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Naturalistic follow-up of subjects affected with anorexia nervosa 8 years after multimodal treatment: Personality and psychopathology changes and predictors of outcome

Published online by Cambridge University Press:  23 March 2020

F. Amianto ,
A. Spalatro ,
L. Ottone ,
G. Abbate Daga  and
S. Fassino
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Abstract

Background:

Eating disorders (EDs) are serious mental illnesses of growing clinical and social impact. Despite their severity, there is still no satisfactory evidence-based treatment. Follow-up investigations are the most reliable studies to enlighten long-term outcome predictors and modifiers.

Methods:

In total, 59 subjects affected with anorexia nervosa were assessed 8 years after their admission into an outpatient multimodal treatment program for eating disorders. The follow-up changes in diagnostic criteria were compared with Chi-square test. Improved and not-improved subjects were compared. Clinical, personality and psychopathology features between T0 and T1 were compared with t-test for repeated measures. Correlation between T0 features and changes at T1 in personality and psychopathology features were assessed.

Results:

The rate of complete remission was 42%, an overall rate of 67.8% improved, a rate of 18.6% worsened. Concerning personality, a significant decrease of harm avoidance and increase in self-directedness were evidenced. Interoceptive awareness, drive for thinness, bulimia were significantly reduced at follow-up. Many T0 personality facets were related to personality and psychopathology improvement at follow-up.

Conclusion:

Multimodal treatment encompassing psychiatric, nutritional and psychological approaches is at the moment the most reliable approach for the treatment of moderate to severe anorexia nervosa with a discrete rate of improvement. Some personality and psychopathology characteristics may represent specific factors which favor resistance and impair improvement. Future approaches should consider the personalization of therapeutic approach according to these features.

Keywords

Anorexia nervosaMultimodal treatmentPersonalityPsychopathologyPsychotherapyPredictors of outcome
Type
Original article
Information
European Psychiatry , Volume 45 , September 2017 , pp. 198 - 206
Copyright
Copyright © European Psychiatric Association 2017

