51
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Berner P, Bezner JR, Morris D, Lein DH. Nutrition in Physical Therapist Practice: Tools and Strategies to Act Now. Phys Ther 2021; 101:6134190. [PMID: 33577673 DOI: 10.1093/ptj/pzab061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/02/2020] [Accepted: 12/31/2020] [Indexed: 02/09/2023]
Abstract
It has been established that physical therapist practice includes screening for and providing information on diet and nutrition to patients, clients, and the community. Yet, an overwhelming amount of often contradictory diet and nutrition information poses a challenge for physical therapists to identify and maintain knowledge that they can rely on to screen for and discuss these topics with their patients, clients, and community members. The purposes of this perspective paper are to summarize the best known screening tools for general health, diet, and nutrition; provide intervention strategies that can be used to support behavior change related to diet and nutrition; and identify the most relevant resources and approaches from which physical therapist clinicians can build skill in addressing the nutritional needs of patients, clients, and the community.
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Affiliation(s)
| | - Janet R Bezner
- Department of Physical Therapy, Texas State University, Round Rock, Texas, USA
| | - David Morris
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Donald H Lein
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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52
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Golden NH, Cheng J, Kapphahn CJ, Buckelew SM, Machen VI, Kreiter A, Accurso EC, Adams SH, Le Grange D, Moscicki AB, Sy AF, Wilson L, Garber AK. Higher-Calorie Refeeding in Anorexia Nervosa: 1-Year Outcomes From a Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-037135. [PMID: 33753542 PMCID: PMC8015147 DOI: 10.1542/peds.2020-037135] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We recently reported the short-term results of this trial revealing that higher-calorie refeeding (HCR) restored medical stability earlier, with no increase in safety events and significant savings associated with shorter length of stay, in comparison with lower-calorie refeeding (LCR) in hospitalized adolescents with anorexia nervosa. Here, we report the 1-year outcomes, including rates of clinical remission and rehospitalizations. METHODS In this multicenter, randomized controlled trial, eligible patients admitted for medical instability to 2 tertiary care eating disorder programs were randomly assigned to HCR (2000 kcals per day, increasing by 200 kcals per day) or LCR (1400 kcals per day, increasing by 200 kcals every other day) within 24 hours of admission and followed-up at 10 days and 1, 3, 6, and 12 months post discharge. Clinical remission at 12 months post discharge was defined as weight restoration (≥95% median BMI) plus psychological recovery. With generalized linear mixed effect models, we examined differences in clinical remission over time. RESULTS Of 120 enrollees, 111 were included in modified intent-to-treat analyses, 60 received HCR, and 51 received LCR. Clinical remission rates changed over time in both groups, with no evidence of significant group differences (P = .42). Medical rehospitalization rates within 1-year post discharge (32.8% [19 of 58] vs 35.4% [17 of 48], P = .84), number of rehospitalizations (2.4 [SD: 2.2] vs 2.0 [SD: 1.6]; P = .52), and total number of days rehospitalized (6.0 [SD: 14.8] vs 5.1 [SD: 10.3] days; P = .81) did not differ by HCR versus LCR. CONCLUSIONS The finding that clinical remission and medical rehospitalization did not differ over 1-year, in conjunction with the end-of-treatment outcomes, support the superior efficacy of HCR as compared with LCR.
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Affiliation(s)
- Neville H. Golden
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jing Cheng
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California
| | - Cynthia J. Kapphahn
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Sara M. Buckelew
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
| | - Vanessa I. Machen
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
| | - Anna Kreiter
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | - Sally H. Adams
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
| | - Daniel Le Grange
- Psychiatry and Behavioral Sciences,,Department of Psychiatry and Behavioral Neuroscience, School of Medicine, The University of Chicago, Chicago, Illinois; and
| | - Anna-Barbara Moscicki
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Allyson F. Sy
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Leslie Wilson
- Medicine, and Clinical Pharmacy, University of California, San Francisco, San Francisco, California
| | - Andrea K. Garber
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
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53
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Instrument Context Relevance Evaluation, Translation, and Psychometric Testing of the Diabetes Eating Problem Survey-Revised (DEPS-R) among People with Type 1 Diabetes in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073450. [PMID: 33810376 PMCID: PMC8037186 DOI: 10.3390/ijerph18073450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022]
Abstract
Background: People with type 1 diabetes are susceptible to disordered eating behaviors. The American Diabetes Association recommends using the Diabetes Eating Problem Survey-Revised (DEPS-R) to screen them. There is no validated diabetes-specific screening measure in China. The objectives were to adapt DEPS-R into Mandarin Chinese and to test its psychometric properties among youths and adults with type 1 diabetes in China, respectively. Methods: This study was conducted in two phases. Phase 1 included context relevance evaluation and instrument translation. Phase 2 was psychometric testing of reliability and construct validity among 89 youths (8~17 years old) and 61 adults with type 1 diabetes. Result: The Context Relevance Index and Translation Validity Index of this instrument were good. Strong internal consistency reliability correlations and convergent validity were demonstrated among youths and adults. Discussion: The Chinese version of the DEPS-R is a valid and reliable tool for screening disordered eating behaviors in Chinese youths and adults with type 1 diabetes. The Context Relevance Index is advocated to evaluate the difference between the context in which an instrument was originally developed and the target context.
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54
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Merker JB, Hill SB, Wolff J, Winternitz SR, Ressler KJ, Kaufman ML, Lebois LAM. Posttraumatic cognitions predict distorted body perceptions in women with dissociative identity disorder. J Psychiatr Res 2021; 134:166-172. [PMID: 33388699 PMCID: PMC7870557 DOI: 10.1016/j.jpsychires.2020.12.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/13/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dissociative identity disorder (DID) is a psychobiological syndrome associated with a history of exposure to childhood abuse and neglect. The consequences of these traumatic events often include a profound impact on the way individuals inhabit and experience their bodies. Despite this, there is a paucity of empirical research on the subject. The aim of this study was to systematically document the occurrence of distorted body perceptions in DID and examine childhood maltreatment, posttraumatic stress disorder (PTSD) symptom severity, and posttraumatic cognitions as predictors of distorted body perceptions in DID. METHODS Participants were adult women with histories of childhood abuse and neglect and a current DID diagnosis receiving treatment at a psychiatric care facility. Data were obtained through a battery of self-report measures, including the Body Uneasiness Test, Childhood Trauma Questionnaire, PTSD Checklist for DMS-5, and Posttraumatic Cognitions Inventory. RESULTS A series of unpaired t-tests documented elevated levels of weight phobia, body image concerns, body avoidance, compulsive self-monitoring, and depersonalization in DID compared to published non-clinical data on the Body Uneasiness Test. A series of multiple regression models including measures of childhood trauma, PTSD symptoms, and posttraumatic cognitions demonstrated that over and above childhood trauma and PTSD symptom severity, posttraumatic cognitions significantly predicted distorted body perceptions. CONCLUSIONS In a treatment-seeking sample of women with DID, distorted body perceptions were elevated. Furthermore, posttraumatic cognitive distortions significantly predicted distorted body perceptions when controlling for childhood maltreatment and PTSD symptom severity. This suggests that distorted cognitions are a key target for therapeutic intervention.
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Affiliation(s)
| | - Sarah B. Hill
- McLean Hospital, Belmont, MA, USA,Department of Psychology, Northern Illinois University
| | - Jonathan Wolff
- McLean Hospital, Belmont, MA, USA,Lynch School of Education and Development, Boston College
| | - Sherry R. Winternitz
- McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kerry J. Ressler
- McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Milissa L. Kaufman
- McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lauren A. M. Lebois
- McLean Hospital, Belmont, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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55
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Otani M, Hiraide M, Horie T, Mitsui T, Yoshida T, Takamiya S, Sakuta R, Usami M, Komaki G, Yoshiuchi K. Psychometric properties of the Eating Disorder Examination-Questionnaire and psychopathology in Japanese patients with eating disorders. Int J Eat Disord 2021; 54:203-211. [PMID: 33368571 DOI: 10.1002/eat.23452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used tools to assess the core psychopathology of eating disorders (ED). However, recent empirical findings did not support the original four-factor structure. The aims of the present study were to investigate the factor structure of the EDE-Q in Japanese ED patients, to test the reliability and convergent validity of the EDE-Q, to examine group differences between various ED groups and healthy participants, and to explore the main behavioral features of Japanese ED patients using the newly developed Japanese version of EDE-Q. METHOD A total of 148 ED patients and 469 healthy participants completed the EDE-Q, Eating Attitudes Test-26 (EAT-26), and Eating Disorder Inventory-2 (EDI-2). The factor structure, reliability, and validity of the EDE-Q were assessed in ED patients. Group differences were assessed using the new Japanese version of the EDE-Q (EDE-Q-J). RESULTS The EDE-Q-J had three factors. Cronbach's alphas ranged from 0.83 to 0.93. Total score and subscale scores of "Dieting" and "Bulimia and Food Preoccupation" of EAT-26 and of "Drive for Thinness," "Body Dissatisfaction," and "Bulimia" of EDI-2 correlated with the global score and three subscale scores of the EDE-Q-J. DISCUSSION For Japanese female ED patients, the EDE-Q-J had three subscales that were not consistent with the original subscales, but were interpretable. It demonstrated sufficient reliability and validity. Japanese female patients with restricting-type anorexia nervosa (AN-R) displayed less dissatisfaction with shape and weight than healthy participants. AN-R patients in Japan might present with a non-fat-phobic symptom profile.
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Affiliation(s)
- Makoto Otani
- Department of Psychosomatic Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Maiko Hiraide
- Department of Psychosomatic Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeshi Horie
- Department of Psychosomatic Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomoyo Mitsui
- Department of Psychology, Faculty of Human Development and Education, Kobe Shinwa Women's University, Kobe, Hyogo, Japan
| | - Toshiyuki Yoshida
- School of Medical Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Shizuo Takamiya
- Department of Psychiatry, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan.,Takamiya Psychiatry Clinic, Akashi, Hyogo, Japan
| | - Ryoichi Sakuta
- Child Development and Psychosomatic Medicine Center, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Gen Komaki
- Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Kazuhiro Yoshiuchi
- Department of Psychosomatic Medicine, The University of Tokyo Hospital, Tokyo, Japan.,Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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56
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Embodiment: Cultural and gender differences and associations with life satisfaction. Body Image 2020; 35:1-10. [PMID: 32877841 DOI: 10.1016/j.bodyim.2020.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/22/2020] [Accepted: 07/10/2020] [Indexed: 01/07/2023]
Abstract
Although cultural factors have an important impact on individuals' experiences of living in their bodies, to date no studies have examined cross-cultural or gender differences in individuals' experience of embodiment. This study compared Swedish and Canadian women's experience of embodiment (and other body image related constructs), as well as Swedish men and women's experience of embodiment. Associations between embodiment, body esteem, and life satisfaction in men and women were also examined. Participants were 302 Swedish women, 242 Swedish men, and 216 Canadian women. Results showed that Swedish women had overall more positive experience of embodiment, more positive body esteem, lower thin-ideal internalization and lower levels of disordered eating than Canadian women. In comparison to Swedish men, however, Swedish women had more negative experience of embodiment in some ways, but similar experience of embodiment in other ways. Although associations between embodiment, body esteem, and life satisfaction were strong, embodiment was a better predictor of life satisfaction than body esteem for both men and women. Results are interpreted through the lens of the developmental theory of embodiment and consider cultural differences between Sweden and Canada, as well as Swedish society's both progress and problems in promoting gender equity.
