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Danielsen YS, Årdal Rekkedal G, Frostad S, Kessler U. Effectiveness of enhanced cognitive behavioral therapy (CBT-E) in the treatment of anorexia nervosa: a prospective multidisciplinary study. BMC Psychiatry 2016; 16:342. [PMID: 27716162 PMCID: PMC5053175 DOI: 10.1186/s12888-016-1056-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/29/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a debilitating psychiatric disorder associated with a wide array of negative health complications and psychiatric comorbidity. Existing evidence for AN treatment in adults is weak, and no empirically supported treatment has been reliably established. The primary objective of this study is to gain knowledge about the effectiveness of enhanced cognitive behavioral therapy (CBT-E) for anorexia nervosa delivered in a public hospital setting. Baseline predictors of treatment outcome and dropout are studied. Furthermore, there will be collected blood and stool samples for a general biobank to be able to initiate research on possible pathophysiological mechanisms underlying AN. METHODS The study will assess the potency of outpatient CBT-E in a sample of patients suffering from AN (age >16) admitted to the Section for Eating Disorders at the Department for Psychosomatic Medicine, Haukeland University Hospital in Bergen, Norway. The study has a longitudinal design with five main assessment time points: before treatment, at 3 months, at the end of treatment, at 20 weeks, and at 12 months follow-up including biobank samples. A control group without an eating disorder will also be recruited. DISCUSSION Treatment research in a public hospital setting is important for gaining knowledge about the transportability of treatments evaluated in research clinics into ordinary clinical practice. Furthermore, biological material from the thoroughly described patient cohort will serve as a basis for further research on the pathophysiological mechanisms in AN. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02745067 . Registered 14 April 2016. .
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Affiliation(s)
- Yngvild S. Danielsen
- Department of Clinical Psychology, University of Bergen, Christiesgt.12, Po.box. 7800, 5021 Bergen, Norway
| | - Guro Årdal Rekkedal
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
| | - Stein Frostad
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
| | - Ute Kessler
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
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Caring for Patients With Severe and Enduring Eating Disorders (SEED): Certification, Harm Reduction, Palliative Care, and the Question of Futility. J Psychiatr Pract 2016; 22:313-20. [PMID: 27427843 DOI: 10.1097/pra.0000000000000160] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anorexia nervosa is a serious mental illness with a high mortality rate. The body image distortion inherent to this disorder and the impaired judgment and cognition due to malnutrition frequently result in patients refusing treatment. Treatment is most effective if patients are treated early in the course of their illness and undergo a full course of treatment. Involuntary treatment may therefore be both life-saving and critical to recovery. Between April 2012 and March 2016, 109 patients (5.2% of patients admitted to the Eating Recovery Center in Denver, CO) were certified, 39% of whom were transferred from the ACUTE Center for Eating Disorders at Denver Health Medical Center. Of these 109 certified patients, 31% successfully completed treatment, and 42% returned for a further episode of care; 24% of the certifications were terminated as involuntary treatment was not found to be helpful. Conclusions supported by these data are that patients with anorexia nervosa who are the most medically ill often require involuntary treatment. In addition, although many patients who are certified successfully complete treatment, involuntary treatment is not helpful approximately 25% of the time. Many of the patients for whom certification is ineffective are those who suffer from a lifetime of illness that is severe and enduring. Patients with severe and enduring eating disorders (SEED) typically undergo cyclical weight restoration and weight loss. Many of these patients question the value of serial treatments, especially when they have few (if any) illness-free intervals. Patients, families, and treating physicians often wish to explore other models of care, including harm reduction and palliative care. In addition, patients with SEED may also contemplate whether a compassionate death would be better than an ongoing lifetime of suffering. In this review, we outline arguments for and against the concept of futility in SEED, and explore whether (or when) patients are competent to make the decision to die.
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Dimitropoulos G, Herschman J, Toulany A, Steinegger C. A qualitative study on the challenges associated with accepting familial support from the perspective of transition-age youth with eating disorders. Eat Disord 2016. [PMID: 26212112 DOI: 10.1080/10640266.2015.1064276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to identify types of family support desired by young adults with eating disorders during the transfer of care from paediatric to adult eating disorders programs. Using constant comparative analysis, two salient themes from qualitative interviews with 15 young adults were identified: (a) uncertainty about the role of parents in maintaining recovery during the transfer; and (b) the need for parental support, defined as assistance with eating and maintenance of recovery. Young adults voiced that parental emotional involvement and assistance with navigating adult care services is critical to their successful transfer between the two systems of care.
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Affiliation(s)
- Gina Dimitropoulos
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada.,b Eating Disorders Program , University Health Network , Toronto , Ontario , Canada.,c Faculty of Social Work , Department of Psychiatry, University of Calgary , Calgary , Alberta , Canada
| | - Jessica Herschman
- d Department of Paediatrics , University of Toronto , Toronto , Ontario , Canada
| | - Alene Toulany
- d Department of Paediatrics , University of Toronto , Toronto , Ontario , Canada.,e Division of Adolescent Medicine , Department of Paediatrics, The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Cathleen Steinegger
- d Department of Paediatrics , University of Toronto , Toronto , Ontario , Canada.,e Division of Adolescent Medicine , Department of Paediatrics, The Hospital for Sick Children , Toronto , Ontario , Canada
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Schreyer CC, Coughlin JW, Makhzoumi SH, Redgrave GW, Hansen JL, Guarda AS. Perceived coercion in inpatients with Anorexia nervosa: Associations with illness severity and hospital course. Int J Eat Disord 2016; 49:407-12. [PMID: 26578421 DOI: 10.1002/eat.22476] [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: 07/10/2015] [Revised: 09/22/2015] [Accepted: 09/28/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of coercion in the treatment for anorexia nervosa (AN) is controversial and the limited studies to date have focused on involuntary treatment. However, coercive pressure for treatment that does not include legal measures is common in voluntarily admitted patients with AN. Empirical data examining the effect of non-legal forms of coerced care on hospital outcomes are needed. METHOD Participants (N = 202) with AN, Avoidant/Restrictive Food Intake Disorder (ARFID), or subthreshold AN admitted to a hospital-based behavioral specialty program completed questionnaires assessing illness severity and perceived coercion around the admissions process. Hospital course variables included inpatient length of stay, successful transition to a step-down partial hospitalization program, and achievement of target weight prior to program discharge. RESULTS Higher perceived coercion at admission was associated with increased drive for thinness and body dissatisfaction, but not with admission BMI. Perceived coercion was not related to inpatient length of stay, rate of weight gain, or achievement of target weight although it was predictive of premature drop-out prior to transition to an integrated partial hospitalization program. DISCUSSION These results, from an adequately powered sample, demonstrate that perceived coercion at admission to a hospital-based behavioral treatment program was not associated with rate of inpatient weight gain or achieving weight restoration, suggesting that coercive pressure to enter treatment does not necessarily undermine formation of a therapeutic alliance or clinical progress. Future studies should examine perceived coercion and long-term outcomes, patient views on coercive pressures, and the effect of different forms of leveraged treatment.
