Full and Partial Hospitalization Interventions for Eating Disorders

Eating disorders (EDs) are a severe form of mental illness plagued by physical and psychological sequelae such as osteoporosis, social isolation, and psychiatric comorbidity. As a result, people with eating disorders experience low quality of life and have abnormally high mortality rates. Anorexia nervosa (AN), bulimia nervosa and binge eating disorder are the most commonly diagnosed eating disorders and sufferers are mainly treated in the outpatient setting with a multidisciplinary approach including psychiatric, psychotherapy, and nutritional sessions. Less data are available for less studied conditions such as avoidant/restrictive food intake disorder (ARFID). Unfortunately, currently available treatments do not work for all sufferers so some patients develop a severe and enduring disorder, with acute presentations that require the administration of intensive interventions (e.g. EKG and blood test monitoring, nasogastric intubation) in hospitals to stabilize. Furthermore, multiple factors including egosyntonicity and feelings of ambivalence about recovery can prevent sufferers of eating disorders from engaging in treatment or from sustaining the required motivation to complete an efficacious treatment time course. The end result is that patients with eating disorders can enter a vicious cycle of long durations of untreated illness punctuated with acute and intensive interventions for life-threatening symptoms (e.g., severe bradycardia, suicidal risk, electrolyte imbalance due to purging behaviors) performed during inpatient hospitalizations. Other patients may need treatment in partial hospitalization programs if outpatient treatment is not effective. These resulting full and partial hospitalizations present unique challenges for both patients and clinicians because these interventions are delivered in a very acute and difficult phase of the disorder. Therefore, not only are affected individuals in a particularly difficult moment (e.g., acute malnutrition, failure of multiple treatments in the past), but it is also hard to disentangle and measure the effectiveness of the available treatment approaches, often delivered together (e.g., cognitive-behavioral, psychodynamic, dialectical-behavioral therapy models) as required by the complexity of the ED.

It is of note that very sparse data exist on effective treatments specifically aimed at avoiding re-hospitalization. Thus, this Research Topic aims to focus on full and partial hospitalizations and on interventions aimed to avoid re-hospitalization of patients with EDs in order to gather a comprehensive body of evidence on the types of interventions that allow patients to achieve a positive outcome (i.e., weight restoration for AN and ARFID, improvement of suicidal risk, reduction of anxiety and depressive symptoms, enhancement of motivation), regardless of the severity of symptoms that resulted in their admission. Using this approach, our ultimate hope is to improve the effectiveness of treatments for patients with EDs and to reduce the need for intervention as an inpatient.

The goal of this Research Topic is to describe and measure the clinical feasibility and effectiveness of full and partial hospitalization interventions and of those interventions that are aimed at avoiding re-hospitalization of patients with EDs. In fact, although both manage patients with a severe clinical condition, full and partial hospitalization programs have different treatment approaches and purposes. Broadly speaking, a full hospitalization to the inpatient setting is mostly required because of a life-threatening (organic and/or psychiatric) condition requiring an immediate short-term outcome, while partial hospitalization programs are mostly focused on psychological interventions and enhancing long-term treatment outcomes.

Submissions (i.e., original research articles, systematic reviews, methods (including those papers proposing new ideas requiring more data), clinical trials, brief research reports) addressing the following topics are of special interest:

1. Trials of different interventions delivered during full and partial hospitalization for EDs (e.g., group, psychological, psychoeducation interventions, family-based interventions, neuro-modulation techniques, medications)
2. Clinical features (including comorbid, medical and suicidal life-threatening conditions) requiring full and partial hospitalization
3. Predictors of treatment response of patients who need to be acutely hospitalized
4. Clinical management of patients with extremely low (< 12) Body Mass Index including novel approaches to weight restoration in EDs
5. Outcome after full and partial hospitalization for EDs: follow-up assessments, therapeutic alliance analysis, web-based technologies (machine learning, ecological momentary interventions), and self-help interventions applied to avoid re-hospitalizations
6. Full and partial hospitalization of treatment-resistant patients: novel evidence-based approaches
7. Full and partial hospitalization and emerging approaches for less studied eating disorders (e.g., avoidant/ restrictive food intake disorder)
8. Interventions for carers and significant others in the hospitalization and partial hospitalization settings
9. Management of intensive treatments (full and partial hospitalization) for severe and enduring patients
10. Patients’ perspectives on what helps to bring about recovery when fully or partially hospitalized