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Rienecke RD, Mehler PS, Duffy A, Le Grange D, Peterson CB, Blalock DV. Eating Disorder Examination-Questionnaire: Norms for Adults in Higher Levels of Care. Assessment 2024; 31:1179-1188. [PMID: 37927104 DOI: 10.1177/10731911231208386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Establishing normative data for questionnaires is essential for the accurate interpretation of scores, given that these norms can vary according to different subpopulations and treatment contexts. The purpose of this study was to establish norms for the Eating Disorder Examination-Questionnaire (EDE-Q) among adults receiving higher levels of care (HLOCs) for the treatment of eating disorders. Participants were 2,283 people receiving treatment at the inpatient, residential, partial hospitalization, or intensive outpatient levels of care. The EDE-Q was completed at admission. Patients with anorexia nervosa-restricting subtype (AN-R) had the lowest EDE-Q Global scores when compared with all other eating disorder diagnoses. When compared with intensive outpatient care, only those in residential treatment had higher EDE-Q Global scores. This study is among the first to describe norms for the EDE-Q in a large sample of adults receiving various HLOCs. Programs utilizing the EDE-Q to assess treatment outcomes can use these findings to aid people in interpreting their scores.
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Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center and Pathlight Mood & Anxiety Center, Chicago, IL, USA
- Northwestern University, Chicago, IL, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Mood & Anxiety Center, Chicago, IL, USA
- Denver Health, CO, USA
- University of Colorado, Denver, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood & Anxiety Center, Chicago, IL, USA
| | - Daniel Le Grange
- University of California, San Francisco, USA
- The University of Chicago, IL, USA
| | | | - Dan V Blalock
- Durham Veterans Affairs Medical Center, NC, USA
- Duke University School of Medicine, Durham, NC, USA
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2
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Hail L, Drury CR, McGrath RE, Murray SB, Hughes EK, Sawyer SM, Le Grange D, Loeb KL. Parent version of the Eating Disorder Examination: Reliability and validity in a treatment-seeking sample. J Eat Disord 2024; 12:101. [PMID: 39026364 PMCID: PMC11264699 DOI: 10.1186/s40337-024-01062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Assessment of eating disorders (ED) in youth relies heavily on self-report, yet persistent lack of recognition of the presence and/or seriousness of symptoms can be intrinsic to ED. This study examines the psychometric properties of a semi-structured interview, the parent version of the Eating Disorder Examination (PEDE), developed to systematically assess caregiver report of symptoms. METHODS A multi-site, clinical sample of youth (N = 522; age range: 12 to 18 years) seeking treatment for anorexia nervosa (AN) and subsyndromal AN were assessed using the Eating Disorder Examination (EDE) for youth and the PEDE for collateral caregiver report. RESULTS Internal consistencies of the four PEDE subscales were on par with established ranges for the EDE. Significant medium-sized correlations and poor to moderate levels of agreement were found between the corresponding subscales on each measure. For the PEDE, confirmatory factor analysis of the EDE four-factor model provided a poor fit; an exploratory factor analysis indicated that a 3-factor model better fits the PEDE. CONCLUSIONS Findings suggest that the PEDE has psychometric properties on par with the original EDE. The addition of the caregiver perspective may provide incremental information that can aid in the assessment of AN in youth. Future research is warranted to establish psychometric properties of the PEDE in broader transdiagnostic ED samples.
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Affiliation(s)
- Lisa Hail
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, UCSF Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA, USA
| | - Catherine R Drury
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, UCSF Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA, USA.
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA.
| | - Robert E McGrath
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth K Hughes
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, UCSF Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Neuroscience (emeritus), The University of Chicago, Chicago, IL, USA
| | - Katharine L Loeb
- School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ, USA
- Chicago Center for Evidence-Based Treatment, Chicago, IL, USA
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3
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Vanzhula I, Hagan K, Duck SA, Pan I, Wang EY, Steinglass J, Attia E, Wildes JE, Guarda AS, Schreyer C. Eating disorder symptom non-endorsers in hospitalised patients with anorexia nervosa: Who are they? EUROPEAN EATING DISORDERS REVIEW 2024; 32:795-808. [PMID: 38528330 DOI: 10.1002/erv.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE Impaired insight and illness denial are common in anorexia nervosa (AN). Missing an AN diagnosis may delay treatment and negatively impact outcomes. METHOD The current retrospective study examined the prevalence and characteristics of AN symptom non-endorsement (i.e., scoring within the normal range on the Eating Disorder Examination Questionnaire [EDE-Q] or the Eating Disorder Examination [EDE] interview) in three independent samples of hospitalised patients with AN (N1 = 154; N2 = 300; N3 = 194). A qualitative chart review of a subsample of non-endorsers (N4 = 32) extracted reports of disordered eating behaviours observed by the treatment team. RESULTS The prevalence of non-endorsement ranged from 11% to 34% across sites. Non-endorsers were more likely to be diagnosed with AN restricting type (AN-R) and reported fewer symptoms of co-occurring psychopathology than endorsers. Groups benefitted equally from treatment. The qualitative chart review indicated that objective symptoms of AN were recorded by staff in over 90% of non-endorsers. CONCLUSIONS Eating disorder symptom assessments using the EDE-Q or EDE may miss symptomatology in up to a third of individuals hospitalised with AN. This study highlights the potential utility of multi-modal assessment including patient interviews, collateral informants, and behavioural observation to circumvent non-endorsement.
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Affiliation(s)
- Irina Vanzhula
- University of Kansas, LifeSpan Institute, Lawrence, Kansas, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelsey Hagan
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia, New York, USA
| | - Sarah Ann Duck
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Isabella Pan
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin Y Wang
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joanna Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia, New York, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia, New York, USA
| | - Jennifer E Wildes
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago Medicine, Chicago, Illinois, USA
| | - Angela S Guarda
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colleen Schreyer
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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4
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Gander M, Buchheim A, Sevecke K. Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders. Res Child Adolesc Psychopathol 2024; 52:457-471. [PMID: 37889355 PMCID: PMC10896792 DOI: 10.1007/s10802-023-01141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria.
