Moderators of treatment outcomes in a partial hospitalization and intensive outpatient program for eating disorders

Abstract

Eating disorders cause a number of severely impairing symptoms that may require more intensive intervention that is available through outpatient therapy services. The PHP/IOP level of care may be an effective mode of treatment in these cases, but few studies have examined overall outcomes or treatment moderators for this level of care. Using a large sample from a PHP/IOP specifically designed for the treatment of eating disorders, the current study examines a variety of symptoms (eating disorder severity, quality of life, depression, etc.) from admission to discharge, as well as potential moderators of treatment, including demographic and clinical factors. Overall, the PHP/IOP level of care was found to improve treatment outcomes. Age, race, gender, and depression were found to moderate the change in quality of life and functional impairment. Additionally, patients diagnosed with anorexia nervosa had significantly lowered quality of life and greater eating disorder symptomatology than all other diagnoses. The results of this study can help to inform clinical practice and help guide in treatment decisions at the partial hospitalization level of care.

Treatment Utilization and Medical Problems in a Community Sample of Adult Women With Anorexia Nervosa

“…There were not significant differences by groups for other medical problems [non-ED associated medical problems, AN-CC, 0%, AN-CR, 18.2%, AN-WR, 27.8%, χ 2 (2) = 5.33, p = 0.07]. The non-ED associated medical problems reported included migraines (Hayes et al, 2018), fibromyalgia, thyroid disorder (Hayes et al, 2018), rheumatoid arthritis, osteoarthritis, pelvic pain, and asthma. There were no differences in engagement with a primary care provider across the groups [percent with primary care provider, AN-CC, 11.8%, AN-CR, 18.2%, AN-WR, 33.3%, χ 2 (2) = 2.50, p = 0.29].…”

“…Participants were also queried about the presence any medical illnesses derived from the eating disorder (low bone mineral density, anemia, electrolyte disturbances, and cardiovascular problems) or likely to impact their eating disorder symptoms (gastrointestinal disorders) as well as any non-ED associated medical problems. The AN-CC group reported significantly more ED-associated medical issues [low bone mineral density (Dejong et al, 2012), hypoglycemia, anemia (Hayes et al, 2018), hypophosphatemia] than the AN-CR (inflammatory bowel disease) and AN-WR (low bone mineral density, functional gastrointestinal disorders) groups [ED associated medical problems, AN-CC, 52.9%, AN-CR, 9.1%, AN-WR, 16.7%, χ 2 (2) = 8.29, p = 0.02]. There were not significant differences by groups for other medical problems [non-ED associated medical problems, AN-CC, 0%, AN-CR, 18.2%, AN-WR, 27.8%, χ 2 (2) = 5.33, p = 0.07].…”

“…Although this disease often begins in adolescence and young adulthood, the course of disease is prolonged and outcomes are poor (Eddy et al, 2017). In examination of treatment outcomes in partial hospitalization and intensive outpatient settings, individuals with AN had worse outcomes for global eating disorder severity and quality of life than individuals with bulimia nervosa, binge eating disorder, and other specified feeding or eating disorder (Hayes et al, 2018). Additionally, a recent meta-analysis showed that treatment changed only short-term weight outcomes but did not significantly impact either short-term or long-term psychosocial outcomes or long-term recovery (Murray et al, 2018).…”

Naturalistic outcomes for a day‐hospital programme in a mixed diagnostic sample of adolescents with eating disorders

“…Given the status of FBT in the literature as the outpatient treatment of choice for adolescent AN (Couturier, Kimber, & Szatmari, ; Lock, ), recent literature has explored the feasibility of adopting FBT approaches for implementation in higher levels of care (Girz, Robinson, Foroughe, Jasper, & Boachie, ; Hayes, Welty, Slesinger, & Washburn, ; Henderson et al, ; Hoste, ; Murray et al, ; Ornstein, Lane‐Loney, & Hollenbeak ; Rienecke, Richmond & Lebow, ; Rienecke & Richmond, ). The majority of existing studies have employed naturalistic and open trial formats, except for one randomized trial conducted in Germany wherein DHP was compared with inpatient care for weight restoration and maintenance (Herpertz‐Dahlmann et al, ).…”

Latent trajectories of eating disorder treatment response among female patients in residential care

“…To date, trajectory classification has been limited to single‐symptom investigations (e.g., binge‐eating frequency or weight change) and is therefore applicable to only a subset of all ED diagnostic groups encountered in routine treatment. This limits generalizability to community and private treatment settings, where providers often work with patients transdiagnostically (Brown et al, 2018; Hayes, Welty, Slesinger, & Washburn, 2019; Twohig, Bluett, Torgesen, Lensegrav‐Benson, & Quakenbush‐Roberts, 2015). Characterizing heterogeneous trajectories and using them to inform treatment planning in transdiagnostic populations may be particularly clinically useful in intensive settings, where treatment is more costly and resource‐intensive (Striegel‐Moore & Leslie, 2000; Williamson, Thaw, & Varnado‐Sullivan, 2001).…”