Sense of coherence in long-term follow-up of adolescents with anorexia nervosa

Abstract

Background

Sense of coherence (SOC) is a personal resource that allows people to stay healthy in spite of stressful situations. SOC is known to be low in eating disorders. We explored whether SOC correlated with anorexia nervosa (AN) symptoms several years after initial hospitalization for AN, to inform us whether AN treatment concepts could more specifically focus on increasing SOC.

Methods

Former patients were contacted 5–11 years after hospitalization for AN in a German integrative medicine hospital. Participants completed the Eating Disorder Inventory (EDI-2) and the SOC Questionnaire (SOC-13). Hospital records were reviewed. Correlations between EDI-2 subscales and SOC-13 were tested. A t-test was conducted to assess the difference between the SOC-13 and the norm. A median split was performed, dividing SOC scores into two groups and comparing these with EDI-2 subscales.

Results

Of 149 previously hospitalized female patients, 83 could be contacted and 68 agreed to participate (46%). 17.6% self-reported that they currently suffered from an eating disorder. The mean follow-up time was 7.2 years. All EDI-2 subscales correlated negatively with the SOC-13 score (p < .01). The mean SOC was significantly lower than the norm (p < .001). In the median split, the lower SOC group had significantly higher scores on all EDI-2 subscales.

Conclusions

Amongst previously hospitalized AN patients, the SOC was lower than a normative sample and correlated with on-going eating disorder symptoms in long-term follow-up. Strengthening SOC as a personal resource should be incorporated as a specific goal in AN treatment and its impact on long-term outcomes evaluated.

Keywords:

• Anorexia nervosa
• sense of coherence
• mental health

Acknowledgements

We thank Dr Elaine C. Meyer for helpful comments on the manuscript, and Dr Karl-Heinz Ruckgaber, Jürgen Weik and Dr Eduard Helmert for their support and input during data collection and analysis.

Author contributions

JV conceptualized and supervised the study, led the data analysis and interpretation and revised the manuscript. TK wrote the study protocol, interviewed participants and analyzed the data. CB analyzed and interpreted the data and wrote part of the manuscript. JS critically reviewed the manuscript. MH supervised the study. TvSA interpreted the data and wrote the manuscript. All authors read and approved the final manuscript.

Disclosure statement

The authors declare that they have no competing interests.

Notes on contributors

Jan Vagedes, MD, MA, is a pediatrician, specialized in neonatology and anthroposophic medicine. He is head of pediatrics and head of the ARCIM Institute at the Filderklinik, Germany. His research focus is on the clinical outcomes of integrative medicine, integrating conventional medicine with anthroposophic medicine.

Theresa Kleih, PhD candidate, studied psychology at University of Tübingen and works as a researcher and psychologist at the Institute of Medical Psychology at Charité University Hospital in Berlin. Her doctoral research at the Institute of Psychology at Humboldt-University Berlin investigates the association between traumatic childhood experiences and perinatal depression.

Cara Belizer, PhD, is a clinical psychologist who studied psychology at the University of Tübingen. Her doctoral research focused at the University of Tübingen focused on the psychophysiological effects of a multimodal therapy concept in adolescents with anorexia nervosa.

Jennifer Svaldi is professor of Clinical Psychology and Psychotherapy at the University of Tübingen. She is head of the adjoint outpatient clinic. Her research focuses on mechanisms involved in the development and maintenance of pathological eating behaviour and body image disturbances.

Martin Hautzinger, professor of Clinical Psychology and Psychotherapy at the University of Tübingen, is a clinical psychologist, managing director of the Tübingen Academy for Children and Adolescent Psychotherapy and co-director of the Fliednerklinik Stuttgart Day Clinic for Psychiatry and Psychotherapy.

Tido von Schoen-Angerer, MD, MPH, is a pediatrician in Geneva and a researcher at the ARCIM Institute of the Filderklinik and the department of community medicine at Fribourg University, Switzerland with a focus on integrative medicine.

Data availability statement

The data that support the findings of this study are available on request.

Additional information

Funding

The ARCIM Institute is supported by an unrestricted grant by the Mahle Foundation. The funder had no role at any stage in the analysis or in manuscript preparation.