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria.
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, 6020, Austria
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Radunz M, Wade TD. Towards an understanding of help-seeking behaviour for disordered eating: Refinement of a barriers to help-seeking measure. Early Interv Psychiatry 2023; 17:1012-1020. [PMID: 36650706 DOI: 10.1111/eip.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/02/2022] [Accepted: 01/01/2023] [Indexed: 01/19/2023]
Abstract
AIM Early intervention in eating disorders (EDs) is hampered by a lack of validated measures of barriers to treatment seeking. The present study examined the factor structure of the Perceived Barriers to Psychological Treatment scale (PBPT) and a combination of PBPT and Barriers to Seeking Help for ED items (BATSH-ED) with respect to treatment-seeking for an ED. METHOD Participants were 456 female university students aged 17-25 reporting a wide range of disordered eating severity. Confirmatory factor analyses were conducted with the whole sample followed by correlational and regression analyses with a high-risk sample to assess validity of the selected questionnaire items. RESULTS Four models were tested. First, we replicated the original PBPT 8-factor structure in our sample with comparable fit indices. Second, the addition of six ED items comprising a Denial and Ambivalence subscale improved model fit. Third and fourth, when only significant subscales predicting treatment seeking were retained, with removal of items with weak loadings, a 15-item six-factor solution provided a best fit. A range of psychosocial measures had relationships in the expected directions with the questionnaire subscales. In addition to disordered eating, the denial subscale was uniquely associated with treatment seeking. CONCLUSIONS While the present study contributes to refining the assessment of barriers to help-seeking, future studies should consider co-design with lived experience to further improve the model fit of the questionnaire and improve predictiveness of help-seeking.
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Affiliation(s)
- Marcela Radunz
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
- Blackbird Initiative, Flinders Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
- Blackbird Initiative, Flinders Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
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Drury CR, Hail L, Rienecke RD, Accurso EC, Coelho JS, Lock J, Le Grange D, Loeb KL. Psychometric properties of the Parent Eating Disorder Examination Questionnaire. Int J Eat Disord 2023; 56:1730-1742. [PMID: 37248808 PMCID: PMC10524762 DOI: 10.1002/eat.23999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To examine the psychometric properties of the Parent Eating Disorder Examination Questionnaire (PEDE-Q), developed to improve eating disorder (ED) assessment among youth by including parents as informants. METHODS A multi-site, transdiagnostic sample of 355 adolescents with EDs completed the Eating Disorder Examination Questionnaire (EDE-Q) and their parents completed the PEDE-Q. RESULTS The internal consistencies of the PEDE-Q subscales were on par with established EDE-Q ranges (.73 to .90), both when examined using the original four-factor EDE-Q subscales and the seven-item, three-factor subscales of the brief EDE-Q. Statistically significant medium- to large-sized correlations and poor to moderate levels of agreement were found between the corresponding EDE-Q and PEDE-Q subscales. Receiver-operator characteristic (ROC) curves showed that the PEDE-Q had a statistically significant area under the curve (AUC) to maximize sensitivity and specificity in diagnosing full-syndrome AN, whereas the EDE-Q did not. Based on chi-square analyses, the PEDE-Q identified a statistically significantly greater number of AN cases than the EDE-Q. The EDE-Q yielded a BN diagnosis more frequently than the PEDE-Q, although this difference was not statistically significant. DISCUSSION Results suggest that the PEDE-Q has good psychometric properties and provides incremental information that can aid in the assessment and diagnosis of adolescents with EDs, particularly those with AN. PUBLIC SIGNIFICANCE There exist complex challenges to identifying clinically significant eating disorders among youth. The PEDE-Q is a questionnaire measure that improves eating disorder assessment among children and adolescents by asking parents to report on the symptoms and behaviors they have observed in their child and that youth may not fully disclose. The PEDE-Q can aid in the diagnosis of adolescents with eating disorders, particularly those with anorexia nervosa.
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Affiliation(s)
- Catherine R Drury
- School of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey, USA
| | - Lisa Hail
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Renee D Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Katharine L Loeb
- Chicago Center for Evidence-Based Treatment, Chicago, Illinois, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Harrop EN, Hutcheson R, Harner V, Mensinger JL, Lindhorst T. "You Don't Look Anorexic": Atypical anorexia patient experiences of weight stigma in medical care. Body Image 2023; 46:48-61. [PMID: 37236121 PMCID: PMC10524894 DOI: 10.1016/j.bodyim.2023.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
Eating disorders (ED) and weight stigma pose significant healthcare challenges. Patients at higher weights, like some with atypical anorexia (AAN), may face increased challenges due to weight stigma. This study analyzed patients' lived experiences with weight stigma in healthcare. Thirty-eight adult patients with AAN completed in-depth, semi-structured interviews regarding healthcare experiences. Guided by narrative inquiry approaches, transcripts were thematically coded. Across the illness trajectory (ED development, pre-treatment, treatment, post-treatment), patients reported that weight stigma in healthcare contributed to initiation and persistence of ED behaviors. Themes included "providers pathologizing patient weight," which patients reported triggered ED behaviors and relapse, "provider minimization and denial" of patients' EDs, which contributed to delays in screening and care, and "overt forms of weight discrimination," leading to healthcare avoidance. Participants reported that weight stigma prolonged ED behaviors, delayed care, created suboptimal treatment environments, deterred help-seeking, and lowered healthcare utilization. This suggests that many providers (pediatricians, primary care providers, ED treatment specialists, other healthcare specialists) may inadvertently reinforce patients' EDs. Increasing training, screening for EDs across the weight spectrum, and targeting health behavior promotion rather than universal weight loss, could enhance quality of care and improve healthcare engagement for patients with EDs, particularly those at higher weights.