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57
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Sicilia A, Fuller-Tyszkiewicz M, Rodgers RF, Granero-Gallegos A, Lo Coco G, Dion J, McCabe M, Strodl E, Markey CH, Aimé A, Gullo S, Mellor D, Castelnuovo G, Probst M, Maïano C, Manzoni GM, Beginr C, Blackburn ME, Pietrabissa G, Hayami-Chisuwa N, He Q, Caltabiano M, Alcaraz-Ibánez M. Cross-Country Measurement Invariance and Effects of Sociodemographic Factors on Body Weight and Shape Concern-Related Constructs in Eight Countries. Body Image 2020; 35:288-299. [PMID: 33181385 DOI: 10.1016/j.bodyim.2020.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/31/2020] [Accepted: 09/30/2020] [Indexed: 01/24/2023]
Abstract
The aim of this study was to examine the cross-country invariance of five well-established measures of body weight and shape concern-related attitudes and behaviors (i.e., drive for leanness, drive for muscularity, strategies to increase muscle, strategies to lose weight, and weight and shape concerns). A secondary objective was to examine the effects of several sociodemographic factors (age, BMI, socioeconomic status, and gender) on item and latent factor scores of these constructs. A total of 6272 emerging adults (4218 women; Mage = 21.46, SD = 3.11) from Australia, Belgium, Canada, China, Italy, Japan, Spain, and the U.S. completed a self-report online survey as part of a larger study. Overall, support for partial invariance both across countries and in terms of the considered sociodemographic factors was found for reduced versions of the five measures. Significant differences in latent means were found across countries, these being of greater magnitude for drive for leanness and strategies to lose weight. The considered sociodemographic factors (most notably BMI and gender) were associated with the latent mean scores of the assessed constructs. The present study contributes to current literature by providing cross-cultural invariant versions of several measures of relevance in the field of body image.
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Affiliation(s)
- Alvaro Sicilia
- Health Research Centre and Department of Education, University of Almeria, Ctra de Sacramento, s/n, 04120, Almeria, Spain.
| | | | - Rachel F Rodgers
- Department of Applied Psychology, North Eastern University, 360 Huntington Ave., Boston, MA, 02115, USA and Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France.
| | - Antonio Granero-Gallegos
- Health Research Centre and Department of Education, University of Almeria, Ctra de Sacramento, s/n, 04120, Almeria, Spain.
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Viale delle Sciennze edificio 15, 90128, Palermo, Italy.
| | - Jacinthe Dion
- Department of Health Sciences, Universite du Quebec a Chicoutimi, 555, boul. De l'universite, Chicoutimi, Quebec, G7H 2BI, Canada.
| | - Marita McCabe
- School of Health Sciences, Swinburne University, Burwood Road, Hawthorn, 3122, Australia.
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Victoria Park Rd., Kelvin Grove, Queensland, 4059, Australia.
| | - Charlotte H Markey
- Department of Psychology, Health Sciences Center, Rutgers University, Camden, NJ, 08102, USA.
| | - Annie Aimé
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, 5, Rue Saint-Joseph, Saint-Jérôme, Québec, J7Z 0B7, Canada.
| | - Salvatore Gullo
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Viale delle Sciennze edificio 15, 90128, Palermo, Italy.
| | - David Mellor
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia.
| | - Gianluca Castelnuovo
- Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Strada Cadorna 90, 28824, Oggebbio, VB, Italy; Department of Psychology, Catholic University of Milan, Largo Agostino Gemelli, 1, 20123, Milan, Italy.
| | - Michel Probst
- Dept of Rehabilitation Sciences, KU Leuven, O&N 4 Herestraat 49, 3000, Leuven, Belgium.
| | - Christophe Maïano
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, 5, Rue Saint-Joseph, Saint-Jérôme, Québec, J7Z 0B7, Canada.
| | - Gian Mauro Manzoni
- Department of Psychology, eCampus University, Novedrate, CO, Italy; Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Strada Cadorna 90, 28824, Oggebbio, VB, Italy.
| | - Catherine Beginr
- School of Psychology, Laval University, 2325 Allee des Bibliotheques, Quebec, GIVOA6, Canada.
| | - Marie-Eve Blackburn
- ECOBES-Research and Transfer, Cegep de Jonquiere, 2505, Saint-Hubert Street, Jonquiere, Quebec, Canada.
| | - Giada Pietrabissa
- Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Strada Cadorna 90, 28824, Oggebbio, VB, Italy; Department of Psychology, Catholic University of Milan, Largo Agostino Gemelli, 1, 20123, Milan, Italy.
| | - Naomi Hayami-Chisuwa
- Graduate School of Human Life Sciences, Osaka City University, 3-3-138 Sugimoto Sumiyoshi-ku, Osaka, 558-8585, Japan.
| | - Qiqiang He
- School of Health Sciences, Wuhan University, PR China.
| | - Marie Caltabiano
- School of Psychology, James Cook University, McGregor Road, Smithfield, Queensland, 4870, Australia.
| | - Manuel Alcaraz-Ibánez
- Health Research Centre and Department of Education, University of Almeria, Ctra de Sacramento, s/n, 04120, Almeria, Spain.
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Jenkins PE, Davey E. The brief (seven-item) eating disorder examination-questionnaire: Evaluation of a non-nested version in men and women. Int J Eat Disord 2020; 53:1809-1817. [PMID: 32767481 DOI: 10.1002/eat.23360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Several recent studies have examined the psychometric properties of brief measures of eating disorder attitudes based on the Eating Disorder Examination Questionnaire (EDE-Q). A seven-item version (the EDE-Q7) has been proposed but, as yet, has only been investigated by looking at the items when presented as part of the longer EDE-Q (i.e., as a nested version). The current study presented the EDE-Q7 as a standalone instrument and examined factor structure fit and measurement invariance across male and female genders. METHODS University students (244 women; 155 men; 1 did not identify with either gender) completed questionnaires as part of two independent studies. All individuals completed the EDE-Q7 and measures of eating disorder behaviors. In a mixed-gender subsample (n = 286), measures of depression and eating disorder-specific quality of life were also included. Confirmatory factor analysis of the EDE-Q7 was conducted on males and females independently, in addition to estimates of internal consistency reliability and validity. Measurement invariance was assessed through multigroup confirmatory factor analysis. RESULTS The EDE-Q7 demonstrated good internal consistency and findings supported measurement invariance by gender. In a mixed-gender subsample, the measure showed positive associations with depression and both eating disorder behaviors and eating disorder-specific quality of life. DISCUSSION The present study adds to the literature supporting the psychometric properties of the EDE-Q7, extending this to use of the questionnaire as a standalone instrument. Measurement invariance suggests that the measure may be appropriate for college-age men and women, although future studies should establish psychometric properties more fully.
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Affiliation(s)
- Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Emily Davey
- Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Experimental Psychology, University of Oxford, Oxford, UK
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Gorrell S, Lebow J, Kinasz K, Mitchell JE, Goldschmidt AB, Le Grange D, Accurso EC. Psychotropic medication use in treatment-seeking youth with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:739-749. [PMID: 32926514 DOI: 10.1002/erv.2788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/07/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Psychotropic medication use in youth with eating disorders (EDs) is poorly understood despite high co-occurrence of psychiatric disorders. This study examined characteristics associated with medication use in treatment-seeking youth with EDs. METHOD Youth up to age 18 reported on medication use when presenting to an academic medical center outpatient ED service in the United States. Data presented were collected between 1998-2015. RESULTS The sample (N = 604) was predominantly female (90.6%) with a mean age of 15.3 years (SD = 2.3). Approximately one-third (30%, n = 173) were taking psychotropic medications (40%, n = 70, were taking multiple medications). Antidepressant use was most common (26%, n = 152), followed by atypical antipsychotics (8%, n = 43). Adjusting for co-occurring psychiatric disorders, non-Hispanic Whites who had received prior treatment (psychotherapy, hospitalization) were significantly more likely to be using medication. Longer illness duration and prior treatment were associated with greater antidepressant use. For atypical antipsychotics, prior hospitalization was associated with greater use. CONCLUSIONS Findings confirm moderate psychotropic medication use among young patients with EDs despite a lack of clarity regarding optimally effective pharmacologic interventions in this population. Pharmacological trials examining the efficacy of medications for young patients with EDs are warranted to inform future prescribing practice.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Jocelyn Lebow
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn Kinasz
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - James E Mitchell
- Sanford Biobehavioral Research Institute, Fargo, North Dakota, USA.,School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota, USA
| | - Andrea B Goldschmidt
- Weight Control and Diabetes Research Center, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, California, USA.,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Erin C Accurso
- Department of Psychiatry, University of California, San Francisco, California, USA
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60
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Manasse SM, Murray HB, Parker M, Forman EM, Juarascio AS. A characterization of binge planning behavior in individuals with binge-spectrum eating disorders. Eat Weight Disord 2020; 25:1099-1103. [PMID: 31065976 DOI: 10.1007/s40519-019-00697-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Although binge eating is associated with impulsivity, clinical reports suggest that some individuals with bulimia nervosa (BN) and binge eating disorder (BED) plan binge episodes in advance. This study is the first to examine: (1) the frequency of binge planning (BP; defined as both advanced knowledge that a binge episode will occur and taking steps to facilitate the binge episode); (2) associations of BP with ED severity, and (3) whether BP serves a negative reinforcement function. METHOD Patients with BN- and BED-spectrum eating disorders (EDs; n = 111) were administered semi-structured interview questions regarding BP. RESULTS Results indicate that a substantial minority of patients (27.8%) engage in BP. BP was significantly more common in BN versus BED-spectrum EDs (38.3% versus 20.6%, p = 0.04) and in those who did versus did not endorse self-induced vomiting (50.0% versus 21.3%, p < 0.01). Frequency of BP was positively associated with overall ED psychopathology (r = 0.19, p < 0.05). Exploratory analyses indicated that approximately two-thirds (67.7%) reported that BP served to distract from unpleasant experiences. DISCUSSION BP is present for a significant subset of patients and may play a critical role in the reinforcement cycles of binge eating. Future research should further elucidate the function of BP to inform treatment development.
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Affiliation(s)
- Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.
| | - Helen B Murray
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Megan Parker
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
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61
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Therapist written goodbye letters: evidence for therapeutic benefits in the treatment of anorexia nervosa. Behav Cogn Psychother 2020; 48:419-431. [PMID: 32178754 DOI: 10.1017/s1352465820000089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite their use in clinical practice, there is little evidence to support the use of therapist written goodbye letters as therapeutic tools. However, preliminary evidence suggests that goodbye letters may have benefits in the treatment of anorexia nervosa (AN). AIMS This study aimed to examine whether therapist written goodbye letters were associated with improvements in body mass index (BMI) and eating disorder symptomology in patients with AN after treatment. METHOD Participants were adults with AN (n = 41) who received The Maudsley Model of Anorexia Treatment for Adults (MANTRA) in a clinical trial evaluating two AN out-patient treatments. As part of MANTRA, therapists wrote goodbye letters to patients. A rating scheme was developed to rate letters for structure and quality. Linear regression analyses were used to examine associations between goodbye letter scores and outcomes after treatment. RESULTS Higher quality letters and letters that adopted a more affirming stance were associated with greater improvements in BMI at 12 months. Neither the overall quality nor the style of goodbye letters were associated with improvements in BMI at 24 months or reductions in eating disorder symptomology at either 12 or 24 months. CONCLUSIONS The results highlight the potential importance of paying attention to the overall quality of therapist written goodbye letters in the treatment of AN, and adopting an affirming stance.
