A multicenter audit of outpatient care for adult anorexia nervosa: Symptom trajectory, service use, and evidence in support of "early stage" versus "severe and enduring" classification

TY - JOUR

T1 - A multicenter audit of outpatient care for adult anorexia nervosa

T2 - Symptom trajectory, service use, and evidence in support of "early stage" versus "severe and enduring" classification

AU - Ambwani, Suman

AU - Cardi, Valentina

AU - Albano, Gaia

AU - Cao, Li

AU - Crosby, Ross D

AU - Macdonald, Pamela

AU - Schmidt, Ulrike

AU - Treasure, Janet

N1 - © 2020 Wiley Periodicals, Inc.

PY - 2020/8/1

Y1 - 2020/8/1

N2 - Background: We explored the utility of “staging” anorexia nervosa (AN) by duration of illness and psychological wellbeing. We also investigated 12-month symptom trajectories and service usage in a large cohort of patients with AN assessed for outpatient treatment. Method: We conducted secondary analyses on data from a multisite clinical trial of adults with AN (n = 187) recruited from 22 NHS England specialist eating disorder (ED) services into a digital treatment augmentation study. Clinical outcomes and service use were measured at postintervention (six weeks), 6 and 12 months. We grouped patients into two categories: “early stage” (illness duration <3 years; n = 60) and “severe and enduring” stage (SE-AN; n = 41) indicated by distress (Depression Anxiety and Stress Scales, DASS ≥60) and illness duration (≥7 years). Results: At 12 months, patients reported large improvements in body mass index, small to moderate improvements in ED symptoms, mood, and work/social adjustment, and 23.6% met criteria for recovery. However, patients classified as SE-AN reported higher rates of accessing intensive services, higher ED symptomatology, and poorer work/social adjustment at baseline, and lower rates of improvement in work/social adjustment at 12 months compared to “early stage” respondents. Discussion: Although present findings suggest overall symptomatic improvements, exploratory results highlight marked differences in course and service use between people at different stages of AN, suggesting a need to consider staging for clinical decision-making. Further research differentiating between clinical subtypes of AN and adoption of a more personalized approach may ensure that services and care pathways better fit patient needs.

AB - Background: We explored the utility of “staging” anorexia nervosa (AN) by duration of illness and psychological wellbeing. We also investigated 12-month symptom trajectories and service usage in a large cohort of patients with AN assessed for outpatient treatment. Method: We conducted secondary analyses on data from a multisite clinical trial of adults with AN (n = 187) recruited from 22 NHS England specialist eating disorder (ED) services into a digital treatment augmentation study. Clinical outcomes and service use were measured at postintervention (six weeks), 6 and 12 months. We grouped patients into two categories: “early stage” (illness duration <3 years; n = 60) and “severe and enduring” stage (SE-AN; n = 41) indicated by distress (Depression Anxiety and Stress Scales, DASS ≥60) and illness duration (≥7 years). Results: At 12 months, patients reported large improvements in body mass index, small to moderate improvements in ED symptoms, mood, and work/social adjustment, and 23.6% met criteria for recovery. However, patients classified as SE-AN reported higher rates of accessing intensive services, higher ED symptomatology, and poorer work/social adjustment at baseline, and lower rates of improvement in work/social adjustment at 12 months compared to “early stage” respondents. Discussion: Although present findings suggest overall symptomatic improvements, exploratory results highlight marked differences in course and service use between people at different stages of AN, suggesting a need to consider staging for clinical decision-making. Further research differentiating between clinical subtypes of AN and adoption of a more personalized approach may ensure that services and care pathways better fit patient needs.

KW - anorexia nervosa

KW - classification

KW - illness duration

KW - outpatient care

KW - social adjustment

KW - staging

KW - treatment outcomes

UR - http://www.scopus.com/inward/record.url?scp=85079732059&partnerID=8YFLogxK

U2 - 10.1002/eat.23246

DO - 10.1002/eat.23246

M3 - Article

C2 - 32064663

SN - 1098-108X

VL - 53

SP - 1337

EP - 1348

JO - The International journal of eating disorders

JF - The International journal of eating disorders

IS - 8

ER -