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Affiliation(s)
- Erin N Harrop
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA; University of Denver Graduate School of Social Work, 2148 South High Street, Denver, CO 80208, USA.
| | - Rebecca Hutcheson
- University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Vern Harner
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA
| | - Janell L Mensinger
- M. Louise Fitzpatrick College of Nursing at Villanova University, 800 E. Lancaster Ave., Villanova, PA 19085, USA; Nova Southeastern University, 3301 College Ave, Fort Lauderdale, FL 33314, USA
| | - Taryn Lindhorst
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA
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Kambanis PE, Bottera AR, Mancuso CJ, Spoor SP, Anderson LM, Burke NL, Eddy KT, Forbush KT, Keith JF, Lavender JM, Mensinger JL, Mujica C, Nagata JM, Perez M, De Young KP. Eating Disorder Examination-Questionnaire and Clinical Impairment Assessment norms for intersectional identities using an MTurk sample. Int J Eat Disord 2022; 55:1690-1707. [PMID: 36054425 PMCID: PMC10263063 DOI: 10.1002/eat.23799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There are limited data to guide the interpretation of scores on measures of eating-disorder psychopathology among underrepresented individuals. We aimed to provide norms for the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) across racial/ethnic, gender, and sexual identities, and sexual orientations and their intersections by recruiting a diverse sample of Amazon MTurk workers (MTurkers; N = 1782). METHOD We created a comprehensive, quantitative assessment of racial/ethnic identification, gender identification, sex assigned at birth, current sexual identification, and sexual orientation called the Demographic Assessment of Racial, Sexual, and Gender Identities (DARSGI). We calculated normative data for each demographic category response option. RESULTS Our sample was comprised of 68% underrepresented racial/ethnic identities, 42% underrepresented gender identities, 13% underrepresented sexes, and 49% underrepresented sexual orientations. We reported means and standard deviations for each demographic category response option and, where possible, mean estimates by percentile across intersectional groups. EDE-Q Global Score for a subset of identities and intersections in the current study were higher than previously reported norms for those identities/intersections. DISCUSSION This is the most thorough reporting of norms for the EDE-Q and CIA among racial/ethnic, sexual, and gender identities, and sexual orientations and the first reporting on multiple intersections, filling some of the gaps for commonly used measures of eating-disorder psychopathology. These norms may be used to contextualize eating-disorder psychopathology reported by underrepresented individuals. The data from the current study may help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups. PUBLIC SIGNIFICANCE We provide the most thorough reporting on racial/ethnic, sexual, and gender identities, and sexual orientations for the Eating Disorder Examination - Questionnaire and Clinical Impairment Assessment, and the first reporting on intersections, which fills some of the gaps for commonly used measures of eating-disorder psychopathology. These norms help inform research on the prevention and treatment of eating-disorder psychopathology in underrepresented groups.
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Affiliation(s)
| | | | | | | | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN
| | | | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Jill F. Keith
- Department of Family and Consumer Sciences, Human Nutrition and Food/Dietetics, University of Wyoming, Laramie, WY
| | - Jason M. Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
- Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD
- The Metis Foundation, San Antonio, TX
| | - Janell L. Mensinger
- Department of Clinical and School Psychology, Nova Southeastern University, Ft. Lauderdale, FL
| | - Christin Mujica
- Department of Psychology, University of Arkansas, Fayetteville, AK
| | - Jason M. Nagata
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Marisol Perez
- Department of Psychology, Arizona State University, Tempe, AZ
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9
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O'Logbon J, Newlove-Delgado T, McManus S, Mathews F, Hill S, Sadler K, Ford T. How does the increase in eating difficulties according to the Development and Well-Being Assessment screening items relate to the population prevalence of eating disorders? An analysis of the 2017 Mental Health in Children and Young People survey. Int J Eat Disord 2022; 55:1777-1787. [PMID: 36264637 PMCID: PMC10092017 DOI: 10.1002/eat.23833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We examine the test accuracy of the Development and Well-Being Assessment (DAWBA) eating disorder screening items to explore whether the increased eating difficulties detected in the English National Mental Health of Children and Young People (MHCYP) Surveys 2021 reflect an increased population prevalence. METHODS Study 1 calculated sensitivity, specificity, and positive and negative predictive values from responses to the DAWBA screening items from 4057 11-19-year-olds and their parents, in the 2017 MHCYP survey. Study 2 applied the positive predictive value to data from 1844 11-19-year-olds responding to the 2021 follow-up to estimate the prevalence of eating disorders in England compared to 2017 prevalence. RESULTS Parental report most accurately predicted an eating disorder (93.6%, 95% confidence interval: 92.7-94.5). Sensitivity increased when parent and child answers were combined, and with a higher threshold (of two) for children. The prevalence of eating disorders in 2021 was 1% in 17-19-year-olds, and .6% in 11-16-year-olds-similar to the prevalence reported in 2017 (.8% and .6%, respectively). However, estimates for boys (.2%-.4%) and young men (.0%-.4%) increased. DISCUSSION We found tentative evidence of increased population prevalence of eating disorders, particularly among young men. Despite this, the DAWBA screening items are useful for ruling out eating disorders, particularly when parents or carers screen negative, but are relatively poor at predicting who will have a disorder. Data from both parents and children and applying a higher cut point improves accuracy but at the expense of more missed cases. PUBLIC SIGNIFICANCE STATEMENT The prevalence of eating disorders did not markedly change from 2017 to 2021, but we found tentative evidence of an increase, particularly among young men. This is despite larger increases in problematic eating, which need further investigation. The DAWBA screen is best suited to ruling out eating disorders which limits its clinical applications as it would provide many false positives requiring further assessment.
