Between wellness, relapse, and remission: Stages of illness in anorexia nervosa

Abstract

ObjectivePsychiatric illnesses, like medical illnesses, can sometimes be considered as progressing through stages. Understanding these stages can lead to a better understanding of pathophysiology, and clarification of prognosis and treatment needs. Opinions from experts in the field of anorexia nervosa (AN) were sought to create a model of stages of illness.MethodThe Delphi approach was used to achieve consensus from a panel of 31 individuals from a range of disciplines with expertise in AN. Over three iterative rounds, participants rated agreement with statements about an overall staging framework and definitions of specific stages.ResultsAgreement was reached about a longitudinal progression including Subsyndromal, Full Syndrome, Persistent Illness, and Partial and Full Remission. The panel achieved consensus in defining Subsyndromal AN as characterized by body image disturbance and mild to moderate restrictive eating. Overall, there was consensus that restrictive eating is central to the behavioral features of all stages of AN, and agreement that its absence is essential to any stage of health. There was little consensus about biological markers, other than body mass index, and no consensus about quality of life indices associated with different stages.DiscussionThis panel discussion yielded an expert‐informed staging model for AN. This model now needs to be tested for its validity. The lack of consensus in several areas highlighted other research questions to address in order to develop an empirically valid and scientifically useful model of the progression of AN.

A Systematic Review and Meta-Analysis Finds Increased Blood Levels of All Forms of Ghrelin in Both Restricting and Binge-Eating/Purging Subtypes of Anorexia Nervosa

“…Further, illness progression is thought to be linked to changes in underlying pathophysiology, which could be better quantified by biomarkers. There has been growing interest in applying a staging model for AN [ 106 ] to represent different stages of the disorder from acutely ill to fully recovered. However, while experts reached, for example, consensus on a five-stage model in AN, there is still little agreement regarding appropriate biomarkers (besides BMI) that could be used to differentiate these stages of illness.…”

Cholinergic dysfunction in the dorsal striatum promotes habit formation and maladaptive eating

“…There have been conflicting data over the involvement of excessive and maladaptive habits in eating disorders (25,47). Using a self-reported habit index, Davis et al recently found that the chronicity and severity of anorexia nervosa were related to the strength of habits (48).…”

Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa

“…A BMI of 18.5 kg/ m 2 is the suggested lower threshold of normal BMI in the general population, and is commonly used as a guide for "underweight" status in meeting criteria for AN [59]. There is some consensus within the eating disorders field that achieving BMI ≥ 18.5 kg/m 2 is a required component of remission [72], and several studies support that this threshold is associated with sustained recovery [25,73,74]. In our sample, the rate of maintenance at or above a BMI of 18.5 kg/m 2 for the duration of follow-up, from one to five years, was 46.1%, similar to or slightly higher than rates reported in previous studies [12,24,41].…”