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

Agneta Rosling,Helena Salonen Ros,Ingemar Swenne

doi:10.3109/03009734.2016.1141810

Agneta Rosling, Helena Salonen Ros + Show 1 more

Open Access

https://doi.org/10.3109/03009734.2016.1141810

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Abstract

Aims To study the 1-year outcome and to analyse predictors of outcome of a cohort of adolescent girls with anorexia nervosa (AN) or restrictive eating disorders not otherwise specified (EDNOSr) treated as out-patients in a family-based programme at a specialized eating disorder service. To calculate the incidence of anorexia nervosa among treatment-seeking girls younger than 18 in Uppsala County from 2004 to 2006.Methods A total of 168 female patients were offered treatment, and 141 were followed-up 1 year after starting treatment, 29 with AN and 112 with EDNOSr.Results Of the 29 girls who initially had AN, 6 (20%) had a good outcome and were free of any form of eating disorder at follow-up; only 1 (3%) had AN. Of the patients with EDNOSr, 54 (48%) had a good outcome and were free of eating disorders. Three (3%) had a poor outcome and had developed AN. The incidence of AN was 18/100,000 person-years in girls younger than 12 and 63/100,000 in girls younger than 18.Conclusion Restrictive eating disorders, including AN, in children and adolescents can be successfully treated in a family-based specialized out-patient service without in-patient care.

Highlights

Anorexia nervosa (AN) continues to have a serious prognosis despite considerable efforts to improve its treatment
The 168 adolescent girls were diagnosed with AN (n 1⁄4 31) or EDNOSr (n 1⁄4 137)
The assessment was performed within 19 ± 12 days for AN patients, and 27 ± 20 days for EDNOSr

Summary

Introduction

Anorexia nervosa (AN) continues to have a serious prognosis despite considerable efforts to improve its treatment. Poor outcome and a chronic course of disease have been reported in 15%–20% of cases, and premature death occurs [1,2,3]. In the Global Burden of Disease Study 2013 eating disorders in women aged 15–19 in Western Europe rank as number 7 [4]. The most recent lethal case of AN in a person under 20 was recorded in 1991 by the Swedish Causes of Death Register [6]. There are ambiguous findings concerning the prognosis of AN with adolescent onset. Some studies report a better prognosis compared to later-onset AN, whereas others report that pre-menarcheal onset has a poorer outcome [1,7]. Most studies are from specialist units where the referral system may cause selection bias. Randomized controlled trials (RCTs) that have been performed are difficult to interpret as many AN patients evade randomization and follow-up [7,8,9]

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Conclusion