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Jordan J, McIntosh VVW, Carter FA, Joyce PR, Frampton CMA, Luty SE, McKenzie JM, Bulik CM. Clinical characteristics associated with premature termination from outpatient psychotherapy for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:278-84. [PMID: 24842307 DOI: 10.1002/erv.2296] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 11/10/2022]
Abstract
AIM The literature on clinical characteristics associated with premature termination of treatment (PTT) is beset with conflicting and non-replicated findings. This study explores clinical characteristics potentially associated with PTT in a randomised controlled outpatient psychotherapy trial for anorexia nervosa (AN). METHODS Participants were 56 women aged 17-40 years with spectrum AN. The completer group (n = 35) included those completing at least 15/20 planned sessions with the remainder of the sample comprising the PTT group (n = 21). Variables examined included demographic factors, psychosocial functioning, psychiatric history, lifetime comorbidity, temperament and eating disorder characteristics. Logistic regression was used to examine significant variables. A Kaplan-Meier survival curve was used to illustrate time taken to PTT. RESULTS The mean number of sessions in the PTT group was 8.1. Lower self-transcendence scores on the Temperament and Character Inventory were associated with PTT. CONCLUSIONS Recognising and addressing personality factors have the potential to enhance retention in treatment.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand
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Abd Elbaky GB, Hay PJ, le Grange D, Lacey H, Crosby RD, Touyz S. Pre-treatment predictors of attrition in a randomised controlled trial of psychological therapy for severe and enduring anorexia nervosa. BMC Psychiatry 2014; 14:69. [PMID: 24606873 PMCID: PMC3995934 DOI: 10.1186/1471-244x-14-69] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/04/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Attrition is common in the treatment of anorexia nervosa and its causes are complex and incompletely understood. In particular, its relationship with adaptive function and motivational stage of change has been little studied. This study aimed to (1) investigate and (2) compare the strength of associations between adaptive function, stage of change and other previously found factors such as illness sub-type and treatment attrition in women with severe and enduring anorexia nervosa (SE-AN). METHODS Participants were 63 adult women with SE-AN of at least 7 years duration who were enrolled in a multi-site randomized controlled trial conducted from July 2007 through June 2011. Treatment comprised 30 outpatient visits over 8 months of either Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN) or Specialist Supportive Clinical Management (SSCM) both of which were modified for severe and enduring illness. Assessments were done at baseline, end of treatment, and 6 and 12 month post treatment follow-up. Demographic variables, duration of illness, specific and generic health related quality of life (QoL), eating disorder (ED) and mood disorder symptoms, social adjustment, body mass index (BMI), and motivation for change were assessed with interview and self-report questionnaires. Treatment attrition was defined as leaving therapy after either premature termination according to trial protocol or self-instigated discharge. Binary logistic regression was used to investigate relative strength of associations. RESULTS Those who did not complete treatment were significantly more likely to have the purging sub-type of anorexia nervosa and poorer ED related QoL. There were no significant differences between attrition and which therapy was received, educational level, and global ED psychopathology, stage of change, BMI, social adjustment, duration of illness or level of depression. The strongest predictors on multivariable analysis were ED QoL and AN-purging subtype. CONCLUSION This study supported previous findings of associations between attrition and purging subtype. Furthermore, we found associations between a potentially important cycle of attrition, and poorer EDQoL, which has not been previously reported. Contrary to expectations we did not find an association with BMI, severity of ED symptoms, low level of motivation to change ED features, or level of education.
