1
|
Woolley MG, Schwartz SE, Knudsen FM, Lensegrav-Benson T, Quakenbush-Roberts B, Twohig MP. Thought-shape fusion in residential eating disorder treatment: Cognitive defusion as a mediator between thought-action fusion and treatment outcome. Eat Behav 2024; 54:101909. [PMID: 39167931 DOI: 10.1016/j.eatbeh.2024.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
An understudied cognitive bias within eating disorder (ED) psychopathology is Thought-Shape Fusion (TSF), which involves irrational beliefs about the likelihood and moral implications of feared outcomes related to shape, weight, and food. This phenomenon has received less attention within the context of ED treatment, with little known about potential processes of change to address TSF and ultimately promote ED recovery. We propose cognitive defusion as a process of change, a metacognitive process that emphasizes observing thoughts objectively rather than appraising thoughts as absolute truth. We explored whether cognitive defusion, that is, reductions in body image-related cognitive fusion, mediated the relationship between trait-level TSF and treatment outcomes in a transdiagnostic ED sample of adult and adolescent females (N = 130) presenting to residential care. We found that reductions in body image-related cognitive fusion mediates the association between trait-level TSF at baseline and ED severity at discharge. However, when the sample was separated into adolescent and adult subgroups, these results only remained significant for adolescents. These findings underscore the relevance of targeting cognitive defusion as a potential mechanism to address the impact of trait levels of TSF cognitions on ED psychopathology.
Collapse
Affiliation(s)
| | | | | | - Tera Lensegrav-Benson
- Utah State University, Logan, UT, United States of America; Avalon Hills Eating Disorder Specialists, United States of America; Mindful Path Psychological Services, United States of America
| | | | | |
Collapse
|
2
|
Hail L, Drury CR, McGrath RE, Murray SB, Hughes EK, Sawyer SM, Le Grange D, Loeb KL. Parent version of the Eating Disorder Examination: Reliability and validity in a treatment-seeking sample. J Eat Disord 2024; 12:101. [PMID: 39026364 PMCID: PMC11264699 DOI: 10.1186/s40337-024-01062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Assessment of eating disorders (ED) in youth relies heavily on self-report, yet persistent lack of recognition of the presence and/or seriousness of symptoms can be intrinsic to ED. This study examines the psychometric properties of a semi-structured interview, the parent version of the Eating Disorder Examination (PEDE), developed to systematically assess caregiver report of symptoms. METHODS A multi-site, clinical sample of youth (N = 522; age range: 12 to 18 years) seeking treatment for anorexia nervosa (AN) and subsyndromal AN were assessed using the Eating Disorder Examination (EDE) for youth and the PEDE for collateral caregiver report. RESULTS Internal consistencies of the four PEDE subscales were on par with established ranges for the EDE. Significant medium-sized correlations and poor to moderate levels of agreement were found between the corresponding subscales on each measure. For the PEDE, confirmatory factor analysis of the EDE four-factor model provided a poor fit; an exploratory factor analysis indicated that a 3-factor model better fits the PEDE. CONCLUSIONS Findings suggest that the PEDE has psychometric properties on par with the original EDE. The addition of the caregiver perspective may provide incremental information that can aid in the assessment of AN in youth. Future research is warranted to establish psychometric properties of the PEDE in broader transdiagnostic ED samples.
Collapse
Affiliation(s)
- Lisa Hail
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, UCSF Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA, USA
| | - Catherine R Drury
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, UCSF Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA, USA.
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA.
| | - Robert E McGrath
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth K Hughes
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, UCSF Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Neuroscience (emeritus), The University of Chicago, Chicago, IL, USA
| | - Katharine L Loeb
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA
- Chicago Center for Evidence-Based Treatment, Chicago, IL, USA
| |
Collapse
|
3
|
Gradl-Dietsch G, Peters T, Meule A, Hebebrand J, Voderholzer U. Body Mass Index Distribution in Female Child, Adolescent and Adult Inpatients with Anorexia Nervosa-A Retrospective Chart Review. Nutrients 2024; 16:1732. [PMID: 38892665 PMCID: PMC11175141 DOI: 10.3390/nu16111732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The variation in body mass index (BMI) of inpatients with anorexia nervosa has not been analyzed across the age span. A positive correlation between BMI and age has been reported in adolescent inpatients aged 15 years and younger that levels off at 15 to 18 years. BMIs standardized for age and sex (standard deviation scores, SDSs) were negatively correlated with age in these inpatients aged 8 to 18 years. METHODS The aims of the current retrospective study were threefold: first, to confirm the relationships of BMI, BMI-SDS and age in adolescent inpatients in a larger sample; second, to systematically assess the relationship of BMI, BMI-SDS, body height-SDS and age in adult inpatients at the time of referral; and third, to assess body height-SDSs and age to evaluate stunting. RESULTS We included 1001 girls (aged 12-17.9 years) and 1371 women (aged 18-73 years) admitted to inpatient treatment between 2014 and 2021. Mean BMI at admission was 14.95 kg/m2 (SD = 1.43; range 10.67-18.47) in adolescents and 14.63 kg/m2 (SD = 2.02; range 8.28-18.47) in adults. None of the adolescent patients but 20 adults had very low BMI values below 10 kg/m2. Adolescents showed a small but significant positive correlation between age and BMI (r = 0.12; p = 2.4 × 10-4). In adults, BMI was not correlated with age (r = -0.03; p = 0.3). BMI-SDSs was negatively correlated with age in adolescents and less so in adults (r = -0.35; p < 0.001 and r = -0.09; p = 0.001). Curve fit analyses for all patients indicated that there was a quadratic (age × age) relationship between age and BMI-SDS. Height correlated positively with BMI in adult (r = 0.1; p < 0.001) and adolescent (r = 0.09 p = 0.005) patients and we detected no evidence for stunting. CONCLUSIONS In conclusion, the BMI of inpatients seems to be relatively stable across the age span with mean values between 14 and 15 kg/m2. BMI values initially increase with age in younger patients, drop between ages 18 and 23 and then slowly decline with age.
Collapse
Affiliation(s)
- Gertraud Gradl-Dietsch
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburg Str. 21, 45147 Essen, Germany; (T.P.); (J.H.)
- Center for Translational Neuro and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Triinu Peters
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburg Str. 21, 45147 Essen, Germany; (T.P.); (J.H.)
- Center for Translational Neuro and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Adrian Meule
- Department of Psychology, University of Regensburg, Universitätsstr. 31, 93053 Regensburg, Germany;
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburg Str. 21, 45147 Essen, Germany; (T.P.); (J.H.)
- Center for Translational Neuro and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80539 Munich, Germany;
- Schoen Clinic Roseneck, 83209 Chiemsee, Germany
| |
Collapse
|
4
|
Shabahang R, Kim S, Chen X, Aruguete MS, Zsila Á. Downloading appetite? Investigating the role of parasocial relationship with favorite social media food influencer in followers' disordered eating behaviors. Eat Weight Disord 2024; 29:28. [PMID: 38647734 PMCID: PMC11035395 DOI: 10.1007/s40519-024-01658-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Although a number of investigations have been carried out on the marketing outcomes of parasocial relationships (PSR) with food influencers on social media, little attention has been paid to the potential contribution of these one-sided emotional bonds to followers' eating attitudes and habits. Drawing on the Parasocial Theory, the role of parasocial attachment with food influencers was investigated in predicting eating disorders, food addiction, and grazing. To increase the accuracy of PSR measurement, a brief self-report scale was developed to gauge social media users' feelings of mutual awareness, attention, and adjustment with their favorite food influencer at a distance through social media. METHODS Participants were a convenience sample of 405 Iranian social media users (231women; Mage = 28.16, SDage = 9.40), who followed a favorite food influencer on social media. RESULTS The 8-item Parasocial Relationship with Favorite Food Influencer Scale (PSRFFIS) revealed a unidimensional structure with excellent content and construct validity and internal consistency. Regarding gender differences, men showed stronger parasocial attachment to their favorite food influencers. Adjusting age, gender, and subjective social status as control variables, PSR with favorite food influencers partially contributed to the explanation of eating disorder symptom severity, food addiction, and grazing. CONCLUSION These findings show that PSR with favorite food influencers appears to be associated with followers' craving for food, which, in turn, may contribute to maladaptive eating habits. This highlights media-related factors, such as PSR with food influencers, as potential drivers of dysfunctional eating habits in the digital age, particularly in countries like Iran where disordered eating is prevalent. LEVEL OF EVIDENCE Level V-based on cross-sectional data (correlational study; scale development).
Collapse
Affiliation(s)
- Reza Shabahang
- Department of Psychology, College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
| | - Sohee Kim
- Department of Counseling and Instructional Sciences, University of South Alabama, Alabama, USA
| | | | - Mara S Aruguete
- Department of Social and Behavioral Sciences, Lincoln University, Missouri, MO, USA
| | - Ágnes Zsila
- Institute of Psychology, Pázmány Péter Catholic University, Budapest, Hungary.
- Institute of Psychology, ELTE Eötvös Loránd Universtiy, Budapest, Hungary.
| |
Collapse
|
5
|
Halaj A, Konstantakopoulos G, Ghaemi NS, David AS. Anxiety Disorders: The Relationship between Insight and Metacognition. Psychopathology 2024; 57:434-443. [PMID: 38537613 PMCID: PMC11446293 DOI: 10.1159/000538096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/26/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND The exploration of metacognition in relation to anxiety has received considerable attention in recent decades. Research indicates that it plays a role in the development and maintenance of anxiety disorders while also providing benefits, including the ability to assess situations, modify behaviors, and make informed decisions. SUMMARY We propose that having an awareness of a disorder, also known as insight, is related to metacognition in anxiety. This relationship stems from the ability it provides individuals to recognize their mental state through reflection on personal experiences. We discuss the impact of insight and metacognition on decision-making, treatment-seeking behaviors, and coping strategy selection. KEY MESSAGES Understanding the concept of insight in anxiety disorders, as compared to other mental disorders like psychosis, requires exploring its complexities while carefully considering the balance of harms and benefits. While the medicalization of symptoms in psychosis is widely regarded as clearly beneficial, evaluating the role of insight in anxiety disorders demands a more nuanced understanding. Gaining a fuller perspective on patients' beliefs can impact their behaviors and decision-making. Clinicians can achieve this by encouraging active self-reflection to increase awareness, which includes evaluating both severity and impact on daily functioning. This also involves expressing experiences and exploring attributions of anxiety. This practical approach enables clinicians to understand engagement and treatment-seeking behaviors, allowing them to tailor treatment plans and develop effective coping and management strategies. Ultimately, this knowledge promotes a deeper comprehension of insight into anxiety disorders.
