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Open Access Highly Accessed Research article

A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK

Elizabeth Goddard1*, Rebecca Hibbs1, Simone Raenker1, Laura Salerno2, Jon Arcelus3, Nicky Boughton4, Frances Connan5, Ken Goss6, Bert Laszlo7, John Morgan8, Kim Moore9, David Robertson10, Saeidi S8, Christa Schreiber-Kounine11, Sonu Sharma12, Linette Whitehead4, Ulrike Schmidt1 and Janet Treasure1

Author Affiliations

1 Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK

2 Department of Psychology, University of Palermo, Palermo, Italy

3 Eating Disorders Service, Brandon Unit, Leicestershire Partnership NHS Trust, Leicester, UK

4 Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, UK

5 Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, London, UK

6 Eating Disorders Service, Coventry and Warwickshire NHS Partnership Trust, Coventry, UK

7 Wonford House Hospital, Devon Partnership NHS Trust, Exeter, UK

8 Yorkshire Centre for Eating Disorders, Leeds and St George’s University of London, Leeds, UK

9 Kinver Centre, Eating Disorders, South Staffordshire and Shropshire NHS Foundation Trust, Staffordshire, UK

10 National Centre for Mental Health, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK

11 STEPS Eating Disorders Unit, Avon and Wiltshire Partnership Mental Health NHS Trust, Bristol, UK

12 Eating Disorders Service, The Priory Hospital Cheadle Royal, Manchester, UK

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BMC Psychiatry 2013, 13:287  doi:10.1186/1471-244X-13-287

Published: 7 November 2013

Abstract

Individual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored.

Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177).

One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI, although most patients continued to have a clinical level of eating disorder symptoms at discharge. The potentially modifiable predictors of outcome included confidence to change, social functioning and carer expressed emotion and control.

Overall, the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness. Adolescents had a better response. Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms. As predicted by the carer interpersonal maintenance model, carer behaviour may influence the response to inpatient care, as may improved social functioning and confidence to change.

Keywords:
Eating disorders; Anorexia Nervosa; Inpatients; Treatment response; Predictors; Treatment