Computer-based quality assurance of specialist eating disorder (ED) care is a possible way of meeting demands for evaluating the real-life effectiveness of treatment, in a large-scale, cost-effective and highly structured way. The Internet-based Stepwise system combines clinical utility for patients and practitioners, and provides research-quality naturalistic data. Stepwise was designed to capture relevant variables concerning EDs and general psychiatric status, and the database can be used for both clinical and research purposes. The system comprises semi-structured diagnostic interviews, clinical ratings and self-ratings, automated follow-up schedules, as well as administrative functions to facilitate registration compliance. As of June 2009, the system is in use at 20 treatment units and comprises 2776 patients. Diagnostic distribution (including subcategories of eating disorder not otherwise specified) and clinical characteristics are presented, as well as data on registration compliance. Obstacles and keys to successful implementation of the Stepwise system are discussed, including possible gains and on-going challenges inherent in large-scale, Internet-based quality assurance.

The present study explored treatment satisfaction among eating disorder patients participating in a Swedish multicentre study (N = 469) who had been followed up 36 months after initial assessment. Satisfaction was measured using a questionnaire focusing on initial reception at the treatment unit, suitability of treatment, ability of staff to listen and understand, confidence in the unit and agreement on treatment goals. After 36 months, 38% of patients were ‘highly satisfied’ with treatment, while 39% were ‘satisfied’ and 23% were ‘unsatisfied’. Satisfaction was predicted by treatment interventions focusing on support and increased control of eating problems. Although unsatisfied patients were characterized by significantly higher levels of eating disorder psychopathology and psychiatric symptoms as well as more negative interpersonal profiles at follow‐up, these patients had been virtually indistinguishable from the other groups at initial assessment, with a few notable exceptions. Unsatisfied patients had previously been less prepared to change their eating habits, had higher levels of conflict with their fathers, had a lesser degree of present weight acceptance and tended to expect less from treatment interventions focusing on control of eating problems. It is concluded that, although we may be successful in engaging and satisfying patients who are predisposed to therapeutic strategies focusing on support and control of eating problems, we may be less successful with those who have a greater number of interpersonal problems and who are not as focused on their symptoms of disordered eating. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.

It is important to focus on self-image in the treatment of both diagnostic groups, but especially in anorexia nervosa, where control-submission interactions between patient and therapist should be handled with care.

Although no significant differences in outcome were found between dropouts and completers, greater clinical improvement was found among those who completed treatment. The dropouts examined in this study did well despite premature termination of treatment. Clinical and research implications are discussed.