Abstract
Background
Anorexia nervosa (AN) is a severe psychiatric disorder, for which recovery is often a protracted process, such that a proportion of individuals with AN experience a chronic illness course. The role of prior specialized inpatient treatment on subsequent treatment attempts for those with chronic AN remains unclear. Research examining predictors of treatment response for severe and enduring AN is urgently needed to improve outcomes.
Method
Participants (N = 135) with chronic AN (ill ≥7 years) admitted to an integrated inpatient-partial hospitalization eating disorders (ED) unit with prior ED hospitalization(s) (+ PH; n = 100) were compared to those without prior ED hospitalizations (-PH; n = 35) on admission characteristics (BMI, length of illness, outpatient ED treatment history, symptomatology (ED, anxiety and depressive), treatment motivation, history of suicide attempts or non-suicidal self-injury (NSSI)), and discharge outcomes (discharge BMI, rate of weight gain, length of stay, clinical improvement).
Results
At admission, groups were similar in age, prolonged length of illness, and BMIs. The + PH group however had lower desired weight, lower lifetime nadir BMI, lower self-efficacy for normative eating, and higher state and trait anxiety compared to the -PH group. The + PH group was also more likely to endorse history of NSSI and suicide attempt. Regarding discharge outcomes, the + PH group spent more days inpatient, but groups did not differ on rate of weight gain, likelihood of attending partial hospital, partial hospital length of stay, program discharge BMI, or likelihood of clinical improvement (p’s > .05).
Conclusions
Participants with chronic AN + PH exhibited more severe psychiatric comorbidity and lower self-efficacy for normative eating, but had similar short-term discharge outcomes to chronic AN -PH. Results suggest that targeting comorbidities may be important for patients who did not respond to prior intensive treatment. Although both groups had similar illness duration, those with chronic AN -PH may be distinct in terms of prognosis. For example, they may be able to transition to partial hospital earlier than those with chronic AN + PH. Longer-term data comparing these groups is needed to best individualize care and determine prognosis including relapse risk following intensive treatment and weight restoration.