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Eating Disorders

Reliable Change in Comorbid Symptoms During Treatment for Anorexia Nervosa in Adolescents: A replication study

(PS6-B30) Reliable Change in Comorbid Symptoms During Treatment for Anorexia Nervosa in Adolescents: A Replication Study

Friday, November 17, 2023
4:00 PM – 5:00 PM PST
Location: Regency Ballroom, Level 7
Background: Anorexia nervosa (AN) is a highly comorbid condition with nine in ten individuals with AN reporting a comorbid diagnosis. Family based treatment (FBT) is the first line approach in youth with AN, focusing on renourishment and return to normal eating. Critiques of FBT include a lack of explicit focus on comorbid symptoms. Our prior research shows high rates of internalizing symptoms in youth with AN undergoing treatment (30%: anxiety, 25%: depression), with most comorbid symptoms significantly decreasing post-treatment. We sought to replicate findings in a sample of youth receiving FBT. We hypothesize that internalizing symptoms will be common and that rates of clinically significant symptoms (internalizing and externalizing) will decrease post-FBT.

Methods: Our sample were 64 youth (Mage =15yrs) receiving FBT for AN. Participants were mostly White (78%), cisgender girls. Participants completed the Behavior Assessment System for Children at baseline (T1) and six months later at treatment completion (T2). T-scores classified youth in the clinical and at risk range on symptom scales and we examined change via the Reliable Change Index (RCI).

Results: At T1, 20% of participants reported anxious symptoms in the clinical range, while clinical depressive and somatic symptoms were seen in 21% and 9% of youth respectively. Only 1% of youth were in the clinical range for atypicality with 3% for attention problems and 5% for hyperactivity. Anxiety decreased by T2 (8% of youth) as did depression (20%); although, rates of somatic symptoms did not (9%). For externalizing symptoms, we saw no change in rates of attention problems (3%), with youth in the clinical range for atypicality increasing (4%) and those reporting hyperactivity decreasing (3%). Using the RCI, 14% of youth reported significant improvement in anxiety and 12% in depression at T2.

Discussion: This study partially replicated our prior findings. Clinically significant internalizing symptoms were more common than externalizing symptoms, though overall rate of comorbid symptoms was substantially lower.  Improvements in anxious and depressive symptoms show that, while not directly targeted, comorbidity is effectively reduced during the course of FBT for AN. These data are critical to educate families and therapists who may be hesitant about FBT due to concern about comorbid symptoms. However, persisting comorbidity, particularly depressive symptoms, highlight the need to identify effective treatments for lingering symptoms post-FBT.