Collapse
Affiliation(s)
- Asala Halaj
- UCL Institute of Mental Health, Division of Psychiatry, University College London, London, UK
| | - George Konstantakopoulos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Zografou, Greece
- Research Department of Clinical, Education and Health Psychology, University College London, London, UK
| | - Nassir S Ghaemi
- Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony S David
- UCL Institute of Mental Health, Division of Psychiatry, University College London, London, UK
| |
Collapse
|
6
|
Webster AE, Zickgraf HF, Gideon N, Mond JM, Serpell L, Lane-Loney SE, Essayli JH. Preliminary Validation of The Eating Disorders Examination Questionnaire-Short Parent Version (EDE-QS-P). Eat Disord 2023; 31:651-662. [PMID: 37306284 DOI: 10.1080/10640266.2023.2218675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE There is a lack of reliable and valid parent-report measures assessing eating disorder (ED) pathology in children and adolescents. This study aimed to develop and provide preliminary validation of a new parent-report measure, the 12-item Eating Disorder Examination Questionnaire-Short Parent Version (EDE-QS-P). METHOD The EDE-QS-P was completed by 296 parents seeking treatment for their child at an ED clinic. Children (ages 6-18, N = 296) completed the Eating Disorder Examination-Questionnaire (EDE-Q), the seven-item Generalized Anxiety Disorder Questionnaire (GAD-7), and the nine-item Patient Health Questionnaire (PHQ-9). RESULTS After removing item 10, the 11-item version of the EDE-QS-P showed borderline adequate fit to the one factor solution and strong internal consistency (α = 0.91). This measure also demonstrated strong convergent validity with child scores on the EDE-Q (r = .69), and moderate convergent validity with child scores on the GAD-7 (r = .37) and PHQ-9 (r = .46). The EDE-QS-P was able to differentiate children with EDs characterized by body image disturbances (e.g. anorexia nervosa) from those with avoidant/restrictive food intake disorder, who do not experience shape or weight concerns. DISCUSSION The 11-item EDE-QS-P may be a promising parent-report measure of ED pathology in children and adolescents.
Collapse
Affiliation(s)
- Aiyana E Webster
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Hana F Zickgraf
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Nicole Gideon
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Jonathon M Mond
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lucy Serpell
- Penn State College of Medicine, Department of Pediatrics, Department of Psychiatry and Behavioral Health, University Drive, Hershey, Pennsylvania, USA
| | - Susan E Lane-Loney
- Penn State College of Medicine, Department of Pediatrics, Department of Psychiatry and Behavioral Health, University Drive, Hershey, Pennsylvania, USA
| | - Jamal H Essayli
- Penn State College of Medicine, Department of Pediatrics, Department of Psychiatry and Behavioral Health, University Drive, Hershey, Pennsylvania, USA
| |
Collapse
|
7
|
O'Logbon J, Newlove-Delgado T, McManus S, Mathews F, Hill S, Sadler K, Ford T. How does the increase in eating difficulties according to the Development and Well-Being Assessment screening items relate to the population prevalence of eating disorders? An analysis of the 2017 Mental Health in Children and Young People survey. Int J Eat Disord 2022; 55:1777-1787. [PMID: 36264637 PMCID: PMC10092017 DOI: 10.1002/eat.23833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We examine the test accuracy of the Development and Well-Being Assessment (DAWBA) eating disorder screening items to explore whether the increased eating difficulties detected in the English National Mental Health of Children and Young People (MHCYP) Surveys 2021 reflect an increased population prevalence. METHODS Study 1 calculated sensitivity, specificity, and positive and negative predictive values from responses to the DAWBA screening items from 4057 11-19-year-olds and their parents, in the 2017 MHCYP survey. Study 2 applied the positive predictive value to data from 1844 11-19-year-olds responding to the 2021 follow-up to estimate the prevalence of eating disorders in England compared to 2017 prevalence. RESULTS Parental report most accurately predicted an eating disorder (93.6%, 95% confidence interval: 92.7-94.5). Sensitivity increased when parent and child answers were combined, and with a higher threshold (of two) for children. The prevalence of eating disorders in 2021 was 1% in 17-19-year-olds, and .6% in 11-16-year-olds-similar to the prevalence reported in 2017 (.8% and .6%, respectively). However, estimates for boys (.2%-.4%) and young men (.0%-.4%) increased. DISCUSSION We found tentative evidence of increased population prevalence of eating disorders, particularly among young men. Despite this, the DAWBA screening items are useful for ruling out eating disorders, particularly when parents or carers screen negative, but are relatively poor at predicting who will have a disorder. Data from both parents and children and applying a higher cut point improves accuracy but at the expense of more missed cases. PUBLIC SIGNIFICANCE STATEMENT The prevalence of eating disorders did not markedly change from 2017 to 2021, but we found tentative evidence of an increase, particularly among young men. This is despite larger increases in problematic eating, which need further investigation. The DAWBA screen is best suited to ruling out eating disorders which limits its clinical applications as it would provide many false positives requiring further assessment.
Collapse
Affiliation(s)
- Jessica O'Logbon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | | | | | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
8
|
Cresswell C, Watson HJ, Jones E, Howell JA, Egan SJ. The role of compulsive exercise in the relationship between perfectionism and eating disorder pathology in underweight adolescents with eating disorders. Eat Behav 2022; 47:101683. [PMID: 36410135 DOI: 10.1016/j.eatbeh.2022.101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Perfectionism has a strong association with eating disorders. Research in non-clinical adults has suggested that perfectionism has both direct and indirect effects on eating disorder symptoms, and that compulsive exercise is a potential mediator. The aim of this study was to understand whether perfectionism is associated with eating disorder symptoms, both directly and indirectly through compulsive exercise in underweight adolescents with eating disorders. Participants were 149 female adolescents (M = 14.90 years, age range 13-17) with eating disorders from the Helping to Outline Paediatric Eating Disorders (HOPE) Project, an ongoing, registry study of individuals consecutively referred individuals to a statewide eating disorder service. The majority had a diagnosis of anorexia nervosa restricting type (66 %), followed by unspecified feeding or eating disorder (21 %), and anorexia nervosa binge-eating purging type (13 %). To test the model, path analyses with bootstrapping were conducted. All paths were statistically significant, including the indirect effect from perfectionism to eating disorder pathology via the mediator of compulsive exercise, and the direct effect of perfectionism on eating disorder pathology. Overall, this research provides further evidence that compulsive exercise may be one factor that can explain the relationship between perfectionism and eating disorder symptoms. Future research should seek to determine the relative efficacy of approaches for the treatment of eating disorders in adolescents which target perfectionism and compulsive exercise.
Collapse
Affiliation(s)
- Camilla Cresswell
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Hunna J Watson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia; Department of Psychiatry, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, United States; Division of Pediatrics, School of Medicine, The University of Western Australia, Perth, Australia
| | - Emily Jones
- Eating Disorders Program, Child and Adolescent Health Service, Perth, Australia
| | - Joel A Howell
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
| | - Sarah J Egan
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia; enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
| |
Collapse
|
9
|
Yakın E, Obeid S, Fekih-Romdhane F, Soufia M, Sawma T, Samaha S, Mhanna M, Azzi R, Mina A, Hallit S. "In-between orthorexia" profile: the co-occurrence of pathological and healthy orthorexia among male and female non-clinical adolescents. J Eat Disord 2022; 10:155. [PMID: 36329509 PMCID: PMC9633027 DOI: 10.1186/s40337-022-00673-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The profile of adolescents with orthorexic eating behaviors remains to be explored. This study is the first to explore the typology of Lebanese adolescents from a large non-clinical sample based on orthorexia nervosa (ON) and healthy orthorexia (HO). METHOD A total of 555 adolescents (aged between 15 and 18 years) completed a set of questionnaires assessing orthorexic behaviors, self-esteem, stress, depressive and anxiety symptoms. Cluster analysis based on ON and HO scores was used to identify the typology of the sample. More precisely, this analysis was used to reveal and distinguish between naturally occurring subgroups of individuals with different orthorexic eating profiles, within the studied sample. Further, a series of one-way ANOVA was used to compare observed clusters based on their scores on used questionnaires. This analysis was used to capture the behavioral and psychological differences between previously yielded subgroups of individuals. RESULTS Cluster analysis based on ON and HO scores yielded 3 distinct groups: "Low orthorexia", "Moderate in-between orthorexia" and "High in-between orthorexia". While the first group represented individuals with no particular (healthy or pathological) interest in healthy eating, the two latter groups represented those with respectively moderate and high degrees of an interest in healthy eating that has both pathological and healthy aspects. Significant differences between clusters regarding their levels of stress, depression, anxiety and self-esteem was observed, yet they were found to be negligible due to poor effect sizes. CONCLUSION Findings from this study suggest that ON and HO can indeed co-occur among adolescents, that this co-occurrence can be experienced at different severity levels. Low effect sizes for ANOVA comparisons may suggest the possibility of the co-occurrence of ON and HO reducing the negative effects of ON behavior to some degree. The potential role of confusion around what constitutes "healthy eating" in the emergence of these "in-between orthorexia" profiles is put forward.
