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Byrne CE, Kass AE, Accurso EC, Fischer S, O'Brien S, Goodyear A, Lock J, Le Grange D. Overvaluation of shape and weight in adolescents with anorexia nervosa: does shape concern or weight concern matter more for treatment outcome? J Eat Disord 2015; 3:49. [PMID: 26677412 PMCID: PMC4681038 DOI: 10.1186/s40337-015-0086-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/09/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Overvaluation of shape and weight is a key diagnostic feature of anorexia nervosa (AN); however, limited research has evaluated the clinical utility of differentiating between weight versus shape concerns. Understanding differences in these constructs may have important implications for AN treatment given the focus on weight regain. This study examined differences in treatment outcome between individuals whose primary concern was weight versus those whose primary concern was shape in a randomized controlled trial of treatment for adolescent AN. METHODS Data were drawn from a two-site randomized controlled trial that compared family-based treatment and adolescent focused therapy for AN. Chi-square tests and logistic regression analyses were conducted. RESULTS Thirty percent of participants presented with primary weight concern (n = 36; defined as endorsing higher Eating Disorder Examination (EDE) Weight Concern than Shape Concern subscale scores); 60 % presented with primary shape concern (n = 72; defined as endorsing higher EDE Shape Concern than Weight Concern scores). There were no significant differences between the two groups in remission status at the end of treatment. Treatment did not moderate the effect of group status on achieving remission. CONCLUSIONS Results suggest that treatment outcomes are comparable between adolescents who enter treatment for AN with greater weight concerns and those who enter treatment with greater shape concerns. Therefore, treatment need not be adjusted based on primary weight or primary shape concerns.
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Affiliation(s)
| | - Andrea E Kass
- Department of Medicine, The University of Chicago, Chicago, IL USA
| | - Erin C Accurso
- Department of Psychiatry, University of California, San Francisco, CA USA
| | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, VA USA
| | - Setareh O'Brien
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL USA
| | - Alexandria Goodyear
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL USA
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA USA
| | - Daniel Le Grange
- Department of Psychiatry and Department of Pediatrics, University of California, San Francisco, CA USA
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152
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Madden S, Miskovic-Wheatley J, Wallis A, Kohn M, Lock J, Le Grange D, Jo B, Clarke S, Rhodes P, Hay P, Touyz S. A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychol Med 2015; 45:415-427. [PMID: 25017941 PMCID: PMC4301212 DOI: 10.1017/s0033291714001573] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 05/30/2014] [Accepted: 06/06/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN. METHOD We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12-18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT). RESULTS The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group. CONCLUSIONS Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.
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Affiliation(s)
- S. Madden
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Discipline of Pediatrics, Faculty of Medicine, The University of Sydney, Australia
| | - J. Miskovic-Wheatley
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Westmead Clinical School, The University of Sydney, Australia
| | - A. Wallis
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
| | - M. Kohn
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Discipline of Pediatrics, Faculty of Medicine, The University of Sydney, Australia
- Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit, Westmead Hospital, Australia
| | - J. Lock
- Psychiatry and Behavioral Science, School of Medicine, Stanford University, USA
| | - D. Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, USA
| | - B. Jo
- Psychiatry and Behavioral Science, School of Medicine, Stanford University, USA
| | - S. Clarke
- Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit, Westmead Hospital, Australia
| | - P. Rhodes
- School of Psychology, The University of Sydney, Australia
| | - P. Hay
- Centre for Health Research, School of Medicine, The University of Western Sydney and School of Medicine, James Cook University, Australia
| | - S. Touyz
- School of Psychology, The University of Sydney, Australia
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153
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Accurso EC, Fitzsimmons-Craft EE, Ciao AC, Le Grange D. From efficacy to effectiveness: comparing outcomes for youth with anorexia nervosa treated in research trials versus clinical care. Behav Res Ther 2014; 65:36-41. [PMID: 25557396 DOI: 10.1016/j.brat.2014.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 12/08/2014] [Accepted: 12/12/2014] [Indexed: 11/19/2022]
Abstract
This study examined outcomes for 84 youth with anorexia nervosa (AN) who received family-based treatment (FBT) in a research trial (randomized trial care [RTC]: n = 32) compared to fee-for-service care (specialty clinical care [SCC]: n = 52) at an outpatient eating disorder clinic. Weight was collected up to 12 months post-baseline. Survival curves were used to examine time to weight restoration as predicted by type of care, baseline demographic and clinical characteristics, and their interaction. There was not a significant main effect for type of care, but its interaction with initial %EBW was significant (p = .005), indicating that weight restoration was achieved faster in RTC compared to SCC for youth with a lower initial %EBW (i.e., ≤81), while rates of weight restoration were comparable for those with a higher initial %EBW (i.e., >81). These data suggest that FBT is as effective as it is efficacious, except for youth with lower initial body weights. Therefore, clinicians may need to be particularly active in encouraging early weight gain for this subset of patients. Nevertheless, this study suggests that FBT is appropriate as a first-line treatment for youth with AN who present for clinical care.
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Affiliation(s)
- Erin C Accurso
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, USA.
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, USA
| | - Anna C Ciao
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, USA
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154
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Kjaersdam Telléus G, Jepsen JR, Bentz M, Christiansen E, Jensen SOW, Fagerlund B, Thomsen PH. Cognitive profile of children and adolescents with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 23:34-42. [PMID: 25504443 PMCID: PMC4309487 DOI: 10.1002/erv.2337] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 12/21/2022]
Abstract
Objective Few studies of cognitive functioning in children and adolescents with anorexia nervosa (AN) have been conducted. The aim of this study was to examine the neurocognitive and intelligence profile of this clinical group. Method The study was a matched case–control (N = 188), multi-centre study including children and adolescents with AN (N = 94) and healthy control participants (N = 94). Results The results suggest that Full Scale Intelligence Quotient (Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III) in this patient group is close to the normal population mean of 100. Individuals with AN exhibited significantly worse performance in nonverbal intelligence functions (i.e. Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III, Perceptual Organization Index) and in verbal memory (Test of Memory and Learning—Second Edition, Memory for Stories) and motor speed (Cambridge Neuropsychological Test Automated Battery, Simple and Choice Reaction Time) compared with healthy control participants. No significant difference in set-shifting ability (Cambridge Neuropsychological Test Automated Battery, Intra-Extra Dimensional Set Shift and Trail Making Test B) was found. Conclusions Inefficiency in nonverbal intelligence functions and in specific cognitive functions was found in this study of children and adolescents with AN. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Gry Kjaersdam Telléus
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark; Section of Eating Disorders, Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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155
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Godfrey K, Rhodes P, Miskovic-Wheatley J, Wallis A, Clarke S, Kohn M, Touyz S, Madden S. Just one more bite: a qualitative analysis of the family meal in family-based treatment for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 23:77-85. [PMID: 25469661 DOI: 10.1002/erv.2335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 09/26/2014] [Accepted: 11/08/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The family meal is an integral component of Maudsley family-based treatment for anorexia nervosa. The aim of this study was to determine whether there are different types of family meal, as suggested in the treatment manual, and whether within session processes differ according to meal type. METHOD Thirty video-recorded family meal sessions from a randomised controlled trial were transcribed and analysed using thematic analysis. RESULTS Analyses revealed two types of family meal. In the first, the patient ate one mouthful more than they were willing to eat. This meal type was characterised by processes that were consistent with the Maudsley model. In the second, the patient ate what was asked of them with little to no difficulty. Therapist and family avoidance differentiated this meal type from the first. DISCUSSION The current findings, along with the existing theory, suggest that avoidance may have reduced the therapeutic impact of the meal for many families. Strategies to challenge therapist and family avoidance are suggested. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Kate Godfrey
- Clinical Psychology Unit, The University of Sydney, Sydney, NSW 2006, Australia
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156
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Elran-Barak R, Accurso EC, Goldschmidt AB, Sztainer M, Byrne C, Le Grange D. Eating patterns in youth with restricting and binge eating/purging type anorexia nervosa. Int J Eat Disord 2014; 47:878-83. [PMID: 24777645 PMCID: PMC4337799 DOI: 10.1002/eat.22289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe eating patterns in youth with restricting and binge/purge type anorexia nervosa (AN) and to examine whether eating patterns are associated with binge eating or purging behaviors. METHOD Participants included 160 children and adolescents (M = 15.14 ± 2.17 years) evaluated at The University of Chicago Eating Disorders Program who met criteria for DSM-5 restrictive type AN (AN-R; 75%; n = 120) or binge eating/purging type AN (AN-BE/P; 25%; n = 40). All participants completed the eating disorder examination on initial evaluation. RESULTS Youth with AN-R and AN-BE/P differed in their eating patterns, such that youth with AN-R consumed meals and snacks more regularly relative to youth with AN-BE/P. Among youth with AN-BE/P, skipping dinner was associated with a greater number of binge eating episodes (r = -.379, p < .05), while skipping breakfast was associated with a greater number of purging episodes (r = -.309, p < .05). DISCUSSION Youth with AN-R generally follow a regular meal schedule, but are likely consuming insufficient amounts of food across meals and snacks. In contrast, youth with AN-BE/P tend to have more irregular eating patterns, which may play a role in binge eating and purging behaviors. Adults monitoring of meals may be beneficial for youth with AN, and particularly those with AN-BE/P who engage in irregular eating patterns.
