Screening of adolescent Atypical Anorexia Nervosa in primary care: is the current use of the eating disorders examination a barrier to accessing treatment?

Background General practitioners (GPs) are often the first point of contact for adolescents with eating disorders (EDs) in Australia and play a central role in initiating access to the Medicare-funded Eating Disorders Treatment and Management Plan (EDP). Symptom non-endorsement can hinder GPs’ ability to recognise, diagnose, and enable access to EDPs at primary care, potentially contributing to the low proportion of Australians with EDs receiving treatment or support. This may be particularly relevant for individuals with Atypical Anorexia Nervosa (AAN), who must show elevated self-report symptomology to be eligible for the EDP. However, little is known about the prevalence and characteristics of symptom non-endorsement among adolescents with AAN. Methods Participants were 223 adolescents (92.4% female, 9–18 years) referred from primary care to a public outpatient specialist ED clinic and diagnosed with Anorexia Nervosa (AN) or AAN. Participants completed self-reported measures of ED symptomology and other psychological factors. Results Overall, 25.6% of participants with AN or AAN did not endorse ED symptoms. The prevalence rate did not differ significantly between diagnoses. Additionally, non-endorsers reported significantly lower depressive and anxiety symptoms, less ED-related clinical impairments and ego-syntonic identification with ED symptoms, and greater quality of life than symptom endorsers. Conclusions These findings highlight a critical barrier within primary care, where reliance on self-report symptom endorsement may prevent GPs from identifying and supporting adolescents with AAN through the EDP scheme. Enhancing GP awareness of symptom non-endorsement and revising EDP eligibility criteria may improve early detection and facilitate more equitable access to treatment.