Kimberly B Glazer1, Kendrin R Sonneville2, Nadia Micali3, Sonja A Swanson4, Ross Crosby5, Nicholas J Horton6, Kamryn T Eddy7, Alison E Field8. 1. Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island. Electronic address: kimberly_glazer@brown.edu. 2. Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan. 3. Child and Adolescent Psychiatry Division, University of Geneva, DEA, HUG, Geneva, Switzerland; Institute of Child Health, University College London, London, United Kingdom. 4. Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 5. Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota. 6. Department of Mathematics and Statistics, Amherst College, Amherst, Massachusetts. 7. Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. 8. Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; Department of Pediatrics, Warren Alpert Medical School, Providence, Rhode Island.
Abstract
PURPOSE: To quantify eating disorder (ED) stability and diagnostic transition among a community-based sample of adolescents and young adult females in the United States. METHODS: Using 11 prospective assessments from 9,031 U.S. females ages 9-15 years at baseline of the Growing Up Today Study, we classified cases of the following EDs involving bingeing and purging: bulimia nervosa (BN), binge ED, purging disorder (PD), and subthreshold variants defined by less frequent (monthly vs. weekly) bingeing and purging behaviors. We measured number of years symptomatic and probability of maintaining symptoms, crossing to another diagnosis, or resolving symptoms across consecutive surveys. RESULTS: Study lifetime disorder prevalence was 2.1% for BN and roughly 6% each for binge ED and PD. Most cases reported symptoms during only one survey year. Twenty-six percent of cases crossed between diagnoses during follow-up. Among participants meeting full threshold diagnostic criteria, transition from BN was most prevalent, crossing most frequently from BN to PD (12.9% of BN cases). Within each disorder phenotype, 20%-40% of cases moved between subthreshold and full threshold criteria across consecutive surveys. CONCLUSIONS: Diagnostic crossover is not rare among adolescent and young adult females with an ED. Transition patterns from BN to PD add support for considering these classifications in the same diagnostic category of disorders that involve purging. The prevalence of crossover between monthly and weekly symptom frequency suggests that a continuum or staging approach may increase utility of ED classification for prognostic and therapeutic intervention.
PURPOSE: To quantify eating disorder (ED) stability and diagnostic transition among a community-based sample of adolescents and young adult females in the United States. METHODS: Using 11 prospective assessments from 9,031 U.S. females ages 9-15 years at baseline of the Growing Up Today Study, we classified cases of the following EDs involving bingeing and purging: bulimia nervosa (BN), binge ED, purging disorder (PD), and subthreshold variants defined by less frequent (monthly vs. weekly) bingeing and purging behaviors. We measured number of years symptomatic and probability of maintaining symptoms, crossing to another diagnosis, or resolving symptoms across consecutive surveys. RESULTS: Study lifetime disorder prevalence was 2.1% for BN and roughly 6% each for binge ED and PD. Most cases reported symptoms during only one survey year. Twenty-six percent of cases crossed between diagnoses during follow-up. Among participants meeting full threshold diagnostic criteria, transition from BN was most prevalent, crossing most frequently from BN to PD (12.9% of BN cases). Within each disorder phenotype, 20%-40% of cases moved between subthreshold and full threshold criteria across consecutive surveys. CONCLUSIONS: Diagnostic crossover is not rare among adolescent and young adult females with an ED. Transition patterns from BN to PD add support for considering these classifications in the same diagnostic category of disorders that involve purging. The prevalence of crossover between monthly and weekly symptom frequency suggests that a continuum or staging approach may increase utility of ED classification for prognostic and therapeutic intervention.
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