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Affiliation(s)
- Roni Elran-Barak
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Erin C. Accurso
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Andrea B. Goldschmidt
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Maya Sztainer
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Catherine Byrne
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Daniel Le Grange
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
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157
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Grange DL, Lock J, Accurso EC, Agras WS, Darcy A, Forsberg S, Bryson SW. Relapse from remission at two- to four-year follow-up in two treatments for adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry 2014; 53:1162-7. [PMID: 25440306 PMCID: PMC4254507 DOI: 10.1016/j.jaac.2014.07.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/29/2014] [Accepted: 08/13/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Long-term follow-up studies documenting maintenance of treatment effects are few in adolescent anorexia nervosa (AN). This exploratory study reports relapse from full remission and attainment of remission during a 4-year open follow-up period using a convenience sample of a subgroup of 65% (n = 79) from an original cohort of 121 participants who completed a randomized clinical trial comparing family-based therapy (FBT) and adolescent-focused individual therapy (AFT). METHOD Follow-up assessments were completed up to 4 years posttreatment (average, 3.26 years). Available participants completed the Eating Disorder Examination as well as self-report measures of self-esteem and depression at 2 to 4 years posttreatment. RESULTS Two participants (6.1%) relapsed (FBT: n = 1, 4.5%; AFT: n = 1, 9.1%), on average 1.98 years (SD = 0.14 years) after remission was achieved at 1-year follow-up. Ten new participants (22.7%) achieved remission (FBT: n = 1, 5.9%; AFT: n = 9, 33.3%). Mean time to remission for this group was 2.01 years (SD = 0.82 years) from 1-year follow-up. There were no differences based on treatment group assignment in either relapse from full remission or new remission during long-term follow-up. Other psychopathology was stable over time. CONCLUSION There were few changes in the clinical presentation of participants who were assessed at long-term follow-up. These data suggest that outcomes are generally stable posttreatment regardless of treatment type once remission is achieved. Clinical trial registration information-Effectiveness of Family-Based Versus Individual Psychotherapy in Treating Adolescents With Anorexia Nervosa; http://www.clinicaltrials.gov/; NCT00149786.
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158
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Chan CW, Leung SF. Validation of the Eating Disorder Examination Questionnaire: an online version. J Hum Nutr Diet 2014; 28:659-65. [DOI: 10.1111/jhn.12275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. W. Chan
- School of Nursing; The Hong Kong Polytechnic University; Hung Hom Kowloon Hong Kong
| | - S. F. Leung
- School of Nursing; The Hong Kong Polytechnic University; Hung Hom Kowloon Hong Kong
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159
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Kawai K, Yamashita S, Komaki G, Shimizu M, Nakashima M, Etou S, Takakura S, Takii M, Kubo C, Sudo N. The outcome of treatment for anorexia nervosa inpatients who required urgent hospitalization. Biopsychosoc Med 2014; 8:20. [PMID: 25225574 PMCID: PMC4163679 DOI: 10.1186/1751-0759-8-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 08/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background This study was done to determine which psychosocial factors are related to the urgent hospitalization of anorexia nervosa patients (AN) due to extremely poor physical condition and to evaluate their outcome after inpatient treatment. Methods 133 hospitalized AN patients were classified into an urgent hospitalization (n = 24) or a planned hospitalization (n = 109) group. Multiple regression analysis was done of clinical features, body mass index (BMI), psychological tests [The Minnesota Multiphasic Personality Inventory (MMPI), alexithymia, relationship with parents, and the Eating Disorder Inventory (EDI)]. The effectiveness of treatment was prospectively determined two years after discharge by the Global Clinical Score (GCS). The hospitalized weight gain and the frequency of outpatient visits were evaluated. Results Of the factors assessed, only BMI at admission was related to the necessity of urgent hospitalization (β = − 1.063, P = 0.00). The urgent group had significantly more weight loss after discharge and poorer social adaptation on the GCS, even when the patient had a sufficient increase in body weight during inpatient treatment and an equivalent number of outpatient consultations. Conclusion None of the parameters of the psychosocial tests studied were significantly different between the groups. The outcome of the urgent group was poor. Two years after discharge they had difficulty maintaining weight and continued to have poor social adaptation.
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Affiliation(s)
- Keisuke Kawai
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, 3-1-1 Higashi-ku, Fukuoka 812-8582, Japan
| | - Sakino Yamashita
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, 3-1-1 Higashi-ku, Fukuoka 812-8582, Japan
| | - Gen Komaki
- School of Health Sciences Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Miki Shimizu
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, 3-1-1 Higashi-ku, Fukuoka 812-8582, Japan
| | - Megumi Nakashima
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, 3-1-1 Higashi-ku, Fukuoka 812-8582, Japan
| | - Samami Etou
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, 3-1-1 Higashi-ku, Fukuoka 812-8582, Japan
| | - Shu Takakura
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, 3-1-1 Higashi-ku, Fukuoka 812-8582, Japan
| | - Masato Takii
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, 3-1-1 Higashi-ku, Fukuoka 812-8582, Japan
| | - Chiharu Kubo
- Kyushu University, 3-1-1 Higashi-ku, Fukuoka 812-8582, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Science, Kyushu University, 3-1-1 Higashi-ku, Fukuoka 812-8582, Japan
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160
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Arigo D, Schumacher L, Martin LM. Upward appearance comparison and the development of eating pathology in college women. Int J Eat Disord 2014; 47:467-70. [PMID: 24375614 DOI: 10.1002/eat.22240] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/26/2013] [Accepted: 12/14/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Body dissatisfaction and disordered eating behaviors are common among college women, yet only a subset of this population develops clinically significant disordered eating symptoms during college. Appearance-based social comparisons, particularly those made to others with "better" bodies (i.e., upward appearance comparisons), have demonstrated concurrent relationships with body dissatisfaction and disordered eating. Little is known about the value of these comparisons for predicting the development of eating pathology, however. METHOD The present study examined the predictive value of upward appearance comparisons, as well as established risk factors (e.g., body dissatisfaction, negative affect), for the onset of clinically significant eating pathology over one college semester. College women (N = 454) completed validated self-report measures at the beginning of one semester, and again nine weeks later. RESULTS Women who were newly above the clinical threshold for eating pathology at follow-up (n = 31) exhibited stronger baseline tendencies toward upward appearance comparisons than women who were below the threshold at both time points. In contrast, women who were already above the clinical threshold at baseline scored higher on established risk factors. DISCUSSION These findings suggest that the extent of upward appearance comparison may be useful for identifying college women at particular risk for developing clinically significant disordered eating symptoms.
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Affiliation(s)
- Danielle Arigo
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
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161
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Elran-Barak R, Sztainer M, Goldschmidt AB, Le Grange D. Family meal frequency among children and adolescents with eating disorders. J Adolesc Health 2014; 55:53-8. [PMID: 24529833 PMCID: PMC4065806 DOI: 10.1016/j.jadohealth.2013.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Previous studies on family meals and disordered eating have mainly drawn their samples from the general population. The goal of the current study is to determine family meal frequency among children and adolescents with anorexia nervosa (AN), bulimia nervosa (BN), and feeding or eating disorder not elsewhere classified (FED-NEC) and to examine whether family meal frequency is associated with eating disorder psychopathology. METHODS Participants included 154 children and adolescents (M = 14.92 ± 2.62), who met criteria for AN (n = 60), BN (n = 32), or FED-NEC (n = 62). All participants completed the Eating Disorder Examination and the Family Meal Questionnaire prior to treatment at the University of Chicago Eating Disorders Program. RESULTS AN and BN participants significantly differed in terms of family meal frequency. A majority of participants with AN (71.7%), compared with less than half (43.7%) of participants with BN, reported eating dinner with their family frequently (five or more times per week). Family meal frequency during dinner was significantly and negatively correlated with dietary restraints and eating concerns among participants with BN (r = -.381, r = -.366, p < .05) and FED-NEC (r = -.340, r = -.276, p < .05). CONCLUSIONS AN patients' higher family meal frequency may be explained by their parents' relatively greater vigilance over eating, whereas families of BN patients may be less aware of eating disorder behaviors and hence less insistent upon family meals. Additionally, children and adolescents with AN may be more inhibited and withdrawn and therefore are perhaps more likely to stay at home and eat together with their families.
