Eating disorders in adolescents and young adults : diagnosis, occurrence, treatment, and outcome
Year: 2021
Type: dissertation
Study design: Observational Study
Abstract: Background and aims: Eating disorders are severe mental health issues that undermine psychological and physical health and quality of life. This thesis aimed to investigate the occurrence of eating disorders in a community sample of adolescents and young adults. Eating disorders were defined using the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A second major aim was to describe how often individuals with eating disorders were detected and received treatment and what kind of treatment was offered. Finally, the natural course and outcome of different subcategories of eating disorders were also examined. Methods: The study used two population-based Finnish twin datasets and one clinical dataset. FinnTwin12 followed all twins born in Finland between 1983 and 1987, whereas FinnTwin16 followed all twins born between 1975 and 1979, from adolescence to adulthood. From the FinnTwin12 data, we studied the occurrence, detection and treatment of eating disorders in health care and the natural course of these diseases. From the FinnTwin16 data, we examined the effects of diagnostic changes on the occurrence and prognosis of anorexia nervosa. From the clinical data of the Helsinki and Uusimaa Hospital District (HUS) Adolescent Psychiatry Eating Disorders Unit, we examined the treatment and prognosis of adolescents with typical and atypical anorexia nervosa. In all studies, we analysed the outcome of eating disorders using survival analysis. Results: Eating disorders were common. Up to one in 6 females and 1 in 40 males had suffered from an eating disorder during their development towards adulthood. Changes in diagnostic criteria increased the lifetime prevalence of anorexia nervosa by more than half and increased diagnostic heterogeneity. Overall, anorexia nervosa and related subthreshold symptoms were prevalent among females: One in 10 young women had suffered from a restrictive eating disorder by early adulthood. We also found that eating disorder symptoms in a community setting were diverse, and many reported eating disorder symptoms that could not be clearly labelled. This was particularly true among boys and men. Many individuals with eating disorders also described an unmet need for care; healthcare professionals diagnosed only one-third and even fewer received treatment. In addition, eating disorder symptoms were highly persistent: Five years after disease onset, less than two-fifths of the females and two-thirds of the males had recovered. The likelihood of recovery was similar between those who had and who had not received treatment, but more severe cases were more likely to receive treatment. Conclusions: Overall, this thesis showed that eating disorders are common, and their symptoms are highly diverse among Finnish adolescents and young adults. Considering the magnitude of the problem, detection and treatment approaches for eating disorders are still inadequate and mainly focused on typical presentations of eating disorders. In addition, eating disorder symptoms often persisted for years. Future research should determine how the prevention and detection of eating disorders could be improved in Finland. The threshold for access to treatment should also be lowered, and additional interventions should be developed. Future studies should investigate whether these actions could eventually lead to better outcomes.
Source: Työväentutkimus Vuosikirja
Author: Silén, Yasmina
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7046894433