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Renee D Rienecke - One of the best experts on this subject based on the ideXlab platform.
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predictors of improvement in a family based Partial Hospitalization intensive outpatient program for eating disorders
Eating Disorders, 2020Co-Authors: Renee D Rienecke, Kendra J Homan, Susan L CrowleyAbstract:The efficacy of family-based treatment (FBT) in outpatient settings has led to efforts to incorporate FBT principles into higher levels of care. The present study examined predictors of improvement in an FBT-based Partial Hospitalization program/intensive outpatient program (PHP/IOP) as measured by the Eating Disorder Examination-Questionnaire. Participants were 113 patients with anorexia nervosa (AN) or eating disorder not otherwise specified (EDNOS) consecutively participating in an FBT-based PHP/IOP. Multilevel modeling was used to investigate predictors for adolescents and young adults separately. Predictors considered included illness duration, previous Hospitalization, Hospitalization immediately prior to treatment, previous outpatient therapy, Hospitalization during treatment, diagnosis, gaining 4 pounds in 4 weeks, and family status as time-invariant variables. Time-varying variables considered included depression symptoms and mothers'/fathers' ratings of parental self-efficacy and expressed emotion. For adolescents, depression by time and diagnosis by time interactions were statistically significant. At all levels of depression, adolescent patients with AN demonstrated greater reductions in eating disorder symptoms compared to patients with EDNOS. For young adults, depression and gaining 4 pounds in 4 weeks were significant predictors. The relationships for young adults were curvilinear such that, while lower eating disorder symptoms were found during treatment, these gains were not maintained at follow up.
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early weight gain predicts treatment response in adolescents with anorexia nervosa enrolled in a family based Partial Hospitalization program
International Journal of Eating Disorders, 2020Co-Authors: Jessica L Van Huysse, Renee D Rienecke, Kellsey Smith, Kathleen A Mammel, Natalie ProhaskaAbstract:Objective Improved treatment outcome in family-based treatment (FBT) for anorexia nervosa (AN) is predicted by weight gain occurring early in the course of treatment (i.e., about 4 lbs by week 4). Although prior work suggests that early weight gain in higher levels of care (e.g., Partial Hospitalization programs [PHP]) predicts weight restoration at discharge, no study has examined the specific rate of gain within FBT-informed PHP programs that best predicts treatment response. Method This study examined rate of weight gain in pounds and percent expected body weight (EBW) that predicts positive outcome in 70 patients (M age = 15.49 years, SD = 2.56) with AN who were enrolled in a family-based PHP. Results Receiver operator characteristic analyses demonstrated that changes in %EBW during weeks 2-5 were more useful than changes in weight in predicting positive outcome. Gaining at least 8.9 pounds or over 8% of EBW in the first 4 weeks of treatment significantly predicted positive outcome. Discussion Findings suggest that positive outcome in an FBT-informed PHP is predicted by rapid weight gain in the initial weeks of treatment. Research is needed to identify specific family and patient characteristics that facilitate weight gain and to develop corresponding interventions to improve outcome.
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desired weight and treatment outcome among adolescents in a novel family based Partial Hospitalization program
Psychiatry Research-neuroimaging, 2019Co-Authors: Renee D Rienecke, Myla EbelingAbstract:The purpose of the current study was to investigate desired weight percentage and weight difference percentage and their association with treatment outcome in a novel family-based Partial Hospitalization program. Twenty-six adolescents with anorexia nervosa or subthreshold anorexia nervosa between the ages of 12 and 19 completed the Eating Disorder Examination (EDE) at intake and upon completion from a Partial Hospitalization program in which parents played a large role in the recovery process, consistent with family-based treatment principles. Lower desired weight percentage at baseline was associated with higher scores on the restraint subscale of the EDE at end of treatment. Higher weight difference percentage (greater desire to lose weight) at baseline was associated with higher scores on all EDE subscales and global score at end of treatment. Neither desired weight percentage nor weight difference percentage at baseline were associated with treatment dropout or percent expected body weight at end of treatment. In a family-based program, participants' desired weight may be related to eating disorder thoughts (for example, shape or weight concerns) but not to behavioral outcomes such as weight gain or treatment dropout, which may be more directly under the influence of the parents.