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Affiliation(s)
- Jessica O'Logbon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | | | | | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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10
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Bryant-Waugh R, Stern CM, Dreier MJ, Micali N, Cooke LJ, Kuhnle MC, Burton Murray H, Wang SB, Breithaupt L, Becker KR, Misra M, Lawson EA, Eddy KT, Thomas JJ. Preliminary validation of the pica, ARFID and rumination disorder interview ARFID questionnaire (PARDI-AR-Q). J Eat Disord 2022; 10:179. [PMID: 36419081 PMCID: PMC9682666 DOI: 10.1186/s40337-022-00706-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Pica, ARFID, and Rumination Disorder Interview (PARDI) is a structured interview that can be used to determine diagnosis, presenting characteristics, and severity across three disorders, including avoidant/restrictive food intake disorder (ARFID). The purpose of this study was to evaluate the psychometric properties of a questionnaire focused specifically on ARFID (PARDI-AR-Q), which has the potential to provide related information with less participant burden. METHODS Adolescents and adults (n = 71, ages 14-40 years) with ARFID (n = 42) and healthy control participants (HC, n = 29) completed the PARDI-AR-Q and other measures. A subset of the ARFID group (n = 27) also completed the PARDI interview. RESULTS An exploratory factor analysis of proposed subscale items identified three factors corresponding to the ARFID phenotypes of avoidance based on the sensory characteristics of food, lack of interest in eating or food, and concern about aversive consequences of eating. Further analyses supported the internal consistency and convergent validity of the PARDI-AR-Q subscales, and subscale ratings on the questionnaire showed large and significant correlations (all p-values < 0.001; r's ranging from 0.48 to 0.77) with the corresponding subscales on the interview. The ARFID group scored significantly higher than HC on all subscales. Furthermore, 90% of the ARFID group scored positive on the PARDI-AR-Q diagnostic algorithm while 93% of the HC scored negative. CONCLUSIONS Though replication in larger and more diverse samples is needed, findings provide early support for the validity of the PARDI-AR-Q as a self-report measure for possible ARFID in clinical or research settings.
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Affiliation(s)
- Rachel Bryant-Waugh
- South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Casey M Stern
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
| | - Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Department of Psychology, Rutgers University, Piscataway, USA
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Eating Disorders Research Unit, Mental Health Center Ballerup, Mental Health Services of the Capital Region of Denmark, Ballerup, Denmark
| | - Lucy J Cooke
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Megan C Kuhnle
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Department of Epidemiology, Boston University, Boston, USA
| | - Helen Burton Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Center for Neurointestinal Health, Massachusetts General Hospital, Boston, USA.,Harvard Medical School, Boston, USA
| | - Shirley B Wang
- Department of Psychology, Harvard University, Cambridge, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Harvard Medical School, Boston, USA.,Department of Psychiatry, Athinoula A. Martinos Center for Biomedical Imaging, Boston, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Harvard Medical School, Boston, USA
| | - Madhusmita Misra
- Harvard Medical School, Boston, USA.,Neuroendocrine Unit, Massachusetts General Hospital, Boston, USA
| | - Elizabeth A Lawson
- Harvard Medical School, Boston, USA.,Neuroendocrine Unit, Massachusetts General Hospital, Boston, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.,Harvard Medical School, Boston, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, USA.
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11
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Fatt SJ, Mitchison D, Bussey K, Mond J. Methods used to assess insight in individuals with eating disorders: a scoping review. J Ment Health 2022:1-12. [PMID: 35543348 DOI: 10.1080/09638237.2022.2069696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
Insight can be impaired in individuals with an eating disorder and the nature of this impairment can vary. Although this topic has been the focus of several studies and reviews, methodologies used to assess insight have received less attention. A scoping review was conducted using a systematic search of articles before January 2021 to elucidate the methodologies used to assess insight in those with an eating disorder, with discussion of strengths and limitations. A total of 3089 studies were screened, and 24 quantitative studies which assessed at least one aspect of insight in individuals with an eating disorder were included in the review. Methods of assessing insight included coding of clinical notes, low scores on measures of self-report symptoms, direct assessment of insight, vignette, and self-report single-item questions. Insight into disordered eating symptoms was most frequently assessed. Most research used samples who were female, white, diagnosed with anorexia nervosa, and were seeking or receiving treatment. In designing future research and interventions, optimal methods used to assess insight should consider the research/clinical question, available resources, and the targeted demographic. Further, descriptions of which aspects of insight are being assessed should be considered in the interpretation of both current and future findings.
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Affiliation(s)
- Scott J Fatt
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Kay Bussey
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia
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12
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Spiegel J, Arnold S, Salbach H, Gotti EG, Pfeiffer E, Lehmkuhl U, Correll CU, Jaite C. Emotional abuse interacts with borderline personality in adolescent inpatients with binge-purging eating disorders. Eat Weight Disord 2022; 27:131-138. [PMID: 33677816 PMCID: PMC8860808 DOI: 10.1007/s40519-021-01142-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/01/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Childhood abuse is associated with an increased risk of developing eating disorders (EDs) as well as personality disorders (PDs). However, their interaction is still uncertain, particularly in adolescents. This study investigates the correlations between childhood emotional neglect (CEN), childhood emotional abuse (CEA), and obsessive-compulsive and borderline personality styles in female adolescent inpatients with eating disorders (EDs). METHODS One hundred and twenty-eight inpatients (ages 14-18) were assessed, 54 were diagnosed with restricting-type anorexia nervosa (AN-R) and 33 with a binge-purging ED [BP-ED; comprising patients with binge-purging type anorexia nervosa (AN-BP), n = 15, and bulimia nervosa (BN), n = 18]. Fifty healthy participants made up the control group (CG). CEN and CEA were assessed with the Childhood Trauma Questionnaire, while the Personality Style and Disorder Inventory was implemented to determine personality styles. RESULTS A MANOVA revealed a significant main effect of CEA on spontaneous-borderline personality style [F(8,119) = 17.1, p < 0.001, η2 = 0.126], as well as a main effect of ED group on spontaneous-borderline [F(2,119) = 3.1, p = 0.048, η2 = 0.050]. A significant interaction between ED group, CEA, and spontaneous-borderline was found [F(2,119) = 3.5, p = 0.034, η2 = 0.055] with BP-ED showing significantly higher scores in CEA (9.3 ± 4.0) and in spontaneous-borderline (14.2 ± 6.2). CONCLUSIONS Considering CEA and borderline personality style in adolescent inpatients with BN or AN-BP may help improve the understanding of the etiology and maintenance of BP-ED and provide more effective treatment targets. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- J Spiegel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital Urban, Berlin, Germany
| | - S Arnold
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - H Salbach
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - E G Gotti
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Pfeiffer
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U Lehmkuhl
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C U Correll
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - C Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
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13
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Orsini G. Compliance and resistance to treatment in an Italian residential Centre for eating disorders. Anthropol Med 2021; 29:193-207. [PMID: 34866516 DOI: 10.1080/13648470.2021.1994333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The dominant biomedical model perceives eating disorders as mental disorders and its 'sufferers' as people who need to be healed. It follows that people diagnosed with an eating disorder are pressured to accept medical and psychological care due to the moral obligations that are associated with the sick role, as delineated by Parsons. This, however, does not necessarily imply that they are willing to heal. By analysing compliance and resistance to treatment in an Italian residential Centre for eating disorders, this paper suggests that patients may accept medical care in order to achieve objectives other than those for which power is exerted over them. By complying with treatment, patients may in fact attempt to (re)become anorexic or escape from their everyday environment and problems. It is therefore argued that biomedical power can be subverted from within through the adoption of what De Certeau defines as tactics.
