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


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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    • "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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    • "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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