Das Strukturierte Interview für Anorektische und Bulimische Ess-Störungen nach DSM-IV und ICD-10 zur Expertenbeurteilung (SIAB-EX) und dazugehöriger Fragebogen zur Selbsteinschätzung (SIAB-S)

Background: The Structured Inventory for Anorexic and Bulimic Syndromes according to DSM-IV and ICD-10 consists of the Structured Expert Interview for Anorexic and Bulimic Syndromes (SIAB-EX) and the corresponding self report questionnaire (SIAB-S). These instruments assess symptoms of eating disorders and other symptoms often found in eating-disordered individuals (e.g. anxieties, symptoms of OCD, depression, substance abuse and impairment of sexuality and social integration). Thus, parallel forms for self-report and expert rating are available. Separate factor analyses resulted in very similar factor structures for self-report and interview as well as for both time points assessed: current (last 3 months before the interview) and past (time from puberty up to 3 months before the interview). Both assessments can be used for diagnosing eating disorders according to DSM-IV and ICD-10 and a total score can be computed. Method: Test criteria were assessed using a sample of 377 inpatients treated for an eating disorder. For the expert interview, SIAB-EX data were collected in a community sample of 202 young women without eating disorders. Results: Test criteria were satisfying or better. Interrater reliability (kappa) for the expert interview SIAB-EX was 0,81 (current) and 0,85 (past). Sensitivity, specificity, and positive predictive value were very good for the SIAB-EX (ppv = 0.91 lifetime) and the SIAB-S (ppv = 0.98 lifetime). Means for SIAB-EX and SIAB-S for the inpatient sample are reported. For the expert interview SIAB-EX norms for 202 young non-eating disordered women are given. Conclusion: The expert interview SIAB-EX can be seen as a `gold standard' for the assessment of eating disorders. The SIAB-EX is available in German, English, Italian and Spanish

Veränderung von Persönlichkeitsmerkmalen im Verlauf einer stationären Therapie

Background: The Freiburger Personality Inventory (FPI-R) is a well established and proven instrument for the assessment of personality traits. Although personality is conceived as a stable trait, clinical experience indicates that impressive changes are found on personality scales during intensive treatment. Method A large sample of inpatients which were treated with cognitive-behavioral therapy for bulimia nervosa, tinnitus or anxiety disorder was evaluated concerning the question which items of the FPI-R were answered differently or identically before and after intensive therapy. Results: It could be found that items which cover aspects that are central to the therapy more often show changing answers. The use of conditional form and indefinite frequency adjuncts in the formulation of items evidently allowed a more differentiated weighting of pros and cons at the end of therapy. Effects of regression to the mean could be excluded as an explanation by empirical data. Conclusion: It can be concluded that changes in answering items before and after intensive therapy can be explained as specific effects of therapy

Internet-based relapse prevention for anorexia nervosa: nine- month follow-up

To study the longer term effects of an internet-based CBT intervention for relapse prevention (RP) in anorexia nervosa

Langzeitverlauf der Bulimia nervosa bei stationär behandelten Patientinnen und Patienten

