Adolescent-onset anorexia nervosa in the acute stage and after 30 years

Abstract

Anorexia nervosa (AN) is a severe eating disorder (ED) that predominantly affects females in early adolescence. The overarching aim of this thesis has been to examine individuals with adolescent-onset AN in the acute stage, with regard to the neuropsychological profile, and 30 years after the onset of AN regarding overall outcome. Study I-III were based on a group of 51 individuals with adolescent-onset AN recruited by community screening and followed prospectively since the mid 1980’s (AN group) together with a healthy age-, gender-, and school-matched comparison group (COMP group). In Study I, 30-years after the onset of AN, at mean age 44, ED symptoms, psychiatric morbidity, global functioning and quality of life were examined. In Study II, the perinatal status, mental and physical health of the offspring born to the females in the AN group were explored and compared with health outcomes of the children in the COMP group. In Study III, health care utilisation, social assistance, sick leave and disability pension were examined. Data were collected from Swedish national registers. Study IV was based on 20 adolescent females with acute AN, their parents and 28 healthy comparison cases. The cognitive profile was explored, using neuropsychological tests, and its associations with autism spectrum disorder (ASD) and ADHD were investigated. Results showed that at 30-year follow-up no individuals were deceased, 64% showed full ED symptom recovery, 19% had an ED and 38% had other psychiatric disorders in the AN group. Later age at onset of AN and premorbid perfectionism predicted a good outcome. Birth weight, length, head circumference and ponderal index were significantly reduced in the children of mothers in the AN group. Few differences in childhood psychiatric health were found across the two groups of offspring. However, parental interviews showed an overrepresentation of current psychiatric diagnoses in the children of mothers in the AN group. Endocrinological, immune and metabolic disorders were more common in the offspring in the AN group. The healthcare utilisation was increased in the AN group and 22% had received disability pension. In Study IV, neuropsychological tasks revealed a more detail-oriented processing style in weight-restored adolescents with AN. A possible link between neuropsychological deficits and traits of ASD and ADHD could not be confirmed. In summary, three decades after adolescent-onset AN, the outcome was favorable for the majority of the AN cases. However, one in five had an ED, a minority depended on society for their income and the offspring exhibited some unfavorable health outcomes. More efforts need to be directed towards preventing AN from developing into a protracted course with consequences on both an individual and health economic level. With the goal of potentially reducing negative perinatal outcomes in the offspring of women with current or previous EDs, we suggest that screening procedures for EDs are implemented in maternal care. Previous theories of an endophenotype in AN, characterized by a tendency to focus on details rather than perceiving the whole, were supported in this thesis and have implications for treatment strategies that address this cognitive style.