Theodore Weltzin

Evolution of symptom severity during residential treatment of females with eating disorders

Objectives:The overall objective of this study was to measure the evolution of symptom severity in a residential programme based on a multidimensional approach to treatment that includes cognitive-behavioural, interpersonal, experiential and family therapies. The specific aims of the study were: 1) to evaluate changes in symptom severity in bulimic and anorexic patients between admission and discharge; 2) to compare the severity of these symptoms with those of non-patient college females (control group); and 3) to monitor the progression of symptom changes six months after discharge.Methods:The evolution of symptom severity was measured by comparing the mean raw scores of the Eating Disorder Inventory (EDI original inventory, 1983 version), which was administered at the beginning and end of the residential treatment. A subgroup of patients was also administered the EDI six months after discharge. The study involved 99 females: 47 with bulimia and 52 with anorexia as diagnosed by means of a clinical interview using DSM-IV criteria. The mean raw EDI scores in the control group (FC1, female college students) were obtained from the EDI manual. The population means were compared using the t-test for paired data (Microsoft Excel, version 2000).Results:The overall results for the population as a whole show that the eight subscales of the EDI improved significantly with treatment (<0.001). The subscales with the largest numerical improvements were drive for thinness, ineffectiveness and interoceptive awareness. When divided on the basis of diagnosis, the mean feelings of perfectionism score of the bulimic patients was less than that of the control female college sample; the symptoms of bulimia in the anorexic patients were similar to those found in the control group. The fact that the mean follow-up scores for a number of the EDI subscales remained similar to those recorded at the time of discharge suggests that some of the improvements in symptoms remained for at least six months.Conclusions:The results of our study show that multidimensional residential treatment leads to statistically significant changes in the severity of the symptoms manifested by females with eating disorders.

Treatment of Obsessive-Compulsive Disorder Complicated by Comorbid Eating Disorders

Purpose: Eating disorders and obsessive-compulsive disorder (OCD) commonly co-occur, but there is little data for how to treat these complex cases. To address this gap, we examined the naturalistic outcome of 56 patients with both disorders, who received a multimodal treatment program designed to address both problems simultaneously. Methods: A residential treatment program developed a cognitive-behavioral approach for patients with both OCD and an eating disorder by integrating exposure and response prevention (ERP) treatment for OCD with ERP strategies targeting eating pathology. Patients also received a supervised eating plan, medication management, and social support. At admission and discharge, patients completed validated measures of OCD severity (the Yale-Brown Obsessive-Compulsive Scale—Self Report [Y-BOCS-SR]), eating disorder severity (the Eating Disorders Examination-Questionnaire), and depressive severity (the Beck Depression Inventory II [BDI-II]). Body mass index (BMI) was also measured. Paired-sample t-tests examined change on these measures. Main Results: Between 2006 and 2011, 56 individuals completed all study measures at admission and discharge. Mean length of stay was 57 days (SD = 27). Most (89%) were on psychiatric medications. Significant decreases were observed in OCD severity, eating disorder severity, and depression. Those with bulimia nervosa showed more improvement than those with anorexia nervosa. BMI significantly increased, primarily among those underweight at admission. Conclusion: Simultaneous treatment of OCD and eating disorders using a multimodal approach that emphasizes ERP techniques for both OCD and eating disorders can be an effective treatment strategy for these complex cases.

Gender differences in the progression of co-morbid psychopathology symptoms of eating disordered patients

This study examined the utility of the Personality Assessment Inventory (PAI) in screening for comorbid psychopathology in eating disordered males and females undergoing residential treatment. The PAI, a self-administered screening tool containing 344 items to provide information on 11 clinical constructs, was administered at admission and discharge to 181 patients, 154 females and 27 males. Average age was 26.88 years (SD=9.35) and average length of stay was 58.31 days (SD=39.94). The results showed that both male and female patients exhibit several comorbid disorders at admission to residential treatment and the severity of these symptoms was statistically significantly reduced over the course of treatment. When comparing differences among genders, the results show that females present with more psychopathology symptoms at the start of treatment but make better progress than males in reducing these symptoms over time. When comparing patients across eating disorder diagnoses, subjects with bulimia displayed more severe comorbid symptomatology as compared to those with anorexia or other eating disorders. A thorough clinical assessment of eating disordered patients including comorbid psychopathology disorders is relevant for clinical diagnosis, treatment planning, and perhaps ultimately the outcome of treatment.