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Affiliation(s)
- Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, Maryland, 21287
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, Maryland, 21287
| | - Saniha H Makhzoumi
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Catonsville, Maryland, 21250
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, Maryland, 21287
| | - Jennifer L Hansen
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, Maryland, 21287
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 101, Baltimore, Maryland, 21287
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Westmoreland P, Krantz MJ, Mehler PS. Medical Complications of Anorexia Nervosa and Bulimia. Am J Med 2016; 129:30-7. [PMID: 26169883 DOI: 10.1016/j.amjmed.2015.06.031] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 11/19/2022]
Abstract
Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.
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Affiliation(s)
| | - Mori J Krantz
- Cardiology Division, Denver Health Medical Center, Denver, Colo; Department of Medicine, University of Colorado Health Sciences Center, Denver
| | - Philip S Mehler
- Eating Recovery Center of Denver, Denver, Colo; Department of Medicine, University of Colorado Health Sciences Center, Denver; ACUTE at Denver Health, Denver Health Medical Center, Denver, Colo.
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Martinez MA, Craighead LW. Toward Person(ality)-Centered Treatment: How Consideration of Personality and Individual Differences in Anorexia Nervosa May Improve Treatment Outcome. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2015. [DOI: 10.1111/cpsp.12111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Griffiths S, Mond JM, Murray SB, Touyz S. Positive beliefs about anorexia nervosa and muscle dysmorphia are associated with eating disorder symptomatology. Aust N Z J Psychiatry 2015; 49:812-20. [PMID: 25690746 DOI: 10.1177/0004867415572412] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The ego-syntonic nature of anorexia nervosa means that sufferers often deny their symptoms or experience them as positive or comforting. Positive beliefs about eating disorder symptoms may contribute to the development and/or maintenance of eating-disordered behaviour. To date, however, research in this field has been confined to women and anorexia nervosa. Given increasing scientific interest in muscle dysmorphia, a potential eating disorder with ego-syntonic qualities, there is a need to extend current research to include men and muscle dysmorphia. The present study examined whether positive beliefs about anorexia nervosa and muscle dysmorphia were associated with more marked eating disorder symptoms and explored sex differences in these associations. METHOD Male and female university students (n = 492) read descriptions of a male or female character with clinically significant symptoms of anorexia nervosa or muscle dysmorphia. Participants subsequently answered questions about the characters and completed a measure of disordered eating. Knowledge, personal history and interpersonal familiarity with the conditions were assessed. RESULTS Results from two simultaneous multiple regressions showed that more positive beliefs about anorexia nervosa and muscle dysmorphia were uniquely associated with more eating disorder symptoms for both male and female participants. Effect sizes for these relationships were medium to large (partial eta-squared = 0.09-0.10). The relationships were not moderated by the sex of the participant, nor the sex of the character. CONCLUSIONS Although preliminary, these findings suggest that, among young men and women, positive beliefs about anorexia nervosa and muscle dysmorphia may contribute to the development and maintenance of these conditions. Some symptoms of muscle dysmorphia may be perceived as ego-syntonic, providing another parallel with anorexia nervosa.
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Affiliation(s)
- Scott Griffiths
- School of Psychology, University of Sydney, Sydney, Australia
| | - Jonathan M Mond
- Department of Psychology, Macquarie University, Sydney, Australia Research School of Psychology, The Australian National University, Canberra, Australia
| | - Stuart B Murray
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
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Guarda AS, Schreyer CC, Boersma GJ, Tamashiro KL, Moran TH. Anorexia nervosa as a motivated behavior: Relevance of anxiety, stress, fear and learning. Physiol Behav 2015; 152:466-72. [PMID: 25846837 DOI: 10.1016/j.physbeh.2015.04.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/02/2015] [Indexed: 12/12/2022]
Abstract
The high comorbidity between anorexia nervosa (AN) and anxiety disorders is well recognized. AN is a motivated behavioral disorder in which habit formation is likely to contribute to the persistence of abnormal eating and exercise behaviors. Secondary alterations in brain circuitry underlying the reward value of food and exercise, along with disturbances in neuroendocrine hunger and satiety signaling arising from starvation and excessive exercise, are likely contributors to the maintenance of anorectic behaviors in genetically vulnerable individuals. The potential role of fear conditioning in facilitating onset of AN, or of impaired fear extinction in contributing to the high relapse rates observed following weight restoration, is of interest. Evidence from animal models of anxiety and human laboratory studies indicate that low estrogen impairs fear extinction. Low estradiol levels in AN may therefore play a role in perpetuating fear of food and fat in recently weight restored patients. Translational models including the activity based anorexia (ABA) rodent model of AN, and neuroimaging studies of fear extinction and conditioning, could help clarify the underlying molecular mechanisms and neurocircuitry involved in food avoidance behaviors in AN. Moreover, the adaptation of novel treatment interventions with efficacy in anxiety disorders may contribute to the development of new treatments for this impairing disorder.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Gretha J Boersma
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Kellie L Tamashiro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Timothy H Moran
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
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Douzenis A, Michopoulos I. Involuntary admission: the case of anorexia nervosa. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2015; 39:31-35. [PMID: 25660351 DOI: 10.1016/j.ijlp.2015.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Involuntary treatment of psychiatric disorders has always been controversial; this is especially true for eating disorders. Patients with anorexia nervosa of life threatening severity frequently refuse psychiatric hospitalization. Ambivalence toward treatment is characteristic of eating disorders and patients are often admitted to inpatient programs under pressure from family and doctors. In this article, we report research on the positive or negative impact of involuntary admission in the treatment of eating disorders, its application and effectiveness as well as the adverse consequences of coercive treatment in eating disorders. A literature review was done. From a total of 134 publications which were retrieved from the literature search, 50 studies were directly relevant to the scope of this review and fulfilled all inclusion criteria. There are trends and arguments for both sides; for and against involuntary treatment in anorexia nervosa. The scientific literature so far is inconclusive, although in the short term, involuntary hospitalization has benefits. This review has also shown that involuntary hospitalization can have adverse long-term consequences for the patient-therapist allegiance. We conclude that in some cases, involuntary treatment can save lives of young patients with anorexia nervosa; however, in other cases, it can break the psychotherapeutic relationship and make the patient abandon treatment. It is the clinician who has to decide for whom and when to approve involuntary treatment or not.
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Affiliation(s)
- Athanasios Douzenis
- Second Department of Psychiatry, Medical School, University of Athens, "Attikon" General Hospital, Athens, Greece
| | - Ioannis Michopoulos
- Second Department of Psychiatry, Medical School, University of Athens, "Attikon" General Hospital, Athens, Greece.
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Hage TW, Rø Ø, Moen A. "Time's up" - staff's management of mealtimes on inpatient eating disorder units. J Eat Disord 2015; 3:13. [PMID: 25861449 PMCID: PMC4389322 DOI: 10.1186/s40337-015-0052-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refeeding and normalizing eating behaviour are main treatment aims for individuals admitted to inpatient eating disorder units. Consequently, mealtime activities are specific, everyday activities, serving a clear therapeutic purpose, despite numerous challenges for both staff and patients. Few studies have specifically addressed staff involvement, interactions, and management activities to structure mealtimes. In this study, we investigated the structure of mealtime activities on inpatient eating disorder units, and identified associated staff behaviour. METHODS Descriptive and exploratory qualitative study using video observations to investigate the structure of mealtimes and staff management of mealtime activities. Forty main meals were video recorded and the observational data were analysed using interaction analysis. RESULTS An initial analysis during data screening identified three main parts of the meal: 'pre-eating', 'eating', and 'meal completion'. For each part, a regular pattern of activities occurred which were associated with staff behaviour. CONCLUSIONS Increased awareness amongst staff regarding how they manage the meal and act through a clear internal structure can help staff members to further explore their behaviours and collaboration during mealtimes, and also contribute to improved interaction with patients during the various phases of the meal.