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14
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Oldham-Cooper R, Semple C. Prevention and early help for eating disorders in young people with type 1 diabetes. Clin Child Psychol Psychiatry 2021; 26:656-668. [PMID: 33601920 DOI: 10.1177/1359104521994172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
There is building evidence that early intervention is key to improving outcomes in eating disorders, whereas a 'watch and wait' approach that has been commonplace among GPs and other healthcare professionals is now strongly discouraged. Eating disorders occur at approximately twice the rate in individuals with type 1 diabetes compared to the general population. In this group, standard eating disorder treatments have poorer outcomes, and eating disorders result in a particularly high burden of morbidity. Therefore, our first priority must be prevention, with early intervention where disordered eating has already developed. Clinicians working in both eating disorders and diabetes specialist services have highlighted the need for multidisciplinary team collaboration and specific training, as well as improved treatments. We review the current evidence and future directions for prevention, identification and early intervention for eating disorders in children and young people with type 1 diabetes.
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Affiliation(s)
- Rosie Oldham-Cooper
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK.,School of Psychological Science, University of Bristol, UK
| | - Claire Semple
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK
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15
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Rousselet M, Reinhardt H, Forestier B, Eyzop E, Lambert S, Rocher B, Gailledrat L, Hardouin JB, Grall-Bronnec M. Are marked body shape concerns associated with poorer outcomes at the one-year follow-up in anorexia nervosa? Brain Behav 2021; 11:e02199. [PMID: 34037330 PMCID: PMC8323028 DOI: 10.1002/brb3.2199] [Citation(s) in RCA: 1] [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: 10/22/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Anorexia nervosa (AN) is a complex disease in which obsessive thoughts about body image, shape, or weight are expressed. The intensity of these concerns varies among individuals, and only a few studies have focused on their impact on patients' clinical course when patients are treated on an outpatient basis. Our study aimed to determine whether marked body concerns at inclusion were predictive of the one-year follow-up. METHOD Participants (N = 72) were women seeking treatment for AN in a specialized unit for eating disorder management. All participants were assessed at inclusion and at the 1-year follow-up. Clinical outcome was assessed using the Morgan & Russel Outcome Average Score (MROAS), and body concerns were assessed using the Body Shape Questionnaires (BSQ). RESULTS Marked body concerns (BSQ score >140) at inclusion were associated with a poorer outcome at the 12-month follow-up (lower MROAS "total score"). Other characteristics at inclusion that were predictive of a poorer outcome at 12 months were as follows: higher severity of ED at inclusion, longer hospitalization during follow-up, and experiencing a lower impact of the illness on school/work life. DISCUSSION The results confirmed the importance of a multifocal treatment that should address body concerns and motivation to change. Our results also highlighted the necessity of promoting the maintenance of school/work during the treatment course.
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Affiliation(s)
- Morgane Rousselet
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France.,UMR 1246, Nantes University and Tours University, Nantes, France
| | - Hélène Reinhardt
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | | | - Emeline Eyzop
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Sylvain Lambert
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Bruno Rocher
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Lucie Gailledrat
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | | | - Marie Grall-Bronnec
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France.,UMR 1246, Nantes University and Tours University, Nantes, France
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16
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Risk Factors for Oral Health in Anorexia Nervosa: Comparison of a Self-Report Questionnaire and a Face-to-Face Interview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084212. [PMID: 33923379 PMCID: PMC8071502 DOI: 10.3390/ijerph18084212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022]
Abstract
Behavioral, nutritional, and local risk factors for oral health are frequent in people with anorexia nervosa. However no self-report questionnaire is available for screening in clinical practice or for research purposes. The objective of this study was to design a questionnaire to identify risk factors and symptoms of oral diseases and to test its reliability as a self-report form among people with anorexia nervosa. A 26-item questionnaire was designed based on a sound literature review performed by a group of dentists, psychiatrists, and epidemiologists specialized in the field of eating disorders. Sixty-nine anorexia nervosa inpatients (mean age 18.72 ± 5.1) were included from four specialized units. The questionnaire was first self-reported by the patients, then the same questionnaire was administrated by a dentist during a structured face-to-face interview as the gold standard. The concordance between the two forms was evaluated globally and item per item using Cohen’s kappa statistical tests. The overall concordance between the self-report questionnaire and the face-to-face structured interview was 55%. Of the 26 items, 19 showed significant concordance. Items relating to water intake, extracted teeth, gingival status, and oral hygiene had the best concordance (all kappa coefficients > 0.4). A questionnaire that identifies risk factors and symptoms of oral diseases in anorexia nervosa was developed and tested. The 26-item form of the questionnaire (long version) is moderately reliable as a self-reported form. A short version of the questionnaire, including the 10 most reliable items, is recommended for oral risk assessment in patients with anorexia nervosa. The clinical value of the self-administered questionnaire remains to be evaluated.
