Magazine article Clinical Psychiatry News

Benefits Sustained from Eating Disorder Program

Magazine article Clinical Psychiatry News

Benefits Sustained from Eating Disorder Program

Article excerpt

SEATTLE--Initial improvements in anorexia nervosa and bulimia nervosa achieved in an intensive residential treatment program are largely sustained 4-5 years later, Dr. Timothy D. Brewerton reported.

"Data on long-term follow-up of individuals with anorexia nervosa and bulimia nervosa following intensive inpatient or residential treatment are limited," said Dr. Brewerton, a psychiatrist at the Medical University of South Carolina, Charleston, who also is in private practice in Mt. Pleasant, S.C. "Many studies are primarily on adolescents and/or outpatients, and others have included individuals who have not received any treatment."

The investigators surveyed patients with eating disorders who had received at least 30 days of treatment in a residential program in Malibu, Calif. Outcomes on the Eating Disorder Inventory-2 (EDI-2), the Beck Depression Inventory (BDI), and a structured eating disorder assessment were evaluated at three time points: admission, discharge, and the most recent of 13 postgraduate follow-ups, which ranged from 1 to 10 years.

Analyses were based on 85 patients with anorexia and 71 patients with bulimia. The mean time between discharge and postgraduate follow-up was 4.5 and 4.1 years, respectively. On average, the patients in each group were about 30 years old (range, 17-57).

In the anorexia group, mean BMI scores (reported by a physician therapist, or dietician) increased significantly between admission and discharge (from 16 to 18), Dr. Brewerton told those attending an international conference sponsored by the Academy for Eating Disorders. Moreover, a further significant increase was seen from discharge to postgraduate follow-up (from 18 to 19).

By discharge, the patients with anorexia had significant improvements in 9 of 11 subscales of the EDI-2. They had further significant improvements in five of the subscales--drive for thinness, body dissatisfaction, interoceptive awareness, maturity fears, and asceticism--between discharge and postgraduate follow-up.

The percentage of anorexia patients with a good outcome, defined as a return of body mass index (BMI) to at least 18 and normal menses, increased between discharge and postgraduate follow-up (from 19% to 41%). At the same time, there was a decrease in the percentages with an intermediate outcome, defined as restoration of BMI or normal menses (from 48% to 46%), and a poor outcome, defined as restoration of neither BMI nor menses (from 33% to 12%).

The frequency of 3 of 10 eating-disordered behaviors--bingeing, vomiting, and laxative use--was significantly higher at postgraduate follow-up than at discharge. …

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