Inpatient treatment for eating disorders: outcome at discharge and 3-month follow-up

There have been few studies of inpatient treatment for eating disorders. Existing studies have mostly examined small samples of either anorexic or bulimic patients. The current study evaluated large samples of anorexic and bulimic inpatients at intake, discharge, and a 3-month follow-up. At discharge, patients in both groups showed substantial and statistically significant improvements on self-report measures of depression and eating disorder symptomatology. Treatment gains were largely maintained at follow-up. Correlational analyses found consistent inverse relationships between degree of change experienced during and after hospitalization. More favorable outcome during treatment was associated with less favorable outcome after treatment. Implications of these findings for the assessment and treatment of eating disorders are discussed.     

A 20-month follow-up study of 628 women with eating disorders: II. Course of associated symptoms and related clinical features

In response to a magazine article, 628 women with eating disorders completed questionnaires in 1982 and in 1984, an average of 20 months later. The majority of these respondents met simulated DSM-III criteria for normal-weight bulimia (NWB) or fell into a somewhat healthier group that we called subdiagnostic eating disorders (SDED). Five percent met simulated criteria for anorexia nervosa with bulimic features (BAN). Although at follow-up there was some improvement in eating disorders criterion symptoms and slight improvement in associated symptoms such as menstrual irregularities, depression, and self-destructive behaviors, the burden of these symptoms remained considerable. Furthermore, at follow-up the BAN group reported an increased use of alcohol and the NWB group an increased use of cigarettes.     

Negative self-image and outcome in eating disorders: results at 3-year follow-up

INTRODUCTION: Negative self-image has been hypothesised to be of aetiological significance in eating disorders; however, its relationship to outcome remains unclear. The present study examined the relationship between self-image and follow-up status in a heterogeneous sample of eating disorder patients (N=246). METHODS: Patients were assessed at intake and after 36 months. Self-image was measured using SASB, and a general outcome measure was calculated comprising eating disorder symptoms, occupational status, interpersonal relationships and general psychopathology. RESULTS: SASB self-hate was the most important variable for predicting poor outcome, followed by occupational status, interpersonal relationships, eating disorder symptoms, SASB self-emancipation and general psychiatric symptoms. Together these variables predicted 23% of the variance in outcome. DISCUSSION: High levels of self-hate may increase the risk of poor outcome in eating disorders by adversely affecting interpersonal relationships and making it difficult for patients to engage in treatment.     

Laxative withdrawal and anxiety in bulimia nervosa

Symptoms of anxiety can be prominent during treatment of bulimia nervosa Our experience is that bulimics who abuse laxatives have the most prominent symptoms of anxiety. We conducted ratings of anxiety in 23 bulimics who purge with laxatives and 17 who purge by vomiting. We found that the laxative-abusing group had higher levels of state but not trait anxiety and that they were more likely to be treated with medication for anxiety during hospitalization. These data suggest an association between laxatives and anxiety in bulimia nervosa. © 1995 by John Wiley & Sons, Inc.     

Objective and subjective binge eating in underweight eating disorders: associated features and treatment outcome

Objective:

To define the utility of the DSM‐IV‐TR definition of binge eating, as it applies to anorexia nervosa (AN) and underweight eating disorder not otherwise specified (ED‐NOS).

Method:

We investigated the psychopathological features associated with bulimic episodes in 105 underweight individuals with eating disorders who reported regular objective bulimic episodes with or without subjective bulimic episodes (OBE group, n = 33), regular subjective bulimic episodes only (SBE group, n = 36) and neither objective nor subjective bulimic episodes (n = 36, no‐RBE group). The Eating Disorder Examination (EDE), anxiety, depression, and personality tests were administered before and upon completion of inpatient cognitive behavior therapy (CBT) treatment 6 months later.

Results:

Compared with the SBE group, OBE subjects had higher body mass index, and more frequent self‐induced vomiting, while both OBE and SBE groups had more severe eating disorder psychopathology and lower self‐directness than the no‐RBE group. Dropout rates and outcomes in response to inpatient CBT were similar in the three groups.

