Adults with chronic eating disorders. Two-year follow-up after inpatient treatment

Abstract

Objective: The aims of this prospective study were (1) to report on the 2-year outcome of chronically ill adult eating disorder patients, (2) to investigate whether a specialized inpatient treatment might influence the course of the illness, and (3) to search for prognostic factors. Method: Seventy-two patients were treated in a 4-5-month specialized group treatment programme for chronically ill adults with eating disorders. Sixty-five (90%) with mean age of 30 years were available for the follow-up assessment. Results: Forty-six (71%) patients had improved at the 2-year follow-up and 17 (26%) did not meet diagnostic criteria for an eating disorder. The symptom reductions per time were statistically significantly larger during the inpatient period compared to the waiting-list and follow-up periods. No significant predictors of treatment outcome were found. Patients with avoidant personality disorder had a higher level of distress at all times, but improved at the same rate as the others. Conclusion: At the 2-year follow-up, there were substantial reductions in eating disorder symptoms and general psychiatric symptoms. Most of the improvement occurred during inpatient treatment, which might be an option for chronic eating disorders.

Update on course and outcome in eating disorders

“…Various predictors of poor outcome in BED have included higher palliative reacting to problems (using distraction or self-comforting behaviors), 14 more interpersonal problems, 15 sexual abuse history, 18 and psychiatric comorbidity. 18 In studies of other EDNOS or in samples with mixed diagnoses, low BMI and AN diagnosis have emerged as poor prognostic indicators, 1,22 supporting previous findings that AN is associated with a more chronic course compared to other eating disorders. 30 An additional poor prognostic indicator identified for EDNOS was absence of close friends.…”

“…Overall, results from these studies are consistent with those reported earlier. Among individuals who predominantly have full-threshold AN or BN at intake, a considerable proportion migrate to a diagnosis of EDNOS at follow-up, 22,23 and rates of remission appear to increase with duration of follow-up. 23 However, at 10-year followup, 26 a considerable minority of individuals continue to report a diagnosable eating disorder suggesting a chronic course for eating disorders in a third of individuals ascertained through inpatient settings.…”

Two-year prospective study of personality disorders in adults with longstanding eating disorders

“…We reported that in a sample of 62 patients with chronic EDs, 86% still had an ED or a subthreshold ED at 2-year follow-up although 71% had improved (Rø, Martinsen, Hoffart, Sexton, & Rosenvinge, 2004). In the current study, we expanded the series and studied the course of PDs and 57 of the sample of 74 patients had one or more comorbid PDs at admission.…”

“…In a previous paper (Rø, Martinsen, Hoffart, Sexton, & Rosenvinge, 2004), we reported the course of ED symptoms at 2-year follow-up after inpatient treatment of 65 patients with chronic EDs. At the 2-year follow-up, 71% of the patients were improved, including 14% who were recovered.…”

The outcome at follow-up after inpatient eating disorder treatment: a naturalistic study

“…Both the American Psychiatric Association (APA) guidelines [1], and the National Institute for Health and Care Excellence (NICE) guidelines [2], recommend inpatient treatment as one treatment option in cases of severe illness (psychological and medical symptoms), enduring illness, and unsuccessful outcome of treatment. Symptom improvement during inpatient treatment of adult patients with an ED enrolled in different treatment programs has been reported [3][4][5][6][7][8][9][10][11], and findings showed that improvement was mainly sustained at follow-up [3,6,[8][9][10][11]. However, outcome after inpatient treatment is reported as poor [12].…”