Do symptom-specific stages of change predict eating disorder treatment outcome?

  • Diann M. AckardEmail author
  • Catherine L. Cronemeyer
  • Sara Richter
  • Amber Egan
Original Article



Interview methods to assess stages of change (SOC) in eating disorders (ED) indicate that SOC are positively correlated with symptom improvement over time. However, interviews require significant time and staff training and global measures of SOC do not capture varying levels of motivation across ED symptoms. This study used a self-report, ED symptom-specific SOC measure to determine prevalence of stages across symptoms and identify if SOC predict treatment outcome.


Participants [N = 182; age 13–58 years; 92 % Caucasian; 96 % female; average BMI 21.7 (SD = 5.9); 50 % ED not otherwise specified (EDNOS), 30.8 % bulimia nervosa (BN), 19.2 % anorexia nervosa (AN)] seeking ED treatment at a diverse-milieu multi-disciplinary facility in the United States completed stages of change, behavioral (ED symptom use and frequency) and psychological (ED concerns, anxiety, depression) measures at intake assessment and at 3, 6 and 12 months thereafter. Descriptive summaries were generated using ANOVA or Kruskal–Wallis (continuous) and χ 2 (categorical) tests. Repeated measures linear regression models with autoregressive correlation structure predicted treatment outcome.


At intake assessment, 53.3 % of AN, 34.0 % of BN and 18.1 % of EDNOS patients were in Preparation/Action. Readiness to change specific symptoms was highest for binge-eating (57.8 %) and vomiting (56.5 %). Frequency of fasting and restricting behaviors, and scores on all eating disorder and psychological measures improved over time regardless of SOC at intake assessment. Symptom-specific SOC did not predict reductions in ED symptom frequency. Overall SOC predicted neither improvement in Eating Disorder Examination Questionnaire (EDE-Q) scores nor reduction in depression or trait anxiety; however, higher overall SOC predicted lower state anxiety across follow-up.


Readiness to change ED behaviors varies considerably. Most patients reduced eating disorder behaviors and increased psychological functioning regardless of stages of change, indicating the benefits of treatment and effectiveness of treatment-as-usual for overall psychiatric improvement.


Eating disorder Anorexia nervosa Bulimia nervosa Eating disorder not otherwise specified Stages of change Treatment outcome Depression Anxiety 



Funding for this study was provided by an Innovation Grant from the Park Nicollet Foundation. The Park Nicollet Foundation had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Diann M. Ackard
    • 1
    • 2
    Email author
  • Catherine L. Cronemeyer
    • 2
  • Sara Richter
    • 3
  • Amber Egan
    • 3
  1. 1.Golden ValleyUSA
  2. 2.Park Nicollet Melrose CenterSt Louis ParkUSA
  3. 3.Park Nicollet InstituteSt Louis ParkUSA

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