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Affiliation(s)
- Ghada B Abd Elbaky
- NSW Institute of Psychiatry Fellow, University of Western Sydney, School of Medicine, Sydney, Australia
| | - Phillipa J Hay
- School of Medicine, Centre for Health Research, University of Western Sydney, Sydney, Australia
- School of Medicine, James Cook University, Townsville, Australia
| | - Daniel le Grange
- Department of Psychiatry and Behavioural Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Hubert Lacey
- Eating Disorders Research Team, St George’s University of London, London, UK
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA
- Department of Clinical Neuroscience, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
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Rocks T, Pelly F, Wilkinson P. Nutrition therapy during initiation of refeeding in underweight children and adolescent inpatients with anorexia nervosa: a systematic review of the evidence. J Acad Nutr Diet 2014; 114:897-907. [PMID: 24512952 DOI: 10.1016/j.jand.2013.11.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 11/20/2013] [Indexed: 01/08/2023]
Abstract
Restoration of weight and nutritional rehabilitation are recognized as fundamental steps in the therapeutic treatment of children and adolescent inpatients with anorexia nervosa (AN). However, current recommendations on initial energy requirements for this population are inconsistent, with a clear lack of empirical evidence. Thus, the aim of our study was to systematically review, assess, and summarize the available evidence on the effect of differing nutrition therapies prescribed during refeeding on weight restoration in hospitalized children and adolescents (aged 19 years and younger) with diagnosed AN. Searches were conducted in Scopus, Web of Science, Global Health (CABI), PubMed, and the Cochrane database for articles published in English up to May 2012, and complemented by a search of the reference lists of key publications. Seven observational studies investigating a total of 403 inpatients satisfied the inclusion criteria. The range of prescribed energy intakes varied from 1,000 kcal to >1,900 kcal/day with a progressive increase during the course of hospitalization. It appeared that additional tube feeding increased the maximum energy intake and led to greater interim or discharge weight; however, this was also associated with a higher incidence of adverse effects. Overall, the level of available evidence was poor, and therefore consensus on the most effective and safe treatment for weight restoration in inpatient children and adolescents with AN is not currently feasible. Further research on refeeding methods is crucial to establish the best practice approach to treatment of this population.
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Harris J, Steele AM. Have we lost our minds? The siren song of reductionism in eating disorder research and theory. Eat Disord 2014; 22:87-95. [PMID: 24365532 DOI: 10.1080/10640266.2014.857532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jim Harris
- a Department of Psychology , Southern Methodist University , Dallas , Texas , USA
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55
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Rance NM, Clarke V, Moller NP. "If I see somebody…I'll immediately scope them out": anorexia nervosa clients' perceptions of their therapists' body. Eat Disord 2014; 22:111-20. [PMID: 24555509 DOI: 10.1080/10640266.2013.860847] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although people with eating disorders are known to observe and assess body related stimuli, research has yet to explore these behaviors in the therapy room. Consequently, practitioners do not know if their bodies are having an impact on their clients or the therapy process. This lack of knowledge is problematic given the poor recovery rates and high levels of drop-out in eating disorders treatment. Using semi-structured interviews this study investigated the beliefs and experiences of 11 women diagnosed with anorexia nervosa or bulimia nervosa with a history of restricting, who had received counseling from a female therapist. Results derived from thematic analysis suggest that the patients not only observed, speculated, and made assumptions about their therapists' bodies but also that their assumptions and speculations had the potential to influence both their beliefs about the therapist's ability to help them, and their willingness to engage in therapy.
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Affiliation(s)
- Nicola M Rance
- a Centre for Appearance Research, Department of Health and Social Sciences, Faculty of Health and Life Sciences , The University of the West of England , Bristol , UK
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56
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Kelly AC, Carter JC. Eating disorder subtypes differ in their rates of psychosocial improvement over treatment. J Eat Disord 2014; 2:2. [PMID: 24999425 PMCID: PMC4081788 DOI: 10.1186/2050-2974-2-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with Anorexia Nervosa (AN) are renowned for their poor short- and long-term treatment outcomes. To gain more insight into the reasons for these poor outcomes, the present study compared patients with AN-R (restrictive subtype), AN-BP (binge-purge subtype), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) over 12 weeks of specialized eating disorders treatment. Eighty-nine patients completed the Eating Disorder Examination- Questionnaire (EDE-Q) and various measures of psychosocial functioning at baseline, and again after weeks 3, 6, 9, and 12 of treatment. RESULTS Multilevel modeling revealed that, over the 12 weeks, patients with AN-BP and AN-R had slower improvements in global eating disorder pathology, shape concerns, and self-compassion than those with EDNOS and BN. Patients with AN-BP had slower improvements in shame, social safeness (i.e., feelings of warmth in one's relationships), and received social support compared to those with AN-R, BN, and EDNOS. CONCLUSIONS These findings support the need for more effective and comprehensive clinical interventions for patients with AN and especially AN-BP. Results also highlight not-yet studied processes that might contribute to the poor outcomes AN patients often face during and after treatment.
