Health in adulthood after severe anorexia nervosa in adolescence: a study of exposed and unexposed women

Abstract

Objective

To compare the global health status, frequency of somatic and psychological problems, and alcohol use in adulthood among women hospitalized in adolescence for severe anorexia nervosa (AN), with a matched control sample from the general population.

Method

Women (n = 86) who had been hospitalized for AN 9.31 ± 1.82 years previously were compared with 258 controls matched for gender, age, and socio-professional category. Data were retrieved from a French survey on health and social insurance coverage, and was mainly collected by self-report, except for the assessment of current eating disorders for those previously hospitalized for AN (assessed with the MINI).

Results

The women who had been hospitalized for AN reported significantly poorer current health status compared to controls (OR 2.9, 95% CI 1.5–5.79). According to the MINI, 13 women previously hospitalized with severe AN still presented an eating disorder (ED). Women with past AN reported more frequent acute throat infections (OR 4.9, 95% CI 1.81–13.51), gastralgia (OR 3.6, 95% CI 1.9–6.83), gastro-oesophageal reflux (OR 5.279, 95%CI 2.11–13.22), excess blood cholesterol or triglyceride levels (OR 2.55, 95% CI 1.03–6.33), anxiety (OR 8.7, 95% CI 3.48–21.8) and depression (OR 5.02 (2.8–9.01). These differences remained significant and of the same order of magnitude in sensitivity analyses among subjects with previous AN but without current ED, except for perceived health status and excess cholesterol and triglyceride levels.

Discussion

Women who had been hospitalized for severe AN reported more symptoms 10 years after treatment, implies psychological and somatic follow-up in the long term.

Level of evidence

Level III, case–control analytic study.

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References

  1. 1.

    Steinhausen H-C (2009) Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am 18:225–242. https://doi.org/10.1016/j.chc.2008.07.013

    Article  PubMed  Google Scholar 

  2. 2.

    Mitchell JE, Crow S (2006) Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry 19:438–443. https://doi.org/10.1097/01.yco.0000228768.79097.3e

    Article  PubMed  Google Scholar 

  3. 3.

    NICE guidelines (2017) Eating disorders: recognition and treatment

  4. 4.

    American Psychiatric Association (2006) Treatment of patients with eating disorders, third edition. American Psychiatric Association. Am J Psychiatry 163:4–54

    Google Scholar 

  5. 5.

    HAS (2011) Anorexia Nervosa: Management. Clinical Practice Guidelines. HAS, Saint-Denis

    Google Scholar 

  6. 6.

    Vestergaard P, Emborg C, Støving RK et al (2002) Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders—a nationwide register study. Int J Eat Disord 32:301–308. https://doi.org/10.1002/eat.10101

    Article  PubMed  Google Scholar 

  7. 7.

    Andersen AE, Ryan GL (2009) Eating disorders in the obstetric and gynecologic patient population. Obstet Gynecol 114:1353–1367. https://doi.org/10.1097/AOG.0b013e3181c070f9

    Article  PubMed  CAS  Google Scholar 

  8. 8.

    Ante Z, Luu TM, Healy-Profitós J et al (2020) Pregnancy outcomes in women with anorexia nervosa. Int J Eat Disord. https://doi.org/10.1002/eat.23251

    Article  PubMed  Google Scholar 

  9. 9.

    Forney KJ, Buchman-Schmitt JM, Keel PK, Frank GKW (2016) The medical complications associated with purging. Int J Eat Disord 49:249–259. https://doi.org/10.1002/eat.22504

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Stheneur C, Bergeron S, Lapeyraque A-L (2014) Renal complications in anorexia nervosa. Eat Weight Disord 19:455–460. https://doi.org/10.1007/s40519-014-0138-z

    Article  PubMed  Google Scholar 

  11. 11.

    Romanos GE, Javed F, Romanos EB, Williams RC (2012) Oro-facial manifestations in patients with eating disorders. Appetite 59:499–504. https://doi.org/10.1016/j.appet.2012.06.016

    Article  PubMed  Google Scholar 

  12. 12.

    Katzman DK (2005) Medical complications in adolescents with anorexia nervosa: a review of the literature. Int J Eat Disord 37(Suppl):S52–59. https://doi.org/10.1002/eat.20118(discussion S87–89)

    Article  PubMed  Google Scholar 

  13. 13.

    Smith C, Feldman SS, Nasserbakht A, Steiner H (1993) Psychological characteristics and DSM-III-R diagnoses at 6-year follow-up of adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry 32:1237–1245. https://doi.org/10.1097/00004583-199311000-00018

    Article  PubMed  CAS  Google Scholar 

  14. 14.

