Abstract
BackgroundSeveral aetiological models of anorexia nervosa (AN) hold non-eating/weight-gain-related anxiety as a factor relevant to the onset and maintenance of the disorder. Longitudinal studies that allow assessment of this hypothesis have been conducted; however, the evidence has not yet been aggregated in a systematic manner. The proposed study will systematically review articles describing prospective investigations of the relationship between anxiety and AN development or maintenance, with the aim of providing a balanced summary of current understanding and identifying areas for further research.Methods/designElectronic databases will be searched for articles investigating the longitudinal influence of non-eating/weight-gain-related anxiety (anxiety disorders and trait anxiety) on the development/maintenance of AN. References of eligible articles will be searched to ensure the identification of all relevant studies. Two independent reviewers will complete the title and abstract, and full-text, screening, with a third independent reviewer resolving any conflicts at each stage. A systematic review will be completed, and the quality of the included studies, as well as the strength of the body of evidence generated, will be assessed and reported.DiscussionAlthough there are limitations to the present review, understanding the current evidence for the role of non-eating/weight-gain-related anxiety in AN can direct future research that may ensure accurate aetiological models of AN and effective treatments.Systematic review registrationThe study is registered on PROSPERO under the reference number CRD42017069644
Highlights
Several aetiological models of anorexia nervosa (AN) hold non-eating/weight-gain-related anxiety as a factor relevant to the onset and maintenance of the disorder
The high levels of anxiety surrounding eating has caused AN to be compared to anxiety disorders [3], and anxious symptomatology in AN has been empirically investigated in attempts to better understand AN aetiology
With the inclusion of anxiety in aetiological models of AN, it is important that the relevance of anxiety to AN development and maintenance is clarified
Summary
With the inclusion of anxiety in aetiological models of AN, it is important that the relevance of anxiety to AN development and maintenance is clarified. Understanding the relationship of anxiety with both remission and relapse in AN would further inform knowledge of the factors associated with AN maintenance. Because of their longitudinal nature, studies of the review are likely to be subject to high levels of attrition, which is an issue that has implications on the validity of conclusions that may be drawn from the review. A further limitation is that we will be unable to parse apart the explanatory power of different types of anxiety on AN development/maintenance given studies may have measured only one type of anxiety, focusing on one disorder or trait anxiety for example.
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