Discussion:

Despite a few significant differences at baseline, the similar outcome in response to CBT indicates that categorizing patients with underweight eating disorder on the basis of the type or frequency of bulimic episodes is of limited clinical utility. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012;)     

Travel distance and attrition in outpatient eating disorders treatment

OBJECTIVE: The purpose of this study was to investigate the impact of the distance patients had to travel for treatment on attendance patterns and treatment attrition. METHOD: Contact information, clinical records, and/or appointment records of 209 adult patients presenting to an outpatient eating disorder treatment center over a specific period of time were reviewed. Information was obtained on demographics, diagnosis, number of appointments attended, cancelled, and failed, and termination status. Patients were classified as treatment completers or dropouts and compared on demographic, diagnostic, attendance, and distance to treatment site variables. RESULTS: Treatment completer and dropout groups did not differ significantly on demographic variables, with the exception of employed patients being more likely to drop out of treatment. Although not statistically significant, patients diagnosed with bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) were more likely to drop out of treatment prematurely. Surprisingly, distance traveled to the treatment site was not significantly different between groups and did not appear to significantly impact attendance patterns. CONCLUSION: Results of this archival investigation were unexpected and likely limited by the design. Results can be useful in understanding motivational factors inherent in noncompliance and premature termination of treatment. A prospective study including fine-grained analysis of variables associated with eating disorder treatment attrition is indicated.     

Social anxiety as a barrier to treatment for eating disorders

BACKGROUND: The goal of this pilot investigation is to determine the relationship between social anxiety and treatment-seeking behavior for eating disorders in an outpatient psychiatric clinic. METHOD: Twenty-eight patients seeking treatment for anorexia or bulimia at an outpatient eating disorders clinic completed a battery of self-report measures on eating pathology, attachment style and functioning, and social anxiety at initial intake appointment. Levels of eating pathology and social anxiety at consult were compared with service utilization records on entry into treatment. RESULTS: Individuals who did not engage in treatment had significantly higher levels of social anxiety (F = 8.29, df = 1, p < .05) compared with those who did engage in treatment. There were no differences in demographic characteristics, diagnoses, or level of eating pathology at intake. CONCLUSIONS: Social anxiety may act as a barrier to effective help-seeking and utilization of mental health treatment among individuals with eating disorders. Replication of these findings in a larger sample and more in-depth study of the mechanism of the observed association between use of services and social anxiety may be useful in planning more effective outreach in the community to underserved populations in need of treatment for eating disorders.     

Chewing and spitting in eating disorders and its relationship to binge eating

OBJECTIVE: This study examined (i) the frequency of chewing and spitting and (ii) its association with other pathological eating behaviors in eating-disordered inpatients. We hypothesized a positive association between chewing and spitting and binge eating given the phenomenological similarities between these disordered eating behaviors. METHOD: Frequent chewers/spitters were compared with those who did not regularly engage in this behavior with regard to diagnosis, psychometric test results, and associated eating pathology. RESULTS: Chewing and spitting was not associated with elevated bingeing. Rather, frequent chewers/spitters exhibited higher levels of restrictive eating behaviors and the behavior was more prevalent in younger patients. DISCUSSION: Contrary to our predictions, chewing and spitting is more closely associated with restrictive than with binge behaviors. This suggests that most individuals chew and spit small portions of food. The behavior is frequent, occurs across diagnostic groups, and may be associated with greater psychopathology. Future studies should clarify the amount of food consumed during chew/spit episodes and the presence of a sense of loss of control.     

A novel approach to treating eating disorders in a day-hospital treatment program

Aim: The aim of the present study was to evaluate the short-term effectiveness of an adult day-hospital program that uses a novel approach to delivering nutritional interventions. Methods: Fifty-six adult eating disorder patients of the Sydney West Area Eating Disorders Day Treatment Program participated in the study. Participants completed standardised self-reported questionnaires designed to measure eating disorder symptoms, at the commencement of treatment and after 12 weeks. Results: Participation in day-hospital treatment was associated with increases in weight, reductions in number of binge-eating and purging episodes, and frequency of exercise sessions. Participants also experienced improvements in their eating attitudes, drive for thinness, bulimia, depression and anxiety symptoms. Conclusion: These findings add to the growing body of literature supporting the use of day-hospital programs in the treatment of eating disorders. A number of strategies are suggested for the effective delivery of nutritional interventions in day-hospital programs, such as methods that assist with integrating new information, having an experiential focus and the use of collaborative education processes.     

Barriers to treatment for eating disorders among ethnically diverse women.

OBJECTIVE: This study examined barriers to treatment in an ethnically diverse community sample of women with eating disorders. METHOD: Participants were 61 women (22 Hispanics, 8 Asians, 12 Blacks, 19 Whites) with eating disorders. Diagnosis was determined using the Eating Disorder Examination. Treatment-seeking history, barriers to treatment seeking, ethnic identity, and acculturation were assessed. RESULTS: Although 85% of the sample reported wanting help for an eating problem, only 57% had ever sought treatment for an eating or weight problem. Individuals who had sought treatment reported being significantly more distressed about their binge eating than those who had not sought treatment and having begun overeating at a younger age. Of those who had sought help, 86% had not received any treatment for their eating problems. The main barriers to treatment seeking were financial reasons. CONCLUSION: Women from minority groups who have eating disorders are underdiagnosed and typically not treated.     