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17
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Chubbs-Payne A, Lee J, Isserlin L, Norris ML, Spettigue W, Spence K, Longmuir PE. Attitudes toward physical activity as a treatment component for adolescents with anorexia nervosa: An exploratory qualitative study of patient perceptions. Int J Eat Disord 2021; 54:336-345. [PMID: 33185901 DOI: 10.1002/eat.23411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/15/2020] [Accepted: 10/31/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) with compulsive exercise is associated with poor treatment outcomes. This study sought to understand the attitudes of adolescents with AN from various stages of treatment, toward physical activity research practices and physical activity as a component of treatment. METHOD Seventeen adolescents 12-18 years old (15 female) with AN (10 with acknowledged history of compulsive exercise) were recruited from a Canadian Tertiary Care Hospital's Eating Disorder Program. Six inpatients, 5-day program patients, and six outpatients treated by either the inpatient and/or day treatment program in the past 2 years completed individual, semi-structured interviews that were audio-recorded and transcribed. Results were analyzed deductively using qualitative techniques. RESULTS Participants recognized both benefits (psychological, sociological, and physiological) and risks (trigger negative thoughts, increase competitive behavior) of implementing physical activity into acute AN treatment. Patient characteristics, such as stage of treatment and exercise history, had an impact on participants' perceptions toward physical activity in AN. Participants suggested that the ideal physical activity program would be focused on fun, individualized and progressively integrated, group-based, and directly supported by staff. Although the majority of participants stated that they would wear an activity monitor for research purposes, concerns were voiced regarding compliance and the potential impact on eating disorder symptomatology. DISCUSSION Participants overwhelmingly supported the careful implementation of structured physical activity and physical activity psychoeducation into the acute treatment of adolescents with AN. This study allows for the inclusion of patient voices in the conversation surrounding the role of physical activity in AN treatment.
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Affiliation(s)
- Adam Chubbs-Payne
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Ottawa's Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jacqueline Lee
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Leanna Isserlin
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Mark L Norris
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Kelly Spence
- Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Ottawa's Faculty of Medicine, Ottawa, Ontario, Canada
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18
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Tyszkiewicz-Nwafor M, Jowik K, Dutkiewicz A, Krasinska A, Pytlinska N, Dmitrzak-Weglarz M, Suminska M, Pruciak A, Skowronska B, Slopien A. Neuropeptide Y and Peptide YY in Association with Depressive Symptoms and Eating Behaviours in Adolescents across the Weight Spectrum: From Anorexia Nervosa to Obesity. Nutrients 2021; 13:nu13020598. [PMID: 33670342 PMCID: PMC7917982 DOI: 10.3390/nu13020598] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 12/28/2022] Open
Abstract
Neuropeptide Y (NPY) and peptide YY (PYY) are involved in metabolic regulation. The purpose of the study was to assess the serum levels of NPY and PYY in adolescents with anorexia nervosa (AN) or obesity (OB), as well as in a healthy control group (CG). The effects of potential confounders on their concentrations were also analysed. Eighty-nine adolescents were included in this study (AN = 30, OB = 30, and CG = 29). Anthropometric measurements and psychometric assessment of depressive symptoms, eating behaviours, body attitudes, and fasting serum levels of NPY and PYY were analysed. The AN group presented severe depressive symptoms, while the OB group held different attitudes towards the body. The levels of NPY were lower in the AN and OB groups as compared with the CG. The PYY levels were higher in the OB group than in the AN group and the CG. The severity of eating disorder symptoms predicted fasting serum concentrations of NPY. Lower levels of NPY in AN, as well as in OB suggests the need to look for a common link in the mechanism of this effect. Higher level of PYY in OB may be important in explaining complex etiopathogenesis of the disease. The psychopathological symptoms may have an influence on the neurohormones regulating metabolism.
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Affiliation(s)
- Marta Tyszkiewicz-Nwafor
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (K.J.); (A.D.); (N.P.); (A.S.)
- Correspondence:
| | - Katarzyna Jowik
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (K.J.); (A.D.); (N.P.); (A.S.)
| | - Agata Dutkiewicz
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (K.J.); (A.D.); (N.P.); (A.S.)
| | - Agata Krasinska
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.K.); (M.S.); (B.S.)
| | - Natalia Pytlinska
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (K.J.); (A.D.); (N.P.); (A.S.)
| | - Monika Dmitrzak-Weglarz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Marta Suminska
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.K.); (M.S.); (B.S.)
| | - Agata Pruciak
- Institute of Plant Protection—National Research Institute, Research Centre of Quarantine, Invasive and Genetically Modified Organisms, 60-318 Poznan, Poland;
| | - Bogda Skowronska
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.K.); (M.S.); (B.S.)
| | - Agnieszka Slopien
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (K.J.); (A.D.); (N.P.); (A.S.)
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19
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The majority of professionally active women diagnosed with eating disorders may be at risk of work addiction: an overlooked comorbidity. HEALTH PSYCHOLOGY REPORT 2021. [DOI: 10.5114/hpr.2020.98734] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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20
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Mirabella M, Giovanardi G, Fortunato A, Senofonte G, Lombardo F, Lingiardi V, Speranza AM. The Body I Live in. Perceptions and Meanings of Body Dissatisfaction in Young Transgender Adults: A Qualitative Study. J Clin Med 2020; 9:jcm9113733. [PMID: 33233761 PMCID: PMC7699932 DOI: 10.3390/jcm9113733] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023] Open
Abstract
Body dissatisfaction in individuals with Gender Incongruence (GI) represents a primary source of suffering. Several studies have highlighted how this suffering has psychological, physical, and biological implications. This work aims to explore experiences related to body dissatisfaction and investigate the issues associated with living in a body perceived as incongruent for individuals with GI. Thirty-six individuals, aged between 18 and 30 years old and at stage T0 of hormone treatment, participated in the study. Body dissatisfaction and experiences related to it were investigated using the Clinical Diagnostic Interview. The Consensual Qualitative Research methodology was applied to the transcripts of the interviews. Several themes emerged: experiences with GI development, experiences with puberty and bodily changes, perception of one’s body, psychological problems and complex behavioral patterns related to body dissatisfaction. Results pointed out the complexity implied in the relationship with one’s body for individuals with GI, highlighting specific aspects of body dissatisfaction among these individuals (e.g., eating disorders, sexual difficulties, social withdrawal). This study underlines the need for a deeper understanding of some aspects of GI to better define guidelines for a correct assessment of it. In this way it will be easier to avoid negative outcomes for the psychological and general health of transgender people.
