Cognitive-Behavioral Therapy for Threshold and Subthreshold Anorexia Nervosa: A Three-Year Follow-Up Study

Abstract

Background: Few long-term follow-up studies have evaluated the response to psychotherapeutical interventions in anorexia nervosa (AN). The effectiveness of individual cognitive-behavioral therapy (CBT) and the possible predictors of outcome in outpatients suffering from threshold and subthreshold AN (s-AN) were evaluated. Methods: At the beginning (T0) and at the end of treatment (T1), and 3 years after the end of treatment (T2), 53 subjects with AN and 50 with s-AN (all DSM-IV criteria except amenorrhea or underweight) were assessed by a face-to-face clinical interview and by self-reported questionnaires for eating attitudes and behavior (Eating Disorder Examination Questionnaire), body uneasiness (Body Uneasiness Test) and general psychopathology (Symptom Checklist, Beck Depression Inventory, State-Trait Anxiety Inventory). Results: No deaths occurred during the treatment and the follow-up period. At the end of the follow-up 34 subjects (33%) initially enrolled in the study obtained a full recovery. AN and s-AN patients did not show significant differences on most of the clinical measures at baseline and in terms of treatment response (T1, T2). The reduction in weight and shape concerns was associated with weight gain at T1 and T2, and the shape concern level at baseline represented the main risk factor for recovery and treatment resistance. According to survival analysis, patients with high shape concern had a lower probability of remission across time. Conclusions: The distinction between threshold and subthreshold AN does not seem to be of clinical relevance in terms of response to CBT. Shape concern rather than demographic or general psychopathological features represents the best predictor of outcome for CBT.

Identity and Eating Disorders (IDEA): A Questionnaire Evaluating Identity and Embodiment in Eating Disorder Patients

“…shape, weight) in determining a different course of patients with EDs, in terms of response to treatment and long-term outcome [15,54]. This study suggests that a specific disorder of lived corporeality might help to explain why persons with EDs overvalue their body shape and weight.…”

“…According to this theory, different studies found that severe concerns about body shape and weight can play a significant role in the persistence of EDs [6,7,8,9,10,11]. Furthermore, shape and weight concerns have been associated with different responses to psychological treatment in several reports [12,13,14,15]. …”

Psychological Treatment for Anorexia Nervosa: A Meta-Analysis of Standardized Mean Change

“…In terms of sample selection, for almost all of the older studies the inclusion criterion for patients was underweight. However, underweight is no longer a necessary inclusion criterion for AN as some recent studies included eating disorders not otherwise specified (EDNOS) or partially recovered patients as well [14,28,97]. This may clinically be meaningful, as patients with a BMI of 18 may show all other symptoms of AN and be as impaired as patients fulfilling all criteria.…”

Is Feeling Extraneous from One's Own Body a Core Vulnerability Feature in Eating Disorders?

“…In the last decade, a large body of literature has focused on the relationships between eating disorder symptomatology and the beliefs and emotions related to the body [6,7,8,9,10]. As a whole, the data obtained suggest that excessive concerns, overvaluation and uneasiness about the body, its shape and weight are among the main psychopathological features that favor the onset and maintenance of eating disorders.…”