Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature

Abstract

Objective: This systematic review assesses the average duration of untreated eating disorder (DUED) in help-seeking populations at the time of first eating disorder (ED) treatment and investigates the relationship between DUED and symptom severity/clinical outcomes.Method: PRISMA guidelines were followed throughout. Selected studies provided information on either: (i) length of DUED, (ii) components of DUED, (iii) cross-sectional associations between DUED and symptom severity, (iv) associations between DUED and clinical outcomes, or (v) experimental manipulation of DUED. Study quality was assessed.Results: Fourteen studies from seven countries were included. Across studies, average DUED weighted by sample size was 29.9 months for anorexia nervosa, 53.0 months for bulimia nervosa and 67.4 months for binge eating disorder. A younger age at time of first treatment was indicative of shorter DUED. Retrospective studies suggest that a shorter DUED may be related to a greater likelihood of remission. Manipulation of DUED by shortening service-related delays may improve clinical outcomes.Conclusions: Data on length of DUED provide a benchmark for early intervention in EDs. Preliminary evidence suggests DUED may be a modifiable factor influencing outcomes in EDs. To accurately determine the role of DUED, definition and measurement must be uniformly operationalised.

“I’m not a teenager, I’m 22. Why can’t I snap out of it?”A Qualitative Exploration of Seeking Help for a First-Episode Eating Disorder During Emerging Adulthood

“…The present study aimed to understand help-seeking for ED symptoms amongst emerging adults receiving treatment for an ED through an early intervention care pathway. Accordingly, all participants in the present study had received specialist treatment for their ED and had done so relatively early in their illness, with an average duration of untreated ED of 20.14 months, compared to averages between 29.9 to 67.4 months across diagnoses indicated by a previous systematic review (5). Future research should therefore focus on elucidating the factors that might be relevant for other sub-groups of emerging adults who experience EDs (e.g.…”

“…Individuals commonly present to specialist services with considerable duration of untreated ED. A recent systematic review estimated an average of 29.9 months in AN, 53.0 months in BN, 43.8 months in other speci ed feeding and eating disorders (OSFED) and 67.4 months in BED (5). Lengthy duration of untreated ED represents a major challenge for successful intervention, as illness duration is a key predictor of outcome in EDs (6,7).…”

“…If strategies to hasten professional help-seeking are to be maximally effective, research must go beyond documenting generic reasons for delay and identify speci c sources of delay across different ED diagnoses and populations (5). There are strong indications that the transition to adulthood represents a risk-period for delayed (or absent) help-seeking for mental health problems, including EDs.…”

“I’m not a teenager, I’m 22. Why can’t I snap out of it?” A Qualitative Exploration of Seeking Help for a First-Episode Eating Disorder During Emerging Adulthood

“…Regarding limitations, all participants in the present study had received specialist treatment for their ED and had done so relatively early in their illness, with an average DUED of 20.14 months, compared to averages between 29.9 to 53.0 months across diagnoses indicated by a previous systematic (5). It is likely that this sample may be a "less severe" group than is typical of this age-group with regard to help-seeking, and different barriers may apply to people who seek help much later in their illness, or never do.…”

“…Eating disorders (EDs) typically have their onset during adolescence or the transition to adulthood; mean age of onset for anorexia nervosa (AN) and bulimia nervosa (BN) is between 15 and 19 years, although there is greater variability in binge-eating disorder (BED) onset (1)(2)(3)(4). Individuals commonly present to specialist services with considerable duration of untreated ED (DUED), with a recent systematic review estimating average DUED of 29.9 months in AN, 53.0 months in BN and 43.8 months in other specified feeding and eating disorders (OSFED) (5). Lengthy DUED represents a major challenge for successful intervention, as illness duration is a key predictor of outcome in EDs (6,7).…”