Article

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: 5.15). 09/2009; 118(3):587-97. DOI: 10.1037/a0016481
Source: PubMed

ABSTRACT

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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    • "), including full-syndrome eating disorders (Stice et al., 2009). While eating episodes characterized by LOC, regardless of episode size, are relatively stable in adults, significant crossover between large and not-large episodes has been observed over 2 years of follow-up (Peterson et al., 2012). "
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    ABSTRACT: Overeating (eating an unusually large amount of food) and binge eating (overeating with loss of control [LOC]) predict adverse health consequences in adolescence. We aimed to characterize the stability of and risk factors for these distinct but interrelated constructs during critical developmental transitions. We used a population-based sample (n = 1,902) that completed surveys at 5-year intervals spanning adolescence and young adulthood. The trajectories of no overeating, overeating, binge eating, and binge eating disorder (BED; recurrent binge eating with associated distress) were characterized using cross-tabulations. Body mass index, depressive symptoms, self-esteem, and body satisfaction were examined as risk factors for no overeating, overeating, and binge eating (including BED) 5-years later using multinomial logistic regression. We found that all overeating categories tended to remit to no overeating at 5-year follow-up. Although overeating had the lowest remittance rates at each time-point, binge eating and BED showed higher rates of persistence or worsening of symptoms during the transition from late adolescence/early young adulthood to early/middle young adulthood. Overeating and binge eating had similar risk factors, although for females, depressive symptoms, body satisfaction, and self-esteem in late adolescence/early young adulthood differentially predicted binge eating versus overeating in early/middle young adulthood (ps < .05). While overeating with or without LOC tends to remit over time, problematic eating persists for a subset of individuals. Greater psychosocial problems in late adolescence/early young adulthood predicted greater odds of binge eating relative to overeating in early/middle young adulthood among females, indicating that poorer psychosocial functioning in this developmental stage portends more severe eating-related psychopathology later in life. (PsycINFO Database Record
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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.
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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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