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heterogeneous weight restoration trajectories during Partial Hospitalization treatment for anorexia nervosa
International Journal of Eating Disorders, 2018Co-Authors: Johnny Berona, Rebekah Richmond, Renee D RieneckeAbstract:Early response to treatment has been shown to predict good outcome in family-based treatment, but little is known about who responds quickly. Objective The purpose of the current study was to examine the short-term weight gain trajectories among youth receiving Partial Hospitalization program services for anorexia nervosa (AN), and to identify predictors of these trajectories. Method Adolescent and young adults (n = 102) with AN or subthreshold AN completed semi-structured interviews and self-report measures on admission to a family-based Partial Hospitalization program. Patients participated in programming 5 days a week. Results Three weight gain trajectories were found to indicate slow, moderate, and rapid weight gain trajectories. All rapid responders gained at least four lbs. in the first 4 weeks of treatment, compared to 86.1% of moderate responders and 51.2% of slow responders. Patients were less likely to have a moderate or rapid response trajectory if they had a mood disorder diagnosis and higher parental expressed emotion. Additionally, the presence of compensatory behavior increased the likelihood of having a rapid response. Discussion Despite the sometimes chronic nature of AN, most patients fell into one of the two favorable response trajectories. The identification of these trajectories underscores the importance of considering the core disordered eating behaviors (i.e., restricting, binge eating, and purging), comorbid psychopathology, and parental expressed emotion.
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therapeutic alliance expressed emotion and treatment outcome for anorexia nervosa in a family based Partial Hospitalization program
Eating Behaviors, 2016Co-Authors: Renee D Rienecke, Rebekah Richmond, Jocelyn LebowAbstract:Adolescent therapeutic alliance has been found to be associated with improvements in eating disorder cognitions and with early weight gain. The current study assessed patient and parent therapeutic alliance, correlates of parent alliance, and relationship between alliance and treatment outcome. Fifty-six patients with anorexia nervosa completed measures of therapeutic alliance and eating disorder symptoms. Patients' parents completed measures of therapeutic alliance, expressed emotion, and psychopathology. Patients' alliance predicted cognitive and behavioral symptomatology at end of treatment (β=-0.39, p=0.001), though it was not related to changes in weight (β=0.12, p=0.377). Maternal hostility was associated with lower maternal alliance (r=-0.34, p=0.05). Findings suggest that maternal hostility should be addressed in treatment, and that patient alliance may be important in achieving psychological recovery from disordered eating.
Peter Fonagy - One of the best experts on this subject based on the ideXlab platform.
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8 year follow up of patients treated for borderline personality disorder mentalization based treatment versus treatment as usual
FOCUS, 2013Co-Authors: Anthony Bateman, Peter FonagyAbstract:ObjectiveThis study evaluated the effect of mentalization-based treatment by Partial Hospitalization compared to treatment as usual for borderline personality disorder 8 years after entry into a randomized, controlled trial and 5 years after all mentalization-based treatment was complete.MethodInterviewing was by research psychologists blind to original group allocation and structured review of medical notes of 41 patients from the original trial. Multivariate analysis of variance, chi-square, univariate analysis of variance, and nonparametric Mann-Whitney statistics were used to contrast the two groups depending on the distribution of the data.ResultsFive years after discharge from mentalization-based treatment, the mentalization-based treatment by Partial Hospitalization group continued to show clinical and statistical superiority to treatment as usual on suicidality (23% versus 74%), diagnostic status (13% versus 87%), service use (2 years versus 3.5 years of psychiatric outpatient treatment), use of m...
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8 year follow up of patients treated for borderline personality disorder mentalization based treatment versus treatment as usual
American Journal of Psychiatry, 2008Co-Authors: Anthony Bateman, Peter FonagyAbstract:Objective: This study evaluated the effect of mentalization-based treatment by Partial Hospitalization compared to treatment as usual for borderline personality disorder 8 years after entry into a randomized, controlled trial and 5 years after all mentalization-based treatment was complete. Method: Interviewing was by research psychologists blind to original group allocation and structured review of medical notes of 41 patients from the original trial. Multivariate analysis of variance, chi-square, univariate analysis of variance, and nonparametric Mann-Whitney statistics were used to contrast the two groups depending on the distribution of the data. Results: Five years after discharge from mentalization-based treatment, the mentalization-based treatment by Partial Hospitalization group continued to show clinical and statistical superiority to treatment as usual on suicidality (23% versus 74%), diagnostic status (13% versus 87%), service use (2 years versus 3.5 years of psychiatric outpatient treatment), ...