Collapse
Affiliation(s)
- Ecem Yakın
- Centre d'Études et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, UT2J, 5 allées Antonio Machado, 31058, Toulouse, France
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Toni Sawma
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Serena Samaha
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Mariam Mhanna
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Reine Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Anthony Mina
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| |
Collapse
|
10
|
Fatt SJ, Mitchison D, Bussey K, Mond J. Methods used to assess insight in individuals with eating disorders: a scoping review. J Ment Health 2022:1-12. [PMID: 35543348 DOI: 10.1080/09638237.2022.2069696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
Insight can be impaired in individuals with an eating disorder and the nature of this impairment can vary. Although this topic has been the focus of several studies and reviews, methodologies used to assess insight have received less attention. A scoping review was conducted using a systematic search of articles before January 2021 to elucidate the methodologies used to assess insight in those with an eating disorder, with discussion of strengths and limitations. A total of 3089 studies were screened, and 24 quantitative studies which assessed at least one aspect of insight in individuals with an eating disorder were included in the review. Methods of assessing insight included coding of clinical notes, low scores on measures of self-report symptoms, direct assessment of insight, vignette, and self-report single-item questions. Insight into disordered eating symptoms was most frequently assessed. Most research used samples who were female, white, diagnosed with anorexia nervosa, and were seeking or receiving treatment. In designing future research and interventions, optimal methods used to assess insight should consider the research/clinical question, available resources, and the targeted demographic. Further, descriptions of which aspects of insight are being assessed should be considered in the interpretation of both current and future findings.
Collapse
Affiliation(s)
- Scott J Fatt
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Kay Bussey
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia
| |
Collapse
|
11
|
Tie B, Chen G, He J. Validation of the inflexible eating questionnaire in a large sample of Chinese adolescents: psychometric properties and gender-related differential item functioning. Eat Weight Disord 2022; 27:1029-1037. [PMID: 34137005 DOI: 10.1007/s40519-021-01239-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The aim of this study was to provide preliminary psychometric evidence for the Chinese version of the Inflexible Eating Questionnaire (C-IEQ) among a large sample of Chinese adolescents. METHODS For testing the psychometric properties of the C-IEQ, a total of 2241 (Mage = 13.91 years; 46.4% boys) adolescents from mainland China responded to the survey. Confirmatory factor analysis (CFA) was used to examine the factor structure of the C-IEQ. Measurement invariance by gender was examined by both multi-group CFA and differential item functioning (DIF). Convergent validity of the C-IEQ was assessed via examining the correlations between the C-IEQ scores and theoretically related constructs (e.g., orthorexia nervosa symptomatology, eating disorder symptomatology, and body image inflexibility). RESULTS The unidimensional structure with correlated errors of the C-IEQ showed good model fit (χ2 = 1674.05, df = 44, p < 0.001; CFI = 0.93; TLI = 0.91; RMSEA = 0.13; SRMR = 0.06). The C-IEQ had an adequate internal consistency (α = 0.89) and demonstrated strong measurement invariance across genders. Moreover, the scores of the C-IEQ showed significant correlations with theoretically correlated constructs: orthorexia nervosa symptomatology (girls; r = 0.53 p < 0.001, boys; r = 0.45 p < 0.001), eating disorder symptomatology (girls; r = 0.32 p < 0.001, boys; r = 0.25 p < 0.001) body image inflexibility (girls; r = 0.41 p < 0.001, boys; r = 0.36 p < 0.001), suggesting good convergent validity of the C-IEQ. CONCLUSION The C-IEQ showed good psychometric properties in a sample of Chinese adolescents and can be used in future studies to assess eating-specific psychological inflexibility among Chinese adolescents. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
Collapse
Affiliation(s)
- Bijie Tie
- School of Education, Zhengzhou University, Zhengzhou, Henan, China
| | - Gui Chen
- College of Educational Science, Hengyang Normal University, Hengyang, Hunan, China
| | - Jinbo He
- School of Humanities and Social Science, Chinese University of Hong Kong, Shenzhen, 518172, Guangdong, China.
| |
Collapse
|
12
|
Kolar DR, Meule A, Naab S, Voderholzer U. Early within-person weight gain and variability during inpatient treatment for anorexia nervosa: Age-dependent effects on treatment outcome. EUROPEAN EATING DISORDERS REVIEW 2022; 30:328-340. [PMID: 35297141 DOI: 10.1002/erv.2893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Early weight gain during inpatient treatment for anorexia nervosa (AN) is a dynamic process characterised by within-person variability that may be age-dependent. We examined whether age moderates the effect of within-person weight gain and variability on treatment outcome. METHOD Within-person level estimates of N = 2881 underweight adolescents and adults with AN for daily average weight gain (linear slope) and variability (root mean squared errors) were obtained using random-effects modelling. Between-person level regression analyses were calculated to assess effects on weight, eating disorder psychopathology and attaining normal body weight (body mass index [BMI]: 18.5-25 kg/m2 ). RESULTS Higher weight gain during first 2 weeks of inpatient treatment predicted higher weight, lower drive for thinness and lower body dissatisfaction at discharge, but not lower bulimic symptoms. Moreover, it predicted a higher probability of discharge weight within normal range. Younger age was associated with stronger effects of early weight gain on weight, drive for thinness and body dissatisfaction at discharge. Weight variability was not associated with any outcome. CONCLUSIONS Age moderated effects of early weight gain on treatment outcomes, with larger effects for younger patients. Weight variability alone did not influence treatment across age and should be of lesser clinical concern during early inpatient treatment.
Collapse
Affiliation(s)
- David R Kolar
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Silke Naab
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| |
Collapse
|
13
|
The relationship between emotional intelligence and eating disorders or disordered eating behaviors: A meta-analysis. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
14
|
Emotion Dysregulation as a Mediator of the Relationship between Anxiety, Compulsive Exercise and Eating Disorder Symptoms in Adolescents. CHILDREN 2021; 8:children8121088. [PMID: 34943286 PMCID: PMC8700564 DOI: 10.3390/children8121088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
Anxiety has been suggested to be a key contributing factor for compulsive exercise, however, existing literature has demonstrated contradictory relationships between anxiety and compulsive exercise among adolescents. According to the Emotional Cascade Model (ECM), factors such as rumination and emotional suppression may mediate the association between affect and exercise. The current study therefore aimed to investigate whether rumination and emotional suppression mediate the relationship between anxiety and compulsive exercise in predicting ED symptoms in adolescents. Questionnaires assessing compulsive exercise, anxiety, depressive rumination, emotional suppression, and ED symptoms were completed by 212 adolescent males (Mage = 13.39, SD = 1.22) and 189 adolescent females (Mage = 13.64, SD = 1.29). The structural equation model showed indirect effects between anxiety and compulsive exercise through rumination and emotional suppression in males but not in females. Moreover, anxiety had an indirect effect on eating disorder symptoms through rumination, emotional suppression and compulsive exercise in both males and females. In line with ECM, the results suggest that rumination and emotional suppression may have a key role in the association between anxiety, compulsive exercise and eating disorder symptoms in adolescents. These findings suggest that compulsive exercise may be used as a dysfunctional coping mechanism to escape from a negative emotional cascade generated by the interaction of anxiety, rumination and emotional suppression. Future longitudinal studies to test the role of compulsive exercise as a dysfunctional behaviour in the ECM are needed.
Collapse
|
15
|
Leslie M, Halls D, Leppanen J, Sedgewick F, Lang K, Fonville L, Simic M, Mandy W, Nicholls D, Williams S, Tchanturia K. The neural correlates of a central coherence task in young women with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2021; 29:744-755. [PMID: 34278640 DOI: 10.1002/erv.2852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Heightened detail-processing and low levels of central coherence are common in individuals with anorexia nervosa (AN) and predict poorer prognosis. However, it is unclear whether these processing styles predate the disorder or, rather, emerge during later stages of AN. The current study aimed to address this question by investigating central coherence, and the neural correlates of central coherence, in a sample of young women with AN with shorter duration of illness than previous studies recruiting adult samples. METHODS We recruited 186 participants, including: 73 young women with AN, 45 young women weight-recovered from AN, and 68 age-matched controls. Participants completed the Embedded Figures Task during an fMRI scan. RESULTS There were no significant differences between the participant groups in performance accuracy or reaction time. There were no other between-groups differences in neural response to the Embedded Figures Task. CONCLUSIONS These findings contrast with evidence from older adults demonstrating differences in the neural underpinning of central coherence amongst participants with AN versus control participants. The current study adds to an increasing literature base demonstrating the resilience of neuropsychological traits and associated brain systems in the early stages of AN.
