A longitudinal study of the long-term course and outcome of adult patients with various eating disorders (ED). The project aims to increase the understanding of severe and enduring ED and to inform treatment by examining prognostic factors related to outcome.

Hanna Punsvik Eielsen is a clinical psychologist who graduated from the Norwegian University of Science and Technology (NTNU) in 2014. Since 2016 she has been working as a clinician at the specialized ED unit at Modum Bad, in combination with a position at the Research Institute at Modum Bad. The hospital gives an excellent opportunity to bridge the gap between research and clinical work, so that new findings can be tested and implemented, and clinical questions can be examined in a scientific manner. Hanna’s research interests are eating disorders, childhood trauma, treatment, long-term outcome and recovery.

About the Project

From August 1998 to June 2001, all patients that were admitted to the specialized eating disorder unit at Modum Bad psychiatric hospital were invited to partake in a longitudinal follow-up study. Admission to the unit required age above 18 years, inadequate response to previous treatment, and symptoms that fulfilled criteria of either anorexia nervosa (AN), bulimia nervosa (BN) or OSFED (other specified feeding or eating disorder). A total of 86 patients entered the study. The patients have been assessed at admission and discharge, and at one, two, five and 17 years after admission. The repeated evaluation applied structured diagnostic interviews; the Eating Disorder Examination (EDE) interview to explore eating disorder symptoms, and the Structured Clinical Interview for DSM-IV Axis II diagnoses (SCID-II) to examine personality disorders. At the 17-year follow-up the Mini International Neuropsychiatric Interview (MINI) was utilized to assess general psychopathology and experiences of childhood trauma was addressed using the Childhood Trauma Questionnaire. Self-report forms were also applied on each measuring point.  The aim of the study was to provide knowledge concerning long-term course and outcome, and uncover relevant prognostic factors that could aid in developing treatment for patient with longstanding ED.

Objectives

The project’s objectives are to explore the course of ED in adulthood by investigating the long-term outcome with respect to ED symptoms, personality disorders, general psychopathology, along with psychosocial functioning and life satisfaction. The study also aims to examine factors that might mediate outcome, particularly focusing on personality disorders and different types of childhood trauma.

Results

The main findings from the 17-year follow-up study are:

• Less than 30% of the patients were fully recovered at the 17-year follow-up. A total of 21% were partially recovered, while the remaining 50% presented no recovery.
• Although there was a reduction in patients that fulfilled the criteria for an ED diagnosis, there were no significant changes in recovery rates from the 5- to the 17-year follow-up.
• Comorbidity was widespread with more than 70% of the patients presenting with at least one Axis-I disorder other than ED.
• The number of patients without any comorbid PD increased from 26% at baseline to 76% at the 17-year assessment.
• There was a reciprocal relationship between PD and ED, where a high level of either disorder was associated with a high level of the other throughout the follow-up period.
• Borderline PD at baseline predicted poor ED outcome over time.
• The patients followed four distinct trajectories of change with symptom levels that were either low, moderate, or high throughout the 17-year course.
• More than 70% of the patients were exposed to one or more type of childhood trauma, such as sexual abuse, physical abuse, emotional abuse, or emotional or physical neglect.
• Childhood sexual abuse was far more common among patients with poor long-term outcome. This highlights the importance of trauma informed care.

Background

The project is a continuation of an ongoing longitudinal study, and members of the project group have published papers covering the findings from the previous assessments at one, two and five year- follow-up.

Funding

The project is funded by Norwegian Women’s Public Health Association

Contact Information

Project Contact: Hanna Punsvik Eielsen

You can also reach us through the Modum Bad telephone service: 32 74 97 00.

Project participants

Hanna Punsvik Eielsen, Clinical Psychologist, Ph.D.-candidate, Modum Bad

KariAnne Vrabel, PhD, Research Director, Modum Bad. Associate Professor II, University of Oslo

Asle Hoffart, PhD, Clinical psychologist. Senior researcher at Modum Bad, Professor Emeritus, University of Oslo

Øyvind Rø, PhD, Adjunct professor, University of Oslo

Jan Rosenvinge, PhD, Vice-Dean, The Artic University of Norway

Publications

https://pubmed.ncbi.nlm.nih.gov/33660895/

https://pubmed.ncbi.nlm.nih.gov/36214278/

https://pubmed.ncbi.nlm.nih.gov/37897047/

Eating disorder researchers at Modum Bad