A multicenter audit of outpatient care for adult anorexia nervosa: Symptom trajectory, service use, and evidence in support of “early stage” versus “severe and enduring” classification
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Background: We explored the utility of “staging” anorexia nervosa (AN) by duration of illness and psychological wellbeing. We also investigated 12‐month symptom trajectories and service usage in a large cohort of patients with AN assessed for outpatient treatment. Method: We conducted secondary analyses on data from a multisite clinical trial of adults with AN (n = 187) recruited from 22 NHS England specialist eating disorder (ED) services into a digital treatment augmentation study. Clinical outcomes and service use were measured at postintervention (six weeks), 6 and 12 months. We grouped patients into two categories: “early stage” (illness duration <3 years; n = 60) and “severe and enduring” stage (SE‐AN; n = 41) indicated by distress (Depression Anxiety and Stress Scales, DASS ≥60) and illness duration (≥7 years). Results: At 12 months, patients reported large improvements in body mass index, small to moderate improvements in ED symptoms, mood, and work/social adjustment, and 23.6% met criteria for recovery. However, patients classified as SE‐AN reported higher rates of accessing intensive services, higher ED symptomatology, and poorer work/social adjustment at baseline, and lower rates of improvement in work/social adjustment at 12 months compared to “early stage” respondents. Discussion: Although present findings suggest overall symptomatic improvements, exploratory results highlight marked differences in course and service use between people at different stages of AN, suggesting a need to consider staging for clinical decision‐making. Further research differentiating between clinical subtypes of AN and adoption of a more personalized approach may ensure that services and care pathways better fit patient needs.
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AN recovery is much more successful when treated early.
“Given that AN recovery is much more successful when treated early (Ambwani et al., 2020)”
From Is there a basis for a weight cut‐off point? A large‐scale investigation of atypical anorexia and anorexia nervosa subtypes among patients at a residential treatment centre. (2024) · cites this paper as Ambwani et al., 2020
The introduction (p. 8) says research suggests early intervention produces good outcomes and people with enduring illness respond less well. The exploratory results (p. 17) find less improvement on some measures in the severe-and-enduring group, but they do not establish that treating AN early makes recovery much more successful; the reported recovery rate is for the full cohort (p. 16). (LLM, conf=0.87)
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Self-citation
- Authors
- Ambwani, S., Cardi, V., Albano, G., Cao, L., Crosby, R. D., Macdonald, P., Schmidt, U., & Treasure, J.
- Affiliations
- Dickinson College (US)
- King's College London (GB)
- University of North Dakota (US)
- Corresponding author
- Ambwani, Suman
- ORCID
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2020-02-17
- Volume
- 53
- Issue
- 8
- Pages
- 1337-1348
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W3008429043
- Cited by
- 109
- References
- 63
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 30 · 2023: 12 · 2022: 13 · 2021: 19 · 2020: 12
- FWCI
- 5.60
- Type
- journal article
- Language
- en
- Open access
- green
- kclpure.kcl.ac.uk
- Licence
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Padua Research Archive (University of Padova) (submittedVersion, other-oa)
- Funders
- National Institute for Health Research (PB‐PG‐0712‐28041)
- 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, adult anorexia nervosa, severe and enduring anorexia nervosa, symptom trajectories, service utilization, outpatient care, eating disorder recovery, work and social adjustment, individualized care
- MeSH terms
- Adult, Ambulatory Care, Anorexia Nervosa, Female, Humans, Male
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