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Child Psychiatrist /Adult Psychiatrist

Atypical Anorexia Nervosa: Increased Anxiety, Stable Binge-Eating Trajectories

Atypical anorexia nervosa (AN) is more prevalent among people of color and is associated with increasing anxiety and stable binge-eating trajectories over time, according to study results published in the International Journal of Eating Disorders.


Increased Anxiety

Atypical AN is categorized by significant weight loss and psychological symptoms that closely resemble AN, but with “normal” or higher weight relative to typical AN. Although atypical AN has become increasingly recognized as an eating disorder following its inclusion in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is still relatively understudied and underrepresented in clinical settings. To address this knowledge gap, investigators explored the natural course of atypical AN compared with AN and bulimia nervosa (BN) among college students.


The investigators conducted a prospective cohort study at a public university in the United States to delineate the progression of eating disorder and internalizing symptoms among college students with and without histories of atypical AN, AN, and BN. First-year college students (18 years of age and older) were recruited to complete a self-reported questionnaire on sociodemographic information, psychiatric symptoms, and health behaviors, and follow-up assessments were conducted each year of college. Eating disorder symptoms were evaluated using the Eating Disorder Examination Questionnaire, while internalizing symptoms were assessed using the 8-item Symptom Checklist-90.

The investigators included data from 989 first-year students, 1208 sophomores, 1727 juniors, and 1854 seniors. Overall, 61.4% of included students were women and 47.2% were White. Participants were categorized into 4 groups: those who met the criteria for atypical AN (n=125), AN (n=160), BN (n=617), or non-eating disorder controls (NCs, n=5876). Relative to the AN group, participants with atypical AN were significantly more likely to identify as non-White (B=0.74; P =.004).


Across all groups, body mass index (BMI) significantly increased over time and BMI trajectory did not differ across groups. Relative to NCs, participants with atypical AN were significantly more likely to report fasting (P <.001), driven exercise (P =.006), purging (P =.007), anxiety (P =.002), and depression (P <.001). However, only anxiety (P =.038) and fasting (P <.001) remained elevated over time.


Among the eating disorder groups, students with atypical AN had more stable binge eating trajectories (B=0.25; 95% CI, -0.21 to 0.70) relative to BN participants who displayed decreases in binge eating over time (B= -2.84; 95% CI, -3.18 to -2.49; P <.001). The atypical AN, AN, and BN groups did not significantly differ for the remaining eating disorder and internalizing symptom trajectories.


“Given that atypical AN is under-represented in treatment settings and affects a greater proportion of people of color than AN, healthcare providers should be aware of biases that may delay diagnosis and care,” the investigators noted. Study authors concluded, “[Current] results improve understanding of atypical AN symptom trajectories relative to AN and BN, emphasizing the need for ongoing research in nonclinical samples beyond the context of college.”


Study limitations include reliance on self-reported data, potential sample size suppression in the atypical AN group, varying assessment times, and participant attrition.


Note: This article originally appeared on Psychiatry Advisor

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