Long‐term outcome of inpatients with bulimia nervosa—Results from the Christina Barz Study

Quadflieg, Norbert; Fichter, Manfred M.

doi:10.1002/eat.23084

Cited by 37 publications

(49 citation statements)

References 32 publications

(101 reference statements)

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“…Eating disorders are serious by virtue of associated medical complications (Westmoreland, Krantz, & Mehler, 2016), psychological comorbidities (Grilo, White, & Masheb, 2009; Himmerich et al, 2019; Hudson, Hiripi, Pope, & Kessler, 2007), and psychiatric impairment (Stice, Marti, & Rohde, 2013). Eating disorders are often chronic and difficult to change (Cooper et al, 2016; Keel & Brown, 2010); half of individuals seeking treatment for an eating disorder will not recover (Keel & Brown, 2010; Quadflieg & Fichter, 2019). When examining the natural course of eating disorders, anorexia nervosa is associated with the slowest time to recovery followed by bulimia nervosa and then binge‐eating disorder (Eddy et al, 2017; Fairburn, Cooper, Doll, Norman, & O'Connor, 2000).…”

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confidence: 99%

Longitudinal trajectories of behavior change in a national sample of patients seeking eating‐disorder treatment

Chapa

Hagan

Forbush

et al. 2020

Intl J Eating Disorders

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Objective: Rapid response to treatment, indicated by substantial decreases in eatingdisorder (ED) symptoms within the first 4-6 weeks of treatment, is the most reliable predictor of treatment outcomes for EDs. However, there is limited research evaluating short-term longitudinal trajectories of ED symptoms during treatment. Thus, it is difficult to know which aspects of ED psychopathology are slow or fast to change. The purpose of this study was to elucidate three-month trajectories of ED psychopathology during treatment and test whether ED diagnosis influenced the direction and rate of change.Method: Participants were Recovery Record users seeking treatment for an ED (N = 4,568; 86.8% female). Participants completed the Eating Pathology Symptoms Inventory once per month for 3 months.Results: Latent growth curve models indicated that ED diagnosis influenced the rate of ED behavior change. Anorexia nervosa was associated with faster reductions in cognitive restraint, excessive exercise, restricting, yet slower reductions in body dissatisfaction, and binge eating. Bulimia nervosa was associated with faster reductions in binge eating, cognitive restraint, excessive exercise, and purging. Binge-eating disorder was associated with faster reductions in body dissatisfaction and binge eating, yet slower reductions in restricting. Conclusions:Our results have implications for future research by providing initial information about the direction and rate of ED change over the course of treatment.If clinicians and researchers know which ED symptoms are slow to change, on average, across diagnostic groups, treatment protocols could be adjusted to target slow changing symptoms more quickly, and therefore improve ED treatment outcomes.

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confidence: 99%

Longitudinal trajectories of behavior change in a national sample of patients seeking eating‐disorder treatment

Chapa

Hagan

Forbush

et al. 2020

Intl J Eating Disorders

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“…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].…”