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Affiliation(s)
- Trine Wiig Hage
- Institute for Health and Society, University of Oslo, Oslo, Norway ; Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Moen
- Institute for Health and Society, University of Oslo, Oslo, Norway
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Abstract
BACKGROUND Patient-controlled admission is a concept that invites patients with long-term mental illness to decide for themselves when inpatient treatment is necessary without a clinician serving as gatekeeper. AIM To review the current knowledge of patient-controlled hospital admission in adult psychiatry. METHOD A systematic literature search was conducted in PubMed/MEDLINE, EMBASE and the Cochrane Library with the aim of identifying all relevant scientific papers from 1990 onwards. RESULTS Six articles reporting on four different study sites were identified. Detailed account of the models is given and quantitative and qualitative outcome data is reviewed. Rationales behind the concept include increased patient autonomy, promotion of coping skills, early help-seeking, avoidance of power struggles, establishment of an asylum function, reduced time spent in inpatient care and prevention of coercive measures. Quantitative data points toward a dramatic reduction of total time spent in inpatient care and of involuntary admissions in patients with previously high inpatient care consumption, whereas qualitative data indicates that the concept increases patient autonomy, responsibility and confidence in daily life. CONCLUSION Patient-controlled admission is a promising novel approach to inpatient care in psychiatry. However, available studies are small and quality of evidence is generally low.
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Affiliation(s)
- Mattias Strand
- a Mattias Strand, M.D., Stockholm Centre for Eating Disorders, Stockholm, and Centre for Psychiatry Research, Department of Clinical Neuroscience , Karolinska Institute , Stockholm , Sweden
| | - Yvonne von Hausswolff-Juhlin
- b Yvonne von Hausswolff-Juhlin, M.D., Ph.D., Stockholm Centre for Eating Disorders, Stockholm, and Centre for Psychiatry Research, Department of Clinical Neuroscience , Karolinska Institute , Stockholm , Sweden
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Quality of life in eating disorders: a meta-analysis. Psychiatry Res 2014; 219:1-9. [PMID: 24857566 DOI: 10.1016/j.psychres.2014.05.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 05/01/2014] [Accepted: 05/03/2014] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) comprise a variety of symptoms and have a profound impact on everyday life. They are associated with high morbidity and mortality. The objective of this study was to analyse published data on health-related quality of life (HRQoL) in EDs so as to compare the results to general population norm data and to investigate potential differences between ED diagnostic groups. A systematic review of the current literature was conducted using a keyword-based search in PubMed and PsychInfo. The search covered anorexia nervosa (AN), bulimia nervosa (BN), eating disorders not otherwise specified (EDNOS) and binge eating disorder (BED) and used the Medical Outcomes Study Short Form-36 Health Survey (SF-36) as a measure of HRQoL. Of the 102 citations identified, 85 abstracts were reviewed and seven studies were included in the meta-analysis. AN patients were included in five studies (n=227), BN in four studies (n=216), EDNOS in two studies (n=166) and BED in four studies (n=148). We tested for between-study variation and significant differences between the diagnostic groups. The results confirmed a significantly lower level of HRQoL in all EDs compared to a population mean. It was not possible to establish any differences between the diagnostic groups.
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Weigel A, Rossi M, Wendt H, Neubauer K, von Rad K, Daubmann A, Romer G, Löwe B, Gumz A. Duration of untreated illness and predictors of late treatment initiation in anorexia nervosa. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-014-0642-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Smith AR, Joiner TE, Dodd DR. Examining implicit attitudes toward emaciation and thinness in anorexia nervosa. Int J Eat Disord 2014; 47:138-47. [PMID: 24488837 DOI: 10.1002/eat.22210] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/08/2013] [Accepted: 09/19/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine if females with anorexia nervosa (AN) associate emaciation with beauty by examining implicit attitudes toward emaciated bodies relative to thin bodies. METHOD Thirty women with AN and 29 healthy control women were primed by viewing images of either emaciated or thin women. Participants then completed a lexical decision task (LDT), wherein they distinguished words from nonwords as quickly and accurately as possible. Response times were measured. Real words consisted of beautiful, ugly, neutral, and positive words. Body mass index (BMI) was measured and several clinical interviews were completed, including the Eating Disorders Examination Questionnaire 4 (EDEQ-4). RESULTS There was a significant effect of group in the emaciated condition; participants with AN responded faster to both beautiful and ugly words than control women did. Eating disorder symptom severity (as measured by the EDEQ-4 subscales) predicted the strength of the association between emaciation and beauty. DISCUSSION At an implicit, automatic level, women with AN in this study had stronger associations between emaciation and both beauty and ugliness than control women did, suggesting that women with AN may have atypical beliefs about beauty. Thin ideal internalization is an important factor in the development and maintenance of eating disorders; the type of thin ideal being internalized may be important to consider, particularly given the extent to which pro-eating disorder websites promote idealization of emaciation. The associations found by using the LDT highlight the utility of implicit measures, particularly when conducting assessments involving sensitive or atypical beliefs.
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Affiliation(s)
- April R Smith
- Department of Psychology, Miami University, Oxford, Ohio
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Marzola E, Nasser JA, Hashim SA, Shih PAB, Kaye WH. Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. BMC Psychiatry 2013; 13:290. [PMID: 24200367 PMCID: PMC3829207 DOI: 10.1186/1471-244x-13-290] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/08/2013] [Indexed: 02/08/2023] Open
Abstract
Restoration of weight and nutritional status are key elements in the treatment of anorexia nervosa (AN). This review aims to describe issues related to the caloric requirements needed to gain and maintain weight for short and long-term recovery for AN inpatients and outpatients.We reviewed the literature in PubMed pertaining to nutritional restoration in AN between 1960-2012. Based on this search, several themes emerged: 1. AN eating behavior; 2. Weight restoration in AN; 3. Role of exercise and metabolism in resistance to weight gain; 3. Medical consequences of weight restoration; 4. Rate of weight gain; 5. Weight maintenance; and 6. Nutrient intake.A fair amount is known about overall caloric requirements for weight restoration and maintenance for AN. For example, starting at 30-40 kilocalories per kilogram per day (kcal/kg/day) with increases up to 70-100 kcal/kg/day can achieve a weight gain of 1-1.5 kg/week for inpatients. However, little is known about the effects of nutritional deficits on weight gain, or how to meet nutrient requirements for restoration of nutritional status.This review seeks to draw attention to the need for the development of a foundation of basic nutritional knowledge about AN so that future treatment can be evidenced-based.