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References

Campbell, KPeebles, REating disorders in children and adolescents: state of the art review. Pediatrics 2014; 134(3): 582–592.CrossRefGoogle ScholarPubMed
Crow, SEating disorders and risk of death. Am J Psychiatry 2013; 170: 824–825.CrossRefGoogle ScholarPubMed
Klump, KLBulik, CMKaye, WHTreasure, JTyson, EAcademy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord 2009; 42(2): 97–103.CrossRefGoogle ScholarPubMed
Fassino, SAbbate-Daga, GResistance to treatment in eating disorders: a critical challenge. BMC Psychiatry 2013; 7(13): 282CrossRefGoogle Scholar
Von Holle, APoyastro Pinheiro, AThornton, LMKlump, KLBerrettini, WHBrandt, H, et al.Twelve-year course and outcome predictors of anorexia nervosa. Aust N Z J Psychiatry 2008; 42: 108–117.CrossRefGoogle Scholar
Wentz, EGillberg, ICAnckarsater, HGillberg, CRastam, MAdolescent-onset anorexia nervosa: 18-year outcome. Br J Psychiatry 2009; 194: 168–174.CrossRefGoogle ScholarPubMed
Clausen, LTime to remission for eating disorder patients: a 2½-year follow-up study of outcome and predictors. Nord J Psychiatry 2008;62:151.CrossRefGoogle Scholar
Keel, PKBrown, TAUpdate on course and outcome in eating disorders. Int J Eat Disord 2010; 43(3): 195–204.Google ScholarPubMed
Castellini, GLo Sauro, CMannucci, ERavaldi, CRotella, CMFaravelli, C, et al.Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study. Psychosom Med 2011; 73: 270–279.CrossRefGoogle ScholarPubMed
Fichter, MMQuadflieg, NLong-term stability of eating disorder diagnoses. Int J Eat Disord 2007;40:S61–S66.CrossRefGoogle ScholarPubMed
Bardone-Cone, AMSturm, KLawson, MARobinson, DPSmith, RPerfectionism across stages of recovery from eating disorders. Int J Eat Disord 2010; 43(2): 139–148.Google ScholarPubMed
Emanuelli, FWaller, GJones-Chester, MOstuzzi, RRecovery from disordered eating: sufferers’ and clinicians’ perspectives. Eur Eat Disord Rev 2012; 20(5): 363–372.CrossRefGoogle ScholarPubMed
Yu, JAgras, WSBryson, SDefining recovery in adult bulimia nervosa. Eat Disord 2013; 21(5): 379–394.CrossRefGoogle ScholarPubMed
Jarman, MWalsh, SEvaluating recovery from anorexia nervosa and bulimia nervosa: integrating lessons learned from research and clinical practice. Clin Psychol Rev 1999; 19: 773–788.CrossRefGoogle ScholarPubMed
Page, LASutherby, KTreasure, JLA preliminary description of the use of “relapse management cards” in anorexia nervosa. Eur Eat Disord Rev 2002; 10(4): 281–291.CrossRefGoogle Scholar
Oldershaw, AHambrook, DStahl, DTchanturia, KTreasure, JSchmidt, UThe socio emotional processing stream in anorexia nervosa. Neurosci Biobehav Rev 2011; 35(3): 970–988.CrossRefGoogle ScholarPubMed
Segura-García, CChiodo, DSinopoli, FDe Fazio, P. Temperamental factors predict long-term modifications of eating disorders after treatment. BMC Psychiatry 2013;13:288. http://dx.doi.org/10.1186/1471-244X-13-288.CrossRefGoogle ScholarPubMed
Faravelli, CRavaldi, CTruglia, EZucchi, TCosci, FRicca, VClinical epidemiology of eating disorders: results from the Sesto Fiorentino study. Psychother Psychosom 2006; 75(6): 376–383.CrossRefGoogle ScholarPubMed
Brauhardt, Ade Zwaan, MHilbert, AThe therapeutic process in psychological treatments for eating disorders: a systematic review. Int J Eat Disord 2014; 47(6): 565–584.CrossRefGoogle ScholarPubMed
Fassino, SAbbate-Daga, GPierò, ALeombruni, PRovera, GGDropout from brief psychotherapy within a combination treatment in bulimia nervosa: role of personality and anger. Psychother Psychosom 2003; 72(4): 203–210.CrossRefGoogle ScholarPubMed
Fassino, SPierò, ATomba, EAbbate-Daga, GFactors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry 2009;9:67.CrossRefGoogle Scholar
Fassino, SSobrero, CAbbate Daga, GDoes it exist a personality core of mental illness? A systematic review on core psychobiological personality traits in mental disorders. Panminerva Med 2013; 55(4): 397–413.Google ScholarPubMed