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Olofsson ME, Oddli HW, Vrabel KAR, Hoffart A. «In solitude is safeness»: a patient perspective on eating disorders in the context of multiple childhood trauma. NORDIC PSYCHOLOGY 2020. [DOI: 10.1080/19012276.2020.1762714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | - Asle Hoffart
- Department of Psychology, Oslo University, Oslo, Norway
- Modum Bad Research Institute, Vikersund, Norway
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van den Berg E, Melisse B, Koenders J, de Jonge M, Blankers M, de Beurs E, Dekker J. Online cognitive behavioral therapy enhanced for binge eating disorder: study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:190. [PMID: 32349692 PMCID: PMC7189605 DOI: 10.1186/s12888-020-02604-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Binge eating disorder is characterized by recurrent episodes of binge eating accompanied by a sense of lack of control. Of the different treatments available, Cognitive Behavioral Therapy-Enhanced and guided self-help treatment are recommended. As online treatment offers several additional advantages, we have developed a CBT-Enhanced online guided self-help intervention. The aim of this study is to determine whether this intervention reduces eating disorder pathology and increases the amount of binge free days in adults classified with binge eating disorder or other specified feeding or eating disorder- binge eating disorder, compared to an untreated waiting list condition. The experimental condition is hypothesized to be superior to the waiting list condition. METHODS The efficacy of an online guided self-help intervention for binge eating disorder will be assessed by conducting a randomized controlled trial. The trial will target adult individuals classified with binge eating disorder or other specified feeding or eating disorder- binge eating disorder with a body mass index between 19.5 and 40, referred to an eating disorder treatment center. Dual arm allotment will be performed in a 1:1 ratio stratified for BMI above or below 30. Randomization will be blinded to the online intervention (n = 90), or to the control waiting list condition (n = 90). Assessors will be blinded and assessments will be administered at baseline, week 5, at end-of-treatment, and at 12 and 24 weeks follow-up. Primary outcome will be eating disorder pathology, operationalized as number of days on which binge eating occurred between the two conditions during the period of the intervention. Secondary outcome measures will be differences in other eating disorder pathology, clinical impairment and in quality of life, while therapeutic alliance, demographic characteristics and followed treatment module will serve as effect moderators. Several types of costs will be assessed. DISCUSSION This paper presents an online guided self-help Cognitive Behavioral Therapy- Enhanced study protocol for individuals classified with binge eating disorder or other specified feeding or eating disorder. Efficacy will be examined through a Randomized Controlled Trial. TRIAL REGISTRATION The study protocol is registered with the Netherlands Trial Registry NTR (NTR 7994) since 6 September 2019.
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Affiliation(s)
- Elske van den Berg
- Novarum Center for Eating Disorders & Obesity, Jacob Obrechtstraat 92, 1071 KR Amsterdam, the Netherlands
| | - Bernou Melisse
- Novarum Center for Eating Disorders & Obesity, Jacob Obrechtstraat 92, 1071, KR, Amsterdam, the Netherlands.
| | - Jitske Koenders
- Novarum Center for Eating Disorders & Obesity, Jacob Obrechtstraat 92, 1071 KR Amsterdam, the Netherlands
| | - Margo de Jonge
- Novarum Center for Eating Disorders & Obesity, Jacob Obrechtstraat 92, 1071 KR Amsterdam, the Netherlands
| | - Matthijs Blankers
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN Amsterdam, the Netherlands
| | - Edwin de Beurs
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN Amsterdam, the Netherlands ,grid.5132.50000 0001 2312 1970Section Clinical Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, the Netherlands
| | - Jack Dekker
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN Amsterdam, the Netherlands
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Dzombak JW, Haynos AF, Rienecke RD, Van Huysse JL. Brief report: Differences in nonsuicidal self-injury according to binge eating and purging status in an adolescent sample seeking eating disorder treatment. Eat Behav 2020; 37:101389. [PMID: 32388487 PMCID: PMC9340432 DOI: 10.1016/j.eatbeh.2020.101389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 11/17/2022]
Abstract
Nonsuicidal self-injury (NSSI) is elevated in adults with eating disorders (EDs), with a particularly increased incidence among individuals who engage in binge eating and/or purging (B/P) behaviors. Despite substantially elevated prevalence of NSSI in adolescence in general, NSSI in child and adolescent ED samples is understudied. There is some evidence for elevated prevalence of NSSI between B/P and restriction-only groups; however, this finding is not consistently reported and research in this area has excluded certain diagnostic groups (e.g., other specified feeding or eating disorder). Our aim was to identify the rates at which a transdiagnostic sample of adolescent patients with EDs (n = 155) report lifetime or past-month NSSI, and whether these rates differ between individuals who engaged in recent B/P behaviors vs. restriction only. Lifetime NSSI was present in 40.6% of the sample, and 23.2% of participants reported engaging in NSSI in the month prior to treatment. Individuals who reported recent B/P behaviors were more likely to report past-month (p = .005, OR = 5.57) and lifetime (p = .004, OR = 4.39) NSSI compared to individuals who did not report B/P behaviors. These results suggest an increase in risk for NSSI in child and adolescent patients in ED treatment who endorse B/P behaviors compared to patients who endorse restriction only. Research is needed to clarify the etiologic factors that may explain this association and the longitudinal changes in NSSI throughout the course of EDs.
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Affiliation(s)
- Jesse W.P. Dzombak
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America
| | - Renee D. Rienecke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America,Eating Recovery Center/Insight Behavioral Health Centers, Chicago, IL, United States of America,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, United States of America
| | - Jessica L. Van Huysse
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America,Corresponding author at: Department of Psychiatry, University of Michigan, C.S. Mott Children’s Hospital, 5th Floor Reception B, 1540 E Hospital Dr., Ann Arbor, MI 48109, United States of America. (J.L. Van Huysse)
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65
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Shomaker LB, Gulley LD, Clark ELM, Hilkin AM, Pivarunas B, Tanofsky-Kraff M, Nadeau KJ, Barbour LA, Scott SM, Sheeder JL. Protocol for a pilot randomized controlled feasibility study of brief interpersonal psychotherapy for addressing social-emotional needs and preventing excess gestational weight gain in adolescents. Pilot Feasibility Stud 2020; 6:39. [PMID: 32206334 PMCID: PMC7082950 DOI: 10.1186/s40814-020-00578-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 02/26/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Excess gestational weight gain (GWG) in pregnant adolescents is a major public health concern. Excess GWG increases risk of pregnancy complications as well as postpartum and offspring obesity and cardiometabolic disease. Prevention interventions for pregnant adults that target lifestyle modification (i.e., healthy eating/physical activity) show insufficient effectiveness. Pregnant adolescents have distinct social-emotional needs, which may contribute to excess GWG. From an interpersonal theoretical framework, conflict and low social support increase negative emotions, which in turn promote excess GWG through mechanisms such as overeating and physical inactivity. METHODS The current manuscript describes the design of a pilot randomized controlled feasibility trial of adolescent interpersonal psychotherapy (IPT) to address social-emotional needs and prevent excess GWG. Up to 50 pregnant, healthy adolescents 13-19y, 12-18 weeks gestation are recruited from an interdisciplinary adolescent maternity hospital clinic and randomized to IPT + usual care or usual care alone. IPT involves 6 individual 60-minute sessions delivered by a trained behavioral health clinician during 12-30 weeks gestation. Sessions include relationship psychoeducation, emotion identification and expression, and teaching/role-playing communication skills. Between sessions, adolescents are instructed to complete a daily journal and to have conversations to work on relationship goals. Outcomes are assessed at baseline, mid-program, post-program, and 3-months postpartum. Primary outcomes are feasibility and acceptability based upon rate of recruitment, session attendance, program acceptability ratings, and follow-up retention. Secondary outcomes are perinatal social functioning, stress, depression, and eating behaviors assessed with validated surveys and interviews; perinatal physical activity and sleep measured via accelerometer; GWG from measured weights; and at 3-months postpartum only, maternal adiposity by dual energy x-ray absorptiometry, maternal insulin sensitivity derived from 2-hour oral glucose tolerance testing, and infant adiposity by air displacement plethysmography. DISCUSSION This pilot trial will address a key gap in extant understanding of excess GWG prevention for a high-risk population of adolescents. If feasible and acceptable, brief psychotherapy to address social-emotional needs should be tested for its effectiveness to address excess GWG and postpartum maternal/infant health. If effective, such an approach has potential to interrupt an adverse, intergenerational cycle of social-emotional distress, obesity, and cardiometabolic disease among young mothers and their offspring. TRIAL REGISTRATION ClinicalTrials.gov NCT03086161, retrospectively registered.
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Affiliation(s)
- Lauren B. Shomaker
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO USA
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Lauren D. Gulley
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Emma L. M. Clark
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Allison M. Hilkin
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Bernadette Pivarunas
- Department of Human Development and Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570 USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology and Department of Medicine, Uniformed Services University of the Health Sciences, Department of Defense, Bethesda, MD USA
| | - Kristen J. Nadeau
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
| | - Linda A. Barbour
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO USA
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO USA
| | - Stephen M. Scott
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO USA
| | - Jeanelle L. Sheeder
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO USA
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO USA
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Baceviciene M, Balciuniene V, Jankauskiene R. Validation of the Lithuanian version of the Eating Disorder Examination Questionnaire 6.0 in a student sample. Brain Behav 2020; 10:e01555. [PMID: 31991064 PMCID: PMC7066329 DOI: 10.1002/brb3.1555] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0) is one of the most broadly used self-report tools that assesses attitudes and behaviors associated with eating disorders (EDs). The aim of the present study was to examine the reliability, validity, and factor structure of the Lithuanian version of the EDE-Q 6.0 (LT-EDE-Q 6.0) in a nonclinical student sample. MATERIALS AND METHODS A sample of 382 students (mean age 24.0 ± 6.4) participated in the study. The students completed a self-report questionnaire measuring the risk of EDs (LT-EDE-Q 6.0), body image (LT-MBSRQ-AS), quality of life (LT-WHOQOL-BREF), and self-esteem (RSES). Cronbach's alpha assessed the internal consistency of the EDE-Q 6.0. Pearson's correlations were used for the analyses of the construct and concurrent validity with the subscales of LT-MBSRQ-AS, LT-WHOQOL-BREF, and RSES. Intraclass correlation coefficients (ICC) were calculated for assessing test-retest reliability. RESULTS The mean score of the LT-EDE-Q 6.0 in the mixed sample was 1.5 ± 1.02. For women and men, the general mean scores were higher than in the majority of the samples of Western Europe but lower than in the United States. Acceptable internal consistency for the four subscales (0.75-0.88) and the LT-EDE-Q 6.0 general score (0.94) was obtained. Test-retest reliability was good to excellent for all subscales (0.66-0.91) and for the items that assessed essential behavioral features of EDs (0.84-0.90, except item 14 ICC = 0.4). The LT-EDE-Q 6.0 scores had adequate concurrent validity. However, the original 4-factor structure or other proposed models of EDE-Q were not obtained by CFA. CONCLUSIONS The results of the current study support the applicability, validity, and reliability of the LT-EDE-Q 6.0 in a nonclinical Lithuanian student sample. However, we recommend assessing the general scale score without the application of the subscales. The Lithuanian version of this instrument should be further investigated with clinical samples to identify clinically diagnosed cases.
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Affiliation(s)
- Migle Baceviciene
- Department of Physical and Social EducationLithuanian Sports UniversityKaunasLithuania
| | - Vaiva Balciuniene
- Department of Physical and Social EducationLithuanian Sports UniversityKaunasLithuania
| | - Rasa Jankauskiene
- Institute of Sport Science and InnovationLithuanian Sports UniversityKaunasLithuania
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67
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Chevinsky JD, Wadden TA, Chao AM. Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges. Diabetes Metab Syndr Obes 2020; 13:1117-1131. [PMID: 32341661 PMCID: PMC7166070 DOI: 10.2147/dmso.s213379] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/26/2020] [Indexed: 12/21/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.
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Affiliation(s)
| | - Thomas A Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Ariana M Chao
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
- Correspondence: Ariana M Chao University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA19104, USATel +1215-746-7183Fax +1215-898-2878 Email
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68
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Davis HA, Smith GT, Keel PK. An examination of negative urgency and other impulsigenic traits in purging disorder. Eat Behav 2020; 36:101365. [PMID: 32018192 PMCID: PMC7044031 DOI: 10.1016/j.eatbeh.2020.101365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 11/25/2022]
Abstract
There is extensive evidence for the clinical significance of Purging Disorder (PD), an eating disorder characterized by recurrent purging behavior (self-induced vomiting, laxative use, and diuretic use) in the absence of binge eating and low weight (Smith, Crowther, & Lavender, 2017). Research on the personality profile of PD is still developing but evidence supports an association with impulsivity (Brown, Haedt-Matt, & Keel, 2011). The personality underpinnings of impulsive behavior include several different impulsigenic traits. To investigate personality contributors to impulsive behavior among women with PD, we compared 31 women with PD to 57 women with bulimia nervosa (BN) and 31 healthy control women on four impulsigenic traits: negative urgency, lack of premeditation, lack of perseverance, and sensation seeking. Compared to healthy controls, women with PD reported significantly greater levels of negative urgency, but no significant differences on the other traits. Compared to BN, PD was associated with significantly lower levels of negative urgency, but no other significant differences. Compared with controls, women in the BN group had significantly higher scores on lack of premeditation and lack of perseverance, but no significant difference on sensation seeking. Findings indicate negative urgency is a potentially important personality trait for distinguishing those with PD.
