One-year outcome and incidence of anorexia nervosa and restrictive eating disorders among adolescent girls treated as out-patients in a family-based setting

Figures & data

Figure 1. Number of adolescent girls assessed, diagnosed, and followed up after 1 year for anorexia nervosa (AN) or eating disorder not otherwise specified of restrictive type (EDNOSr). BN = bulimia nervosa; EDNOSb = eating disorder not otherwise specified of bulimic type.

Table 1. Diagnoses and eating disorder features at assessment and follow-up of 141 adolescents with eating disorders.

		At 1-year follow-up
		No ED (DSM-IV)
	At assessment	Free of all symptoms	A few lingering ‘symptoms’	Persistent ED
	n = 141 (100%)	n = 40	n = 20	n = 81 (57%)
AN	29 (21%)	–	–	4 (3%)
EDNOSr	112 (79%)	–	–	75 (53%)
EDNOS-BN	–	–	–	2 (1%)
No ED	–	40 (28%)	20 (14%)	–
Depression	64 (45%)	2 (5%)	5 (25%)	32 (40%)
Weight-controlling behaviours
Food restriction	141 (100%)	0	0	75 (93%)
Exercise	61 (43%)	0	0	23 (28%)
Vomiting	29 (21%)	0	0	17 (21%)
Laxative use	0	0	0	1 (1%)
EDI-C	n = 128	n = 33	n = 20	n = 62
Total score	74 ± 33	47 ± 34	77 ± 34	72 ± 27
Drive for thinness	8 ± 7	1 ± 2**	6 ± 5*	8 ± 7
Bulimia	2 ± 3	2 ± 2	3 ± 5	2 ± 2
Body dissatisfaction	11 ± 7	5 ± 5*	12 ± 6	13 ± 7
Ineffectiveness	8 ± 5	6 ± 5	9 ± 5	8 ± 4
Perfectionism	4 ± 3	3 ± 3	3 ± 2	4 ± 4
Intrapersonal distrust	6 ± 4	4 ± 4	6 ± 4	5 ± 4
Interceptive awareness	7 ± 5	4 ± 4	8 ± 7	7 ± 4
Maturity fears	7 ± 4	5 ± 3	5 ± 2	6 ± 4
Asceticism	8 ± 4	4 ± 2	7 ± 3	8 ± 4
Impulse regulation	6 ± 6	5 ± 6	9 ± 6	6 ± 5
Social insecurity	7 ± 4	7 ± 5	9 ± 5	7 ± 4
Morgan–Russel outcome assessment schedule	–	n = 35	n = 19	n = 70
A1–3 (food intake/weight)	–	11.0 ± 1.1	9.6 ± 1.6	7.2 ± 2.3
B (menstrual pattern)	–	8.8 ± 4.9	11.2 ± 1.7	6.1 ± 5.5
C (mental state)	–	11.3 ±1.8	9.9 ±3.1	9.7 ±2.8
E5 (school attendance)	–	11.5 ± 2.1	11.2 ± 2.9	10.7 ± 2.6
MADRS-S	n = 138	n = 32	n = 20	n = 66
Total score	17 ± 10	6 ± 6	11 ± 9	14 ± 11

Values are means ± SD.

Significance of difference versus values obtained at assessment:

*p< 0.05;

**p< 0.01.

Table 2. Patients with anorexia nervosa (AN) or eating disorders not otherwise specified, restrictive subtype (EDNOSr), treated at the Eating Disorders Unit (EDU) or at other units in the Child and Adolescent Psychiatry (CAP) department, and number with each diagnosis at follow-up.

		Diagnosis at 1-year follow-up
	Treatment during first year	AN	EDNOSr	BN	No ED
AN (n = 29)
EDU, day care^a	14	0	12	0	2
EDU, out-patient^b	15	1	10	0	4
CAP, other units	0	–	–	0	0
No treatment	0	–	–	0	0
Total	29	1	22	0	6
EDNOSr (n = 112)
EDU, day care^a	16	2	11	0	3
EDU, out-patient^b	88	1	36	2	49
CAP, other units	5	0	5	0	0
No treatment	3	0	1	0	2
Total	112	3	53	2	54
All patients (n = 141)	141	4	75	2	60

a Treated in day care some part of the year.

b Only treated as out-patient during the year.

