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International Journal of Eating Disorders


Background: We explored the utility of “staging” anorexia nervosa (AN) by duration of illness and psychological wellbeing. We also investigated 12-month symptom trajectories and service usage in a large cohort of patients with AN assessed for outpatient treatment.

Method: We conducted secondary analyses on data from a multisite clinical trial of adults with AN (n = 187) recruited from 22 NHS England specialist eating disorder (ED) services into a digital treatment augmentation study. Clinical outcomes and service use were measured at postintervention (six weeks), 6 and 12 months. We grouped patients into two categories: “early stage” (illness duration years; n = 60) and “severe and enduring” stage (SE-AN; n = 41) indicated by distress (Depression Anxiety and Stress Scales, DASS ≥60) and illness duration (≥7 years).

Results: At 12 months, patients reported large improvements in body mass index, small to moderate improvements in ED symptoms, mood, and work/social adjustment, and 23.6% met criteria for recovery. However, patients classified as SE-AN reported higher rates of accessing intensive services, higher ED symptomatology, and poorer work/social adjustment at baseline, and lower rates of improvement in work/social adjustment at 12 months compared to “early stage” respondents.

Discussion: Although present findings suggest overall symptomatic improvements, exploratory results highlight marked differences in course and service use between people at different stages of AN, suggesting a need to consider staging for clinical decision-making. Further research differentiating between clinical subtypes of AN and adoption of a more personalized approach may ensure that services and care pathways better fit patient needs.


Published as:
Ambwani, Suman, Valentina Cardi, Gaia Albano, Li Cao, Ross D. Crosby, Pamela Macdonald, Ulrike Schmidt, and Janet Treasure. "A Multicenter Audit of Outpatient Care for Adult Anorexia Nervosa: Symptom Trajectory, Service Use, and Evidence in Support of "Early Stage" Versus "Severe and Enduring" Classification." International Journal of Eating Disorders (Article published online February 17, 2020).

This author post-print is made available on Dickinson Scholar with the permission of the publisher. For more information on the published version, visit Wiley's Website.



Available for download on Wednesday, February 17, 2021