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Rapid response is predictive of treatment outcomes in a transdiagnostic intensive outpatient eating disorder sample: a replication of prior research in a real-world setting

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Objective

There is a growing call to identify specific outcome predictors in real-world eating disorder (ED) treatment settings. Studies have implicated several ED treatment outcome predictors [rapid response (RR), weight suppression, illness duration, ED diagnosis, and psychiatric comorbidity] in inpatient settings or randomized controlled trials of individual outpatient therapy. However, research has not yet examined outcome predictors in intensive outpatient programs (IOP). The current study aimed to replicate findings from randomized controlled research trials and inpatient samples, identifying treatment outcome predictors in a transdiagnostic ED IOP sample.

Method

The current sample comprised 210 consecutive unique IOP patient admissions who received evidence-based ED treatment, M(SD)Duration = 15.82 (13.38) weeks. Weekly patient measures of ED symptoms and global functioning were obtained from patients’ medical charts.

Results

In relative weight analysis, RR was the only significant predictor of ED symptoms post treatment, uniquely accounting for 45.6% of the predicted variance in ED symptoms. In contrast, baseline ED pathology was the strongest unique predictor of end-of-treatment global functioning, accounting for 15.89% of predicted variance. Baseline factors did not differentiate patients who made RR from those who did not.

Conclusions

Consistent with findings in more controlled treatment settings, RR remains a robust predictor of outcome for patients receiving IOP-level treatment for EDs. Future work should evaluate factors that mediate and moderate RR, incorporating these findings into ED treatment design and implementation.

Level of evidence

Level IV, uncontrolled intervention.

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Notes

  1. The DSM-5 was published in May 2013, so clients evaluated for treatment from May to June 2013 were diagnosed using DSM-IV criteria. During data entry, patients’ initial evaluations were reviewed to ensure that the diagnosis was consistent with DSM-5 criteria. DSM-IV and DSM-5 diagnoses were consistent for all patients (n = 31) originally diagnosed using DSM-IV diagnostic criteria.

  2. Individuals with substance use disorders were required to be in remission or concurrent treatment, with blood and urine screens required. Those with active moderate and severe substance use disorders were directed to first complete substance-specific treatment and then to demonstrate sobriety and concurrent ongoing substance abuse treatment.

  3. Clinicians did not record specific reasons why clients were diagnosed with anorexia nervosa at BMIs higher than 18.5 or 85% ideal body weight alongside their diagnoses; however, review of the patients’ charts who were at the highest BMIs in AN-R and AN-BP diagnostic groups were cases in which clients self-reported extreme caloric restriction.

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Funding

Lisa Anderson is currently being supported through a National Institutes of Health T32 grant: MH082761 (PI: Scott J. Crow, MD) and Sasha Gorrell is currently being supported by the National Institutes of Health T32 grant: MH0118261-33 (PI: Linda Pfiffner, PhD).

Author information

Authors and Affiliations

  1. Department of Psychology, Union College, 807 Union Street, Schenectady, NY, USA

    D. Catherine Walker

  2. Department of Psychology, University at Albany, State University of New York, Albany, NY, USA

    Joseph M. Donahue, Sydney Heiss & Drew A. Anderson

  3. Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA

    Sasha Gorrell

  4. Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA

    Lisa M. Anderson

  5. Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA

    Julia M. Brooks

  6. School of Psychological Sciences, University of Indianapolis, Indianapolis, IN, USA

    Emily P. Ehrlich

  7. HPA/LiveWell, Albany, NY, USA

    Julie N. Morison

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Corresponding author

Correspondence to D. Catherine Walker.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The procedures detailed in the current study were approved by Union College’s Human Subjects Review Committee.

Informed consent

A waiver of informed consent was provided by the Human Subjects Review Committee for participants who began IOP treatment from May 2013 to May 2016 under the Department of Health and Human Services section §46.116 paragraph (d), with data used consisting solely of a retrospective chart review. Participants who participated in the study from May 2016 to May 2017 completed informed consent at their first clinical appointment, consenting to use all data provided for routine outcome monitoring during their course of IOP involvement to be used in research. Adult participants provided written informed consent; legal minor participants provided their written informed assent with one parent or legal guardian providing informed consent.

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Walker, D.C., Donahue, J.M., Heiss, S. et al. Rapid response is predictive of treatment outcomes in a transdiagnostic intensive outpatient eating disorder sample: a replication of prior research in a real-world setting. Eat Weight Disord 26, 1345–1356 (2021). https://doi.org/10.1007/s40519-020-00939-y

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