Integrative inpatient treatment for eating disorders: Effectiveness and clinical significance of symptom changes

To date, a growing body of evidence suggests that patients with severe eating disorders (EDs) may show benefit from integrative approaches, which combine multidisciplinary and multimodal interventions in intensive care settings (Thompson-Brenner, 2015). However, most studies measured treatment outcome only in terms of statistical significance, not enabling to determine if symptomatic change was clinically relevant. To overcome this limitation, some investigations employed an approach in which both patients’ treatment response and shifts into the functional population range are taken into account (Diedrich et al., 2018; Schlegl et al., 2016). The main aim of this study was to evaluate the effectiveness of an inpatient treatment program with a strong psychotherapeutic focus for individuals with EDs, as well as to determine the clinical significance of symptom change relying on the Jacobson and Truax’s (1991) criteria. The sample consisted in 112 patients who fulfill the following criteria: (a) they met DSM-5 diagnostic criteria for EDs; (b) presenting no organic syndrome; (c) they completed an integrated treatment in an ED specialized treatment center. ED diagnoses were established at intake using the SCID-5. All patients were asked to complete the Eating Attitudes Test-40 (Garner et al., 1979), the Eating Disorder Inventory-3 (Garner, 2004), the Beck Depression Inventory-II (Beck et al., 2006), and the Symptom Checklist-90-Revised (Derogatis, 1994) at treatment intake and discharge. Findings showed a statistically significant symptom reduction, especially on overall eating disorder and depressive symptoms severity, even when controlling for treatment length. Moreover, the majority of patients showed both reliable and clinically significant symptomatic improvement at discharge. These findings suggest the beneficial effects of intensive and multidisciplinary inpatient treatment setting for ED and the importance of clinical significance for evaluating treatment outcome.