Understanding the nature of anorexia nervosa: typologies and maladaptive schemas
Creators: name: Romagnano, Stephanie
Publisher: name: RMIT University
Year: 2024

description: Anorexia Nervosa (AN) is the most severe eating disorder (ED), affects significantly more females than males, and typically begins during adolescence. The development and maintenance of AN is influenced by the complex interrelationship between a number of factors; some of which relate to eating, weight, and body shape (e.g., body dissatisfaction) and others that may underlie the presentation of these concepts (e.g., perfectionism). The aim of this thesis was to build upon the current theories of the development and maintenance of AN by evaluating the characteristics of adolescent females with AN beyond diagnostic criteria. <br><br>Study 1 investigated whether a group of adolescent females diagnosed with AN or subthreshold AN could be grouped into clinically relevant typologies based upon a range of variables, which were not limited to the diagnostic criteria for AN. A clinical audit was conducted on 39 adolescent females aged between 13 and 18 years. Medical, psychological, behavioural, and family information were collected from case notes, as well as follow-up medical data recorded six months after the initial diagnosis. A two-step cluster analysis derived two clinically distinct typologies. Cluster 1 was characterised by severely underweight patients who reported no clinical elevations on any eating or mental health disturbances. Conversely, Cluster 2 was characterised by healthy weight patients who reported significantly higher levels of eating, psychological, and behavioural problems. Limited follow-up data highlighted that Cluster 1 patients tended to report better outcomes in terms of weight gain and other health outcomes compared to Cluster 2 patients.<br><br>Study 2 assessed the early maladaptive schemas (EMSs) reported by adolescent females, aged between 13 and 18 years, who were diagnosed with AN or subthreshold AN compared with a community group. Thirty-six adolescent females with AN or subthreshold AN were recruited from outpatient hospital and private ED clinics in Melbourne, Australia. The community group comprised 111 female secondary school students. Participants were assessed on EMSs, adaptive and maladaptive personality and behavioural features, and general psychopathology. In general, the AN clinic group reported greater EMSs, general psychopathology, and behaviour problems than the community group. A two-step cluster analysis based upon responses to a general measure of psychopathology and problem behaviours used in both studies derived two AN clusters, which replicated the results of Study 1. Additionally, 32% of the community group had indicated a possible ED, according to results of a brief ED screen, thus, the community group was divided into an At-risk group and Non-ED group. Subsequent analyses showed that: Cluster 2 patients reported the highest level of EMSs and psychopathology; few differences were found between Cluster 1 and Non-ED participants; and At-risk participants reported greater EMSs and psychopathology than Non-ED participants. Six EMSs were found to be characteristic of AN in adolescent females. <br><br>These studies enhance the understanding of AN in adolescent females as identifying the differences between this patient group may facilitate clinicians in understanding their clients from a perspective other than simply their eating pathology and may assist with the application of individualised treatment approaches, which may include schema-focused therapy.<br>