Vitousek, KMStumpf, REDifficulties in the assessment of personality traits and disorders in eating-disordered individuals. Eat Disord 2005; 13(1): 37–60.CrossRefGoogle ScholarPubMed
Fassino, SAbbate-Daga, GAmianto, FLeombruni, PBoggio, SRovera, GGTemperament and character profile of eating disorders: a controlled study with the Temperament and Character Inventory. Int J Eat Disord 2002; 32(4): 412–425.CrossRefGoogle ScholarPubMed
Kaye, WHKlump, KLFrank, GKStrober, MAnorexia and bulimia nervosa. Annu Rev Med 2000; 51: 299–313.CrossRefGoogle ScholarPubMed
Amianto, FAbbate-Daga, GMorando, SSobrero, CFassino, SPersonality development characteristics of women with anorexia nervosa, their healthy siblings and healthy controls: what prevents and what relates to psychopathology?. Psychiatry Res 2011; 187(3): 401–408.CrossRefGoogle ScholarPubMed
Wagner, ABarbarich-Marsteller, NCFrank, GKBailer, UFWonderlich, SACrosby, RD, et al.Personality traits after recovery from eating disorders: do subtypes differ?. Int J Eat Disord 2006; 39(4): 276–284.CrossRefGoogle ScholarPubMed
Dalle Grave, RACalugi, SABrambilla, FBMarchesini, GCPersonality dimensions and treatment drop-outs among eating disorder patients treated with cognitive behavior therapy. Psychiatry Res 2008; 158(3): 381–388.CrossRefGoogle ScholarPubMed
Anderson, CBJoyce, PRCarter, FAMcIntosh, VVBulik, CMThe effect of cognitive-behavioral therapy for bulimia nervosa on temperament and character as measured by the temperament and character inventory. Compr Psychiatry 2002; 43(3): 182–188.CrossRefGoogle ScholarPubMed
Agüera, ZKrug, ISánchez, IGranero, RPenelo, EPeñas-Lledó, E, et al.Personality changes in bulimia nervosa after a cognitive behavior therapy. Eur Eat Disord Rev 2012; 20(5): 379–385.CrossRefGoogle Scholar
Bloks, HHoek, HWCallewaert, Ivan Furth, EStability of personality traits in patients who received intensive treatment for a severe eating disorder. J Nerv Ment Dis 2004; 192(2): 129–138 [9:67].CrossRefGoogle ScholarPubMed
Klump, KLStrober, MBulik, CMThornton, LJohnson, CDevlin, B, et al.Personality characteristics of women before and after recovery from an eating disorder. Psychol Med 2004; 34(8): 1407–1418.CrossRefGoogle ScholarPubMed
Spitzer, RLWilliams, JBGibbon, MFirst, MBThe structured clinical interview for DSM-III-R (SCID). I: history, rationale, and description. Arch Gen Psychiatry 1992; 49(8): 624–629.CrossRefGoogle ScholarPubMed
Fassino, SAmianto, FFerrero, ABrief Adlerian psychodynamic psychotherapy: theoretical issues and process indicators. Panminerva Med 2008; 50(2): 165–175.Google ScholarPubMed
Cloninger, CRTemperament and personality. Curr Opin Neurobiol 1994; 4(2): 266–273.CrossRefGoogle Scholar
Garner, DMGarfinkel, PEBody image in anorexia nervosa: measurement, theory and clinical implications. Int J Psychiatry Med 1981; 11(3): 263–284 [http://www.ncbi.nlm.nih.gov/pubmed/7309395].CrossRefGoogle ScholarPubMed
Evans, CDolan, BBody Shape Questionnaire: derivation of shortened “alternate forms”. Int J Eat Disord 1993; 13(3): 315–321.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Gormally, JBlack, SDaston, SRardin, DBinge Eating Scale: the assessment of binge eating severity among obese persons. Addict Behav 1982; 7: 47–55.CrossRefGoogle ScholarPubMed
Beck, ATRial, WYRickels, KShort form of depression inventory: cross-validation. Psychol Rep 1974; 34(3): 1184–1186.Google ScholarPubMed
Castellini, GMontanelli, LFaravelli, CRicca, VEating disorder outpatients who do not respond to cognitive behavioral therapy: a follow-up study. Psychother Psychosom 2014; 83(2): 125–127.CrossRefGoogle Scholar
Fichter, MMQuadflieg, NHedlund, STwelve-year course and outcome predictors of anorexia nervosa. Int J Eat Disord 2006; 39(2): 87–100.CrossRefGoogle ScholarPubMed
Carter, JCMercer-Lynn, KBNorwood, SJBewell-Weiss, CVCrosby, RDWoodside, DB, et al.A prospective study of predictors of relapse in anorexia nervosa: implications for relapse prevention. Psychiatry Res 2012;200(2–3):518–523. http://dx.doi.org/10.1016/j.psychres.2012.04.037.CrossRefGoogle ScholarPubMed