    Herpertz-Dahlmann B, Müller B, Herpertz S et al (2001) Prospective 10-year follow-up in adolescent anorexia nervosa-course, outcome, psychiatric comorbidity, and psychosocial adaptation. J Child Psychol Psychiatry 42:603–612

    Article  CAS  Google Scholar 

  15. 15.

    Godart NT, Flament MF, Perdereau F, Jeammet P (2002) Comorbidity between eating disorders and anxiety disorders: a review. Int J Eat Disord 32:253–270. https://doi.org/10.1002/eat.10096

    Article  PubMed  CAS  Google Scholar 

  16. 16.

    Lange CRA, Ekedahl Fjertorp H, Holmer R et al (2019) Long-term follow-up study of low-weight avoidant restrictive food intake disorder compared with childhood-onset anorexia nervosa: psychiatric and occupational outcome in 56 patients. Int J Eat Disord 52:435–438. https://doi.org/10.1002/eat.23038

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Andrés-Pepiñá S, Plana MT, Flamarique I et al (2020) Long-term outcome and psychiatric comorbidity of adolescent-onset anorexia nervosa. Clin Child Psychol Psychiatry 25:33–44. https://doi.org/10.1177/1359104519827629

    Article  PubMed  Google Scholar 

  18. 18.

    Deter HC, Herzog W (1994) Anorexia nervosa in a long-term perspective: results of the Heidelberg–Mannheim Study. Psychosom Med 56:20–27

    Article  CAS  Google Scholar 

  19. 19.

    Wentz E, Gillberg IC, Gillberg C, Råstam M (2000) Ten-year follow-up of adolescent-onset anorexia nervosa: physical health and neurodevelopment. Dev Med Child Neurol 42:328–333. https://doi.org/10.1111/j.1469-8749.2000.tb00098.x

    Article  PubMed  CAS  Google Scholar 

  20. 20.

    Dobrescu SR, Dinkler L, Gillberg C et al (2020) Anorexia nervosa: 30-year outcome. Br J Psychiatry 216:97–104. https://doi.org/10.1192/bjp.2019.113

    Article  PubMed  Google Scholar 

  21. 21.

    Prince M, Patel V, Saxena S et al (2007) No health without mental health. Lancet 370:859–877. https://doi.org/10.1016/S0140-6736(07)61238-0

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Erdur L, Kallenbach-Dermutz B, Lehmann V et al (2012) Somatic comorbidity in anorexia nervosa: first results of a 21-year follow-up study on female inpatients. Biopsychosoc Med 6:4. https://doi.org/10.1186/1751-0759-6-4

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Stheneur C, Ali A, Tric L et al (2017) Impact of somatic severity on long-term mortality in anorexia nervosa. Eat Weight Disord 22:285–289. https://doi.org/10.1007/s40519-016-0346-9

    Article  PubMed  Google Scholar 

  24. 24.

    Roux H, Blanchet C, Stheneur C et al (2013) Somatic outcome among patients hospitalised for anorexia nervosa in adolescence: disorders reported and links with global outcome. Eat Weight Disord 18:175–182. https://doi.org/10.1007/s40519-013-0030-2

    Article  PubMed  Google Scholar 

  25. 25.

    Godart N, Atger F, Perdereau F et al (2004) Treatment of adolescent patients with eating disorders: description of a psychodynamic approach in clinical practice. Eat Weight Disord 9:224–227

    Article  CAS  Google Scholar 

  26. 26.

    Godart N, Wallier J, Hubert T et al (2009) Determining factors for target weights in an anorexia nervosa inpatient program for adolescents and young adults: study on the links between theory-based hypotheses and the realities of clinical practice. Eat Weight Disord 14:e176–183

    Article  CAS  Google Scholar 

  27. 27.

    Allonier C, Dourgnon P, Rochereau T (2008) Enquête sur la santé et la protection sociale. IRDES  

  28. 28.

    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. American Psychiatric Association, Arlington

    Google Scholar 

  29. 29.

    Hubert T, Pioggiosi P, Huas C et al (2013) Drop-out from adolescent and young adult inpatient treatment for anorexia nervosa. Psychiatry Res 209:632–637. https://doi.org/10.1016/j.psychres.2013.03.034

    Article  PubMed  Google Scholar 

  30. 30.

    Wentz E, Gillberg IC, Anckarsäter H et al (2009) Reproduction and offspring status 18 years after teenage-onset anorexia nervosa—a controlled community-based study. Int J Eat Disord 42:483–491. https://doi.org/10.1002/eat.20664

    Article  PubMed  Google Scholar 

  31. 31.

