Presentations in 2008

The study sought to determine if obligatory exercise is associated with long-term treatment outcome. A total of 227 patients from Eating Disorders Institute completed self-report questionnaires. Participants were divided into two groups by the percentage of time exercise was used to control weight: nonobligatory (0 percent to 50 percent) versus obligatory (75 percent to 100 percent) exercisers. At follow-up, obligatory exercisers were more compromised than nonobligatory exercisers on measures of anxiety, quality of life, dietary restraint and concerns about eating, shape and weight. They also were more likely to have active eating disorders. Obligatory exercisers reported a poorer quality of life in psychological, physical, cognitive and work and school areas relating to the eating disorder. Eating disorder patients who obligatorily exercise may benefit from tailored clinical interventions.

Eating disorders do not follow age boundaries, and more women age 30 or older are seeking treatment for eating disorders. In this interactive and didactic presentation, we first presented research study findings investigating the diversity of personal and clinical factors relevant to older patients, and discussed differences between patients ages 30 and older and those who are younger. We conducted a retrospective chart review of 171 adult women seeking treatment at Eating Disorders Institute in early 2007, and categorized our findings by the client’s age at intake as typical (ages 18-29) or older (ages 30 and older). Our findings indicate the older sample group was more likely to be married with several children, report a significantly longer duration of the eating disorder, struggle with greater body dissatisfaction and poorer self-esteem and score higher on an eating disorder risk scale than younger adults. We discussed the implications from these study findings and how they can influence treatment interventions. We also presented innovations in treatment specifically tailored to meet the different needs of older patients who often are balancing their eating disorders treatment with parenting demands, career conflicts, marital strife and other stage-of-life issues. From our individual and meal group experiences with mature clients, we shared stories of success and clinical challenges and opportunities for learning. Blending research results with true client journeys, we interactively explored with the conference attendees how best to provide care for this population.

Purpose: This study sought to evaluate using the stage of change (precontemplation, contemplation, preparation/action) as a predictor of treatment outcome among treatment-seeking eating disorder patients.
Methods: 161 females (99.4 percent Caucasian; average age 24.4 years; average BMI* 22.0; 17.8 percent AN-R*; 29.3 percent BN*; 52.9 percent EDNOS*) completed a self-report measure of stage of change for ED* behaviors (dietary restriction, fasting, binge-eating, self-induced vomiting and using laxatives, diet pills, diuretics and metabolic enhancements) at admission to a Minnesota treatment facility. The lowest stage of change associated with any ED behavior was used to predict treatment outcome. At intake and three months after admission, participants completed BDI-2*, STAI* and EDE-Q* inventories. Analyses of covariance were used to evaluate differences by stage of change, controlling for the score on the variable at intake.
Results: Those in the preparation or action stage at intake were less depressed (p less than .001) and anxious (p less than .001) at three-month follow-up compared to precontemplators and contemplators. However, contemplators scored lowest at three-month follow-up measures of eating concerns (p equal to .13) and shape concerns (p<.001), similarly low scores by those in the preparation or action stage compared to precontemplators.
Discussion: In this study, treatment was not tailored to a patient’s motivation to change. A stronger intention to change ED behaviors at intake was associated with a more favorable outcome from ED symptoms and related psychopathology across a three-month period. Future research may evaluate if tailored treatment interventions further stimulate a favorable outcome from an eating disorder.