Einleitung und Fragestellung Wissen über den Langzeitverlauf einer Erkrankung ist für die Betroffenene und ihren Angehörigen wichtig um einen Eindruck zu bekommen, wie die Erkrankung in der weiteren Zukunft verlaufen wird. Für die behandelnden Personen ist dieses Wissen für die Beratung und Therapieplanung von Bedeutung. Bulimia nervosa (BN) ist eine Essstörung, die zu schweren psychischen und sozialen Einschränkungen führen kann. Zum Langzeitverlauf dieser Erkrankung ist überraschend wenig bekannt. Die vorliegende Studie berichtet Ergebnisse zum kurzfristigen (2 Jahre nach Behandlung), mittelfristigen (bis zu 10 Jahre nach Behandlung) und langfristigen (mehr als 10 Jahre nach Behandlung) Verlauf und Outcome von BN. Methoden Die Fragestellung wurde in zwei Stichproben untersucht. Stichprobe (1): Erwachsene Frauen (N = 196), die zwischen September 1985 und Juni 1988 wegen einer BN purging-Typ (DSM-IV) stationär in der Psychosomatischen Klinik Roseneck (jetzt Schön Klinik Roseneck) in Prien am Chiemsee behandelt worden waren, wurde mehrfach (im Mittel 2, 6 und 12 Jahre nach Behandlung) nachuntersucht. Von den überlebenden Frauen konnten 99 % nach 2 Jahren, 95 % nach 6 Jahren und 85 % nach 12 Jahren nachbefragt werden. Zwei, bzw. vier Frauen waren bei der 6-, bzw. 12-Jahreskatamnese verstorben. Stichprobe (2): Erwachsenen Männer (N = 51) und Frauen (N = 1.982), die zwischen Mai 1985 und Dezember 2005 wegen einer BN (purging und non-purging-Typ; DSM-IV) stationär in der der gleichen Klinik zur Behandlung einer BN aufgenommen worden waren, wurden im Mittel 11 Jahre nach Behandlung nachuntersucht (N = 1.351 Personen mit Katamnese-Fragebogen). Dies war eine Erweiterung von Stichprobe (1). Daneben wurde eine Teilstichprobe mit einem mittleren Katamnesezeitraum von 21 Jahren (N = 147) definiert. Die Datenerhebung erfolgte mittels Fragebögen und klinischen Interviews zur Erfassung der Essstörungssymptomatik und der allgemeinen Psychopathologie, sowie Fragen zu soziodemographische Merkmalen und weiteren Behandlungen. In Stichprobe (2) wurde auch der Vitalstatus erfasst. Berichtet werden Ergebnisse zum diagnostischen Outcome zum jeweiligen Querschnitt, psychiatrische Komorbidität, Prädiktoren, und zur Mortalität. Alle Patientinnen und Patienten füllten bei Aufnahme und Entlassung ein Fragebogenpaket aus. Die Nachuntersuchung erfolgte postalisch mit einem ähnlichen Fragebogenpaket. Stichprobe (1) wurde zusätzlich mit strukturierten klinischen Experteninterviews – meist telefonisch - nachbefragt. Ergebnisse Von den Frauen der Stichprobe (1) waren nach 2 Jahren 57 %, nach 6 Jahren 71 % und nach 12 Jahren 70 % remittiert. Eine BN bei Katamnese hatten 34 % nach 2 Jahren, 22 % nach 6 Jahren und 10 % nach 12 Jahren. Ein Diagnosenwechsel zur AN fand bei ca. 5 % der Patientinnen statt. Der Wechsel zur Binge-Eating-Störung, also der Verzicht auf gegensteuernde Maßnahmen bei persistierenden Essattacken, war selten (1-2 %). Psychiatrische Komorbidität war hoch mit 80 % lifetime-Prävalenz, meist affektive Störungen (69 %) und Angststörungen (36 %). In Stichprobe (2) waren 38 % der nachuntersuchten Personen nach 11 Jahren bzw. 42 % nach 21 Jahren remittiert. Der Anteil persistierender BN war 14 % nach 11 Jahren, bzw. 12 % nach 21 Jahren. Die in Fragebögen erhobenen Symptomausprägungen (u. a. Schlankheitsstreben, bulimische Verhaltensweisen, Angst, Zwang, Depression) verringerten sich während der stationären Therapie, stiegen nach Entlassung wieder an (ohne das Niveau der Aufnahme zu erreichen) und sanken dann über die weitere Beobachtungszeit weiter ab. Als signifikante Prädiktoren für einen schlechten Outcome (Risikofaktoren) ergaben sich 1. Ein kürzeres Katamneseintervall; 2. Mehr Schlankheitsstreben; 3. Höheres Alter bei Behandlung; 4. Niedrigeres globales Funktionsniveau. In Stichprobe (2) waren 49 von 1.930 (2.5 %) Personen mit BN und verifiziertem Vitalstatus verstorben. Die standardisierte Sterblichkeitsrate betrug 1.49 (5 % Konfidenzintervall = 1.10 – 1.97; p < .05). Personen mit stationär behandelter BN wiesen damit ein eineinhalbfaches Risiko zu Sterben gegenüber der Allgemeinbevölkerung gleichen Alters und gleichen Geschlechts auf. Schlussfolgerung Die vorliegende Studie erweitert das Wissen zum Verlauf der BN wesentlich. Langfristig zeigen 15 % bis 20 % der an BN erkrankten Personen einen chronischen Verlauf, während etwa zwei Drittel eine wesentliche Besserung oder Remission aufweisen. Nach 10 bis 12 Jahren stabilisiert sich der Outcome und es gibt nur noch wenige Änderungen. Die Ergebnisse zum Outcome zeigen einen beachtlichen Anteil an Chronifizierung