    Rizk M, Kern L, Lalanne C et al (2019) High-intensity exercise is associated with a better nutritional status in anorexia nervosa. Eur Eat Disorders Rev 27:391–400. https://doi.org/10.1002/erv.2661

    Article  Google Scholar 

  32. 32.

    Billeci L, Brunori E, Scardigli S et al (2018) Excessive physical activity in young girls with restrictive-type anorexia nervosa: its role on cardiac structure and performance. Eat Weight Disord 23:653–663. https://doi.org/10.1007/s40519-017-0447-0

    Article  PubMed  Google Scholar 

  33. 33.

    Fisher M, Golden NH, Katzman DK et al (1995) Eating disorders in adolescents: a background paper. J Adolesc Health 16:420–437. https://doi.org/10.1016/1054-139X(95)00069-5

    Article  PubMed  CAS  Google Scholar 

  34. 34.

    Fairburn CG, Harrison PJ (2003) Eating disorders. Lancet 361:407–416. https://doi.org/10.1016/S0140-6736(03)12378-1

    Article  PubMed  Google Scholar 

  35. 35.

    Shaheen NJ, Richter JE (2009) Barrett’s oesophagus. Lancet 373:850–861. https://doi.org/10.1016/S0140-6736(09)60487-6

    Article  PubMed  CAS  Google Scholar 

  36. 36.

    Halmi KA, Eckert E, Marchi P et al (1991) Comorbidity of psychiatric diagnoses in anorexia nervosa. Arch Gen Psychiatry 48:712–718

    Article  CAS  Google Scholar 

  37. 37.

    Foulon C, Guelfi JD, Kipman A et al (2007) Switching to the bingeing/purging subtype of anorexia nervosa is frequently associated with suicidal attempts. Eur Psychiatry 22:513–519. https://doi.org/10.1016/j.eurpsy.2007.03.004

    Article  PubMed  CAS  Google Scholar 

  38. 38.

    Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 68:724–731. https://doi.org/10.1001/archgenpsychiatry.2011.74

    Article  PubMed  Google Scholar 

  39. 39.

    Prabhakaran R, Misra M, Miller KK et al (2008) Determinants of height in adolescent girls with anorexia nervosa. Pediatrics 121:e1517–1523. https://doi.org/10.1542/peds.2007-2820

    Article  PubMed  Google Scholar 

  40. 40.

    Wentz E, Mellström D, Gillberg C et al (2003) Bone density 11 years after anorexia nervosa onset in a controlled study of 39 cases. Int J Eat Disord 34:314–318. https://doi.org/10.1002/eat.10192

    Article  PubMed  Google Scholar 

  41. 41.

    Linna MS, Raevuori A, Haukka J et al (2013) Reproductive health outcomes in eating disorders. Int J Eat Disord 46:826–833. https://doi.org/10.1002/eat.22179

    Article  PubMed  Google Scholar 

  42. 42.

    Gueguen J, Godart N, Chambry J et al (2012) Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality. Int J Eat Disord 45:537–545. https://doi.org/10.1002/eat.20987

    Article  PubMed  Google Scholar 

  43. 43.

    Strobel C, Quadflieg N, Voderholzer U et al (2018) Short- and long-term outcome of males treated for anorexia nervosa: a review of the literature. Eat Weight Disord 23:541–552. https://doi.org/10.1007/s40519-018-0538-6

    Article  PubMed  Google Scholar 

  44. 44.

    Voderholzer U, Hessler JB, Naab S et al (2019) Are there differences between men and women in outcome of intensive inpatient treatment for anorexia nervosa? An analysis of routine data. Eur Eat Disord Rev 27:59–66. https://doi.org/10.1002/erv.2624

    Article  PubMed  Google Scholar 

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Acknowledgements

Mrs Jo Ann Cahn.

Funding

Fondation Wyeth.

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Correspondence to Caroline Huas.

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The authors declare that they have no conflict of interest.

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“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.” This research was authorized in 2007 by the Ile-de-France III Ethics Committee (No Am359-1-2353) and complied with the terms of the Helsinki declaration, and accepted by the CNIL no 253/29-05-06. Patients and parents (during the admission for AN) provided informed written consent.

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Chapelon, E., Barry, C., Hubert, T. et al. Health in adulthood after severe anorexia nervosa in adolescence: a study of exposed and unexposed women. Eat Weight Disord (2020). https://doi.org/10.1007/s40519-020-00940-5

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Keywords

  • Anorexia nervosa
  • Outcome
  • Global health
  • Somatic and psychological problems
  • Adolescence