The dietitian's role in the treatment of eating disorders

Eating disorders have both psychological and physiological elements and so require treatment that combines expertise in both. Professionals who treat patients with an eating disorder need to have knowledge of the nutritional effects and physiological consequences of the illness. This is rare within a predominantly mental health setting. The extreme dieting behaviour in anorexia nervosa leading to the severe weight loss and symptoms of semi‐starvation; binge‐eating behaviour, seen in cases in bulimia nervosa and binge eating disorder; and the patient’s distorted beliefs about nutrition and dietary requirements all underpin the need for the expertise provided by dietitians. They now have an essential role within the multi‐disciplinary assessment and treatment programmes for all three major eating disorders.     

Season of birth and eating disorders: patterns across diagnoses in a specialized eating disorders service

OBJECTIVE: In view of inconsistent findings from previous studies, the aim was to investigate possible seasonal variation in month of birth in patients with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. METHOD: We examined the month of birth in a cohort of 1,305 adult patients with a DSM-IV eating disorder diagnosis at first presentation to a specialized eating disorders service. RESULTS: When compared to general population data, we found no evidence of significant variation in month or season of birth in anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified. CONCLUSION: The authors question whether people who develop eating disorders differ from the general population in their season of birth. Caution is expressed about further speculation regarding the etiological significance of season of birth in eating disorders.     

Laxative abuse complicating bulimia: Medical and treatment implications

Literature concerning laxative abuse among young women with bulimia is reviewed. Laxative abuse appears to be much more common among females with bulimia than among females who do not meet criteria for bulimia. Patients with bulimia most commonly abuse stimulant-type laxatives. The abuse of laxatives is associated with potentially serious sequellae involving the gastrointestinal tract as well as generalized systemic effects. The different types of laxatives, their mechanisms of action, and the medical complications of laxative abuse are reviewed. Recommendations regarding laxative withdrawal are offered.     

Exercise and eating disorders: a 3-year inpatient hospital record analysis

The purpose of this study was to describe the exercise behavior across the DSM-IV eating disorder diagnosis (anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS)) and determine if differences exist among exercise category (high level and low level), type of exercise (aerobic, strength, and total), Eating Attitudes Test (EAT), Eating Disorders Inventory (EDI-2), and the length of inpatient hospitalization. This study was a retrospective analysis of 199 inpatient hospital records of female patients (age M=20.6, S.D.=7.03) in the following diagnostic categories: AN (n=115, 58%), BN (n=38, 19%), and EDNOS (n=46, 23%). Patients were also grouped by a median split into low- and high-level exercise categories based on their total amount of weekly exercise. No significant relationship was found between diagnosis and exercise category (high and low) or diagnosis and exercise type (total, aerobic, and strength exercise). This is valuable because exercise specialist may be a worthwhile addition to treatment teams working with all eating disorder diagnostic groups. The high-level exercisers showed significantly greater scores on the EAT [F(2,1,110)=5.117, P<.05] and weight preoccupation [F(1,1010)=4.861, P<.05] than the low-level exercise groups. There were significant relationships between total exercise and EAT (r=.354, P<.01), drive for thinness (r=.262, P<.01), and body dissatisfaction (r=.312, P<.001). Total aerobic exercise was significantly related to EAT (r=.352, P<.001), drive for thinness (r=.272, P<.01), and body dissatisfaction (r=.268, P<.01). Finally, total strength exercise was related to body dissatisfaction (r=.249, P<.05). A significant difference was found among exercise group and length of hospitalization [F(1,155)=14.384, P<.000]. The high-level exercisers were in treatment for 3 weeks longer than their low-level exercisers. A forced stepwise multiple linear regression was calculated to predict the length of hospitalization. At Step 1, diagnosis and Body Mass Index (BMI) on admission explained 27% of the variance in length of inpatient hospitalization [F(4,154)=18.08, P<.004, r(2)=.273]. When two exercise variables were included, aerobic activity explained an additional 5% of variance, whereas strength activity explained an additional 0.3% of the variance. Three-fourths of the predictors explained significant components of the total 32% variance. The present study demonstrates that patients with greater total exercise and a greater total aerobic exercise show a significantly greater drive for thinness and require a longer length of hospitalization. This association was not present with total strength exercise levels. Effective clinical methods to modify total aerobic exercise levels need to be determined with inpatient populations.