Background An early psychotherapeutic treatment of anorexia nervosa (AN) is crucial for a good prognosis. In order to improve treatment initiation, knowledge about facilitators and barriers to treatment is needed. Objective Against this background, we aimed to identify facilitators and barriers from the perspectives of patients, carers and professionals using a qualitative approach. Method To this end, semi-structured interviews were conducted in triads of female patients with AN aged 14 years and older at the beginning of their first psychotherapeutic treatment, their carers, and referring health care professionals. A modified Grounded Theory approach was used for analysis. Results In total, 22 interviews were conducted (n = 6 adults, n = 4 adolescents, 4 full triads). The duration of untreated AN ranged between 30 days and 25.85 years (M = 3.06 ± 8.01 years). A wide spectrum of facilitators and barriers within the patient, the social environment, the health care system and the society were identified. Most prominent factors were ‘recognizing and addressing’ by close others, ‘waiting times and availability’ and ‘recommendations and referrals’ by health care professionals. ‘Positive role models for treatment’ were perceived as a specific facilitative social influence. Facilitators were more frequently mentioned than barriers and most of the factors seem to hold potential for modifiability. Conclusion Overall, the findings suggest that early intervention approaches for AN should not only address patients and the health care system, but may also involve carers and successfully treated former patients. Trial registration ClinicalTrials.gov Identifier: NCT03713541.

The authors developed a concept that applies self-organization theory to psychodynamic principles. According to this concept, episodes of temporary destabilization represent a precondition for abrupt changes within the therapeutic process. The authors examined six courses of therapy (patients diagnosed with depression and personality disorder). After each therapy session, patients rated their experience of the therapeutic interaction. A measure of instability was used to identify episodes of destabilization with respect to patients' interaction experience throughout the process. Episodes of pronounced destabilization occurred in the four courses of therapy that showed better therapy outcomes. These episodes were characterized by temporary strong deteriorations in interaction experience (negative peaks). Three of the four courses showed subsequent discontinuous improvements to a higher level of interaction. Results indicate that the systematic inclusion of a measure of instability is worthwhile in investigations of discontinuous changes. This method allows the theoretical assumptions of the psychodynamic approach to be tested.

BackgroundThe length of stay (LOS) strongly influences anorexia nervosa (AN) inpatient weight outcomes. Hence, understanding the predictors of LOS is highly relevant. However, the existing evidence is inconsistent and to draw conclusions, additional evidence is required.MethodsWe conducted a prospective, multi-center study including adult female inpatients with AN. Using stepwise linear regression, the following demographic and clinical variables were examined as potential predictors for LOS: admission BMI, AN-subtype, age, age of onset, living situation, partnership status, education, previous hospitalization, self-rated depression, anxiety and somatic symptoms (PHQ-9, PHQ-15, GAD-7), self-rated therapy motivation (FEVER) and eating disorder psychopathology (EDI-2 subscale scores).ResultsThe average LOS of the sample (n = 176) was 11.8 weeks (SD = 5.2). Longer LOS was associated with lower admission BMI (ß = −1.66; p < .001), purging AN-subtype (ß = 1.91; p = .013) and higher EDI-2 asceticism (ß = 0.12; p = .030). Furthermore, differences between treatment sites were evident.ConclusionsBMI at admission and AN-subtype are routinely assessed variables, which are robust and clinically meaningful predictors of LOS. Health care policies might consider these variables. In light of the differences between treatment sites future research on geographical variations in mental health care seems recommended.

Objective: We aimed to provide a comprehensive overview of the role of self-esteem in the treatment of patients with anorexia nervosa (AN). Specifically, our objectives were to investigate the differences in self-esteem between individuals with AN and healthy controls, or individuals with other eating disorders, and to examine self-esteem as an outcome, predictor, moderator, and mediator in AN treatment.Method: The databases PsycINFO, PSYNDEXplus, Ovid MEDLINE ® , and ProQuest were searched for studies published from 1990 to 2018. To estimate aggregated effect sizes, we performed random-effects meta-analyses.Results: A screening of 1,596 abstracts and 203 full-texts identified 68 relevant publications.Results suggest a significantly lower global self-esteem in individuals with AN than in healthy