تداخل بیماری در بی اشتهایی عصبی

Objective “Illness intrusiveness” refers to illness-induced lifestyle disruptions. The primary aim of the current study was to compare the level of illness intrusiveness in anorexia nervosa (AN) to that reported in a variety of other chronic medical and psychiatric conditions. A secondary aim was to compare the two subtypes of AN (binge/purge vs. restricting) in terms of the nature and extent of illness intrusiveness. A final goal was to examine changes in the level of illness intrusiveness in AN following successful completion of specialized inpatient treatment. Methods The participants were a consecutive series of 121 female inpatients with AN who were admitted to a specialized inpatient unit for treatment of the eating disorder. Assessments took place before and after inpatient treatment and at 3-month follow-up. Results At baseline, illness intrusiveness scores for AN patients were significantly higher than those reported by women in the medical and psychiatric comparison groups. Overall, illness intrusiveness scores decreased (i.e., improved) significantly following successful completion of inpatient treatment. Among patients with the restricting subtype, scores continued to improve during follow-up, whereas this was not the case among patients with the binge–purge subtype of AN, whose scores did not change significantly during follow-up. Conclusion Despite being notoriously ambivalent about change, these findings suggest that AN patients perceive their illness to be highly disruptive to a variety of life domains, even more so than patients with other chronic medical and psychiatric conditions.

Anorexia nervosa (AN) is an eating disorder characterized by severe food restriction, maintenance of an abnormally low body weight, intense fear of weight gain, and body image disturbance [1]. In about half of cases, there is recurrent binge-eating and purging through self-induced vomiting or laxative misuse (i.e., binge–purge subtype). The disorder tends to run a chronic course and is associated with significant psychiatric comorbidity, serious medical complications, and considerable impairment in psychosocial functioning. Some previous studies have found greater self-reported impairment in health-related quality of life among those with the binge–purge subtype (AN-BP), as compared with the restricting subtype (AN-R) of the disorder [2], [3], [4] and [5], while other studies have not [6] and [7]. Possible reasons for these contradictory findings include the use of different measures and different populations (e.g., patients vs. community samples). Most previous studies have used the Medical Outcomes Study Short Form 36-item Health Survey (SF-36) [8], a well-validated questionnaire that provides a global measure of health-related quality of life, by assessing physical, emotional, and social well-being. In the present study, we were interested in examining one particular aspect of health-related quality of life, namely, illness intrusiveness, which is defined as illness-induced lifestyle disruptions that interfere with continued involvement in valued activities and interests [9]. To measure illness intrusiveness, the Illness Intrusiveness Ratings Scale (IIRS) [9], which measures the extent to which an illness and/or its treatment interferes with 13 domains central to quality of life, has been developed [10]. Illness intrusiveness correlates significantly with a number of quality of life indicators, including life satisfaction, depressive symptoms, self-esteem, marital satisfaction, and global psychopathology, as well as social and occupational functioning [9], [11] and [12]. Normative data is not available for the IIRS since the nature of the measure requires its testable population to be restricted to individuals with a medical illness, and norms would require extremely large numbers of participants stratified by their particular illness. However, there is an ongoing effort to determine how illness intrusiveness differs among different medically ill populations. Devins et al. have administered the IIRS to a number of medically ill populations, including patients with end-stage renal disease, multiple sclerosis, cancer, and rheumatoid arthritis [9], [13], [14], [15], [16] and [17], as well as patients with a variety of psychiatric disorders, including anxiety disorders, schizophrenia, bipolar disorder, and insomnia [18], [19], [20] and [21]. Thus, although standard norms are not available, there is a literature available to allow for comparisons between specific illnesses. Although AN is widely recognized to be highly disruptive to patients' quality of life, the degree to which AN compromises quality of life as compared to other chronic physical and psychiatric conditions is unknown. The primary aim of the current study was to compare the level of illness intrusiveness in AN female patients with that reported by female patients with a variety of other serious medical and psychiatric illnesses. Data for the comparison groups were obtained from previous studies. A secondary aim was to compare the two subtypes of AN (i.e., AN-BP vs. AN-R) in terms of the nature and extent of illness intrusiveness. A final goal was to examine changes in illness intrusiveness in AN following successful completion of specialized inpatient treatment for the eating disorder and at 3-month follow-up.