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Eating Disorders: Outcome of Residential Treatment
Henry P. Powers, Ph.D., Kristina Martinez, B.A., Pauline S. Powers, M.D.
 Introduction: Patients with eating disorders (ED) often require residential treatment, but its impact on core symptoms is poorly understood. Psychological factors, which mediate required intensity and duration of treatment, are unknown. Following complete residential treatment we hypothesize that: anorexia nervosa (AN) patients will have a significant weight gain and 75% will achieve a normal body mass index (BMI); binge-eating and/or purging will be associated with longer lengths of stay (LOS).
Methods: Information for this report is derived in part from a prospective quality improvement study conducted as part of the eating disorders program at Fairwinds Residential Treatment Center in Clearwater, Florida, from November 1998 to June 30, 2005.  Psychological factors were assessed with the Guilt Questionnaire (GQ), Beck Depression Inventory (BDI), and Defense Style Questionnaire (DSQ). A total of 107 patients completed all three tests at admission.
Results: 140 patients were evaluated: 36 (25.7%) had ANR (anorexia nervosa, restricting type); 50 (35.7%) had ANBP (anorexia nervosa, binge/purge type); 35 (25%) had BNP (bulimia nervosa, purging type); 18 (12.9%) had EDNOS (eating disorder, not otherwise specified); and 1 (0.7%) had BNNP (bulimia nervosa, non-purging type). Most of the patients were young females (mean age of 24 years and 89% were female). 117 (84%) completed treatment. Among completers, average length of stay was 83 days, compared to 55 days for non-completers. The 72 AN (both ANR and ANBP) completers gained a mean of 18.9 lbs., and 81% achieved normal BMI (non-completers gained 5.6 lbs., and 36% achieved normal BMI).
Also, among those who completed treatment: 82% of binge-eating patients ceased this behavior; 86% of purging patients ceased purging by vomiting, and 98% ceased purging by laxatives for at least 14 days prior to discharge. All three psychological factors studied were associated with a longer length of stay when all patients were considered. When correlation analyses were utilized (evaluating effect with each of the diagnostic groups), there were: 1.) significant positive correlation for length of stay and the BDI for patients with BN, ANBP, and EDNOS, but not for ANR; 2.) significant positive correlations for length of stay and GQ and DSQ-MAD and significant negative correlation for length of stay and DSQ-AD for patients with ANBP; and 3.) significant positive correlation for length of stay and DSQ-SSD for patients with BNP.
Discussion: Most AN patients who completed treatment achieved normal BMI. Most completers who had binge-eaten or purged prior to admission to residential treatment discontinued this behavior. Certain psychological factors may predict the need for longer residential treatment, but further study is needed to clarify the differences in impact of these factors by eating disorder diagnosis.
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