der BN. Es müssen Strukturen zur langfristigen Nachsorge geschaffen werden, um zum einen Chronifizierung zu vermeiden, und zum anderen auch Personen mit einem chronischen Verlauf möglichst frühzeitig therapeutisch zu erreichen.Research question The long-term course and outcome of any illness is important to know for persons affected by this illness, and for their loved ones. They all want to know the future course of the illness. For health professionals this knowledge is relevant for counselling and therapy planning. Bulimia nervosa (BN) is an eating disorder with a potential for severe mental and social impairment. Surprisingly little is known on the long-term course of BN. The present study presents results on the short-term (2 years after treatment), medium-term (up to 10 years after treatment) and long-term (more than 10 years after treatment) course and outcome of BN. Methods Two samples were included in this study. Sample (1): Adult females (N = 196) treated between September 1985 and Juni 1988 as inpatients for a BN purging type (DSM-IV) in the Psychosomatische Klinik Roseneck (now Schön Klinik Roseneck) in Prien am Chiemsee, were followed-up after a mean 2, 6, and 12 years. Of the surviving females, 99 % were assessed at 2-year follow-up, 95 % were assessed at 6-year follow-up (2 females were deceased) and 85 % were assessed at 12-year follow-up (4 females were deceased). Sample (2): Adult females (N = 1,982) and males (N = 51) treated between May 1985 und December 2005 for BN (purging and non-purging-type; DSM-IV) in the same hospital were followed-up 11 years after treatment (N = 1,351 individuals with follow-up questionnaire). This was an extension of sample (1). In addition a sub-sample was defined with a mean follow-up period of 21 years (N = 147). Data collected included questionnaires and clinical expert-interviews covering eating disorder and general psychopathology, socio-demographic variables and additional treatments. In sample (2), vital status was also ascertained. Results on diagnostic outcome for each follow-up, psychiatric comorbidity, predictors of outcome and mortality are reported. At admission and discharge all patients filled-out a package of questionnaires. A similar package of questionnaires was mailed to the patients for follow-up. At follow-up sample (1) was additionally interviewed by clinical experts, mostly on the phone. Results After two years 57 % of the females of sample (1) reported remission. After 6 years 71 % and after 12 years 70 % of the same sample were remitted. A persisting BN reported 34 %, 22 %, and 10 % two, six, and 12 years after treatment, respectively. Cross-over to anorexia nervosa was reported by 5 %. Cross-over to binge-eating disorder, i.e. persisting binge-eating in the absence of counterregulatory measures to control weight, was found only rarely (1-2 %). Psychiatric comorbidity was high with 80 % lifetime-prevalence, mostly affective (69 %) and anxiety (36 %) disorders. In sample (2) 38 % of the participants reported remission after 11 years, after 21 years remission was reported by 42 %. Persisting BN was found in 14 % after 11 years and in 12 % after 21 years. Symptom severity as assessed by questionnaires (e.g. drive for thinness, bulimic behavior, anxiety, obsessive-compulsive symptoms, depression) decreased during inpatient therapy. Severity increased after discharge (but did not reach the level as assessed at admission), and further decreased over the follow-up period. Significant predictors of poor outcome (risk factors) were 1. Shorter folllow-up interval; 2. Higher drive for thinness; 3. Higher age at treatment; 4. Lower assessment of functioning score. In sample (2), 49 of 1,930 persons with BN (2.5 %) and ascertained vital status were deceased. The standardized mortality ratio was 1.49 (5 % confidence interval = 1.10 – 1.97; p < .05). Individuals who were treated as inpatients for BN carried a 1.5 fold increased risk of death compared to the general population of the same age and sex. Conclusion This study extends the knowledge on the course and outcome of BN considerably. In the long term, about 15 - 20 % of the patients with BN have a chronic course of BN, and about two thirds show improvement or remission. After 10 to 12 years, outcome seems to be stable and only little additional improvement seems to occur. Outcome results indicate a considerable percentage of chronification of BN. There is a need for additional programs for long-term aftercare to prevent chronification and to reach individuals with chronic BN for early clinical and social intervention

