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August 7, 2017

Motivation to Recover: Adolescent Research on Anorexia

Woman struggling with eating disorders

For adolescents who struggle with anorexia nervosa, understanding motivation to change and recover can be helpful in the treatment of the eating disorder, particularly for professionals and clinicians who are engaging with this population.

Currently, the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) is a helpful tool utilized by some clinicians to assess motivation and readiness for change in individuals with anorexia, including its relation to self-esteem and coping style.

A recent study published in the Journal of Eating Disorders evaluated the effectiveness and validity of the ANSOCQ in determining motivation to change, coping, and self-esteem in adolescent anorexia nervosa.

This provides valuable insight for eating disorder professionals, particularly those who are treating adolescents with anorexia nervosa.

Assessing Motivation to Change

In this particular study, which was published in the April 2017 Journal of Eating Disorders, the quality of the ANSOCQ was analyzed for its effectiveness to measure motivation to change in adolescents with anorexia nervosa [1].

Research has found that individuals with a higher level of change are predictive of improved outcome measures in treatment, including lower body dissatisfaction, increased quality of a therapeutic alliance, and a lower drive for thinness [2].

Certain interventions have also been shown to help increase an individual’s motivation level of engaging in treatment, which can help providers form a therapeutic alliance and more efficiently facilitate treatment approaches.

Several tools have been utilized by professionals in an attempt to assess the readiness for change in eating disorder sufferers, including the Readiness and Motivation Interview, and the Attitudes Towards Change in Eating Disorders Scale.

Woman with Anorexia

The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), is a 20-item self-report measure that highlights several different areas associated with motivational issues, such as emotional and/or interpersonal problems, determination to gain weight, and motivation to overcome symptomatic behaviors [3].

Researchers in this particular study sought to assess the psychometric properties of the ANSOCQ in a Swiss-German sample of adolescent patients with eating disorders.

In addition, researchers attempted to understand the connection between motivation better to change with various coping styles and self-esteem [1].

Lastly, researchers sought to assess the predictive validity of the ANSOCQ in relation to treatment outcomes, with previous studies showing that low scores were correlated with hospital admission, while higher scores were associated with weight maintenance after inpatient treatment [1].

Understanding the Research

In order to complete this study, 92 adolescents meeting the criteria for anorexia nervosa were involved in participation, with the mean BMI of the patient sample being 16.4. All participants studied had the restrictive type (91.3%) and purging type (8.7%) of anorexia nervosa, with the majority of participants receiving treatment in an outpatient unity (95.7%) [1].

All 92 adolescent patients participated in the ANSOCQ questionnaire, and nine months later, the clinical diagnosis and BMI of each participant was reevaluated.

Based on the results of the questionnaire and data gathered from participants nine months later, researchers found that patients with higher motivation to change were more likely to recover from anorexia nervosa after nine months and less inclined to discontinue treatment [1].

Researchers also found that high self-esteem was related to higher motivation to change and that maladaptive coping strategies were associated with a lower motivation to overcome the eating disorder.

From data that was gathered and analyzed, the authors of this study also determined that those individuals with higher self-esteem and healthier coping mechanisms displayed greater motivation to change, likely due to feeling more capable of creating change.

Woman by the sea

Importance of Motivation to Change

Overall, this study highlighted and supported the psychometric properties of the ANSOCQ in measuring motivation to change in adolescents with anorexia nervosa.

Overall, patients with higher motivation to change also displayed higher levels of self-esteem and active coping mechanisms, which increased their likeliness of recovering from the eating disorder after nine months [1].

Based on the findings of this study, the ANSOCQ is a validated instrument for measuring motivation to change, and understanding this information may be helpful for clinicians who are working toward improving motivational strategies for adolescents recovering from eating disorders.

Further research in this area could potentially assess motivation to change over a longer period of time, such as before and after treatment for anorexia nervosa.

Crystal Headshot 2About the Author: Crystal Karges, MS, RDN, IBCLC is a Contributing Writer for Eating Disorder Hope.

Crystal is a Masters-level Registered Dietitian Nutritionist (RDN) with a specialty focus in eating disorders, maternal/child health and wellness, and intuitive eating. Combining clinical experience with a love of social media and writing. As a Certified Intuitive Eating Counselor, Crystal has dedicated her career to helping others establish a healthy relationship with food and body through her work with EDH and nutrition private practice.


[1]  Dagmar Pauli, et al.  Motivation to change, coping, and self-esteem in adolescent anorexia nervosa: a validation study of the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) Journal of Eating Disorders 2017 5:11
[2]: Gusella J, Butler G, Nichols L, Bird D. A brief questionnaire to assess readiness to change in adolescents with eating disorders: Its applications to group therapy. Eur Eat Disord Rev. 2003;11:58–71.
[3]: Rieger E, Touyz S. An investigation of the factorial structure of motivation to recover in anorexia nervosa using the anorexia nervosa stages of change questionnaire. Eur Eat Disord Rev. 2006;14:269–75.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on August 7, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on August 7, 2017.
Published on EatingDisorderHope.com

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