Rigaud, DPennacchio, HBizeul, CReveillard, VVergès, BOutcome in AN adult patients: a 13-year follow-up in 484 patients. Diabetes Metab 2011; 37(4): 305–311. http://dx.doi.org/10.1016/j.diabet.2010.11.020.CrossRefGoogle Scholar
Vall, EWade, TDTrail making task performance in inpatients with anorexia nervosa and bulimia nervosa. Eur Eat Disord Rev 2015; 23(4): 304–311. http://dx.doi.org/10.1002/erv.2364.CrossRefGoogle ScholarPubMed
Le Grange, DLock, JAccurso, ECAgras, WSDarcy, AForsberg, S, et al.Relapse from remission at two- to four-year follow-up in two treatments for adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry 2014; 53(11): 1162–1167. http://dx.doi.org/10.1016/j.jaac.2014.07.014.CrossRefGoogle ScholarPubMed
Freudenberg, CJones, RALivingston, GGoetsch, VSchaffner, ABuchanan, LEffectiveness of individualized, integrative outpatient treatment for females with anorexia nervosa and bulimia nervosa. Eat Disord 2016; 24(3): 240–254. http://dx.doi.org/10.1080/10640266.2015.1090868.CrossRefGoogle ScholarPubMed
Miettunen, JRaevuori, AA meta-analysis of temperament in axis I psychiatric disorders. Compr Psychiatry 2012; 53(2): 152–166.CrossRefGoogle ScholarPubMed
Amianto, FSiccardi, SAbbate-Daga, GMarech, LBarosio, MFassino, SDoes anger mediate between personality and eating symptoms in bulimia nervosa?. Psychiatry Res 2012;200(2–3):502–512.CrossRefGoogle ScholarPubMed
Skårderud, FBruch revisited and revised. Eur Eat Disord Rev 2009; 17(2): 83–88. http://dx.doi.org/10.1002/erv.923.CrossRefGoogle ScholarPubMed
Amianto, FNorthoff, GAbbate Daga, GFassino, STasca, GAIs anorexia nervosa a disorder of the self? A psychological approach. Front Psychol 2016;7:849.CrossRefGoogle Scholar
Bruch, HAnorexia nervosa: therapy and theory. Am J Psychiatry 1982; 139(12): 1531–1538.Google ScholarPubMed
Northoff, GBrain and self – a neurophilosophical account. Child Adolesc Psychiatry Ment Health 2013; 7(1): 28. http://dx.doi.org/10.1186/1753-2000-7-28.CrossRefGoogle Scholar
Cloninger, CRSvrakic, DMPrzybeck, TRCan personality assessment predict future depression? A twelve-month follow-up of 631 subjects. J Affect Disord 2006; 92(1): 35–44.CrossRefGoogle ScholarPubMed
Signorini, ABellini, OPasanisi, FContaldo, FDe Filippo, EOutcome predictors in the short-term treatment of anorexia nervosa: an integrated medical-psychiatric approach. Eat Weight Disord 2003; 8(2): 168–172.CrossRefGoogle ScholarPubMed
Gulliksen, KSEspeset, EMNordbø, RHSkårderud, FGeller, JHolte, APreferred therapist characteristics in treatment of anorexia nervosa: the patient's perspective. Int J Eat Disord 2012; 45(8): 932–941. http://dx.doi.org/10.1002/eat.22033.CrossRefGoogle ScholarPubMed
Vitousek, KWatson, SWilson, GTEnhancing motivation for change in treatment-resistant eating disorders. Clin Psychol Rev 1998; 18(4): 391–420.CrossRefGoogle ScholarPubMed
Abbate-Daga, GBuzzichelli, SAmianto, FRocca, GMarzola, EMcClintock, SM, et al.Cognitive flexibility in verbal and nonverbal domains and decision making in anorexia nervosa patients: a pilot study. BMC Psychiatry 2011;11:162. http://dx.doi.org/10.1186/1471-244X-11-162.CrossRefGoogle Scholar
Grenon, RTasca, GAMaxwell, HBalfour, LProulx, GBissada, HParental bonds and body dissatisfaction in a clinical sample: the mediating roles of attachment anxiety and media internalization. Body Image 2016; 19: 49–56.CrossRefGoogle Scholar
Abbate-Daga, GAmianto, FDelsedime, NDe-Bacco, CFassino, SResistance to treatment and change in anorexia nervosa [corrected]: a clinical overview. BMC Psychiatry 2013;13:294. http://dx.doi.org/10.1186/1471-244X-13-294 [Erratum in: BMC Psychiatry. 2014;14:62].CrossRefGoogle Scholar
Treasure, JRussell, GThe case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors. Br J Psychiatry 2011; 199(1): 5–7. http://dx.doi.org/10.1192/bjp.bp.110.087585.CrossRefGoogle ScholarPubMed
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