title: Motivation to change and perceptions of the admission process with respect to outcome in adolescent anorexia nervosa.
abstract: 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.
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany. simona.hillen@rwth-aachen.de.
authors.forename: Simona
authors.initials: S
authors.lastname: Hillen
authors.affiliation: Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany. dempfle@medinfo.uni-kiel.de.|Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany. dempfle@medinfo.uni-kiel.de.
authors.forename: Astrid
authors.initials: A
authors.lastname: Dempfle
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany. jseitz@ukaachen.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Seitz
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany. bherpertz-dahlmann@ukaachen.de.
authors.forename: Beate
authors.initials: B
authors.lastname: Herpertz-Dahlmann
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany. kbuehren@ukaachen.de.
authors.forename: Katharina
authors.initials: K
authors.lastname: Bühren
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D001294:Attitude to Health; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D003863:Depression / Q000150:complications; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D009042:Motivation; D010343:Patient Admission; D063868:Patient Outcome Assessment; D010555:Personality Inventory / Q000706:statistics & numerical data; D011446:Prospective Studies; D011599:Psychopathology; D011613:Psychotherapy / Q000379:methods; D011795:Surveys and Questionnaires; D015430:Weight Gain