An examination of adults with atypical anorexia nervosa at admission to treatment at higher levels of care: An attempt to increase diagnostic clarity
Corresponding Author
Jamie L. Manwaring PhD
ACUTE Center for Eating Disorders and Malnutrition at Denver Health, Denver, Colorado, USA
Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
Correspondence
Jamie L. Manwaring, ACUTE, at Denver Health, 723 Delaware St, Denver, CO 80204, USA.
Email: [email protected]
Contribution: Conceptualization, Data curation, Writing - original draft, Writing - review & editing
Search for more papers by this authorDan V. Blalock PhD
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
Contribution: Formal analysis, Writing - original draft
Search for more papers by this authorAlan Duffy MS
Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorDaniel Le Grange PhD
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
Contribution: Writing - review & editing
Search for more papers by this authorPhilip S. Mehler MD
ACUTE Center for Eating Disorders and Malnutrition at Denver Health, Denver, Colorado, USA
Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
Contribution: Writing - review & editing
Search for more papers by this authorMegan Riddle MD, PhD
Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
Contribution: Conceptualization
Search for more papers by this authorRenee D. Rienecke PhD
Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
Contribution: Conceptualization, Data curation, Writing - review & editing
Search for more papers by this authorCorresponding Author
Jamie L. Manwaring PhD
ACUTE Center for Eating Disorders and Malnutrition at Denver Health, Denver, Colorado, USA
Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
Correspondence
Jamie L. Manwaring, ACUTE, at Denver Health, 723 Delaware St, Denver, CO 80204, USA.
Email: [email protected]
Contribution: Conceptualization, Data curation, Writing - original draft, Writing - review & editing
Search for more papers by this authorDan V. Blalock PhD
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
Contribution: Formal analysis, Writing - original draft
Search for more papers by this authorAlan Duffy MS
Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
Contribution: Data curation, Writing - review & editing
Search for more papers by this authorDaniel Le Grange PhD
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
Contribution: Writing - review & editing
Search for more papers by this authorPhilip S. Mehler MD
ACUTE Center for Eating Disorders and Malnutrition at Denver Health, Denver, Colorado, USA
Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
Contribution: Writing - review & editing
Search for more papers by this authorMegan Riddle MD, PhD
Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
Contribution: Conceptualization
Search for more papers by this authorRenee D. Rienecke PhD
Eating Recovery Center and Pathlight Behavioral Health Centers, Denver, Colorado, USA
Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
Contribution: Conceptualization, Data curation, Writing - review & editing
Search for more papers by this authorAbstract
Objective
Anorexia nervosa (AN) is a serious illness with a high mortality rate and multiple physiological complications. The vague definition of atypical AN allows for subjective interpretation. This retrospective study aimed to focus future research on the operational definition of atypical AN by examining four factors associated with atypical AN at admission to higher level of care treatment.
Methods
Adults with atypical AN (n = 69) were examined within sample analyses among four groups: (1) >10% versus ≤10% weight loss; (2) weight loss within the previous 3 months versus >3 months; (3) engaging in purging behaviors versus absence of purging behaviors; and (4) endorsing versus not endorsing significant cognitive aspects of AN.
Results
Patients with atypical AN endorsed elevated ED cognitions on the Eating Disorder Examination-Questionnaire and depressive symptoms; a lack of association was found between weight loss severity and weight loss time frame with depressive symptoms, eating concern, and restraint. Purging behavior was associated with a higher expected body weight percentage (%EBW) and dietary restraint, while greater AN cognitions were associated with a higher EBW and weight loss percentage. Few patients demonstrated bradycardia, hypophosphatemia, or amenorrhea.
Discussion
This study demonstrated the severity of ED cognitions and depressive symptoms in this atypical AN sample and provided directions for future studies in the nosology of atypical AN. It may be important to distinguish between individuals with atypical AN who are purging and those who are not. Atypical AN was associated with a low frequency of physiological disturbances.
Public Significance
This study provides further clarification regarding the operational definition of atypical AN; currently, a constellation of symptoms under Other Specified Feeding or Eating Disorders. This study was consistent with previous research in reporting severe eating disorder cognitions in adults with atypical AN, and noted the potential importance of distinguishing a purging distinction. A minority of patients in this study had physiological impairments.
CONFLICT OF INTEREST STATEMENT
Dr Dan Blalock was supported by Career Development Award 19-035 (IK2HX003085-01A2) from the United States Department of Veterans Affairs Health Services Research and Development (HSR&D) Service. Dr Renee Rienecke receives consulting fees from the Training Institute for Child and Adolescent Eating Disorders, LLC, and receives royalties from Routledge. Dr Daniel Le Grange receives royalties from Guilford Press and Routledge for books related to family-based treatment, is co-director of the Training Institute for Child and Adolescent Eating Disorders, LLC, and is a member of Equip Health Clinical Advisory Board.
Open Research
DATA AVAILABILITY STATEMENT
Data will be made available upon reasonable request.
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