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treatment of borderline personality disorder with psychoanalytically oriented Partial Hospitalization an 18 month follow up
FOCUS, 2006Co-Authors: Anthony Bateman, Peter FonagyAbstract:Objective: The aim of this study was to determine whether the substantial gains made by patients with borderline personality disorder following completion of a psychoanalytically oriented Partial Hospitalization program, in comparison to patients treated with standard psychiatric care, were maintained over an 18-month follow-up period. Method: Forty-four patients who participated in the original study were assessed every 3 months after completion of the treatment phase. Outcome measures included frequency of suicide attempts and acts of self-harm, number and duration of inpatient admissions, service utilization, and self-reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment. Results: Patients who completed the Partial Hospitalization program not only maintained their substantial gains but also showed a statistically significant continued improvement on most measures in contrast to the patients treated with standard psychiatric care, who showed...
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treatment of borderline personality disorder with psychoanalytically oriented Partial Hospitalization
2006Co-Authors: Anthony Bateman, Peter FonagyAbstract:An 18-Month Follow-Up Objective: The aim of this study was to determine whether the substantial gains made by patients with borderline personality disorder following completion of a psychoanalytically oriented Partial Hospitalization program, in comparison to patients treated with standard psychiatric care, were maintained over an 18-month follow-up period. Method: Forty-four patients who participated in the original study were assessed every 3 months after completion of the treatment phase. Outcome measures included frequency of suicide attempts and acts of self-harm, number and duration of inpatient admissions, service utilization, and self-reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment. Results: Patients who completed the Partial Hospitalization program not only maintained their substantial gains but also showed a statistically significant continued improvement on most measures in contrast to the patients treated with standard psychiatric care, who showed only limited change during the same period. Conclusions: The superiority of psychoanalytically oriented Partial Hospitalization over standard psychiatric treatment found in a previous randomized, controlled trial was maintained over an 18-month follow-up period. Continued improvement in social and interpersonal functioning suggests that longer-term changes were stimulated.
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health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented Partial Hospitalization versus general psychiatric care
American Journal of Psychiatry, 2003Co-Authors: Anthony Bateman, Peter FonagyAbstract:OBJECTIVE: The authors assessed health care costs associated with psychoanalytically oriented Partial hospital treatment for borderline personality disorder compared with treatment as usual within general psychiatric services. METHOD: Health care utilization of all borderline personality disorder patients who participated in a previous trial of Partial hospital treatment compared with treatment as usual was assessed by using information from case notes and service providers. Costs were compared for the 6 months before treatment, 18 months of treatment, and an 18-month follow-up period. RESULTS: There were no cost differences between the groups during pretreatment or treatment. Costs of Partial hospital treatment were offset by less psychiatric inpatient care and reduced emergency room treatment. The trend for costs to decrease in the Partial Hospitalization group during the follow-up period was not apparent in the treatment-as-usual group. CONCLUSIONS: Specialist Partial hospital treatment for borderline ...
Anthony Bateman - One of the best experts on this subject based on the ideXlab platform.
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8 year follow up of patients treated for borderline personality disorder mentalization based treatment versus treatment as usual
FOCUS, 2013Co-Authors: Anthony Bateman, Peter FonagyAbstract:ObjectiveThis study evaluated the effect of mentalization-based treatment by Partial Hospitalization compared to treatment as usual for borderline personality disorder 8 years after entry into a randomized, controlled trial and 5 years after all mentalization-based treatment was complete.MethodInterviewing was by research psychologists blind to original group allocation and structured review of medical notes of 41 patients from the original trial. Multivariate analysis of variance, chi-square, univariate analysis of variance, and nonparametric Mann-Whitney statistics were used to contrast the two groups depending on the distribution of the data.ResultsFive years after discharge from mentalization-based treatment, the mentalization-based treatment by Partial Hospitalization group continued to show clinical and statistical superiority to treatment as usual on suicidality (23% versus 74%), diagnostic status (13% versus 87%), service use (2 years versus 3.5 years of psychiatric outpatient treatment), use of m...
