Changes in Patient Measures as Predictors of Therapists’ Ratings of Treatment Collaboration and Change in Eating Disorder Subgroups

Abstract

This study examined how implicit and explicit changes following integrative inpatient treatment of adolescents with eating disorder (ED) may predict the posttreatment ratings of psychodynamic therapists of their patients' openness to therapeutic processes and their change (Therapist Evaluation Inventory). The relative contribution of inpatients' ego functions was compared with that of their mental distress and ED symptoms in two subgroups: restricting type anorexia (AN-R) and binging/purging type EDs (B/P). Data indicated that the implicit personality variable of elevated ability to modulate affects was the best predictor of therapist-rated global outcome among patients with B/P symptoms, whereas in patients with AN-R, evolving openness to implicit negative affects and a reduction in reported distress were best predictors. In patients with AN-R, attenuated affect control was also significantly correlated with therapist posttreatment ratings. These data point that in addition to addressing behavioral/symptomatic aspects, personality variables should be addressed in the psychological treatment of EDs.

Canadian practice guidelines for the treatment of children and adolescents with eating disorders

“…Mean length of stay for these studies was between 203 and 115 days. Three studies (total n = 126) reported improvements in Eating Attitudes Test (EAT) scores at admission and discharge [186,198,203]. Length of stay varied between these three studies (29.8 days, 91 days and not reported).…”

“…Mixed diagnoses Two studies of multimodal inpatient treatment were found which reported on weight gain during inpatient treatment for patients with mixed eating disorder diagnoses (Table 39). One study differentiated between patients with AN restricting type versus those with AN binge-purge type or BN [203], and the other differentiated between those with AN restricting type or AN binge-purge type versus those with BN or Eating Disorder Not Otherwise Specified binge-purge type (EDNOS-B/P) [193]. Multimodal treatment was provided in both studies but varied between studies.…”

“…One of these studies compared symptom change using the EAT at admission to discharge in the group of patients with AN restricting type (n = 33) versus AN binge-purge type or BN (n = 29 ) [203]. Overall there was a statistically significant improvement in EAT scores over the course of the admission.…”

Outcomes of inpatient psychological treatments for children and adolescents with eating disorders at time of discharge: a systematic review

“…We failed to identify any RCTs exploring outcomes of inpatient treatment specifically for pediatric AN, including atypical anorexia nervosa. We identified twenty studies (total n = 1091) describing inpatient treatment based on an integrative approach for AN, including psychiatric, medical, nutritional, and pharmacologic management, as well as individual, group and family therapy along with skilled nursing support [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. None of these studies included control or comparison groups.…”

“…Of note, BMI at discharge was higher in the Fennig et al (2015) study than the other three studies that reported on EDE-Q scores. Three studies (total n = 126) reported change in Eating Attitude Test (EAT) scores at admission and discharge [21,30,32]. The difference in EAT scores was noted to improve in two of the studies [21,32].…”