Retrospective maternal report of early eating behaviours in anorexia nervosa

Eating disorder symptom non-endorsers in hospitalised patients with anorexia nervosa: Who are they?

OBJECTIVE

Impaired insight and illness denial are common in anorexia nervosa (AN). Missing an AN diagnosis may delay treatment and negatively impact outcomes.

METHOD

The current retrospective study examined the prevalence and characteristics of AN symptom non-endorsement (i.e., scoring within the normal range on the Eating Disorder Examination Questionnaire [EDE-Q] or the Eating Disorder Examination [EDE] interview) in three independent samples of hospitalised patients with AN (N1 = 154; N2 = 300; N3 = 194). A qualitative chart review of a subsample of non-endorsers (N4 = 32) extracted reports of disordered eating behaviours observed by the treatment team.

RESULTS

The prevalence of non-endorsement ranged from 11% to 34% across sites. Non-endorsers were more likely to be diagnosed with AN restricting type (AN-R) and reported fewer symptoms of co-occurring psychopathology than endorsers. Groups benefitted equally from treatment. The qualitative chart review indicated that objective symptoms of AN were recorded by staff in over 90% of non-endorsers.

CONCLUSIONS

Eating disorder symptom assessments using the EDE-Q or EDE may miss symptomatology in up to a third of individuals hospitalised with AN. This study highlights the potential utility of multi-modal assessment including patient interviews, collateral informants, and behavioural observation to circumvent non-endorsement.

Trajectories of picky eating during childhood: A general population study

OBJECTIVE

This cohort study describes the prevalence of picky eating and examines prognostic factors for picky eating trajectories during childhood.

METHODS

4,018 participants of a population-based cohort with measurements from pregnancy onwards were included. Picky eating was assessed by maternal report when children were 1.5, 3, and 6 years old. The associations of child and family characteristics with trajectories of picky eating were examined using logistic regression. Never picky eaters were used as the reference group.

RESULTS

Prevalence of picky eating was 26.5% at 1.5 years of age, 27.6% at the age of 3 and declined to 13.2% at 6 years. Four main picky eating trajectories were defined: (1) never picky eating at all three assessments (55% of children), (2) remitting (0-4 years, 32%), (3) late-onset (6 years only, 4%), and (4) persistent (all ages, 4%). This implies that almost two thirds of the early picky eaters remitted within 3 years. Male sex, lower birth weight, non-Western maternal ethnicity, and low parental income predicted persistent picky eating. More often late-onset picky eaters were children of parents with low income and non-Western ethnicity.

DISCUSSION

We found that nearly half (46%) of children were picky eaters at some point during early childhood. Remittance was very high. This suggests that picky eating is usually a transient behavior and part of normal development in preschool children. However, a substantial group of persistent picky eaters, often from a socially disadvantaged background, continues to have problems beyond the preschool age.