Inpatient treatment of anorexia nervosa in adolescents: A 1‐year follow‐up study

Abstract

Objective: Inpatient treatment effectively increases body weight and decreases eating disorder symptoms in adolescents with anorexia nervosa (AN). However, there is a high risk of relapse within the first year after discharge, which calls for investigating long-term treatment success and its moderators. Method: Female adolescent inpatients with AN (N ¼ 142) were assessed, of which 85% participated at 1-year follow-up. Dependent variables were body mass index percentiles, eating disorder symptoms, depressive symptoms, compulsive exercise and life satisfaction. Results: On average, body weight increased and eating disorder symptoms and depressive symptoms decreased from admission to discharge and remained stable at follow-up. Compulsive exercise decreased and life satisfaction increased from admission to discharge and even improved further at follow-up. Age, duration of illness, previous inpatient treatments, length of stay and readmission after discharge moderated changes in several outcome variables. Conclusions: This study confirms the high effectiveness of inpatient treatment for adolescents with AN and demonstrates that treatment effects remain stable or even improve further within the first year after discharge. However, subgroups of patients (e.g., those with an older age, longer duration of illness, and previous inpatient treatments) require special attention during inpatient treatment and aftercare to prevent relapse. K E Y W O R D S adolescents, anorexia nervosa, inpatient treatment, moderators, treatment outcome 1 | INTRODUCTION AND AIMS Anorexia nervosa (AN) is an eating disorder marked by restriction of energy intake-which leads to a significantly low body weight-intense fear of gaining weight and body image disturbance (American Psychiatric Association, 2013). Although AN can occur at any age, the highest incidence rates can be found in adolescence (Zipfel, Giel,

Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria

“…Fully or partially remitted patients were at younger age with an earlier onset of the eating disorder, had a higher BMI percentile at admission, and less eating disorder symptoms. This goes in line with the current literature that younger patients with a higher BMI at admission, shorter illness duration, and lower eating disorder severity have a better treatment response, outcome, and prognosis [37,59,[64][65][66]68]. Thus, our results confirm the current recommendations of early recognition, diagnosis and treatment start to prevent an enduring course also in patients without psychiatric comorbidities [3,25,26].…”

“…The highest effect sizes were found for increase in BMI which are comparable to the effects found for other inpatient treatments [14,31,37,[39][40][41]43,46,75]. Similarly, the effects on restraint eating and eating concerns are in line with findings from previous studies [14,31,37,40,[43][44][45].…”

“…The highest effect sizes were found for increase in BMI which are comparable to the effects found for other inpatient treatments [14,31,37,[39][40][41]43,46,75]. Similarly, the effects on restraint eating and eating concerns are in line with findings from previous studies [14,31,37,40,[43][44][45]. Noteworthy, lower effects (some of them having reached statistical significance, some of them not) were observed for outcomes assessing weight/shape concerns, drive for thinness, body dissatisfaction, ineffectiveness, asceticism, maturity fears as well as for outcomes related to temperament (e.g., perfectionism, impulse regulation).…”

“…The complex phenomenology of this illness and its long enduring course of over 20 years in more than half of those affected, requires specially adapted treatment concepts to increase remission and recovery rates [1,3,5,24]. Current treatment guidelines tors to increase insight into the mechanisms of AN in order to improve current treatment interventions [37,40,[58][59][60][61][62][63]. However, the current evidence does not yet provide a sufficient picture on the factors relevant for favorable treatment outcome on the one hand [22,24,54,64,65], and optimal length of inpatient stay on the other hand [33][34][35][36], primarily due to the inconsistent results and high heterogeneity of the methods used.…”

A Comprehensive Review of Complications and New Findings Associated with Anorexia Nervosa

“…Severe AN is defined by a BMI of <15 kg/m 2 . For adolescents, inpatient treatment of AN has been shown to be highly effective, with sustained increases in body weight and decreases in eating disorder symptoms found at one-year follow-up [30]. Due to a lack of insight into the severity of the disease among patients, involuntary treatment may be indicated [31].…”