Predictors of relapse in eating disorders: A meta-analysis

Sala, Margaret; Keshishian, Ani C.; Song, Sarah; Moskowitz, Rivka; Bulik, Cynthia M.; Roos, Corey R.; Levinson, Cheri A.

doi:10.1016/j.jpsychires.2023.01.002

Cited by 17 publications

(25 citation statements)

References 48 publications

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“…For the variable self-esteem, one study found no effect on relapse (Carter et al, 2004) and three found lower self-esteem predictive of relapse in AN (Carter et al, 2012;Fichter et al, 2006;McFarlane et al, 2008). While Carter et al (2004) The results of our systematic review suggesting that higher levels of comorbidity might predict relapse in AN were in accordance with the meta-analysis of Sala et al (2023) and the systematic review of Berends et al (2016). There was a 40.7% overlap in the articles included in our study and those in the work by Sala et al (2023), and a 33.3% overlap with the study conducted by Berends et al (2018).…”

Section: Personalitysupporting

confidence: 84%

“…However, no causal link has been established between baseline depression and risk of AN relapse. As both the current study, Sala et al (2023) and Frostad et al (2022) have found that BMI was a predictor of relapse, it may be wise to work on a more extensive relapse prevention plan when BMI remains low after treatment completion.…”

Section: Personalitymentioning

confidence: 64%

“…"What are predictors of relapse in people who have been previously diagnosed with an ED?". Although the primary goal of the study was to examine this for all EDs, the article changed its scope to AN after the article of Sala et al (2023) Subsequently, the full texts of all included abstracts were also screened by two researchers to determine eligibility for the review. A high inter rater agreement was found for included studies (Cohen's kappa = .82) and disagreements were resolved by means of discussion.…”

Section: Search Strategymentioning

confidence: 99%

“…Specifically, the study of Sala et al (2023) indicated that depression was the only comorbid disorder which predicted increased relapse chances across EDs. Our meta-analysis indeed revealed that higher levels of pre-treatment depression also predicted relapse for AN specifically.…”

Section: Personalitymentioning

confidence: 99%

“…Reviewing these predictors could provide insight into what factors contribute to relapse in AN and might assist in the formation of more effective treatments and (relapse) prevention programs (Berends et al, 2018; Bodell & Mayer, 2011; Carter et al, 2012). However, high variability exists across studies examining predictors, including differences in designs (Berends et al, 2018; Glashouwer et al, 2018; Khalsa et al, 2017), as well as the use of different relapse and recovery definitions (Khalsa et al, 2017; Sala et al, 2023). Some studies defined relapse according to levels of BMI, while others provided a more extensive definition including the presence of compensatory, binging and/or purging behaviors (Khalsa et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

An overview and investigation of relapse predictors in anorexia nervosa: A systematic review and meta‐analysis

de Rijk,

Almirabi,

Robinson

et al. 2023

Intl J Eating Disorders

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ObjectiveAn extensive number of predictors has been examined across the literature to improve knowledge of relapse in anorexia nervosa (AN). These studies provide various recovery and relapse definitions, follow‐up durations and relapse rates. The current study summarizes these values and predictors of relapse in AN in a review and meta‐analysis.MethodThe study was executed according to PRISMA guidelines. Different databases were searched and studies in which participants did not receive an official clinical diagnosis were excluded. A quality analysis was performed using the National Institute of Health's Study Quality Assessment Tool. Random‐effects meta‐analyses were conducted to summarize data.ResultsDefinitions of relapse and recovery were diverse. During an average follow‐up period of 31 months an average relapse rate of 37% was found. Predictive variables from 28 studies were grouped in six categories: age and sex, symptoms and behaviors, AN subtype and duration, weight or weight change, comorbidity, and personality. The studies were characterized by non‐significant and contradictory results. Meta‐analyses were performed for the predictors age, AN duration, pre‐treatment BMI, post‐treatment BMI and depression. These yielded significant effects for post‐treatment BMI and depression: higher pre‐treatment depression (SMD = .40 CI [.21–.59] and lower post‐treatment BMI (SMD = −.35 CI [−.63 to −.07]) increased relapse chances in AN.DiscussionOur results emphasized a lack of sufficiently powered studies, consistent results, and robust findings. Solely post‐treatment BMI and pre‐treatment depression predicted relapse. Future research should use uniform definitions, larger samples and better designs, to improve our understanding of relapse in AN.Public significanceKnowledge about predictors is important to understand high relapse rates. Our study performed a review and meta‐analysis of relapse predictors in AN. Related to the heterogeneity in studies examining predictors, an overview of relapse and recovery definitions, follow‐up durations and relapse rates for AN was provided. Significant effects were found for post‐treatment BMI and pre‐treatment depression. More studies with uniform definitions are needed to improve clinical implications.

