Motivation to change and perceptions of the admission process with respect to outcome in adolescent anorexia nervosa

BMC Psychiatry

Katharina Bühren²  Beate Herpertz-Dahlmann²  Jochen Seitz²  Astrid Dempfle¹  Simona Hillen² 

[1] Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany;Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, Aachen, 52074, Germany

关键词: Stages of change;    Perception of admission process;    Treatment;    Outcome;    Weight gain;    Adolescence;    Anorexia nervosa;    Readiness to change;    Motivation to change;   

Others  :  1217928
DOI  :  10.1186/s12888-015-0516-8

 received in 2015-01-11, accepted in 2015-06-02,  发布年份 2015

【 摘 要 】

Background

In patients with anorexia nervosa (AN), there is evidence that readiness to change is an important predictor of outcome with respect to weight gain and improvement in eating disorder psychopathology. In particular, young patients are characterized by a low level of motivation for recovery and perceive more coercion at hospitalization. Thus, a better understanding of the variables that influence readiness to change and perception of the admission process in adolescent AN may help to support patients in initiating change and staying motivated for treatment.

Methods

In 40 adolescent patients diagnosed with AN according to DSM-IV criteria, we assessed in a prospective clinical cohort study the motivation to change using the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) at admission to inpatient treatment, in week 9 after admission and at discharge. Additional variables were assessed, including depressive symptoms (Beck Depression Inventory, BDI), eating disorder-specific psychopathology (Eating Disorder Inventory, EDI-2), body mass index (BMI) and the percentage of expected body weight (%EBW). The patients’ perceptions of the admission process and their perceived need for hospitalization were assessed using a self-report scale developed by Guarda et al. (2007).

Results

Younger patients perceived more coercion than older patients did. Low %EBW and more severe eating disorder-specific psychopathology were associated with a greater perceived need for hospitalization. Moreover, low %EBW at admission and a longer duration of illness were accompanied by a greater motivation to change at admission, whereas more severe eating disorder psychopathology was associated with a low motivation to change. The motivation to change increased significantly between admission and discharge. Patients with a greater motivation to change at admission exhibited a higher weekly weight gain during treatment but did not show better outcome in eating disorder-specific psychopathology and depression.

Conclusions

Motivation to change is an important predictor of short-term outcome with respect to weight gain trajectory during treatment of adolescent AN. As patients with a higher BMI at admission and those with more severe eating disorder-specific symptoms seem to be less motivated to change, the crucial issue of motivation to change should be addressed with these patients during the therapeutic process.

