Severe and enduring eating disorder (SE-ED) in adolescents: A longitudinal study on risk factors, and evaluation of a novel treatment for those at risk of SE-ED

Research problem and specific questionsAbout 20% of eating disorders (ED) will have a chronic course, called severe and enduring eating disorders (SE-ED), associated with high morbidity and mortality.

Among identified risk factors for SE-ED are early onset of ED, having an overcontrolled personality style, and signs of systemic inflammation.

This project aims to further increase our knowledge about risk factors related to SE-ED, both clinical, psychological and biological, and to evaluate a treatment against maladaptive emotional overcontrol.Data and method1.

A longitudinal data collection in adolescent patients with EDs, including clinical, psychological and biological risk factors, and to evaluate their importance for outcome2.

Evaluate feasibility, acceptability and -3. treatment effect of Radically Open Dialectical Behavior Therapy (RO-DBT), targeting emotional overcontrol, for adolescents with anorexia nervosa who have not responded to evidence-based treatment, and thereby at high risk for SE-EDPlan for project realisation150 patients each year are assessed at the child and adolescent psychiatry (CAP) unit for EDs at Uppsala University Hospital, and will be invited to study 1.

Data will be collected from diagnostic interviews, questionnaires about psychological risk factors such as emotional regulation (ER) difficulties and experience of loneliness, and analyses of biomarkers. With start in 2023, 500 participants will be included.

Assessments will be repeated after 3, 5, 10 and 20-years, and combined with data from national health registers. 18 patients with anorexia who failed to respond to evidence-based treatment will be invited to the RO-DBT study.

In study 2, feasibility and acceptability will be evaluated by assessing e.g., interviews, completion rates and treatment adherence.

In study 3, treatment effect will be evaluated in a controlled single-case experimental design study with multiple baselines.We are applying for grants for a research nurse and for a doctoral student.RelevanceKnowledge about risk factors for SE-ED can give rise to new or improved treatments, and there is a need for new treatments with the capacity to break a chronic course in ED.

This project will increase our knowledge about how psychological and biological risk factors interact through analyses of their unique and shared effects on outcome, and the project will evaluate the effect of RO-DBT for adolescent patients at high risk for SE-ED