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Affiliation(s)
- Allison C Kelly
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Jacqueline C Carter
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL A1B 3X9, Canada
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Huke V, Turk J, Saeidi S, Kent A, Morgan JF. The Clinical Implications of High Levels of Autism Spectrum Disorder Features in Anorexia Nervosa: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2013; 22:116-21. [DOI: 10.1002/erv.2269] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Vanessa Huke
- St George's, University of London; London UK
- Yorkshire Centre for Eating Disorders; Leeds UK
| | - Jeremy Turk
- St George's, University of London; London UK
- Southwark Child & Adolescent Mental Health Neurodevelopmental Service; South London and Maudsley NHS Foundation Trust; UK
- Institute of Psychiatry; King's College; London UK
| | | | - Andrew Kent
- St George's, University of London; London UK
| | - John. F. Morgan
- St George's, University of London; London UK
- Yorkshire Centre for Eating Disorders; Leeds UK
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Hubert T, Pioggiosi P, Huas C, Wallier J, Maria AS, Apfel A, Curt F, Falissard B, Godart N. Drop-out from adolescent and young adult inpatient treatment for anorexia nervosa. Psychiatry Res 2013; 209:632-7. [PMID: 23639255 DOI: 10.1016/j.psychres.2013.03.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 03/25/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
We examined factors predictive of dropout from inpatient treatment for anorexia nervosa (AN) among adolescents in a prospective study of 359 consecutive hospitalizations for AN (DSM-IV). Patients were assessed at admission (clinical, socio-demographic, and psychological data). Multivariate analyses were performed. Drop-out (i.e. leaving hospital before the target weight is achieved) occurred in 24% (n=86) of hospitalizations; in 42.3% (n=30) of the cases, dropout was initiated by the treatment team and in 58.6% (n=41) by the patients and/or their parents. 18.6% (16/86) occurred during the first half of the inpatient program. Frequency of drop-out was significantly higher when the patient was living with only one parent, had been hospitalized previously, had a lower BMI at admission and was over 18 at admission. These elements should draw the attention of the clinician, so that he/she can prepare hospitalization with patients presenting lower admission BMI, particularly by motivational interventions for a better therapeutic alliance, and by the deployment of intensive accompaniment of single parents. Further studies aiming to replicate these results, and including the evaluation of other clinical dimensions such as impulsivity and other personality traits, are needed to elucidate this important topic.
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Affiliation(s)
- Tamara Hubert
- Department of Psychiatry, Institut Mutualiste Montsouris (IMM), Paris, France; Department of General Practice, Univ Paris 7 Denis Diderot., Paris, France; Ecole des Hautes Etudes en Santé Publique (EHESP), Rennes, France; Univ. Paris Ouest Nanterre La Defense, Nanterre, France
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Gorse P, Nordon C, Rouillon F, Pham-Scottez A, Revah-Levy A. Subjective motives for requesting in-patient treatment in female with anorexia nervosa: a qualitative study. PLoS One 2013; 8:e77757. [PMID: 24204951 PMCID: PMC3808348 DOI: 10.1371/journal.pone.0077757] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/08/2013] [Indexed: 11/18/2022] Open
Abstract
Background Anorexia nervosa is a severe psychiatric disorder mainly affecting women. Its treatment is long and accepted with much difficulty, in particular in-patient treatment. Aims To describe the subjective motives of women with anorexia nervosa for requesting in-patient admission, from a qualitative analysis of application letters. Methods Participants were adult women (18 years and older) with anorexia nervosa who were admitted as in-patients in a referral hospital unit in France from January 2008 to December 2010. The application letters, prerequisites to admission, were studied by the interpretative phenomenological method of content analysis. Results 63 letters have been analysed, allowing the identification of six themes related to requests for in-patient care: loss of control of behaviour, and of thoughts, mental exhaustion, isolation, inner struggle and fear of recovery. Conclusions Requests for in-patient admission were motivated by very personal, subjective experiences, unrelated to medical reasons for admission. These results may help improve pre-admission motivational work with individuals, by basing it on their subjective experience.