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Affiliation(s)
- Heather A. Davis
- Department of Psychology, University of Kentucky, Lexington, KY, United States
| | - Gregory T. Smith
- Department of Psychology, University of Kentucky, Lexington, KY, United States
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, FL, United States
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Smith S, Woodside DB. Characterizing Treatment-Resistant Anorexia Nervosa. Front Psychiatry 2020; 11:542206. [PMID: 33488410 PMCID: PMC7819894 DOI: 10.3389/fpsyt.2020.542206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background: The issue of treatment resistance in eating disorder care is controversial. Prior research has identified multiple failed treatment attempts as a common criterion for severe and enduring anorexia nervosa, but little is known about patients who have multiple failed treatment attempts. This study was designed to compare the clinical and demographic characteristics of eating disorder patients with multiple, incomplete inpatient admissions to those with good outcomes. Understanding if these patient populations differ at initial admissions has implications for the prediction and characterization of inpatient eating disorder treatment resistance. Methods: This study analyzed existing data from a specialist inpatient eating disorder program at a large Canadian teaching hospital collected between 2000 and 2016. Treatment resistance was defined as two or more incomplete admissions and no complete admissions in the study period. Data were available on 37 patients who met this criteria, and 38 patients who had completed their first admission and remained well (defined as a BMI > 18.5 with no binging or purging behavior) 1 year after discharge. Variables of interest included age, weight, diagnoses, duration of illness, eating disorder psychopathology, eating disorder behavioral frequencies and depressive symptoms at the time of index inpatient admissions. Statistical analyses consisted of Mann-Whitney U tests, Chi-square tests, and a logistic regression. Results: In our main bivariate analyses, patients with multiple incomplete admissions were characterized by more severe eating disorder psychopathology and depressive symptoms at admission as well as an increased prevalence of the binge purge subtype of anorexia nervosa. In our exploratory multivariate analyses controlling for diagnostic subtype and depressive symptoms, severity of eating disorder psychopathology did not remain significant. No statistically significant difference in body mass index (BMI) or frequencies of eating disorder behaviors were found. A trend toward a longer duration of illness did not meet statistical significance. Conclusions: This study found that patients considered resistant to inpatient eating disorder treatment differ from those with good outcomes at initial admission. These results suggest that while treatment-resistant anorexia nervosa may be related to severe and enduring anorexia nervosa, it may also be a different concept that warrants additional research.
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Affiliation(s)
- Sarah Smith
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University Health Network, Toronto, ON, Canada
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Abstract
PURPOSE OF REVIEW This review summarizes emerging evidence for the relationship between food insecurity and eating disorder (ED) pathology, outlines priorities for future research in this area, and comments on considerations for clinical and public health practice. RECENT FINDINGS Among adults, food insecurity is cross-sectionally associated with higher levels of overall ED pathology, binge eating, compensatory behaviors, binge-eating disorder, and bulimia nervosa. Evidence for similar relationships among adolescents has been less robust; however, compared to studies of adults, there have been substantially fewer studies conducted in adolescents to date. Emerging evidence consistently indicates that food insecurity is cross-sectionally associated with bulimic-spectrum ED pathology among adults. Findings emphasize the need for ED research to include marginalized populations who have historically been overlooked in the ED field. Much more research is needed to better understand the relationship between food insecurity and ED pathology and to determine effective ways to intervene.
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Affiliation(s)
- Vivienne M Hazzard
- Sanford Center for Biobehavioral Research, 120 Eighth Street South, Fargo, ND, 58103, USA.
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Laura Hooper
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
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The role of body image disturbance in the onset, maintenance, and relapse of anorexia nervosa: A systematic review. Clin Psychol Rev 2019; 74:101771. [DOI: 10.1016/j.cpr.2019.101771] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 09/04/2019] [Accepted: 10/15/2019] [Indexed: 12/16/2022]
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The influence of identity on the prevalence and persistence of disordered eating and weight control behaviors in Mexican American college women. Appetite 2019; 140:180-189. [PMID: 31077772 DOI: 10.1016/j.appet.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/21/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022]
Abstract
Disordered eating behaviors are prevalent in Mexican-American college-enrolled women and contribute to compromised physical and psychological health. Although disordered eating behaviors are multi-determined, few studies have examined individual difference factors that contribute to disordered eating behaviors in Mexican women beyond acculturation. Evidence suggests that individual differences in the constellation of identities may be an important factor influencing the disordered eating behaviors. We hypothesized that individual differences in the collection of identities (self-schemas) increases susceptibility to defining oneself as fat (fat self-schema) and contribute to disordered eating behaviors over time in Mexican American college women. A 12-month longitudinal design was used to measure the level of disordered eating behaviors at 5 points over 12 months in 477 Mexican American women. Identity properties (i.e., positive self-schemas, negative self-schemas, fat self-schema) were measured at baseline. Controlling for relevant covariates, latent growth curve models showed that Mexican American women with few positive and many negative self-schemas were more likely to define themselves as fat, which in turn, predicted purging and fasting/restricting behaviors across the year. However, identity properties were not predictive of binge eating and excessive exercise episodes. Interventions focused on development of positive self-schemas that reflect areas of interest and competence and the revision of negative self-schemas may protect against purging and fasting/restricting in Mexican American college-enrolled women.
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Herpertz-Dahlmann B, Dahmen B. Children in Need-Diagnostics, Epidemiology, Treatment and Outcome of Early Onset Anorexia Nervosa. Nutrients 2019; 11:E1932. [PMID: 31426409 PMCID: PMC6722835 DOI: 10.3390/nu11081932] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022] Open
Abstract
Knowledge of anorexia nervosa (AN) in childhood is scarce. This review gives a state-of-the-art overview on the definition, classification, epidemiology and etiology of this serious disorder. The typical features of childhood AN in comparison to adolescent AN and avoidant restrictive eating disorder (ARFID) are described. Other important issues discussed in this article are somatic and psychiatric comorbidity, differential diagnoses and medical and psychological assessment of young patients with AN. Special problems in the medical and psychological treatment of AN in children are listed, although very few studies have investigated age-specific treatment strategies. The physical and mental outcomes of childhood AN appear to be worse than those of adolescent AN, although the causes for these outcomes are unclear. There is an urgent need for ongoing intensive research to reduce the consequences of this debilitating disorder of childhood and to help patients recover.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany.
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany
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Compte EJ, Nagata JM, Sepúlveda AR, Schweiger S, Sbdar LS, Silva BC, Bressan M, Rivas A, Menga S, Cortes C, Bidacovich G, López PL, Muiños R, Rutsztein G, Torrente F, Murray SB. Confirmatory factor analysis and measurement invariance of the eating disorders examination-questionnaire across four male samples in Argentina. Int J Eat Disord 2019; 52:740-745. [PMID: 30912863 DOI: 10.1002/eat.23075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/09/2019] [Accepted: 03/10/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The eating disorder examination-questionnaire (EDE-Q) is among the most widely used instruments in eating disorder research and clinical practice. However, the underlying structure remains a source of confusion, and contradictory results have emerged in studies among male populations. In the current study, we examined previously proposed models of EDE-Q structure in four community samples of Argentinian men. METHOD A series of confirmatory factor analyses (CFAs) were performed for five previous factor structure models of the EDE-Q among 232 Argentinian male university students, 277 weightlifters, 275 cross-fit users, and 202 athletes. A multigroup CFA was conducted in the model we retained, to assess measurement invariance across groups. RESULTS A respecified model of the brief eight-item one-factor proposal provided acceptable fit to the data over the original four-factor structure and three other proposed models. Results from the multigroup CFA showed that the retained model was invariant across samples. CONCLUSION Our results provide support for retaining a one-factor EDE-Q structure over a multifactor solution for research purposes among male community samples in Argentina. These data underscore the importance of undertaking psychometric assessment of eating disorder symptom measures before their utilization in specific populations.
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Affiliation(s)
- Emilio J Compte
- Department of Psychiatry, University of California, San Francisco, California.,School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina.,DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, California
| | - Ana R Sepúlveda
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Sofia Schweiger
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Lara S Sbdar
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Bárbara Camila Silva
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Michelle Bressan
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Andrés Rivas
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Sol Menga
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - Camila Cortes
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
| | - German Bidacovich
- School of Psychology, University of Buenos Aires, Buenos Aires, Argentina
| | - Pablo L López
- Laboratory of Psychopathology Research, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Roberto Muiños
- School of Psychology, University of Buenos Aires, Buenos Aires, Argentina.,School of Statistics - Department of Scientific Methodology and Epistemology, National University of Tres de Febrero, Buenos Aires, Argentina
| | | | - Fernando Torrente
- Laboratory of Psychopathology Research, Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, California
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75
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Cardiac biomarkers of disordered eating: A case for decreased mean R wave amplitude. Psychiatry Res 2019; 272:555-561. [PMID: 30616123 DOI: 10.1016/j.psychres.2018.12.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/03/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to identify cardiac biomarkers of disordered eating. Mean R wave amplitude (mV), mean T wave amplitude (mV), QRS interval (sec), QTc interval (sec), and Tpeak-Tend interval (sec) were assessed via electrocardiography among women with clinical (n = 53) and subclinical (n = 56) eating disorder symptoms versus asymptomatic controls (n = 32). QRS and QTc intervals were significantly longer and mean T and R wave amplitudes significantly lower among women with clinical symptoms compared to asymptomatic controls. QTc interval length was significantly longer and mean R wave amplitude was significantly lower among women with subclinical symptoms versus asymptomatic controls. Decreased mean R wave amplitude yielded a comparable effect size as QTc when differentiating between asymptomatic and subclinical groups and a larger effect size than QTc when differentiating between asymptomatic and clinical groups, representing a promising clinical biomarker.
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76
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Dietary patterns as a red flag for higher risk of eating disorders among female teenagers with and without type I diabetes mellitus : Adolescents with type I diabetes mellitus are a risk factor for eating disorders: a case-control study. Eat Weight Disord 2019; 24:151-161. [PMID: 28913823 DOI: 10.1007/s40519-017-0442-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Female adolescents with type I diabetes mellitus (TIDM) have an increased risk of developing eating disorders (ED) due to the dietary recommendations. OBJECTIVE Investigate the association between dietary intake and increased risk of ED. METHODS Case-control study with 50 T1DM female adolescents (11-16 years) and 100 healthy peers (CG). Measures included food frequency questionnaire (FFQ-PP), Child-EDE.12, economic and anthropometric data. RESULTS Comparing female adolescents with T1DM vs CG, the first had higher intake of: bread, cereal, rice, and pasta (29.7 vs 23.8%, p = 0.001), vegetables (6.5 vs 2.8%, p < 0.001), milk yogurt and cheese (9.9 vs 7.6%, p = 0.032), fat, and oils (8.2 vs 5.9%, p = 0.003), besides higher fiber intake (19.2 vs 14.7%, p = 0.006) and lower consumption of sweets (13.6 vs 30.7%, p < 0.001). No differences on ED psychopathology (Child-EDE subscales and global score) were found between groups. In unadjusted association between the ED psychopathology and dietary intake, a diet rich in fiber was significantly associated with both the global and eating concern scores. Among CG, increased intake of meat, poultry, fish, and eggs and decreased bread, cereal, rice, and pasta consumption were significantly associated with higher ED psychopathology. When BMI and age are adjusted, the association between fiber intake and ED psychopathology is no longer significant among diabetic participants; however, in the CG, this association remains. CONCLUSIONS The study suggests that an association between dietary intake and ED psychopathology might exist in female adolescents with and without TIDM and that careful evaluation of the dietary profile and risk of developing an ED should be considered in clinical practice. LEVEL OF EVIDENCE Level III, case-control study.
