Evaluating empirically valid and clinically meaningful change in intensive residential treatment for severe eating disorders at discharge and at a 6-month follow-up

Muzi, Laura; Tieghi, Laura; Rugo, Michele; Lingiardi, Vittorio

doi:10.1007/s40519-019-00798-2

Cited by 9 publications

(3 citation statements)

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“…The results showed higher levels of stress and depression in patients affected by overweight/obesity with a psychiatric diagnosis compared with those with no psychiatric diagnosis. However, despite this significant difference between groups, levels of psychological distress (relating to depression, stress, and anxiety) in the psychiatric patients affected by overweight/obesity were lower than the averages reported for the clinical population [ 19 , 31 , 32 ]. Furthermore, increased psychological distress during the COVID-19 lockdown did not seem to predict weight gain for these patients; instead, they were more likely to gain weight as a result of binge eating behaviors, which preceded the lockdown situation and were frequently a symptom of their psychiatric diagnosis.…”

Section: Discussioncontrasting

confidence: 56%

Weight Gain in a Sample of Patients Affected by Overweight/Obesity with and without a Psychiatric Diagnosis during the Covid-19 Lockdown

et al. 2020

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The present study aimed at identifying psychological and psychosocial variables that might predict weight gain during the COVID-19 lockdown in patients affected by overweight/obesity with and without a psychiatric diagnosis. An online survey was administered between 25 April and 10 May 2020, to investigate participants’ changes in dietary habits during the lockdown period. 110 participants were recruited and allocated to two groups, 63 patients had no psychiatric diagnosis; there were 47 patients with psychiatric diagnosis. ANOVA analyses compared the groups with respect to psychological distress levels, risk perception, social support, emotion regulation, and eating behaviors. For each group, a binary logistic regression analysis was conducted, including the factors that were found to significantly differ between groups. Weight gain during lockdown was reported by 31 of the participants affected by overweight/obesity without a psychiatric diagnosis and by 31 patients with a psychiatric diagnosis. Weight gain predictors were stress and low depression for patients without a psychiatric diagnosis and binge eating behaviors for patients with a psychiatric diagnosis. Of patients without a psychiatric diagnosis, 60% reported much more frequent night eating episodes. The risk of night eating syndrome in persons affected by overweight/obesity with no psychiatric diagnosis should be further investigated to inform the development of tailored medical, psychological, and psychosocial interventions.

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Section: Discussioncontrasting

confidence: 56%

Weight Gain in a Sample of Patients Affected by Overweight/Obesity with and without a Psychiatric Diagnosis during the Covid-19 Lockdown

et al. 2020

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“…Second, the studies investigated treatment responses primarily through traditional significance testing, which does not provide information regarding within-patient variation or the clinical relevance of therapeutic gains at treatment termination. Conversely, several authors pointed to an increased need to operationalize therapy outcomes also at the individual level, considering both the statistical and the clinical significance of symptomatic change, as well as related predictors [29,30]. Clinical significance methods, such as the well-known approach proposed by Jacobson and Truax [31], typically classify treatment response at the individual level (i.e., calculating the proportion of patients who made a significant and reliable change, and those who did not) combined with an examination of whether individual patients moved from the dysfunctional to the functional population.…”

Section: Introductionmentioning

confidence: 99%

Personality as a predictor of symptomatic change in a residential treatment setting for anorexia nervosa and bulimia nervosa