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Affiliation(s)
- Pauline Gorse
- Department of Adult Psychiatry, CMME, Sainte-Anne University Hospital, Paris, France
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60
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Surgenor LJ, Maguire S. Assessment of anorexia nervosa: an overview of universal issues and contextual challenges. J Eat Disord 2013; 1:29. [PMID: 24999408 PMCID: PMC4081667 DOI: 10.1186/2050-2974-1-29] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 06/03/2013] [Indexed: 02/07/2023] Open
Abstract
AIM Anorexia Nervosa (AN) is a complex and clinically challenging syndrome. Intended for specialist audiences, this narrative review aims to summarise the available literature related to assessment in the adult patient context, synthesising both research evidence and clinical consensus guidelines. METHOD We provide a review of the available literature on specialist assessment of AN focusing on common trajectories into assessment, obstacles accessing assessment, common presenting issues and barriers to the assessment process, the necessary scope of assessment, and tools and techniques. It describes the further step of synthesising assessment information in ways that can inform resultant care plans. RESULTS In addition to assessment of core behaviours and diagnostic skills, considerations for the expert assessor include the functions of primary care, systemic and personal barriers, knowledge of current assessment tools and research pertaining to comorbid pathology in AN, assessing severity of illness, role of family at assessment, as well as medical, nutritional and compulsory elements of assessment. CONCLUSION Comprehensive assessment of AN in the current healthcare context still remains largely the remit of the specialist ED clinician. Assessment should remain an on-going process, paying particular attention to available empirical evidence, thereby reducing the gap between research and practice.
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Affiliation(s)
- Lois J Surgenor
- Department of Psychological Medicine, University of Otago at Christchurch, 4 Oxford Terrace, Christchurch 8140, New Zealand
| | - Sarah Maguire
- Centre for Eating and Dieting Disorders, University of Sydney, 92-94 Parramatta Road, Camberdown, New South Wales 2050, Australia
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Huke V, Turk J, Saeidi S, Kent A, Morgan JF. Autism Spectrum Disorders in Eating Disorder Populations: A Systematic Review. EUROPEAN EATING DISORDERS REVIEW 2013; 21:345-51. [DOI: 10.1002/erv.2244] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Andy Kent
- St George's, University of London; London; UK
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Bühren K, von Ribbeck L, Schwarte R, Egberts K, Pfeiffer E, Fleischhaker C, Wewetzer C, Kennes LN, Dempfle A, Herpertz-Dahlmann B. Body mass index in adolescent anorexia nervosa patients in relation to age, time point and site of admission. Eur Child Adolesc Psychiatry 2013; 22:395-400. [PMID: 23392754 DOI: 10.1007/s00787-013-0376-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 01/07/2013] [Indexed: 11/25/2022]
Abstract
Body mass index (BMI) at admission is an important predictor of outcome in adolescent eating disorders. However, few studies have investigated BMI at admission, its changes in recent years, or modifying factors, such as duration of illness and age at onset in different geographical regions. Thus, this study aimed to investigate changes in BMI at admission over the past decade in one clinic, the differences in BMI between various treatment sites and the influence of duration of illness before admission and age at admission. Our sample consisted of 158 adolescent female patients with anorexia nervosa (AN) admitted between 2001 and 2009 to a major university hospital and 169 adolescent female patients recruited in a multicenter study between 2007 and 2010. We assessed the differences between departments in different regions of Germany in the multi-site sample. Changes over time in age-adjusted BMI and age at admission as well as modifying factors for age-adjusted BMI at admission, such as age at admission and duration of illness, were assessed in a representative local sample. There were no significant differences between departments in different regions of Germany. Over the course of the local study, there was a small but significant increase in the age-adjusted BMI score and absolute BMI at admission. In addition, there was a positive association between year of admission and age at admission. Older adolescents with AN had a lower age-adjusted BMI score and a longer duration of illness at the time of admission. The BMI at admission, which is one of the most important predictors of outcome in AN, has increased slightly during the past 10 years. Education strategies for parents and professionals should continue to be improved to further shorten the duration of illness before admission, especially for older adolescents.
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Affiliation(s)
- Katharina Bühren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany.