Section: Introductionmentioning

confidence: 99%

“…In general, there have been inconsistent research results regarding predictors of treatment outcome in ED samples [17], and results regarding inpatient adult samples are limited. However, some factors of importance for a positive outcome at follow-up have been reported, such as higher body mass index (BMI) at admission (for AN patients) [8,19], higher BMI at discharge (for AN patients) [11,19], lower age at admission [8,9], length of inpatient stay [20], and duration of illness and follow-up period [8,9].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background Patients with eating disorders may experience a severe and enduring course of illness. Treatment outcome for patients provided with inpatient treatment is reported as poor. Research to date has not provided consistent results for predictors of treatment outcome. The aims of the study were to investigate rates of remission at follow-up after inpatient treatment, symptom change from admission to follow-up, and predictors of treatment outcome. Methods The follow-up sample consisted of 150 female adult former patients (69.4% of all eligible female patients) with eating disorders. Mean age at admission was 21.7 (SD = 4.9) years. Diagnostic distribution: 66% (n = 99) anorexia nervosa, 21.3% (n = 32) bulimia nervosa and 12.7% (n = 19) other specified feeding or eating disorder, including binge eating. Data were collected at admission, discharge and follow-up (mean 2.7 (SD = 1.9) years). Definition of remission was based on the EDE-Q Global score, body mass index and binge/purge behavior. Paired T-tests were performed to investigate change over time. Univariate and multivariate logistic regressions were estimated to investigate predictors of remission. Results At follow-up, 35.2% of the participants were classified as in remission. Significant symptom reduction (in all patients) (p < 0.001) and significant increase in body mass index (BMI) (in underweight participants at admission) (p < 0.001) was found. Increased BMI (p < 0.05), the level of core eating disorder symptoms at admission (p < 0.01) and reduced core eating disorder symptoms (p < 0.01) during inpatient treatment were found significant predictors of outcome in the multivariate model. Conclusions All participants had an eating disorder requiring inpatient treatment. Approximately one-third of all participants could be classified as in remission at follow-up. However, most participants experienced significant symptom improvement during inpatient treatment and the improvements were sustained at follow-up. Increased probability of remission at follow-up was indicated by lower core ED symptoms at admission for all patients, raised BMI during admission for patients with AN, and reduced core ED symptoms during inpatient treatment for all patients. This finding contributes important information and highlights the importance of targeting these core symptoms in transdiagnostic treatment programs.

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“…The efficacy of treatment (or lack thereof) is reflected in illness duration and remission rates. A series of publications on very long-term (10–20 years) follow-up studies of inpatients with an eating disorder showed that, respectively 64% of persons previously diagnosed with anorexia nervosa, 53% of those previously diagnosed with bulimia nervosa, and 30% of those previously diagnosed with BED, still met diagnostic criteria for an eating disorder at follow-up; a further 6% for anorexia nervosa, 9% for bulimia nervosa and 31% for BED had remaining eating disorder symptoms [ 7 , 8 ▪▪ , 9 ]. Higher recovery rates of anorexia nervosa were reported in two smaller long-term (≥20 years) follow-up studies of adolescent-onset anorexia nervosa; one on an outpatient sample [ 10 ], the other on a community sample [ 11 ▪▪ ].…”

Section: Introductionmentioning

confidence: 99%

Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden

Hoeken

Hoek

2020

Current Opinion in Psychiatry

345

241

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Purpose of review To review the recent literature on the burden of eating disorders in terms of mortality, disability, quality of life, economic cost, and family burden, compared with people without an eating disorder. Recent findings Estimates are that yearly over 3.3 million healthy life years worldwide are lost because of eating disorders. In contrast to other mental disorders, in anorexia nervosa and bulimia nervosa years lived with disability (YLDs) have increased. Despite treatment advances, mortality rates of anorexia nervosa and bulimia nervosa remain very high: those who have received inpatient treatment for anorexia nervosa still have a more than five times increased mortality risk. Mortality risks for bulimia nervosa, and for anorexia nervosa treated outside the hospital, are lower but still about twice those of controls. In people with an eating disorder, quality of life is reduced, yearly healthcare costs are 48% higher than in the general population, the presence of mental health comorbidity is associated with 48% lower yearly earnings, the number of offspring is reduced, and risks for adverse pregnancy and neonatal outcomes are increased. Summary People with a current or former eating disorder are at risk of increased mortality, high YLD rates, a reduced quality of life, increased costs, and problems with childbearing.

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Long‐term outcome of inpatients with bulimia nervosa—Results from the Christina Barz Study

Cited by 37 publications

References 32 publications

Longitudinal trajectories of behavior change in a national sample of patients seeking eating‐disorder treatment

Longitudinal trajectories of behavior change in a national sample of patients seeking eating‐disorder treatment

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

Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden

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