Muzi

Tieghi²,

Rugo³

et al. 2020

Eat Weight Disord

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Purpose Although personality has been widely researched in patients with anorexia nervosa (AN) and bulimia nervosa (BN), the nature of this relationship has not yet been clearly articulated. The pathoplasty model theorizes that personality might shape symptomatic presentation and thus affect therapeutic outcomes, but more research is needed. The present study aimed at investigating the predictive value of a broad spectrum of personality traits in determining AN and BN treatment outcomes, considering both the statistical and clinical significance of the therapeutic change. Methods Eighty-four female patients with AN and BN treated in a residential program were evaluated at treatment onset using the Shedler-Westen Assessment Procedure-200—a clinician-rated measure of personality disorders and healthy personality functioning. At both intake and discharge, patients completed the Eating Disorder Inventory-3 to assess eating symptoms and the Outcome Questionnaire-45.2 to evaluate overall impairment. Results Considering overall ED symptomatic change, multiple regression analyses showed that, even when controlling for baseline symptoms and DSM-5 categories, schizoid (B = 0.41, p ≤ 0.01), avoidant (B = 0.31, p ≤ 0.05), and paranoid (B = 0.25, p ≤ 0.05) personality features predicted worse therapeutic outcomes. Similar results were found when applying the clinical significance approach, with the emotionally dysregulated factor as an additional negative predictor of significant/reliable change (B = − 0.09; p < 0.01). Healthy personality functioning predicted better therapeutic outcomes (B = − 0.34, p ≤ 0.001). Conclusions Pathoplastic models and personality-based research in this clinical population have the potential to inform effective treatment strategies by targeting relevant individual factors. Level of evidence Level III, longitudinal cohort study.

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“…Cluster B personality characteristics have also been related to other therapeutic variables, such as a history of psychiatric hospitalization for an ED or other condition (Westen and Harnden-Fischer, 2001) and a greater risk of discharge against medical advice and re-admission following intensive ED treatment (Wildes et al, 2011). These observations seem particularly relevant to intensive treatment settings, such as residential programs, in which these features may lead to a tendency to break rules and thereby limit patients' adjustment to the structured treatment protocol (Friedman et al, 2016;Muzi et al, 2019Muzi et al, , 2020.…”

Section: Discussionmentioning

confidence: 99%

The Mediator Effect of Personality on the Relationship Between Symptomatic Impairment and Treatment Outcome in Eating Disorders

Muzi

Tieghi²,

Franco³

et al. 2021

Front. Psychol.

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Features of personality disorders (PDs) have been found to explain meaningful variance in the onset, maintenance, and symptomatic presentation of eating disorders (EDs), and a co-occurent personality pathology is commonly associated with poorer response to ED treatment. The “pathoplasty model” of the relationship between personality and EDs implies that, once both conditions are established, they are likely to interact in ways that modify therapy outcome; however, to date, no studies have explored overall personality functioning, and especially PD clusters, as a mediator of treatment outcome. The present study aimed at conjointly exploring the associations between personality functioning and PDs, respectively, with pre-treatment ED symptomatic impairment and therapy outcome; and the mediating role of personality variables. At treatment onset, a sample of 107 women with ED problems were evaluated using both the Structured Clinical Interview for DSM-5 (SCID-5-CV) and the Shedler-Westen Assessment Procedure-200 (SWAP-200)—a clinician-rated procedure to dimensionally assess personality. Participants were also asked to complete self-report questionnaires on overall ED symptomatology, symptoms of binge eating and purging behaviors, and therapy outcome. The findings showed that, over and above the categorical ED diagnosis, the SWAP-200 healthy personality functioning score mediated the relationship between baseline ED symptom severity and therapy outcome, as well as the association between baseline bulimic symptoms and treatment outcome; furthermore, SWAP-200 Cluster B PD scores mediated the link between baseline binge eating and purging symptoms and therapy outcome, whereas scores in Clusters A and C showed no significant effects. The findings suggest that personality-based outcome research may improve treatment effectiveness in this difficult-to-treat population.

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Evaluating empirically valid and clinically meaningful change in intensive residential treatment for severe eating disorders at discharge and at a 6-month follow-up

Cited by 9 publications

References 50 publications

Weight Gain in a Sample of Patients Affected by Overweight/Obesity with and without a Psychiatric Diagnosis during the Covid-19 Lockdown

Weight Gain in a Sample of Patients Affected by Overweight/Obesity with and without a Psychiatric Diagnosis during the Covid-19 Lockdown

Personality as a predictor of symptomatic change in a residential treatment setting for anorexia nervosa and bulimia nervosa

The Mediator Effect of Personality on the Relationship Between Symptomatic Impairment and Treatment Outcome in Eating Disorders

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