Predictors of resumption of menses in Anorexia Nervosa: A four-year longitudinal study.

 Objective: Amenorrhea is a disabling medical consequence of Anorexia Nervosa (AN), therefore resumption of menses (ROM) represents an important goal in the treatment of these patients. The aim of the present study was to evaluate possible clinical, psychopathological and biological predictors of ROM, including age, BMI (Body Mass Index), AN subtype, childhood abuse, duration of illness, general and Eating Disorder (ED) specific psychopathology and sexual hormones. Methods: Fifty amenorrhoeic patients with AN were enrolled. Baseline clinical data and information regarding childhood abuse were collected. Questionnaires to evaluate general and ED-specific psychopathology were administered, and blood samples were drawn. All patients received treatment as usual and underwent regular follow-up visits for four years or until ROM. Time to ROM, BMI at last evaluation and data regarding diagnostic cross-over into bulimia nervosa were collected. Results: Twenty-nine (58.0%) patients recovered menses. Diagnostic cross-over was associated with a higher probability of ROM (odds ratio=10.3, p=0.030). Time-to-event analysis showed that a shorter duration of illness (χ(1)=11.00, p=0.001), binge-eating/purging subtype (χ(1)=7.01, p=0.008), and history of childhood abuse (χ(1)=4.03, p=0.045), were associated with an earlier ROM. Furthermore, higher baseline ED-specific psychopathology was associated with reduced likelihood for ROM, whereas higher general psychopathology and follicle-stimulating hormone levels predicted an earlier ROM (all p<0.050). Age, BMI, luteinizing hormone, and oestrogen hematic levels had no predictive value with respect to ROM. Conclusions: The present study provides data in support of an integrated model, emphasising the importance of duration of illness, childhood abuse and psychopathological characteristics of amenorrhoeic patients with AN in predicting ROM. Psychosom Med. 2020 Aug 12. doi: 10.1097/PSY.0000000000000849. Online ahead of print. PMID: 32796334

September 2020 EDReferral