title: Predictors and moderators of outcome for severe and enduring anorexia nervosa.
abstract: Few of the limited randomized controlled trials (RCTs) for adults with anorexia nervosa (AN) have explored predictors and moderators of outcome. This study aimed to identify predictors and moderators of outcome at end of treatment (EOT) and 6- and 12-month follow-up for adults with AN (N = 63). All participants met criteria for severe and enduring AN (duration of illness ≥ 7 years) and participated in an RCT of cognitive-behavioral therapy (CBT-AN) and specialist supportive clinical management (SSCM). General linear models were utilized and included all available outcome data at all time points. Outcome was assessed across three domains: eating disorder quality of life (EDQOL), mental health (MCS), and depressive symptoms (BDI). Predictors of better outcome included: lower age, shorter duration of illness, having AN-R, being employed, not taking psychotropic medication, and better social adjustment. Four moderators of treatment outcome emerged: eating disorder psychopathology (EDE Global), depression (BDI), age, and AN subtype. Participants with higher baseline scores on these measures, older age, or binge eating/purging subtype benefited more from CBT-AN than SSCM. Older patients with more severe eating-related psychopathology and depression have better outcomes in a behaviorally targeted treatment such as CBT-AN rather than a supportive treatment such as SSCM.
authors.affiliation: The University of Chicago, Chicago, IL, USA. Electronic address: legrange@uchicago.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Le Grange
authors.affiliation: The University of Chicago, Chicago, IL, USA.
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Fitzsimmons-Craft
authors.affiliation: Neuropsychiatric Research Institute and the University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.affiliation: University of Western Sydney, Sydney, Australia.
authors.forename: Phillipa
authors.initials: P
authors.lastname: Hay
authors.affiliation: St. George's, University of London, London, UK.
authors.forename: Hubert
authors.initials: H
authors.lastname: Lacey
authors.affiliation: St. George's, University of London, London, UK.
authors.forename: Bryony
authors.initials: B
authors.lastname: Bamford
authors.affiliation: The University of Chicago, Chicago, IL, USA; Northwestern University, Chicago, IL, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Stiles-Shields
authors.affiliation: University of Sydney, Sydney, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Touyz
mesh_terms: D000328:Adult; D000367:Age Factors; D000856:Anorexia Nervosa / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000150:complications / Q000628:therapy; D004651:Employment / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008603:Mental Health; D008875:Middle Aged; D065840:Protective Factors; D011613:Psychotherapy; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D012917:Social Adjustment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: CBT-AN; Moderators; Predictors; SSCM; Severe and enduring anorexia nervosa