Therapeutic outcome and long-term naturalistic follow-up of female adolescent outpatients with AN: clinical, personality and psychopathology evolution, process indicators and outcome predictors

Abstract

Abstract Background Anorexia nervosa (AN) is a serious mental illness of growing prevalence in childhood and adolescence. Despite its severity, there are still no completely satisfactory evidence-based treatments. Follow-up studies represent the most effective attempt to enlighten treatment effectiveness, outcome predictors and process indicators. Methods 73 female participants affected with AN were assessed at intake (T0), and at 6 (T1) and 12 (T2) months after treatment into an outpatient multimodal treatment program, 19 participants were also assessed 15 years after demission (T3). Changes in diagnostic criteria were compared with the chi-square test. Clinical, personality and psychopathology evolution were tested with GLM ANOVA for repeated measures, and using t-test or Wilcoxon test as post-hoc. T0 features of dropout, stable and healed participants were compared with ANOVA. Healed and unhealed long-term follow-up groups were compared using Mann-Whitney U test. Treatment changes were correlated to each other and to initial features using multivariate regression analysis. Results the rate of complete remission after treatment (T2) was 64.4% and 73.7% in the long-term follow-up participants (T3). Twenty-two percent of participants maintained a full diagnosis after treatment (T2), and only 15.8% of the participants at follow-up (T3). BMI significantly increased at each timepoint with respect to T0. A significant decrease of persistence and increase in self-directedness were evidenced between T0 and T2. Interoceptive awareness, drive to thinness, and impulsivity significantly decreased after treatment. Parent-rated and adolescent-rated general psychopathology significantly reduced after treatment. Lower reward dependence and cooperativeness characterized the dropout group. The healed group displayed lower adolescent-rated aggressive and externalizing, and lower parent-rated delinquent behaviors. BMI, personality and psychopathology changes were related with each other and with initial features. Conclusion a 12-months outpatient multimodal treatment encompassing psychiatric, nutritional and psychological approaches is an effective approach for the treatment of mild to moderate anorexia nervosa in adolescence. Treatment not only increases BMI but also fosters personality development and changes in both eating and general psychopathology. Lower relational abilities may obstacle healing. Approaches to treatment resistance should be personalized according to these features.