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Treatment Results of Anorexia Nervosa and Bulimia Nervosa in a Residential Treatment Program
Abstract
Data on the effectiveness of residential treatment for patients with anorexia nervosa (AN) and bulimia nervosa (BN) are limited. We analyzed patient survey results at admission and discharge from Monte Nido Residential Treatment Program. Of 287 consecutive admissions, 80% (231) "graduated" (completed ≥ 30 days of treatment), and of these (all of whom gave consent), only patients with AN (N = 120) or BN (N = 95) were included (215 of 231, 93%) in this study. Analyses included a comparison of admission vs. discharge variables (paired t-tests) for each diagnosis. At each assessment, graduates completed the Eating Disorders Inventory-2 (EDI-2), the Beck Depression Inventory (BDI), and a structured eating disorder assessment questionnaire. For patients with AN, there were statistically significant improvements in mean BMI. In addition, for both AN and BN patients, there were statistically significant improvements in BDI scores, all 11 EDI-2 subscales, and frequencies of bingeing, vomiting, laxative abuse, chewing and spitting, stimulant abuse, and restricting behavior. The great majority of patients completing treatment showed significant improvement at discharge from intensive residential treatment.
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Individuals with AN-R are observed to have reduced awareness of emotions.
“Individuals with AN-R are observed to have reduced awareness of emotions”
From The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidence-Based Practice Implementation in Residential Treatment (2021) · cites this paper as [67]
Some degree of relapse is common post-discharge.
“Some degree of relapse is common post-discharge (67)”
From The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidence-Based Practice Implementation in Residential Treatment (2021) · cites this paper as [67]
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Lock, J., & La Via, M. C. (2015) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2015.01.018 · Cited by 181
Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines
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Friedman, K., Ramirez, A. L., Murray, S. B., Anderson, L. K., Cusack, A., Boutelle, K. N., & Kaye, W. H. (2016) · European Eating Disorders Review · doi:10.1002/erv.2449 · Cited by 108
Gregorowski, C., Seedat, S., & Jordaan, G. P. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-289 · Cited by 105
“Residential treatment programmes have been found to be effective in the treatment of AN and BN both post-treatment and at 3–4 year follow-up [101,102].”
BackgroundA systematic review of outcomes following residential treatment for eating disorders
Peckmezian, T., & Paxton, S. J. (2020) · European Eating Disorders Review · doi:10.1002/erv.2733 · Cited by 71
“One study reported significant improvements in depression that persisted through long-term (mean 4.6 years) follow-up (Brewerton & Costin, 2011a).”
BackgroundResultInfluentialPrognostic factors and outcome in anorexia nervosa: a follow-up study
Errichiello, L., Iodice, D., Bruzzese, D., Gherghi, M., & Senatore, I. (2015) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-015-0211-2 · Cited by 60
Long-term Outcome of Residential Treatment for Anorexia Nervosa and Bulimia Nervosa
Brewerton, T. D., & Costin, C. (2011) · Eating Disorders · doi:10.1080/10640266.2011.551632 · Cited by 54
“As previously described (Brewerton & Costin, 2011), 30 days was used as an a priori minimum effective duration of treatment, and these treatment completers are referred to as “graduates.””
MethodInfluentialUpdates on Treatments for Adolescent Anorexia Nervosa
Lock, J. (2019) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2019.05.001 · Cited by 50
Intensive treatment for adults with anorexia nervosa: The cost of weight restoration
Guarda, Á. S., Schreyer, C. C., Fischer, L. K., Hansen, J. L., Coughlin, J. W., Kaminsky, M. J., Attia, E., & Redgrave, G. W. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22668 · Cited by 31
Scharff, A., Ortiz, S. N., Forrest, L. N., Smith, A. R., & Boswell, J. F. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23106 · Cited by 27
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Thompson-Brenner, H., Singh, S., Gardner, T., Brooks, G. E., Smith, M. T., Lowe, M. R., & Boswell, J. F. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.641601 · Cited by 26
“Individuals with AN-R are observed to have reduced awareness of emotions, though comparisons between individuals with active AN-R and recovered individuals, individuals with AN-binge/purge type, and individuals with other ED diagnoses are complex and require additional study (67).”
