Vol.:(0123456789) 1 3 Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity https://doi.org/10.1007/s40519-019-00798-2 ORIGINAL ARTICLE Evaluating empirically valid and clinically meaningful change in intensive residential treatment for severe eating disorders at discharge and at a 6‑month follow‑up Laura Muzi 1  · Laura Tieghi 2  · Michele A. Rugo 2  · Vittorio Lingiardi 1 Received: 3 July 2019 / Accepted: 14 October 2019 © Springer Nature Switzerland AG 2019 Abstract Purpose The present study evaluated the statistical and clinical signifcance of symptomatic change at discharge and after 6 months of an intensive residential treatment for patients with eating disorders (ED), and explored the individual factors that may afect therapeutic outcomes. Methods A sample of 118 female ED patients were assessed at intake and discharge on the following dimensions: BMI, ED-specifc symptoms, depressive features, and overall symptomatic distress. A subsample of 59 patients flled out the same questionnaires at a 6-month follow-up after discharge. Results Findings evidenced statistically signifcant changes in all outcome measures at both discharge and follow-up. Between 30.1 and 38.6% of patients at discharge and 35.2–54.2% at the 6-month follow-up showed clinically signifcant sympto- matic change; additionally, 19.8–29.1% of patients at discharge and 22.9–38.3% at follow-up improved reliably. However, 34.9–39.8% remained unchanged and 2–4.8% worsened. At the 6-month follow-up, 21.3–25.9% showed no symptomatic change and 0–3.7% had deteriorated. Unchanged and deteriorated patients had an earlier age of ED onset and were more likely to sufer a comorbid personality pathology and to be following concurrent pharmacological treatment. Conclusions Results suggested that intensive and multimodal residential treatment may be efective for the majority of ED patients, and that therapeutic outcomes tend to improve over time. Prevention strategies should focus on early onset subjects and those with concurrent personality pathology. Level of evidence Level III, evidence obtained from a longitudinal cohort study. Keywords Eating disorders · Residential treatment · Efectiveness · Symptom change · Clinical signifcance Introduction Eating disorders (ED) are commonly considered amongst the most challenging psychiatric disorders to treat, show- ing high rates of psychiatric and medical comorbidity [1–3], elevated mortality rates [4, 5], and signifcant recidivism [6]. Furthermore, several studies have shown that ED patients typically develop a history of negative therapy experiences and repeated treatment failure [7, 8], ranging from dropout [9, 10] to relapse [11]. To overcome these clinical challenges, most guidelines agree that there should be a continuum of care linked to the patient’s symptom severity, overall medical status, treatment history, and social circumstances [12, 13]. Among the ED treatment services available, intensive residential treatment settings are recommended for patients who are medically stable and not actively suicidal, but who show severe and persistent ED symptoms associated with poor-to-fair moti- vation to change and psychiatric comorbidities. Residential care settings ofer a structured treatment program similar to inpatient hospital settings, but in a more homelike environ- ment. Patients typically receive both individual and group therapies, multidisciplinary interventions, meal support, and nutritional counseling [14]. These therapeutic pro- grams are considered a viable and comfortable alternative to * Laura Muzi laura1.muzi@uniroma1.it 1 Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy 2 Eating Disorder Clinic “Residenza Gruber”, Bologna, Italy