کیفیت زندگی و انگیزه برای تغییر در اختلالات تغذیه ای . ادراک بیمار ـ روانپزشک

Purpose To assess motivation to change (Mch) of patients with an eating disorder (ED) and its relationship with quality-of-life (QoL) by comparing patient and psychiatrist perceptions. Method Patients (n = 358) with an ED completed the disease-specific Health-Related Quality of Life for Eating Disorders (HeRQoLED) questionnaire, the Eating Attitudes Test (EAT-26) and the Short-Form Health Survey (SF-12) at baseline; 273 completed them after 1 year of treatment. The relationship between health-related quality of life (HRQoL) and the Mch stage was assessed using analysis of variance. Chi-square and Kappa statistical analysis assessed congruence in motivational change perception of the patients and psychiatrists. Results Higher patient-reported Mch was associated with higher HRQoL at the study beginning and end but not using the patient Mch as perceived by the psychiatrist. Initially, the patient and psychiatrist perceptions of Mch differed (kappa coefficient, − 0.01); after 1 year they tended to converge (k = 0.34). Conclusions Higher Mch and higher QoL are positively associated. However, patient and psychiatrist perceptions of Mch and the relationship with QoL differ. After 1 year of treatment, these differences decreased.

A primary obstacle in treating eating disorders (EDs) is the lack of motivation to change (Mch) by patients and their ambivalence regarding treatment (Geller, Cockell, & Drab, 2001). The transtheoretical model of Prochaska (Prochaska & Di Clemente, 1992) describes this concept well, and several authors have attempted to apply it to EDs (Blake et al., 1997, Engel and Wilms, 1986, Hasler et al., 2004, Sullivan and Ch., 2001, Vansteenkiste et al., 2005 and Wilson and Schlam, 2004). According to this model, patients are said to be at different disease stages based on their degree of motivation and attitude toward change. The aims of the current study were to assess the evolution of the MCh stage in patients with an ED after 1 year of treatment and its relationship with patients' health-related quality of life (HRQoL) and with their psychopathology, and identify potential differences between patient and psychiatrist perceptions of these variables.