Abstract
This pilot study adapted family-based treatment (FBT) for youth with potentially prodromal anorexia nervosa (AN). Fifty-nine youth with clinically significant AN symptom constellations, but who never met full Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) (DSM-IV) criteria for AN, were enrolled in a partially randomized preference design study. Participants were offered randomization to FBT or supportive psychotherapy (SPT); those who declined to be randomized because of a strong treatment preference were entered into a parallel, non-randomized self-selected intervention study. Without accessing outcome data, an observational analysis with three diagnostic subclasses was designed based on AN symptom severity profiles, combining randomized and non-randomized participants, such that participants receiving FBT and SPT within each subclass were similar on key baseline characteristics. Outcomes of this pilot study were explored by calculating effect sizes for end-of-treatment values within each subclass, and also with a longitudinal mixed effect model that accounted for subclass. Weight trajectory was measured by percent expected body weight. Psychological outcomes were fear of weight gain, feeling fat, importance of weight, and importance of shape. Results show that the pattern of symptom observations over time was dependent on subclass of SAN (least symptomatic, moderately symptomatic, or most symptomatic) and on the target outcome variable category (weight or psychological). Results from this study, which should be considered in the context of the small sample sizes overall and within groups, can generate hypotheses for future, larger research trials on early treatment strategies. Feasibility findings illustrate how the innovative partially randomized preference design has potential broader application for AN intervention research.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT00418977.
Highlights
Anorexia nervosa (AN) typically onsets in adolescence, with medical and psychiatric sequelae often appearing even before the diagnostic threshold is crossed [1, 2]
Rates of randomization were similar across the three subclasses depicted in Table 2: 40% (14/35) for the least symptomatic group, 30% (3/10) for the moderately symptomatic group, and 36% (5/14) for the most symptomatic group
Ranges for baseline and endof-treatment means are reported as measures of variability instead of standard deviations, which would not indicate variability well for the subgroups with an n of 2
Summary
Anorexia nervosa (AN) typically onsets in adolescence, with medical and psychiatric sequelae often appearing even before the diagnostic threshold is crossed [1, 2]. The AN syndrome is invariably preceded by a prodromal state [3,4,5], during the prospective symptom development phase, there are no definitive markers of risk for full AN [4]. It is not known with precision for which adolescents the AN features will progress, will remain at a chronically subdiagnostic level, or will be transient. The diagnostic revisions to AN in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 22) are designed, in part, to render the criteria more developmentally sensitive [9, 18, 19, 23, 24]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
