scholarly journals Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa

2021 ◽  
Author(s):  
Tom Jewell ◽  
Moritz Herle ◽  
Lucy Serpell ◽  
Alison Eivors ◽  
Mima Simic ◽  
...  
Keyword(s):  
Emotion Regulation ◽  
Anorexia Nervosa ◽  
Treatment Outcome ◽  
Family Therapy ◽  
Mental States ◽  
Positive Outcome ◽  
Self Report ◽  
Poor Outcome ◽  
Positive Treatment ◽  
Adolescent Anorexia Nervosa

AbstractAnorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20–0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one’s feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00–1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.

scholarly journals Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa

2020 ◽  
Author(s):  
Tom Jewell ◽  
Moritz Herle ◽  
Lucy Serpell ◽  
Alison Eivors ◽  
Mima Simic ◽  
...  
Keyword(s):  
Emotion Regulation ◽  
Anorexia Nervosa ◽  
Treatment Outcome ◽  
Family Therapy ◽  
Mental States ◽  
Self Report ◽  
Mediating Role ◽  
Poor Outcome ◽  
Positive Treatment ◽  
Adolescent Anorexia Nervosa

Objective: Anorexia nervosa focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well-understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome at nine months. Therapeutic alliance at one month was tested as a potential mediator of the effect of attachment and mentalization at baseline on outcome at nine months.Method: 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Results: Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: .42, CI: .20 to .87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one’s feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00 - 1.21). Alliance scores at one month were predictive of success but did not play a mediating role in relation to baseline predictors.Conclusion: These novel findings suggest that, particularly in parents, a tendency towards inappropriate certainty about mental states in others may predict poor outcome in family therapy for adolescent AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.

scholarly journals Lifetime Weight Characteristics of Adult Inpatients With Severe Anorexia Nervosa: Maximal Lifetime BMI Predicts Treatment Outcome

2021 ◽  
Vol 12 ◽  
Author(s):  
Lisa-Katrin Kaufmann ◽  
Hanspeter Moergeli ◽  
Gabriella Franca Milos
Keyword(s):  
Anorexia Nervosa ◽  
Treatment Outcome ◽  
Strong Predictor ◽  
Negative Influence ◽  
Positive Influence ◽  
The Body ◽  
Linear Regression Models ◽  
Weight Suppression ◽  
Positive Treatment

Background: The body mass index is a key predictor of treatment outcome in patients with anorexia nervosa. In adolescents, higher premorbid BMI is a strong predictor of a favorable treatment outcome. It is unclear whether this relationship holds true for adults with anorexia nervosa. Here, we examine adult patients with AN and investigate the lowest and highest lifetime BMI and weight suppression as predisposing factors for treatment outcome.Methods: We included 107 patients aged 17–56 with anorexia nervosa and tracked their BMI from admission to inpatient treatment, through discharge, to follow-up at 1–6 years. Illness history, including lowest and highest lifetime BMI were assessed prior to admission. We used multiple linear regression models with minimal or maximal lifetime BMI or weight suppression at admission as independent variables to predict BMI at admission, discharge and follow-up, while controlling for patients' age, sex, and duration of illness.Results: Low minimal BMI had a negative influence on the weight at admission, which in turn resulted in a lower BMI at discharge. Higher maximal BMI had a substantial positive influence on BMI at discharge and follow-up. Weight suppression was highly correlated with maximal BMI and showed similar effects to maximal BMI.Conclusion: Our findings strongly support a relationship between low minimal lifetime BMI and lower BMI at admission, and between higher maximal lifetime BMI or weight suppression and a positive treatment outcome, even years after discharge. Overall, maximal BMI emerged as the most important factor in predicting the weight course in adults with AN.

scholarly journals A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Ivan Eisler ◽  
Mima Simic ◽  
John Hodsoll ◽  
Eia Asen ◽  
Mark Berelowitz ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Family Therapy ◽  
Single Family ◽  
Adolescent Anorexia Nervosa

Who’s in the Room? A Parent-Focused Family Therapy for Adolescent Anorexia Nervosa

