Does early intervention improve the prognosis in anorexia nervosa? A systematic review of the treatment‐outcome literature

Abstract

Objective: Early intervention has been suggested to be an important positive prognostic factor in the treatment of anorexia nervosa (AN). The treatment-outcome studies conducted thus far were systematically reviewed in search of evidence to confirm this suggestion. Method: An extensive search was conducted for treatment outcome studies specifically addressing the prognostic value of the duration of the illness. Thirty-three follow-up studies of eating disorders and AN in particular were subjected to nine ''best-evidence'' criteria for methodological soundness. Six of these studies were found to meet all of the criteria and thus considered in greater detail. Results: In four of these studies, the duration of illness was not found to be related to the treatment outcome. This is presumably because of the low variability in duration of illness found in these studies. In the two remaining studies, a negative relation between duration of illness and the outcome of treatment was reported. As a result of methodological shortcomings and a lack of control for potentially confounding variables, however, the prognostic value of early intervention could still not be estimated on the basis of these studies. Discussion: The prognostic value of early intervention in AN cannot be estimated on the basis of the treatment-outcome literature. Unfortunately, the duration of the illness and not the occurrence of early intervention is considered in most of the outcome studies of AN. In addition, a number of methodological shortcomings make it impossible to evaluate the prognostic value of early intervention.

Early identification and treatment of eating disorders: prodrome to syndrome

“…First, early diagnosis and treatment bodes favourably in terms of long-term prognosis for AN, 19,52 although more studies are needed to untangle two variables often conflated in the literature, namely time from onset to first intervention and overall duration of illness. 53 Second, prepubertal onset AN is at least as severe as postpubertal AN 54 and may represent a particularly pernicious form of the disorder, 55,56 heightening the importance of early intervention. Third, even early, subthreshold presentations of AN can be associated with health impairment and physiological complications including growth retardation, pubertal delay and deficiencies in bone mineral acquisition, [57][58][59] as well as significant psychological distress and impairment, equivalent to levels seen in AN.…”

“…19,52,116,117 However, more studies are needed to untangle two variables often conflated in the literature: time from onset to first intervention (point of intervention), and overall duration of illness (degree of chronicity). 53,118 In other words, if adolescents are more responsive to treatment, is the operative variable: (i) shorter duration of illness; or (ii) early intervention? 16,53,118…”

“…53,118 In other words, if adolescents are more responsive to treatment, is the operative variable: (i) shorter duration of illness; or (ii) early intervention? 16,53,118…”

Secondary prevention for eating disorders: The impact of education, screening, and referral in a college‐based screening program

“…Although it is not yet known whether early intervention may prevent the development of full-syndrome eating disorders, substantial evidence supports that disordered eating is frequently a precursor of full-syndrome eating disorders (Shisslak, Crago, & Estes, 1995). Moreover, some evidence suggests that a shorter duration of illness is associated with more favorable outcomes for eating disorders (Schoemaker, 1997). Therefore, early case detection and referral to treatment may be a useful adjunct, or even a superior strategy, to primary prevention programs.…”

Compliance and outcome in treatment‐resistant anorexia and bulimia: A retrospective study

“…Poor outcome in anorexia nervosa and bulimia nervosa has been associated with a number of prognostic indicators. These include longer duration of illness, increased severity of symptoms, poor motivation for therapy, failure of previous treatment, chronicity, and psychiatric comorbidity (Herzog, Keller, & Lavori, 1988;Herzog, Nussbaum, & Marmor, 1996;Jones, Halford, & Dooley, 1993;Pollice, Kaye, Greeno, & Weltzin, 1997;Schoemaker, 1997;Treasure, 1991). Several of the aforementioned indicators are typically present in eating-disordered patients with a history of recalcitrance or resistance to treatment, and poor outcome is common in this population (Hamburg, Herzog, & Brotman, 1996;Hamburg, Herzog, Brotman, & Stasior, 1989;Yager, 1992).…”