risk in males is about 0 . 5% . It should also be considered that the diagno"
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    ABSTRACT: Objective: The aim of the present study was to investigate the prevalence risk for developing anorexia nervosa (AN) in a very wide sample of adolescents aged 15–19 years, obtaining a psychological profile of these at-risk subjects, as assessed by the Italian Offer Self-Image Questionnaire (OSIQ). Method: Data were extracted from ESPAD-Italia®2005 database (European School Survey Project on Alcohol and Other Drugs). The study (17,866 adolescents, 15–19 years old; 47.8% males), also evaluated gender, age, weight, height and Eating Attitude Test-26 (EAT-26). The OSIQ psychometric qualities were evaluated. Multinomial analysis assessed self-image risk of AN association. Results: Adolescents at risk approached 1.4% (2.2% of girls and 0.5% of boys); 19- and 7-year-old females exhibited a higher prevalence. Overall adolescent risk included: impulse control, family relationships and psychopathology. Critical areas in the AN developing showed age and gender differences: body image for younger females, impulse control for the older, psychopathology for young males and sexual attitudes for the older represented the poorer adjustment dimensions. Discussion: Results support screening procedures and tailored school-based prevention.
    10/2014; DOI:10.1080/21662630.2014.965721
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