Collapse
Affiliation(s)
- Monica Leslie
- Department of Psychological Medicine - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
- Department of Psychology, University of Chester, Chester, UK
| | - Daniel Halls
- Department of Psychological Medicine - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
| | - Jenni Leppanen
- Department of Psychological Medicine - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
| | - Felicity Sedgewick
- Department of Psychological Medicine - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
- School of Education, University of Bristol, Bristol, UK
| | - Katie Lang
- Department of Psychology - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
| | - Leon Fonville
- Division of Brain Sciences, Imperial College London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, UK
| | - William Mandy
- Research Department of Clinical, Health and Educational Psychology, UCL, London, UK
| | | | - Steven Williams
- Department of Neuroimaging - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
| | - Kate Tchanturia
- Department of Psychological Medicine - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
- Psychology Department, Illia State University, Tbilisi, Georgia
| |
Collapse
|
16
|
Konstantakopoulos G, Georgantopoulos G, Gonidakis F, Michopoulos I, Stefanatou P, David AS. Development and validation of the schedule for the assessment of insight in eating disorders (SAI-ED). Psychiatry Res 2020; 292:113308. [PMID: 32707219 DOI: 10.1016/j.psychres.2020.113308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022]
Abstract
This study examined the reliability, validity and internal structure of the newly developed, interview-based Schedule for the Assessment of Insight in Eating Disorders (SAI-ED) and the relationships of insight with demographic and clinical characteristics in EDs. Ninety-four female patients - 44 with anorexia nervosa (AN) and 50 with bulimia nervosa (BN) - were assessed with SAI-ED. The Brown Assessment of Beliefs Scale was used to evaluate convergent validity of SAI-ED. Hierarchical cluster analysis and multidimensional scaling were used to identify insight components and assess their inter-relationships. The final 8-item SAI-ED demonstrated good psychometric properties. Inter-rater and test-retest reliabilities were high. Three subscales of SAI-ED were identified which measure major insight components: awareness of illness, awareness of symptoms, and treatment engagement. Patients with AN had significant lower score on SAI-ED than patients with BN. Impaired insight was associated with: (a) lower current and lowest lifetime BMI and more severe dietary restrain in AN, (b) illness duration, severity of overall ED symptoms, body-related concerns and obsessionality in BN. Insight is a multidimensional construct in EDs associated with different clinical aspects in AN and BN. The SAI-ED is a valid and reliable tool for the assessment of insight in EDs patients.
Collapse
Affiliation(s)
- George Konstantakopoulos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Georgios Georgantopoulos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece
| | - Fragiskos Gonidakis
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioannis Michopoulos
- Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece
| | - Pentagiotissa Stefanatou
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece
| | - Anthony S David
- UCL Institute of Mental Health, Division of Psychiatry, University College London, UK
| |
Collapse
|
17
|
Improving School Mental Health Services for Students with Eating Disorders. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
18
|
Calugi S, Sartirana M, Misconel A, Boglioli C, Dalle Grave R. Eating disorder psychopathology in adults and adolescents with anorexia nervosa: A network approach. Int J Eat Disord 2020; 53:420-431. [PMID: 32314382 DOI: 10.1002/eat.23270] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess and compare eating disorder feature networks in adult and adolescent patients with anorexia nervosa. METHODS Patients seeking treatment for anorexia nervosa in inpatient and outpatient settings were consecutively recruited from January 2008 to September 2019. Body mass index was measured, and each patient completed the Eating Disorder Examination Questionnaire. RESULTS The sample comprised 547 adolescent and 724 adult patients with anorexia nervosa. Network analysis showed that in both adults and adolescents, the most central and highly interconnected nodes in the network were related to shape overvaluation and desiring weight loss. The network comparison test identified similar global strength and network invariance, confirming the similarity of the two network structures. DISCUSSION The network structures in adult and adolescent patients with anorexia nervosa are similar, and lend weight to the cognitive behavioral theory that overvaluation of shape and weight is the core feature of anorexia nervosa psychopathology.
Collapse
Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | | | - Arianna Misconel
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Camilla Boglioli
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | | |
Collapse
|
19
|
Limburg K, Shu CY, Watson HJ, Hoiles KJ, Egan SJ. Implications of DSM-5 for the diagnosis of pediatric eating disorders. Int J Eat Disord 2018. [PMID: 29517799 DOI: 10.1002/eat.22856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of the study was to compare the DSM-IV, DSM-5, and ICD-10 eating disorders (ED) nomenclatures to assess their value in the classification of pediatric eating disorders. We investigated the prevalence of the disorders in accordance with each system's diagnostic criteria, diagnostic concordance between the systems, and interrater reliability. METHOD Participants were 1062 children and adolescents assessed at intake to a specialist Eating Disorders Program (91.6% female, mean age 14.5 years, SD = 1.75). Measures were collected from routine intake assessments. RESULTS DSM-5 categorization led to a lower prevalence of unspecified EDs when compared with DSM-IV. There was almost complete overlap for specified EDs. Kappa values indicated almost excellent agreement between the two coders on all three diagnostic systems, although there was higher interrater reliability for DSM-5 and ICD-10 when compared with DSM-IV. DISCUSSION DSM-5 nomenclature is useful in classifying eating disorders in pediatric clinical samples.
Collapse
Affiliation(s)
- Karina Limburg
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technichal University of Munich, Munich, Germany.,Eating Disorders Program, Child and Adolescent Mental Health Service, Perth, Australia
| | - Chloe Y Shu
- Eating Disorders Program, Child and Adolescent Mental Health Service, Perth, Australia
| | - Hunna J Watson
- School of Psychology, Curtin University, Perth, Australia.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Kimberley J Hoiles
- Eating Disorders Program, Child and Adolescent Mental Health Service, Perth, Australia
| | - Sarah J Egan
- School of Psychology, Curtin University, Perth, Australia
| |
Collapse
|
20
|
The role of trait emotional intelligence in body dissatisfaction and eating disorder symptoms in preadolescents and adolescents. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2017.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
21
|
Landstedt E, Hammarström A, Fairweather-Schmidt AK, Wade T. Associations between adolescent risk for restrictive disordered eating and long-term outcomes related to somatic symptoms, body mass index, and poor well-being. Br J Health Psychol 2018; 23:496-518. [DOI: 10.1111/bjhp.12301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 01/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anne Hammarström
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | | | - Tracey Wade
- School of Psychology; Flinders University; Adelaide South Australia Australia
| |
Collapse
|
22
|
Curzio O, Maestro S, Rossi G, Calderoni S, Giombini L, Scardigli S, Ragione LD, Muratori F. Transdiagnostic vs. disorder-focused perspective in children and adolescents with eating disorders: Findings from a large multisite exploratory study. Eur Psychiatry 2018; 49:81-93. [PMID: 29413810 DOI: 10.1016/j.eurpsy.2017.12.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/21/2017] [Accepted: 12/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The transdiagnostic model of eating disorders (ED) proposes common cognitive mechanisms in patients with ED psychopathology. Little is known about their role in the maintenance of ED in children and adolescents. This study aimed to determine whether the relationships between key factors (low self-esteem, weight and shape control, clinical perfectionism, interpersonal problems, distress and mood instability) and core maintaining mechanisms (binge-eating and restraint) would support a transdiagnostic theory in young patients. METHODS A total of 419 patients (mean age 14.7 ± 2.14 years; age range: 7-18 years; males 13.8%) diagnosed with an ED were assessed in six Italian clinical centers in 2013. Multiple comparisons between ED diagnosis, correlation analysis and principal component analysis (PCA) were performed. RESULTS Of the entire collective, 51.5% of patients were diagnosed with Anorexia Nervosa (AN), 12.3% were diagnosed with Bulimia Nervosa (BN) and 36.2% with Eating Disorder Not Otherwise Specified (EDNOS). In PCA, the core ED mechanisms, dietary restraint and binge eating, acted as poles of attraction of the other variables. The AN group was particularly linked to restraint and the BN group was particularly related to "Bulimia". Considering the diagnostic subtypes, there were no significant differences between the anorexic binge-purging group, bulimic purging group and bulimic non-purging group, which constituted a unique cluster related to affective, interpersonal problems and to perfectionism, indicating a very homogeneous subgroup. Restricting anorexic group (AN-R), related to shape concern and anxious-depressed mood, was not linked to the other subtypes. EDNOS appeared to be opposed to the AN-R group; the binge eating disorder group appeared to be independent from others. CONCLUSION Our results suggest the presence of both specific and transdiagnostic mechanisms in ED subtypes, whose knowledge is of relevance for clinical practice.
Collapse
Affiliation(s)
- O Curzio
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - S Maestro
- IRCCS Stella Maris Foundation, Pisa, Italy.
| | - G Rossi
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, Pisa, Italy; G Monasterio Foundation, CNR-Tuscany Region, Pisa, Italy
| | - S Calderoni
- IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - L Giombini
- Eating Disorders Services - ASL n. 1 'Palazzo Francisci', Todi, Italy
| | | | - L Dalla Ragione
- Eating Disorders Services - ASL n. 1 'Palazzo Francisci', Todi, Italy
| | - F Muratori
- IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| |
Collapse
|
23
|
Jennings KM, Phillips KE. Eating Disorder Examination-Questionnaire (EDE-Q): Norms for Clinical Sample of Female Adolescents with Anorexia Nervosa. Arch Psychiatr Nurs 2017; 31:578-581. [PMID: 29179824 PMCID: PMC5728684 DOI: 10.1016/j.apnu.2017.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Karen M Jennings
- The University of Chicago, Psychiatry & Behavioral Neuroscience, 5841 S. Maryland Avenue, Chicago, IL 06824, United States.
| | - Kathryn E Phillips
- Fairfield University, 1073 N. Benson Road, Fairfield, CT 06825, United States.
| |
Collapse
|
24
|
Kirk KM, Martin FC, Mao A, Parker R, Maguire S, Thornton LM, Zhu G, McAloney K, Freeman JL, Hay P, Madden S, Morgan C, Russell J, Sawyer SM, Hughes EK, Fairweather-Schmidt AK, Fursland A, McCormack J, Wagg F, Jordan J, Kennedy MA, Ward W, Wade TD, Bulik CM, Martin NG. The Anorexia Nervosa Genetics Initiative: Study description and sample characteristics of the Australian and New Zealand arm. Aust N Z J Psychiatry 2017; 51:583-594. [PMID: 28378620 DOI: 10.1177/0004867417700731] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Anorexia nervosa is a severe psychiatric disorder with high mortality rates. While its aetiology is poorly understood, there is evidence of a significant genetic component. The Anorexia Nervosa Genetics Initiative is an international collaboration which aims to understand the genetic basis of the disorder. This paper describes the recruitment and characteristics of the Australasian Anorexia Nervosa Genetics Initiative sample, the largest sample of individuals with anorexia nervosa ever assembled across Australia and New Zealand. METHODS Participants completed an online questionnaire based on the Structured Clinical Interview Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) eating disorders section. Participants who met specified case criteria for lifetime anorexia nervosa were requested to provide a DNA sample for genetic analysis. RESULTS Overall, the study recruited 3414 Australians and 543 New Zealanders meeting the lifetime anorexia nervosa case criteria by using a variety of conventional and social media recruitment methods. At the time of questionnaire completion, 28% had a body mass index ⩽ 18.5 kg/m2. Fasting and exercise were the most commonly employed methods of weight control, and were associated with the youngest reported ages of onset. At the time of the study, 32% of participants meeting lifetime anorexia nervosa case criteria were under the care of a medical practitioner; those with current body mass index < 18.5 kg/m2 were more likely to be currently receiving medical care (56%) than those with current body mass index ⩾ 18.5 kg/m2 (23%). Professional treatment for eating disorders was most likely to have been received from general practitioners (45% of study participants), dietitians (42%) and outpatient programmes (42%). CONCLUSIONS This study was effective in assembling the largest community sample of people with lifetime anorexia nervosa in Australia and New Zealand to date. The proportion of people with anorexia nervosa currently receiving medical care, and the most common sources of treatment accessed, indicates the importance of training for general practitioners and dietitians in treating anorexia nervosa.
