Recognition and duration of illness in adolescent eating disorders: Parental perceptions of symptom onset

Abstract

Aim: To understand the earliest parent reported signs suggesting their child may have an eating disorder (ED), and to quantify time from symptom onset to specialist assessment.Methods: This is a secondary analysis of data derived from parents of 78 young people presenting to a British community ED service who completed a questionnaire asking when they first noticed their child displaying (a) a change in eating pattern, (b) weight concerns, (c) shape concerns. Parents were also asked to describe the first thing they noticed in terms of possible ED symptoms.Results: Mean age was 14.9 (SD: 1.58), 94% were female with diagnoses of anorexia nervosa (n = 50), bulimia nervosa (n = 10) and atypical anorexia nervosa (n = 18).Weight and shape concerns were most often noticed over a year prior to assessment (mean 12.7 months [SD: 12.8] and 13.3 months [SD: 13.2], respectively), with eating pattern change observed a mean of 9.7 months (SD: 7.6) before referral to specialist care. Seven main themes were developed from parents' descriptions of their child's symptoms: (1) eating pattern change, (2) shape concern, (3) weight concern, (4) observed weight loss, (5) binge eating/compensatory behaviours, (6) other mental health concerns and (7) physical symptoms. Conclusions:The most common parental concerns were eating pattern change, specifically their child becoming more rigid/rule-bound with regard to eating and dietary restraint. Such external changes are likely observed before physical changes such as weight loss, offering potential for early identification by parents, primary care and other professionals, with implications for improved prognosis.

Eating disorder psychopathology, psychiatric impairment, and symptom frequency of atypical anorexia nervosa versus anorexia nervosa: A systematic review and meta‐analysis

“…Nine (45%) studies examined the difference between AN and atypAN using the composite global score on the EDE or EDE‐Q. Five (56%) studies reported no significant differences between the two groups on global severity (Birgegard et al, 2012; Dann et al, 2022a, 2022b; Kim et al, 2023; Matthews et al, 2022; Rosello, Gledhill, Yi, Watkins, Harvey, Hosking, Viner et al, 2021; Rosello, Gledhill, Yi, Watkins, Harvey, Hosking, & Nicholls, 2021). Three (33%) studies reported the atypAN group had greater severity on the global composite score than the AN group (Garber et al, 2019; Jablonski et al, 2022; Sawyer et al, 2016), whereas one (11%) study reported the AN group had greater severity than the atypAN group (Wade & O'Shea, 2015).…”

Parents' illness representations of their child with anorexia nervosa: A systematic review of qualitative studies using the common‐sense model

“…This component refers to the perceived symptoms of the disorder (Banerjee et al, 2022; Bear et al, 2021; Shiyanbola et al, 2018). Several studies reported that parents observed a range of symptoms associated with anorexia nervosa (Coelho et al, 2021; Cottee‐Lane et al, 2004; McMahon et al, 2022; Rosello et al, 2022; Thomson et al, 2014; Whitney et al, 2005; Williams, Russell‐Mayhew, et al, 2020). The most common symptoms observed included sudden changes in their child's eating behavior (e.g., dieting, eating “healthy,” becoming vegetarian, counting calories), physical appearance (e.g., weight loss), and increasing isolation from friends, family, and social activities (Coelho et al, 2021; Cottee‐Lane et al, 2004; McMullen, 2018; Rosello et al, 2022; Thomson et al, 2014; Williams, Russell‐Mayhew, et al, 2020).…”

“…Several studies reported that parents observed a range of symptoms associated with anorexia nervosa (Coelho et al, 2021; Cottee‐Lane et al, 2004; McMahon et al, 2022; Rosello et al, 2022; Thomson et al, 2014; Whitney et al, 2005; Williams, Russell‐Mayhew, et al, 2020). The most common symptoms observed included sudden changes in their child's eating behavior (e.g., dieting, eating “healthy,” becoming vegetarian, counting calories), physical appearance (e.g., weight loss), and increasing isolation from friends, family, and social activities (Coelho et al, 2021; Cottee‐Lane et al, 2004; McMullen, 2018; Rosello et al, 2022; Thomson et al, 2014; Williams, Russell‐Mayhew, et al, 2020). Less commonly mentioned symptoms included cognitive changes (e.g., rigidity about food) and emotional changes such as low self‐esteem (Cottee‐Lane et al, 2004; McMullen, 2018; Rosello et al, 2022; Thomson et al, 2014; Whitney et al, 2005).…”

“…This component refers to the perceived symptoms of the disorder (Banerjee et al, 2022;Bear et al, 2021;Shiyanbola et al, 2018). Several studies reported that parents observed a range of symptoms associated with anorexia nervosa (Coelho et al, 2021;Cottee-Lane et al, 2004;McMahon et al, 2022;Rosello et al, 2022;Thomson et al, 2014;Whitney et al, 2005;Williams, Russell-Mayhew, et al, 2020). The most common symptoms observed included sudden changes in their child's eating behavior (e.g., dieting, eating "healthy,"…”

“…becoming vegetarian, counting calories), physical appearance (e.g., weight loss), and increasing isolation from friends, family, and social activities (Coelho et al, 2021;Cottee-Lane et al, 2004;McMullen, 2018;Rosello et al, 2022;Thomson et al, 2014;Williams, Russell-Mayhew, et al, 2020). Less commonly mentioned symptoms included cognitive changes (e.g., rigidity about food) and emotional changes such as low self-esteem (Cottee-Lane et al, 2004;McMullen, 2018;Rosello et al, 2022;Thomson et al, 2014;Whitney et al, 2005).…”