Motivation for change as a predictor of eating disorder treatment outcomes using a brief self-report YBC-EDS in a residential eating disorder population

The aim of this study was to investigate the factor structure and psychometric properties of a new brief self-report form of the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS-BSR) in a transdiagnostic eating disorder population, and to determine the predictive ability of motivation for change and ego syntonic subscales on treatment outcome. Self-report measures of the YBC-EDS-BSR, eating pathology, depression, anxiety and obsessive compulsive symptoms were collected from 164 individuals entering residential treatment. Of these, 107 individuals completed identical measures at discharge. The admission items on the YBC-EDS-BSR were examined for factor structure, and subscales were examined for internal, convergent and discriminant validity. Multiple regression analysis was used to investigate predictive value of the motivation and ego syntonic subscales on two measures of treatment outcome. Results indicate that the YBC-EDS-BSR demonstrated a robust factor structure and good psychometric properties in this population. The predicted ego-syntonic subscale did not emerge as an independent factor. The motivation for change subscale significantly predicted treatment outcome on the EDE-Q and the EDI-3 Global Maladjustment Scale. The ego-syntonic items and other psychopathology measures had no predictive value on treatment outcome. Results suggest that motivation for change is a significant predictor of treatment outcome over and above baseline psychopathology.

The combined presence of obsessive compulsive behaviors in males and females with eating disorders account for longer lengths of stay and more severe eating disorder symptoms

The goal of this study was to analyze the impact of obsessive compulsive behaviors (OCB) in eating disorder males and females admitted for residential treatment in terms of length of stay and severity of symptoms. Patients (N=384) were separated into four groups based on gender and the score obtained for the Maudsley Obsessive-Compulsive Inventory at admission. The instrument used to assess severity of eating disorder symptoms was the Eating Disorder Inventory (EDI-2) at admission and discharge. The results showed that the presence of comorbid OCB in eating disordered males and females account for longer length of stay (LOS) and an increased severity of eating disorder symptoms. Clinically, these findings point to the need for development of more targeted residential programs that are equipped for and adept at treating the comorbid eating disorder/OCB patient population.

Sex differences in the effects of residential treatment on the quality of life of eating disorder patients.

AimsThis study compared the effects of residential treatment on improving health-related quality of life (HRQOL) between males and females diagnosed with eating disorders (EDs) from admission to discharge and at follow-up. This study also analyzed the association between changes in HRQOL and changes in the severity of ED pathology, depression, and trait anxiety.Methods145 consecutive patients (34 males and 111 females) admitted to a residential ED unit completed a panel of surveys at admission and discharge. The survey panel included the Eating Disorders Quality of Life Survey (EDQLS), the Eating Disorder Examination Questionnaire, the Quick Inventory of Depressive Symptomatology and the State-Trait Anxiety Inventory. An online follow-up survey was also conducted for the EDQLS. Mixed-factorial ANOVA was used to examine sex differences and changes in HRQOL between admission, discharge and post-treatment follow-up. Multiple regression analysis was used to investigate the relationship between sex, change in HRQOL, and changes in all other variables studied.ResultsBy the end of residential treatment, both males and females had made similar statistically significant improvements in HRQOL from admission to discharge, which persisted after treatment. Greater decreases in ED pathology and trait anxiety significantly predicted greater increases in HRQOL during residential treatment while sex and changes in depression did not.ConclusionThe data show that residential treatment is an effective approach to improving HRQOL in both males and females with EDs. Greater improvements in trait anxiety and ED pathology contributed to greater improvement in HRQOL in these patients.