Collapse
Affiliation(s)
- Katherine M Kirk
- 1 Genetic Epidemiology Laboratory, QIMR Berghofer Institute of Medical Research, Brisbane, QLD, Australia
| | - Felicity C Martin
- 1 Genetic Epidemiology Laboratory, QIMR Berghofer Institute of Medical Research, Brisbane, QLD, Australia
| | - Amy Mao
- 2 Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Richard Parker
- 1 Genetic Epidemiology Laboratory, QIMR Berghofer Institute of Medical Research, Brisbane, QLD, Australia
| | | | - Laura M Thornton
- 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gu Zhu
- 1 Genetic Epidemiology Laboratory, QIMR Berghofer Institute of Medical Research, Brisbane, QLD, Australia
| | - Kerrie McAloney
- 1 Genetic Epidemiology Laboratory, QIMR Berghofer Institute of Medical Research, Brisbane, QLD, Australia
| | - Jeremy L Freeman
- 5 Australia & New Zealand Academy for Eating Disorders, Sydney, NSW, Australia
| | - Phillipa Hay
- 6 Western Sydney University, Sydney, NSW, Australia
| | - Sloane Madden
- 6 Western Sydney University, Sydney, NSW, Australia.,7 The Sydney Children's Hospital Network, Sydney, NSW, Australia
| | | | | | - Susan M Sawyer
- 9 The Royal Children's Hospital, Melbourne, VIC, Australia
| | | | | | - Anthea Fursland
- 11 Centre for Clinical Interventions, Perth, WA, Australia.,12 Curtin University, Perth, WA, Australia
| | - Julie McCormack
- 13 Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Fiona Wagg
- 14 Royal Hobart Hospital, Hobart, TAS, Australia
| | | | | | - Warren Ward
- 2 Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,16 School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Cynthia M Bulik
- 4 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,17 Karolinska Institutet, Stockholm, Sweden
| | - Nicholas G Martin
- 1 Genetic Epidemiology Laboratory, QIMR Berghofer Institute of Medical Research, Brisbane, QLD, Australia
| |
Collapse
|
25
|
Sheridan G, McArdle S. Exploring Patients' Experiences of Eating Disorder Treatment Services From a Motivational Perspective. QUALITATIVE HEALTH RESEARCH 2016; 26:1988-1997. [PMID: 26138701 DOI: 10.1177/1049732315591982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study employed qualitative methods to explore eating disorder (ED) patients' perspectives on their treatment experiences to gain insight into those factors that influenced their motivational trajectory. Semistructured interviews were conducted with a purposive female sample of current (N = 11) and discharged (N = 3) ED service users, aged 18 to 31 years (M = 23.21, SD = 4.19). An interpretive thematic analytic approach, comprising both inductive and deductive methods of analysis, was employed to identify key themes in the data. Self-determination theory (SDT) provided a conceptual lens for analyzing data. Participants highlighted that factors such as physical design and nature of the treatment environment, relational aspects of care, and therapeutic methods all played a role in treatment engagement. The findings highlight ways in which current ED services might more effectively meet the needs of service users and support the utility of applying SDT to the study of motivational dynamics in the treatment of EDs.
Collapse
|
26
|
Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. Eur Child Adolesc Psychiatry 2016; 25:903-18. [PMID: 26754944 DOI: 10.1007/s00787-015-0808-z] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 12/06/2015] [Indexed: 10/22/2022]
Abstract
We aimed to assess the prevalence, incidence, age-of-onset and diagnostic stability of threshold and subthreshold anorexia nervosa (AN) and bulimia nervosa (BN) in the community. Data come from a prospective-longitudinal community study of 3021 subjects aged 14-24 at baseline, who were followed up at three assessment waves over 10 years. Eating disorder (ED) symptomatology was assessed with the DSM-IV/M-CIDI at each wave. Diagnostic stability was defined as the proportion of individuals still affected with at least symptomatic eating disorders (EDs) at follow-ups. Baseline lifetime prevalence for any threshold ED were 2.9 % among females and 0.1 % among males. For any subthreshold ED lifetime prevalence were 2.2 % for females and 0.7 % for males. Symptomatic expressions of EDs (including core symptoms of the respective disorder) were most common with a lifetime prevalence of 11.5 % among females and 1.8 % among males. Symptomatic AN showed the earliest onset with a considerable proportion of cases emerging in childhood. 47 % of initial threshold AN cases and 42 % of initial threshold BN cases showed at least symptomatic expressions of any ED at any follow-up assessment. Stability for subthreshold EDs and symptomatic expressions was 14-36 %. While threshold EDs are rare, ED symptomatology is common particularly in female adolescents and young women. Especially threshold EDs are associated with a substantial risk for stability. A considerable degree of symptom fluctuation is characteristic especially for subthreshold EDs.
Collapse
|
27
|
Pratt HD, Phillips EL, Greydanus DE, Patel DR. Eating Disorders in the Adolescent Population:. JOURNAL OF ADOLESCENT RESEARCH 2016. [DOI: 10.1177/0743558403018003007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescents become vulnerable to developing eating disorders as they mature. Very little is known about the prevalence, etiology, assessment, treatment, and outcome of eating disorders among adolescents. In general, research on eating disorders continues to be plagued with design flaws. Future studies need to be prospective research based on larger, more diverse samples of adolescents that represent all developmental stages of adolescence. Consistent diagnostic criteria and definitions of treatment interventions and outcomes also need to be employed. In addition, research should address the identification of protective and risk factors that predict who will actually develop an eating disorder.
Collapse
|
28
|
Mantilla EF, Birgegård A. Eating disorder examination questionnaire: Norms and clinical reference data from adolescent boys and girls in Sweden. Psychiatry Res 2016; 239:156-62. [PMID: 27137979 DOI: 10.1016/j.psychres.2016.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 12/22/2015] [Accepted: 03/10/2016] [Indexed: 11/15/2022]
Abstract
The study investigated norms and clinical reference values for the 14-day time frame version of the Eating Disorders Examination Questionnaire (EDE-Q) specifically developed to suit adolescent populations. The EDE-Q is a self-report instrument measuring problematic eating behaviors and attitudes. A general population sample (N=487, 239 girls and 248 boys) and a clinical sample (N=1051, 989 girls and 62 boys) aged 12-14 years were analyzed. Descriptive statistics for EDE-Q subscales and Global scale, as well as key behaviors, are presented, along with sex differences and diagnostic differences (clinical sample). General population sample sex differences were consistent and medium to large, with some evidence of floor effects for boys. In the clinical sample there was a main effect of gender, with girls scoring higher overall. The covariate age accounted for more variance in EDE-Q subscale scores than did diagnostic group. Results are discussed in terms of the appropriateness of the EDE-Q for boys, and possible denial of illness among patients.
Collapse
Affiliation(s)
- Emma Forsén Mantilla
- Karolinska Institute, Dept. of Clinical Neuroscience, Resource Center for Eating Disorders, Norra Stationsgatan 69, Plan 7, 113 64 Stockholm, Sweden.
| | - Andreas Birgegård
- Karolinska Institute, Dept. of Clinical Neuroscience, Resource Center for Eating Disorders, Norra Stationsgatan 69, Plan 7, 113 64 Stockholm, Sweden
| |
Collapse
|
29
|
Évaluation des attitudes et des comportements alimentaires : comparaison entre un groupe d’adolescentes athlètes pratiquant un sport esthétique et un groupe témoin. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.neurenf.2015.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
30
|
Wade TD, O'Shea A. DSM-5 unspecified feeding and eating disorders in adolescents: what do they look like and are they clinically significant? Int J Eat Disord 2015; 48:367-74. [PMID: 24854848 DOI: 10.1002/eat.22303] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/04/2014] [Accepted: 05/11/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The recent DSM-5 categorization of eating disorders introduces a new category of eating disorders, Unspecified Feeding and Eating Disorders (UFED), where symptoms do not meet criteria for any other diagnostic category, but cause clinically significant distress or impairment. The aim of the current study was to explore what disorders in UFED might look like in an adolescent population. METHOD We examined a large cohort of adolescent female twins (N = 699) who were assessed on three occasions and who did not meet a DSM-5 eating disorder diagnosis but who reported threshold levels of either fasting and/or driven exercise (N = 33; 4.7%). This group of girls was compared to girls who reported no eating disorder over the three waves, and girls who met a diagnosis of either anorexia nervosa (AN) or atypical AN. RESULTS The UFED group was characterized as being in the overweight range while striving to lose weight, and placing a high degree of importance on weight and shape in their self-evaluation. This group was indistinguishable from the two eating disorder groups on measures of global eating disorder severity, and demonstrated significantly elevated impairment and distress compared to the no eating disorder group commensurate with the eating disorder groups. DISCUSSION Further research of this group is necessary to ensure that these individuals are not overlooked, and that treatment options are appropriate and available.