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Affiliation(s)
- Enrica Marzola
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Jennifer A Nasser
- Department of Nutrition Sciences, Drexel University, 19102 Philadelphia, PA, USA
| | - Sami A Hashim
- Department of Medicine, St. Luke's/Roosevelt Hospital Center, 10025 New York, NY, USA
| | - Pei-an Betty Shih
- UCSD Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C – 207 La Jolla, 92037 San Diego, CA, USA
| | - Walter H Kaye
- UCSD Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C – 207 La Jolla, 92037 San Diego, CA, USA
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Abbate-Daga G, Amianto F, Delsedime N, De-Bacco C, Fassino S. Resistance to treatment and change in anorexia nervosa [corrected]: a clinical overview. BMC Psychiatry 2013; 13:294. [PMID: 24199620 PMCID: PMC3879222 DOI: 10.1186/1471-244x-13-294] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 10/25/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current literature on Eating Disorders (EDs) is devoid of evidence-based findings providing support to effective treatments, mostly for anorexia nervosa (AN). This lack of successful guidelines may play a role in making these disorders even more resistant. In fact, many individuals do not respond to the available treatments and develop an enduring and disabling illness. With this overview we aimed to highlight and discuss treatment resistance in AN--with an in-depth investigation of resistance-related psychological factors.A literature search was conducted on PubMed and PsychINFO; English-language articles published between 1990 and 2013 investigating the phenomenon of resistance to treatment in AN have been considered. DISCUSSION The selected papers have been then grouped into four main thematic areas: denial of illness; motivation to change; maintaining factors and treatment outcome; and therapeutic relationship. Eating symptomatology was found to only partially explain resistance to treatment. The role of duration of illness has been questioned whilst some maintaining factors seemed promising in providing a useful framework for this phenomenon. Emotive and relational aspects have been investigated on their role in resistance as well as therapists' countertransference. SUMMARY Remarkably there has been little research done on resistance to treatment in the ED field, in spite of its clinical relevance. Motivation, insight and subjective meaning of the illness can be useful tools to manage the resistance phenomenon when coupled with a wider approach. The latter enables the therapists to be aware of their role in the therapeutic alliance through countertransference aspects and to consider the EDs as disorders of the development of both personality and self, entailing severe impairments as regards identity and relationships.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Nadia Delsedime
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Carlotta De-Bacco
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
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Gregorowski C, Seedat S, Jordaan GP. A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders. BMC Psychiatry 2013; 13:289. [PMID: 24200300 PMCID: PMC4226257 DOI: 10.1186/1471-244x-13-289] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/31/2013] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Research has shown that eating disorder (ED) patients who abuse substances demonstrate worse ED symptomatology and poorer outcomes than those with EDs alone, including increased general medical complications and psychopathology, longer recovery times, poorer functional outcomes and higher relapse rates. This article provides a broad overview of the prevalence, aetiology, assessment and management of co-morbid EDs and substance use disorders (SUDs). REVIEW The co-occurrence of EDs and SUDs is high. The functional relationship between EDs and SUDs vary within and across ED subtypes, depends on the class of substance, and needs to be carefully assessed for each patient. Substances such as caffeine, tobacco, insulin, thyroid medications, stimulants or over the counter medications (laxatives, diuretics) may be used to aid weight loss and/or provide energy, and alcohol or psychoactive substances could be used for emotional regulation or as part of a pattern of impulsive behaviour. A key message conveyed in the current literature is the importance of screening and assessment for co-morbid SUDs and EDs in patients presenting with either disorder. There is a paucity of treatment studies on the management of co-occurring EDs and SUDs. Overall, the literature indicates that the ED and SUD should be addressed simultaneously using a multi-disciplinary approach. The need for medical stabilization, hospitalization or inpatient treatment needs to be assessed based on general medical and psychiatric considerations. Common features across therapeutic interventions include psycho-education about the aetiological commonalities, risks and sequelae of concurrent ED behaviours and substance abuse, dietary education and planning, cognitive challenging of eating disordered attitudes and beliefs, building of skills and coping mechanisms, addressing obstacles to improvement and the prevention of relapse. Emphasis should be placed on building a collaborative therapeutic relationship and avoiding power struggles. Cognitive behavioural therapy has been frequently used in the treatment of co-morbid EDs and SUDs, however there are no randomized controlled trials. More recently evidence has been found for the efficacy of dialectical behavioural therapy in reducing both ED and substance use behaviours. CONCLUSION Future research would benefit from a meta-analysis of the current research in order to better understand the relationships between these two commonly co-occurring disorders.
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Affiliation(s)
- Claire Gregorowski
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Gerhard P Jordaan
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
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Merwin RM, Zucker NL, Timko CA. A Pilot Study of an Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa. COGNITIVE AND BEHAVIORAL PRACTICE 2013; 20:485-500. [PMID: 27307691 PMCID: PMC4905735 DOI: 10.1016/j.cbpra.2012.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of adolescent anorexia nervosa (AN) has improved significantly with the increased emphasis on family-based intervention. Yet despite advances, a substantial number of adolescents do not respond optimally to existing treatment models and thus there is a need for treatment alternatives that address barriers to recovery. We developed and piloted an acceptance-based separated family treatment (ASFT) with 6 adolescents with AN or subthreshold AN (eating disorder not otherwise specified, with the primary symptoms of restriction and severe weight loss). Treatment acceptability was adequate. Overall, parents rated the treatment as credible and expected improvement in their child's condition. Five of the 6 adolescents treated with ASFT restored weight to their ideal body mass index as indicated by age, height, and sex and determined by individual growth charts. Many demonstrated improved psychological health and adaptive functioning. There was evidence of broad effects, with parents reporting decreased anxiety and caregiver burden. ASFT holds promise as a treatment option for AN. The efficacy of this therapeutic approach should be tested in larger trials and compared to current family-based interventions to determine unique effects.
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Oudijn MS, Storosum JG, Nelis E, Denys D. Is deep brain stimulation a treatment option for anorexia nervosa? BMC Psychiatry 2013; 13:277. [PMID: 24175936 PMCID: PMC4229382 DOI: 10.1186/1471-244x-13-277] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 10/22/2013] [Indexed: 11/10/2022] Open
Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity, comorbidity and mortality, which in a subset of patients (21%) takes on a chronic course. Since an evidence based treatment for AN is scarce, it is crucial to investigate new treatment options, preferably focused on influencing the underlying neurobiological mechanisms of AN. The objective of the present paper was to review the evidence for possible neurobiological correlates of AN, and to hypothesize about potential targets for Deep brain stimulation (DBS) as a treatment for chronic, therapy-refractory AN. One avenue for exploring new treatment options based on the neurobiological correlates of AN, is the search for symptomatologic and neurobiologic parallels between AN and other compulsivity- or reward-related disorders. As in other compulsive disorders, the fronto-striatal circuitry, in particular the insula, the ventral striatum (VS) and the prefrontal, orbitofrontal, temporal, parietal and anterior cingulate cortices, are likely to be implicated in the neuropathogenesis of AN. In this paper we will review the few available cases in which DBS has been performed in patients with AN (either as primary diagnosis or as comorbid condition). Given the overlap in symptomatology and neurocircuitry between reward-related disorders such as obsessive compulsive disorder (OCD) and AN, and the established efficacy of accumbal DBS in OCD, we hypothesize that DBS of the nucleus accumbens (NAc) and other areas associated with reward, e.g. the anterior cingulated cortex (ACC), might be an effective treatment for patients with chronic, treatment refractory AN, providing not only weight restoration, but also significant and sustained improvement in AN core symptoms and associated comorbidities and complications. Possible targets for DBS in AN are the ACC, the ventral anterior limb of the capsula interna (vALIC) and the VS. We suggest conducting larger efficacy studies that also explore the functional effects of DBS in AN.