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Affiliation(s)
- Roni Elran-Barak
- TheUniversity of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Maya Sztainer
- TheUniversity of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Andrea B. Goldschmidt
- TheUniversity of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois.
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Ferreira MC, De Castro Coelho L, Asakura L, Molina Cohrs F, Sachs A, Sávio K, De Cássia Akutsu R. Relationship Between Social and Personal Variables, Body Image, and Wellbeing at Work of Nutritionists. REVISTA COLOMBIANA DE PSICOLOGÍA 2014. [DOI: 10.15446/rcp.v23n1.39873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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163
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Manasse SM, Juarascio AS, Forman EM, Berner LA, Butryn ML, Ruocco AC. Executive functioning in overweight individuals with and without loss-of-control eating. EUROPEAN EATING DISORDERS REVIEW 2014; 22:373-7. [PMID: 24962637 DOI: 10.1002/erv.2304] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/11/2014] [Accepted: 05/30/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The current study sought to examine executive function (EF) in overweight individuals with and without loss-of-control (LOC) eating. METHOD Eighty overweight and obese individuals entering a behavioural weight loss trial with (n=18) and without (n=62) LOC eating were administered a clinical interview and neuropsychological battery designed to assess self-regulatory control, planning, delayed discounting and working memory. RESULTS After controlling for age, IQ and depression, individuals with LOC eating performed worse on tasks of planning and self-regulatory control and did not differ in performance on other tasks. DISCUSSION Results indicate that overweight individuals with LOC eating display relative deficits in EF compared with overweight individuals without LOC eating. Planning and self-regulatory control deficits in particular may contribute to dysregulated eating patterns, increasing susceptibility to LOC episodes. Future research should examine how EF deficits relate to treatment outcome.
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164
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Melin A, Tornberg ÅB, Skouby S, Møller SS, Sundgot-Borgen J, Faber J, Sidelmann JJ, Aziz M, Sjödin A. Energy availability and the female athlete triad in elite endurance athletes. Scand J Med Sci Sports 2014; 25:610-22. [PMID: 24888644 DOI: 10.1111/sms.12261] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2014] [Indexed: 12/31/2022]
Abstract
The female athlete triad (Triad), links low energy availability (EA), with menstrual dysfunction (MD), and impaired bone health. The aims of this study were to examine associations between EA/MD and energy metabolism and the prevalence of Triad-associated conditions in endurance athletes. Forty women [26.2 ± 5.5 years, body mass index (BMI) 20.6 ± 2.0 kg/m(2), body fat 20.0 ± 3.0%], exercising 11.4 ± 4.5 h/week, were recruited from national teams and competitive clubs. Protocol included gynecological examination; assessment of bone health; indirect respiratory calorimetry; diet and exercise measured 7 days to assess EA; eating disorder (ED) examination; blood analysis. Subjects with low/reduced EA (< 45 kcal/kg FFM/day), had lower resting metabolic rate (RMR) compared with those with optimal EA [28.4 ± 2.0 kcal/kg fat-free mass (FFM)/day vs 30.5 ± 2.2 kcal/kg FFM/day, P < 0.01], as did subjects with MD compared with eumenorrheic subjects (28.6 ± 2.4 kcal/kg FFM/day vs 30.2 ± 1.8 kcal/kg FFM/day, P < 0.05). 63% had low/reduced EA, 25% ED, 60% MD, 45% impaired bone health, and 23% had all three Triad conditions. 53% had low RMR, 25% hypercholesterolemia, and 38% hypoglycemia. Conclusively, athletes with low/reduced EA and/or MD had lowered RMR. Triad-associated conditions were common in this group of athletes, despite a normal BMI range. The high prevalence of ED, MD, and impaired bone health emphasizes the importance of prevention, early detection, and treatment of energy deficiency.
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Affiliation(s)
- A Melin
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Å B Tornberg
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.,Genetic & Molecular Epidemiology (GAME) Unit, Lund University Diabetes Center, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
| | - S Skouby
- Endocrinological and Reproductive Unit, Department of Ob/Gyn. Herlev Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark
| | - S S Møller
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | | | - J Faber
- Endocrinological and Reproductive Unit, Department of Ob/Gyn. Herlev Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark
| | - J J Sidelmann
- Unit for Thrombosis Research, Institute of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - M Aziz
- Endocrinological and Reproductive Unit, Department of Ob/Gyn. Herlev Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark
| | - A Sjödin
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
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165
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Eating attitudes of anorexia nervosa, bulimia nervosa, binge eating disorder and obesity without eating disorder female patients: differences and similarities. Physiol Behav 2014; 131:99-104. [DOI: 10.1016/j.physbeh.2014.04.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/28/2014] [Accepted: 04/15/2014] [Indexed: 01/13/2023]
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166
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El Ghoch M, Milanese C, Calugi S, Pellegrini M, Battistini NC, Dalle Grave R. Body composition, eating disorder psychopathology, and psychological distress in anorexia nervosa: a longitudinal study. Am J Clin Nutr 2014; 99:771-8. [PMID: 24500157 DOI: 10.3945/ajcn.113.078816] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although the effect of immediate weight restoration on body composition and body fat distribution has previously been studied in anorexia nervosa (AN), its influence in women with AN on eating disorder psychopathology and psychological distress has not previously been investigated to our knowledge. OBJECTIVES We assessed body composition and fat mass distribution before and after body weight restoration and investigated any relation between changes in body fat patterns of patients with AN treated in a specialist inpatient unit and their eating disorder and psychological distress features. DESIGN Body composition was measured by using dual-energy X-ray absorptiometry in 50 female, adult patients with AN before and after complete weight restoration [body mass index (BMI; in kg/m²) ≥18.5] and 100 healthy control subjects matched by age and posttreatment BMI of study group participants. Eating disorder psychopathology and psychological distress were assessed in the AN group before and after weight restoration by using the Eating Disorder Examination interview and the Global Severity Index of the Brief Symptom Inventory (BSI-GSI), respectively. RESULTS After the achievement of complete weight restoration, patients with AN had higher trunk (P < 0.001), android (P < 0.001), and gynoid (P < 0.001) fat masses and lower arm (P < 0.001) and leg (P = 0.001) fat masses with respect to control subjects. No relation was shown between body-composition variables and eating disorder psychopathology in the AN group, and the only significant predictor of change in BSI-GSI was the baseline BSI-GSI score. CONCLUSION The normalization of body weight in patients with AN is associated with a preferential distribution of body fat in central regions, which does not, however, seem to influence either eating disorder psychopathology or psychological distress scores.
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Affiliation(s)
- Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy (MEG, SC, and RDG); the Department of Neurological and Movement Sciences, University of Verona, Verona, Italy (CM); and the Department of Diagnostic, Clinical and Public Health, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy (MP and NCB)
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167
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Accurso EC, Ciao AC, Fitzsimmons-Craft EE, Lock JD, Le Grange D. Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa. Behav Res Ther 2014; 56:1-6. [PMID: 24632109 DOI: 10.1016/j.brat.2014.02.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 11/28/2022]
Abstract
The main aims of this study were to describe change in psychological outcomes for adolescents with anorexia nervosa across two treatments, and to explore predictors of change, including baseline demographic and clinical characteristics, as well as weight gain over time. Participants were 121 adolescents with anorexia nervosa from a two-site (Chicago and Stanford) randomized controlled trial who received either family-based treatment or individual adolescent supportive psychotherapy. Psychological symptoms (i.e., eating disorder psychopathology, depressive symptoms, and self-esteem) were assessed at baseline, end of treatment, 6-month, and 12-month follow-up. Conditional multilevel growth models were used to test for predictors of slope for each outcome. Most psychological symptoms improved significantly from baseline to 12 month follow-up, regardless of treatment type. Depressive symptoms and dietary restraint were most improved, weight and shape concerns were least improved, and self-esteem was not at all improved. Weight gain emerged as a significant predictor of improved eating disorder pathology, with earlier weight gain having a greater impact on symptom improvement than later weight gain. Adolescents who presented with more severe, complex, and enduring clinical presentations (i.e., longer duration of illness, greater eating disorder pathology, binge-eating/purging subtype) also appeared to benefit more psychologically from treatment.