Collapse
Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | | |
Collapse
|
31
|
Shu CY, Limburg K, Harris C, McCormack J, Hoiles KJ, Hamilton MJ, Watson HJ. Clinical presentation of eating disorders in young males at a tertiary setting. J Eat Disord 2015; 3:39. [PMID: 26557990 PMCID: PMC4640410 DOI: 10.1186/s40337-015-0075-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young males with eating disorders are a neglected study population in eating disorders. The aim of this study was to provide knowledge about the clinical presentation of eating disorders in young males. METHODS The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project (N ~ 1000), a prospective, ongoing registry comprising consecutive paediatric (<18 years) tertiary eating disorder referrals. Young males with DSM-5 eating disorders (n = 53) were compared with young females with eating disorders (n = 704). RESULTS There was no significant difference in the prevalence of diagnosis of bulimia nervosa (2 % vs 11 %, p = 0.26) among sexes. Males had comparable duration of illness (9 months; p = 0.28) and a significantly earlier age of onset (M = 12 years; p <0.001). Shape concern (2.39 vs 3.57, p <0.001) and weight concern (1.97 vs 3.09, p <0.001) were lower in males, and body mass index z score (-1.61 vs -1.42, p = 0.29) and medical compromise (odds ratio [OR] = 0.64, 95 % CI: 0.36, 1.12) were comparable. Males had a two-folder higher odds of being diagnosed with unspecified feeding or eating disorders (40 % vs 22 % for females, p = 0.004). Driven exercise to control weight and shape was common and comparable in prevalence among males and females (51 % vs 47 %, p = 0.79) and males were less likely to present with self-induced vomiting (OR = 0.23, 95 % CI: 0.09, 0.59). CONCLUSION Boys with eating disorders are an understudied group with similarities and differences in clinical presentation from girls with eating disorders. Parents and physicians are encouraged to consider changes in weight, disturbed vital signs, and driven, frequent exercise for the purposes of controlling weight or shape, as possible signs of eating disorders among male children. Diagnostic classification, assessment instruments, conceptualisation, and treatment methods need to be refined to improve application to young males.
Collapse
Affiliation(s)
- Chloe Y Shu
- Eating Disorders Program located at Princess Margaret Hospital for Children, Specialised Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Australia ; School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Karina Limburg
- Eating Disorders Program located at Princess Margaret Hospital for Children, Specialised Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Australia
| | | | - Julie McCormack
- Eating Disorders Program located at Princess Margaret Hospital for Children, Specialised Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Australia
| | - Kimberley J Hoiles
- Eating Disorders Program located at Princess Margaret Hospital for Children, Specialised Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Australia ; School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Matthew J Hamilton
- Eating Disorders Program located at Princess Margaret Hospital for Children, Specialised Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Australia
| | - Hunna J Watson
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia ; Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, USA ; School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| |
Collapse
|
32
|
Abstract
Existing randomized controlled trials of family therapy for treatment of bulimia nervosa in adolescence highlight the need for further development of treatments. This article describes the development of multi-family treatment for bulimia nervosa in adolescents aged 13-18. It outlines the theory guiding this development, the areas of need identified by previous studies, and the treatment that has been designed to meet these needs. Particular attention is given to the need to increase communication between family members, strategies to reduce high levels of criticism or hostility, and skills to manage emotion dysregulation and low tolerance for negative emotions. To these ends the program draws on the multi-family treatment for anorexia nervosa, cognitive behavioral therapy techniques, and dialectical behavior therapy.
Collapse
|
33
|
Mantilla EF, Birgegård A. The enemy within: the association between self-image and eating disorder symptoms in healthy, non help-seeking and clinical young women. J Eat Disord 2015; 3:30. [PMID: 26309737 PMCID: PMC4549025 DOI: 10.1186/s40337-015-0067-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/17/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous research has shown self-image according to the interpersonal Structural Analysis of Social Behavior model, to relate to and predict eating disorder symptoms and outcomes. METHODS We examined associations between self-reported self-image and ED symptoms in three groups of 16-25 year old females: healthy (N = 388), non help-seeking (N = 227) and clinical (N = 6384). Analyses were divided into age groups of 16-18 and 19-25 years, and the patient sample was divided into diagnostic groups. RESULTS Stepwise regressions with self-image aspects as independent variables and eating disorder symptoms as dependent showed that low self-love/acceptance and high self-blame were associated with more eating disorder symptoms in all groups, except older patients with bulimia nervosa where self-hate also contributed. Associations were generally weaker in the healthy groups and the older samples. CONCLUSIONS We put forward that older age, low desirability of symptoms, poorly working symptoms, and being acknowledged as ill, may weaken the association, with implications for treatment and prevention.
Collapse
Affiliation(s)
- Emma Forsén Mantilla
- Karolinska Institute, Department of Clinical neuroscience, Resource center for eating disorders, Norra Stationsgatan 69, plan 7, 113 64 Stockholm, Sweden
| | - Andreas Birgegård
- Karolinska Institute, Department of Clinical neuroscience, Resource center for eating disorders, Norra Stationsgatan 69, plan 7, 113 64 Stockholm, Sweden
| |
Collapse
|
34
|
Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, Touyz S, Ward W. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry 2014; 48:977-1008. [PMID: 25351912 DOI: 10.1177/0004867414555814] [Citation(s) in RCA: 329] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guidelines (CPG) Project 2013-2014. METHODS The CPG was developed in accordance with best practice according to the National Health and Medical Research Council of Australia. Literature of evidence for treatments of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified and unspecified eating disorders and avoidant restrictive food intake disorder (ARFID) was sourced from the previous RANZCP CPG reviews (dated to 2009) and updated with a systematic review (dated 2008-2013). A multidisciplinary working group wrote the draft CPG, which then underwent expert, community and stakeholder consultation, during which process additional evidence was identified. RESULTS In AN the CPG recommends treatment as an outpatient or day patient in most instances (i.e. in the least restrictive environment), with hospital admission for those at risk of medical and/or psychological compromise. A multi-axial and collaborative approach is recommended, including consideration of nutritional, medical and psychological aspects, the use of family based therapies in younger people and specialist therapist-led manualised based psychological therapies in all age groups and that include longer-term follow-up. A harm minimisation approach is recommended in chronic AN. In BN and BED the CPG recommends an individual psychological therapy for which the best evidence is for therapist-led cognitive behavioural therapy (CBT). There is also a role for CBT adapted for internet delivery, or CBT in a non-specialist guided self-help form. Medications that may be helpful either as an adjunctive or alternative treatment option include an antidepressant, topiramate, or orlistat (the last for people with comorbid obesity). No specific treatment is recommended for ARFID as there are no trials to guide practice. CONCLUSIONS Specific evidence based psychological and pharmacological treatments are recommended for most eating disorders but more trials are needed for specific therapies in AN, and research is urgently needed for all aspects of ARFID assessment and management. EXPERT REVIEWERS Associate Professor Susan Byrne, Dr Angelica Claudino, Dr Anthea Fursland, Associate Professor Jennifer Gaudiani, Dr Susan Hart, Ms Gabriella Heruc, Associate Professor Michael Kohn, Dr Rick Kausman, Dr Sarah Maguire, Ms Peta Marks, Professor Janet Treasure and Mr Andrew Wallis.
Collapse
Affiliation(s)
- Phillipa Hay
- Members of the CPG Working Group School of Medicine and Centre for Health Research, University of Western Sydney, Australia School of Medicine, James Cook University, Townsville, Australia
| | - David Chinn
- Members of the CPG Working Group Capital and Coast District Health Board, Wellington, New Zealand
| | - David Forbes
- Members of the CPG Working Group School of Pediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Sloane Madden
- Members of the CPG Working Group Eating Disorders Service, Sydney Children's Hospital Network, Westmead, Australia; School of Psychiatry, University of Sydney, Australia
| | - Richard Newton
- Members of the CPG Working Group Mental Health CSU, Austin Health, Australia; University of Melbourne, Australia
| | - Lois Sugenor
- Members of the CPG Working Group Department of Psychological Medicine, University of Otago at Christchurch, New Zealand
| | - Stephen Touyz
- Members of the CPG Working Group School of Psychology and Centre for Eating and Dieting Disorders, University of Sydney, Australia
| | - Warren Ward
- Members of the CPG Working Group Eating Disorders Service Royal Brisbane and Women's Hospital; University of Queensland, Brisbane, Australia
| | | |
Collapse
|
35
|
Neubauer K, Weigel A, Daubmann A, Wendt H, Rossi M, Löwe B, Gumz A. Paths to first treatment and duration of untreated illness in anorexia nervosa: are there differences according to age of onset? EUROPEAN EATING DISORDERS REVIEW 2014; 22:292-8. [PMID: 24888519 DOI: 10.1002/erv.2300] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 01/12/2023]
Abstract
This study examined paths to first treatment and the duration of untreated illness in 140 anorexia nervosa patients using validated questionnaires and a clinical interview. The differences between individuals with an early (≤14 years, n = 40), intermediate (15-18 years, n = 53) and late onset (≥19 years, n = 47) were investigated. Participants were most commonly informed about their diagnosis and first treatment facility through general practitioners and paediatricians. The duration of untreated illness exceeded 2 years in the complete sample (25.14 months) and was longest for individuals with an early onset. The early onset group was more often externally vs. internally motivated and more frequently informed about treatment options by their social network, e.g. parents, than patients with a late onset. The results emphasize the relevance of training general practitioners and paediatricians about anorexia, the need to include parents and teachers in eating disorder prevention and to improve targeting young individuals in early interventions.
