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Patterns of diagnostic transition in eating disorders: a longitudinal population study in Sweden

Published online by Cambridge University Press:  18 June 2018

Katherine Schaumberg ,
Andreas Jangmo ,
Laura M. Thornton ,
Andreas Birgegård ,
Catarina Almqvist ,
Claes Norring ,
Henrik Larsson  and
Cynthia M. Bulik Open the ORCID record for Cynthia M. Bulik [Opens in a new window]
Katherine Schaumberg
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Andreas Jangmo
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Laura M. Thornton
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Andreas Birgegård
Affiliation:
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
Catarina Almqvist
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
Claes Norring
Affiliation:
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden Stockholm Centre for Eating Disorders, Stockholm, Sweden
Henrik Larsson
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Cynthia M. Bulik*
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
*
Author for correspondence: Cynthia M. Bulik, E-mail: cbulik@med.unc.edu
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Abstract

Background

Transition across eating disorder diagnoses is common, reflecting instability of specific eating disorder presentations. Previous studies have examined temporal stability of diagnoses in adult treatment-seeking samples but have not uniformly captured initial presentation for treatment. The current study examines transitions across eating disorder diagnostic categories in a large, treatment-seeking sample of individuals born in Sweden and compares these transitions across two birth cohorts and from initial diagnosis.

Methods

Data from Swedish eating disorders quality registers were extracted in 2013, including 9622 individuals who were seen at least twice from 1999 to 2013. Patterns of remission were examined in the entire sample and subsequently compared across initial diagnoses. An older (born prior to 1990) and younger birth cohort were also identified, and analyses compared these cohorts on patterns of diagnostic transition.

Results

Although diagnostic instability was common, transition between threshold eating disorder diagnoses was infrequent. For all diagnoses, transition to remission was likely to occur following a diagnosis state that matched initial diagnosis, or through a subthreshold diagnostic state. Individuals in the younger cohort were more likely to transition to a state of remission than those in the older cohort.

Conclusions

Results indicate more temporal continuity in eating disorder presentations than suggested by previous research and highlight the importance of early detection and intervention in achieving remission.

Keywords

Anorexia nervosabinge-eating disorderbulimia nervosaclassificationcrossoverdiagnosiseating disorders
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 5 , April 2019 , pp. 819 - 827
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

*

These authors contributed equally to this work.

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