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Affiliation(s)
- Erin C Accurso
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, USA.
| | - Anna C Ciao
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, USA
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, USA
| | - James D Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Rd., MC 5719, Stanford, CA 94305, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, USA
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168
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Forbush KT, Wildes JE, Hunt TK. Gender norms, psychometric properties, and validity for the Eating Pathology Symptoms Inventory. Int J Eat Disord 2014; 47:85-91. [PMID: 23996154 DOI: 10.1002/eat.22180] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 07/21/2013] [Accepted: 07/21/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The Eating Pathology Symptoms Inventory [EPSI; Forbush KT, Wildes JE, Pollack LO, Dunbar D, Luo J, Patterson K, et al. Development and validation of the EPSI. Psychological Assessment, in press] is an empirically derived self-report measure of eating disorder (ED) symptoms. The EPSI is able to capture the majority of variance associated with established ED measures, yet possesses additional content that is not currently represented in any existing multidimensional ED measure. The purpose of this study was to present normative and psychometric data for the EPSI in a large sample of college men (N = 502) and women (N = 625). METHOD Participants completed the EPSI and a battery of self-report measures to evaluate convergent and discriminant validity. To provide context as to how normative scores compare to ED psychopathology, undergraduate student scores were compared to scores from individuals with EDs (N = 150). RESULTS Confirmatory factor analyses indicated that the EPSI had a robust eight-factor structure that was replicated in both men and women. Mean scores for most scales were significantly higher in women, except for Excessive Exercise, Muscle Building, and Negative Attitudes toward Obesity, which were significantly higher in men. Most scale scores were significantly lower in college students than in patients with EDs. Results indicated excellent convergent and discriminant validity in both genders. DISCUSSION These data provide the first large-scale normative data for the EPSI in young adults, as well as additional evidence supporting the psychometric properties and construct validity of the EPSI.
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Affiliation(s)
- Kelsie T Forbush
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana
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169
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Davis C, Dutton WB, Durant T, Annunziato RA, Marcotte D. Achieving cultural congruency in weight loss interventions: can a spirituality-based program attract and retain an inner-city community sample? J Obes 2014; 2014:641939. [PMID: 24804086 PMCID: PMC3997900 DOI: 10.1155/2014/641939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/05/2014] [Accepted: 03/14/2014] [Indexed: 01/22/2023] Open
Abstract
UNLABELLED Ethnic minorities continue to be disproportionately affected by obesity and are less likely to access healthcare than Caucasians. It is therefore imperative that researchers develop novel methods that will attract these difficult-to-reach groups. The purpose of the present study is to describe characteristics of an urban community sample attracted to a spiritually based, weight loss intervention. METHODS. Thirteen participants enrolled in a pilot version of Spiritual Self-Schema Therapy (3S) applied to disordered eating behavior and obesity. Treatment consisted of 12 one-hour sessions in a group therapy format. At baseline, participants were measured for height and weight and completed a battery of self-report measures. RESULTS The sample was predominantly African-American and Hispanic and a large percentage of the sample was male. Mean baseline scores of the EDE-Q, YFAS, and the CES-D revealed clinically meaningful levels of eating disordered pathology and depression, respectively. The overall attrition rate was quite low for interventions targeting obesity. DISCUSSION This application of a spiritually centered intervention seemed to attract and retain a predominantly African-American and Hispanic sample. By incorporating a culturally congruent focus, this approach may have been acceptable to individuals who are traditionally more difficult to reach.
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Affiliation(s)
- Chad Davis
- Department of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY 10458, USA
- *Chad Davis:
| | - William Blake Dutton
- Department of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY 10458, USA
| | - Taryn Durant
- Department of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY 10458, USA
| | - Rachel A. Annunziato
- Department of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY 10458, USA
| | - David Marcotte
- Department of Psychology, Fordham University, 441 E. Fordham Road, Bronx, NY 10458, USA
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170
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Sullivan S, Stein R, Jonnalagadda S, Mullady D, Edmundowicz S. Aspiration therapy leads to weight loss in obese subjects: a pilot study. Gastroenterology 2013; 145:1245-52.e1-5. [PMID: 24012983 PMCID: PMC4025911 DOI: 10.1053/j.gastro.2013.08.056] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/05/2013] [Accepted: 08/29/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Obese patients rarely achieve long-term weight loss with only lifestyle interventions. We evaluated the use of endoscopic aspiration therapy for obesity. Aspiration therapy involves endoscopic placement of a gastrostomy tube (A-Tube) and the AspireAssist siphon assembly (Aspire Bariatrics, King of Prussia, PA) to aspirate gastric contents 20 minutes after meal consumption. METHODS We performed a pilot study of 18 obese subjects who were randomly assigned (2:1) to groups that underwent aspiration therapy for 1 year plus lifestyle therapy (n = 11; mean body mass index, 42.6 ± 1.4 kg/m(2)) or lifestyle therapy only (n = 7; mean body mass index, 43.4 ± 2.0 kg/m(2)). Lifestyle intervention comprised a 15-session diet and behavioral education program. RESULTS Ten of the 11 subjects who underwent aspiration therapy and 4 of the 7 subjects who underwent lifestyle therapy completed the first year of the study. After 1 year, subjects in the aspiration therapy group lost 18.6% ± 2.3% of their body weight (49.0% ± 7.7% of excess weight loss [EWL]) and those in the lifestyle therapy group lost 5.9% ± 5.0% (14.9% ± 12.2% of EWL) (P < .04). Seven of the 10 subjects in the aspiration therapy group completed an additional year of therapy and maintained a 20.1% ± 3.5% body weight loss (54.6% ± 12.0% of EWL). There were no adverse effects of aspiration therapy on eating behavior and no evidence of compensation for aspirated calories with increased food intake. No episodes of binge eating in the aspiration therapy group or serious adverse were reported. CONCLUSIONS In a pilot study, aspiration therapy appears to be a safe and effective long-term weight loss therapy for obesity.
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Affiliation(s)
- Shelby Sullivan
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri.
| | - Richard Stein
- Divisions of Geriatrics and Nutritional Science, Washington University School of Medicine, St Louis, Missouri
| | | | - Daniel Mullady
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Steven Edmundowicz
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
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171
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Lock J, Agras WS, Le Grange D, Couturier J, Safer D, Bryson SW. Do end of treatment assessments predict outcome at follow-up in eating disorders? Int J Eat Disord 2013; 46:771-8. [PMID: 23946139 DOI: 10.1002/eat.22175] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine the predictive value of end of treatment (EOT) outcomes for longer term recovery status. METHOD We used signal detection analysis to identify the best predictors of recovery based on outcome at EOT using five different eating disorder samples from randomized clinical treatment trials. We utilized a transdiagnostic definition of recovery that included normalization of weight and eating related psychopathology. RESULTS Achieving a body weight of 95.2% of expected body weight by EOT is the best predictor of recovery for adolescents with anorexia nervosa (AN). For adults with AN, the most efficient predictor of weight recovery (BMI > 19) was weight gain to greater than 85.8% of ideal body weight. In addition, for adults with AN, the most efficient predictor of psychological recovery was achievement of an eating disorder examination (EDE) weight concerns score below 1.8. The best predictor of recovery for adults with Bulimia Nervosa (BN) was a frequency of compensatory behaviors less than two times a month. For adolescents with BN, abstinence from purging and reduction in the EDE restraint score of more than 3.4 from baseline to EOT were good predictors of recovery. For adults with binge eating disorder, reduction of the Global EDE score to within the normal range (<1.58) was the best predictor of recovery. DISCUSSION The relationship between EOT response and recovery remains understudied. Utilizing a transdiagnostic definition of recovery, no uniform predictors were identified across all eating disorder diagnostic groups.
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Affiliation(s)
- James Lock
- Department of Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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172
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Thomas JJ, Roberto CA, Berg KC. The Eating Disorder Examination: a semi-structured interview for the assessment of the specific psychopathology of eating disorders. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/21662630.2013.840119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christina A. Roberto
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Kelly C. Berg
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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173
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Merwin RM, Zucker NL, Timko CA. A Pilot Study of an Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa. COGNITIVE AND BEHAVIORAL PRACTICE 2013; 20:485-500. [PMID: 27307691 PMCID: PMC4905735 DOI: 10.1016/j.cbpra.2012.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of adolescent anorexia nervosa (AN) has improved significantly with the increased emphasis on family-based intervention. Yet despite advances, a substantial number of adolescents do not respond optimally to existing treatment models and thus there is a need for treatment alternatives that address barriers to recovery. We developed and piloted an acceptance-based separated family treatment (ASFT) with 6 adolescents with AN or subthreshold AN (eating disorder not otherwise specified, with the primary symptoms of restriction and severe weight loss). Treatment acceptability was adequate. Overall, parents rated the treatment as credible and expected improvement in their child's condition. Five of the 6 adolescents treated with ASFT restored weight to their ideal body mass index as indicated by age, height, and sex and determined by individual growth charts. Many demonstrated improved psychological health and adaptive functioning. There was evidence of broad effects, with parents reporting decreased anxiety and caregiver burden. ASFT holds promise as a treatment option for AN. The efficacy of this therapeutic approach should be tested in larger trials and compared to current family-based interventions to determine unique effects.