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77
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Tobin LN, Lacroix E, von Ranson KM. Evaluating an abbreviated three-factor version of the Eating Disorder Examination Questionnaire in three samples. Eat Behav 2019; 32:18-22. [PMID: 30476704 DOI: 10.1016/j.eatbeh.2018.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022]
Abstract
A brief, three-factor structure for the Eating Disorder Examination-Questionnaire (EDE-Q) has been identified that has stronger psychometric properties than the original four-factor EDE-Q structure. However, there is a need for independent replication of the brief version in different samples, and examination of how comparable the brief version is in women and men of diverse ages. This study compared factor structure fit and other psychometric properties between the original and brief versions in three independent samples of adults to evaluate the reliability and validity of this brief version. It also examined measurement invariance across gender in a middle-aged community sample. Participants included university women (N = 659), university women and men (N = 358), and crowdsourced community women and men (N = 544). Across samples, compared to the original version the brief version demonstrated greater internal consistency, somewhat less item overlap, and superior model fit in confirmatory factor analyses, although some fit indices fell below recommended cut-offs. Separate confirmatory factor analyses of the brief version in community women and men suggested the brief version may better fit community men than women, and measurement invariance across gender for the brief version was not supported for the community sample. This independent replication supports the factorial validity of the brief version in three samples of students and crowdsourced community adults, and highlights the importance of further examination of the psychometric properties of this brief three-factor version across gender and age categories, among others sample characteristics.
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Affiliation(s)
- Leah N Tobin
- Department of Psychology, University of Calgary, Calgary, AB, Canada.
| | - Emilie Lacroix
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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78
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Uniacke B, Wang Y, Biezonski D, Sussman T, Lee S, Posner J, Steinglass J. Resting-state connectivity within and across neural circuits in anorexia nervosa. Brain Behav 2019; 9:e01205. [PMID: 30590873 PMCID: PMC6373651 DOI: 10.1002/brb3.1205] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Obsessional thoughts and ritualized eating behaviors are characteristic of Anorexia Nervosa (AN), leading to the common suggestion that the illness shares neurobiology with obsessive-compulsive disorder (OCD). Resting-state functional connectivity MRI (rs-fcMRI) is a measure of functional neural architecture. This longitudinal study examined functional connectivity in AN within the limbic cortico-striato-thalamo-cortical (CSTC) loop, as well as in the salience network, the default mode network, and the executive control network (components of the triple network model of psychopathology). METHODS Resting-state functional connectivity MRI scans were collected in unmedicated female inpatients with AN (n = 25) and healthy controls (HC; n = 24). Individuals with AN were scanned before and after weight restoration and followed for one month after hospital discharge. HC were scanned twice over the same timeframe. RESULTS Using a seed-based correlation approach, individuals with AN had increased connectivity within the limbic CSTC loop when underweight, only. There was no significant association between limbic CSTC connectivity and obsessive-compulsive symptoms or prognosis. Exploratory analyses of functional network connectivity within the triple network model showed reduced connectivity between the salience network and left executive control network among AN relative to HC. These abnormalities persisted following weight restoration. CONCLUSIONS The CSTC findings suggest that the neural underpinnings of obsessive-compulsive symptoms may differ from those of OCD. The inter-network abnormalities warrant examination in relation to illness-specific behaviors, namely abnormal eating behavior. This longitudinal study highlights the complexity of the neural underpinnings of AN.
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Affiliation(s)
- Blair Uniacke
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Yun Wang
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | | | - Tamara Sussman
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Seonjoo Lee
- Division of Mental Health Data Science, New York State Psychiatric Institute, New York, New York.,Department of Biostatistics, Columbia University Irving Medical Center, New York, New York
| | - Jonathan Posner
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Joanna Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York, New York
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79
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Rizk M, Kern L, Lalanne C, Hanachi M, Melchior JC, Pichard C, Mattar L, Berthoz S, Godart N. High-intensity exercise is associated with a better nutritional status in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2018; 27:391-400. [PMID: 30585369 DOI: 10.1002/erv.2661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/21/2018] [Accepted: 12/04/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Our aim is to investigate the links between duration and intensity of exercise and the nutritional status in terms of body composition in acute anorexia nervosa (AN) patients. METHOD One hundred ninety-one hospitalized women suffering from AN were included. Exercise duration and intensity were assessed using a semistructured questionnaire. Body composition was measured using bioelectrical impedance. Linear multiple regression analyses were carried out using body mass index, fat-free mass index, and fat mass index as dependent variables and including systematically exercise duration, exercise intensity, and other confounding variables described in the literature that were significantly associated with each dependent variable in univariate analysis. RESULTS A lower BMI was linked to lower exercise intensity, AN restrictive type, and presence of amenorrhea. A lower FFMI was linked to lower exercise intensity, older age, AN restrictive type, and premenarchal AN. Duration of exercise was not linked to the nutritional status. CONCLUSIONS Exercising at higher intensity in AN is associated with a better nutritional status, thus, a better resistance to starvation. The impact of therapeutic physical activity sessions, adapted in terms of exercise intensity and patient's clinical status, should be evaluated during nutrition rehabilitation.
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Affiliation(s)
- Melissa Rizk
- CESP, INSERM, University of Paris-Descartes, Paris, France
| | - Laurence Kern
- Laboratory EA 2931, CERSM, UFR-STAPS, Nanterre, France
| | | | - Mouna Hanachi
- Nutrition-TCA Unit, Hospital Poincaré, APHP, Garches, France
| | - Jean-Claude Melchior
- Nutrition-TCA Unit, Hospital Poincaré, APHP, Garches, France.,University of Versailles Saint-Quentin-en-Yvelines, France
| | - Claude Pichard
- Clinical Nutrition, University Hospital of Geneva, Geneva, Switzerland
| | - Lama Mattar
- Natural Sciences department, nutrition program, Lebanese American University, Beirut, Lebanon
| | | | - Sylvie Berthoz
- CESP, INSERM, University of Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Nathalie Godart
- CESP, INSERM, University of Paris-Descartes, Paris, France.,Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France.,Adolescent and young adult mental health Unit, Fondation Santé des étudiants de France, Paris, France
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80
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Yiu A, Christensen K, Arlt JM, Chen EY. Distress tolerance across self-report, behavioral and psychophysiological domains in women with eating disorders, and healthy controls. J Behav Ther Exp Psychiatry 2018; 61:24-31. [PMID: 29885596 DOI: 10.1016/j.jbtep.2018.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/19/2018] [Accepted: 05/28/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES The tendency to engage in impulsive behaviors when distressed is linked to disordered eating. The current study comprehensively examines emotional responses to a distress tolerance task by utilizing self-report, psychophysiological measures (respiratory sinus arrhythmia [RSA], skin conductance responses [SCRs] and tonic skin conductance levels [SCLs]), and behavioral measures (i.e., termination of task, latency to quit task). METHODS 26 healthy controls (HCs) and a sample of treatment-seeking women with Bulimia Nervosa (BN), Binge Eating Disorder (BED) and Anorexia Nervosa (AN) (N = 106) completed the Paced Auditory Serial Addition Task- Computerized (PASAT-C). Psychophysiological measurements were collected during baseline, PASAT-C, and recovery, then averaged for each time period. Self-reported emotions were collected at baseline, post-PASAT-C and post-recovery. RESULTS Overall, we found an effect of Time, with all participants reporting greater negative emotions, less happiness, lower RSA, more SCRs and higher tonic SCLs after completion of the PASAT-C relative to baseline. There were no differences in PASAT-C performance between groups. There was an effect of Group for negative emotions, with women with BN, BED and AN reporting overall higher levels of negative emotions relative to HCs. Furthermore, we found an effect of Group for greater urges to binge eat and lower RSA values among BED, relative to individuals with BN, AN and HCs. LIMITATIONS This study is cross-sectional and lacked an overweight healthy control group. CONCLUSION During the PASAT-C, individuals with eating disorders (EDs) compared to HCs report higher levels of negative emotions, despite similar physiological and behavioral manifestations of distress.
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Affiliation(s)
- Angelina Yiu
- TEDp (Temple Eating Disorders program), Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, United States
| | - Kara Christensen
- Cognition and Emotion Lab, Ohio State University, 1835 Neil Avenue, Columbus, OH, 43210, United States
| | - Jean M Arlt
- TEDp (Temple Eating Disorders program), Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, United States
| | - Eunice Y Chen
- TEDp (Temple Eating Disorders program), Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, United States.
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81
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Green MA, Kroska A, Herrick A, Bryant B, Sage E, Miles L, Ravet M, Powers M, Whitegoat W, Linkhart R, King B. A preliminary trial of an online dissonance-based eating disorder intervention. Eat Behav 2018; 31:88-98. [PMID: 30199771 DOI: 10.1016/j.eatbeh.2018.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We conducted a controlled randomized preliminary trial of an expanded online version of the Body Project (n = 46) compared to an assessment-only control condition (n = 36) via a longitudinal design (baseline, postintervention, 2-month follow-up) in a community sample of women (N = 82) with clinical (n = 53) and subclinical (n = 29) eating disorder symptoms. METHOD The traditional content of the Body Project was modified to include verbal, written, and behavioral exercises designed to dissuade objectification and maladaptive social comparison and adapted to an online format. Body dissatisfaction, self-esteem, self-objectification, thin-ideal internalization, maladaptive social comparison, trait anxiety, positive affect, negative affect, and eating disorder symptomatology were evaluated in the control and the online expanded Body Project condition at baseline, postintervention, and 2-month follow-up. RESULTS A 2 (condition: online expanded Body Project, control) × 3 (time: baseline, postintervention, 2-month follow-up) mixed factorial multivariate analysis of variance (MANOVA) was conducted to examine statistically significant group differences. As predicted, results indicated a statistically significant condition × time interaction. CONCLUSIONS Participants in the expanded online Body Project condition showed significant reductions in eating disorder symptoms and several associated psychological risk correlates from baseline to postintervention and follow-up; contrary to predictions, eating disorder symptoms and risk correlates were not significantly lower in the online expanded Body Project condition compared to the waitlist control condition at postintervention or 2-month follow-up.
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Affiliation(s)
- M A Green
- Department of Psychology, Cornell College, United States of America.
| | - A Kroska
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - A Herrick
- Department of Psychology, Cornell College, United States of America
| | - B Bryant
- Department of Psychology, Cornell College, United States of America
| | - E Sage
- Department of Psychology, Cornell College, United States of America
| | - L Miles
- Department of Psychology, Cornell College, United States of America
| | - M Ravet
- Department of Psychology, Cornell College, United States of America
| | - M Powers
- Department of Psychology, Cornell College, United States of America
| | - W Whitegoat
- Department of Psychology, Cornell College, United States of America
| | - R Linkhart
- Department of Psychology, Cornell College, United States of America
| | - B King
- Department of Psychology, Cornell College, United States of America
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82
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Serier KN, Smith JE, Yeater EA. Confirmatory factor analysis and measurement invariance of the Eating Disorder Examination Questionnaire (EDE-Q) in a non-clinical sample of non-Hispanic White and Hispanic women. Eat Behav 2018; 31:53-59. [PMID: 30142550 DOI: 10.1016/j.eatbeh.2018.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 07/25/2018] [Accepted: 08/09/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Body dissatisfaction and eating disorder rates have increased in racial and ethnic minority groups, yet the validity of various commonly-used eating disorder instruments has not been established in these populations. One way to establish validity is to test for measurement invariance; namely, that the same constructs are being measured across groups. This study tested the measurement invariance of the Eating Disorder Examination Questionnaire (EDE-Q) across non-Hispanic White and Hispanic women. METHOD Female undergraduates (n = 561) were recruited from a southwestern U.S. university. Confirmatory factor analysis (CFA) and measurement invariance of the EDE-Q were tested in non-Hispanic White and Hispanic samples. RESULTS CFA analyses revealed that the original four-factor structure did not fit the data in either group. Only a modified 7-item, three-factor structure of the EDE-Q provided an acceptable fit in both non-Hispanic White and Hispanic women. Thus, this modified EDE-Q factor structure was used to test the equivalence of the measure between groups. Results found that the factor structure was similar across groups, but the factor loadings and intercepts differed across non-Hispanic White and Hispanic women. DISCUSSION A modified 7-item, three-factor structure of the EDE-Q provided an acceptable fit of the data, which is supported by previous research. However, the lack of measurement invariance suggests that researchers should be cautious when using this modified EDE-Q to make explicit comparisons between non-Hispanic White and Hispanic women. Future research should further examine the psychometric properties of the EDE-Q in ethnically diverse groups, specifically the role of dietary restraint among Hispanic women.
