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

Nord J Psychiatry. 2021 Aug;75(6):415-419. doi: 10.1080/08039488.2021.1877814. Epub 2021 Feb 9.


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; mental health; sense of coherence.

MeSH terms

  • Adolescent
  • Anorexia Nervosa* / therapy
  • Feeding and Eating Disorders*
  • Female
  • Follow-Up Studies
  • Humans
  • Sense of Coherence*
  • Surveys and Questionnaires