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Section: Personalitysupporting

confidence: 84%

Section: Personalitymentioning

confidence: 64%

Section: Search Strategymentioning

confidence: 99%

Section: Personalitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

An overview and investigation of relapse predictors in anorexia nervosa: A systematic review and meta‐analysis

de Rijk,

Almirabi,

Robinson

et al. 2023

Intl J Eating Disorders

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Changes in the eating disorder voice over time and the association of voice characteristics at baseline with clinical symptoms in patients with anorexia nervosa

Natali,

Ward,

Rowlands

et al. 2023

Clin Psychology and Psychoth

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ObjectivePatients with eating disorders report the experience of living with an eating disorder voice, a second‐ or third‐person, negative commentary about eating, weight, shape and their implications for self‐esteem. Qualitative and cross‐sectional studies suggest that the severity and characteristics of the eating disorder voice might play a role in the maintenance of eating disorder symptoms. The goal of this study was to expand the evidence base as to how the eating disorder voice changes over time and whether the characteristics of the voice are associated with changes in eating disorder symptoms during treatment.MethodSeventy‐two patients with anorexia nervosa receiving intensive eating disorder treatment were recruited. They completed self‐report measures of eating disorder symptoms, psychological distress and eating disorder voice's severity and characteristics (e.g., malevolence, benevolence and omnipotence) at baseline and approximately 6 months later.ResultsOver time, patients reported lower levels of eating and weight concern (small effect size), shape concern (large effect size) and anxiety (small effect size).They also reported a reduction in the severity, perceived malevolence (medium effect size) and omnipotence (small effect size) of the eating disorder voice. Greater severity and malevolence of the voice, and lower benevolence at baseline predicted greater reductions in eating disorder symptoms (i.e., restraint and shape concern).ConclusionBeliefs about the eating disorder voice (i.e., malevolence) and severity of the voice appear to be malleable to treatment and are associated with a reduction of eating disorder symptoms. The potential of using dialogical approaches to target the eating disorder voice is discussed.

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Overvaluation of shape/weight at posttreatment predicts relapse at 12‐month follow‐up after successful behaviorally‐based treatment of binge‐eating disorder

Grilo,

Ivezaj,

Gueorguieva

2024

Intl J Eating Disorders

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ObjectiveTo test whether overvaluation of shape/weight at the end of treatment prospectively predicts relapse at 12‐month follow‐up in patients with binge‐eating disorder (BED).MethodParticipants were 129 patients with BED who achieved abstinence from binge eating after 6 months of behaviorally‐based weight‐loss treatments in a clinical trial. Independent assessments conducted at posttreatment and at 12‐month follow‐up included the Eating Disorder Examination interview, the Beck Depression Inventory, and weight measurements.ResultsOf the 129 participants who attained abstinence from binge‐eating at posttreatment, 46 (36%) were categorized with clinical overvaluation and 83 (64%) with subclinical overvaluation; 115 (89%) were re‐assessed at 12‐month follow‐up. Participants with overvaluation at posttreatment were significantly more likely than those without to relapse at 12‐months to non‐abstinence from binge eating (54% vs. 28%) and to diagnosis‐level binge‐eating frequency of once weekly or greater (31% vs. 13%). Overvaluation at posttreatment predicted significantly higher eating‐disorder psychopathology and depression scores at 12‐month follow‐up but were unrelated to weight and weight changes. Treatment groups did not have main or interaction effects; posttreatment overvaluation effects were observed regardless of treatment and of covarying for posttreatment value of dependent variables.ConclusionsOur findings suggest that overvaluation of shape/weight at the end of treatment predicts relapse and heightened eating‐disorder psychopathology and depression scores 1 year later in patients who achieved abstinence from binge eating with behaviorally‐based treatments.Overvaluation of shape/weight has significant clinical implications and warrants consideration as a diagnostic specifier for BED as it provides important prospective prognostic information.Public SignificanceAlthough effective treatments are available for binge‐eating disorder, relapse following successful treatments is not uncommon. Almost nothing is known about what predicts relapse following treatments for binge‐eating disorder. Our study found that overvaluation of shape/weight (i.e., body image concerns that overly impact self‐worth) at posttreatment prospectively predicted relapse and higher eating‐disorder psychopathology and depression 1 year later in patients who achieved binge‐eating abstinence with behaviorally based treatments.Clinicaltrials.gov registration: NCT00829283. (Treatment of obesity and binge eating: Behavioral weight loss vs. stepped care.)

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Predictors of relapse in eating disorders: A meta-analysis

Cited by 17 publications

References 48 publications

An overview and investigation of relapse predictors in anorexia nervosa: A systematic review and meta‐analysis

An overview and investigation of relapse predictors in anorexia nervosa: A systematic review and meta‐analysis

Changes in the eating disorder voice over time and the association of voice characteristics at baseline with clinical symptoms in patients with anorexia nervosa

Overvaluation of shape/weight at posttreatment predicts relapse at 12‐month follow‐up after successful behaviorally‐based treatment of binge‐eating disorder

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