Clinical Observations of the Impact of Maudsley Therapy in Improving Eating Disorder Symptoms, Weight, and Depression in Adolescents Receiving Treatment for Anorexia Nervosa

This article describes a comparison of adolescent patients with a diagnosis of anorexia nervosa receiving treatment with and without family-based therapy. Sixteen patients with anorexia nervosa were evaluated and compared pretreatment and post-treatment. The family-based program used is an adaptation of the Maudsley approach; a parallel treatment program used the standard multidisciplinary treatment at Rogers Memorial Hospital. The outcome measures in both programs were depression, eating disorder symptoms, weight, and body mass index. Individuals treated with the Maudsley approach made significant improvements in all outcomes measured. These preliminary findings support the notion that parental involvement in the treatment of anorexia nervosa is effective in significantly reducing overall eating disorder behaviors, decreasing symptoms of depression, and improving weight.

The Effects of a Multidisciplinary Approach to Treatment in the Recovery of Males and Females Diagnosed with Anorexia Nervosa in the Presence and Absence of Co-Morbid Obsessive Compulsive Disorders

ABSTRACT The objectives of this study were to evaluate whether a multidisciplinary residential treatment program for eating disorders had a positive impact in the recovery of 107 individuals (72 females and 35 males) diagnosed with anorexia nervosa (AN) in the presence and absence of comorbid obsessive-compulsive disorders (OCD) and to explore gender differences in the response to treatment. Residential treatment used concurrent psychotherapy, which combines group, family, and individual therapies in a multidisciplinary approach. The results show that symptoms of depression decreased and weight increased during treatment in all patients groups. Symptoms were more severe in individuals with comorbid OCD and improvements were more pronounced in males compared to females.

Long-Term Effects of a Multidisciplinary Residential Treatment Model on Improvements of Symptoms and Weight in Adolescents With Eating Disorders

This report describes a multidisciplinary residential treatment approach for adolescents with eating disorders. It presents data on treatment efficacy and analyzes long term follow-up results focusing on nutritional and behavioral interventions delivered in a systematic residential setting. Residents were evaluated at admission, discharge, and follow-up (M=24 months post-discharge) using a panel of well-established psychological measures (EDE-Q, BDI, YBOC, STAI). The results showed both statistically and clinically significant reductions in eating disorder symptomology between admission and discharge. At the end of residential treatment, symptoms of anxiety, depression and obsessive compulsive behaviors had decreased to within the norms of non-diseased populations, and there was little regression from discharge to follow-up. Weight gains were also sustained after discharge. These results indicate that a multidisciplinary model to treat eating disorders in a residential setting is an effective approach to treat these disorders and further supports the need to grow residential care in behavioral health settings.

Gender differences in eating disorder psychopathology across DSM-5 severity categories of anorexia nervosa and bulimia nervosa

OBJECTIVE This study examined whether patterns of eating-disorder (ED) psychopathology differed by gender across DSM-5 severity specifiers in anorexia nervosa (AN) and bulimia nervosa (BN). METHOD We tested whether ED psychopathology differed across DSM-5 severity specifiers among 532 adults (76% female) in a residential treatment center with AN or BN. We hypothesized that severity of ED psychopathology would increase in tandem with increasing severity classifications for both males and females with AN and BN. RESULTS Among females with BN, DSM-5 severity categories were significantly associated with increasing ED psychopathology, including Eating Disorder Examination-Questionnaire dietary restraint, eating concern, shape concern, and weight concern; and Eating Disorder Inventory drive for thinness and bulimia. ED psychopathology did not differ across DSM-5 severity levels for males with BN. For both males and females with AN, there were no differences in ED psychopathology across severity levels. DISCUSSION Results demonstrate that DSM-5 severity specifiers may function differently for males versus females with BN. Taken together, data suggest DSM-5 severity specifiers may not adequately capture severity, as intended, for males with BN and all with AN. Future research should evaluate additional clinical validators of DSM-5 severity categories (e.g., chronicity, treatment non-response), and consider alternate classification schemes.