Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa

• Published in: Behaviour research and therapy 2014-05, Vol.56, p.1-6
• Main Authors: Accurso, Erin C., Ciao, Anna C., Fitzsimmons-Craft, Ellen E., Lock, James D., Le Grange, Daniel
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent anorexia nervosa; Adolescent Behavior - psychology; Adolescents; Adult and adolescent clinical studies; Anorexia; Anorexia nervosa; Anorexia Nervosa - complications; Anorexia Nervosa - diagnosis; Anorexia Nervosa - psychology; Anorexia Nervosa - therapy; Biological and medical sciences; Child psychology; Clinical outcomes; Depression - complications; Depression - psychology; Depression - therapy; Eating behavior disorders; Eating disorders; Families & family life; Family psychotherapy. Systemic therapy; Family Therapy; Family-based treatment; Feeding Behavior - psychology; Female; Humans; Male; Medical sciences; Medical treatment; Models, Biological; Outcome; Pathology; Psychological problems; Psychological recovery; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapies. Psychological and clinical counseling; Psychotherapy; Self Concept; Teenagers; Treatments; Weight Gain
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/j.brat.2014.02.006

The main aims of this study were to describe change in psychological outcomes for adolescents with anorexia nervosa across two treatments, and to explore predictors of change, including baseline demographic and clinical characteristics, as well as weight gain over time. Participants were 121 adolescents with anorexia nervosa from a two-site (Chicago and Stanford) randomized controlled trial who received either family-based treatment or individual adolescent supportive psychotherapy. Psychological symptoms (i.e., eating disorder psychopathology, depressive symptoms, and self-esteem) were assessed at baseline, end of treatment, 6-month, and 12-month follow-up. Conditional multilevel growth models were used to test for predictors of slope for each outcome. Most psychological symptoms improved significantly from baseline to 12 month follow-up, regardless of treatment type. Depressive symptoms and dietary restraint were most improved, weight and shape concerns were least improved, and self-esteem was not at all improved. Weight gain emerged as a significant predictor of improved eating disorder pathology, with earlier weight gain having a greater impact on symptom improvement than later weight gain. Adolescents who presented with more severe, complex, and enduring clinical presentations (i.e., longer duration of illness, greater eating disorder pathology, binge-eating/purging subtype) also appeared to benefit more psychologically from treatment. •Psychological symptoms improved significantly across two adolescent AN treatments.•Weight gain was one of the best predictors of eating disorder symptom improvement.•Improvements in weight and shape concerns were small and not impacted by weight gain.•More severe, complex, and enduring cases of AN had greater psychological improvement.