Is there an optimal length of psychological treatment for eating disorder pathology?

Treatment guidelines for eating disorders (ED) are unclear about the optimal length of psychological care. We aimed to investigate associations between treatment duration and changes in ED pathology. Data for 164 outpatients accessing psychological interventions for ED were analyzed using MANOVA. We tested associations between number of therapy sessions and pre‐post treatment changes in clinical outcomes (EDE‐Q global scores, binge eating, purging); adjusting for baseline measures, diagnoses, and treatment type. Secondary analyses included rapid response variables in the above outcomes by treatment session eight. Partial correlations between treatment duration and BMI changes (adjusting for intake BMI) were examined for anorexia nervosa cases. Treatment duration was not significantly associated with changes in ED outcomes after adjusting for rapid response. BMI change (weight regain) was not correlated with treatment duration in anorexia nervosa cases. Rapid response was associated with better EDE‐Q outcomes, but not with changes in binge eating or purging behaviors. ED outcomes are unrelated to treatment duration; rapid response is a useful prognostic indicator for treatment planning.     

Structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10: Updated (third) revision

Objectives: Earlier versions of the Structured Interview for Anorexic and Bulimic Disorders (SIAB) were modified in order to include new research findings and to update the expert rating interview to the diagnostic criteria of DSM-IV and ICD-10. The semistandardized interview was developed for reliable and valid assessment of the specific as well as the general psychopathology of eating disorders. Method: Data from SIAB-EX interviews (current and past/lifetime symptom expression) were available from three samples: (a) 330 eating-disordered patients assessed at the start of treatment, (b) 148 former eating-disordered patients with anorexia nervosa (AN) or bulimia nervosa (BN) assessed at follow-up, and (c) 111 community controls. Sixty-one of the 87 items of the SIAB-EX with a 5-point scale were factor analyzed. Results: Principal components analyses with varimax rotation produced the following six components of the SIAB-EX (lifetime): (I) Body Image and Slimness Ideal; (II) General Psychopathology; (III) Sexuality and Social Integration; (IV) Bulimic Symptoms; (V) Measures to Counteract Weight Gain, Fasting, and Substance Abuse; and (VI) Atypical Binges. The factor solution for the current symptom expression was very similar to that based on lifetime symptom expression. Average item and factor scores are given for six groups of eating-disordered patients and controls. High interrater reliability was established for both current and the past symptom expression. Cronbach's alpha coefficients indicated good internal consistency for five of the six components of the SIAB-EX. DSM-IV and ICD-10 diagnoses for eating disorders can be derived directly or by using a computer algorithm from the SIAB-EX. A detailed 90-page manual facilitates the training of interviewers. Conclusion: The 87-item SIAB-EX was originally developed for detailed assessment of eating disorders cross-sectionally and longitudinally. The updated version which allows for diagnosis according to DSM-IV and ICD-10 is described here. © 1998 by John Wiley & Sons, Inc. Int J Eat Disord 24: 227–249, 1998.