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Affiliation(s)
- Marloes S Oudijn
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105, AZ Amsterdam, the Netherlands
| | - Jitschak G Storosum
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105, AZ Amsterdam, the Netherlands
| | - Elise Nelis
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105, AZ Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105, AZ Amsterdam, the Netherlands.
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Gorse P, Nordon C, Rouillon F, Pham-Scottez A, Revah-Levy A. Subjective motives for requesting in-patient treatment in female with anorexia nervosa: a qualitative study. PLoS One 2013; 8:e77757. [PMID: 24204951 PMCID: PMC3808348 DOI: 10.1371/journal.pone.0077757] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/08/2013] [Indexed: 11/18/2022] Open
Abstract
Background Anorexia nervosa is a severe psychiatric disorder mainly affecting women. Its treatment is long and accepted with much difficulty, in particular in-patient treatment. Aims To describe the subjective motives of women with anorexia nervosa for requesting in-patient admission, from a qualitative analysis of application letters. Methods Participants were adult women (18 years and older) with anorexia nervosa who were admitted as in-patients in a referral hospital unit in France from January 2008 to December 2010. The application letters, prerequisites to admission, were studied by the interpretative phenomenological method of content analysis. Results 63 letters have been analysed, allowing the identification of six themes related to requests for in-patient care: loss of control of behaviour, and of thoughts, mental exhaustion, isolation, inner struggle and fear of recovery. Conclusions Requests for in-patient admission were motivated by very personal, subjective experiences, unrelated to medical reasons for admission. These results may help improve pre-admission motivational work with individuals, by basing it on their subjective experience.
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Affiliation(s)
- Pauline Gorse
- Department of Adult Psychiatry, CMME, Sainte-Anne University Hospital, Paris, France
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Huke V, Turk J, Saeidi S, Kent A, Morgan JF. Autism Spectrum Disorders in Eating Disorder Populations: A Systematic Review. EUROPEAN EATING DISORDERS REVIEW 2013; 21:345-51. [DOI: 10.1002/erv.2244] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Andy Kent
- St George's, University of London; London; UK
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Zugai J, Stein-Parbury J, Roche M. Effective nursing care of adolescents with anorexia nervosa: a consumer perspective. J Clin Nurs 2013; 22:2020-9. [PMID: 23398386 DOI: 10.1111/jocn.12182] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2012] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To establish how nurses ensure weight gain and a positive inpatient experience for the treatment of adolescents with anorexia nervosa by considering consumer perspectives. BACKGROUND Consumer perspective literature indicates approval and dissatisfaction with certain aspects of the inpatient experience, and there is a limited understanding of what consumers perceive to be effective nursing practice. DESIGN The design of this study was qualitative, the data being interpreted with a thematic analysis. METHODS This study sought the perspectives of eight (n = 8) recovered consumers through semi-structured interviews. RESULTS Nurses were considered highly influential over the inpatient experience. The findings of this study are characterised by three overall themes regarding nursing practice: (1) ensuring weight gain, (2) maintaining a therapeutic milieu, and (3) the nursing relationship. CONCLUSIONS Consumers have clear perspectives of how nurses effectively ensure weight gain and how nurses ensure a positive inpatient experience. The quality of relationships between consumers and nurses had implications for both weight gain and the perceived quality of the inpatient experience. By relying on the strength of positive, thoughtful and well-timed interactions, nurses may contribute to productive physical outcomes and a positive inpatient experience. Consumers indicated that motivation to adhere to care was derived from strong relationships with nurses. Ensuring both weight gain and a positive experience involves achieving a productive 'balance of restrictions'. Consumers also valued nurses that created a comfortable and productive environment. RELEVANCE TO CLINICAL PRACTICE This study indicates that the process of weight gain may be enhanced when accompanied by a process of therapeutic engagement. Therapeutic alliance may be an effective way for nurses to ensure weight gain and an enhanced inpatient experience. Therapeutically beneficial relationships may enhance treatment and possibly enhance outcomes for consumers.
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Affiliation(s)
- Joel Zugai
- University of Technology, Sydney, Cherrybrook, NSW, Australia.
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Weiss CV, Mills JS, Westra HA, Carter JC. A preliminary study of motivational interviewing as a prelude to intensive treatment for an eating disorder. J Eat Disord 2013; 1:34. [PMID: 24999413 PMCID: PMC4081789 DOI: 10.1186/2050-2974-1-34] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/12/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Engaging patients with an eating disorder in change is difficult and intensive treatment programs have high drop-out rates. The purpose of the study was to determine whether Motivational Interviewing (MI) in the form of a brief, pre-treatment intervention would be associated with higher completion rates in subsequent intensive treatment for an eating disorder. Thirty-two participants diagnosed with an eating disorder participated in the study. All participants were on the waitlist for admission to an intensive, hospital-based treatment program. Sixteen participants were randomly assigned to four individual sessions of MI that began prior to entrance into the treatment program (MI condition) and 16 participants were assigned to treatment as usual (control condition). The main outcome was completion of the intensive treatment program. Participants also completed self-report measures of motivation to change. RESULTS Participants in the MI condition were significantly more likely to complete intensive treatment (69% completion rate) than were those in the control condition (31%). CONCLUSIONS MI can be a useful intervention to engage individuals with severe eating disorders prior to participation in intensive treatment. MI as a brief prelude to hospital-based treatment for an eating disorder may help to improve completion rates in such programs. Further research is required to determine the precise therapeutic mechanisms of change in MI.
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Affiliation(s)
- Carmen V Weiss
- Department of Psychiatry, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Jennifer S Mills
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Henny A Westra
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Jacqueline C Carter
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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Abstract
The aim of this study was to compare quality of life in anorexia nervosa patients to that of subjects without eating disorders, with other eating disorders, or with other psychiatric disorders. Results showed reduced quality of life for eating disorder patients, including anorexia nervosa, as compared to normal controls and individuals with other psychiatric disorders; however, whether anorexia nervosa treatment resulted in improved quality of life remains controversial. Furthermore, anorexia nervosa had a modest impact in the physical domain, although this may reflect self-report limitations as well as the psychopathology of the disorder rather than healthy functioning.
