Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature

Amelia Austin; Michaela Flynn; Katie Richards; John Hodsoll; Tiago Antunes Duarte; Paul Robinson; Jonathan Kelly; Ulrike Schmidt

doi:10.1002/erv.2745

Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature

Eur Eat Disord Rev. 2021 May;29(3):329-345. doi: 10.1002/erv.2745. Epub 2020 Jun 23.

Authors

Amelia Austin¹, Michaela Flynn¹, Katie Richards¹, John Hodsoll², Tiago Antunes Duarte³, Paul Robinson⁴, Jonathan Kelly⁵, Ulrike Schmidt^{1

6}

Affiliations

¹ Section of Eating Disorder, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
² Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
³ Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal.
⁴ Division of Medicine, University College London, London, UK.
⁵ Beat, Norwich, UK.
⁶ South London and Maudsley NHS Foundation Trust, London, UK.

PMID: 32578311
DOI: 10.1002/erv.2745

Abstract

Objective: This systematic review assesses the average duration of untreated eating disorder (DUED) in help-seeking populations at the time of first eating disorder (ED) treatment and investigates the relationship between DUED and symptom severity/clinical outcomes.

Method: PRISMA guidelines were followed throughout. Selected studies provided information on either: (i) length of DUED, (ii) components of DUED, (iii) cross-sectional associations between DUED and symptom severity, (iv) associations between DUED and clinical outcomes, or (v) experimental manipulation of DUED. Study quality was assessed.

Results: Fourteen studies from seven countries were included. Across studies, average DUED weighted by sample size was 29.9 months for anorexia nervosa, 53.0 months for bulimia nervosa and 67.4 months for binge eating disorder. A younger age at time of first treatment was indicative of shorter DUED. Retrospective studies suggest that a shorter DUED may be related to a greater likelihood of remission. Manipulation of DUED by shortening service-related delays may improve clinical outcomes.

Conclusions: Data on length of DUED provide a benchmark for early intervention in EDs. Preliminary evidence suggests DUED may be a modifiable factor influencing outcomes in EDs. To accurately determine the role of DUED, definition and measurement must be uniformly operationalised. Highlights This systematic review is the first to examine duration of untreated eating disorder (DUED) across different eating disorders. Definitions and measurement of DUED and its components vary considerably between studies. Across different eating disorders average DUED weighted by sample size ranges from approximately two and a half years (for anorexia nervosa) to nearly 6 years (for binge eating disorder). DUED appears to be related to age such that younger patients have shorter DUED.

Keywords: anorexia nervosa; bulimia nervosa; duration of untreated illness; early intervention; eating disorder.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Anorexia Nervosa* / diagnosis
Anorexia Nervosa* / therapy
Binge-Eating Disorder* / diagnosis
Binge-Eating Disorder* / therapy
Bulimia Nervosa* / therapy
Cross-Sectional Studies
Feeding and Eating Disorders* / therapy
Humans
Retrospective Studies

Grants and funding

DH_/Department of Health/United Kingdom