BN = bulimia nervosa and sub-threshold bulimia nervosa; ED = eating disorder.

Table 3. Anthropometric measures and menstrual status according to diagnosis at assessment and follow-up of 168 adolescent girls with eating disorders (ED).

		Diagnoses at follow-up
Diagnosis at assessment	AN	AN	EDNOSr	BN	No ED
n	31^a	1	22	–	6
Age (years)	15.1 ± 2.0	14.3	16.4 ± 1.8	–	15.2 ± 2.5
Weight (kg)	39.7 ± 6.4	35.0	51.1 ± 5.2	–	50.4 ± 8.3
Height (m)	1.62 ± 0.09	1.58	1.65 ± 0.06	–	1.61 ± 0.08
BMI (kg/m^2)	15.1 ± 1.22	14.1	18.8 ± 1.26	–	19.2 ± 1.5
BMI (SDS)	–2.73 ± 0.68	–3.14	–0.84 ± 0.74	–	–0.24 ± 0.23
Weight gain (kg)	–	7.1 ^b	10.7 ± 4.2	–	12.5 ± 1.6
Menstrual status
Pre-menarcheal	10	1	4	–	2
Secondary amenorrhea	19	0	7	–	0
Menses	–	0	11	–	4
Contraceptives	2	0	0	–	0
Pregnant	0	0	0	–	0
	EDNOSr	AN	EDNOSr	BN	No ED
n	137^a	3	53	2	54
Age (years)	15.2 ± 1.7	17.4 ± 1.9	16.2 ± 1.8	16.2 ± 1.4	16.1 ± 1.5
Weight (kg)	50.0 ± 7.3	45.3 ± 3.6	54.3 ± 7.6	55.3 ± 9.6	57.2 ± 7.39
Height (m)	1.64 ± 0.08	1.69 ± 0.04	1.64 ± 0.07	1.67 ± 0.03	1.66 ± 0.08
BMI (kg/m^2)	18.5 ± 1.97	15.9 ± 1.11	20.0 ± 2.14	19.6 ± 2.64	20.6 ± 1.94
BMI (SDS)	–0.70 ± 0.88	–2.80 ± 0.69	–0.22 ± 0.98	–0.44 ± 0.90	0.03 ± 0.76
Weight gain (kg)	–	–7.3 ± 2.1	4.8 ± 5.7	6.6 ± 5.7	6.3 ± 4.7
Menstrual status
Pre-menarcheal	15	0	6	0	2
Secondary amenorrhea	37	3	4	0	1
Menses	73	0	29	2	33
Contraceptives	12	0	14	0	16
Pregnant	0	0	0	0	1

Values are means ± SD for the number of observations indicated.

a Two patients with AN and 25 with EDNOS were not followed up.

b Weight 27.9 kg at treatment start, day care.

BN = bulimia nervosa or sub-threshold bulimia nervosa.

Table 4. Comparison of 1-year outcome in two RCTs in specialist out-patient and family-based therapy (FBT) with a case series of a specialist out-patient FBT in Sweden.

	Gowers, 2007, UK	Lock, 2010, USA	Rosling, 2013, Sweden
Population base (million)	7.2	≈4.4	0.3
Length of study (years)	3	4	3
AN identified/included	216/170 (79%)	175/121 (69%)	31/29 (93%)
AN in comparable treatment	55	61	29
At assessment
Mean age (years)	14.9	14.1	15.1
Mean disease duration (months)	13	12.3 (±8.5)	9.1 (±7.2)
Amenorrhea	91%	some not	100%
Mean BMI (kg/m^2)	15.3 (±1.6)	≈16.2	15.1 (±1.2)
Mean BMI SDS	≈–2.5	≈–1.5	–2.7 (±0.7)
1-year follow-up
Followed-up	53 (96%)	51 (84%)	29 (100%)
Mean BMI (kg/m^2)	17.9 (±2.2)	≈19.2	18.7 (±1.5)
Mean BMI SDS	≈–1.3	≈–0.5	–0.8 (±0.8)
Outcome (MROAS)
Good	8 (15%)	21 (42%)	13 (45%)
Intermediate ≈ EDNOS	22 (40%)	24 (48%)	15 (52%)
Poor ≈ AN	24 (44%)	5 (10%)	1 (3%)

≈approximation.