Langzeitverlauf der Bulimia nervosa bei stationär behandelten Patientinnen und Patienten

Einleitung und Fragestellung Wissen über den Langzeitverlauf einer Erkrankung ist für die Betroffenene und ihren Angehörigen wichtig um einen Eindruck zu bekommen, wie die Erkrankung in der weiteren Zukunft verlaufen wird. Für die behandelnden Personen ist dieses Wissen für die Beratung und Therapieplanung von Bedeutung. Bulimia nervosa (BN) ist eine Essstörung, die zu schweren psychischen und sozialen Einschränkungen führen kann. Zum Langzeitverlauf dieser Erkrankung ist überraschend wenig bekannt. Die vorliegende Studie berichtet Ergebnisse zum kurzfristigen (2 Jahre nach Behandlung), mittelfristigen (bis zu 10 Jahre nach Behandlung) und langfristigen (mehr als 10 Jahre nach Behandlung) Verlauf und Outcome von BN. Methoden Die Fragestellung wurde in zwei Stichproben untersucht. Stichprobe (1): Erwachsene Frauen (N = 196), die zwischen September 1985 und Juni 1988 wegen einer BN purging-Typ (DSM-IV) stationär in der Psychosomatischen Klinik Roseneck (jetzt Schön Klinik Roseneck) in Prien am Chiemsee behandelt worden waren, wurde mehrfach (im Mittel 2, 6 und 12 Jahre nach Behandlung) nachuntersucht. Von den überlebenden Frauen konnten 99 % nach 2 Jahren, 95 % nach 6 Jahren und 85 % nach 12 Jahren nachbefragt werden. Zwei, bzw. vier Frauen waren bei der 6-, bzw. 12-Jahreskatamnese verstorben. Stichprobe (2): Erwachsenen Männer (N = 51) und Frauen (N = 1.982), die zwischen Mai 1985 und Dezember 2005 wegen einer BN (purging und non-purging-Typ; DSM-IV) stationär in der der gleichen Klinik zur Behandlung einer BN aufgenommen worden waren, wurden im Mittel 11 Jahre nach Behandlung nachuntersucht (N = 1.351 Personen mit Katamnese-Fragebogen). Dies war eine Erweiterung von Stichprobe (1). Daneben wurde eine Teilstichprobe mit einem mittleren Katamnesezeitraum von 21 Jahren (N = 147) definiert. Die Datenerhebung erfolgte mittels Fragebögen und klinischen Interviews zur Erfassung der Essstörungssymptomatik und der allgemeinen Psychopathologie, sowie Fragen zu soziodemographische Merkmalen und weiteren Behandlungen. In Stichprobe (2) wurde auch der Vitalstatus erfasst. Berichtet werden Ergebnisse zum diagnostischen Outcome zum jeweiligen Querschnitt, psychiatrische Komorbidität, Prädiktoren, und zur Mortalität. Alle Patientinnen und Patienten füllten bei Aufnahme und Entlassung ein Fragebogenpaket aus. Die Nachuntersuchung erfolgte postalisch mit einem ähnlichen Fragebogenpaket. Stichprobe (1) wurde zusätzlich mit strukturierten klinischen Experteninterviews – meist telefonisch - nachbefragt. Ergebnisse Von den Frauen der Stichprobe (1) waren nach 2 Jahren 57 %, nach 6 Jahren 71 % und nach 12 Jahren 70 % remittiert. Eine BN bei Katamnese hatten 34 % nach 2 Jahren, 22 % nach 6 Jahren und 10 % nach 12 Jahren. Ein Diagnosenwechsel zur AN fand bei ca. 5 % der Patientinnen statt. Der Wechsel zur Binge-Eating-Störung, also der Verzicht auf gegensteuernde Maßnahmen bei persistierenden Essattacken, war selten (1-2 %). Psychiatrische Komorbidität war hoch mit 80 % lifetime-Prävalenz, meist affektive Störungen (69 %) und Angststörungen (36 %). In Stichprobe (2) waren 38 % der nachuntersuchten Personen nach 11 Jahren bzw. 42 % nach 21 Jahren remittiert. Der Anteil persistierender BN war 14 % nach 11 Jahren, bzw. 12 % nach 21 Jahren. Die in Fragebögen erhobenen Symptomausprägungen (u. a. Schlankheitsstreben, bulimische Verhaltensweisen, Angst, Zwang, Depression) verringerten sich während der stationären Therapie, stiegen nach Entlassung wieder an (ohne das Niveau der Aufnahme zu erreichen) und sanken dann über die weitere Beobachtungszeit weiter ab. Als signifikante Prädiktoren für einen schlechten Outcome (Risikofaktoren) ergaben sich 1. Ein kürzeres Katamneseintervall; 2. Mehr Schlankheitsstreben; 3. Höheres Alter bei Behandlung; 4. Niedrigeres globales Funktionsniveau. In Stichprobe (2) waren 49 von 1.930 (2.5 %) Personen mit BN und verifiziertem Vitalstatus verstorben. Die standardisierte Sterblichkeitsrate betrug 1.49 (5 % Konfidenzintervall = 1.10 – 1.97; p < .05). Personen mit stationär behandelter BN wiesen damit ein eineinhalbfaches Risiko zu Sterben gegenüber der Allgemeinbevölkerung gleichen Alters und gleichen Geschlechts auf. Schlussfolgerung Die vorliegende Studie erweitert das Wissen zum Verlauf der BN wesentlich. Langfristig zeigen 15 % bis 20 % der an BN erkrankten Personen einen chronischen Verlauf, während etwa zwei Drittel eine wesentliche Besserung oder Remission aufweisen. Nach 10 bis 12 Jahren stabilisiert sich der Outcome und es gibt nur noch wenige Änderungen. Die Ergebnisse zum Outcome