ABSTRACT
BACKGROUND: While atypical anorexia nervosa (AAN) has been found to present with significant physical and psychological complications, the presentation of AAN has not been described in a multi-ethnic Singaporean population. METHODS: This retrospective cohort analysis aimed to characterize the baseline presentation of adolescents with anorexia nervosa (AN) (N = 317) and AAN (N = 141) in a Singaporean cohort that presented to a specialist paediatric eating disorder program between January 2010 and October 2020 for assessment. RESULTS: In patients with AAN, there were increased proportions of males (16% vs. 7%) and of Malay ethnicity (11% vs. 4%) compared to AN. Compared to adolescents with AN, adolescents with AAN had lower rates of admission (61% vs. 81%), bradycardia (45% vs. 75%), and hypotension (7% vs. 21%) but had a higher rate of syncope (13% vs. 7%). Likewise, adolescents with AAN had higher rates of self-harm and drug overdose (14% vs. 1.5%) requiring admission, more purging (45.1% vs. 14.8%) and more shape concerns. CONCLUSION: Highlighting the severity of the illness, Singaporean adolescents with AAN presented with physical complications of malnutrition and had more severe eating disorder psychopathology and a higher frequency of other psychological comorbidities than did adolescents with AN.
Singaporean adolescents with atypical anorexia nervosa experience both physical and psychological complications of the illness.
ABSTRACT
OBJECTIVE: This study describes the implementation of family-based treatment (FBT) in an eating disorder program in Asia as well as clinical outcomes of Asian adolescents with anorexia nervosa (AN) treated with FBT. METHOD: This retrospective consecutive cohort study of 147 Asian adolescents with AN was compared between those in FBT (n = 65) versus treatment as usual (TAU) (n = 82). Variables associated with weight restoration were analyzed between groups. RESULTS: Participants' mean age was 14.2 (SD = 1.5) years and 93% were female. Mean presenting %mBMI was 74.0 (SD = 7.8) and average illness duration was 7.7 (SD = 6.1) months. The two groups' baseline characteristics were not significantly different. Weight restoration rates in the FBT group were significantly higher than the TAU group at 6-, 12-, and 24-month time points. A linear mixed model showed the mean %mBMI was significantly higher at 0, 6, 12, and 24 months in the FBT group. The median time to weight restoration for patients on FBT was shorter (FBT: 7.0 months, TAU: 19.0 months; 95% CI [14.5, 23.5] χ2 = 15.84, p < .001). Within the FBT group, those that completed ≥9 FBT sessions had significantly higher rates of weight restoration at 12 months. Across all participants, those with a lower starting %mBMI were less likely to achieve weight restoration by 12 months. CONCLUSION: FBT can be effectively implemented in a multidisciplinary eating disorder program managing Asian adolescents with AN with improved rates of weight restoration. Further research is needed to understand the predictors and moderators of remission using FBT in Asian adolescents with AN.