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Affiliation(s)
- Rachel Sy
- Department of Psychiatry, University of Hawai'i at Mānoa, Mānoa, Hawai'i, USA
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Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2012. [DOI: 10.1007/s10879-012-9223-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Holsen LM, Lawson EA, Blum J, Ko E, Makris N, Fazeli PK, Klibanski A, Goldstein JM. Food motivation circuitry hypoactivation related to hedonic and nonhedonic aspects of hunger and satiety in women with active anorexia nervosa and weight-restored women with anorexia nervosa. J Psychiatry Neurosci 2012; 37:322-32. [PMID: 22498079 PMCID: PMC3447131 DOI: 10.1503/jpn.110156] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies have provided evidence of food motivation circuitry dysfunction in individuals with anorexia nervosa. However, methodological limitations present challenges to the development of a cohesive neurobiological model of anorexia nervosa. Our goal was to investigate the neural circuitry of appetite dysregulation across states of hunger and satiety in active and weight-restored phases of anorexia nervosa using robust methodology to advance our understanding of potential neural circuitry abnormalities related to hedonic and nonhedonic state and trait. METHODS We scanned women with active anorexia nervosa, weight-restored women with anorexia nervosa and healthy-weight controls on a 3-T Siemens magnetic resonance scanner while they viewed images of high- and low-calorie foods and objects before (premeal) and after (postmeal) eating a 400 kcal meal. RESULTS We enrolled 12 women with active disease, 10 weight-restored women with anorexia nervosa and 11 controls in our study. Compared with controls, both weight-restored women and those with active disease demonstrated hypoactivity premeal in the hypothalamus, amygdala and anterior insula in response to high-calorie foods (v. objects). Postmeal, hypoactivation in the anterior insula persisted in women with active disease. Percent signal change in the anterior insula was positively correlated with food stimuli ratings and hedonic and nonhedonic appetite ratings in controls, but not women with active disease. LIMITATIONS Our findings are limited by a relatively small sample size, which prevented the use of an analysis of variance model and exploration of interaction effects, although our substantial effect sizes of between-group differences suggest adequate power for our statistical analysis approach. Participants taking psychotropic medications were included. CONCLUSION Our data provide evidence of potential state and trait hypoactivations in food motivation regions involved in the assessment of food's reward value and integration of these with interoceptive signalling of one's internal state of well-being, with important relations between brain activity and homeostatic and hedonic aspects of appetite. Our findings give novel evidence of disruption in neurobiological circuits and stress the importance of examining both state and trait characteristics in the investigation of brain phenotypes in individuals with anorexia nervosa.
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Affiliation(s)
- Laura M. Holsen
- Correspondence to: L.M. Holsen, Division of Women’s Health, BC-3, 1620 Tremont St., Boston MA 02120;
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Deep-brain stimulation for anorexia nervosa. World Neurosurg 2012; 80:S29.e1-10. [PMID: 22743198 DOI: 10.1016/j.wneu.2012.06.039] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/25/2012] [Accepted: 06/21/2012] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a complex and severe, sometimes life-threatening, psychiatric disorder with high relapse rates under standard treatment. After decades of brain-lesioning procedures offered as a last resort, deep-brain stimulation (DBS) has come under investigation in the last few years as a treatment option for severe and refractory AN. METHODS AND RESULTS In this jointly written article, Sun et al. (the Shanghai group) report an average of 65% increase in body weight in four severe and refractory patients with AN after they underwent the DBS procedure (average follow-up: 38 months). All patients weighed greater than 85% of expected body weight and thus no longer met the diagnostic criteria of AN at last follow-up. Nuttin et al. (the Leuven group) describe other clinical studies that provide evidence for the use of DBS for AN and further discuss patient selection criteria, target selection, and adverse event of this evolving therapy. CONCLUSION Preliminary results from the Shanghai group and other clinical centers showed that the use of DBS to treat AN may be a valuable option for weight restoration in otherwise-refractory and life-threatening cases. The nature of this procedure, however, remains investigational and should not be viewed as a standard clinical treatment option. Further scientific investigation is essential to warrant the long-term efficacy and safety of DBS for AN.
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Jones M, Völker U, Lock J, Taylor CB, Jacobi C. Family-based early intervention for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2012; 20:e137-43. [PMID: 22438094 DOI: 10.1002/erv.2167] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/16/2012] [Accepted: 02/09/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study explores whether potential risk factors for anorexia nervosa (AN) can be modified by a family-based Internet-facilitated intervention and examines the feasibility, acceptability, and short-term efficacy of the Parents Act Now programme in the USA and Germany. METHOD Forty-six girls aged 11-17 were studied during a 12-month period and evaluated at screening, baseline, and post-intervention. Parents participated in the six-week intervention. RESULTS Twenty-four per cent of girls (n = 791) screened met the risk criteria for AN. Parents accessed the majority of the online sessions and rated the programme favourably. At post-assessment, 16 of 19 participants evidenced reduced risk status. Participants remained stable or increased in ideal body weight and reported decreased eating disorder attitudes and behaviours. DISCUSSION Results suggest that an easily disseminated, brief, online programme with minimal therapist support is feasible, accepted favourably by parents, and may be beneficial for prevention of exacerbation of AN pathology.
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Affiliation(s)
- Megan Jones
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
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Weight suppression as a predictor of weight gain and response to intensive behavioral treatment in patients with anorexia nervosa. Behav Res Ther 2012; 50:266-74. [PMID: 22398152 DOI: 10.1016/j.brat.2012.02.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/09/2012] [Accepted: 02/13/2012] [Indexed: 11/21/2022]
Abstract
Previous studies have documented that weight suppression (a person's highest adult weight minus current weight) predicts weight gain and disordered eating symptoms during treatment of bulimia spectrum disorders, but no research has examined weight suppression in individuals with anorexia nervosa (AN). Thus, this study sought to characterize weight suppression in a large sample of patients with AN (N = 185), and to evaluate whether weight suppression at admission for intensive behavioral treatment predicts weight gain and clinical outcomes at discharge. Weight suppression varied from 0 kg to 78 kg (M [SD] = 17.1 [10.8] kg) in AN patients. Higher levels of weight suppression predicted greater total weight gain, a faster rate of weight gain, and bulimic symptoms during intensive treatment even after controlling for body mass index on admission, length and type of intensive treatment received, restricting versus binge-eating/purging AN subtype, and other predictors of study outcomes. These findings converge with previous research documenting the clinical significance of weight suppression in the treatment of eating disorders. Future work is needed to replicate the current findings, and examine whether weight suppression predicts the course of AN following discharge from intensive treatment.
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Abstract
Animals housed with running wheels and subjected to daily food restriction show paradoxical reductions in food intake and increases in running wheel activity. This phenomenon, known as activity-based anorexia (ABA), leads to marked reductions in body weight that can ultimately lead to death. Recently, ABA has been proposed as a model of anorexia nervosa (AN). AN affects about 8 per 100,000 females and has the highest mortality rate among all psychiatric illnesses. Given the reductions in quality of life, high mortality rate, and the lack of pharmacological treatments for AN, a better understanding of the mechanisms underlying AN-like behavior is greatly needed. This chapter provides basic guidelines for conducting ABA experiments using mice. The ABA mouse model provides an important tool for investigating the neurobiological underpinnings of AN-like behavior and identifying novel treatments.
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Holm JS, Brixen K, Andries A, Hørder K, Støving RK. Reflections on involuntary treatment in the prevention of fatal anorexia nervosa: a review of five cases. Int J Eat Disord 2012; 45:93-100. [PMID: 21344467 DOI: 10.1002/eat.20915] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Involuntary treatment in the prevention of fatal anorexia nervosa (AN) is still controversial. METHOD Five fatal cases of AN were identified out of 1,160 patients who attended a specialized eating disorder unit between 1994 and 2006. Information on inpatient, ambulatory, and emergency room treatment was extracted from a population-based registration system. RESULTS Personality disorders were diagnosed in all five patients and substance abuse in three patients. In all cases, illness duration was more than 10 years and late onset was seen in two cases. None of the deaths were due to suicide. Involuntary hospital admission was instituted for three patients, but only one patient was compulsory detained more than once. Four patients died after having discontinued treatment. DISCUSSION Compulsory treatment may be of crucial importance in the prevention of fatalities in patients with long-standing AN and psychiatric comorbidity who discontinue treatment.