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174
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Aardoom JJ, Dingemans AE, Spinhoven P, Hakkaart-van Roijen L, Van Furth EF. An Internet-based intervention for eating disorders consisting of automated computer-tailored feedback with or without supplemented frequent or infrequent support from a coach: study protocol for a randomized controlled trial. Trials 2013; 14:340. [PMID: 24135131 PMCID: PMC3853403 DOI: 10.1186/1745-6215-14-340] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 10/10/2013] [Indexed: 11/30/2022] Open
Abstract
Background Several Internet-based interventions for eating disorders have shown their effectiveness. Still, there is a need to refine such interventions given that most existing programs seem to be limited by their static ‘one-size-fits-all’ approach. ‘Featback’, an Internet-based intervention for symptoms of eating disorders provides a more individualized approach. It consists of several components (psychoeducation, a fully automated monitoring and feedback system, and support from a coach), which can be matched to participants’ needs and preferences. Until now, it is unclear whether online self-help interventions for eating disorders with support are more effective than those without. The aims of the current study are i) to examine the relative effectiveness of (the different components of) Featback; ii) to examine predictors, moderators and mediators of intervention responses; iii) to report on practical experiences with Featback; and iv) to examine the cost-effectiveness of Featback. Methods/design Individuals aged 16 years or older, with mild to severe eating disorder symptoms will be randomized to one of the four study conditions. In condition one, participants receive the basic version of Featback, consisting of psychoeducation and a fully automated monitoring and feedback system. In conditions two and three, participants receive the basic version of Featback supplemented with the possibility of infrequent (weekly) or frequent (three times a week) e-mail, chat, or Skype support from a coach, respectively. The fourth condition is a waiting list control condition. Participants are assessed at baseline, post-intervention (8 weeks), and at 3- and 6-month follow-up (the latter except for participants in the waiting list control condition). Primary outcome measures are disordered eating behaviors and attitudes. Secondary outcome measures are (eating disorder-related) quality of life, self-stigma of seeking help, self-esteem, mastery and support, symptoms of depression and anxiety, repetitive negative thinking, motivation to change, user satisfaction, compliance, and help-seeking attitudes and behaviors. Discussion This study aims to provide more insight into the (cost-) effectiveness of Internet-based interventions for eating disorders, particularly those with and without professional support, as well as different levels of support. Trial registration NTR3646
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Affiliation(s)
- Jiska J Aardoom
- Center for Eating Disorders Ursula, Postbox 422, 2260 AK, Leidschendam, The Netherlands.
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175
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Friborg O, Reas DL, Rosenvinge JH, Rø Ø. Core pathology of eating disorders as measured by the Eating Disorder Examination Questionnaire (EDE-Q): the predictive role of a nested general (g) and primary factors. Int J Methods Psychiatr Res 2013; 22:195-203. [PMID: 24038315 PMCID: PMC6878513 DOI: 10.1002/mpr.1389] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The present study examined several factor models of the Eating Disorder Examination Questionnaire (EDE-Q), and in particular, whether a nested general factor ('g') was present, hence supporting a common pathology factor. A total of 1094 women were randomly selected by Statistics Norway and mailed a questionnaire packet. The sample was randomly split, using the first half for exploratory analyses and the second for confirmatory validation purposes. A four-factor solution received the best support, but the structure deviated from the original model of Fairburn. The internal consistency was high for the first three factors (.93, .82 and .86) and satisfactory for the fourth (.78). The additional specification of a general (g) factor improved model fit significantly, implying that the EDE-Q scores are indicators of both a general core and four primary symptom patterns. Furthermore, the g was more strongly related to predictors like age and body mass index (BMI) than the four primary factors in a full structural equation model. The validity of interpreting the global EDE-Q score as indicative of g was supported. A brief Shape and Weight Concern subscale of 11 items was strongly related to the g-factor, and may provide an abbreviated measure of overall eating disorder pathology.
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Affiliation(s)
- Oddgeir Friborg
- Department of Psychology, University of Tromsø, Tromsø, Norway; Psychiatric Research Centre of Northern Norway, University Hospital of Northern Norway, Tromsø, Norway
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176
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Mariano P, Watson HJ, Leach DJ, McCormack J, Forbes DA. Parent-child concordance in reporting of child eating disorder pathology as assessed by the eating disorder examination. Int J Eat Disord 2013; 46:617-25. [PMID: 23847149 DOI: 10.1002/eat.22158] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to examine parent-youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample. METHOD The sample comprised 619 parent-youth dyads of youth (8-18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports. RESULTS On the whole, parent-youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK = 0.48-0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC = 0.07-0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents. DISCUSSION Results support the utility of parent-youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed.
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Affiliation(s)
- Paige Mariano
- School of Psychology, Murdoch University, Perth, Australia
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Berg KC, Swanson SA, Stiles-Shields EC, Eddy KT, Peterson CB, Le Grange D. Response patterns on interview and questionnaire versions of the Eating Disorder Examination and their impact on latent structure analyses. Compr Psychiatry 2013; 54:506-16. [PMID: 23375185 PMCID: PMC3687014 DOI: 10.1016/j.comppsych.2012.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The purpose of this investigation was to compare the latent structures of the interview (EDE) and questionnaire (EDE-Q) versions of the Eating Disorder Examination. METHODS Participants were 280 children, adolescents, and young adults seeking eating disorder treatment. Two separate latent structure analyses (LSAs) were conducted; one used variables from the EDE as indicators and the other used the corresponding variables from the EDE-Q as indicators. RESULTS The EDE and EDE-Q models both yielded four-class solutions. Three of the four classes from the EDE-Q model demonstrated moderate to high concordance with their paired class from the EDE model. Using the EDE-Q to detect the EDE, the sensitivity and specificity of measuring certain classes varied from poor (18.6%) to excellent (93.7%). The overall concordance was moderate (κ=.49). DISCUSSION These data suggest that LSAs using the EDE and EDE-Q may be directly compared; however, differences between results may represent inconsistencies in response patterns rather than true differences in psychopathology.
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Affiliation(s)
- Kelly C. Berg
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Sonja A. Swanson
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | | | - Kamryn T. Eddy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Daniel Le Grange
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
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Sandberg K, Erford BT. Choosing Assessment Instruments for Bulimia Practice and Outcome Research. JOURNAL OF COUNSELING AND DEVELOPMENT 2013. [DOI: 10.1002/j.1556-6676.2013.00107.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katie Sandberg
- Department of Education Specialties; Loyola University Maryland
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Goldschmidt AB, Peterson CB, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Crow SJ, Cao L, Berg KC. Trait-level and momentary correlates of bulimia nervosa with a history of anorexia nervosa. Int J Eat Disord 2013; 46:140-6. [PMID: 22987478 PMCID: PMC3570735 DOI: 10.1002/eat.22054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Some investigators have suggested subtyping bulimia nervosa (BN) by anorexia nervosa (AN) history. We examined trait-level and momentary eating-related and psychosocial factors in BN with and without an AN history. METHOD Interview, questionnaire, and ecological momentary assessment data of eating-related and psychological symptoms were collected from 122 women with BN, including 43 with (BN+) and 79 without an AN history (BN-). RESULTS Body mass index (kg/m(2) ) was lower in BN+ than BN- (p = 0.001). Groups did not differ on trait-level anxiety, shape/weight concerns, psychiatric comorbidity, or dietary restraint; or on momentary anxiety, dietary restriction, binge eating, purging, or exercise frequency, or affective patterns surrounding binge/purge behaviors. Negative affect increased prior to exercise and decreased thereafter in BN+ but not BN-, although groups did not statistically differ. DISCUSSION Results do not support formally subtyping BN by AN history. Exercise in BN+ may modulate negative affect, which could have important treatment implications.
