Delusional intensity as a prognostic indicator among individuals with severe to extreme anorexia nervosa hospitalized at an acute medical stabilization program

Abstract

Objective: Eating disorder-related beliefs among individuals with anorexia nervosa (AN) often approach delusional intensity. Research to date on delusional beliefs in AN has been cross sectional. Thus, it is unknown how the intensity of delusional beliefs changes over time and if such change has prognostic value. Method: We assessed 50 individuals with severe to extreme AN (≥18 years old; M [SD] body mass index =12.7[1.3] kg/m 2 ) at an inpatient medical stabilization facility within 96 hr of admission; 35 (70%) also completed the assessment at discharge (M [SD] = 25.53[13.21] days). Participants completed the Brown Assessment of Beliefs Scale and a battery of self-report measures of eating disorder-related psychopathology.Results: The admission-to-discharge decrease in delusional intensity was not significant (p = .592; Hedges g = .10). Tests of predictive effects indicated that higher delusional intensity at intake predicted higher fear of fatness and restrictive eating, two hallmark features of AN, but not BMI, body checking, feared food avoidance, eating disorder-related impairment, depression, binge eating, or purging behavior at discharge.Discussion: Although the delusional intensity of eating disorder beliefs did not significantly improve over this relatively brief interval, delusional intensity may be associated with the severity of central eating disorder attitudes and behaviors. Delusional intensity may therefore be a negative prognostic indicator, possibly warranting further treatment. Future research should examine changes in delusional intensity over longer intervals and test whether specifically targeting delusional beliefs improves treatment outcomes among individuals with AN.

Delusions in Anorexia Nervosa

“…Consistent with the results of qualitative research (O'Connell et al, 2018), some beliefs also related to biological exceptionality (e.g. "If I eat, I won't be able to go to the bathroom because my body can't process food") (Kambanis et al 2022).…”

“…Several studies have attempted to quantitively assess these differences in belief strength by employing the BABS, concluding that while some patients exhibit strong enough conviction in their body size beliefs to be considered delusional, most do not hold their beliefs with delusional strength, instead being classified as holding overvalued ideas, or exhibiting good insight (Barton et al, 2022;De Young et al, 2022;Hartmann, Thomas, Wilson, & Wilhelm, 2013;Kambanis et al, 2022;Konstantakopoulos, Ioannidi, Patrikelis, & Gonidakis, 2020;Konstantakopoulos et al, 2012;G. McKenna, Fox, & Haddock, 2014;Mountjoy, Farhall, & Rossell, 2014;Şenay & Yücel, 2022;Steinglass, Eisen, Attia, Mayer, & Walsh, 2007).…”

“…Other prompts are similarly open ended, for example, "What ideas or beliefs do you have that are of significant concern to you, specifically about food, eating, or your body shape or weight?" (De Young et al, 21;Kambanis et al, 2022). Unfortunately, some studies do not report the prompt they used (Hartmann et al, 2013;McKenna et al 2014;Barton et al, 2022) and only three report the kinds of belief-content that were studied.…”

Inpatient treatments for adults with anorexia nervosa: a systematic review of literature

“…Data about the different populations of patients analyzed in the single studies are available in Table 1 . While not every study provided details on the gender of the patients, 97.55% of the population in 24 studies were female [ 31 , 33 – 50 , 52 – 56 ]. Employment status was reported in five studies [ 30 , 40 , 42 , 44 , 48 ], revealing that about 47.5% were students, 25.67% were employed, and 15.72% were unemployed.…”

“…In patients with BMI < 13 enteral nutrition via NGT during the first 48 h. Initial enteral caloric intake 10 kcal/kg. Objective of caloric intake 30 kcal/kg/day 18 Yamazaki et al 2021 [ 47 ] 13.58 n.r n.r Expected weight gain 1 kg/week, usage of supplementary enteral nutrition 19 Smith et al 2021 [ 48 ] n.r n.r n.r n.r 20 Dauty et al [ 49 ] 13.80 1.00 n.r > 500 g per week , weight monitoring twice a week, NGT at entry > 1500 kcal × 36 gg approximately, dietary consultations once per week, supervised meals 21 Young et al [ 50 ] 12.70 n.r n.r n.r 22 Fouladi et al [ 51 ] 14.60 5.33 n.r 3200–3400 kcal at discharge 23 Funayama et al [ 52 ] 13.40 n.r n.r Mainly oral nutritional rehabilitation, intravenous feeding sometimes used, less frequently NGT. Initial caloric prescription 600–1400 kcal/day, increased by 200 kcal/day.…”