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Davies, J. E., Cockfield, A., Brown, A., Corr, J., Smith, D. M., & Munro, C. (2016) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2016.09.005 · Cited by 26
Take charge: Personality as predictor of recovery from eating disorder
Levallius, J., Roberts, B. W., Clinton, D. N., & Norring, C. E. A. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.08.064 · Cited by 21
Demographics and Outcomes of Patients With Eating Disorders Treated in Residential Care
Fisher, M., Henretty, J. R., Cox, S. A., Feinstein, R., Fornari, V., Moskowitz, L., Schneider, M., Levine, S. B., Malizio, J. B., & Fishbein, J. S. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02985 · Cited by 20
The Role of Higher Levels of Care for Eating Disorders in Youth
Derenne, J. L. (2019) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2019.05.006 · Cited by 18
Effectiveness and clinical response rates of a residential eating disorders facility
Twohig, M., Bluett, E., Cullum, J., Mitchell, P. R., Powers, P., Lensegrav-Benson, T. L., & Quakenbush-Roberts, B. (2016) · Eating Disorders · doi:10.1080/10640266.2015.1064279 · Cited by 12
“The treatments offered are difficult to compare and, with few exceptions (Bean et al., 2004; Bean & Weltzin, 2001; Brewerton & Costin, 2011a, 2011b; McHugh, 2007), outcomes are not known.”
BackgroundResultInfluentialWeltzin, T. E., Bean, P., Klosterman, E., Lee, H., & Welk-Richards, R. (2014) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-014-0162-z · Cited by 14
Day, S., Mitchison, D., Mannan, H. R., Tannous, K., Conti, J., Dearden, A., Doyle, A. K., Gill, K. H., Hannigan, A., Houlihan, C., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.11.054 · Cited by 12
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Zugai, J. S., Gill, K. H., Molloy, L., Raeburn, T., & Ramjan, L. M. (2023) · International Journal of Mental Health Nursing · doi:10.1111/inm.13242 · Cited by 9
“Residential programmes provide a de-monstrably effective means of transition from intensive care settings (Brewerton & Costin, 2011a, 2011b; Hiney-Saunders et al., 2021).”
Day, S., Houlihan, C., Mitchison, D., Conti, J., Gill, K. H., Mannan, H. R., McMahon, K., Ramjan, L. M., Rankin, R. M., Tannous, K., et al. (2024) · Adolescents · doi:10.3390/adolescents4030023 · Cited by 9
“Key to their residential treatment model is also the opportunity for independent skill development and hands-on experience in areas such as cooking meals and portioning meals, eating out, and attending social outings [14].”
BackgroundMethodInfluentialThe utility of deep brain stimulation surgery for treating eating disorders: A systematic review
Potes, M. I., Joaquin, C., Wiecks, N., Phan, S., & Hassan, O. (2021) · Surgical Neurology International · doi:10.25259/sni_730_2020 · Cited by 9
“[11] Another study on residential treatment programs reported that 39% (47/120) of participants achieved a BMI of at least 18 on discharge following a mean of 97 days in treatment.[5] Varying follow-up times may influence the rates in which a healthy BMI is achieved.”
BackgroundBrusa, F., Scarpina, F., Bastoni, I., Valentina, V., Gianluca, C., Emanuela, A., Sandra, S., & Mendolicchio, L. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-023-00906-9 · Cited by 7
“Here, it was a monocentric-based study, as done elsewhere [1, 29, 30]; therefore, such results should be generalized with some caution.”
BackgroundDay, S., Mitchison, D., Tannous, K., Conti, J., Gill, K. H., Le, L. K., Mannan, H. R., Mihalopoulos, C., Ramjan, L. M., Rankin, R. M., et al. (2025) · International Journal of Eating Disorders · doi:10.1002/eat.24448 · Cited by 6
“For those who require more intensive care than outpatient treat-ment, however, residential services offer 24-h care in a home-like environment, blending medical oversight with a focus on psychological and functional recovery (Brewerton and Costin 2011b).”
InfluentialRienecke, R. D., Blalock, D. V., Mills, H. D., Duffy, A., Manwaring, J. L., Grange, D. L., Mehler, P. S., McClanahan, S. F., & Johnson, C. (2022) · JMIR Research Protocols · doi:10.2196/32270 · Cited by 4
“Residential programs that have reported results separately for patients with BN often find stability in BMI over time and improvements in eating disorder psychopathology and depression [10-14].”