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Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Stephen A. Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Ross D. Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Scott G. Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Li Cao
- Department of Clinical Research, Neuropsychiatric Research Institute, and Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, North Dakota, USA
| | - Kelly C. Berg
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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181
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CLAUSEN LOA. Forandring hos spiseforstyrrede patienter i psykoterapi; et naturalistisk studie. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/00291463.2003.10637409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- LOA CLAUSEN
- a Psykologisk Institut, Århus Universitet og Center for Spiseforstyrrelser, Århus Universitetshospital
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182
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DeJong H, Oldershaw A, Sternheim L, Samarawickrema N, Kenyon MD, Broadbent H, Lavender A, Startup H, Treasure J, Schmidt U. Quality of life in anorexia nervosa, bulimia nervosa and eating disorder not-otherwise-specified. J Eat Disord 2013; 1:43. [PMID: 24999421 PMCID: PMC4081766 DOI: 10.1186/2050-2974-1-43] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/31/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study aimed to assess differences in Quality of Life (QoL) across eating disorder (ED) diagnoses, and to examine the relationship of QoL to specific clinical features. RESULTS 199 patients with a diagnosed ED completed the Clinical Impairment Assessment (CIA) [Cognitive Behavior Therapy and Eating Disorders, 315-318, 2008] and the Eating Disorders Examination (EDE) [Int J Eat Disord 6:1-8]. Differences between diagnostic groups were examined, as were differences between restrictive and binge-purge subtypes. CIA scores and EDE scores were positively correlated and higher in groups with binge-purge behaviours. CIA scores were not correlated with BMI, illness duration or frequency of bingeing/purging behaviours, except in the binge-purge AN group, where CIA scores negatively correlated with BMI. CONCLUSIONS Patients with EDs have poor QoL and impairment increases with illness severity. Patients with binge/purge diagnoses are particularly impaired. It remains unclear which clinical features best predict the degree of impairment experienced by patients with EDs.
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Affiliation(s)
- Hannah DeJong
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Anna Oldershaw
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Lot Sternheim
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Nelum Samarawickrema
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Martha D Kenyon
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Hannah Broadbent
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Anna Lavender
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen Startup
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
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183
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Carter JC, Mercer-Lynn KB, Norwood SJ, Bewell-Weiss CV, Crosby RD, Woodside DB, Olmsted MP. A prospective study of predictors of relapse in anorexia nervosa: implications for relapse prevention. Psychiatry Res 2012; 200:518-23. [PMID: 22657951 DOI: 10.1016/j.psychres.2012.04.037] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 04/12/2012] [Accepted: 04/29/2012] [Indexed: 12/22/2022]
Abstract
Anorexia nervosa (AN) is a serious psychiatric disorder with a high rate of relapse. The goal of this study was to identify predictors of relapse in adult AN using a prospective, longitudinal design. Participants were 100 AN patients who had successfully completed specialized inpatient/day treatment, were weight-restored to a body mass index (BMI) of at least 20 for a minimum of 2 weeks, and reported less than one binge-purge (BP) episode over the previous 28 days at the end of treatment. Predictor variables included baseline demographic and clinical features, behavioral and psychological changes during treatment, residual psychopathology at post-treatment, and motivation to recover. Results indicated that 41% of participants relapsed during the 1-year follow-up period. The highest risk period for relapse was between 4 and 9 months post-treatment. Predictors of relapse included: the BP subtype of AN, severity of checking behaviors at pre-treatment, decrease in motivation to recover during treatment, and lower motivation to recover at post-treatment. These findings suggest that individuals with the BP subtype of AN are particularly susceptible to relapse. Increasing and maintaining motivation to recover during acute treatment may have an important impact on long-term outcome.
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Affiliation(s)
- Jacqueline C Carter
- Eating Disorders Program, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 8 Eaton North, Toronto, Ontario, Canada M5G 2C4.
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184
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Grilo CM, Crosby RD, White MA. Spanish-language Eating Disorder Examination interview: factor structure in Latino/as. Eat Behav 2012; 13:410-3. [PMID: 23121800 PMCID: PMC3490131 DOI: 10.1016/j.eatbeh.2012.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/06/2012] [Accepted: 07/06/2012] [Indexed: 11/18/2022]
Abstract
Latino/as face health care disparities in eating/weight disorders but are under-represented in treatment research and this is especially the case for Spanish-speaking-only persons. The development of psychometrically-sound assessment methods for Latino/as is needed to facilitate eating/weight research. The current study aimed to evaluate the factor structure of the Spanish-language version of the Eating Disorder Examination (S-EDE) interview, one of the primary assessment methods in studies of eating/weight despite limited data regarding psychometric aspects of this measure. Participants were 156 Spanish-speaking-only Latino/as (mean BMI 33.2; 84.6% classified as overweight) who were reliably administered the S-EDE interview by trained bi-lingual doctoral research-clinicians. Confirmatory factor analysis revealed an inadequate fit for the original EDE structure but revealed a good fit for an alternative structure suggested by recent research. CFA supported an 8-item 3-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. These factor analytic findings of the Spanish EDE interview are comparable to recent findings reported for English-speaking obese patient groups and have implications for clinical assessment and research with Latino/as.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, 301 Cedar St., New Haven, CT 06519, United States.
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185
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Abstract
Background Very few studies have investigated the relationship between malnutrition and psychological symptoms in Anorexia Nervosa (AN). They have used only body weight or body mass index (BMI) for the nutritional assessment and did not always report on medication, or if they did, it was not included in the analysis of results, and they did not include confounding factors such as duration of illness, AN subtype or age. The present study investigates this relationship using indicators other than BMI/weight, among which body composition and biological markers, also considering potential confounders related to depression and anxiety. Methods 155 AN patients, (DSM-IV) were included consecutively upon admission to inpatient treatment. Depression, anxiety, obsessive behaviours and social functioning were measured using various scales. Nutritional status was measured using BMI, severity of weight loss, body composition, and albumin and prealbumin levels. Results No correlation was found between BMI at inclusion, fat-free mass index, fat mass index, and severity of weight loss and any of the psychometric scores. Age and medication are the only factors that affect the psychological scores. None of the psychological scores were explained by the nutritional indicators with the exception of albumin levels which was negatively linked to the LSAS fear score (p = 0.024; beta = −0.225). Only the use of antidepressants explained the variability in BDI scores (p = 0.029; beta = 0.228) and anxiolytic use explained the variability in HADs depression scores (p = 0.037; beta = 0.216). Conclusion The present study is a pioneer investigation of various nutritional markers in relation to psychological symptoms in severely malnourished AN patients. The clinical hypothesis that malnutrition partly causes depression and anxiety symptoms in AN in acute phase is not confirmed, and future studies are needed to back up our results.
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Affiliation(s)
- Lama Mattar
- INSERM U669, Maison de Solenn, Paris, France.
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186
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Selby EA, Doyle P, Crosby RD, Wonderlich SA, Engel SG, Mitchell JD, Le Grange D. Momentary emotion surrounding bulimic behaviors in women with bulimia nervosa and borderline personality disorder. J Psychiatr Res 2012; 46:1492-500. [PMID: 22959165 PMCID: PMC3635132 DOI: 10.1016/j.jpsychires.2012.08.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/06/2012] [Accepted: 08/10/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bulimia nervosa (BN) and borderline personality disorder (BPD) are disorders that involve emotion dysregulation, for negative emotion in particular, as well as impulsive behaviors beyond binge eating and vomiting. Given these similarities in psychopathology, it is not surprising that those with BN also present with BPD in approximately one third of cases. Improved understanding of similarities and differences in the experience of negative and positive emotion could aid in the development of treatments specifically tailored to the needs of these disorders. METHODS In this study, we examined Ecological Momentary Assessment (EMA) data from 133 women diagnosed with BN, 25 of whom also exhibited diagnostic levels of BPD. Emotions and behaviors were assessed daily, with multiple random and event-contingent signals to complete questionnaires on portable digital devices, for a period of two weeks. RESULTS Results indicated that the BPD group experienced higher negative emotional variability on bulimic event days. Both groups also demonstrated increasing negative emotion and decreasing positive emotion pre- binge eating and vomiting, with levels of negative emotion decreasing and positive emotion increasing after, for both behaviors. CONCLUSIONS In terms of group differences, additive effects were found for the BN comorbid with BPD group, who demonstrated greater negative emotional variability, on bulimic event days, and also had higher overall levels of negative emotion pre- and post-binge eating. Those with BN only, however, displayed increasing trajectories of positive emotion before and after binge eating and after vomiting, indicating a potential emotional dampening effect of BPD.
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Affiliation(s)
- Edward A. Selby
- Corresponding Author: Rutgers University, Department of Psychology, 53 Avenue E., Piscataway, NJ 08840, , 848-932-1309;
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187
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Abstract
Background: Difficulties with comprehending and managing emotions are core features of the pathology of anorexia nervosa (AN). Advancements in understanding aetiology and treatment have been made within other clinical domains by targeting worry and rumination. However, worry and rumination have been given minimal consideration in AN. Aims: This study is the largest to date of worry and rumination in AN. Method: Sixty-two outpatients with a diagnosis of AN took part. Measures of worry, rumination, core AN pathology and neuropsychological correlates were administered. Results: Findings suggest that worry and rumination are elevated in AN patients compared with both healthy controls and anxiety disorder comparison groups. Regression analyses indicated that worry and rumination were significant predictors of eating disorder symptomatology, over and above the effects of anxiety and depression. Worry and rumination were not associated with neuropsychological measures of set-shifting and focus on detail. Conclusions: The data suggest that worry and rumination are major concerns for this group and warrant further study.
