Fernando Fernández-Aranda1,2,3,4, Janet Treasure5, Georgios Paslakis6, Zaida Agüera1,2,3,7, Mónica Giménez1, Roser Granero3,8, Isabel Sánchez1,3, Eduardo Serrano-Troncoso9, Philip Gorwood10, Beate Herpertz-Dahlmann11, Eva-Maria Bonin12, Palmiero Monteleone13, Susana Jiménez-Murcia1,2,3,4. 1. Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain. 2. Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. 3. Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain. 4. Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. 5. Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 6. Medical Faculty, University Clinic for Psychosomatic Medicine and Psychotherapy, Campus East-Westphalia, Ruhr-University of Bochum, Luebbecke, Germany. 7. Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain. 8. Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Barcelona, Spain. 9. Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu and Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain. 10. CMME, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM, U1266, Paris, France. 11. Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen, Aachen, Germany. 12. Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK. 13. Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Abstract
OBJECTIVE: There are no generally accepted definitions or markers of treatment nonresponse in eating disorders (EDs). The aim of this paper was to examine how the duration of illness and other potential prognostic markers impacted on nonresponse and drop-out from treatment across different EDs subtypes. METHODS: A total sample of 1199 consecutively treated patients with EDs, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, participated in this study. Kaplan-Meier curves were calculated for each ED diagnosis in which the probability of recovery was plotted against the duration of illness. RESULTS: Full remission was more likely for people with binge eating disorder (BED; 47.4%) and anorexia nervosa (AN; 43.9%) compared to bulimia nervosa (BN; 25.2%) and other specified feeding and EDs (OSFED; 23.2%). The cut-off points for the duration of the illness related with high likelihoods of poor response was 6-8 years among OSFED, 12-14 years among AN and BN and 20-21 years among BED. Other variables predicting nonresponse included dysfunctional personality traits. CONCLUSIONS: Nonresponse to treatment is associated with duration of illness which is in turn associated with poor response to previous treatment. However, there was no evidence for staging the illness using specific duration of illness criteria. Nevertheless, the shorter temporal trajectory for OSFED suggests that early interventions may be of importance for this group.
OBJECTIVE: There are no generally accepted definitions or markers of treatment nonresponse in eating disorders (EDs). The aim of this paper was to examine how the duration of illness and other potential prognostic markers impacted on nonresponse and drop-out from treatment across different EDs subtypes. METHODS: A total sample of 1199 consecutively treated patients with EDs, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, participated in this study. Kaplan-Meier curves were calculated for each ED diagnosis in which the probability of recovery was plotted against the duration of illness. RESULTS: Full remission was more likely for people with binge eating disorder (BED; 47.4%) and anorexia nervosa (AN; 43.9%) compared to bulimia nervosa (BN; 25.2%) and other specified feeding and EDs (OSFED; 23.2%). The cut-off points for the duration of the illness related with high likelihoods of poor response was 6-8 years among OSFED, 12-14 years among AN and BN and 20-21 years among BED. Other variables predicting nonresponse included dysfunctional personality traits. CONCLUSIONS: Nonresponse to treatment is associated with duration of illness which is in turn associated with poor response to previous treatment. However, there was no evidence for staging the illness using specific duration of illness criteria. Nevertheless, the shorter temporal trajectory for OSFED suggests that early interventions may be of importance for this group.