Physical/psychological symptoms similar in atypical and full-threshold anorexia nervosa

1. Adolescents with atypical anorexia nervosa (restrictive eating disorder but patients are normal weight) were more likely to have been overweight/obese, to have lost more weight, and to have lost weight over a more extended period of time when compared to adolescents with full anorexia nervosa.

2. Despite their different weight classes and amount of weight lost, there were no major differences found in the rates of adverse physical or psychological symptoms between the atypical and full anorexia nervosa groups.

Evidence Rating Level: 2 (Good)  

Study Rundown: Atypical anorexia nervosa (AN) is a condition similar to AN except for the fact that the patient is not underweight. In recent years, there has been a dramatic rise in the amount of adolescents admitted to hospitals with eating disorders who are not underweight, but it is unknown if these patients display similar physical and psychological issues as patients with AN. The authors of this study sought to define the physical and psychological profile of these adolescents in comparison to patients with AN. Patients with atypical AN were more likely to have been overweight or obese, to have lost more weight, and to have lost weight over a longer period of time than individuals with full AN. Despite weight status, there were no significant differences in the vital signs, medical instability, or psychiatric conditions between these 2 groups. These results are limited by recall bias for premorbid weight and small sample size. Nonetheless, the findings should encourage pediatric providers to be more aware of patients who lose weight, especially those who originally present as overweight or obese.

Click to read the study, published today in Pediatrics

Relevant Reading: Restrictive eating disorders among adolescent inpatients

In-Depth [retrospective cohort]: Researchers analyzed data from 160 adolescent patients (42 atypical AN, 118 full-threshold AN) at The Royal Children’s Hospital Eating Disorders Program from July 2010 to June 2014. Patients were assessed at the time of initial contact with the clinic, at which point anthropometric measurements, blood pressure, pulse rate, and temperature were measured. Diagnoses were assigned based upon patient responses to the Eating Disorder Examination, psychiatric comorbidities based upon the Mini International Neuropsychiatric Interview, and obsessive compulsive tendencies using validated scales from Yale. Adolescents with atypical AN were more likely than patients with AN to have been overweight/obese (71% vs. 12%, p < .001), to lose more weight (17.6 kg. vs. 11.0 kg., p < .001), and to lose the weight over a longer period of time (13.3 vs. 10.2 months, p = .04). There were no significant differences in pulse rate (11% vs. 15%), bradycardia occurrences (24% vs. 33%), orthostatic instability (43% vs. 38%), or hypothermia (10% vs. 13%) between the 2 groups. The groups also did not differ significantly in rates of psychiatric diagnoses, psychiatric medication use, suicidal ideation, depressive symptoms, or obsessive compulsive features.

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