Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes

Abstract

BackgroundPrevious studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients’ treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology.MethodsA total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change.Results20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors.ConclusionsDespite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0258-z) contains supplementary material, which is available to authorized users.

Predictors of Outcome in Inpatients with Anorexia Nervosa: A Prospective Multi-Center Study

“…Consistent with earlier results, we found the treatment duration to be the strongest predictor [1,4]. This result is not surprising considering the use of therapeutic weight contracts; however, it is important for ongoing discussions of reducing treatment durations.…”

“…Thus, early interventions targeting a young age group might be important [10]. Consistent with the work by Schlegl et al [1], patients with a higher level of education were found to be more vulnerable. Future research should address the role of academic achievement as maintaining factor.…”

“…Nevertheless, the proportion of patients with poor responses in recent naturalistic studies appears to be critically high: more than half of the patients remain underweight (BMI <17.5) at discharge [1,2], and there is a strong need for more effective treatments for inpatients with AN [3]. …”

“…Future research should address the role of academic achievement as maintaining factor. Finally, the significance of BMI at t0 most likely reflects the mechanism of a regression to the mean [1]. …”

Aggregating factors of the change process in the treatment of anorexia nervosa

“…The effectiveness of therapies, especially for more severely affected patients in need of inpatient treatment, is unsatisfying (Keel & Brown, 2010). Upon discharge, only half of these patients fall into a normal weight category (Goddard et al, 2013;Schlegl et al, 2014) and only about one third exhibit clinically significant changes in their eating disorder pathologies (Schlegl et al, 2014). Consequently, there is a great need to further enhance the efficacy of interventions.…”