What we do
About our project
Background
Anorexia nervosa is a severe psychiatric disorder with a heterogeneous course with one of the highest rates of morbidity and mortality of all psychiatric disorders. Little is known about factors that predict both course and treatment outcomes of this disorder.
The BRAVE Study is a longitudinal first-onset anorexia nervosa cohort study focusing on four topics of interest in girls only: (1) behavior, (2) neurobiology, (3) cognitive functions, and (4) physical health.
Objective
The primary aim of the BRAVE Study is to identify predictors of treatment response in a large sample of 12-to-22-year-old females with first-onset typical or atypical anorexia nervosa. The second aim is to longitudinally investigate the association between clinically significant changes in eating disorder symptoms with the underlying behavioral, neurobiological, cognitive and physical health changes. The results of this study will allow us to develop more precise treatment strategies in order to provide more optimal treatment.
Methods
The BRAVE Study implements a longitudinal case-control design. Study recruitment was designed within a collaborative network of 16 Dutch mental health organizations, each with expertise in the diagnosis and treatment of patients with anorexia nervosa. After obtaining informed consent, assessments were performed at baseline and one-year follow-up. Patients with anorexia nervosa received treatment as usual. The primary outcome measures at one year are restoration of weight and a reduction of eating disorder symptomatology. Predictive measures include neurobiological, cognitive, behavioral and physical health measures.
Our research focus
Anorexia nervosa
Anorexia nervosa (AN) is a debilitating psychiatric disorder that commonly presents during adolescence and primarily affects girls and young women. Characteristic features of AN include malnutrition, an intense fear of weight gain, disturbed body image and behaviors associated with a drive for thinness, such as severe dietary restriction, laxative and diuretic usage, and excessive physical activity. The exact etiology of AN is unknown and it is currently considered multifactorial, involving the interplay between genetic and environmental factors.
Illness course and duration
As is true with many psychiatric disorders, the course of AN is heterogeneous. Some patients have relatively short-term illness and recover quite quickly, while other patients have a prolonged illness with multiple hospitalizations and long-term impairment. The mean duration of AN is 4.5 years and 20% of all individuals with AN remain chronically ill. Recovery rates vary depending on the specific criteria used. Generally, weight recovery occurs faster (i.e. 11.3 months) than eating disorder symptomatology (i.e. 22.6 months).
The BRAVE cohort
Currently, clinicians, relatives, or other individuals involved in the care of someone with AN cannot predict their clinical course. This lack of predictability is distressing for the individual, their relatives, and the clinicians involved. Identifying predictors of treatment response and illness duration is therefore a top research priority in the field of eating disorders. It is within this framework that we initiated a first-onset study recruiting girls and young women who fit the broader spectrum of first-onset AN. We also recruited a similar number of typically developing (TD) girls and young women without AN. The aim of the BRAVE study is twofold: 1) To identify predictors of one-year treatment response; 2) To investigate over time the association between clinically significant changes in the symptoms of AN with the underlying behavioral, neurobiological, cognitive and physical health changes. Eating disorder symptoms and BMI-SDS are defined as the primary longitudinal outcomes.
Funds & Grants
This work was supported by funding of Stichting tot Steun VCVGZ, the Sophia Foundation for Scientific Research (SSWO) (Grant Numbers: S15-13, S22-65) and through financial support of an internal Erasmus MC grant of the department of Radiology and Nuclear Medicine of the Erasmus University Medical Center. The work of TW was supported by the Intramural Research Program from the National Institutes of Mental Health. We are also very grateful for the financial contribution of the Stichting Vogelgezang, which made it possible to complete our follow-up measurements.
Collaborations
Internal collaborations
The department of Radiology and Nuclear Medicine.
External collaborations
The BRAVE Study is conducted by the Erasmus Medical Center in close collaboration with Altrecht-Rintveld, Bravis Hospital, Curium-LUMC, Elisabeth-TweeSteden hospital, Emergis, Emergis-Ithaka, GGNet-Amarum, GGZ Delfland, GGZ-Rivierduinen, GGZ-WNB, Franciscus Gasthuis and Vlietland hospital, Reinier de Graaf Gasthuis, Stichting Human Concern and The Van Weel Bethesda hospital.
Publications
The implications of the COVID-19 pandemic on eating disorder features and comorbid psychopathology among adolescents with anorexia nervosa and matched controls: a comparative cohort design study. Bracke, K., Steegers, C., van der Harst, T., Pons, R., Legerstee, J., Dierckx, B., de Nijs, P., Bax-van Berkel, M., van Elburg, A., Hekkelaan, M., Hokke, J., de Jong-Zuidema, H., Altes, L. K., Lengton-van der Spil, F., Luijkx, J., Schuurmans, F., Smeets, C., van Wijk, L., Woltering, C., ... Dieleman, G. (2024). Eating and Weight Disorders, 29(1), Article 13. https://doi.org/10.1007/s40519-024-01640-0
Resting-state Functional Connectivity in Female Adolescents with First-onset Anorexia Nervosa Compared to Healthy Controls. Bracké, K., Dieleman, G., Dias, L., Steegers, C., Dremmen, M., Vernooij, MW., & White, TJH. (2023). Journal of the American Academy of Child and Adolescent Psychiatry, 62(10), S167. Article 1.37. https://doi.org/10.1016/j.jaac.2023.09.044
