Between wellness, relapse, and remission: Stages of illness in anorexia nervosa
Open accessAbstract
OBJECTIVE: Psychiatric illnesses, like medical illnesses, can sometimes be considered as progressing through stages. Understanding these stages can lead to a better understanding of pathophysiology, and clarification of prognosis and treatment needs. Opinions from experts in the field of anorexia nervosa (AN) were sought to create a model of stages of illness. METHOD: The Delphi approach was used to achieve consensus from a panel of 31 individuals from a range of disciplines with expertise in AN. Over three iterative rounds, participants rated agreement with statements about an overall staging framework and definitions of specific stages. RESULTS: Agreement was reached about a longitudinal progression including Subsyndromal, Full Syndrome, Persistent Illness, and Partial and Full Remission. The panel achieved consensus in defining Subsyndromal AN as characterized by body image disturbance and mild to moderate restrictive eating. Overall, there was consensus that restrictive eating is central to the behavioral features of all stages of AN, and agreement that its absence is essential to any stage of health. There was little consensus about biological markers, other than body mass index, and no consensus about quality of life indices associated with different stages. DISCUSSION: This panel discussion yielded an expert-informed staging model for AN. This model now needs to be tested for its validity. The lack of consensus in several areas highlighted other research questions to address in order to develop an empirically valid and scientifically useful model of the progression of AN.
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- Authors
- Steinglass, J. E., Glasofer, D. R., Dalack, M., & Attia, E.
- Affiliations
- Columbia University Irving Medical Center (US)
- Cornell University (US)
- Corresponding author
- Steinglass, Joanna E.
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2020-02-07
- Volume
- 53
- Issue
- 7
- Pages
- 1088-1096
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- PMC
- PMC7384605
- OpenAlex
- W3004913272
- Cited by
- 28
- References
- 61
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 2 · 2021: 5 · 2020: 5
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Klarman Family Foundation (Eating Disorders)
- National Institute of Mental Health (K24 MH113737)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- anorexia nervosa, disease progression, remission, relapse, body image disturbance, restrictive eating, body mass index, biomarkers, quality of life, prognosis
- MeSH terms
- Anorexia Nervosa, Delphi Technique, Humans, Longitudinal Studies, Prognosis, Quality of Life, Recurrence, Remission Induction
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