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Title: Symptomatology prior to the onset of eating disorders : prodromal eating disorders in adolescents and young adults : systematic review and empirical research project
Author: McClelland, Jess
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2020
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Systematic review: Background: Eating disorders (EDs) are serious illnesses that typically arise in adolescence, are associated with significant comorbidity and in some cases are life-threatening. Prevention and early intervention offer potential in altering the development and course of EDs. In order to improve such strategies, a better understanding of symptoms that precede and indicate ED onset is warranted. Aim: The aim of this review is to explore the development of a broad range of symptomatology (e.g. ED, mood, anxiety) prior to the onset of a clinically diagnosable ED. Specifically, this review aims to address two questions; which symptoms (both ED and other psychiatric disorder-related) exist prior to the onset of an ED and are there any prospective associations between these symptomatology. Methods: Systematic literature reviews were conducted in MEDLINE, Embase and PsychINFO for large, longitudinal, prospective studies in non-clinical cohorts of children/adolescents that report symptoms prior to the onset of an ED. A quality assessment of included studies was conducted using the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Results: A total of 21 studies were included and over half of these were assessed to be of good quality. Studies identified the presence of a range of symptoms prior to ED onset (e.g. body dissatisfaction, dietary restraint and affective symptoms) and possible prospective associations. Conclusions: The trajectory of symptoms identified to precede and possibly predict onset may represent an ED prodrome. Further research is needed to establish these findings and evaluate how best to target this early stage of EDs. Empirical project: Background: Eating disorders (EDs) are serious illnesses, typically affecting adolescents and young adults, with significant comorbidity and sub-optimal outcomes. Early intervention approaches offer potential in deterring the course of EDs. These could be informed by a better understanding of initial symptoms and illness phases, specifically prodromal stages of EDs. Aim: To evaluate the duration, symptomatology and severity of prodromal EDs in adolescents and young adults with recent onset (< 3 years) illness. Methods: Fifty-four participants (28 adolescents, 26 young adults) completed a retrospective onset interview and life chart. Prodromal duration, symptomatology and severity during ED prodrome and at ED onset were compared according to age and diagnosis. Comparability to clinical estimates and the acceptability of the prodromal assessment employed was also explored. Results: When other psychiatric disorder-related symptoms were considered, adolescents had a shorter prodrome and time between ED onset to start of treatment compared to young adults. Additionally, compared to people with AN, those with BN/BED had longer prodrome periods. There were no age or diagnosis-related differences in symptomatology or severity during prodrome or at ED onset. The onset interview and life chart estimated a longer prodrome period than clinical estimates and was experienced positively by participants. Conclusions: When both ED and other psychiatric disorder-related symptoms are considered, prodromal stages of EDs differ according to age and diagnosis. Further research is needed to refine assessment methods of prodromal EDs and establish their utility in informing early intervention research and clinical interventions for EDs.
Supervisor: Schmidt, Ulrike Hermine Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available