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Gulliksen KS, Espeset EMS, Nordbø RHS, Skårderud F, Geller J, Holte A. Preferred therapist characteristics in treatment of anorexia nervosa: the patient's perspective. Int J Eat Disord 2012; 45:932-41. [PMID: 22729778 DOI: 10.1002/eat.22033] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous research in eating disorders suggests that treatment satisfaction is closely related to the manner in which care is delivered. The present research is a systematic in depth study of health professional characteristics preferred by AN-patients. METHOD Thirty-eight women with AN aged 18-51 were interviewed in depth using a phenomenological study design. Interviews were tape-recorded, transcribed, and analyzed using the QSR-NVivo7 software program. RESULTS Four factors associated with patients' satisfaction with their therapists were identified: "acceptance," "vitality," "challenge," and "expertise." Patients' responses suggested that treatment of AN requires therapists who are capable of using a complex set of behaviors when interacting with their patients. DISCUSSION There is accumulating evidence that across treatment modality, the manner in which treatment is delivered is critical to therapeutic change. Our findings increase the understanding of factors that may be associated with treatment retention, further help seeking, and overall treatment outcome. These exploratory and informant-centered results could guide clinicians in developing a strong therapeutic alliance with AN-patients and promote increased knowledge about the mechanisms that engage this population.
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Affiliation(s)
- Kjersti S Gulliksen
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
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64
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Why do people with eating disorders drop out from inpatient treatment?: the role of personality factors. J Nerv Ment Dis 2012; 200:807-13. [PMID: 22922238 DOI: 10.1097/nmd.0b013e318266bbba] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dropout rates from inpatient treatment for eating disorders are very high and have a negative impact on outcome. The purpose of this study was to identify personality factors predictive of dropout from hospitalization. A total of 64 adult patients with anorexia nervosa consecutively hospitalized in a specialized unit were included; 19 patients dropped out. The dropout group and the completer group were compared for demographic variables, clinical features, personality dimensions, and personality disorders. There was no link between clinical features and dropout, and among demographic variables, only age was associated with dropout. Personality factors, comorbidity with a personality disorder and Self-transcendence dimension, were statistically predictive of premature termination of hospitalization. In a multivariate model, these two factors remain significant. Personality traits (Temperament and Character Inventory personality dimension and comorbid personality disorder) are significantly associated with dropout from inpatient treatment for anorexia nervosa. Implications for clinical practice, to diminish the dropout rate, will be discussed.
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Carter O, Pannekoek L, Fursland A, Allen KL, Lampard AM, Byrne SM. Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Behav Res Ther 2012; 50:487-92. [DOI: 10.1016/j.brat.2012.03.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/09/2012] [Accepted: 03/09/2012] [Indexed: 10/28/2022]
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Dejong H, Broadbent H, Schmidt U. A systematic review of dropout from treatment in outpatients with anorexia nervosa. Int J Eat Disord 2012; 45:635-47. [PMID: 22684990 DOI: 10.1002/eat.20956] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Dropout from treatment has serious implications for patients, clinicians, and researchers. The aim of this study was to examine rates of dropout from outpatient treatment for anorexia nervosa (AN) and critically examine the various definitions of dropout used. METHOD A systematic review was conducted, including pharmacological and psychological interventions. All articles in PubMed, Web of Science, and the Cochrane Library were considered, and screened against a priori inclusion/exclusion criteria. Relationships between treatment outcome and dropout rate were examined across studies. RESULTS Nineteen relevant studies were identified, with dropout rates ranging from 4.8% (family therapy) to 100% (dietary advice). In most cases, dropout was in the range of 20-40%. Definitions of dropout used varied widely. A significant negative correlation was found between rate of dropout and body mass index (BMI) at 1 year, but this did not remain significant when differences in BMI at baseline were taken into account. DISCUSSION High rates of dropout from treatment for AN have serious implications for recovery, research, and the development of new treatments. A suggested reporting structure is proposed, with the aim of increasing the consistency of dropout reporting and facilitating greater understanding of this phenomenon.
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Affiliation(s)
- Hannah Dejong
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, United Kingdom.
