A naturalistic comparison of two inpatient treatment protocols for adults with anorexia nervosa: Does reducing duration of treatment and external controls compromise outcome?

Abstract

Objective Although hospitalization is sometimes necessary when treating individuals with anorexia nervosa, the available literature provides limited guidance to inform decisions surrounding optimal components or duration of inpatient treatments. We report observational data comparing outcomes of two inpatient treatments. The first was longer and more strictly structured around a Contingency Management Protocol (CMP) emphasizing external incentives for achieving weight‐restoration goals; the second was a shorter Autonomy Support Protocol (ASP) that progressively increased patient autonomy around meal management without external incentives. Method We compared data from 41 patients who participated in the ASP to a historical sample of 41 patients treated using the CMP. At admission, discharge, and post‐treatment follow‐up, participants completed the Eating Disorder Examination Questionnaire and the Behavior and Symptom Identification Scale‐32, and we measured height and weight to compute body mass index. Results Multilevel modeling analyses that controlled for time in treatment and time in follow‐up indicated the two protocols yielded equivalent in‐treatment gains and post‐treatment loss of gains. Discussion Our results indicate that shorter inpatient stays emphasizing autonomous control over eating behavior may yield outcomes that are equivalent to those of lengthier, more stringent, and more costly approaches implicating external incentives and controls.

Time trends in treatment modes of anorexia nervosa in a nationwide cohort with free and equal access to treatment

“…In a Cochrane review of four trials including a total of 511 patients there was no clinically relevant difference between specialist inpatient care and outpatient care in weight gain at 12 months after start of treatment (Hay et al, 2019). The same conclusion was drawn from a recent observational study, where the AN outcome of long-term strictly structured hospitalization was not superior to the outcome of a shorter stay with progressively increased patient autonomy around meal management without external incentives (Paquin Hodge et al, 2019). Long-term stays may lead to fewer admissions, simply because re-admission is possible only when the patient has been discharged.…”

A Retrospective Literature Review of Eating Disorder Research (1990–2021): Application of Bibliometrics and Topical Trends

“…Comparative validity of the Chinese versions of the bulimic inventory test Edinburgh and eating attitudes test for DSM-IV eating disorders among high school dance and nondance students in Taiwan [43] T20 AN An audit of a British sample of death certificates in which anorexia nervosa is listed as a cause of death [62] T43 Purge behavior The use of multiple purging methods as an indicator of eating disorder severity [63] T42 Birth Season of birth bias and anorexia nervosa: Results from an international collaboration [64] T30 Risk of comorbidity Suicidality in adolescents and adults with binge-eating disorder: Results from the national comorbidity survey replication and adolescent supplement [65] T35 Abuse Trait-defined eating disorder subtypes and history of childhood abuse [66] T6 Bulimic symptom Anger and bulimic psychopathology among nonclinical women [67] Treatment T32 Syndrome A case report of Usher's syndrome and anorexia nervosa [68] T21 Metabolism Plasma tryptophan levels and anorexia in liver cirrhosis [69] T11 Medical complication Digestive complication in severe malnourished anorexia nervosa patient: a case report of necrotizing colitis [70] T44 Inpatient treatment A naturalistic comparison of two inpatient treatment protocols for adults with anorexia nervosa: Does reducing duration of treatment and external controls compromise outcome? [71] T3 BMI Body composition and menstrual status in adults with a history of anorexia nervosa-at what fat percentage is the menstrual cycle restored? [72] T38 Weight change Elevated pre-morbid weights in bulimic individuals are usually surpassed post-morbidly: Implications for perpetuation of the disorder [73] Social factors T5 Technology User-centered design for technology-enabled services for eating disorders [41] T9 Special care The use of guidelines for dissemination of "best practice" in primary care of patients with eating disorders [74] T10 Economic impact Key factors that influence government policies and decision making about healthcare priorities: Lessons for the field of eating disorders [75] T14 Social impact Eating disorders treatment experiences and social support: Perspectives from service seekers in mainland China [76] Table 3.…”