BackgroundAcceptance and psychological change at the higher levels of care: A naturalistic outcome study
Walden, K., Manwaring, J. L., Blalock, D. V., Bishop, E. R., Duffy, A., & Johnson, C. (2017) · Eating Disorders · doi:10.1080/10640266.2017.1400862 · Cited by 3
“Generally, these findings are consistent with what has been reported in other HLOC outcome studies using smaller, less diagnostically diverse samples (Brewerton & Costin, 2011; Lynch et al., 2013).”
ResultCarer Outcomes From a Residential Treatment Service for Eating Disorders
Day, S., Mitchison, D., Gill, K. H., Rankin, R. M., Tannous, K., & Hay, P. (2024) · European Eating Disorders Review · doi:10.1002/erv.3165 · Cited by 3
Treatment of Eating Disorders in Children and Adolescents
Derenne, J. L., & Lock, J. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-804394-3.00012-7 · Cited by 1
Technology-Based Prevention and Treatment Programs of Eating Disorders
Šmahel, D., Macháčková, H., Šmahelová, M., Čevelíček, M., Almenara, C. A., & Holubčíková, J. (2018) · Springer eBooks · doi:10.1007/978-3-319-93221-7_9 · Cited by 1
Medical Complications and Management Strategies in Patients with Severe Restricting and Purging
Gaudiani, J. L. (2015) · doi:10.1002/9781118574089.ch52 · Cited by 1
Eating Disorders and Health Related Quality of Life: What Residential Treatment Can Do
Welk-Richards, R. (2012) · Loyola eCommons (Loyola University of Chicago)
Understanding and Treatment of Eating Disorders in Children and Adolescents
Garner, D. M. (2021) · Comprehensive Clinical Psychology · doi:10.1016/b978-0-12-818697-8.00084-4
Cerolini, S., Monda, G., D’Amico, M., Quirino, V., Zagaria, A., Mocini, E., Donini, L. M., & Lombardo, C. (2022) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-022-01468-6
Federico, B., Federica, S., Bastoni, I., Villa, V., Gianluca, C., Emanuela, A., Sandra, S., & Leonardo, M. (2024) · Figshare · doi:10.6084/m9.figshare.26623936
Brusa, F., Federica, S., Bastoni, I., Villa, V., Gianluca, C., Emanuela, A., Sandra, S., & Leonardo, M. (2024) · Figshare · doi:10.6084/m9.figshare.26623939
Brusa, F., Federica, S., Bastoni, I., Villa, V., Gianluca, C., Emanuela, A., Sandra, S., & Leonardo, M. (2024) · Figshare · doi:10.6084/m9.figshare.26623942
Nash, B. (2023) · Journal of Sociology and Social Work · doi:10.15640/jssw.v11n1a3
“A sense of making a difference”: staff experiences of residential treatment for eating disorders
Rankin, R. M., Conti, J., Ramjan, L. M., Day, S., Mitchison, D., Tannous, K., Gill, K. H., Mannan, H. R., & Hay, P. (2026) · Eating Disorders · doi:10.1080/10640266.2026.2663774
Metadata
- Authors
- Brewerton, T. D., & Costin, C.
- Affiliations
- Medical University of South Carolina (US)
- Monte Nido & Affiliates
- Corresponding author
- Brewerton, Timothy D.
- Venue
- Eating Disorders
- Publisher
- Informa UK Limited
- Published
- 2011-02-24
- Volume
- 19
- Issue
- 2
- Pages
- 117-131
- ISSN
- 1064-0266 (ISSN-L)
- 1532-530X
- OpenAlex
- W2041557701
- Cited by
- 39
- References
- 23
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 6 · 2023: 3 · 2022: 2 · 2021: 4 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 5 · 2015: 5 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 1.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- anorexia nervosa, bulimia nervosa, residential treatment, treatment outcomes, Beck Depression Inventory, body mass index, binge eating, laxative abuse, stimulant abuse, restrictive eating behavior
- MeSH terms
- Adolescent, Adult, Analysis of Variance, Anorexia Nervosa, Body Image, Humans, Middle Aged, Patient Education as Topic, Personality, Personality Inventory, Prospective Studies, Psychiatric Status Rating Scales, Psychotherapy, Surveys and Questionnaires, Residential Treatment, Self Concept, Body Mass Index, Treatment Outcome, Patient Satisfaction, Bulimia Nervosa
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