Purpose: To compare long-term outcomes across ED* diagnoses using varying definitions of recovery as suggested by Couturier & Lock (2006).
Methods: 221 females (98. percent Caucasian; 78.1 percent single; average age 20.6 years old intake assessment) completed an outcomes study one to 10 years after intake assessment. Intake diagnoses were 40.7 percent AN-R*, 9.0 percent AN-P*, 13.1 percent BN*, and 37.1 percent EDNOS*. “Good outcome” was assessed in four ways: a) BMI* greater than 18.5; b) no diagnosis on the EDDS*; c) within 1 SD* of norms on the EDEQ*; or d) within 1 SD of norms on the EDRSQ*. Chi-squares* for categorical and ANOVAs* for continuous variables were used to evaluate differences across diagnosis, with p less than .05 as the criterion for statistical significance.
Results: Fewer AN-R* (75 percent) and AN-P* (50 percent) patients had achieved a BMI* of 18.5 or greater at follow-up than BN* (91.3 percent) or EDNOS* (81.5 percent) patients (p less than .002). Using the EDDS*, the majority of individuals with AN-R* (67.8 percent) and EDNOS (70.7 percent) did not meet any full or subthreshold ED diagnosis at follow-up, compared to only 45.0 percent of AN-P and 44.8 percent of BN patients (p less than .001). Results for the Shape (p = .043) and Weight Concerns (p = .002) subscales of the EDE-Q were significant across diagnostic categories. For Weight Concerns, more AN-R* (78.6 percent) and EDNOS (77.0 percent) patients were within 1 SD of norms at follow-up than AN-P (64.7 percent) and BN (60.9 percent) patients; for Shape Concerns, more AN-P (88.2 percent) than AN-R (54.2 percent), BN (66.7 percent) or EDNOS (58.1 percent) patients were within 1 SD of norms at follow-up. There were no significant results on the EDRSQ*.
Discussion: The rates of recovery vary greatly by definition used. The ED field could benefit from developing consistently-used criteria for evaluating good outcome.

Purpose: To determine if age of onset of an eating disorder affected treatment outcome among females seeking treatment for an eating disorder.
Methods: 178 females (98.8 percent Caucasian; 79.5 percent single; average age 20.6 intake assessment) who declared their age at eating disorder onset as age 11 or older completed an outcomes study one to 10 years after intake assessment. Intake diagnoses were 43.3 percent AN-R*, 7.9 percent AN-P*, 12.9 percent BN*, and 36.0 percent EDNOS*. We compared groups by age of onset as 19 or younger versus 20 or older. Chi-squares* for categorical and ANOVAs* for continuous variables were used to evaluate differences across diagnosis, with p less than .05 as the criterion for statistical significance.
Results: Overall, no differences exist between groups on race, BMI* at intake, BMI at follow-up, or eating disorder diagnosis at follow-up. However, those with an older (20+ years) age of onset were scored more pathologically on measures of general psychological health (depression, trait anxiety*, general psychological maladjustment) and eating disorder concerns (drive for thinness, personal alienation, interpersonal insecurity and interpersonal alienation, interoceptive* deficits, emphasis on asceticism, ineffectiveness and interpersonal problems, and significant overcontrol) than those with a younger ( less than 19 years) age of onset.
Discussion: Patients who were older than age 20 when their eating disorder symptoms began had a poorer outcome, particularly for a broader set of psychological concerns, than patients who were younger than 19 at onset. Older onset patients may benefit from special clinical interventions tailored to their unique needs.

Purpose: To describe a sample of female patients age 30 or older in treatment and evaluate differences by age on ED* measures and associated factors at admission.
Methods: From a large, multimodal treatment facility, 58 sequential admissions of females age 30 or older (average 41.9 years; range 30 to 79) participated in a chart review from January to May 2007. The sample was described using frequencies and descriptive statistics, and age groups (ages 30-39 versus. ages 40 and older) were compared using chi-square for categorical and ANOVA* for continuous variables.
Results: Most were Caucasian (91.4 percent), and married (48.3 percent) or single (36.2 percent). ED diagnoses were AN-R* (12.3 percent), AN-P* (8.8 percent), BN* (21.1 percent) and EDNOS* (57.9 percent). Overall, the average BMI* was 22.2 (SD = 7.1) and age at ED onset was 20.4 (SD = 10.8), corresponding to a mean duration of ED as 21.7 years (SD = 9.4). No differences existed by current age groups on ED diagnosis as determined by clinical interview, BMI as calculated by anthropometric measures of height and weight, or on the following self-report measures: depression (BDI-2*), anxiety (STAI*), self-esteem (Rosenberg self-esteem scale), body image (Body Image Assessment), or eating disorder characteristics (EDE-Q* and EDI-3*).
Discussion: Within five months, 58 females age 30 or older who were admitted for treatment had a diverse diagnostic presentation. No significant differences exist between those ages 30-39 versus ages 40 and older on mental health and eating disorder characteristics. However, their overall clinical presentation, in part due to long duration of illness, was significant. Facilities treating older patients should seek to understand the special considerations associated with this population. (Physical factors, marital counseling, psychoeducation for children, family therapies with adult patients …)

