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Comorbid depression and anxiety in childhood and adolescent anorexia nervosa: Prevalence and implications for outcome

Authors

  • Elizabeth K. HUGHES

    Corresponding author
    1. Department of Paediatrics, University of Melbourne
    2. Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
      Elizabeth K. Hughes, Centre for Adolescent Health, The Royal Children's Hospital, Parkville, VIC 3052, Australia. Email: libby.hughes@rch.org.au
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  • Funding: Supported by The Baker Foundation and the Victorian Government's Operational Infrastructure Support Program.

  • Conflict of interest: None.

Elizabeth K. Hughes, Centre for Adolescent Health, The Royal Children's Hospital, Parkville, VIC 3052, Australia. Email: libby.hughes@rch.org.au

Abstract

Background:  Comorbid conditions are common in individuals with anorexia nervosa (AN) and can raise issues for diagnosis, prognosis, and treatment planning.

Methods:  First, reported prevalence rates for depression and anxiety in children and adolescents with AN were reviewed. Diagnostic issues and current understanding of the temporal onset and interrelatedness of depression, anxiety, and AN were discussed. Second, existing research on the implications of comorbid depression and anxiety for outcomes related to AN was reviewed with the aim of identifying whether, and to what degree, comorbidity may impact outcomes including recovery. Finally, implications for clinical practice and recommendations for future research were outlined.

Results:  Although reported rates vary, comorbid depression and anxiety disorders are common in children and adolescents with AN. While research suggests that depression tends to onset subsequent to AN and abates with weight restoration, anxiety tends to pre-date eating disorder onset and to persist post recovery. There is currently insufficient evidence, particularly with children and adolescents, to conclude that these conditions necessarily disrupt engagement in treatment or foreshadow a poorer prognosis.

Conclusions:  Continued research is needed in understanding how depression and anxiety may relate to eating disorder presentation in the younger years and potentially impact on the treatment process.

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