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67
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Rodríguez-Cano T, Beato-Fernandez L, Moreno LR, Vaz Leal FJ. Influence of attitudes towards change and self-directness on dropout in eating disorders: a 2-year follow-up study. EUROPEAN EATING DISORDERS REVIEW 2012; 20:e123-8. [PMID: 22302485 DOI: 10.1002/erv.2157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 12/08/2011] [Accepted: 12/21/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study examined dropout-related factors at the Outpatient Eating Disorders Treatment Programme. METHOD One hundred ninety-six eating disorders patients following DSM-IV diagnostic criteria that consecutively commenced treatment were recruited and followed up for a 2-year period. A total of 151 patients completed the whole assessment with a set of questionnaires evaluating eating and general psychopathology. The Attitudes towards Change in Eating Disorders questionnaire was used, and personality was evaluated using the Temperament and Character Inventory. During the follow-up period, patients were re-assessed. Two years later, 102 patients continued on treatment. RESULTS Scores on Precontemplation at the beginning were predictors for dropout at 2-year follow-up. Character variables, as Responsibility, Integrity and Self-acceptance were protective factors to be at Precontemplation stage. DISCUSSION The clinician's challenge is to help eating disorders patients to develop an unyielding sense of responsibility and self-acceptance, aimed to integrate the therapeutic choice into their own intrapersonal frame of goals.
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68
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Huas C, Godart N, Foulon C, Pham-Scottez A, Divac S, Fedorowicz V, Peyracque E, Dardennes R, Falissard B, Rouillon F. Predictors of dropout from inpatient treatment for anorexia nervosa: data from a large French sample. Psychiatry Res 2011; 185:421-6. [PMID: 20546922 DOI: 10.1016/j.psychres.2009.12.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 11/27/2009] [Accepted: 12/12/2009] [Indexed: 11/29/2022]
Abstract
Dropout from anorexia nervosa inpatient treatment programs is frequent and is linked to a poorer outcome. This study aimed to identify predictive factors for dropout among anorexia nervosa inpatients. Between 1988 and 2004, 601 consecutive female inpatients with anorexia, restrictive (AN-R) or binge/purging (AN-B/P) subtype (Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)), were assessed at admission (clinical, socio-demographic, and psychological data). A stepwise logistic model was developed. Dropout rates were respectively 50.0% and 56.2% for AN-R and AN-B/P. Seven predictive factors were identified in multivariate analysis: having one or more children, low desired body mass index (BMI), a low minimum BMI, high scores on the SCL-90 paranoid ideation and the Morgan and Russell eating behavior subscales, and low educational status. Early dropouts had a particular profile: lower desired BMI, higher score on SCL90 paranoid subscale, and more impulsive behaviors (alcohol use, suicide attempts). Dropout appeared as a multifactorial event. In clinical practice, certain factors could serve as warning messages reflecting the severity of the illness (high EDI score and low minimum BMI); while others could be targeted before hospitalization (having at least one child and low desired BMI).
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69
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Nordbø RHS, Espeset EMS, Gulliksen KS, Skårderud F, Geller J, Holte A. Reluctance to recover in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2011; 20:60-7. [PMID: 21305676 DOI: 10.1002/erv.1097] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reluctance to recover may explain poor treatment outcome and high dropout and relapse rates in the treatment of anorexia nervosa (AN). This study systematically explored what AN patients describe as interfering with their wish to recover. METHOD Two independent samples of women with AN (total N = 36) were interviewed in-depth using a phenomenological study design. Interviews were tape recorded, transcribed and analysed using QSR-NVivo7 (QSR International, Melbourne, Australia) software. RESULTS Seven core obstacles were found to interfere with informants' wish to recover as follows: (i) 'perceiving judgements'; (ii) 'feeling stuck'; (iii) 'feeling distressed'; (iv) 'denying AN'; (v) 'eating'; (vi) 'gaining weight'; and (vii) 'appreciating the benefits'. CONCLUSION The wish to recover is an autonomously based, fundamental motivational requirement for becoming ready to change. Understanding factors that contribute to this wish adds to the clinician's toolbox in motivational work with AN patients.
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Affiliation(s)
- Ragnfrid H S Nordbø
- Norwegian Institute of Public Health, Division of Mental Health, Oslo, Norway.