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Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Roma, Italy; (G.G.); (A.F.); (V.L.); (A.M.S.)
- Correspondence: ; Tel.: +39-340-986-7587
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Roma, Italy; (G.G.); (A.F.); (V.L.); (A.M.S.)
| | - Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Roma, Italy; (G.G.); (A.F.); (V.L.); (A.M.S.)
| | - Giulia Senofonte
- Laboratory of Seminology, Sperm Bank “Loredana Gandini,” Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy; (G.S.); (F.L.)
| | - Francesco Lombardo
- Laboratory of Seminology, Sperm Bank “Loredana Gandini,” Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy; (G.S.); (F.L.)
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Roma, Italy; (G.G.); (A.F.); (V.L.); (A.M.S.)
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Roma, Italy; (G.G.); (A.F.); (V.L.); (A.M.S.)
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21
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Konstantakopoulos G, Georgantopoulos G, Gonidakis F, Michopoulos I, Stefanatou P, David AS. Development and validation of the schedule for the assessment of insight in eating disorders (SAI-ED). Psychiatry Res 2020; 292:113308. [PMID: 32707219 DOI: 10.1016/j.psychres.2020.113308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022]
Abstract
This study examined the reliability, validity and internal structure of the newly developed, interview-based Schedule for the Assessment of Insight in Eating Disorders (SAI-ED) and the relationships of insight with demographic and clinical characteristics in EDs. Ninety-four female patients - 44 with anorexia nervosa (AN) and 50 with bulimia nervosa (BN) - were assessed with SAI-ED. The Brown Assessment of Beliefs Scale was used to evaluate convergent validity of SAI-ED. Hierarchical cluster analysis and multidimensional scaling were used to identify insight components and assess their inter-relationships. The final 8-item SAI-ED demonstrated good psychometric properties. Inter-rater and test-retest reliabilities were high. Three subscales of SAI-ED were identified which measure major insight components: awareness of illness, awareness of symptoms, and treatment engagement. Patients with AN had significant lower score on SAI-ED than patients with BN. Impaired insight was associated with: (a) lower current and lowest lifetime BMI and more severe dietary restrain in AN, (b) illness duration, severity of overall ED symptoms, body-related concerns and obsessionality in BN. Insight is a multidimensional construct in EDs associated with different clinical aspects in AN and BN. The SAI-ED is a valid and reliable tool for the assessment of insight in EDs patients.
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Affiliation(s)
- George Konstantakopoulos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Georgios Georgantopoulos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece
| | - Fragiskos Gonidakis
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioannis Michopoulos
- Second Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece
| | - Pentagiotissa Stefanatou
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Greece
| | - Anthony S David
- UCL Institute of Mental Health, Division of Psychiatry, University College London, UK
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22
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Hughes EK, Poker S, Bortz A, Yeo M, Telfer M, Sawyer SM. Adolescent and Parent Experience of Care at a Family-Based Treatment Service for Eating Disorders. Front Psychiatry 2020; 11:310. [PMID: 32372986 PMCID: PMC7186319 DOI: 10.3389/fpsyt.2020.00310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/27/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Incorporating consumer perspectives is an important but often overlooked opportunity to optimize treatment engagement and outcomes for adolescents with eating disorders. This study explored the experience of care of adolescents and their parents at a multidisciplinary specialist eating disorders service providing family-based treatment (FBT) as first-line treatment. METHOD Eighty-five adolescents and 145 parents who completed FBT at the service between 2013 and 2015 were surveyed in 2017 about their experience of care. A study-designed survey asked respondents to rate on Likert scales their experience of service access, intake assessment, education, support, interactions with the treatment team, recovery, and the discharge process. Open-ended comments on helpful and unhelpful aspects of the service provided further context on the ratings. RESULTS Overall families were very positive about their experience, particularly in regard to assessment, education, interactions with the team, and achieving physical health. Although parents tended to be more satisfied, adolescents also held the service in high regard. Some areas were identified that could be improved, including treatment delays, carer support, therapeutic alliance, and preparation for discharge. CONCLUSIONS Surveying families about their experience of care provides an important opportunity to identify service strengths as well as services gaps. The results indicated several areas that specialist eating disorder services could focus on to ensure that the services provided, including FBT, fully meet the needs of families and optimize adolescents' treatment experiences.