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8 year follow up of patients treated for borderline personality disorder mentalization based treatment versus treatment as usual
American Journal of Psychiatry, 2008Co-Authors: Anthony Bateman, Peter FonagyAbstract:Objective: This study evaluated the effect of mentalization-based treatment by Partial Hospitalization compared to treatment as usual for borderline personality disorder 8 years after entry into a randomized, controlled trial and 5 years after all mentalization-based treatment was complete. Method: Interviewing was by research psychologists blind to original group allocation and structured review of medical notes of 41 patients from the original trial. Multivariate analysis of variance, chi-square, univariate analysis of variance, and nonparametric Mann-Whitney statistics were used to contrast the two groups depending on the distribution of the data. Results: Five years after discharge from mentalization-based treatment, the mentalization-based treatment by Partial Hospitalization group continued to show clinical and statistical superiority to treatment as usual on suicidality (23% versus 74%), diagnostic status (13% versus 87%), service use (2 years versus 3.5 years of psychiatric outpatient treatment), ...
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treatment of borderline personality disorder with psychoanalytically oriented Partial Hospitalization an 18 month follow up
FOCUS, 2006Co-Authors: Anthony Bateman, Peter FonagyAbstract:Objective: The aim of this study was to determine whether the substantial gains made by patients with borderline personality disorder following completion of a psychoanalytically oriented Partial Hospitalization program, in comparison to patients treated with standard psychiatric care, were maintained over an 18-month follow-up period. Method: Forty-four patients who participated in the original study were assessed every 3 months after completion of the treatment phase. Outcome measures included frequency of suicide attempts and acts of self-harm, number and duration of inpatient admissions, service utilization, and self-reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment. Results: Patients who completed the Partial Hospitalization program not only maintained their substantial gains but also showed a statistically significant continued improvement on most measures in contrast to the patients treated with standard psychiatric care, who showed...
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treatment of borderline personality disorder with psychoanalytically oriented Partial Hospitalization
2006Co-Authors: Anthony Bateman, Peter FonagyAbstract:An 18-Month Follow-Up Objective: The aim of this study was to determine whether the substantial gains made by patients with borderline personality disorder following completion of a psychoanalytically oriented Partial Hospitalization program, in comparison to patients treated with standard psychiatric care, were maintained over an 18-month follow-up period. Method: Forty-four patients who participated in the original study were assessed every 3 months after completion of the treatment phase. Outcome measures included frequency of suicide attempts and acts of self-harm, number and duration of inpatient admissions, service utilization, and self-reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment. Results: Patients who completed the Partial Hospitalization program not only maintained their substantial gains but also showed a statistically significant continued improvement on most measures in contrast to the patients treated with standard psychiatric care, who showed only limited change during the same period. Conclusions: The superiority of psychoanalytically oriented Partial Hospitalization over standard psychiatric treatment found in a previous randomized, controlled trial was maintained over an 18-month follow-up period. Continued improvement in social and interpersonal functioning suggests that longer-term changes were stimulated.
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health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented Partial Hospitalization versus general psychiatric care
American Journal of Psychiatry, 2003Co-Authors: Anthony Bateman, Peter FonagyAbstract:OBJECTIVE: The authors assessed health care costs associated with psychoanalytically oriented Partial hospital treatment for borderline personality disorder compared with treatment as usual within general psychiatric services. METHOD: Health care utilization of all borderline personality disorder patients who participated in a previous trial of Partial hospital treatment compared with treatment as usual was assessed by using information from case notes and service providers. Costs were compared for the 6 months before treatment, 18 months of treatment, and an 18-month follow-up period. RESULTS: There were no cost differences between the groups during pretreatment or treatment. Costs of Partial hospital treatment were offset by less psychiatric inpatient care and reduced emergency room treatment. The trend for costs to decrease in the Partial Hospitalization group during the follow-up period was not apparent in the treatment-as-usual group. CONCLUSIONS: Specialist Partial hospital treatment for borderline ...
Thröstur Björgvinsson - One of the best experts on this subject based on the ideXlab platform.
