Associations between symptom change and treatment satisfaction in specialized eating disorder treatment

Patients receiving treatment for eating disorders often report dissatisfaction and negative treatment experiences, which may partly reflect the egosyntonic nature of these illnesses. This study aimed to examine different aspects of treatment satisfaction among patients receiving specialized eating disorder treatment, both inpatient and outpatient, and to investigate whether clinical outcomes were associated with treatment satisfaction.

The sample consisted of 774 patients from Norway, adolecents and adults, all diagnosed with an ICD-10 eating disorder including anorexia nervosa (F50.0, F50.1), bulimia nervosa (F50.2, F50.3) and other more unspecified EDs (F50.4, F50.8, F50.9). Patient data was retrieved from the Norwegian Quality Register for Treatment of Eating Disorders. Hierarchical regression analyses were conducted to assess whether changes in eating disorder symptoms-measured by the Eating Disorder Examination Questionnaire (EDE-Q 6.0) and the Clinical Impairment Assessment (CIA 3.0)-as well as changes in body mass index (BMI) and general psychopathology-measured with the Symptom Checklist-Revised (SCL-90-R) and the Strengths and Difficulties Questionnaire (SDQ)-predicted scores on three different measures of treatment satisfaction: self-perceived treatment outcome, experience with treatment and total satisfaction.

Improvement in eating disorder related daily functioning was significantly and positively associated with all measures of treatment satisfaction and emerged as the strongest predictor. Improvements in eating disorder symptoms and BMI were associated with more positive evaluations of treatment outcome and total satisfaction, but not with patients' experiences of treatment. Additionally, patients who received inpatient treatment reported significantly poorer treatment experiences than those treated in outpatient settings. Changes in general psychopathology were not associated with any satisfaction outcomes.

Improvements in eating disorder related symptoms, daily functioning, and weight restoration were associated with higher treatment satisfaction, whereas improvements in general psychopathology were not. Findings indicated that patients may be satisfied with treatment in general despite the egosyntonic nature of the disease, and that treatment level may be of significance.