zeigen einen beachtlichen Anteil an Chronifizierung der BN. Es müssen Strukturen zur langfristigen Nachsorge geschaffen werden, um zum einen Chronifizierung zu vermeiden, und zum anderen auch Personen mit einem chronischen Verlauf möglichst frühzeitig therapeutisch zu erreichen.Research question The long-term course and outcome of any illness is important to know for persons affected by this illness, and for their loved ones. They all want to know the future course of the illness. For health professionals this knowledge is relevant for counselling and therapy planning. Bulimia nervosa (BN) is an eating disorder with a potential for severe mental and social impairment. Surprisingly little is known on the long-term course of BN. The present study presents results on the short-term (2 years after treatment), medium-term (up to 10 years after treatment) and long-term (more than 10 years after treatment) course and outcome of BN. Methods Two samples were included in this study. Sample (1): Adult females (N = 196) treated between September 1985 and Juni 1988 as inpatients for a BN purging type (DSM-IV) in the Psychosomatische Klinik Roseneck (now Schön Klinik Roseneck) in Prien am Chiemsee, were followed-up after a mean 2, 6, and 12 years. Of the surviving females, 99 % were assessed at 2-year follow-up, 95 % were assessed at 6-year follow-up (2 females were deceased) and 85 % were assessed at 12-year follow-up (4 females were deceased). Sample (2): Adult females (N = 1,982) and males (N = 51) treated between May 1985 und December 2005 for BN (purging and non-purging-type; DSM-IV) in the same hospital were followed-up 11 years after treatment (N = 1,351 individuals with follow-up questionnaire). This was an extension of sample (1). In addition a sub-sample was defined with a mean follow-up period of 21 years (N = 147). Data collected included questionnaires and clinical expert-interviews covering eating disorder and general psychopathology, socio-demographic variables and additional treatments. In sample (2), vital status was also ascertained. Results on diagnostic outcome for each follow-up, psychiatric comorbidity, predictors of outcome and mortality are reported. At admission and discharge all patients filled-out a package of questionnaires. A similar package of questionnaires was mailed to the patients for follow-up. At follow-up sample (1) was additionally interviewed by clinical experts, mostly on the phone. Results After two years 57 % of the females of sample (1) reported remission. After 6 years 71 % and after 12 years 70 % of the same sample were remitted. A persisting BN reported 34 %, 22 %, and 10 % two, six, and 12 years after treatment, respectively. Cross-over to anorexia nervosa was reported by 5 %. Cross-over to binge-eating disorder, i.e. persisting binge-eating in the absence of counterregulatory measures to control weight, was found only rarely (1-2 %). Psychiatric comorbidity was high with 80 % lifetime-prevalence, mostly affective (69 %) and anxiety (36 %) disorders. In sample (2) 38 % of the participants reported remission after 11 years, after 21 years remission was reported by 42 %. Persisting BN was found in 14 % after 11 years and in 12 % after 21 years. Symptom severity as assessed by questionnaires (e.g. drive for thinness, bulimic behavior, anxiety, obsessive-compulsive symptoms, depression) decreased during inpatient therapy. Severity increased after discharge (but did not reach the level as assessed at admission), and further decreased over the follow-up period. Significant predictors of poor outcome (risk factors) were 1. Shorter folllow-up interval; 2. Higher drive for thinness; 3. Higher age at treatment; 4. Lower assessment of functioning score. In sample (2), 49 of 1,930 persons with BN (2.5 %) and ascertained vital status were deceased. The standardized mortality ratio was 1.49 (5 % confidence interval = 1.10 – 1.97; p < .05). Individuals who were treated as inpatients for BN carried a 1.5 fold increased risk of death compared to the general population of the same age and sex. Conclusion This study extends the knowledge on the course and outcome of BN considerably. In the long term, about 15 - 20 % of the patients with BN have a chronic course of BN, and about two thirds show improvement or remission. After 10 to 12 years, outcome seems to be stable and only little additional improvement seems to occur. Outcome results indicate a considerable percentage of chronification of BN. There is a need for additional programs for long-term aftercare to prevent chronification and to reach individuals with chronic BN for early clinical and social intervention