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Affiliation(s)
- Kelsey N Serier
- Department of Psychology, MSCO3 2220, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Jane Ellen Smith
- Department of Psychology, MSCO3 2220, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Elizabeth A Yeater
- Department of Psychology, MSCO3 2220, 1 University of New Mexico, Albuquerque, NM 87131, USA.
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83
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Nettersheim J, Gerlach G, Herpertz S, Abed R, Figueredo AJ, Brüne M. Evolutionary Psychology of Eating Disorders: An Explorative Study in Patients With Anorexia Nervosa and Bulimia Nervosa. Front Psychol 2018; 9:2122. [PMID: 30429818 PMCID: PMC6220092 DOI: 10.3389/fpsyg.2018.02122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/15/2018] [Indexed: 02/01/2023] Open
Abstract
Prior research on non-clinical samples has lent support to the sexual competition hypothesis for eating disorders (SCH) where the drive for thinness can be seen as an originally adaptive strategy for women to preserve a nubile female shape, which, when driven to an extreme, may cause eating disorders. Restrictive versus impulsive eating behavior may also be relevant for individual differences in allocation of resources to either mating effort or somatic growth, reflected in an evolutionary concept called “Life History Theory” (LHT). In this study, we aimed to test the SCH and predictions from LHT in female patients with clinically manifest eating disorders. Accordingly, 20 women diagnosed with anorexia nervosa (AN), 20 with bulimia nervosa (BN), and 29 age-matched controls completed a package of questionnaires comprising measures for behavioral features and attitudes related to eating behavior, intrasexual competition, life history strategy, executive functioning and mating effort. In line with predictions, we found that relatively faster life history strategies were associated with poorer executive functioning, lower perceived own mate value, greater intrasexual competition for mates but not for status, and, in part, with greater disordered eating behavior. Comparisons between AN and BN revealed that individuals with BN tended to pursue a “fast” life history strategy, whereas people with AN were more similar to controls in pursuing a “slow” life history strategy. Moreover, intrasexual competition for mates was significantly predicted by the severity of disordered eating behavior. Together, our findings lend partial support to the SCH for eating disorders. We discuss the implications and limitations of our study findings.
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Affiliation(s)
- Johanna Nettersheim
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Cognitive Neuropsychiatry, Ruhr University Bochum, Bochum, Germany
| | - Gabriele Gerlach
- LWL University Hospital Bochum, Department of Psychosomatic Medicine, Ruhr University Bochum, Bochum, Germany
| | - Stephan Herpertz
- LWL University Hospital Bochum, Department of Psychosomatic Medicine, Ruhr University Bochum, Bochum, Germany
| | - Riadh Abed
- Mental Health Tribunals, Ministry of Justice, Sheffield, United Kingdom
| | - Aurelio J Figueredo
- Department of Psychology, School of Mind, Brain, and Behavior, College of Science, University of Arizona, Tucson, AZ, United States
| | - Martin Brüne
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Cognitive Neuropsychiatry, Ruhr University Bochum, Bochum, Germany
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84
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Wallis A, Miskovic-Wheatley J, Madden S, Alford C, Rhodes P, Touyz S. Does continuing family-based treatment for adolescent anorexia nervosa improve outcomes in those not remitted after 20 sessions? Clin Child Psychol Psychiatry 2018; 23:592-600. [PMID: 29781302 DOI: 10.1177/1359104518775145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Our aim was to investigate the benefit of ongoing family-based treatment (FBT) sessions for adolescent anorexia nervosa if remission criteria were not met at session 20. METHOD Participants were 69 medically unstable adolescents with Diagnostic and Statistical Manual of Mental Disorders (4th ed; DSM-IV) anorexia nervosa from a randomized controlled trial investigating length of hospital admission prior to outpatient FBT. Participants were divided post hoc into those meeting remission criteria at session 20 ( n = 16), those that had not remitted but continued with FBT ( n = 39) and those who ceased FBT undertaking alternative treatments ( n = 14). Outcome was assessed as remission and hospital readmission days at 12 months after FBT session 20. RESULTS There were no differences between groups at baseline. There was a significant difference in the use of hospital admission days with those in the Alternate Treatment Group who did not continue with FBT using 71.93 days compared to those in Additional FBT Group with only 12.51 days ( F(2, 66) = 13.239, p < .01). At 12 months after FBT session 20, the Additional FBT Group had a 28.2% increase in remission rate, significantly higher than those in the Alternate Treatment Group (χ2(2) = 17.68, p < .001). DISCUSSION Continuing FBT after session 20 if remission is not achieved can significantly reduce hospital readmission days and improve remission rates.
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Affiliation(s)
- Andrew Wallis
- 1 Eating Disorder Service, The Sydney Children's Hospital Network, Australia.,2 School of Psychology, The University of Sydney, Australia
| | | | - Sloane Madden
- 1 Eating Disorder Service, The Sydney Children's Hospital Network, Australia
| | - Colleen Alford
- 1 Eating Disorder Service, The Sydney Children's Hospital Network, Australia
| | - Paul Rhodes
- 2 School of Psychology, The University of Sydney, Australia
| | - Stephen Touyz
- 2 School of Psychology, The University of Sydney, Australia
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85
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Miniati M, Callari A, Maglio A, Calugi S. Interpersonal psychotherapy for eating disorders: current perspectives. Psychol Res Behav Manag 2018; 11:353-369. [PMID: 30233263 PMCID: PMC6130260 DOI: 10.2147/prbm.s120584] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Interpersonal psychotherapy (IPT) is a time-limited and affect-, life-event-, and present-focused psychotherapy originally conceptualized for unipolar depression, and then adapted to the treatment of other disorders, including eating disorders (EDs). The purpose of this paper is to conduct a systematic review of studies on IPT for EDs. Methods The authors performed literature searches, study selection, method, and quality evaluation independently. Data were summarized using a narrative approach. Results Of the 534 papers retrieved, 37 studies met the inclusion criteria, and 15 were considered for the systematic review (randomized controlled trials and long-term follow-up studies derived from the randomized controlled trials). Their analysis revealed six main findings: 1) no significant differences between IPT and cognitive-behavioral therapy (CBT) were found when administered as monotherapy to patients with anorexia nervosa; 2) when administered as monotherapy to patients with bulimia nervosa (BN), IPT had lower outcomes than CBT and its enhanced version; 3) patients with BN who remitted with IPT showed a prolonged time spent in clinical remission, when followed up on the long term; 4) IPT and CBT, with different timings and methods, have both shown efficacy in the mid-term/long-term period in patients with BN; 5) CBT and its enhanced version produced rapid changes in the acute phase. IPT led to improvements occurring later, with slower changes that tended to maintain efficacy in the long term; 6) abstinence from binge eating with group IPT for binge eating disorder is stable and maintained (or further improved) in the long term. Conclusion IPT is a reasonable, cost-effective alternative to CBT for the overall ED spectrum.
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Affiliation(s)
- Mario Miniati
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy,
| | - Antonio Callari
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy,
| | - Alessandra Maglio
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy,
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Verona, Italy
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86
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Keel PK, Haedt-Matt AA, Hildebrandt B, Bodell LP, Wolfe BE, Jimerson DC. Satiation deficits and binge eating: Probing differences between bulimia nervosa and purging disorder using an ad lib test meal. Appetite 2018; 127:119-125. [PMID: 29654850 DOI: 10.1016/j.appet.2018.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 01/28/2023]
Abstract
Purging disorder (PD) has been included as a named condition within the DSM-5 category of Other Specified Feeding or Eating Disorder and differs from bulimia nervosa (BN) in the absence of binge-eating episodes. The current study evaluated satiation through behavioral and self-report measures to understand how this construct may explain distinct symptom presentations for bulimia nervosa (BN) and purging disorder (PD). Women (N = 119) were recruited from the community if they met DSM-5 criteria for BN (n = 57), PD (n = 31), or were free of eating pathology (n = 31 controls). Participants completed structured clinical interviews and questionnaires and an ad lib test meal during which they provided reports of subjective states. Significant group differences were found on self-reported symptoms, ad lib test meal intake, and subjective responses to food intake between individuals with eating disorders and controls and between BN and PD. Further, ad lib intake was associated with self-reported frequency and size of binge episodes. In a multivariable model, the amount of food consumed during binges as reported during clinical interviews predicted amount of food consumed during the ad lib test meal, controlling for other binge-related variables. Satiation deficits distinguish BN from PD and appear to be specifically linked to the size of binge episodes. Future work should expand exploration of physiological bases of these differences to contribute to novel interventions.
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Affiliation(s)
- Pamela K Keel
- Department of Psychology, Florida State University, United States.
| | | | - Britny Hildebrandt
- Department of Psychiatry, Western Psychiatric Institute and Clinics, United States
| | | | - Barbara E Wolfe
- College of Nursing, University of Rhode Island, United States
| | - David C Jimerson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, United States
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87
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Annameier SK, Kelly NR, Courville AB, Tanofsky-Kraff M, Yanovski JA, Shomaker LB. Mindfulness and laboratory eating behavior in adolescent girls at risk for type 2 diabetes. Appetite 2018; 125:48-56. [PMID: 29407527 PMCID: PMC5878719 DOI: 10.1016/j.appet.2018.01.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/29/2017] [Accepted: 01/26/2018] [Indexed: 11/23/2022]
Abstract
Mindfulness-based intervention has become increasingly popular to address disinhibited eating in obesity and type 2 diabetes (T2D). Theoretically, present-moment attention promotes the ability to recognize and respond to internal hunger cues and to differentiate physiological hunger from other stimuli. Yet, there is limited research describing the relationship of mindfulness with disinhibited eating patterns in adolescents. In this study, we evaluated the relationship of dispositional mindfulness to laboratory eating in 107 adolescent (12-17 years) girls at risk for T2D. Adolescents reported dispositional mindfulness, were evaluated for recent loss-of-control-eating (LOC-eating) by interview, and participated in two successive, standardized laboratory test meals to assess eating when hungry as well as eating in the absence of hunger (EAH). Adolescents rated state appetite throughout the test meal paradigms. In analyses adjusting for body composition and other possible confounds, mindfulness was inversely related to caloric intake during the EAH paradigm. Mindfulness did not relate to energy intake when hungry. Instead, there was a significant interaction of reported LOC-eating by state hunger, such that girls with recent, reported LOC-eating and high state hunger consumed more calories when hungry, regardless of mindfulness. Findings suggest that in girls at risk for T2D, mindfulness may play a role in disinhibited eating. A propensity for LOC-eating may be most salient for overeating in a high hunger state.
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Affiliation(s)
- Shelly K Annameier
- Human Development and Family Studies, College of Health and Human Sciences, Colorado State University, United States
| | - Nichole R Kelly
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States; Counseling Psychology and Human Services and the Prevention Science Institute, College of Education, University of Oregon, United States
| | - Amber B Courville
- Nutrition Department, National Institutes of Health Clinical Center, United States
| | - Marian Tanofsky-Kraff
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States; Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, United States
| | - Jack A Yanovski
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States
| | - Lauren B Shomaker
- Human Development and Family Studies, College of Health and Human Sciences, Colorado State University, United States; Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States; Community and Behavioral Health, Colorado School of Public Health, United States.
