Recovery Trajectories in Adolescent Girls with Anorexia Nervosa

Abstract

Background: This study aimed to document recovery trajectories among adolescents with anorexia nervosa (AN) based on three markers of remission, namely changes in body weight, food restriction, and excessive exercise, and to identify predictors of these trajectories. Methods: One hundred twenty-six adolescent girls (14.7 ± 1.3 years) were recruited during initial assessment visits at specialized eating disorder (ED) programs in five University Health Centers across the province of Quebec, Canada. z-BMI and AN symptom severity (food restriction and excessive exercise) were assessed at initial assessment visits and subsequently reassessed at each quarterly follow-up over a 12-month period to identify recovery trajectories. Results: Considering the three markers of remission, three distinct trajectories emerged: Group 1, rapid responders; Group 2, gradual responders; and Group 3, unstable responders. At initial visits, a difference between groups was found regarding the type of treatment (p = 0.01) and weight suppression (p = 0.02). Group 1 had a higher number of youths hospitalized than Group 2 and Group 3, and a greater weight suppression than Group 3. Furthermore, individuals with atypical AN were more likely to belong to Group 2 than to Group 1 and Group 3 (p < 0.0001). Conclusions: This study contributes to a better understanding of the heterogeneity of recovery trajectories in adolescent girls with AN.

Keywords: adolescents; anorexia nervosa; body weight; clinical; depressive symptomatology; excessive exercise; food restriction; personality; predictors; trajectories.

Figure 1

Multi-trajectories of z-BMI, food restriction, and excessive exercise. The dotted lines represent the average for the entire sample. Group 1: rapid responders; Group 2: gradual responders; Group 3: unstable responders. Note. z-BMI labels according to World Health Organization chart: > −2 = Normal, −2 to −3 = Thinness, < −3 = Severe thinness. Food restriction and excessive exercise labels reflecting the severity level of the specific behavior according to the Eating Disorder Symptom Severity Scale (EDS3): 0 = absence, 1 = mild, 2 = moderate, and 3 = severe.