Symptom Fluctuation in Eating Disorders: Correlates of Diagnostic Crossover

Tozzi, Federica; Thornton, Laura M.; Klump, Kelly L.; Fichter, Manfred M.; Halmi, Katherine A.; Kaplan, Allan S.; Strober, Michael; Woodside, D. Blake; Crow, Scott J.; Mitchell, James E.; Rotondo, Alessandro; Mauri, Mauro; Cassano, Giovanni B.; Keel, Pamela K.; Plotnicov, Katherine; Pollice, Christine; Lilenfeld, Lisa R.; Berrettini, Wade H.; Bulik, Cynthia M.; Kaye, Walter H.

doi:10.1176/appi.ajp.162.4.732

Cited by 261 publications

(224 citation statements)

References 62 publications

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“…This is in line with the findings from other studies which reported relapses to bulimic symptoms in both types of AN and in BN. 4,11 Bulik et al 12 concluded from several studies that a large proportion of AN patients later developed BN with the percentage of patients with BN to be increasing with the follow-up interval. Tozzi et al, 11 assessing diagnostic crossover retrospectively in a large sample, found 27% of BN patients shifting to AN.…”

Section: Resultsmentioning

confidence: 99%

Long-term stability of eating disorder diagnoses

Fichter

Quadflieg²

2007

Int. J. Eat. Disord.

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121

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Objective: Data on the stability of eating disorder (ED) diagnoses (DSM-IV) over 12 years are presented for a large sample (N 5 311) of female eating disordered patients with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).Method: Assessments were made at the beginning of therapy and 2-, 6-, and 12-year follow-ups. Diagnoses were derived from the Structured Inventory for Anorexic and Bulimic Eating Disorders. Possible diagnostic outcome categories were AN, BN, BED, NOS, no ED, and deceased.Results: At all follow-ups, more patients changed from AN or BED to BN than vice versa. No diagnostic crossover from AN to BED or vice versa occurred. BED showed the greatest variability and AN had the greatest stability over time.While the long-term outcome of BN and BED is similar, AN had a considerably worse long-term outcome than either BN or BED. Conclusion

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Section: Resultsmentioning

confidence: 99%

Long-term stability of eating disorder diagnoses

Fichter

Quadflieg²

2007

Int. J. Eat. Disord.

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121

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“…Other studies on AN have used survival analysis to examine events such as mortality, [67][68][69] relapse, 34,68,70 long-term recovery, 34,36 premature termination of treatment, 71 and symptom crossover. 72 In survival analysis, survival time is made up of two principal components: the follow-up time from a defined starting point and the occurrence of a defined event. 73 In this investigation, LOS starting at admission and ending at discharge comprised the time component and participants' status of meeting the outcome criteria at discharge signaled the event occurrence.…”

Section: Discussionmentioning

confidence: 99%

Readiness for change and short‐term outcomes of female adolescents in residential treatment for anorexia nervosa

McHugh

2007

Intl J Eating Disorders

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Objective: To determine if readiness for change (RFC) at admission predicted length of stay (LOS) and short-term outcomes among female adolescents in residential treatment for anorexia nervosa (AN).Method: Using a prospective cohort design to collect data from participants (N 5 65) at admission and discharge, KaplanMeier survival analysis and Cox regression tested whether RFC on admission predicted time in LOS to a favorable short-term outcome-a composite endpoint based on minimum criteria for weight gain, drive for thinness, depression, anxiety, and healthrelated quality of life (HRQOL).Results: Participants with low RFC had a mean survival time to a favorable short-term outcome of 59.4 days compared to 34.1 days for those with high RFC (log rank 5 8.44, df 5 1, p 5 .003). The probability of a favorable short-term outcome was 5.30 times greater for participants with high RFC. Conclusion:Readiness for change is a useful predictor of a favorable short-term outcome and should be considered in the assessment profile of patients with AN. V V C 2007 by Wiley Periodicals, Inc.

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“…16 Several prospective studies of clinical samples found that many participants with AN develop bulimic symptoms within the first 5 years of their disorder. 4,17 Fichter and Quadflieg found that 10% of those with AN developed BN by 2-12 year follow-up. Furthermore, consistent with other prospective studies (e.g., Refs.…”

Section: Long-term Stability Of Eating Disorder Diagnoses (Fichter Andmentioning

confidence: 99%

Stability of eating disorder diagnoses: A commentary

Stice

Spoor

2007

Int. J. Eat. Disord.

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Eat ing disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), are one of the most prevalent psychiatric problems for girls and young women, result in subjective distress and functional impairment, and increase risk for future onset of obesity, depression, suicide attempts, anxiety disorders, substance abuse, and health problems. 1,2 Although these eating disorders are clearly associated with functional impairment, less is known about the course of these eating disorder diagnoses over time. The purpose of this commentary is to discuss the findings of two articles on the longitudinal course of eating disorder diagnoses that appear in this special issue to discuss implications for nosology, and to offer suggestions regarding future research in this area.Long-term Stability of Eating Disorder Diagnoses (Fichter, & Norbert) This manuscript reports data on the stability of eating disorders over a 12-year period in a large treatment sample (N 5 311). Assessments were conducted at the beginning of therapy and at 2-year, 6-year, and 12-year follow-ups. The 12-year stability rate was 41.4% for AN, 34.4% for BN, 3.0% for BED, and 3.2% for other eating disorder not otherwise specified diagnoses (EDNOS). Results suggest moderate longitudinal instability of AN and BN, and pronounced longitudinal intability of BED and other EDNOS conditions. This instability was due to recovery, relapse, and diagnostic crossover. Most crossovers occurred from AN to BN and from BED to BN. Long-term outcome for BN and BED was encouraging, with both showing high recovery rates. The long-term outcome for AN was worse relative to BN and BED. Furthermore, the longitudinal course of BN and BED seemed to be nearly identical with similar percentages of remission and relapse. Relapse rates were low in this treatment sample.Before discussing the implications of these findings for nosology and future research directions, it is important to compare the findings from this study with other studies that have been previously published. Although research indicates that the overarching diagnosis of ''eating disorder'' is relatively stable, 3 several studies suggest that there is considerable longitudinal instability of the specific eating disorder diagnoses of AN, BN, and EDNOS in treatment samples, resulting from recovery, relapse, and crossover between and within the eating disorder diagnoses. 3,4-6 The recovery rates for AN and BN were moderate to high at each of the follow-up assessments in Fichter and Quadflieg study, which is similar to the rates reported by 7 who found that at 5-year follow-up, 56% of patients with AN, 74% of patients with BN, and 78% of patients with EDNOS no longer met criteria for any eating disorder diagnosis.Recovery rates of other treatment studies, however, are somewhat lower. For example, Fichter and Quadflieg reported a remission rate of 43.8% in AN and 56.8% in BN over a 2-year period; these recovery rates increased to about 60% for AN and about 70% for BN over a 6-12-year period....

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Symptom Fluctuation in Eating Disorders: Correlates of Diagnostic Crossover

Cited by 261 publications

References 62 publications

Long-term stability of eating disorder diagnoses

Long-term stability of eating disorder diagnoses

Readiness for change and short‐term outcomes of female adolescents in residential treatment for anorexia nervosa

Stability of eating disorder diagnoses: A commentary

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