(PS14-20) The Role of Weight-gain in Short-term Psychological Recovery During Treatment of Anorexia Nervosa

Background: Patients with anorexia nervosa (AN) are often resistant to weight gain (Watson & Bulik, 2013), but less is known about remission of associated psychological symptoms. Some evidence suggests that those who meet their target weight during treatment are not necessarily psychologically recovered (Bardone-Cone et al., 2010). Thus, the current study aimed to examine differences between patients who do and do not reach their target weight range, defined as at least 90% of expected body weight (EBW; Golden et al., 1997), by the end of treatment.

Methods: 2,098 patients undergoing treatment for AN completed questionnaires assessing symptoms of disordered eating (EDE-Q; Fairburn & Beglin, 1994), obsessive-compulsive disorder (OCI-R; Foa et al., 2002), anxiety (GAD-7; Spitzer et al., 2006), and depression (PHQ-9; Kroenke et al., 2001) at admission and discharge. Weight-gain groups were compared at admission and discharge using t-tests and changes across treatment between groups were assessed with mixed ANOVAs, controlling for EBW at admission.

Results: Surprisingly, those who met at least 90% of their EBW by discharge were significantly higher at admission in restraint, eating concern, and symptoms of depression (p’s < .05), and higher at both admission and discharge in shape concern, weight concern, anxiety, and symptoms of obsessive-compulsive disorder (p’s < .01). Finally, mixed ANOVAs revealed a significant interaction between weight-gain group and symptom improvement across treatment only for restraint symptoms (F[1, 1021] = 8.86, p < .01, partial η² = .009). Specifically, although both weight-gain groups displayed significant improvement across treatment, those reaching their target weight range had greater decreases in restraint scores.

Discussion: Results suggest that despite greater physical recovery, patients who reach target weight ranges may remain more symptomatic, possibly because weight-gain is incongruent with pursuit of thinness in AN or because those who were weight-restored by discharge had demonstrated greater severity at admission. Overall, even with comparable symptom improvement across treatment between groups, it appears that psychological symptom improvement lags behind physical recovery in AN treatment, especially for those who are weight-restored.