【 授权许可】

   
2015 Hillen et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Steinhausen HC: The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 2002, 159:1284-93.
• [2]Arcelus J, Mitchell AJ, Wales J, Nielsen S: Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 2011, 68:724-31.
• [3]Katzman DK: Medical complications in adolescents with anorexia nervosa: a review of the literature. The International journal of eating disorders 2005, 37(S52-59):S87-59.
• [4]Misra M, Klibanski A: Bone metabolism in adolescents with anorexia nervosa. J Endocrinol Invest 2011, 34:324-32.
• [5]Meczekalski B, Podfigurna-Stopa A, Katulski K: Long-term consequences of anorexia nervosa. Maturitas 2013, 75:215-20.
• [6]Steinhausen HC, Grigoroiu-Serbanescu M, Boyadjieva S, Neumarker KJ, Winkler Metzke C: Course and predictors of rehospitalization in adolescent anorexia nervosa in a multisite study. Int J Eat Disord 2008, 41:29-36.
• [7]Castro J, Gila A, Puig J, Rodriguez S, Toro J: Predictors of rehospitalization after total weight recovery in adolescents with anorexia nervosa. Int J Eat Disord 2004, 36:22-30.
• [8]Herpertz-Dahlmann B, Schwarte R, Krei M, Egberts K, Warnke A, Wewetzer C, et al.: Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial. Lancet 2014, 383(9924):1222-9.
• [9]Nordbo RH, Gulliksen KS, Espeset EM, Skarderud F, Geller J, Holte A: Expanding the concept of motivation to change: the content of patients’ wish to recover from anorexia nervosa. Int J Eat Disord 2008, 41:635-42.
• [10]Clausen L, Lubeck M, Jones A: Motivation to change in the eating disorders: a systematic review. Int J Eat Disord 2013, 46:755-63.
• [11]Karlsson GP, Clinton D, Nevonen L: Prediction of weight increase in anorexia nervosa. Nordic journal of psychiatry 2013, 67(6):424-32.
• [12]Wade TD, Frayne A, Edwards SA, Robertson T, Gilchrist P: Motivational change in an inpatient anorexia nervosa population and implications for treatment. Aust N Z J Psychiatry 2009, 43:235-43.
• [13]Bewell CV, Carter JC: Readiness to change mediates the impact of eating disorder symptomatology on treatment outcome in anorexia nervosa. Int J Eat Disord 2008, 41:368-71.
• [14]Carter JC, Mercer-Lynn KB, Norwood SJ, Bewell-Weiss CV, Crosby RD, Woodside DB, et al.: A prospective study of predictors of relapse in anorexia nervosa: implications for relapse prevention. Psychiatry Res 2012, 200:518-23.
• [15]Mander J, Teufel M, Keifenheim K, Zipfel S, Giel KE: Stages of change, treatment outcome and therapeutic alliance in adult inpatients with chronic anorexia nervosa. BMC Psychiatry 2013, 13:111. BioMed Central Full Text
• [16]Abbate-Daga G, Amianto F, Delsedime N, De-Bacco C, Fassino S: Resistance to treatment in eating disorders: a critical challenge. BMC Psychiatry 2013, 13:294. BioMed Central Full Text
• [17]Casasnovas C, Fernandez-Aranda F, Granero R, Krug I, Jimenez-Murcia S, Bulik CM, et al.: Motivation to change in eating disorders: clinical and therapeutic implications. Eur Eat Disord Rev 2007, 15:449-56.
• [18]Geller J, Brown KE, Zaitsoff SL, Menna R, Bates ME, Dunn EC: Assessing readiness for change in adolescents with eating disorders. Psychol Assess 2008, 20:63-9.
• [19]Gowers SG, Smyth B: The impact of motivational assessment interview on initial response to treatment in anorexia nervosa. Eur Eating Disord Rev 2004, 12:87-93.
• [20]Ametller L, Castro J, Serrano E, Martinez E, Toro J: Readiness to recover in adolescent anorexia nervosa: prediction of hospital admission. J Child Psychol Psychiatry 2005, 46:394-400.
• [21]Guarda AS, Pinto AM, Coughlin JW, Hussain S, Haug NA, Heinberg LJ: Perceived coercion and change in perceived need for admission in patients hospitalized for eating disorders. Am J Psychiatry 2007, 164:108-14.
• [22]Tan JO, Stewart A, Fitzpatrick R, Hope T: Attitudes of patients with anorexia nervosa to compulsory treatment and coercion. Int J Law Psychiatry 2010, 33:13-9.
• [23]Thiels C: Forced treatment of patients with anorexia. Curr Opin Psychiatry 2008, 21:495-8.
• [24]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders – DSM-IV. 4th edition. American Psychiatric Association, Washington; 1994.
• [25]Kromeyer-Hauschild K, Wabisch M, Kunze D, Geller D, Geiss HC, Hesse V, et al.: Perzentile für den Body Mass Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschrift für Kinderheilkunde 2001, 149:807-818.
• [26]Hebebrand J, Wehmeier PM, Remschmidt H: Weight criteria for diagnosis of anorexia nervosa. Am J Psychiatry 2000, 157:1024.
• [27]Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B: Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry 2010, 67:1025-32.