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Affiliation(s)
- Janni Schmidt Holm
- Department of Endocrinology, Center for Eating Disorders, Odense University Hospital, Denmark
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Concurrent validity of the Disordered Eating Questionnaire (DEQ) with the Eating Disorder Examination (EDE) clinical interview in clinical and non clinical samples. Eat Weight Disord 2011; 16:e188-98. [PMID: 22290035 DOI: 10.1007/bf03325131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The aim of the present study was to evaluate the concurrent validity, specificity and sensitivity of the Disordered Eating Questionnaire (DEQ). The DEQ is a brief questionnaire (24 items), that can be used for epidemiological screenings. It addresses face valid questions to evaluate frequency and intensity of disordered eating attitudes and behaviors over a time frame of three months. DESIGN The study was conducted using a cross-sectional design. METHODS The DEQ was completed by 190 eating disordered patients (73 patients with Anorexia, 48 with Bulimia, 11 with Binge Eating Disorder, 48 with Eating Disorders Not Otherwise Specified, 10 recovered patients) and 88 healthy controls. RESULTS In the whole group, DEQ scores were highly correlated with the scores of the Eating Disorder Examination (EDE 12.0D). Sensitivity and specificity were evaluated. In the female subsample, the ROC curves indicate that a cut-off score of 30 allows to obtain a sensitivity of 82% and a specificity of 68%. A formative approach of Structural Equationing Model confirm the construct validity of the instrument. CONCLUSIONS The DEQ confirm to be a valid and reliable instrument, whose sensitivity and specificity is comparable to that of the EAT-40 even though it has fewer items.
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Long S, Wallis D, Leung N, Meyer C. “All eyes are on you”: anorexia nervosa patient perspectives of in-patient mealtimes. J Health Psychol 2011; 17:419-28. [DOI: 10.1177/1359105311419270] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this qualitative study was to investigate in-patient perceptions of mealtimes on eating disorders units. Individual interviews were conducted with 12 women with anorexia nervosa. Using thematic analysis, three themes emerged as important: 1) Mealtime delivery (logistical factors influencing meals); 2) Individual outcomes (cognitions, emotions, behaviours and physical sensations during meals); and 3) Mealtime characteristics (including disengagement, perceived battlegrounds, and a desire for involvement in mealtimes). Future research should focus on areas of treatment delivery identified as important by patients. Recommendations are made regarding mealtime protocols based on patients’ views, with increased recognition of behavioural, cognitive, physical and emotional aspects.
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Affiliation(s)
| | | | - Newman Leung
- Birmingham and Solihull Mental Health Foundation NHS Trust
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Jappe LM, Frank GK, Shott ME, Rollin MD, Pryor T, Hagman JO, Yang TT, Davis E. Heightened sensitivity to reward and punishment in anorexia nervosa. Int J Eat Disord 2011; 44:317-24. [PMID: 21472750 PMCID: PMC3072848 DOI: 10.1002/eat.20815] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study is to test whether females with anorexia nervosa (AN) have increased sensitivity to punishing or rewarding stimuli, behaviors that could drive high self-control and anxious, avoidant behaviors. METHOD Sixty-four females completed the study: 33 control females (CFs, mean age 19.7 years) and 31 females with AN (mean age 19.6 years). Participants completed diagnostic exams, questionnaires for eating disorder severity and personality, and the Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ). RESULTS Females with AN scored higher than CFs on SPSRQ sensitivity to punishment (p < 0.00001) and sensitivity to reward (p = 0.005). Females with AN without anxiety or depression continued to have increased SPSRQ scores compared to CFs. DISCUSSION This is the first study comparing the SPSRQ in females with AN and CFs. Results suggest that reward and punishment sensitivity are increased in females with AN and could be potential trait markers. It is possible that harm-avoidant, anxious behaviors in females with AN are related to this heightened sensitivity.
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Affiliation(s)
- Leah M. Jappe
- Department of Psychiatry, University of Colorado Denver, CO
| | - Guido K.W. Frank
- Department of Psychiatry, University of Colorado Denver, CO,Department of Neuroscience, University of Colorado Denver, CO
| | - Megan E. Shott
- Department of Psychiatry, University of Colorado Denver, CO
| | | | | | | | - Tony T. Yang
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California San Diego, CA
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86
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Vansteelandt K, Pieters G, Vanderlinden J, Probst M. Body dissatisfaction moderates weight curves in the inpatient treatment of Anorexia Nervosa. Int J Eat Disord 2010; 43:694-700. [PMID: 19816861 DOI: 10.1002/eat.20763] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine whether drive for thinness, body dissatisfaction, and restrictive/binge eating-purging subtype at admission moderates the weight curves of patients with Anorexia Nervosa (AN) over the course of inpatient treatment. METHOD The nature of weight curves, individual differences herein and moderating factors are examined in 92 AN patients by means of multilevel modeling. RESULTS The average weight curve of AN patients is characterized by a linear weight increase during treatment that levels off near the end of treatment. Substantial individual differences exist in the shape of patients' weight curves. Patients with stronger body dissatisfaction at admission display a slower linear rate of weight gain over the course of treatment. Neither drive for thinness nor restrictive/binge eating-purging subtype predicted patients' weight curve over the course of treatment. DISCUSSION Body dissatisfaction moderates patients' weight curves over the course of inpatient treatment but more research on factors determining weight curves is needed.
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Affiliation(s)
- Kristof Vansteelandt
- University Psychiatric Center Katholieke Universiteit Leuven--Campus Kortenberg, Katholieke Universiteit Leuven, Belgium.
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87
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Court A, Mulder C, Kerr M, Yuen HP, Boasman M, Goldstone S, Fleming J, Weigall S, Derham H, Huang C, McGorry P, Berger G. Investigating the effectiveness, safety and tolerability of quetiapine in the treatment of anorexia nervosa in young people: a pilot study. J Psychiatr Res 2010; 44:1027-34. [PMID: 20447652 DOI: 10.1016/j.jpsychires.2010.03.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 03/17/2010] [Accepted: 03/18/2010] [Indexed: 11/28/2022]
Abstract
To investigate the safety and tolerability of the atypical antipsychotic quetiapine in anorexia nervosa patients, and to determine the effect of quetiapine treatment on anorexic psychopathology and other key outcome measures including weight and body image, we conducted a naturalistic, open-label, 12-week randomized controlled trial of low-dose (100-400 mg/day) quetiapine treatment versus treatment as usual in 33 anorexia nervosa patients from our Eating Disorder Clinics. To monitor the effects of treatment over the medium term, the participants were then followed up with assessment visits at 6 and 12 months after the end of the treatment phase. Low-dose quetiapine treatment resulted in both psychological and physical improvements, with minimal associated side-effects. Given the overall trend toward improvement that we observed, quetiapine appears to be a promising candidate for the treatment of anorexia nervosa. Further large-scale placebo-controlled clinical trials will be necessary to fully evaluate the benefits of quetiapine treatment for this disorder.