Comparing ICD‐11 and DSM‐5 eating disorder diagnoses with the Munich eating and feeding disorder questionnaire (ED‐Quest)

Objective The new ICD-11 eating disorders (ED) guidelines are similar to the DSM-5 criteria. One difference to the DSM-5 is the inclusion of subjective binges in the definition of bulimia nervosa (BN) and binge-eating disorder (BED). The aim of this study was to identify differences between the ICD-11 guidelines and DSM-5 ED criteria, which could impact access to medical care and early treatment. Method Data of 3863 ED inpatients who completed the Munich Eating and Feeding Disorder Questionnaire were analyzed using standardized diagnostic algorithms for DSM-5 and ICD-11. Results Agreement of diagnoses was high (Krippendorff's α = .88, 95% CI [.86, .89]) for anorexia nervosa (AN; 98.9%), BN (97.2%) and BED (100%), and lower for other feeding and eating disorders (OFED; 75.2%). Of the 721 patients with a DSM-5 OFED, 19.8% were diagnosed with AN, BN or BED by the ICD-11 diagnostic algorithm, reducing the number of OFED diagnoses. One-hundred and twenty-one patients received an ICD-11 diagnosis of BN or BED because of subjective binges. Discussion For over 90% of patients, applying either DSM-5 or ICD-11 diagnostic criteria/guidelines resulted in the same full-threshold ED diagnosis. Sub-threshold and feeding disorders exhibited a discrepancy of 25%. Public Significance Statement For about 98% of inpatients, the ICD-11 and DSM-5 agree on the same specified eating disorder diagnosis. This is important when comparing diagnoses made by different diagnostic systems. Including subjective binges in the definition of bulimia nervosa and binge-eating disorder contributes to improved ED diagnoses. Clarifying the wording of diagnostic criteria at several places could further increase this agreement

Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes

Background: Previous studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients' treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology. Methods: A total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change. Results: 20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors. Conclusions: Despite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients

Orthorexic tendencies in the general population: association with demographic data, psychiatric symptoms, and utilization of mental health services

PURPOSE Orthorexia nervosa (ON) is characterized by a preoccupation to eat healthily and restrictive eating habits despite negative psychosocial and physical consequences. As a relatively new construct, its prevalence and correlates in the general population and the associated utilization of mental health services are unclear. METHODS Adults from the general population completed the Düsseldorf Orthorexia Scale (DOS), the Patient Health Questionnaire (PHQ), the Short Eating Disorder Examination (SEED). RESULTS Five-hundred eleven (63.4% female) participants with a mean age of 43.39 (SD = 18.06) completed the questionnaires. The prevalence of ON according to the DOS was 2.3%. Considering only effects of at least intermediate size, independent samples t-tests suggested higher DOS scores for persons with bulimia nervosa (p < .001, Cohen's d = 1.14), somatoform syndrome (p = .012, d = .60), and major depressive syndrome (compared p < .001, d = 1.78) according to PHQ as well as those who reported to always experience fear of gaining weight (p < .001, d = 1.78). The DOS score correlated moderately strong and positively with the PHQ depression (r = .37, p < .001) and stress (r = .33, p < .001) scores as well as the SEED bulimia score (r = .32, p < .001). In multivariate logistic regression analyses, only PHQ depression~scores were associated with past psychotherapeutic or psychiatric treatment (OR = 1.20, p = .002) and intake of psychotropic medication in the last year (OR = 1.22, p = .013). CONCLUSIONS The prevalence of ON was low compared to international studies but is in line with other non-representative German studies. Orthorexic tendencies related to general mental distress and eating disorder symptoms but were no independent reason for seeking treatment. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study

Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes

Background: Previous studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients' treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology. Methods: A total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change. Results: 20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors. Conclusions: Despite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients