Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome

Abstract

This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory-2 (EDI-2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m(2). Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI-2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI-2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non-responders.

Testing predictions of the emotion regulation model of binge‐eating disorder

“…While hypothetical, this suggestion highlights an important point: to provide the most effective treatments, it is necessary to understand who will be most likely to benefit from any given treatment. For instance, depression has been identified as a significant predictor of treatment outcome in self‐help treatment for bulimia nervosa (Jones et al, ) and inpatient treatment for anorexia nervosa (Schlegl et al, ). These findings suggest that clinicians should consider the presence of depression symptoms in both treatment planning and implementation.…”

Improving aftercare with technology for anorexia nervosa after intensive inpatient treatment: A pilot randomized controlled trial with a therapist‐guided smartphone app

“…Studies regarding the effectiveness of inpatient treatment for adolescent and adult patients with AN show response rates (defined as reliable change according to Jacobson & Truax, 1991) of up to 70% (Schlegl et al, 2016;Schlegl, Quadflieg, Löwe, Cuntz, & Voderholzer, 2014). However, it seems to be quite difficult for patients to sustain improvements after discharge, as relapse rates reach up to 41% for patients with AN (Carter et al, 2012).…”

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

“…The decision to hospitalize is generally based on such factors as extent of weight loss, medical instability (hypothermia, hypotension, electrolyte abnormalities, cardiac complications, etc. ), psychiatric complications (suicidality, compulsivity, self‐destructiveness), or high‐frequency binging or purging (Guarda, ; Schlegl et al, ; Vandereycken, ). Goals of hospitalization vary, but usually include objectives of medical stabilization, weight gain, and improvement in the mental status (Vandereycken, ).…”

“…binging or purging (Guarda, 2008;Schlegl et al, 2016;Vandereycken, 2003). Goals of hospitalization vary, but usually include objectives of medical stabilization, weight gain, and improvement in the mental status (Vandereycken, 2003).…”