Collapse
Affiliation(s)
- Karolin Neubauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Germany
| | | | | | | | | | | | | |
Collapse
|
36
|
MacGregor MW, Lamborn P. Personality Assessment Inventory profiles of university students with eating disorders. J Eat Disord 2014; 2:20. [PMID: 25426291 PMCID: PMC4243782 DOI: 10.1186/s40337-014-0020-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 07/08/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Eating disorders are complex disorders that involve medical and psychological symptoms. Understanding the psychological factors associated with different eating disorders is important for assessment, diagnosis, and treatment. METHODS This study sought to determine on which of the 22 Personality Assessment Inventory (PAI) scales patients with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified (EDNOS) differed, and whether the PAI can be used to classify eating disorder subtypes. Because we were interested in both whether the PAI could be used to differentiate eating disorder subtypes from each other, as well as from other disorders, we also included a group of patients with major depression. RESULTS The three eating disorder groups did differ significantly from each other, and from the patients with depression, on a number of the PAI scales. Only two PAI scales (Anxiety and Depression), however, exceeded a T-score of 70 for the patients with anorexia nervosa, no scales exceeded a T-score of 70 for the patients with bulimia nervosa or EDNOS, and only two exceeded a T-score of 70 for the patients with depression (Depression and Suicide). A discriminant function analysis revealed an overall correct classification between the groups of 81.6%. CONCLUSIONS The PAI helps to understand the psychological factors associated with eating disorders and can be used to assist with assessment. Continued investigation using the PAI in an eating disordered population is supported.
Collapse
Affiliation(s)
| | - Paige Lamborn
- University of Saskatchewan, Saskatoon, Saskatchewan Canada
| |
Collapse
|
37
|
Health-related quality of life among adolescents with eating disorders. J Psychosom Res 2014; 76:1-5. [PMID: 24360133 DOI: 10.1016/j.jpsychores.2013.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/05/2013] [Accepted: 11/08/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) is an emerging area of research in eating disorders (EDs) that has not been examined in adolescents in detail. The aim of the current study is to investigate HRQoL in an adolescent ED sample, examining the impact of ED symptoms on HRQoL. METHODS Sixty-seven treatment-seeking adolescents (57 females) with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) completed self-report measures of HRQoL and ED symptoms. RESULTS Participants reported poorer HRQoL in mental health domains than in physical health domains. Disordered attitudes, binge eating, and compensatory behaviors were associated with poorer mental health HRQoL, and body dissatisfaction was associated with poorer physical health HRQoL. CONCLUSION The current study assessed HRQoL among adolescents with EDs, finding several consistencies with the literature on adults with EDs. Future research should compare adolescents and adults with EDs on HRQoL.
Collapse
|
38
|
Walker T, Watson HJ, Leach DJ, McCormack J, Tobias K, Hamilton MJ, Forbes DA. Comparative study of children and adolescents referred for eating disorder treatment at a specialist tertiary setting. Int J Eat Disord 2014; 47:47-53. [PMID: 24166891 DOI: 10.1002/eat.22201] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine child and adolescent differences in the clinical presentation of eating disorders (EDs) at referral to a specialist pediatric program. METHOD This study compared cognitive, behavioral, and physical and medical features of children (≤ 12 years) and adolescents (13-18 years) with EDs presenting to a state-wide specialist pediatric ED service over two decades (N = 656; 8-18 years; 94% female). RESULTS Significant differences were found between the groups. Children were more commonly male (p < .001), had lower eating pathology scores (p < .001), were less likely to binge eat (p = .02), purge (p < .001) or exercise for shape and weight control (p < .001), and lost weight at a faster rate than adolescents (p = .009), whereas adolescents were more likely to present with bulimia nervosa spectrum disorders (p = .004). Children and adolescents did not differ significantly on mean body mass index z-score, percentage of body weight lost, or indicators of medical compromise (p > .05). DISCUSSION The clinical presentation of EDs differs among children and adolescents, with eating pathology and behavioral symptoms less prominent among children. Frontline health professionals require knowledge of these differences to assist with early detection, diagnosis, and prognosis.
Collapse
Affiliation(s)
- Tara Walker
- School of Psychology and Exercise Science, Division of Social Sciences, Humanities and Education, Murdoch University, Perth, Australia
| | | | | | | | | | | | | |
Collapse
|
39
|
Mariano P, Watson HJ, Leach DJ, McCormack J, Forbes DA. Parent-child concordance in reporting of child eating disorder pathology as assessed by the eating disorder examination. Int J Eat Disord 2013; 46:617-25. [PMID: 23847149 DOI: 10.1002/eat.22158] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to examine parent-youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample. METHOD The sample comprised 619 parent-youth dyads of youth (8-18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports. RESULTS On the whole, parent-youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK = 0.48-0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC = 0.07-0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents. DISCUSSION Results support the utility of parent-youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed.
Collapse
Affiliation(s)
- Paige Mariano
- School of Psychology, Murdoch University, Perth, Australia
| | | | | | | | | |
Collapse
|
40
|
Bourion-Bedes S, Baumann C, Kermarrec S, Ligier F, Feillet F, Bonnemains C, Guillemin F, Kabuth B. Prognostic value of early therapeutic alliance in weight recovery: a prospective cohort of 108 adolescents with anorexia nervosa. J Adolesc Health 2013; 52:344-50. [PMID: 23299014 DOI: 10.1016/j.jadohealth.2012.06.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/23/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine whether patients' perception of early therapeutic alliance (TA) could predict time to achieve a target weight among adolescents undergoing treatment for anorexia nervosa. METHOD TA was assessed in a prospective cohort recruited from both inpatient and outpatient settings by self-administered and validated questionnaires. Kaplan-Meier survival curves were compared by log rank test, and Cox regression was used to test whether patients' perception of early TA predicted time to achieve a target weight. RESULTS In total, 108 patients were included, and 79.6% achieved a target weight. Better patient perception of early TA increased the hazard ratio (HR) of achieving a target weight (HR = 2.7, 95% confidence interval: 1.7-4.4, p < .001) such as being in the inpatient setting by 6.7. Being very severely underweight at admission decreased the HR of achieving the target weight. CONCLUSION Patients' perception of early TA is a good predictor of achieving a target weight. Because TA is a modifiable construct, it could be a target for intervention.
Collapse
|
41
|
Konstantakopoulos G, Varsou E, Dikeos D, Ioannidi N, Gonidakis F, Papadimitriou G, Oulis P. Delusionality of body image beliefs in eating disorders. Psychiatry Res 2012; 200:482-8. [PMID: 22494704 DOI: 10.1016/j.psychres.2012.03.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 12/26/2011] [Accepted: 03/17/2012] [Indexed: 11/17/2022]
Abstract
Preoccupation with body shape and weight is characteristic of both anorexia nervosa and bulimia nervosa. Despite their diagnostic and clinical significance, evidence on the nature of the underlying beliefs is relatively scarce. We used the Brown Assessment of Beliefs Scale (BABS) to assess the degree of delusionality of body image beliefs in seventy-two participants: 39 with anorexia and 33 with bulimia nervosa. We also investigated the relationship between body image delusionality and other clinical characteristics in eating disorders. Only patients with anorexia nervosa (28.8%) had delusional body image beliefs, whereas overvalued ideas appeared to be frequent in both anorexia and bulimia nervosa. Body image delusionality in anorexia nervosa was associated with restrictive eating pathology, early onset of the disorder and body dissatisfaction, whereas in the bulimia group it was linked to shorter duration of the illness, more intense dieting behaviors and specific psychological factors: ineffectiveness and maturity fears. Results suggest that a delusional variant of anorexia nervosa represents the one end of a continuum of insight among patients with eating disorders. Categorization of patients with eating disorders based on the level of delusionality of body image beliefs could facilitate further research on the role of insight deficits in these disorders.
Collapse
Affiliation(s)
- George Konstantakopoulos
- Athens University Medical School, First Department of Psychiatry, Greece; King's College, London, Institute of Psychiatry, Section of Cognitive Neuropsychiatry, UK.
| | | | | | | | | | | | | |
Collapse
|
42
|
Stice E, Marti CN, Rohde P. Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. JOURNAL OF ABNORMAL PSYCHOLOGY 2012; 122:445-57. [PMID: 23148784 DOI: 10.1037/a0030679] [Citation(s) in RCA: 478] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We examined prevalence, incidence, impairment, duration, and course for the proposed DSM-5 eating disorders in a community sample of 496 adolescent females who completed annual diagnostic interviews over 8 years. Lifetime prevalence by age 20 was 0.8% for anorexia nervosa (AN), 2.6% for bulimia nervosa (BN), 3.0% for binge eating disorder (BED), 2.8% for atypical AN, 4.4% for subthreshold BN, 3.6% for subthreshold BED, 3.4% for purging disorder (PD), and combined prevalence of 13.1% (5.2% had AN, BN, or BED; 11.5% had feeding and eating disorders not elsewhere classified; FED-NEC). Peak onset age was 19-20 for AN, 16-20 for BN, and 18-20 for BED, PD, and FED-NEC. Youth with these eating disorders typically reported greater functional impairment, distress, suicidality, mental health treatment, and unhealthy body mass index, though effect sizes were relatively smaller for atypical AN, subthreshold BN, and PD. Average episode duration in months ranged from 2.9 for BN to 11.2 for atypical AN. One-year remission rates ranged from 71% for atypical AN to 100% for BN, subthreshold BN, and BED. Recurrence rates ranged from 6% for PD to 33% for BED and subthrehold BED. Diagnostic progression from subthreshold to threshold eating disorders was higher for BN and BED (32% and 28%) than for AN (0%), suggesting some sort of escalation mechanism for binge eating. Diagnostic crossover was greatest from BED to BN. Results imply that the new DSM-5 eating disorder criteria capture clinically significant psychopathology and usefully assign eating disordered individuals to homogeneous diagnostic categories.