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88
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Goode RW, Kalarchian MA, Craighead L, Conroy MB, Wallace J, Eack SM, Burke LE. The feasibility of a binge eating intervention in Black women with obesity. Eat Behav 2018; 29:83-90. [PMID: 29549863 PMCID: PMC5935580 DOI: 10.1016/j.eatbeh.2018.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/20/2018] [Accepted: 03/08/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION U.S. Black women have the highest rates of obesity and report frequent binge eating behaviors. To our knowledge, no intervention research has aimed to treat binge eating specifically among Black women. The purpose of this study was to investigate the feasibility and preliminary effect of Appetite Awareness Treatment (AAT), an 8-week cognitive-behavioral binge eating intervention, among Black women with obesity, and who report binge eating. METHODS Participants (N = 31), had a mean (±SD) age of 48.8 ± 12.8 years, a body mass index of 33.7 ± 3.9 kg/m2, and reported at least one binge eating episode monthly over the last three months. Using a randomized controlled trial design, Black women were randomized to AAT or a wait-list control group (WAIT) group. We examined recruitment, attendance, retention, and adherence. Linear mixed models explored preliminary differences between the AAT and WAIT on the primary outcome variables of binge eating and eating self-efficacy measured at baseline and 8-weeks. RESULTS Approximately one-third of screened participants were eligible and did enroll. Participants completed 55% of homework assignments, and attended 59% of intervention sessions. Retention to AAT was 87.5%. Compared to participants in the WAIT group, AAT participants had greater decreases in binge eating scores and greater improvements in eating self-efficacy scores at the end of Week 8. CONCLUSION Results suggest that AAT is feasible among Black women with binge eating behaviors, with evidence of preliminary efficacy, providing a rationale for a trial of AAT in a larger sample of Black women.
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Affiliation(s)
- Rachel W. Goode
- Schools of Social Work and Nursing, 2117 Cathedral of Learning, Pittsburgh, PA 15260 University of Pittsburgh,School of Social Work, University of North Carolina at Chapel Hill; 325 Pittsboro Street; CB #3550; Chapel Hill, NC 27599-3550
| | - Melissa A. Kalarchian
- School of Nursing, Duquesne University; Fisher Hall, 600 Forbes Avenue, Pittsburgh, PA 15282
| | - Linda Craighead
- Department of Psychology, Emory University; 201 Dowman Drive; Atlanta, GA 30322
| | - Molly B. Conroy
- Division of General Internal Medicine, University of Utah, 30 N 1900E.; Room 9R218; Salt Lake City, Utah 84132
| | - John Wallace
- Schools of Social Work and Nursing, 2117 Cathedral of Learning, Pittsburgh, PA 15260 University of Pittsburgh
| | - Shaun M. Eack
- Schools of Social Work and Nursing, 2117 Cathedral of Learning, Pittsburgh, PA 15260 University of Pittsburgh
| | - Lora E. Burke
- Schools of Social Work and Nursing, 2117 Cathedral of Learning, Pittsburgh, PA 15260 University of Pittsburgh
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89
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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.
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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
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90
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Calvert F, Smith E, Brockman R, Simpson S. Group schema therapy for eating disorders: study protocol. J Eat Disord 2018; 6:1. [PMID: 29344359 PMCID: PMC5761160 DOI: 10.1186/s40337-017-0185-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment of eating disorders is a difficult endeavor, with only a relatively small proportion of clients responding to and completing standard cognitive behavioural therapy (CBT). Given the prevalence of co-morbidity and complex personality traits in this population, Schema Therapy has been identified as a potentially viable treatment option. A case series of Group Schema Therapy for Eating Disorders (ST-E-g) yielded positive findings and the study protocol outlined in this article aims to extend upon these preliminary findings to evaluate group Schema Therapy for eating disorders in a larger sample (n = 40). METHODS/DESIGN Participants undergo a two-hour assessment where they complete a number of standard questionnaires and their diagnostic status is ascertained using the Eating Disorder Examination. Participants then commence treatment, which consists of 25 weekly group sessions lasting for 1.5 h and four individual sessions. Each group consists of five to eight participants and is facilitated by two therapists, at least one of who is a registered psychologist trained on schema therapy. The primary outcome in this study is eating disorder symptom severity. Secondary outcomes include: cognitive schemas, self-objectification, general quality of life, self-compassion, schema mode presentations, and Personality Disorder features. Participants complete psychological measures and questionnaires at pre, post, six-month and 1-year follow-up. DISCUSSION This study will expand upon preliminary research into the efficacy of group Schema Therapy for individuals with eating disorders. If group Schema Therapy is shown to reduce eating disorder symptoms, it will hold considerable promise as an intervention option for a group of disorders that is typically difficult to treat. TRIAL REGISTRATION ACTRN12615001323516. Registered: 2/12/2015 (retrospectively registered, still recruiting).
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Affiliation(s)
- Fiona Calvert
- School of Psychology, University of Wollongong, Wollongong, NSW Australia
- School of Social Sciences and Psychology, Western Sydney University, 1795 Locked bag, Penrith, NSW Australia
| | - Evelyn Smith
- School of Social Sciences and Psychology, Western Sydney University, 1795 Locked bag, Penrith, NSW Australia
| | - Rob Brockman
- University of Technology Sydney, Ultimo, NSW Australia
| | - Susan Simpson
- School of Psychology, Social Work & Social Policy, University of South Australia, Adelaide, SA Australia
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91
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Egbert AH, Wilfley DE, Eddy KT, Boutelle KN, Zucker N, Peterson CB, Celio Doyle A, Le Grange D, Goldschmidt AB. Attention-Deficit/Hyperactivity Disorder Symptoms Are Associated with Overeating with and without Loss of Control in Youth with Overweight/Obesity. Child Obes 2018; 14:50-57. [PMID: 28945463 PMCID: PMC5743031 DOI: 10.1089/chi.2017.0114] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is growing evidence that attention-deficit/hyperactivity disorder (ADHD) and loss of control (LOC) eating, both prevalent in children and adolescents, may be related to one another. However, the relationship between ADHD and overeating without LOC has been largely unexamined, thus precluding an understanding of the independent contributions of LOC and episode size in these associations. The current study sought to examine associations between ADHD symptoms and maladaptive eating by evaluating three different types of eating episodes characterized by the presence/absence of LOC and the amount of food consumed: objectively large LOC episodes [objective binge eating (OBE)], subjectively large binge episodes [subjective binge eating (SBE)], and objectively large overeating episodes without LOC [objective overeating (OO)]. METHODS Participants were 385 youth (M age = 10.89, SD = 2.25) drawn from five different research protocols at institutions across the United States. Participants and their parents completed questionnaires and semistructured interviews to assess ADHD symptoms, OBE, SBE, and OO. RESULTS As hypothesized, negative binomial regressions revealed that ADHD symptoms were significantly associated with OBE, χ2(1) = 16.61, p < 0.001, and with OO, χ2(1) = 10.64, p < 0.01. Contrary to expectations, they were not associated with SBE. CONCLUSIONS These results indicate the need for future studies to explore possible shared mechanisms (e.g., impulsivity) underlying associations between ADHD symptoms, OBE, and OO. Clinical implications include support for considering ADHD symptoms in programs that target both prevention of LOC eating and obesity more generally.
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Affiliation(s)
- Amy Heard Egbert
- Department of Psychology, Loyola University Chicago, Chicago, IL
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Kamryn T. Eddy
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kerri N. Boutelle
- Department of Pediatrics and Psychiatry, University of California San Diego, La Jolla, CA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota Medical Center, Minneapolis, MN
| | - Angela Celio Doyle
- Eating Disorders Center, Evidence Based Treatment Centers of Seattle, Seattle, WA
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco, San Francisco, CA.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL
| | - Andrea B. Goldschmidt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center/The Miriam Hospital, Providence, RI
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92
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Dalai SS, Adler S, Najarian T, Safer DL. Study protocol and rationale for a randomized double-blinded crossover trial of phentermine-topiramate ER versus placebo to treat binge eating disorder and bulimia nervosa. Contemp Clin Trials 2018; 64:173-178. [PMID: 29038069 DOI: 10.1016/j.cct.2017.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Bulimia nervosa (BN) and binge eating disorder (BED) are associated with severe psychological and medical consequences. Current therapies are limited, leaving up to 50% of patients symptomatic despite treatment, underscoring the need for additional treatment options. Qsymia, an FDA-approved medication for obesity, combines phentermine and topiramate ER. Topiramate has demonstrated efficacy for both BED and BN, but limited tolerability. Phentermine is FDA-approved for weight loss. A rationale for combined phentermine/topiramate for BED and BN is improved tolerability and efficacy. While a prior case series exploring Qsymia for BED showed promise, randomized studies are needed to evaluate Qsymia's safety and efficacy when re-purposed in eating disorders. We present a study protocol for a Phase I/IIa single-center, prospective, double-blinded, randomized, crossover trial examining safety and preliminary efficacy of Qsymia for BED and BN. METHODS Adults with BED (n=15) or BN (n=15) are randomized 1:1 to receive 12weeks Qsymia (phentermine/topiramate ER, 3.75mg/23mg-15mg/92mg) or placebo, followed by 2-weeks washout and 12-weeks crossover, where those on Qsymia receive placebo and vice versa. Subsequently participants receive 8weeks follow-up off study medications. The primary outcome is the number of binge days/week measured by EDE. Secondary outcomes include average number of binge episodes, percentage abstinence from binge eating, and changes in weight/vitals, eating psychopathology, and mood. DISCUSSION To our knowledge this is the first randomized, double-blind protocol investigating the safety and efficacy of phentermine/topiramate in BED and BN. We highlight the background and rationale for this study, including the advantages of a crossover design. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02553824 registered on 9/17/2015. https://clinicaltrials.gov/ct2/show/NCT02553824.
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Affiliation(s)
- Shebani Sethi Dalai
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford 94305, CA, USA.
| | - Sarah Adler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford 94305, CA, USA
| | - Thomas Najarian
- Retired, Najarian Center For Obesity, 93402, Los Osos, CA, USA
| | - Debra Lynn Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford 94305, CA, USA
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93
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Rand-Giovannetti D, Cicero DC, Mond JM, Latner JD. Psychometric Properties of the Eating Disorder Examination–Questionnaire (EDE-Q): A Confirmatory Factor Analysis and Assessment of Measurement Invariance by Sex. Assessment 2017; 27:164-177. [DOI: 10.1177/1073191117738046] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The original, theoretically derived factor structure of the Eating Disorder Examination–Questionnaire (EDE-Q) has received limited empirical support and there is no consensus on an appropriate alternative. Moreover, there is a paucity of data on the factor structure of the EDE-Q across sexes. The goals of the current study were to evaluate models of the EDE-Q factor structure and to assess the best-fitting model for differences by sex. Twelve models were compared using confirmatory factor analysis in a sample of 940 undergraduates. Confirmatory factor analysis did not support the original factor structure. A four-factor model fit the data reasonably well with factors corresponding to themes of (a) dietary restraint, (b) preoccupation and restriction, (c) weight and shape concern, and (d) eating shame. The EDE-Q was found to be invariant by sex across all factors except Factor 3. The implications of these findings are discussed.
