Evaluating empirically valid and clinically meaningful change in intensive residential treatment for severe eating disor
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ORIGINAL ARTICLE
Evaluating empirically valid and clinically meaningful change in intensive residential treatment for severe eating disorders at discharge and at a 6‑month follow‑up Laura Muzi1 · Laura Tieghi2 · Michele A. Rugo2 · Vittorio Lingiardi1 Received: 3 July 2019 / Accepted: 14 October 2019 © Springer Nature Switzerland AG 2019
Abstract Purpose The present study evaluated the statistical and clinical significance of symptomatic change at discharge and after 6 months of an intensive residential treatment for patients with eating disorders (ED), and explored the individual factors that may affect therapeutic outcomes. Methods A sample of 118 female ED patients were assessed at intake and discharge on the following dimensions: BMI, ED-specific symptoms, depressive features, and overall symptomatic distress. A subsample of 59 patients filled out the same questionnaires at a 6-month follow-up after discharge. Results Findings evidenced statistically significant changes in all outcome measures at both discharge and follow-up. Between 30.1 and 38.6% of patients at discharge and 35.2–54.2% at the 6-month follow-up showed clinically significant symptomatic change; additionally, 19.8–29.1% of patients at discharge and 22.9–38.3% at follow-up improved reliably. However, 34.9–39.8% remained unchanged and 2–4.8% worsened. At the 6-month follow-up, 21.3–25.9% showed no symptomatic change and 0–3.7% had deteriorated. Unchanged and deteriorated patients had an earlier age of ED onset and were more likely to suffer a comorbid personality pathology and to be following concurrent pharmacological treatment. Conclusions Results suggested that intensive and multimodal residential treatment may be effective for the majority of ED patients, and that therapeutic outcomes tend to improve over time. Prevention strategies should focus on early onset subjects and those with concurrent personality pathology. Level of evidence Level III, evidence obtained from a longitudinal cohort study. Keywords Eating disorders · Residential treatment · Effectiveness · Symptom change · Clinical significance
Introduction Eating disorders (ED) are commonly considered amongst the most challenging psychiatric disorders to treat, showing high rates of psychiatric and medical comorbidity [1–3], elevated mortality rates [4, 5], and significant recidivism [6]. Furthermore, several studies have shown that ED patients typically develop a history of negative therapy experiences
* Laura Muzi [email protected] 1
Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy
Eating Disorder Clinic “Residenza Gruber”, Bologna, Italy
2
and repeated treatment failure [7, 8], ranging from dropout [9, 10] to relapse [11]. To overcome these clinical challenges, most guidelines agree that there should be a continuum of care linked to the patient’s symptom severity, overall medical status, treatment history, and social circumstances [12, 13]. Among the ED tre
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