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predictors of affect following discharge from Partial Hospitalization a two week ecological momentary assessment study
Psychological Medicine, 2021Co-Authors: Marie J C Forgeard, Courtney Beard, Danielle Shayani, Alexandra L Silverman, Eli Tsukayama, Thröstur BjörgvinssonAbstract:BACKGROUND Little is known about the everyday experiences of individuals transitioning from acute to outpatient psychiatric care, an important period of risk for mood symptom relapse. This study used ecological momentary assessment (EMA) to examine whether specific daily experiences were related to momentary affective states following discharge from a Partial Hospitalization program (PHP). METHODS A sample of 114 adults (Mage = 36 years old, 52% female, 83% White) completed four brief EMA surveys every day for 2 weeks assessing intensity/type of stressful events and social contact, as well as positive/negative affect (PA/NA). Half of participants reported therapeutic skills use. RESULTS Stress severity ratings prospectively predicted increased NA. NA predicted spending less time with close relationships. However, interacting with close relationships predicted increased positive affect (PA). Finally, PA predicted spending time with more people. The use of two skills (behavioral activation and interpersonal effectiveness) was concurrently, but not prospectively, associated with improved affect. CONCLUSIONS Examining daily experiences of individuals discharging from Partial Hospitalization provides important information about factors that may influence affective states during the transition from acute to outpatient care. Findings from this study can be used to help prepare patients for discharge and develop interventions for the post-acute period.
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a higher order internalizing dimension predicts response to Partial Hospitalization treatment
Clinical psychological science, 2021Co-Authors: Christopher C Conway, Courtney Beard, Thröstur Björgvinsson, Marie J C Forgeard, Ivar Snorrason, Kristy CuthbertAbstract:Mental disorders may be best represented by dimensional constructs that span traditional diagnostic boundaries. There is evidence that empirically derived dimensional phenotypes improve nosology an...
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dampening of positive affect predicts substance use during Partial Hospitalization
Cognitive Therapy and Research, 2020Co-Authors: Courtney Beard, Thröstur Björgvinsson, Andrew D Peckham, Kathryn R Mchugh, Elizabeth T KneelandAbstract:Elevated positive affect is associated with craving for substances of abuse, yet little is known about regulation of positive emotion in substance use disorders. This study tested if the emotion regulation strategy of dampening (deliberately down-regulating positive affect) contributes to substance use outcomes in a transdiagnostic sample. Participants (N = 120) were adults endorsing risky substance use, recruited from an acute psychiatric treatment program that requires abstinence during treatment. Craving and dampening were assessed at admission. A logistic regression to evaluate likelihood of substance use during treatment yielded a significant interaction between dampening and frequency of substance use in the previous month: odds of use during treatment were higher among those with heavier pre-treatment use, but only at high levels of dampening. This study provides preliminary evidence that dampening increases risk for substance use among those with high levels of pre-treatment substance use. Findings are limited by the use of a general psychiatric sample, which did not include individuals seeking treatment for substance use disorders; future studies are needed to replicate this effect in individuals with substance use disorders. Results point to the need for interventions to enhance healthy regulation of positive affect in substance-using populations.
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effectiveness of a brief adjunctive yoga intervention for short term mood and psychiatric symptom change during Partial Hospitalization
Psychiatric Rehabilitation Journal, 2019Co-Authors: Simone Chadfriedman, Courtney Beard, Lynne Kopeski, Marie J C Forgeard, Katherine Mchugh, Thröstur BjörgvinssonAbstract:Objective Evidence concerning the effectiveness of yoga in Partial hospital programs is limited. Yet, Partial hospitals provide treatment at a critical juncture by bridging inpatient and outpatient care. The present study tested the effectiveness of a single-session group yoga intervention for short-term mood and psychiatric symptom change in participants attending a 1- to 2-week Partial hospital program. Method Participants included 104 Partial hospital patients who participated in the single-session yoga intervention and completed a measure of positive/negative affect before and after the group. Participants, as well as Partial hospital patients who did not attend the yoga intervention (n = 438), completed measures of depression and anxiety symptoms at admission and discharge from the program. At discharge, they also rated their perceived improvement and the overall quality of the care they received. Results Participants who attended the yoga intervention experienced significant improvements in positive and negative affect during the group. They did not show greater improvements in symptoms of anxiety or depression over the course of treatment compared to individuals who did not attend the group. Yoga intervention participants nonetheless gave higher ratings to the quality of the care they received. Conclusions and implications for practice Findings demonstrated that attending a single yoga session during Partial Hospitalization was associated with short-term mood benefits, and with enhanced overall perceptions of treatment. Further research is needed to determine the conditions under which participation in yoga during Partial Hospitalization could contribute to symptom change in this context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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turning the upps down urgency predicts treatment outcome in a Partial Hospitalization program
