Motivation to Change in the Course of a Pilot Study of a Step-Down Treatment Approach of Inpatient and Anorexia Nervosa-Specific Home Treatment and Its Effects on Treatment Outcome

Introduction: Anorexia nervosa (AN) is a serious mental disorder that typically manifests in adolescence. Motivation to change is an important predictor for treatment outcome in adolescent AN, even though its development over the often long therapeutic process, with transitions between treatment settings, has not yet been studied. In this pilot study, the course of motivation to change and its effect on treatment outcome were investigated over the course of a step-down treatment approach during a 12-month observation period.Methods: Twenty-one adolescents admitted to inpatient treatment because of AN received multidisciplinary home treatment (HoT) with several weekly visits after short inpatient stabilization. Eating disorder (ED-)specific cognitive [Eating Disorder Inventory 2 (EDI-2) subscales] and physical [% expected body weight (%EBW)] illness severity and motivation to change [Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ)] were assessed at the time of admission, discharge from hospital, at the end of HoT, and at a 12-month follow-up. Changes in motivation over time and its relationship with treatment outcome were investigated.Results: Mean motivation to change improved significantly over the course of treatment from the contemplation stage [2nd stage, mean ANSOCQ sum score 47.26 (SD 17.60)] at admission to the action stage [4th stage, mean ANSOCQ sum score 77.64 (SD 18.97)] at the end of HoT (p < 0.001) and remained stable during the follow-up period. At each assessment, higher motivation to change was significantly correlated with lower ED-specific cognitive illness severity (Spearman ρs: −0.53 to −0.77, all p < 0.05). Only pretreatment motivation to change significantly predicted ED-specific cognitive illness severity after the first inpatient treatment phase when taking prior illness severity into account.Conclusions: Motivation to change is an important aspect of treatment success in adolescent AN, especially in the early phase of treatment. In addition, home treatment contributed significantly to a higher motivation. Further longitudinal research into how motivation to change in adolescent patients with AN is related to outcome in this often severe and enduring disease and into targeted therapeutic strategies and interventions that reliably enhance the motivation to change in adolescent patients with AN seems promising.

Download Full-text

Short-term follow-up of adults with long standing anorexia nervosa or non-specified eating disorder after inpatient treatment

Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity ◽

10.1007/bf03325047 ◽

2004 ◽

Vol 9 (1) ◽

pp. 62-68 ◽

Cited By ~ 22

Author(s):

Ø. Rø ◽

E. W. Martinsen ◽

A. Hoffart ◽

J. H. Rosenvinge

Keyword(s):

Anorexia Nervosa ◽

Eating Disorder ◽

Inpatient Treatment ◽

Short Term

Download Full-text

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

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.682952 ◽

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.

Download Full-text

An examination of the role of autonomous versus controlled motivation in predicting inpatient treatment outcome for anorexia nervosa

International Journal of Eating Disorders ◽

10.1002/eat.22510 ◽

2016 ◽

Vol 49 (6) ◽

pp. 626-629 ◽

Cited By ~ 20

Author(s):

Lea Thaler ◽

Mimi Israel ◽

Juliana Mazanek Antunes ◽

Sabina Sarin ◽

David C. Zuroff ◽

...

Keyword(s):

Anorexia Nervosa ◽

Treatment Outcome ◽

Inpatient Treatment ◽

Controlled Motivation

Download Full-text

Outcome of severe anorexia nervosa patients receiving inpatient treatment in Japan: An 8-year follow-up study

Psychiatry and Clinical Neurosciences ◽

10.1046/j.1440-1819.2001.00880.x ◽

2001 ◽

Vol 55 (4) ◽

pp. 389-396 ◽

Cited By ~ 30

Author(s):

Hideki Tanaka ◽

Nobuo Kiriike ◽

Toshihiko Nagata ◽

Keisen Riku

Keyword(s):

Anorexia Nervosa ◽

Inpatient Treatment ◽

Follow Up Study

Download Full-text

Early within-person weight gain and variability during inpatient treatment for anorexia nervosa: Age-dependent effects on treatment outcome

10.31234/osf.io/jpu6e ◽

2021 ◽

Author(s):

David R. Kolar ◽

Adrian Meule ◽

Silke Naab ◽

Ulrich Voderholzer

Keyword(s):

Anorexia Nervosa ◽

Treatment Outcome ◽

Weight Gain ◽

Body Dissatisfaction ◽

Inpatient Treatment ◽

Average Weight ◽

Drive For Thinness ◽

Early Weight Gain ◽

Age Dependent ◽

Weight Restoration

Background: Early weight gain during inpatient treatment for anorexia nervosa (AN) is an important predictor of overall treatment outcome. However, weight gain is a dynamic process characterized by within-person variability that may also be age-dependent. Therefore, we examined whether age moderates the effect of within-person weight gain and variability on treatment outcome.Methods: Within-person level estimates of N = 2881 underweight adolescents and adults with AN for daily average weight gain (linear slope) and variability (root mean squared errors) were obtained using random-effects modelling. Linear and logistic regression analyses at the between-person level were calculated to assess their effects on weight, core eating disorder psychopathology and weight restoration. Results: Higher weight gain during the first two weeks of inpatient treatment predicted higher discharge weight, lower drive for thinness and lower body dissatisfaction at discharge, but was not associated with changes in bulimic symptoms. Moreover, higher early weight gain predicted a higher probability of weight restoration at discharge. Moderation analyses revealed that younger age was significantly associated with a stronger effect of early weight gain on weight, drive for thinness and body dissatisfaction at discharge, but was not associated with a higher likelihood of weight restoration. Weight variability was not associated with any treatment outcome. Conclusion: Age moderated the effect of early weight gain on treatment outcome, with larger effects for younger patients. Weight variability did not substantially influence treatment outcome across age and should be of lesser clinical concern during early inpatient treatment when patients gain weight on average.

Download Full-text

manuscript

10.31219/osf.io/3xqy4 ◽

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.

Download Full-text