2015 ◽  
Vol 23 (4) ◽  
pp. 291-301 ◽  
Author(s):  
Elizabeth K. Hughes ◽  
Susan M. Sawyer ◽  
Katharine L. Loeb ◽  
Daniel Le Grange
Keyword(s):  
Anorexia Nervosa ◽  
Family Therapy ◽  
Adolescent Anorexia Nervosa

scholarly journals Emotion regulation difficulties in anorexia nervosa: associations with improvements in eating psychopathology

2021 ◽  
Author(s):  
Marsha Rowsell ◽  
Danielle E. MacDonald ◽  
Jacqueline C. Carter
Keyword(s):  
Emotion Regulation ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Intensive Treatment ◽  
Self Report ◽  
Eating Psychopathology ◽  
Eating Disorder Symptoms ◽  
Core Deficit ◽  
Eating Disorder Psychopathology ◽  
Regulation Strategies

Background Difficulties with emotion regulation have been established as a core deficit in anorexia nervosa (AN). However, limited research has evaluated whether weight gain is associated with improvements in emotion regulation difficulties in AN and whether improvements in emotion regulation are associated with reductions in eating disorder psychopathology. The aims of this study were threefold: 1) to examine the nature and extent of emotion regulation difficulties in AN; 2) to determine whether these difficulties improved during intensive treatment for the eating disorder; and 3) to study whether improvements in emotion regulation were associated with improvements in eating disorder psychopathology. Method The participants were 108 patients who met DSM-IV-TR criteria for AN and were admitted to a specialized intensive treatment program. Self-report measures of eating disorder symptoms and difficulties with emotion regulation were administered at admission to and discharge from the program. Results Patients with the binge-purge subtype of AN reported greater difficulties with impulse control when upset and more limited access to emotion regulation strategies when experiencing negative emotions than those with the restricting subtype. Among those who completed treatment and became weight restored, improvements in emotion regulation difficulties were observed. Greater pre-to-post treatment improvements in emotional clarity and engagement in goal directed behaviours when upset were associated with greater reductions in eating disorder psychopathology during treatment. Conclusions These findings add to growing evidence suggesting that eating disorder symptoms may be related to emotion regulation difficulties in AN and that integrating strategies to address emotion regulation deficits may be important to improving treatment outcome in AN.

scholarly journals manuscript

2021 ◽  
Author(s):  
Lisa-Katrin Kaufmann
Keyword(s):  
Anorexia Nervosa ◽  
Treatment Outcome ◽  
Strong Predictor ◽  
Negative Influence ◽  
Positive Influence ◽  
The Body ◽  
Linear Regression Models ◽  
Weight Suppression ◽  
Positive Treatment

Background: The body mass index is a key predictor of treatment outcome in patients with anorexia nervosa. In adolescents, higher premorbid BMI is a strong predictor of a favourable treatment outcome. It is unclear whether this relationship holds true for adults with anorexia nervosa. Here, we examine adult patients with AN and investigate the lowest and highest lifetime BMI and weight suppression as predisposing factors for treatment outcome.Methods: We included 107 patients aged 17-56 with anorexia nervosa and tracked their BMI from admission to inpatient treatment, through discharge, to follow-up at 1-6 years. Illness history, including lowest and highest lifetime BMI were assessed prior to admission. We used multiple linear regression models with minimal or maximal lifetime BMI or weight suppression at admission as independent variables to predict BMI at admission, discharge and follow-up, while controlling for patients’ age, sex, and duration of illness. Results: Low minimal BMI had a negative influence on the weight at admission, which in turn resulted in a lower BMI at discharge. Higher maximal BMI had a substantial positive influence on BMI at discharge and follow-up. Weight suppression was highly correlated with maximal BMI and showed similar effects to maximal BMI.Conclusion: Our findings strongly support a relationship between low minimal lifetime BMI and lower BMI at admission, and between higher maximal lifetime BMI or weight suppression and a positive treatment outcome, even years after discharge. Overall, maximal BMI emerged as the most important factor in predicting the weight course in adults with AN.

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