A multicenter audit of outpatient care for adult anorexia nervosa: Symptom trajectory, service use, and evidence in support of “early stage” versus “severe and enduring” classification

Ambwani, Suman; Cardi, Valentina; Albano, Gaia; Cao, Li; Crosby, Ross D.; Macdonald, Pamela; Schmidt, Ulrike; Treasure, Janet

doi:10.1002/eat.23246

Cited by 71 publications

(73 citation statements)

References 52 publications

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“…Third, future research examining multivariate predictive models of treatment outcome needs to be a priority for the field of eating disorders. This reflects the emerging direction of research, where duration is combined with previous treatment experience (Austin et al, 2020;Hay & Touyz, 2018). Scholarly investigation of whether duration adds explanatory value to other predictors is required.…”

Section: Discussionmentioning

confidence: 99%

Relationship between eating disorder duration and treatment outcome: Systematic review and meta‐analysis

Radunz

Keegan

Osenk

et al. 2020

Intl J Eating Disorders

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Objective: This systematic review and meta-analysis examine the contribution of duration to treatment outcome for eating disorders. Method: Studies (n = 31) were identified that examined associations (r) between duration and 45 different outcomes. We were unable to extract r for seven studies (9 outcomes) and extracted r for 36 outcomes across 24 studies (2,349 participants). Indicators of treatment outcome were heterogeneous and thus a series of different meta-analyses, aimed at increasing homogeneity, were conducted. Results: First, we examined the average effect size for one primary eating disorder related outcome from each of the 24 studies. There was no association between duration and treatment outcome (r = .05, 95% CI: −.03:.13), with high heterogeneity. Second, we conducted three subgroup analyses to explore possible sources of heterogeneity (diagnosis: anorexia nervosa versus bulimia nervosa; nature of the outcome: binary versus continuous; or type of outcome: binary indicator of recovery, eating disorder psychopathology, weight gain). There was no significant moderation or associations between duration and outcome (ranging from .02-.08), with low to medium heterogeneity. Third, two stand-alone analyses examined outcomes related to weight gain (n = 8) and eating disorder psychopathology (n = 5), with nonsignificant rs of .23/−.06, respectively. High levels of heterogeneity were present. Discussion: Duration did not influence treatment outcome across any of our metaanalyses. Increasing homogeneity and power will allow more stable estimates of the impact of duration on outcome to be calculated; to this end, future treatment studies should include outcome related to weight gain (anorexia nervosa) and improvements in eating disorder psychopathology. Resumen Antecedentes: Esta revisión sistemática y metaanálisis examinan la contribución de la duración al resultado del tratamiento para los trastornos de la conducta alimentaria. Métodos: Se identificaron estudios (n = 31) que examinaron las asociaciones (r) entre la duración y 45 diferentes resultados. No fue posible extraer r para siete estudios (nueve resultados) y se extrajo r para 36 resultados en 24 estudios (2349 participantes). Los indicadores del resultado del tratamiento fueron heterogéneos y, por lo

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Section: Discussionmentioning

confidence: 99%

Relationship between eating disorder duration and treatment outcome: Systematic review and meta‐analysis

Radunz

Keegan

Osenk

et al. 2020

Intl J Eating Disorders

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“…Available data indicate that treatment outcomes in anorexia nervosa are generally better in adolescents than in adults (Ackard, Richter, Egan, & Cronemeyer, ; Ambwani et al, in press; Calugi, Dalle Grave, Sartirana, & Fairburn, ; Dalle Grave, Calugi, Doll, & Fairburn, ; Fairburn, ). It has been hypothesized that these differences in treatment outcome could be due to the clinical impact of neuroprogression (Treasure, Stein, & Maguire, ) and habit formation (Walsh, ) or to the fact that adolescent patients have more structured social networks and a briefer duration of illness than adults (Calugi et al, ).…”

Section: Introductionmentioning

confidence: 99%

Eating disorder psychopathology in adults and adolescents with anorexia nervosa: A network approach

Calugi

Sartirana

Misconel

et al. 2020

Intl J Eating Disorders

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Objective: The aim of this study was to assess and compare eating disorder feature networks in adult and adolescent patients with anorexia nervosa. Methods: Patients seeking treatment for anorexia nervosa in inpatient and outpatient settings were consecutively recruited from Body mass index was measured, and each patient completed the Eating Disorder Examination Questionnaire. Results: The sample comprised 547 adolescent and 724 adult patients with anorexia nervosa. Network analysis showed that in both adults and adolescents, the most central and highly interconnected nodes in the network were related to shape overvaluation and desiring weight loss. The network comparison test identified similar global strength and network invariance, confirming the similarity of the two network structures. Discussion: The network structures in adult and adolescent patients with anorexia nervosa are similar, and lend weight to the cognitive behavioral theory that overvaluation of shape and weight is the core feature of anorexia nervosa psychopathology. K E Y W O R D S adolescent, adult, desiring weight loss, eating disorder psychopathology, feeling fat, shape overvaluation

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“…Thus, it is important to shift attention to other aspects that could influence treatment outcome. One interesting development is the ‘staging’ of anorexia nervosa: taking into account the duration of the illness and a patient's psychological well being, and hence differentiating between clinical subtypes of anorexia nervosa and personalizing care to improve treatment outcome [ 37 ].…”

Section: Barriers To Implementing Psychological Treatment In Clinicalmentioning

confidence: 99%

Developments in the psychological treatment of anorexia nervosa and their implications for daily practice

Jansingh

Danner

Hoek

et al. 2020

Current Opinion in Psychiatry

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Purpose of review Our aim is to give an overview of the recent literature on psychological treatment for young adults and adults with anorexia nervosa and to discuss the implications of the findings for clinical practice. Recent findings Three systematic reviews and meta-analyses have recently been published on psychological treatments for anorexia nervosa. Treatment outcomes are still modest and mainly focus on weight outcome, although outcomes for eating disorder disease and quality of life have also been reported. Adhering to a treatment protocol might lead to faster and better results. Summary For children and adolescents with anorexia nervosa, the major guidelines recommend a family-based treatment. The treatments of choice for young adults and adults with anorexia nervosa are the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), Cognitive Behaviour Therapy-Enhanced (CBT-E) and Specialist Supportive Clinical Management (SSCM), but none of these treatments seem to be superior. In search of other ways to improve outcome, shared decision making may be a way to help patients become more involved in their treatment, enhance their motivation and consequently improve the outcome.

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A multicenter audit of outpatient care for adult anorexia nervosa: Symptom trajectory, service use, and evidence in support of “early stage” versus “severe and enduring” classification

Cited by 71 publications

References 52 publications

Relationship between eating disorder duration and treatment outcome: Systematic review and meta‐analysis

Relationship between eating disorder duration and treatment outcome: Systematic review and meta‐analysis

Eating disorder psychopathology in adults and adolescents with anorexia nervosa: A network approach

Developments in the psychological treatment of anorexia nervosa and their implications for daily practice

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