The change process in adult anorexia nervosa inpatient treatment: a path model

  • Antje Gumz
  • Denise Kästner
  • Angelika Weigel
  • Anne Daubmann
  • Bernhard Osen
  • Matislava Karacic
  • Eileen Wollburg
  • Ulrich Voderholzer
  • Bernd Löwe
Original Article



Knowledge on the change process in the treatment of anorexia nervosa (AN) is an important starting point for the improvement of treatment, yet very little evidence exists. In an exploratory analysis, we aimed to investigate the interdependencies between higher-rank change process factors, BMI and AN-specific cognitions and behaviours over the course of inpatient treatment.


We included 176 female adult AN inpatients from three specialized centres. The temporal interdependencies between the change factors and the outcome variables over the course of treatment (t0: beginning, t1: mid-treatment, t2: end) were investigated using a path model.


The sample had a mean age of 27.1 years (SD = 8.9 years) and a mean BMI at admission of 15.0 kg/m2 (SD = 1.6 kg/m2). A greater basic need satisfaction and a greater emotional involvement and commitment to treatment at t0 positively influenced the BMI at t1. Furthermore, greater basic need satisfaction at t0 led to less AN-specific cognitions and behaviours at t2.


The results are discussed with respect to the self-determination theory and the consistency theory. Further research on the change process in AN treatment is recommended.


Change process Anorexia nervosa Inpatient treatment Basic need satisfaction 



We would like to thank Prof. M. Rose and Dr. B. Meyer for their valuable contributions to the study design and Alexandra Murray for her constructive and important comments on the manuscript. We gratefully acknowledge the support of all physicians and psychotherapists in the three study centres and all patients who participated in our study.

Compliance with ethical standards


This study was funded by a “Swiss Anorexia Nervosa Foundation” grant awarded to Professor B. Löwe and Dr. B. Meyer.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study was approved by all local research ethic committees (Medical Chamber Hamburg MC-419/10, Medical Association Schleswig-Holstein: AZ 030/10; University Medical Center Munich: 246-10). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study.

Supplementary material

40519_2016_341_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 22 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Psychosomatic Medicine and PsychotherapyUniversity Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg EilbekHamburgGermany
  2. 2.Department of Medical Biometry and EpidemiologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Schön Clinic Bad BramstedtBad BramstedtGermany
  4. 4.Schön Clinic Roseneck PrienPrien am ChiemseeGermany
  5. 5.Department of Psychiatry and PsychotherapyUniversity Hospital FreiburgFreiburg im BreisgauGermany

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