Diagnostic evolution and symptomatic development of eating disorders: A retrospective study

Diagnoses of eating disorders often evolve over time, yet research in China is scarce. Thus, this study aims to explore the evolution of eating disorder diagnoses and symptom development characteristics in the Chinese cultural context through high-quality retrospective examination, and to analyze risk factors for common symptom development.

A retrospective analysis of patients diagnosed with eating disorders from 2019 to 2024 with a disease course exceeding two years. Data on age at onset, BMI, symptom onset, and other relevant variables were collected by reviewing outpatient medical records to determine longitudinal symptom progression and diagnostic shifts. A multifactorial cox proportional hazards model was constructed incorporating variables such as age of onset, sex, family history, self-harm, and amenorrhea to predict binge eating in restrictive eating disorder.

Among 128 outpatients with eating disorders, 50.8 % experienced diagnostic shifts, predominantly from restrictive anorexia to binge-purge types, with complex symptom evolution in the majority. Survival analysis indicates that self-harm behavior significantly affects survival time compared to no self-harm (HR = 1.534, 95 %CI = 1.012-2.325, p = 0.044), and amenorrhea significantly affects survival time compared to no amenorrhea (HR = 0.565, 95 % CI = 0.373-0.855, p = 0.007).

In the Chinese cultural context, diagnostic shifts and symptom overlaps across eating disorder subtypes are observed, potentially indicating a natural progression of clinical phenomena. Assessment of self-harm and amenorrhea is crucial in the early diagnosis and treatment of eating disorders, particularly in patients with restrictive eating behaviors.