Therapeutic alliance in inpatients with severe anorexia nervosa

Abstract

Objective Therapeutic alliance (TA) is a relevant aspect in anorexia nervosa (AN), but data on inpatients are lacking. We aimed to evaluate the influence of motivation to change, diagnostic subtypes, and duration of illness on TA at hospital discharge; we also investigated if baseline clinical characteristics were associated with discharge TA, and the TA‐outcome association. Method We enrolled 137 adult inpatients with AN completing Eating Disorder Examination‐Questionnaire, Beck Depression Inventory, State–Trait Anxiety Inventory, Anorexia Nervosa Stages of Change‐Questionnaire, EuroQoL‐Quality of Life Scale‐Visual Analogue Scale, and Working Alliance Inventory‐Short Revised. Results Patients with different AN subtypes and duration of illness reported similar TA. Baseline depression, state anxiety, and motivation to change were statistically significantly associated with TA at discharge. After controlling for all these variables and duration of illness, only motivation to change remained statistically significant. Statistically significant correlations were also found between improvements in body mass index and quality of life and discharge TA. Conclusions Few data exist on TA in inpatients with AN and a long duration of illness. Our findings suggest that baseline motivation to change correlates with TA at discharge independently of other variables. Future studies should ascertain as to whether a causal link exists or not.

The impact of duration of illness on treatment nonresponse and drop‐out: Exploring the relevance of enduring eating disorder concept

“…These findings relating illness duration concur with most of the previous literature (Andrés-Perpiñá et al, 2020;Fichter, Quadflieg, & Hedlund, 2006;Le Grange et al, 2014;Marzola, Albini, Delsedime, Fassino, & Abbate-Daga, 2019) and are also confirmed by recent systematic reviews (Austin et al, 2021;Ghaderi et al, 2018;Gregertsen, Mandy, Kanakam, Armstrong, & Serpell, 2019;Linardon, Kothe, & Fuller-Tyszkiewicz, 2019). Based on our data, successful recovery from BN is more probable if treatment is provided before the illness reaches 13-14 years of duration.…”

Inpatients with severe-enduring anorexia nervosa: Understanding the “enduringness” specifier

“…Furthermore, this data could illuminate how responsive those with a longer DOI can be to structured and short-term treatments, as other research has suggested [4,19]. In keeping with earlier research from our group [47] patients with LD showed a therapeutic alliance comparable to that of the younger ones. Interestingly, those with a shorter DOI improved less in the drive for thinness and body shape concerns, mirroring a network analysis showing patients with a shorter DOI reporting overvaluation of weight or shape as key elements [48].…”

How Should Compassion Be Expressed as a Primary Clinical and Ethical Value in Anorexia Nervosa Intervention?

“…A strong therapeutic alliance in patients with anorexia nervosa has been found to predict treatment completion and change in eating-related psychopathology, both at discharge and at 1-year follow-up. 13,14,15 Evaluating Options Ideally, the team should consider urgent transfer to a specialty behavioral program for the care of patients with eating disorders, especially if VV has not been treated in one before or has left treatment prematurely on past admissions. Expert eating disorders behavioral specialty programs can improve eating disorder symptomatology and weightrestore a majority of patients using a multidisciplinary approach that includes individual, group, and family-based treatments; supervised meals; and behavioral contingency management strategies.…”