Comprehensive Psychiatry, 2019Co-Authors: Andrew D Peckham, Courtney Beard, Marie J C Forgeard, Kean J Hsu, Thröstur BjörgvinssonAbstract:Abstract Background Impulsivity in response to negative mood (negative urgency) and positive mood (positive urgency) is common in psychiatric disorders. The aims of this study were to test if urgency predicts treatment response during Partial Hospitalization in a transdiagnostic sample, and if urgency is malleable over the course of brief treatment. Method Participants (N = 348, 55% female, M age = 32.9) were patients presenting to a CBT-based Partial Hospitalization program. Urgency and a range of symptoms were assessed with self-report measures during treatment. Results Higher negative urgency scores predicted worse outcome for depression and anxiety symptoms. Negative urgency (p Discussion Findings suggest that participants report decreases in urgency during brief Partial Hospitalization treatment. Higher negative urgency predicted poorer treatment response for symptoms of depression and anxiety, demonstrating the need for novel treatments for urgency.
Susan Laneloney - One of the best experts on this subject based on the ideXlab platform.
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caregiver accommodation in adolescents with avoidant restrictive food intake disorder and anorexia nervosa relationships with distress eating disorder psychopathology and symptom change
European Eating Disorders Review, 2020Co-Authors: Allison Wagner, Hana F Zickgraf, Susan LaneloneyAbstract:Objective The role of family and caregiver accommodation is a well-defined maintenance factor for anxiety disorders and OCD. Family accommodation for patients with eating disorders is beginning to be described and characterized, but gaps in the literature remain. The current project compares levels of accommodation in families of those with anorexia nervosa (AN) to those with avoidant/restrictive food intake disorder (ARFID). It additionally establishes whether accommodation changes over the course of treatment and the extent to which these changes are related to changes in eating disorder pathology. Methods A total of 39 adolescents with ARFID and 59 with AN presenting to a Partial Hospitalization program were included, with measures completed at intake and discharge. Results Caregivers of adolescents with AN and those with ARFID reported similar levels of accommodation, with the exception of the Reassurance Seeking subscale of the Accommodation and Enabling Scale for Eating Disorders (AESED). Additionally, accommodation decreased significantly from intake to discharge for both patient groups. Intake AESED scores were also significantly related to caregiver distress, and changes in AESED scores were related to decreases in relevant eating disorder psychopathology for both groups. Conclusions The results of the current study highlight the importance of considering family accommodation for ARFID patients and point to the need for future research to capture changes in accommodation over the course of treatment in relation to the delivery of evidence-based interventions and subsequent changes in ED symptoms. HIGHLIGHTS : Families of patients with ARFID and those of patients with AN attending a Partial Hospitalization treatment program report similar levels of accommodation and enabling behaviours. Accommodation behaviours are positively associated with caregiver distress for both diagnostic categories. Accommodation decreased significantly from intake to discharge for both subtypes of eating disorder, and these changes were related to decreased eating disorder psychopathology.
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further support for diagnostically meaningful arfid symptom presentations in an adolescent medicine Partial Hospitalization program
International Journal of Eating Disorders, 2019Co-Authors: Hana F Zickgraf, Jamal H Essayli, Susan Laneloney, Rollyn M OrnsteinAbstract:Objective To identify potential presentations of avoidant/restrictive food intake disorder (ARFID) in a pediatric eating disorder Partial Hospitalization program (PHP) based on the nature of the eating restriction leading to core symptoms of ARFID. Method A retrospective chart review of 83 patients ages 8-17 admitted to a PHP and diagnosed with ARFID. Charts were independently reviewed by two coders, with high inter-rater agreement (κ = 0.77). Distinct categories were identified and groups were compared on demographics, anthropometrics, comorbid psychopathology, and core ARFID symptoms. Results We identified cases characterized by predominantly selective eating based on aversions to the sensory properties of foods, lack of interest in eating/low appetite, and fear of aversive consequences from eating. We also distinguished a subset of patients with eating restrictions consistent with both selectivity and limited interest/appetite. The four primary ARFID presentation groups differed on core ARFID criteria, symptom trajectory and illness duration, mood and medical comorbidities, age, gender, and parent-reported symptoms of psychopathology. Discussion The present findings suggest that there are diagnostically meaningful ARFID subtypes that can be differentiated based on the nature of their eating restrictions, as well as other demographic, illness history features, and psychiatric comorbidity. As treatments for youth with ARFID are developed and refined, it will be important to take into consideration not only demographic differences, but also the variability in symptoms, as this might require distinct interventions and levels of care. Additionally, differing mechanisms that maintain different types of eating restrictions might necessitate unique psychological and psychiatric interventions.