• [28]Herpertz S, Herpertz-Dahlmann B, Fichter M, Tuschen-Caffier B, Zeeck A: S3-Leitlinie Diagnostik und Behandlung der Essstörungen. Sprinher-Verlag Berlin, New York; 2011.
• [29]Herpertz-Dahlmann B, Salbach-Andrae H: Overview of treatment modalities in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am 2009, 18:131-45.
• [30]Rieger E, Touyz S, Schotte D, Beumont P, Russell J, Clarke S, et al.: Development of an instrument to assess readiness to recover in anorexia nervosa. Int J Eat Disord 2000, 28:387-96.
• [31]Rieger E, Touyz SW, Beumont PJ. The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ): information regarding its psychometric properties. Int J Eat Disord. 2002;24–38.
• [32]Prochaska JO, DiClemente CC. Transtheoretical therapy: toward a more integrative model of change. Psychother Theory Res Pract. 1982;276–288.
• [33]McHugh MD: Readiness for change and short-term outcomes of female adolescents in residential treatment for anorexia nervosa. Int J Eat Disord 2007, 40:602-12.
• [34]Cronbach LJ: Coefficient alpha and the internal strucuture of tests. Psychometrika 1951, 16:297-334.
• [35][http:http://cran.r-project.org/web/packages/psych/index.html] webciteRevelle W: psych: Procedures for Personality and Psychological Research. In Book psych: Procedures for Personality and Psychological Research (Editor ed.^eds.), Version = 1.5.1. edition. pp. City; 2015:. http://cran.r-project.org/web/packages/psych/index.html webcite
• [36]Gardner W, Lidz CW, Hoge SK, Monahan J, Eisenberg MM, Bennett NS, et al.: Patients’ revisions of their beliefs about the need for hospitalization. Am J Psychiatry 1999, 156:1385-91.
• [37]Lidz CW, Hoge SK, Gardner W, Bennett NS, Monahan J, Mulvey EP, et al.: Perceived coercion in mental hospital admission. Pressures and process. Arch Gen Psychiatry 1995, 52:1034-9.
• [38]Fichter M, Quadflieg N: The structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10 (SIAB-EX): reliability and validity. Eur Psychiatry 2001, 16:38-48.
• [39]Paul T, Thiel A: Eating Disorder Inventory-2 (EDI-2): deutsche Version. Hogrefe, Göttingen; 2005.
• [40]Hautzinger M, Kühner C, Keller F. BDI-II Beck-Depressions-Inventar. Pearson Assessment & Information GmbH. San Antonio, TX: Harcourt Assessment Inc; 2006.
• [41]Su YS, Gelman A, Hill J, Yajima M. Multiple Imputation with Diagnostics (mi) in R: opening Windows into the Black Box. J Statistical Software. 2011;45.
• [42]R Core Team: R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna; 2014.
• [43]Sly R, Morgan JF, Mountford VA, Lacey JH: Predicting premature termination of hospitalised treatment for anorexia nervosa: the roles of therapeutic alliance, motivation, and behaviour change. Eat Behav 2013, 14:119-23.
• [44]Berner LA, Shaw JA, Witt AA, Lowe MR: The relation of weight suppression and body mass index to symptomatology and treatment response in anorexia nervosa. J Abnorm Psychol 2013, 122:694-708.
• [45]Geller J, Cassin SE, Brown KE, Srikameswaran S: Factors associated with improvements in readiness for change: low vs. normal BMI eating disorders. Int J Eat Disord 2009, 42:40-46.
• [46]Zaitsoff SL, Taylor A: Factors related to motivation for change in adolescents with eating disorders. Eur Eat Disord Rev 2009, 17:227-33.
• [47]Algars M, Ramberg C, Moszny J, Hagman J, Rintala H, Santtila P: Readiness and Motivation for Change Among Young Women With Broadly Defined Eating Disorders. Eating disorders. 2015;23(3):242-52.
• [48]Nordbo RH, Espeset EM, Gulliksen KS, Skarderud F, Geller J, Holte A: Reluctance to recover in anorexia nervosa. Eur Eat Disord Rev 2012, 20:60-7.
• [49]Castro-Fornieles J, Casula V, Saura B, Martinez E, Lazaro L, Vila M, et al.: Predictors of weight maintenance after hospital discharge in adolescent anorexia nervosa. Int J Eat Disord 2007, 40:129-35.
• [50]Hay PJ, Cho K: A qualitative exploration of influences on the process of recovery from personal written accounts of people with anorexia nervosa. Women Health 2013, 53:730-40.
• [51]Dray J, Wade TD: Is the transtheoretical model and motivational interviewing approach applicable to the treatment of eating disorders? A review. Clin Psychol Rev 2012, 32:558-65.
• [52]Romano M, Peters L: Evaluating the mechanisms of change in motivational interviewing in the treatment of mental health problems: A review and meta-analysis. Clin Psychol Rev 2015, 38:1-12.
• [53]Gowers SG, Weetman J, Shore A, Hossain F, Elvins R: Impact of hospitalisation on the outcome of adolescent anorexia nervosa. British J Psychiatry 2000, 176:138-41.