Abstract
Background and Objectives: Anorexia nervosa (AN) is a complex disorder whose etiopathogenesis involves both biological and environmental factors. The aims of the present study were to retrospectively analyze risk factors in young patients with AN and to assess differences in clinical and eating-related symptoms between patients with and without a diagnosis of post-traumatic stress disorder (PTSD) and with or without a history of acknowledged risk factors. Materials and Methods: Sixty-four patients with AN (<25 years old) were recruited and completed an anamnestic evaluation and the following self-report measures: Eating Disorder Examination Questionnaire (EDE-Q), Childhood Trauma Questionnaire (CTQ), State-Trait Anxiety Inventory (STAI-Y), Beck Depression Inventory (BDI), Life Events Checklist (LEC), and Dissociative Experience Scale (DES). The PTSD diagnosis was assigned according to the Structured Clinical Interview for the DSM-5 (SCID-5). Results: The most frequent risk factors were those associated with relational traumatic events and familiarity for psychiatric disorders. Higher severity of body-related symptoms (i.e., those symptoms impacting on body image and perception and leading to body concerns) emerged in patients with PTSD, versus patients without PTSD diagnosis; however, after controlling for dissociative symptoms, only differences in BMI remained significant. Concerning other risk factors, those with a history of childhood trauma were more depressed than patients without such history and those with familiarity with eating disorders reported more AN-related hospitalizations in the past than those individuals without familiarity. Conclusion: These results suggest the importance of investigating the presence of risk factors and PTSD diagnosis in patients with AN, and to treat post-traumatic symptoms in young patients in order to decrease the risk of developing severe forms of AN. Moreover, a particular focus on those patients with a family member affected by an eating disorder could be of clinical utility.
Highlights
Mental disorders are complex and severe illnesses often leading to psychosocial and physical disability [1]
Other risk factors commonly considered in psychiatry are represented by alcohol and substance abuse; for example, alcohol use in adolescence was described as a predictor of borderline personality disorder, while cannabis use was correlated to an earlier onset of schizophrenia [10,11]
Despite some strengths including the focus on young patients and the analysis of several risk factors, some limitations should be acknowledged as well: the sample size was relatively small; the design was cross-sectional, so causal links cannot be fully clarified; the two subtypes of Anorexia nervosa (AN) were not considered; risk factors related to socioeconomic status and personality features were not taken into account; a healthy control group was not recruited, comparisons with healthy subjects are not available. This is the first study evaluating numerous and different risk factors in young patients (
Summary
Mental disorders are complex and severe illnesses often leading to psychosocial and physical disability [1]. An important role as a psychological/environmental risk factor is played by childhood adversities, maltreatment, and lifetime stressful events, as has been demonstrated for eating disorders [12,13,14] (EDs). The aims of the present study were to retrospectively analyze risk factors in young patients with AN and to assess differences in clinical and eating-related symptoms between patients with and without a diagnosis of post-traumatic stress disorder (PTSD) and with or without a history of acknowledged risk factors. Conclusion: These results suggest the importance of investigating the presence of risk factors and PTSD diagnosis in patients with AN, and to treat post-traumatic symptoms in young patients in order to decrease the risk of developing severe forms of AN. A particular focus on those patients with a family member affected by an eating disorder could be of clinical utility
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