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treatment of avoidant restrictive food intake disorder in a cohort of young patients in a Partial Hospitalization program for eating disorders
International Journal of Eating Disorders, 2017Co-Authors: Rollyn M Ornstein, Jamal H Essayli, Terri A Nicely, Emily Masciulli, Susan LaneloneyAbstract:Objective Avoidant/restrictive food intake disorder (ARFID) is a recently named condition to classify patients who present with restricted nutritional intake without body image distortion or fear of weight gain. We sought to compare treatment outcomes of patients with ARFID in a family-centered Partial hospital program (PHP) to those with other eating disorders (ED). Methods A retrospective chart review of 130 patients 7 to 17 years of age admitted to the program from 2008 to 2012 was performed. Intake and discharge data included: length of stay; percentage median body mass index (%MBMI); and scores on the Children's Eating Attitudes Test (ChEAT) and Revised Children's Manifest Anxiety Scale (RCMAS). Between and within group effects were measured for intake and discharge data. Results Patients with ARFID spent significantly fewer weeks in program than those with anorexia nervosa (AN) and experienced a similar increase in %MBMI as patients with AN and other specified/unspecified feeding and eating disorders. All patients exhibited significant improvements in psychopathology over the course of treatment as measured by scores on the ChEAT and RCMAS. Discussion Our findings suggest that patients with ARFID can be successfully treated in the same PHP as patients with other ED, with comparable improvements in weight and psychopathology over a shorter time period. Results are limited to patients with ARFID who exhibit an acute onset of severe food restriction. Future research should incorporate measures relevant to the diagnosis of ARFID and explore how patients with different ARFID subtypes may respond to various treatments.
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clinical outcomes of a novel family centered Partial Hospitalization program for young patients with eating disorders
Eating and Weight Disorders-studies on Anorexia Bulimia and Obesity, 2012Co-Authors: Rollyn M Ornstein, Susan Laneloney, Christopher S HollenbeakAbstract:AIM: Eating disorders (ED) in children and younger adolescents are becoming more evident, but there is a small evidence base for their management in this population. We hypothesized that a new family-centered Partial hospital program for young patients would be effective in promoting weight gain, as well as improvement in psychiatric symptoms. METHODS: A retrospective chart review of 56 patients treated in the program between August 2008 and November 2009 was performed. Historical data, anthropometric variables and scores from psychological instruments [Children’s Eating Attitudes Test (ChEAT), Children’s Depression Inventory (CDI), and Revised Children’s Manifest Anxiety Scale (RCMAS)] were collected on admission and at discharge. After exclusion, 30 patients were available for statistical analysis, using paired t-tests. The primary outcome variables were improvement in weight and change in total ChEAT score. Secondary outcomes included improvements in the CDI and RCMAS scores. Multivariate analysis included linear regression models that controlled for patient-specific fixed effects. RESULTS: The cohort was 87% female with a mean age of 12.8±2 years; 60% were diagnosed with ED not otherwise specified. Two-thirds had a co-morbid depressive and/or anxiety disorder. Change in weight was significant (p<0.0001), as were improvements on total ChEAT (p<0.0001), CDI (p=0.0002), and RCMAS (p<0.0001) scores. No historical factors were correlated with improvement, nor was use of psychotropic medications. Length of stay in weeks significantly predicted greater weight gain (p=0.004, R2=0.26). CONCLUSIONS: Patients treated in a family-centered Partial hospital program had significant improvements in weight and psychological parameters. This approach holds significant promise for the management of young ED patients.