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188
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Todd L, Anthony S, Dipchand AI, Kaufman M, Solomon M, Stein M, Pollock-BarZiv S. Body Image and Eating Attitudes and Behaviors among Adolescent Heart and Lung Transplant Recipients: A Brief Report. Prog Transplant 2012; 22:259-63. [DOI: 10.7182/pit2012355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Adolescents with chronic illnesses are at increased risk for body image and eating disorders; however, this has not been investigated in solid organ transplant recipients. Adolescent transplant recipients are a vulnerable cohort because of the sustained follow-up and immune-suppressing therapies, which often include steroids and may lead to weight gain and cosmetic changes. Consequences of body dissatisfaction such as disordered behaviors have not been well studied in transplant recipients. Purpose To examine body image, eating attitudes, and behaviors among 28 adolescent thoracic transplant recipients. Methods Adolescent (11–18 years old) heart and lung transplant recipients a minimum of 3 months after transplant provided informed written consent and completed a standardized questionnaire package about eating attitudes and behaviors; body image and drive for thinness; actual, perceived, and desired weight; and medical and anthropometric information (eg, body mass index) during regular transplant clinics. Results Of 25 heart and 3 lung transplant recipients (54% female; median age, 14.5 years; median, 1.6 years after transplant), 37% perceived their current weight as too high or low. Moreover, 81% were dissatisfied with their current weight (38% wanted to lose and 44% wanted to gain weight), yet few engaged in disordered behaviors. Conclusions Despite high levels of self-reported body dissatisfaction, low rates of disordered behaviors were observed. Weight dissatisfaction was high (81%) but bidirectional (to lose or to gain weight). Future assessment of disordered eating behaviors should include insidious activities such as medication nonadherence, in addition to traditional weight-control behaviors such as binge eating, strict dieting, or assiduous exercise. Further research will delineate the impact of body dissatisfaction and eating behaviors and outcomes on long-term transplant survivors, older adolescent cohorts, and other recipients of solid organ transplants.
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Affiliation(s)
- Laura Todd
- The Hospital for Sick Children, University of Toronto, Canada
| | | | | | - Miriam Kaufman
- The Hospital for Sick Children, University of Toronto, Canada
| | - Melinda Solomon
- The Hospital for Sick Children, University of Toronto, Canada
| | - Michael Stein
- The Hospital for Sick Children, University of Toronto, Canada
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189
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Halvorsen I, Rø Ø, Heyerdahl S. Nine-year follow-up of girls with anorexia nervosa and their siblings: retrospective perceptions of parental bonding and the influence of illness on their everyday life. EUROPEAN EATING DISORDERS REVIEW 2012; 21:20-7. [PMID: 22786711 DOI: 10.1002/erv.2191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few previous anorexia nervosa (AN) studies include siblings. OBJECTIVE To investigate if adolescents with AN retrospectively perceived their parents as less caring and more controlling than their siblings, whether perceived parenting was related to psychological problems, and how AN had influenced their everyday lives. METHOD Forty-six former patients (mean age 23.1 years) and 21 siblings participated in the study by completing the Parental Bonding Inventory (PBI) and a questionnaire on the influence of AN during the acute phase. RESULTS Former patients and their siblings had similar PBI results. Better adaptive functioning and lower levels of internalising psychological problems were correlated with higher ratings of parental care in both patients and siblings. Both patients and siblings reported that the illness had created conflict and caused concern, but had also provided valuable experiences. CONCLUSION Perceived parenting was associated with psychological problems in young adulthood but not with eating disorders. Our PBI results for both former patients and siblings were quite similar to non-clinical control groups. Health personnel treating adolescent AN should be aware of siblings' perspectives and needs.
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Affiliation(s)
- Inger Halvorsen
- Regional Department of Eating Disorders, Department of Mental Health and Addiction, Oslo University Hospital, NO-0424 Oslo, Norway.
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190
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Hurst K, Read S, Wallis A. Anorexia Nervosa in Adolescence and Maudsley Family-Based Treatment. JOURNAL OF COUNSELING AND DEVELOPMENT 2012. [DOI: 10.1002/j.1556-6676.2012.00042.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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191
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Jones-Corneille LR, Wadden TA, Sarwer DB, Faulconbridge LF, Fabricatore AN, Stack RM, Cottrell FA, Pulcini ME, Webb VL, Williams NN. Axis I psychopathology in bariatric surgery candidates with and without binge eating disorder: results of structured clinical interviews. Obes Surg 2012; 22:389-97. [PMID: 21088923 DOI: 10.1007/s11695-010-0322-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior studies have reached contradictory conclusions concerning whether binge eating disorder (BED) is associated with greater psychopathology in extremely obese patients who seek bariatric surgery. This study used the Structured Clinical Interview for DSM-IV Diagnoses (SCID) to compare rates of axis I psychopathology in surgery candidates who were determined to have BED or to be currently free of eating disorders. The relationship of BED to other psychosocial functioning and weight loss goals also was examined. METHODS One hundred ninety five bariatric surgery patients completed the Weight and Lifestyle Inventory and the Beck Depression Inventory-II (BDI-II) and were later administered the Eating Disorder Examination. Of these 195, 44 who were diagnosed with BED, and 61 who were currently free of eating pathology, completed a telephone-administered SCID. RESULTS Significantly more BED than non-BED participants had a current mood disorder (27.3% vs. 4.9%, p = 0.002) as well as a lifetime history of this condition (52.3% vs. 23.0%, p = 0.003). More BED than non-BED participants also had a current anxiety disorder (27.3% vs. 8.2%, p = 0.014) and lifetime anxiety disorder (36.4% vs. 16.4%, p = 0.019). BED also was associated with greater symptoms of depression, as measured by the BDI-II, as well as with lower self-esteem. BED and non-BED groups, however, did not differ in their desired weight loss goals following surgery. CONCLUSIONS The present findings indicate that the presence of BED, in patients who seek bariatric surgery, is associated with an increased prevalence of axis I psychopathology, beyond the already elevated rate observed with severe (i.e., class III) obesity.
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192
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Halvorsen I, Platou D, Høiseth A. Bone Mass Eight Years After Treatment for Adolescent-Onset Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2012; 20:386-92. [DOI: 10.1002/erv.2179] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Inger Halvorsen
- Regional Department of Eating Disorders; Oslo University Hospital; Oslo; Norway
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193
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Shaw JA, Herzog DB, Clark VL, Berner LA, Eddy KT, Franko DL, Lowe MR. Elevated pre-morbid weights in bulimic individuals are usually surpassed post-morbidly: implications for perpetuation of the disorder. Int J Eat Disord 2012; 45:512-23. [PMID: 22271593 PMCID: PMC3323765 DOI: 10.1002/eat.20985] [Citation(s) in RCA: 17] [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] [Accepted: 11/15/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine how often patients diagnosed with bulimia nervosa (BN) surpass their highest pre-morbid weight during the course of their disorder. METHOD The weight histories of individuals with BN were determined using retrospective weight data (Study 1) and combined retrospective/prospective data (Study 2). RESULTS Retrospective analyses indicated that 59.0% (n = 46) and 61.8% (n = 110), respectively, reported that their highest weight was reached after developing BN. In Study 2, 35.3% of participants superseded their highest pre-enrollment weights during 8 years of follow-up, and 71.6% reached a post-morbid highest weight before remission. Across studies, the primary difference between patients who did and did not reach their highest weight post-morbidly was that those who did had an earlier age of onset and longer duration of BN. DISCUSSION Findings are discussed in terms of possible links between BN and weight-gain proneness, weight fluctuation across the course of BN, and implications for treating BN.
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194
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Krug I, Penelo E, Fernandez-Aranda F, Anderluh M, Bellodi L, Cellini E, di Bernardo M, Granero R, Karwautz A, Nacmias B, Ricca V, Sorbi S, Tchanturia K, Wagner G, Collier D, Treasure J. Low social interactions in eating disorder patients in childhood and adulthood: A multi-centre European case control study. J Health Psychol 2012; 18:26-37. [DOI: 10.1177/1359105311435946] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The objective of this article was to examine lifestyle behaviours in eating disorder (ED) patients and healthy controls. A total of 801 ED patients and 727 healthy controls from five European countries completed the questions related to lifestyle behaviours of the Cross-Cultural Questionnaire (CCQ). For children, the ED sample exhibited more solitary activities (rigorously doing homework [p<0.001] and watching TV [p<0.05] and less socializing with friends [p<0.05]) than the healthy control group and this continued in adulthood. There were minimal differences across ED sub-diagnoses and various cross-cultural differences emerged. Reduced social activities may be an important risk and maintaining factor for ED symptomatology.
