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Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: characteristics and treatment outcome
Örebro University, School of Medical Sciences. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. University Health Care Research Center, Region Örebro County, Örebro, Sweden.ORCID iD: 0000-0002-1068-6929
Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center,, Region Örebro County, Örebro, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
2017 (English)In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 5, no 1, article id 4Article in journal (Refereed) Published
Abstract [en]

Background: Anorexia Nervosa (AN) destroys developmentally important early years of many young people and knowledge is insufficient regarding course, treatment outcome and prognosis. Only a few naturalistic studies have been conducted within the field of eating disorder (ED) research. In this naturalistic study we included adolescents with AN or subthreshold AN treated in outpatient care, and the overall aim was to examine sample characteristics and treatment outcome. Additional aims were to examine potential factors associated with remission as an outcome variable, and possible differences between three time periods for treatment onset.

Methods: Participants were identified through the Swedish national quality register for eating disorder treatment (SwEat), in which patients are registered at treatment onset and followed up once a year until end of treatment (EOT). Inclusion criteria were: medical or self-referral to one of the participating treatment units between 1999 and 2014, 13-19 years of age at initial entry into SwEat and diagnosed with AN or subthreshold AN. The total sample consisted of 3997 patient from 83 different treatment units.

Results: The results show that 55% of the participants were in remission and approximately 85% were within a healthy weight range at EOT. Of those who ended treatment according to plan, 70% were in remission and 90% within a healthy weight range. The average treatment duration was approximately 15 months. About one third of the patients terminated treatment prematurely, which was associated with a decreased chance of achieving remission. Remission rates and weight recovery increased over time, while treatment duration decreased. Considering treatment outcome, the results did not show any differences between patients with AN or subthreshold AN.

Conclusions: The present study shows a relatively good prognosis for adolescent patients with AN or subthreshold AN in routine care and the results indicate that treatment for adolescents with ED in Sweden has become more effective over the past 15 years. The results of the present study contribute to the scope of treatment research and the large-scale naturalistic setting secures the generalizability to a clinical environment. However, more research is needed into different forms of evidence, new research strategies and diversity of treatment approaches.

Place, publisher, year, edition, pages
BioMed Central, 2017. Vol. 5, no 1, article id 4
Keywords [en]
Adolescents, Anorexia nervosa, Eating disorders, Naturalistic sample, Treatment
National Category
Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:oru:diva-57066DOI: 10.1186/s40337-017-0135-5ISI: 000395733900001PubMedID: 28265410Scopus ID: 2-s2.0-85014399551OAI: oai:DiVA.org:oru-57066DiVA, id: diva2:1088994
Note

Funding Agencies:

Region Örebro County

Örebro University

Available from: 2017-04-18 Created: 2017-04-18 Last updated: 2019-01-23Bibliographically approved
In thesis
1. A life put on hold: inside and outside perspectives on illness, treatment, and recovery in adolescents with restrictive eating disorders
Open this publication in new window or tab >>A life put on hold: inside and outside perspectives on illness, treatment, and recovery in adolescents with restrictive eating disorders
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study adolescents with restrictive eating disorders in relation to illness, treatment, and recovery from an inside and outside perspective. Studies I and II are based on data from a national quality register for eating-disorder treatment. Studies III and IV are based on interviews with adolescents previously treated in outpatient care for a restrictive eating disorder. The results showed that 55% of the adolescents were in remission at the end of treatment, and 85% were within a healthy weight range. The average treatment duration was 15 months. Over the years 1999–2014, remission rates and weight recovery increased, whereas treatment duration decreased. Young patients who received mainly family-based treatment had the highest probability of achieving remission at one-year followup, but the patients themselves were most satisfied with individual therapy. The interviews with the adolescents revealed that they often felt a strong ambivalence during the first treatment sessions, both regarding being defined as sick and the involvement of their parents. In retrospect they believed that family involvement was important, but that individual treatment sessions were crucial. The informants highlighted that trust in the therapist was the key to successful treatment. The adolescents’ narratives drew a picture of a life that was “put on hold” during the time of illness, as their involvement in social contexts outside the family was strongly influenced. It was in these contexts that their problems first became visible, and the quality of their interpersonal relationships played a great role in the recovery process. The results suggest that treatment for adolescents with restrictive eating disorders should be better adapted to changed social structures and patients’ individual contexts – a relevant area for future research.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 122
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 187
Keywords
Adolescents, Anorexia Nervosa, restrictive eating disorders, family involvement, treatment outcome, patient perspectives, qualitative research, social contexts, interpersonal relationships
National Category
General Practice Psychiatry
Identifiers
urn:nbn:se:oru:diva-70520 (URN)978-91-7529-273-1 (ISBN)
Public defence
2019-02-22, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-12-06 Created: 2018-12-06 Last updated: 2019-01-28Bibliographically approved

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Lindstedt, KatarinaKjellin, LarsGustafsson, Sanna Aila

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