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Affiliation(s)
| | | | - Jonathan M. Mond
- University of Tasmania, Launceston, Tasmania, Australia
- Western Sydney University, Campbelltown, New South Wales Australia
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94
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Oberguggenberger A, Meraner V, Sztankay M, Hilbert A, Hubalek M, Holzner B, Gamper E, Kemmler G, Baumgartner T, Lackinger I, Sperner-Unterweger B, Mangweth-Matzek B. Health Behavior and Quality of Life Outcome in Breast Cancer Survivors: Prevalence Rates and Predictors. Clin Breast Cancer 2017; 18:38-44. [PMID: 29017754 DOI: 10.1016/j.clbc.2017.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/24/2017] [Accepted: 09/11/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE Health behavior (HB) has been identified as contributing to breast cancer (BC) disease outcome. The present study was subjected to gain more in-depth insight into breast cancer survivors' (BCS) HB and its associations with patient quality of life (QOL) outcome. We investigated HB focusing on eating disturbances comparing the latter with a reference population sample (PS). MATERIALS AND METHODS The research cohort included 303 BCS completing a comprehensive patient-reported-outcome assessment on HB (eating disturbances, exercise, substance use) and QOL. Data from an age- and education-matched reference PS (n = 303) on eating disturbances were included. RESULTS Overall, 30% of BCS were overweight; 11.7% of BCS (2-11 years after diagnosis, mean = 5.2 years) reported eating disturbances compared with 5% of PS (P < .05). Approximately three-fourths of BCS indicated they exercise regularly, one-fourth smoke regularly, and 30% consume alcohol. Lower consumption of analgesics and tranquilizers, higher frequency of exercise, lower eating concern (EDE-Q), younger age, and lower body mass index were significant predictors for better physical QOL. Lower eating and shape concern were next to age-identified predictive for better psychological QOL. DISCUSSION Obesity and eating disturbances are a considerable HB problem in women with a history of BC. Considering that HB is predictive for long-term QOL in BCS, routine counseling on HB should be integrated into survivorship care to increase patient education and contribute to behavioral changes.
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Affiliation(s)
- Anne Oberguggenberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria.
| | - Verena Meraner
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
| | - Michael Hubalek
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Gamper
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Teresa Baumgartner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Isabelle Lackinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, CL-Service, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Mangweth-Matzek
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
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Øverås M, Kapstad H, Brunborg C, Landrø NI, Rø Ø. Is overestimation of body size associated with neuropsychological weaknesses in anorexia nervosa? EUROPEAN EATING DISORDERS REVIEW 2017; 25:129-134. [PMID: 28217881 DOI: 10.1002/erv.2500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 10/21/2016] [Accepted: 11/25/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent research indicates some evidence of neuropsychological weaknesses in visuospatial memory, central coherence and set-shifting in adults with anorexia nervosa (AN). The growing interest in neuropsychological functioning of patients with AN is based upon the assumption that neuropsychological weaknesses contribute to the clinical features of the illness. However, due to a paucity of research on the connection between neuropsychological difficulties and the clinical features of AN, this link remains hypothetical. The main objective of this study was to explore the association between specific areas of neuropsychological functioning and body size estimation in patients with AN and healthy controls. METHODS The sample consisted of 36 women diagnosed with AN and 34 healthy female controls. Participants were administered the continuous visual memory test and the recall trials of Rey Complex Figure Test to assess visual memory. Central coherence was assessed using the copy trial of Rey Complex Figure Test, and the Wisconsin Card Sorting Test was used to assess set-shifting. Body size estimation was assessed with a computerized morphing programme. RESULTS The analyses showed no significant correlations between any of the neuropsychological measures and body size estimation. CONCLUSION The results suggest that there is no association between these areas of neuropsychological difficulties and body size estimation among patients with AN. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Maria Øverås
- Regional Department for Eating Disorders (RASP), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Hilde Kapstad
- Regional Department for Eating Disorders (RASP), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders (RASP), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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96
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Calugi S, Milanese C, Sartirana M, El Ghoch M, Sartori F, Geccherle E, Coppini A, Franchini C, Dalle Grave R. The Eating Disorder Examination Questionnaire: reliability and validity of the Italian version. Eat Weight Disord 2017; 22:509-514. [PMID: 27039107 DOI: 10.1007/s40519-016-0276-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/18/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To examine the validity and reliability of a new Italian language version of the latest edition of the Eating Disorder Examination Questionnaire (EDE-Q 6.0). METHODS The sixth edition of the EDE-Q was translated into Italian and administered to 264 Italian-speaking inpatient and outpatient (257 females in their mid-20s) with eating disorder (75.4% anorexia nervosa) and 216 controls (205 females). RESULTS Internal consistency was high for both the global EDE-Q and all subscale scores. Test-retest reliability was good to excellent (0.66-0.83) for global and subscale scores, and for items assessing key behavioral features of eating disorders (0.55-0.91). Patients with an eating disorder displayed significantly higher EDE-Q scores than controls, demonstrating the good criterion validity of the tool. Confirmatory factor analysis revealed a good fit for a modified seven-item three-factor structure. CONCLUSIONS The study showed the good psychometric properties of the new Italian version of the EDE-Q 6.0, and validated its use in Italian eating disorder patients, particularly in young females with anorexia nervosa.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy.
| | - Chiara Milanese
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Sartirana
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Federica Sartori
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Eleonora Geccherle
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Andrea Coppini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Cecilia Franchini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda, Verona, Italy
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97
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Darrow SM, Accurso EC, Nauman ER, Goldschmidt AB, Le Grange D. Exploring Types of Family Environments in Youth with Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2017; 25:389-396. [PMID: 28675592 DOI: 10.1002/erv.2531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/08/2017] [Accepted: 05/27/2017] [Indexed: 11/10/2022]
Abstract
While many studies have explored the relationship between different eating disorder diagnoses and the familial social environment, current evidence does not support associations between distinct family interaction patterns (e.g. high enmeshment) and particular diagnoses (e.g. anorexia nervosa). The current study seeks to move beyond the current literature to explore whether empirically derived subtypes of family environment are associated with clinical features within a transdiagnostic sample of youth seeking treatment for eating disorders (n = 123). Latent class modelling of the Family Environment Scale identified three classes (i.e. different Family Environment Scale profiles): (1) Control-Oriented; (2) System Maintenance-Oriented; and (3) Conflict-Oriented. Data are presented to characterize the classes (e.g. age, gender, rates of different eating disorders, severity of eating disorder pathology and rates of comorbid disorders). These preliminary results suggest that family interaction types may help personalize treatment for eating disorders and encourage future research to guide such efforts. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Sabrina M Darrow
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Erin C Accurso
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Emily R Nauman
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Andrea B Goldschmidt
- Weight Control and Diabetes Research Center, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Daniel Le Grange
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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98
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Burke NL, Tanofsky-Kraff M, Crosby R, Mehari RD, Marwitz SE, Broadney MM, Shomaker LB, Kelly NR, Schvey NA, Cassidy O, Yanovski SZ, Yanovski JA. Measurement invariance of the Eating Disorder Examination in black and white children and adolescents. Int J Eat Disord 2017; 50:758-768. [PMID: 28370435 PMCID: PMC5505792 DOI: 10.1002/eat.22713] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/14/2017] [Accepted: 03/17/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The Eating Disorder Examination (EDE) was originally developed and validated in primarily white female samples. Since data indicate that eating pathology impacts black youth, elucidating the psychometric appropriateness of the EDE for black youth is crucial. METHODS A convenience sample was assembled from seven pediatric obesity studies. The EDE was administered to all youth. Confirmatory factor analyses (CFA) were conducted to examine the original four-factor model fit and two alternative factor structures for black and white youth. With acceptable fit, multiple-group CFAs were conducted. For measurement invariant structures, the interactive effects of race with sex, BMIz, adiposity, and age were explored (all significance levels p < .05). RESULTS For both black and white youth (N = 820; 41% black; 37% male; 6-18 years; BMIz -3.11 to 3.40), the original four-factor EDE structure and alternative eight-item one-factor structure had mixed fit via CFA. However, a seven-item, three-factor structure reflecting Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction had good fit and held at the level of strict invariance. Girls reported higher factor scores than boys. BMIz and adiposity were positively associated with each subscale. Age was associated with Dietary Restraint and Body Dissatisfaction. The interactional effects between sex, BMIz, and age with race were not significant; however, the interaction between adiposity and race was significant. At higher adiposity, white youth reported greater pathology than black youth. CONCLUSION An abbreviated seven-item, three-factor version of the EDE captures eating pathology equivalently across black and white youth. Full psychometric testing of the modified EDE factor structure in black youth is warranted.
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Affiliation(s)
- Natasha L. Burke
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Ross Crosby
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, 1919 Elm Street North, Fargo, ND 58102, USA
- Neuropsychiatric Research Institute, 120 South 8th St., Box 1415, Fargo, ND 58107, USA
| | - Rim D. Mehari
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Shannon E. Marwitz
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Miranda M. Broadney
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Lauren B. Shomaker
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
- Department of Human Development and Family Studies, Colorado State University, 303 Behavioral Sciences Building, Campus Delivery 1570, 410 Pitkin Street, Fort Collins, CO 80523, USA
| | - Nichole R. Kelly
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
- Department of Counseling Psychology and Human Services, College of Education, University of Oregon, 1215 University of Oregon, Eugene, OR 97403-1215
| | - Natasha A. Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Omni Cassidy
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
| | - Susan Z. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH, DHHS, 6707 Democracy Blvd, Bethesda, MD 20892, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, 10 Center Drive, Bethesda, MD 20892, USA
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99
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Pinto C, Ferreira C, Mendes AL, Trindade IA. Social safeness and disordered eating: Exploring underlying mechanisms of body appreciation and inflexible eating. Eat Weight Disord 2017; 22:303-309. [PMID: 28421474 DOI: 10.1007/s40519-017-0384-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/13/2017] [Indexed: 10/19/2022] Open
Abstract
Feelings of social safeness and connectedness have been associated with adaptive emotion regulation processes and well-being indicators. Further, literature has demonstrated that interpersonal experiences play an important role in the etiology and maintenance of body and eating psychopathology. However, the study of the role of social variables and emotion regulation processes in the engagement in inflexible eating rules and eating psychopathology is still in its early stages. The current study aims to fill some gaps within the literature and explore the mediator role of body appreciation and inflexible eating rules in the link between social safeness and disordered eating. Participants were 253 women, aged between 18 and 50 years old, who completed a series of online self-report measures. Results from the tested path analysis model showed that social safeness holds a significant effect on eating psychopathology, through the mechanisms of body appreciation and inflexible eating rules. Also, results suggested that women who present higher levels of social safeness tend to present a more positive and respectful attitude towards their body and decreased adoption of inflexible eating rules, which seem to explain lower levels of disordered eating behaviours. These findings seem to present empirical support for the development of intervention programs that promote a positive, affectionate and healthy relationship with one's body image, in order to prevent the inflexible adherence to eating rules and disordered eating behaviours.
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Affiliation(s)
- Catarina Pinto
- CINEICC, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal
| | - Cláudia Ferreira
- CINEICC, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal
| | - Ana Laura Mendes
- CINEICC, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal.
| | - Inês A Trindade
- CINEICC, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal
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100
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Emery RL, Grace JL, Kolko RP, Levine MD. Adapting the eating disorder examination for use during pregnancy: Preliminary results from a community sample of women with overweight and obesity. Int J Eat Disord 2017; 50:597-601. [PMID: 28543865 PMCID: PMC5839101 DOI: 10.1002/eat.22646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The Eating Disorder Examination (EDE) is a structured clinical interview that is widely used for assessing disordered eating. Although the EDE has been used in pregnant women, no standard pregnancy version has been developed. Accordingly, the present study aimed to document adaptations made to a pregnancy version of the EDE (EDE-PV) and to describe the internal reliability of this adapted version. METHOD Three major modifications were made in the development of the EDE-PV. First, disordered eating was assessed during and prior to pregnancy to account for changes across the perinatal period. Second, items were adapted and rules governing ratings were altered to distinguish eating attitudes and behaviors that are considered normative during pregnancy from disordered eating. Third, several items were omitted. RESULTS The EDE-PV was administered to 129 women with overweight and obesity who were between 12 and 20 weeks gestation. Women were 27.25 (SD = 5.48) years of age and 56% were African American. Women endorsed low levels of disordered eating on the EDE-PV, and the internal reliability was similar to previous reports. CONCLUSION These findings provide support for use of the EDE-PV to assess disordered eating among pregnant women with overweight and obesity. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:597-601).
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Affiliation(s)
- Rebecca L. Emery
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer L. Grace
- Department of Psychiatry, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rachel P. Kolko
- Department of Psychiatry, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michele D. Levine
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychiatry, Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Correspondence to: M. D. Levine,
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