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Affiliation(s)
- Isabel Krug
- Eating Disorders Unit and SGDP Research Centre, Institute of Psychiatry, King’s College, London, UK
| | - Eva Penelo
- Laboratori d’Estadística Aplicada, Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
| | | | - Marija Anderluh
- University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
| | - Laura Bellodi
- Department of Neuropsychiatric Sciences (DSNP), Fondazione Centro S. Raffaele del Monte Tabor, Milan, Italy
| | - Elena Cellini
- Department of Neuropsychiatric Sciences (DSNP), Fondazione Centro S. Raffaele del Monte Tabor, Milan, Italy
| | - Milena di Bernardo
- Department of Neuropsychiatric Sciences (DSNP), Fondazione Centro S. Raffaele del Monte Tabor, Milan, Italy
| | - Roser Granero
- Laboratori d’Estadística Aplicada, Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Andreas Karwautz
- Medical University of Vienna, Department of Child and Adolescent Psychiatry, Vienna, Austria
| | - Benedetta Nacmias
- Department of Neuropsychiatric Sciences (DSNP), Fondazione Centro S. Raffaele del Monte Tabor, Milan, Italy
| | - Valdo Ricca
- Department of Neurology and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Sandro Sorbi
- Department of Neurology and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Kate Tchanturia
- Eating Disorders Unit and SGDP Research Centre, Institute of Psychiatry, King’s College, London, UK
| | - Gudrun Wagner
- Medical University of Vienna, Department of Child and Adolescent Psychiatry, Vienna, Austria
| | - David Collier
- Eating Disorders Unit and SGDP Research Centre, Institute of Psychiatry, King’s College, London, UK
| | - Janet Treasure
- Eating Disorders Unit and SGDP Research Centre, Institute of Psychiatry, King’s College, London, UK
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195
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Dahl JK, Eriksen L, Vedul-Kjelsås E, Strømmen M, Kulseng B, Mårvik R, Holen A. Depression, anxiety, and neuroticism in obese patients waiting for bariatric surgery: Differences between patients with and without eating disorders and subthreshold binge eating disorders. Obes Res Clin Pract 2012; 6:e91-e174. [DOI: 10.1016/j.orcp.2011.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 07/14/2011] [Accepted: 07/18/2011] [Indexed: 11/25/2022]
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196
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Abed R, Mehta S, Figueredo AJ, Aldridge S, Balson H, Meyer C, Palmer R. Eating disorders and intrasexual competition: testing an evolutionary hypothesis among young women. ScientificWorldJournal 2012; 2012:290813. [PMID: 22566764 PMCID: PMC3330742 DOI: 10.1100/2012/290813] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 12/20/2011] [Indexed: 11/29/2022] Open
Abstract
The sexual competition hypothesis (SCH) contends that intense female intrasexual competition (ISC) is the ultimate cause of eating disorders. The SCH explains the phenomenon of the pursuit of thinness as an adaptation to ISC in the modern environment. It argues that eating disorders are pathological phenomena that arise from the mismatch between the modern environment and the inherited female adaptations for ISC. The present study has two aims. The first is to examine the relationship between disordered eating behavior (DEB) and ISC in a sample of female undergraduates. The second is to establish whether there is any relationship between disordered eating behavior and life history (LH) strategy. Participants completed a battery of questionnaires examining eating-related attitudes and behaviors, ISC, and LH strategy. A group of 206 female undergraduates were recruited. A structural equation model was constructed to analyze the data. ISC for mates was significantly associated with DEB, as predicted by the SCH. DEB was found to be predicted by fast LH strategy, which was only partially mediated by the SCH. The results of this study are supportive of the SCH and justify research on a clinical sample.
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Affiliation(s)
- Riadh Abed
- Ferham Clinic, Rotherham Doncaster and South Humber NHS Foundation Trust, Rotherham S61 1AJ, UK.
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197
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Berg KC, Peterson CB, Frazier P, Crow SJ. Psychometric evaluation of the eating disorder examination and eating disorder examination-questionnaire: a systematic review of the literature. Int J Eat Disord 2012; 45:428-38. [PMID: 21744375 PMCID: PMC3668855 DOI: 10.1002/eat.20931] [Citation(s) in RCA: 698] [Impact Index Per Article: 58.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The purpose of this study was to systematically review the reliability of scores on the Eating Disorder Examination (EDE) and the Eating Disorder Examination-Questionnaire (EDE-Q) and to examine the validity of their use as measures of eating disorder symptoms. METHOD Articles describing the psychometric properties of the EDE and EDE-Q were identified in a systematic search of major computer databases and a review of reference lists. Articles were selected based on a priori inclusion and exclusion criteria. RESULTS Fifteen studies were identified that examined the psychometrics of the EDE, whereas 10 studies were found that examined the psychometrics of the EDE-Q. DISCUSSION Both instruments demonstrated reliability of scores. There is evidence that scores on the EDE and EDE-Q correlate with scores on measures of similar constructs and support for using the instruments to distinguish between cases and non-cases. Additional research is needed to broaden the generalizability of the findings.
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Affiliation(s)
- Kelly C Berg
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA.
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198
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Trottier K, McFarlane T, Olmsted MP. A Test of the Weight-Based Self-Evaluation Schema in Eating Disorders: Understanding the Link between Self-Esteem, Weight-Based Self-Evaluation, and Body Dissatisfaction. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9446-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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199
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An examination of the Clinical Impairment Assessment among women at high risk for eating disorder onset. Behav Res Ther 2012; 50:407-14. [PMID: 22516320 DOI: 10.1016/j.brat.2012.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 02/22/2012] [Accepted: 02/22/2012] [Indexed: 11/20/2022]
Abstract
Identifying measures that reliably and validly assess clinical impairment has important implications for eating disorder (ED) diagnosis and treatment. The current study examined the psychometric properties of the Clinical Impairment Assessment (CIA) in women at high risk for ED onset. Participants were 543 women (20.6 ± 2.0 years) who were classified into one of three ED categories: clinical ED, high risk for ED onset, and low risk control. Among high risk women, the CIA demonstrated high internal consistency (α = 0.93) and good convergent validity with disordered eating attitudes (rs = 0.27-0.68, ps < 0.001). Examination of the CIA's discriminant validity revealed that CIA global scores were highest among women with a clinical ED (17.7 ± 10.7) followed by high risk women (10.6 ± 8.5) and low risk controls (3.0 ± 3.3), respectively (p < 0.001). High risk women reporting behavioral indices of ED psychopathology (objective and/or subjective binge episodes, purging behaviors, driven exercise, and ED treatment history) had higher CIA global scores than those without such indices (ps < 0.05), suggesting good criterion validity. These data establish the first norms for the CIA in a United States sample. The CIA is psychometrically sound among high risk women, and heightened levels of impairment among these individuals as compared to low risk women verify the relevance of early intervention efforts.
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200
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Mattar L, Pichard C, Godart N, Melchior JC. Can birth weight predict later body composition in anorexia nervosa? Eur J Clin Nutr 2012; 66:964-7. [PMID: 22378228 DOI: 10.1038/ejcn.2012.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES The relationship between birth weight and body composition at later stages in life was not studied previously in anorexia nervosa (AN). The aim of the following brief report is to present results concerning the relationship between birth weight and later body composition specifically in AN, and to check if the programming of body composition from birth weight is still detected in severely emaciated AN patients. SUBJECTS/METHODS One hundred and fifty-one female AN patients aged between 13 and 44 were recruited from 11 inpatient treatment facilities in France. Birth weight, body weight and height were obtained. Body composition was measured using bioelectrical impedance. Birth weight was significantly correlated to lifetime maximum body mass index (BMI; r=0.211, P=0.009) and significantly correlated to fat-free mass index (r=0.190, P=0.027) but not to fat mass index (FMI). RESULTS This report confirms that even in AN when patients are severely emaciated and where fat-free mass (FFM) and fat mass (FM) are low, a link between birth weight and FFM and BMI can still be identified, independently from age. CONCLUSION Further studies are needed on larger samples exploring other factors, such as gender, puberty and ethnicity.
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Affiliation(s)
- L Mattar
- INSERM U669, Maison de Solenn, Paris, France.
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