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Eating Disorders

Comparison of Adults with Atypical Anorexia Nervosa and Anorexia Nervosa: Clinical Characteristics and Preliminary Treatment Course and Eating-Related Response and Outcomes in Remote Treatment

(PS6-A2) Comparison of Adults with Atypical Anorexia Nervosa and Anorexia Nervosa: Clinical Characteristics and Preliminary Treatment Course and Eating-related Response and Outcomes in Remote Treatment

Friday, November 17, 2023
4:00 PM – 5:00 PM PST
Location: Regency Ballroom, Level 7
People with higher weight are frequently overlooked in the eating disorder (ED) field. Atypical Anorexia Nervosa (AAN), in which individuals do not have “significantly low weight”, has gained attention as awareness of weight stigma has grown. Epidemiological studies indicate that AAN may be more prevalent than AN, yet clinical samples typically have a higher proportion of AN patients. Reviews have shown that individuals with AAN resemble those with AN in non-ED-related psychopathology but have higher ED-related psychopathology. This naturalistic observational study compared the clinical characteristics and preliminary treatment course and eating-related response and outcomes of adults with AAN and AN. Few studies have examined these variables within this age group. Data were obtained via a retrospective chart review in an intentionally-remote ED treatment program grounded in weight-inclusive practices with cognitive-behavioral therapies as a core foundation. A total of 121 adult patients with a diagnosis of either AAN (35.5%) or AN (65.5%) were included. The sample was predominantly White (90.9%) women (95.9%). Eating-related measures (ED symptoms, impact of the ED on quality of life, intuitive eating) were collected at admission, monthly, and at discharge. At baseline, AAN patients had higher ED symptomatology, more impaired psychological quality of life, lower unconditional permission to eat and reliance on hunger and satiety cues, and were significantly more likely to be diagnosed with a comorbid mood and/or trauma disorder. Despite these severity indicators, they were less likely to be admitted to the PHP level of care but had longer IOP lengths of stay. Linear mixed-effects models with Bonferroni-correction were used to examine response and outcomes across diagnoses through up to 6 months of treatment. ED symptoms and impact on quality of life decreased significantly, dropping below clinical thresholds across diagnoses, indicating at least partial remission. Significant increases were noted for intuitive eating, with the exception of the Body-Food Choice Congruence (BFCC) subscale. There were no interactions between diagnosis and time for ED symptoms and quality of life, suggesting similar treatment trajectories. A significant interaction was found for the BFCC subscale; scores increased over time for AN but decreased for AAN. Results from study support a growing body of literature illustrating that individuals with AAN may experience greater eating-related pathology and higher psychiatric comorbidity than individuals with AN. Experiences of weight-based stigma and discrimination may explain these findings. These results highlight the need to examine admission criteria and insurance coverage given differences in treatment course. Nevertheless, this study suggests that a remote, weight-inclusive, cognitive-behaviorally-oriented treatment program can be effective for individuals across AN diagnoses. Future research should prioritize more diverse samples and rigorous designs. Additionally, consensus is needed regarding how to define AAN due to inconsistencies and reliance on BMI. Future work elucidating predictors, mediators, moderators, and mechanisms will be important for improving outcomes.