عوامل مرتبط با بهبودی بی اشتهایی عصبی

Previous studies of prognostic factors of anorexia nervosa (AN) course and recovery have followed clinical populations after treatment discharge. This retrospective study examined the association between prognostic factors—eating disorder features, personality traits, and psychiatric comorbidity—and likelihood of recovery in a large sample of women with AN participating in a multi-site genetic study. The study included 680 women with AN. Recovery was defined as the offset of AN symptoms if the participant experienced at least one year without any eating disorder symptoms of low weight, dieting, binge eating, and inappropriate compensatory behaviors. Participants completed a structured interview about eating disorders features, psychiatric comorbidity, and self-report measures of personality. Survival analysis was applied to model time to recovery from AN. Cox regression models were used to fit associations between predictors and the probability of recovery. In the final model, likelihood of recovery was significantly predicted by the following prognostic factors: vomiting, impulsivity, and trait anxiety. Self-induced vomiting and greater trait anxiety were negative prognostic factors and predicted lower likelihood of recovery. Greater impulsivity was a positive prognostic factor and predicted greater likelihood of recovery. There was a significant interaction between impulsivity and time; the association between impulsivity and likelihood of recovery decreased as duration of AN increased. The anxiolytic function of some AN behaviors may impede recovery for individuals with greater trait anxiety.

Anorexia nervosa (AN) is a devastating and costly disorder, which places a high emotional and financial burden on patients and their families. One of the foremost challenges for patients and caregivers is managing an illness that can be lengthy, physically destructive, and psychologically exhausting. The disorder ranks among the ten leading causes of disability among young women (Mathers et al., 2000) and has one of the highest mortality rates of any psychiatric disorder (Harris and Barraclough, 1998; Millar et al., 2005; Sullivan, 1995). However, considerable heterogeneity exists in its long-term course and outcome. The most comprehensive reviews of outcome studies in AN to date report that, on average, only one-third of individuals (37%) recover within 4 years after disease onset; this figure rises to almost half (47%) by year 10 and to 73% after 10 years post onset (Berkman et al., 2007; Steinhausen, 2002). However, approximately 25% of individuals with AN have a chronic or continuously relapsing course and crude mortality from suicide or medical complications from starvation or compensatory behaviors associated with the illness is 9% (Berkman et al., 2007; Steinhausen, 2002). Identifying prognostic factors associated with illness duration and recovery could have crucial benefits. First, it would help patients, family members, and treatment providers manage expectations for illness duration and plan treatment options. Second, it would potentially assist providers in identifying which patients are at highest risk for developing a lengthy course or chronic illness. Third, it would aid providers in tailoring treatment to target each patient's individual risk factors for a longer length of illness while also reinforcing the patient's unique protective factors for recovery. Increasing the intensity or specificity of early treatment for the most at-risk patients could, in turn, shorten illness length or prevent chronicity. The aim of the present study was to examine prognostic factors that are independently associated with AN recovery. The majority of studies examining AN course and prognostic factors has used a prospective longitudinal follow-up design by following patients after treatment discharge from community clinics, specialized clinics, or inpatient care (Berkman et al., 2007). We used a retrospective design with a large sample of women with AN from the multi-site International Price Foundation Genetic Study of AN Trios. Participants were recruited from specialty clinic-based settings and through local and national media advertisements. Given that approximately one-third of the individuals with AN in the community are treated in mental health care settings (Hoek, 2006) and only half of individuals with AN are detected in primary care settings (Hudson et al., 2007), the inclusion of a community-based participants in addition to clinic-ascertained participants potentially increases the ability to observe the course of AN with greater variation in disease severity (Agras et al., 2009). We examined the following prognostic factors: a) eating disorder features, including age of onset, vomiting, laxative abuse, fasting, and excessive exercise; b) the personality traits of novelty seeking, harm avoidance, reward dependence, persistence, impulsivity, trait anxiety, and perfectionism; and c) psychiatric comorbidity including major depressive disorder (MDD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), alcohol abuse or dependence, substance abuse or dependence, and borderline and avoidant personality disorders. 1.1. Hypotheses Based on the extant literature about AN duration and prognostic factors for recovery, we hypothesized that an earlier age of onset and higher novelty seeking would be positive prognostic factors (i.e., factors that predict a higher likelihood of recovery; Ratnasuriya et al., 1991; Strober et al., 1997; Klump et al., 2004). We also anticipated that the following variables would be negative prognostic factors, predicting a lower likelihood of recovery: a) eating disorder features including vomiting, laxative abuse, and excessive exercise (Deter et al., 2005; Fichter et al., 2006; Strober et al., 1997); b) personality traits including greater harm avoidance, greater perfectionism, greater impulsivity, greater trait anxiety (Klump et al., 2004; Bardone-Cone et al., 2007; Fichter et al., 2006; Strober et al., 1997); and c) psychiatric comorbidity with MDD, anxiety, PTSD, OCD, alcohol and substance abuse or dependence, and personality disorders (Fichter et al., 2006; Halvorsen et al., 2004; Wonderlich et al., 1994; Bulik et al., 2008; Papadopoulos et al., 2009).