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Affiliation(s)
- Andrew Court
- Orygen Youth Health, Department of Psychiatry, University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
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88
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Experience with activity based anorexia enhances conditioned taste aversion learning in rats. Physiol Behav 2010; 102:51-7. [PMID: 20946908 DOI: 10.1016/j.physbeh.2010.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 10/05/2010] [Accepted: 10/06/2010] [Indexed: 11/21/2022]
Abstract
Activity based anorexia (ABA) is a model that mimics the self-starvation and hyperactivity features of anorexia nervosa (AN). This study investigated whether a history of ABA will enhance food avoidance learning and retard its extinction in female rats. We compared the acquisition and extinction of a conditioned taste aversion (CTA) in naive (ad lib with no access to RW), ABA, and pair-fed to the food intake of ABA (with access to a locked RW) female Sprague-Dawley rats. The CTA conditioning was conducted after the ABA and pair-fed rats had recovered to their pre-food restriction body weights. For the CTA learning, 0.3M sucrose consumption was followed by low doses LiCl (0.009M or 0.018M at 1.33ml/100g of body weight, IP) injection. The results revealed that the ABA rats acquired an aversion to sucrose significantly sooner than the naive controls. Furthermore, they completely avoided sucrose while the naive and pair-fed controls still sampled it by the end of 10 conditioning trials. When extinction was assessed by 1-bottle and 2-bottle tests, the ABA rats extinguished more slowly than the controls. However, the differences in sucrose aversion extinction between the ABA and control rats were only significant in the 1-bottle test. These data suggest that experience with AN-like behaviors results in an acquired aversion to a preferred food sooner and a longer retention of the negative food associations. These findings have implications for understanding the persistence of aberrant eating behaviors in eating disorders.
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89
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Juarascio AS, Forman EM, Herbert JD. Acceptance and commitment therapy versus cognitive therapy for the treatment of comorbid eating pathology. Behav Modif 2010; 34:175-90. [PMID: 20308357 DOI: 10.1177/0145445510363472] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous research has indicated that although eating pathology is prevalent in college populations, both CBT and non-CBT-based therapies achieve only limited effectiveness. The current study examined several questions related to the treatment of eating pathology within the context of a larger randomized controlled trial that compared standard CBT (i.e., Beck's cognitive therapy; CT) with acceptance and commitment therapy (ACT; Hayes, 2004).The results indicated that the two treatments were differentially effective at reducing eating pathology. Specifically, CT produced modest decreases in eating pathology whereas ACT produced large decreases. In addition, a weaker suggestion emerged that ACT was more effective than CT at increasing clinician-rated global functioning among those with eating pathology. These findings suggest that ACT is a useful treatment for disordered eating and potentially, for eating disorders per se.
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90
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Bryden P, Steinegger C, Jarvis D. The Ontario experience of involuntary treatment of pediatric patients with eating disorders. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2010; 33:138-143. [PMID: 20413158 DOI: 10.1016/j.ijlp.2010.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In this paper, the authors (two clinicians with specialized practices in child and adolescent eating disorders and a lawyer who practices health law in Ontario, Canada) review pertinent aspects of clinical capacity assessment, with elaboration of the specific unique and complex issues which shape that assessment in children and adolescents with eating disorders. The relevant Ontario legislation and institutional framework governing consent and capacity in children and adolescents are reviewed. The literature on involuntary treatment and consent and capacity in patients with eating disorders is reviewed. Specific cases involving child and adolescent patients with eating disorders that have been heard by the Ontario Consent and Capacity Board (OCCB) in the past decade are discussed in order to elucidate the Board's views of consent and capacity in this vulnerable and challenging patient population. Strategies to support clinicians' therapeutic alliances with their patients while both are going through what can be a lengthy and potentially adversarial-seeming legal process are also discussed.
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Affiliation(s)
- Pier Bryden
- Department of Psychiatry, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8 Canada
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91
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A pilot study of personality pathology in patients with anorexia nervosa: modifiable factors related to outcome after hospitalization. Eat Weight Disord 2009; 14:e113-20. [PMID: 19934624 DOI: 10.1007/bf03327808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess improvement in aspects of personality in patients hospitalized with anorexia nervosa (AN) and its relationship to improved depression, body mass index (BMI), and eating disorder outcome after treatment. METHOD Twenty females hospitalized with AN completed intake and discharge assessments of BMI, depression and eating disorder severity, as well as personality pathology with the Minnesota Multiphasic Personality Inventory (MMPI-2) and the Revised NEO Personality Inventory (NEO PI-R). Clinical outcome for a subset of patients at 1-year post-hospitalization was determined. RESULTS The only factor that predicted better versus worse outcome at 1-year post-hospitalization was change in Low Self-Esteem (LSE) from the MMPI-2. Improved LSE from admission to discharge predicted remission at 1-year post-hospitalization, while worsening LSE predicted relapse. Regardless of outcome, NEO PI-R Neuroticism remained pathologically elevated in AN patients during hospitalization. DISCUSSION Pathological levels of neuroticism may represent a vulnerability factor for AN. In contrast, self-esteem appears to be a modifiable factor that predicts outcome following hospitalization, and may be an important target for treatment.
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92
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Herpertz-Dahlmann B, Salbach-Andrae H. Overview of treatment modalities in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am 2009; 18:131-45. [PMID: 19014862 DOI: 10.1016/j.chc.2008.07.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this article is to scrutinize and compare the benefits of distinct treatment settings for anorexia nervosa (AN) and to review the different treatment modalities that have proven helpful in the management of young patients with AN. Evidence-based findings on the effect of different treatment methods for AN are limited. Besides different treatment settings, a multimodal treatment approach comprising nutritional rehabilitation, nutritional counseling, individual psychotherapy and family-based interventions emphazising a group psychoeducation program for parents is presented.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Departments of Child and Adolescent Psychiatry and Psychotherapy, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
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93
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Schneider JE. Give food a chance: treating anorexia nervosa without drugs and psychology. Front Neuroendocrinol 2008; 29:520-1. [PMID: 18625268 DOI: 10.1016/j.yfrne.2008.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 06/12/2008] [Accepted: 06/14/2008] [Indexed: 11/30/2022]
Abstract
The eating disorder, anorexia nervosa, is a potentially lethal, leading cause of disability in young women, and a biological perspective on this important problem might further our understanding of the physiological control of energy balance. The article by Södersten, Nergardh, Bergh, Zandian, and Scheurink describes a new treatment for anorexia nervosa with an impressive success rate and without prescription drugs or psychotherapy. Like the cause of the disease, this new method of treatment lacks a firm theoretical foundation based on experimental data. The authors' explanation for their success rate, however, is intriguing. This new treatment is as worthy of study as any of the others now available. I encourage clinicians to give this biological perspective a fair evaluation, and behavioral neuroendocrinologists to consider the implications for physiological control of ingestive and reproductive behavior.
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Affiliation(s)
- Jill E Schneider
- Department of Biological Sciences, Lehigh University, 111 Research Drive, B217 Iacocca Hall, Bethlehem, PA 18015, USA.
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94
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Fox EA. Purdue Ingestive Behavior Research Center symposium 2007: influences on eating and body weight over the lifespan--childhood and adolescence. Physiol Behav 2007; 94:1-7. [PMID: 18155099 DOI: 10.1016/j.physbeh.2007.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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