Purpose: To examine differences between eating disorder patients who have and have not used laxatives for weight control on treatment factors at intake assessment and follow-up.
Methods: 227 females (98 percent Caucasian; average age 26.1) completed intake evaluation and behavioral, cognitive and psychological follow-up. A total of 94 (42.7 percent) reported ever using laxatives. The age at which patients reported first using laxatives was 19.35, while the age at which regular use began was only slightly higher at 20.07 years. The average number of laxatives used during a typical episode was 5.23 (SD* = 6.79, range 1-30) and 27.78 (SD = 31.22, range 1-120) for the patient’s “worst” episode. The majority of participants (73.3 percent) reported no laxative use in the past three months at follow-up.
Results: Laxative use was significantly associated with higher BMI* and older age at intake assessment. At follow-up, laxative users had significantly lower scores on measures of self-esteem, mental health functioning and self-efficacy for body image and normative eating, and higher scores on measures of depression, trait anxiety*, dietary restraint and eating, and weight and shape concerns. Laxative users reported more pathological scores on psychological, physical and cognitive factors related to quality of life, plus lower overall psychological functioning attributed to their eating disorder than nonlaxative users.
Discussion: Laxative users have poorer outcomes than their nonusing peers on many behavioral, cognitive and psychological factors. Due to the severe medical complications encountered during treatment (dehydration, electrolyte imbalance, abnormal bowel motility and peripheral edema), future research should address the clinical implications of treating people who use laxatives and evaluate the longer-term impact of laxative use on overall health.

Objective for study question: To examine differences between eating disorder patients who have and have not used laxatives for weight control; who have older onset of illness compared to younger or more “average” onset; and on treatment factors at intake assessment and follow-up. We also sought to compare four definitions of recovery to see how patients recovered using varying criteria.
Data source/study setting: Primary data was collected from a large Midwestern multimodal eating disorder treatment facility between Nov. 2006 and May 2007.
Study design: From 1,538 patients receiving either partial or inpatient programming between 1995 and 2005, 202 participated in a study of treatment outcomes. They were assessed at intake at this facility and treated in the inpatient or partial hospitalization programs. They later completed self-report follow-up measures between Nov. 2006 and May 2007.
Data collection/extraction method: Eligible individuals were invited to participate in the study by a mailed letter and consent form. If interested, they mailed back the signed consent form. Once signed consent forms were received, follow-up questionnaires were sent to participants to complete and mail back. A copy of the signed consent also was sent to the participant for their records. Once questionnaires were received, they were scored and data was analyzed.
Principal findings: We compared groups by age of onset as 19 or younger vs. 20 or older. Overall, no differences existed between groups on race, BMI* at intake, BMI at follow-up, or eating disorder diagnosis at follow-up. However, those who had an older (20 plus years) age of onset scored more pathologically on measures of general psychological health and eating disorder concerns than those with a younger (less than 19 years) age of onset. Patients who had and had not used laxatives as a purging method also were compared. Laxative users had significantly lower scores on measures of self-esteem, mental health functioning, physical functioning and self-efficacy for body image and normative eating, and higher scores on measures of depression, trait anxiety*, dietary restraint and eating, weight and shape concerns. Definitions of recovery also were compared by intake diagnosis. Our results showed that patients had a varying level of recovery depending on which definition was used.
Conclusions: Eating disorder patients with an older age (less than 20 years) at onset of symptoms present with a poorer outcome, particularly for a broader set of psychological concerns, than patients with a younger age of onset (less than 19 years of age). Patients who use laxatives also have a poorer outcome across many measures, and also can suffer chronic health problems not found in nonlaxative users. Definitions of recovery are quite arbitrary and, depending on which definition is used in a particular research study, results could change drastically.
Implications for practice or policy: Older onset patients and laxative users may benefit from special clinical interventions tailored to their unique situation. The eating disorders field could benefit from developing consistently used criteria for evaluating a good outcome for research and clinical purposes.