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Darcy AM, Katz S, Fitzpatrick KK, Forsberg S, Utzinger L, Lock J. All better? How former anorexia nervosa patients define recovery and engaged in treatment. EUROPEAN EATING DISORDERS REVIEW 2010; 18:260-70. [PMID: 20589765 DOI: 10.1002/erv.1020] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to explore how individuals with anorexia nervosa (AN) engage in treatment and define recovery. A mixed methods design was used to triangulate the experience of 20 women with a history of AN. Interview data were analysed thematically to explore frequency of emergent themes and current eating disorder psychopathology was assessed using standardized self-report measures. Participants' mean age was 29.35 (SD = 12.11). Participants' scores were indicative of persistent psychopathology. Those with more involvement in treatment choice had better motivation to change and normalized eating. Participants' definition of recovery mapped on well to current research conceptualizations, though a substantial proportion of the group expressed some ambivalence around the concept. Results are interpreted in the context of self-determination theory of motivation and suggest that patients should be involved collaboratively in the formulation of shared goals and concepts of recovery in treatment settings.
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Affiliation(s)
- Alison M Darcy
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305, USA.
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71
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Vandereycken W, Devidt K. Dropping out from a specialized inpatient treatment for eating disorders: the perception of patients and staff. Eat Disord 2010; 18:140-7. [PMID: 20390617 DOI: 10.1080/10640260903585557] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Most studies of treatment drop-outs have focused on demographic and clinical patient characteristics as possible predictors. To get a better insight in the meaning of dropping-out from therapy, during 1 year the viewpoints of patients and staff were compared in each case (N = 21 or 15.2%) of premature termination of an inpatient treatment program for eating disorders. Both patients and staff were reporting as important reasons of drop-out: not enough freedom, treatment being too difficult, and lack of trust. Contrary to the staff, patients were more often satisfied with the therapy and therefore did not expect further benefit in continuing the inpatient treatment. The findings are discussed mainly within the context of patient-staff interaction. The authors propose to abandon the term "drop-out" because of its negative connotation.
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Affiliation(s)
- Walter Vandereycken
- Eating Disorders Unit, Alexian Brothers Psychiatric Hospital, Tienen, Belgium.
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Sly R. What's in a name? Classifying ‘the dropout’ from treatment for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2009; 17:405-7. [DOI: 10.1002/erv.964] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fassino S, Pierò A, Tomba E, Abbate-Daga G. Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry 2009; 9:67. [PMID: 19818137 PMCID: PMC2765944 DOI: 10.1186/1471-244x-9-67] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 10/09/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dropout (DO) is common in the treatment of eating disorders (EDs), but the reasons for this phenomenon remain unclear. This study is an extensive review of the literature regarding DO predictors in EDs. METHODS All papers in PubMed, PsycINFO and Cochrane Library (1980-2009) were considered. Methodological issues and detailed results were analysed for each paper. After selection according to inclusion criteria, 26 studies were reviewed. RESULTS The dropout rates ranged from 20.2% to 51% (inpatient) and from 29% to 73% (outpatient). Predictors of dropout were inconsistent due to methodological flaws and limited sample sizes. There is no evidence that baseline ED clinical severity, psychiatric comorbidity or treatment issues affect dropout. The most consistent predictor is the binge-purging subtype of anorexia nervosa. Good evidence exists that two psychological traits (high maturity fear and impulsivity) and two personality dimensions (low self-directedness, low cooperativeness) are related to dropout. CONCLUSION Implications for clinical practice and areas for further research are discussed. Particularly, these results highlight the need for a shared definition of dropout in the treatment of eating disorders for both inpatient and outpatient settings. Moreover, the assessment of personality dimensions (impulse control, self-efficacy, maturity fear and others) as liability factors for dropout seems an important issue for creating specific strategies to reduce the dropout phenomenon in eating disorders.
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Affiliation(s)
- Secondo Fassino
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy.
| | - Andrea Pierò
- Mental Health Department ASL TO 4, Mental Health Centre, Via Blatta 10, Chivasso, 10034 Turin, Italy
| | - Elena Tomba
- Department of Psychology, University of Bologna, 40127 Bologna, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy
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