title: The NOURISHED randomised controlled trial comparing mentalisation-based treatment for eating disorders (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of borderline personality disorder.
abstract: In this multi-centre randomized controlled trial (RCT) we compared modified mentalisation-based treatment (MBT-ED) to specialist supportive clinical management (SSCM-ED) in patients with eating disorders (EDs) and borderline personality disorder symptoms (BPD). This group of patients presents complex challenges to clinical services, and a treatment which addresses their multiple problems has the potential to improve outcome. MBT has been shown to be effective in improving outcome in patients with BPD, but its use has not been reported in ED.
  
  
  
  Sixty-eight eligible participants were randomised to MBT-ED or SSCM-ED. The primary outcome measure was the global score on the Eating Disorder Examination. Secondary outcomes included measures of BPD symptoms (the Zanarini Rating Scale for Borderline Personality Disorder), general psychiatric state, quality of life and service utilisation. Participants were assessed at baseline and at 6, 12 and 18 months after randomisation. Analysis was performed using linear mixed models.
  
  
  
  Only 15 participants (22 %) completed the 18 month follow-up. Early drop-out occurred significantly more in the SSCM-ED group. Drop-out did not vary with treatment model later in therapy and was sometimes attributed to participants moving away. There was higher drop--out amongst smokers and those with higher neuroticism scores. 47.1 % of participants in the MBT-ED arm and 37.1 % in the SSCM-ED arm attended at least 50 % of therapy sessions offered. Amongst those remaining in the trial, at 12 and 18 months MBT-ED was associated with a greater reduction in Shape Concern and Weight Concern in the Eating Disorder Examination compared to SSCM-ED. At 6, 12 and 18 months there was a decline of ED and BPD symptoms in both groups combined. Ten participants were reported as having had adverse events during the trial, mostly self-harm, and there was one death, attributed as 'unexplained' by the coroner.
  
  
  
  The high drop-out rate made interpretation of the results difficult. Greater involvement of research staff in clinical management might have improved compliance with both therapy and research assessment. MBT-ED may have had an impact on core body image psychopathology.
  
  
  
  Current Controlled Trials: ISRCTN51304415 . Registered on 19 April 2011.
authors.affiliation: University College London, London, UK. p.robinson@ucl.ac.uk.|Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK. p.robinson@ucl.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Robinson
authors.affiliation: IOPPN, King's College London, London, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hellier
authors.affiliation: IOPPN, King's College London, London, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Barrett
authors.affiliation: Kent and Medway Partnership Trust, The Red House, Maidstone, UK.
authors.forename: Daiva
authors.initials: D
authors.lastname: Barzdaitiene
authors.affiliation: University College London, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Bateman
authors.affiliation: Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bogaardt
authors.affiliation: Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Clare
authors.affiliation: Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK.
authors.forename: Nadia
authors.initials: N
authors.lastname: Somers
authors.affiliation: Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK.
authors.forename: Aine
authors.initials: A
authors.lastname: O'Callaghan
authors.affiliation: IOPPN, King's College London, London, UK.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Goldsmith
authors.affiliation: South London and the Maudsley NHS Trust, London, UK.
authors.forename: Nikola
authors.initials: N
authors.lastname: Kern
authors.affiliation: IOPPN, King's College London, London, UK.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schmidt
authors.affiliation: Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Morando
authors.affiliation: Barnet Enfield and Haringey Mental Health Trust, St Ann's Hospital, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Ouellet-Courtois
authors.affiliation: University College London, London, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Roberts
authors.affiliation: Institute for Eating Disorders, Oslo, Norway.
authors.forename: Finn
authors.initials: F
authors.lastname: Skårderud
authors.affiliation: University College London, London, UK.|Anna Freud Centre, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Fonagy
mesh_terms: D000328:Adult; D001883:Borderline Personality Disorder / Q000628:therapy*; D001068:Feeding and Eating Disorders / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D018579:Patient Selection; D016037:Single-Blind Method; D056345:Theory of Mind
keywords: Borderline personality disorder; Drop-out; Eating disorders; Mentalisation-based treatment; Psychotherapy; Randomised controlled trial; Specialist supportive clinical management