Trajectory of Eating Disorder Symptom Change in an Online Sample of Patients Receiving Treatment in the Community

Abstract

The best available eating-disorder (ED) treatments work for only about half of patients. Poor treatment outcomes exist, in part, because clinicians have limited information about how ED symptoms change, on average, during treatment. Without information about average rate of change, clinicians do not have data that can signal when clients are at risk for a poor outcome. The purpose of the current study was to identify typical patterns of change for ED symptoms in patients with EDs and to test how individual differences (e.g., age, illness duration, gender, and ED diagnosis) contribute to the rate of ED symptom reduction. A secondary aim was to test whether change in ED behaviors predicted change in ED cognitions or vice versa. Participants (87.2% female; N = 5,685) were Recovery Record users who completed the Eating Pathology Symptoms Inventory (EPSI) once per month for three months. Results from latent growth curve models indicated that, on average, ED psychopathology significantly declined over three months. Bivariate latent change score analyses indicated that ED behaviors and cognitions changed simultaneously and mutually predicted change in one another. This study was one of the largest studies, to date, to assess change patterns in a treatment-seeking sample of people with EDs. Information about the expected rate and direction of change is useful in clinical settings because it helps therapists better identify individuals who are at risk for slow treatment progress and intensify their ongoing treatment to avoid poor end-of-treatment outcomes.