Collapse
Affiliation(s)
- Eric Stice
- Oregon Research Institute, Eugene, OR 97403, USA.
| | | | | |
Collapse
|
43
|
Stice E, South K, Shaw H. Future Directions in Etiologic, Prevention, and Treatment Research for Eating Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 41:845-55. [DOI: 10.1080/15374416.2012.728156] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
44
|
Abstract
Onset of bulimia nervosa (BN) typically occurs in adolescence and is frequently accompanied by medical and psychiatric sequelae that may have detrimental effects on adolescent development. Potentially serious medical consequences and high comorbid rates of mood disorders and suicidality underscore the need for early recognition and effective treatments. Research among adolescents with BN has lagged behind that of adults, although evidence is accumulating to support the efficacy of family-based interventions and cognitive behavioral treatments that are adapted for use with adolescent populations. The aim of the current article is to provide an overview of recent research on epidemiology, risk factors, diagnostic issues, and treatment interventions focusing on adolescent BN, and to highlight areas for future research.
Collapse
|
45
|
Stiles-Shields EC, Labuschagne Z, Goldschmidt AB, Doyle AC, Le Grange D. The use of multiple methods of compensatory behaviors as an indicator of eating disorder severity in treatment-seeking youth. Int J Eat Disord 2012; 45:704-10. [PMID: 22331840 PMCID: PMC3355214 DOI: 10.1002/eat.22004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study investigated the use and frequency of multiple methods of compensatory behaviors and how they relate to eating-related and general psychopathology for youth with eating disorders (ED). METHOD Participants were 398 referrals to a pediatric ED treatment program (91.2% female; M age = 14.9 ± 2.2). ANOVA and chi-square tests compared participants reporting multiple methods of compensatory behaviors, single method of compensatory behaviors, and no compensatory behaviors on measures of ED and general psychopathology. Partial correlations examined associations between compensatory behavior, frequency and severity of ED and general psychopathology. RESULTS Participants reporting multiple methods of compensatory behaviors had significantly greater ED and general psychopathology than the other groups (ps < .001). Frequency of compensatory behaviors was associated with ED psychopathology (partial r = .14; p = .007) but not with general psychopathology. DISCUSSION Engaging in multiple methods of compensatory behaviors is related to greater ED and general psychopathology, whereas frequency is only related to greater ED symptom severity.
Collapse
Affiliation(s)
| | - Zandrè Labuschagne
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, 60637
| | - Andrea B. Goldschmidt
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, 60637
| | | | - Daniel Le Grange
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, 60637
| |
Collapse
|
46
|
Yücel B, Aslantas Ertekin B, Oglagu Z, Sertel Berk O, Deveci E, Kahraman F, Ersoy M, Turgut I, Yager J. Socio-demographic and clinical characteristics of individuals with diagnoses of eating disorder in a university hospital in Istanbul. Eat Weight Disord 2011; 16:e274-9. [PMID: 22526133 DOI: 10.1007/bf03327472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE This paper reports the first-ever description of a clinical eating disorder population from Turkey. The aim of this study was to examine the socio-demographic and clinical characteristics of individuals with diagnosis of eating disorders (IDED) referred to a university psychiatry clinic in Istanbul between 2003 and 2009. METHOD The diagnoses and subtype of 111 IDEDs, the referral type to the hospital, setting of treatment, and state of involuntary hospitalization were evaluated by interview and semi-structured questionnaire. RESULTS The clinical sample included 64 individuals with anorexia nervosa (AN), 38 with bulimia nervosa (BN), and 9 with eating disorder not otherwise specified (EDNOS), including only one male. Younger individuals and those with a lower BMI were significantly more likely to be family referred and hospitalized involuntarily. DISCUSSION The overall socio-demographic features of the sample are generally consistent with data collected in other communities. However, aspects of the clinical features, referral types of eating disorders and subtypes exhibit some characteristics peculiar to our sample.
Collapse
Affiliation(s)
- B Yücel
- Istanbul University, Istanbul Medical Faculty, Psychiatry Department, Eating Disorders Program, Millet Street, 34090 Fatih-Istanbul, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Loeb KL, Jones J, Roberto CA, Sonia Gugga S, Marcus SM, Attia E, Timothy Walsh B. Adolescent-adult discrepancies on the eating disorder examination: a function of developmental stage or severity of illness? Int J Eat Disord 2011; 44:567-72. [PMID: 21823141 PMCID: PMC4117237 DOI: 10.1002/eat.20882] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2010] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Across studies, adolescents score lower on measures of eating disorder pathology than adults, but it is unclear whether such findings reflect discrepancies inherent to site/study or true developmental differences. The aim of this study was to determine whether age predicts subscale and diagnostic scores of the Eating Disorder Examination (EDE) in adolescents and adults with anorexia nervosa (AN) admitted to a single research center within the same period of time. METHOD The sample consisted of 16 adolescent and 20 adult consecutive admissions to parallel, age-specific, research-based AN treatment programs. Participants completed a baseline evaluation at admission that included the EDE, depression measures, and global assessment of functioning scales. RESULTS Age significantly predicted EDE scores in univariate regression analyses. However, in multivariate models that included severity indices of general and specific psychopathology as covariates, age was no longer a significant predictor of severity of eating disorder symptoms. DISCUSSION This study adds to the growing body of data showing lower scores on the EDE for adolescents with AN relative to their adult counterparts, while eliminating potential site confounds. Results indicate that the higher adult scores may be carried in part by a more overall severe and chronic general clinical profile.
Collapse
Affiliation(s)
- Katharine L Loeb
- School of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey 07666, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Konstantakopoulos G, Tchanturia K, Surguladze SA, David AS. Insight in eating disorders: clinical and cognitive correlates. Psychol Med 2011; 41:1951-1961. [PMID: 21211101 DOI: 10.1017/s0033291710002539] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to explore the extent of lack of insight and its components in eating disorders (EDs) and to investigate the relationship between insight and clinical and cognitive characteristics in this group. METHOD Seventy-five participants were enrolled in the study: 25 with anorexia nervosa (AN), 15 with bulimia nervosa (BN) and 35 healthy controls (HC). Insight was assessed with a modified version of the Schedule for the Assessment of Insight for EDs (SAI-ED) and multi-dimensional scaling (MDS) analysis was used to clarify the internal structure of the scale. Neuropsychological tests included the Trail Making Test (TMT), the Brixton Test and a Verbal Fluency Task. RESULTS Only a subgroup of AN patients (24%) had severe impairment of insight. Patients with the restricting type of AN (AN-R) had poorer overall insight than patients with the binge-purge type of the disorder (AN-B/P). More of the ED patients displayed a deliberate denial of illness rather than a lack of awareness of the illness. A regression model revealed that only performance in part B of the TMT (TMT-B) was a moderate predictor of insight level. No association was found between insight and other cognitive or clinical variables. CONCLUSIONS Impaired insight is a significant feature of some ED patients. Insight in EDs seems to be partially dependent on intact mental flexibility.
Collapse
Affiliation(s)
- G Konstantakopoulos
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College, London, UK.
| | | | | | | |
Collapse
|
49
|
Stice E, Marti CN, Durant S. Risk factors for onset of eating disorders: evidence of multiple risk pathways from an 8-year prospective study. Behav Res Ther 2011. [PMID: 21764035 DOI: 10.1016/j.brat.2011.06.009; s0005-7967(11)00130-6 [pii]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Use classification tree analysis with lagged predictors to determine empirically derived cut-points for identifying adolescent girls at risk for future onset of threshold, subthreshold, and partial eating disorders and test for interactions between risk factors that may implicate qualitatively distinct risk pathways. METHOD Data were drawn from a prospective study of 496 adolescent girls who completed diagnostic interviews and surveys annually for 8 years. RESULTS Body dissatisfaction emerged as the most potent predictor; adolescent girls in the upper 24% of body dissatisfaction showed a 4.0-fold increased incidence of eating disorder onset (24% vs. 6%). Among participants in the high body dissatisfaction branch, those in the upper 32% of depressive symptoms showed a 2.9-fold increased incidence of onset (43% vs. 15%). Among participants in the low body dissatisfaction branch, those in the upper 12% of dieting showed a 3.6-fold increased incidence onset (18% vs. 5%). CONCLUSION This three-way interaction suggests a body dissatisfaction pathway to eating disorder onset that is amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies. It may be possible to increase the effectiveness of prevention programs by targeting each of these qualitatively distinct risk groups, rather than only individuals with a single risk factor.
Collapse
Affiliation(s)
- Eric Stice
- University of Texas at Austin, 1 University Station A8000, Austin, TX 78712, USA.
| | | | | |
Collapse
|
50
|
Risk factors for onset of eating disorders: evidence of multiple risk pathways from an 8-year prospective study. Behav Res Ther 2011; 49:622-7. [PMID: 21764035 DOI: 10.1016/j.brat.2011.06.009] [Citation(s) in RCA: 347] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/21/2011] [Accepted: 06/21/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Use classification tree analysis with lagged predictors to determine empirically derived cut-points for identifying adolescent girls at risk for future onset of threshold, subthreshold, and partial eating disorders and test for interactions between risk factors that may implicate qualitatively distinct risk pathways. METHOD Data were drawn from a prospective study of 496 adolescent girls who completed diagnostic interviews and surveys annually for 8 years. RESULTS Body dissatisfaction emerged as the most potent predictor; adolescent girls in the upper 24% of body dissatisfaction showed a 4.0-fold increased incidence of eating disorder onset (24% vs. 6%). Among participants in the high body dissatisfaction branch, those in the upper 32% of depressive symptoms showed a 2.9-fold increased incidence of onset (43% vs. 15%). Among participants in the low body dissatisfaction branch, those in the upper 12% of dieting showed a 3.6-fold increased incidence onset (18% vs. 5%). CONCLUSION This three-way interaction suggests a body dissatisfaction pathway to eating disorder onset that is amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies. It may be possible to increase the effectiveness of prevention programs by targeting each of these qualitatively distinct risk groups, rather than only individuals with a single risk factor.
Collapse
|