International Journal of Eating Disorders

Volume 57, Issue 4 pp. 924-936

ORIGINAL ARTICLE

Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students

Kelsey E. Hagan PhD,

Corresponding Author

Kelsey E. Hagan PhD

[email protected]

orcid.org/0000-0001-5723-3591

Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA

Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA

Correspondence

Kelsey E. Hagan, Department of Psychiatry, Virginia Commonwealth University, 501 N. 2nd Street, P.O. Box 980253, Richmond, VA 23284, USA.

Email: [email protected]

Contribution: Conceptualization, Supervision, Writing - original draft, Writing - review & editing

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Adanya Johnson BS,

Adanya Johnson BS

orcid.org/0000-0001-5314-4532

Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA

Contribution: Data curation, Visualization, Writing - original draft, Writing - review & editing

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Kira Venables BS,

Kira Venables BS

orcid.org/0009-0001-3713-928X

Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA

Contribution: Data curation, Writing - original draft, Writing - review & editing

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Amanda Makara BS,

Amanda Makara BS

orcid.org/0000-0002-8101-2278

Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA

Contribution: Data curation, Writing - original draft, Writing - review & editing

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The Spit for Science Working Group,

The Spit for Science Working Group

Institute for Research on Behavioral and Emotional Health, Virginia Commonwealth University, Richmond, Virginia, USA

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Ann F. Haynos PhD,

Ann F. Haynos PhD

orcid.org/0000-0002-2548-1731

Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA

Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA

Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minnesota, USA

Contribution: Conceptualization, Formal analysis, Supervision, Writing - original draft, Writing - review & editing

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Kelsey E. Hagan PhD,

Corresponding Author

Kelsey E. Hagan PhD

[email protected]

orcid.org/0000-0001-5723-3591

Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA

Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA

Correspondence

Kelsey E. Hagan, Department of Psychiatry, Virginia Commonwealth University, 501 N. 2nd Street, P.O. Box 980253, Richmond, VA 23284, USA.

Email: [email protected]

Contribution: Conceptualization, Supervision, Writing - original draft, Writing - review & editing

Search for more papers by this author

Adanya Johnson BS,

Adanya Johnson BS

orcid.org/0000-0001-5314-4532

Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA

Contribution: Data curation, Visualization, Writing - original draft, Writing - review & editing

Search for more papers by this author

Kira Venables BS,

Kira Venables BS

orcid.org/0009-0001-3713-928X

Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA

Contribution: Data curation, Writing - original draft, Writing - review & editing

Search for more papers by this author

Amanda Makara BS,

Amanda Makara BS

orcid.org/0000-0002-8101-2278

Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA

Contribution: Data curation, Writing - original draft, Writing - review & editing

Search for more papers by this author

The Spit for Science Working Group,

The Spit for Science Working Group

Institute for Research on Behavioral and Emotional Health, Virginia Commonwealth University, Richmond, Virginia, USA

Search for more papers by this author

Ann F. Haynos PhD,

Ann F. Haynos PhD

orcid.org/0000-0002-2548-1731

Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA

Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA

Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minnesota, USA

Contribution: Conceptualization, Formal analysis, Supervision, Writing - original draft, Writing - review & editing

Search for more papers by this author

First published: 02 February 2024

https://doi.org/10.1002/eat.24152

Citations: 2

Action Editor: B. Timothy Walsh

The Spit for Science Working Group: Director: Karen Chartier. Co-Director: Ananda Amstadter. Past Founding Director: Danielle M. Dick. Registry management: Emily Lilley, Renolda Gelzinis, Anne Morris. Data cleaning and management: Katie Bountress, Amy E. Adkins, Nathaniel Thomas, Zoe Neale, Kimberly Pedersen, Thomas Bannard & Seung B. Cho. Data collection: Kimberly Pedersen, Amy E. Adkins, Peter Barr, Holly Byers, Erin C. Berenz, Erin Caraway, Seung B. Cho, James S. Clifford, Megan Cooke, Elizabeth Do, Alexis C. Edwards, Neeru Goyal, Laura M. Hack, Lisa J. Halberstadt, Sage Hawn, Sally Kuo, Emily Lasko, Jennifer Lend, Mackenzie Lind, Elizabeth Long, Alexandra Martelli, Jacquelyn L. Meyers, Kerry Mitchell, Ashlee Moore, Arden Moscati, Aashir Nasim, Zoe Neale, Jill Opalesky, Cassie Overstreet, A. Christian Pais, Tarah Raldiris, Jessica Salvatore, Jeanne Savage, Rebecca Smith, David Sosnowski, Jinni Su, Nathaniel Thomas, Chloe Walker, Marcie Walsh, Teresa Willoughby, Madison Woodroof & Jia Yan. Genotypic data processing and cleaning: Cuie Sun, Brandon Wormley, Brien Riley, Fazil Aliev, Roseann E. Peterson & Bradley T. Webb.

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Abstract

Objective

Research on the natural course of symptoms of atypical anorexia nervosa (AN) relative to AN and bulimia nervosa (BN) is limited yet needed to inform nosology and improve understanding of atypical AN. This study aimed to 1) characterize trajectories of eating disorder and internalizing (anxiety, depression) symptoms in college students with and without a history of atypical AN, AN, and BN; and 2) compare sex and race/ethnicity distributions across groups.

Method

United States college students who participated in Spit for Science™, a prospective cohort study, were classified as having a history of atypical AN (n = 125), AN (n = 160), BN (n = 617), or as non-eating-disorder controls (NCs, n = 5876). Generalized and linear mixed-effects models assessed group differences in eating and internalizing symptom trajectories, and logistic regression compared groups on sex and race/ethnicity distributions.

Results

Atypical AN participants demonstrated elevated eating disorder and internalizing symptoms compared to NCs during college, but less severe symptoms than AN and BN participants. Although all eating disorder groups showed signs of improvement in fasting and driven exercise, purging and depression remained elevated. Atypical AN participants showed increasing anxiety and stable binge-eating trajectories compared to AN and/or BN participants. The atypical AN group comprised significantly more people of color than the AN group.

Discussion

Findings underscore that atypical AN is a severe psychiatric disorder. As atypical AN may present as less severe than AN and BN and disproportionately affects people of color, clinicians should be mindful of biases that could delay diagnosis and care.

Public Significance

College students with histories of atypical AN, AN, and BN demonstrated improvements in fasting and driven exercise and stable purging and depression levels. Atypical AN students showed worsening anxiety and stable binge-eating trajectories compared to favorable changes among AN and BN students. A higher percentage of atypical AN (vs. AN) students were people of color. Findings may improve the detection of atypical AN in college students.

CONFLICT OF INTEREST STATEMENT

We have no conflicts of interest to disclose.

Open Research

DATA AVAILABILITY STATEMENT

Data from this study are available to qualified researchers via dbGaP (phs001754.v4.p2) or via [email protected] to qualified researchers who provide the appropriate signed data use agreement.

Supporting Information

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Citing Literature

Volume57, Issue4

Special Issue: Atypical Anorexia Nervosa

April 2024

Pages 924-936

Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students

Abstract

Objective

Method

Results

Discussion

Public Significance

CONFLICT OF INTEREST STATEMENT

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students

Abstract

Objective

Method

Results

Discussion

Public Significance

CONFLICT OF INTEREST STATEMENT

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

Related

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley