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Early Course of Symptom Development in Anorexia Nervosa

  • Lisa M. Ranzenhofer
    Correspondence
    Address correspondence to: Lisa M. Ranzenhofer, Ph.D., 1051 Riverside Drive, Suite 2200, New York, NY 10032.
    Affiliations
    Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, New York

    Department of Psychiatry, Columbia University Irving Medical Center (CUIMC), New York, New York
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  • Monica Jablonski
    Affiliations
    Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, New York
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  • Lauren Davis
    Affiliations
    Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, New York

    Department of Psychology, Rutgers University, Highland Park, New Jersey
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  • Jonathan Posner
    Affiliations
    Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, New York

    Department of Psychiatry, Columbia University Irving Medical Center (CUIMC), New York, New York

    Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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  • Author Footnotes
    1 These authors contributed equally.
    B. Timothy Walsh
    Footnotes
    1 These authors contributed equally.
    Affiliations
    Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, New York

    Department of Psychiatry, Columbia University Irving Medical Center (CUIMC), New York, New York
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally.
    Joanna E. Steinglass
    Footnotes
    1 These authors contributed equally.
    Affiliations
    Department of Psychiatry, New York State Psychiatric Institute (NYSPI), New York, New York

    Department of Psychiatry, Columbia University Irving Medical Center (CUIMC), New York, New York
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally.

      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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