Abstract
Purpose
Anorexia nervosa (AN) commonly begins in adolescence; however, detailed knowledge
of symptom trajectories, including their temporal sequence, is less well elucidated.
The purpose of the present study is to describe the onset and duration of disordered
eating behaviors prior to a diagnosis of AN, examine concordance between child and
parent report, and examine the relationships between timing of symptom onset and illness
severity.
Methods
Seventy-one adolescents (ages 12–18 years) and their parents were interviewed about
dieting, restriction, loss of control/binge eating, purging, excessive/compulsive
exercise, weight history, and amenorrhea. Body mass index percentiles were calculated,
and adolescents completed the Eating Disorder Examination-Questionnaire.
Results
Restriction, being underweight, dieting, and excessive exercise were reported by most
of the sample; purging, loss-of-control eating, and having been overweight were reported
by less than a third. Dieting typically emerged first, on average around age 14; the
remainder of behaviors tended to emerge between ages 14 and 14½; and average age of
formal diagnosis was slightly over 15 years. Dyads had good agreement regarding presence
and timing of all behaviors except for dieting, for which children reported about
6 months earlier onset/longer duration, compared to parents. Although older age at
interview was associated with lower body mass index percentile and higher EDE-Q score,
neither age of onset nor duration was associated with severity when controlling for
current age.
Discussion
Teens and parents describe a similar sequence of behavior changes leading up to a
diagnosis of AN that typically begins with dieting and occurs over an approximate
1- to 1½-year period. Querying teens and parents about eating behavior changes may
aid in identification and early intervention in AN; adolescents with normal weight
who engage in persistent dieting or restrictive eating may warrant more frequent weight
monitoring.
Keywords
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Article info
Publication history
Published online: August 13, 2022
Accepted:
June 13,
2022
Received:
February 15,
2022
Footnotes
Conflicts of interest: J.E.S. receives royalties from UpToDate.
Identification
Copyright
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