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Affiliation(s)
- Elizabeth K. Hughes
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Suzannah Poker
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Amy Bortz
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michele Yeo
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Michelle Telfer
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Susan M. Sawyer
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
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Loeb KL, Weissman RS, Marcus S, Pattanayak C, Hail L, Kung KC, Schron D, Zucker N, Le Grange D, Lock J, Newcorn JH, Taylor CB, Walsh BT. Family-Based Treatment for Anorexia Nervosa Symptoms in High-Risk Youth: A Partially-Randomized Preference-Design Study. Front Psychiatry 2020; 10:985. [PMID: 32038326 PMCID: PMC6987468 DOI: 10.3389/fpsyt.2019.00985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
This pilot study adapted family-based treatment (FBT) for youth with potentially prodromal anorexia nervosa (AN). Fifty-nine youth with clinically significant AN symptom constellations, but who never met full Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) (DSM-IV) criteria for AN, were enrolled in a partially randomized preference design study. Participants were offered randomization to FBT or supportive psychotherapy (SPT); those who declined to be randomized because of a strong treatment preference were entered into a parallel, non-randomized self-selected intervention study. Without accessing outcome data, an observational analysis with three diagnostic subclasses was designed based on AN symptom severity profiles, combining randomized and non-randomized participants, such that participants receiving FBT and SPT within each subclass were similar on key baseline characteristics. Outcomes of this pilot study were explored by calculating effect sizes for end-of-treatment values within each subclass, and also with a longitudinal mixed effect model that accounted for subclass. Weight trajectory was measured by percent expected body weight. Psychological outcomes were fear of weight gain, feeling fat, importance of weight, and importance of shape. Results show that the pattern of symptom observations over time was dependent on subclass of SAN (least symptomatic, moderately symptomatic, or most symptomatic) and on the target outcome variable category (weight or psychological). Results from this study, which should be considered in the context of the small sample sizes overall and within groups, can generate hypotheses for future, larger research trials on early treatment strategies. Feasibility findings illustrate how the innovative partially randomized preference design has potential broader application for AN intervention research. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT00418977.
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Affiliation(s)
- Katharine L. Loeb
- School of Psychology, Fairleigh Dickinson University, Teaneck, NJ, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Sue Marcus
- Consultant, Philadelphia, PA, United States
| | - Cassandra Pattanayak
- Department of Mathematics, Quantitative Reasoning Program, and the Quantitative Analysis Institute at Wellesley College, Wellesley, CT, United States
| | - Lisa Hail
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Kelly C. Kung
- Department of Mathematics, Boston University, Boston, MA, United States
| | - Diana Schron
- School of Dentistry, University of California, San Francisco, San Francisco, CA, United States
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, United States (Emeritus)
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeffrey H. Newcorn
- Departments of Psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Center for mHealth, Palo Alto University, Palo Alto, CA, United States
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University, New York, NY, United States
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Differences in Emotion Regulation Difficulties Across Types of Eating Disorders During Adolescence. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:1351-1358. [PMID: 29101588 DOI: 10.1007/s10802-017-0365-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Emotion regulation appears to play a key role in eating disorders. However, prior attempts to associate specific emotion regulation abilities with specific types of eating disorders resulted in inconsistent findings. Moreover, far less is known about emotion regulation in eating disorders during adolescence, a critical period of emotional development. The current study addresses this gap, comparing emotion regulation characteristics between adolescents with restrictive types of eating disorders and those with binge eating or purging types of eating disorders. Ninety-eight adolescents with eating disorders (49 with restrictive and 49 with binge eating/purging eating disorders) completed a set of questionnaires including the Difficulties in Emotion Regulation Scale (DERS). The results revealed that binge eating/purging types of eating disorders were associated with greater difficulties in a variety of emotion regulation dimensions including impulse control, goal-directed behavior and access to effective emotion regulation strategies. Awareness and clarity of emotions were also worse in the binge eating/purging types of eating disorders, but this difference did not remain when comorbid psychopathology measures were controlled for. Moreover, the emotion regulation profile of adolescents with anorexia nervosa-binging/purging type was more similar to that of adolescents with bulimia nervosa than to that of adolescents with anorexia nervosa-restrictive type. While both restrictive and binge eating/purging eating disorders have been associated with emotion regulation difficulties, the current study shows that the presence of binge eating or purging episodes is linked with greater severity of emotion regulation deficits among adolescents with eating disorders.
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25
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Hayes NA, Welty LJ, Slesinger N, Washburn JJ. Moderators of treatment outcomes in a partial hospitalization and intensive outpatient program for eating disorders. Eat Disord 2019; 27:305-320. [PMID: 30204570 DOI: 10.1080/10640266.2018.1512302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Eating disorders cause a number of severely impairing symptoms that may require more intensive intervention that is available through outpatient therapy services. The PHP/IOP level of care may be an effective mode of treatment in these cases, but few studies have examined overall outcomes or treatment moderators for this level of care. Using a large sample from a PHP/IOP specifically designed for the treatment of eating disorders, the current study examines a variety of symptoms (eating disorder severity, quality of life, depression, etc.) from admission to discharge, as well as potential moderators of treatment, including demographic and clinical factors. Overall, the PHP/IOP level of care was found to improve treatment outcomes. Age, race, gender, and depression were found to moderate the change in quality of life and functional impairment. Additionally, patients diagnosed with anorexia nervosa had significantly lowered quality of life and greater eating disorder symptomatology than all other diagnoses. The results of this study can help to inform clinical practice and help guide in treatment decisions at the partial hospitalization level of care.
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Affiliation(s)
- Nicole A Hayes
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Leah J Welty
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA.,b Department of Preventative Medicine, Division of Biostatistics , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Noel Slesinger
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Jason J Washburn
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA.,c Center for Evidence-Based Practice , AMITA Health Behavioral Medicine, Hoffman Estates , IL , USA
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26
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Gander M, Sevecke K, Buchheim A. Disorder-specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode. Clin Psychol Psychother 2018; 25:894-906. [PMID: 30216616 PMCID: PMC6585713 DOI: 10.1002/cpp.2324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/15/2018] [Accepted: 07/31/2018] [Indexed: 11/08/2022]
Abstract
For the first time, the present study investigates disorder‐specific attachment characteristics and childhood trauma in adolescent inpatients with anorexia nervosa (n = 30, girls/boys: 28/2, age: M = 14.84, SD = 1.20), a major depressive episode (n = 30, girls/boys: 27/3, age: M = 15.14, SD = 1.50), and controls (n = 60, girls/boys: 44/16, age: M = 16.10, SD = 1.20). We used the Structured Clinical Interview to diagnose Axis I disorders, the Adult Attachment Projective Picture System to classify attachment representations, and the Childhood Trauma Questionnaire to assess child maltreatment. Our findings demonstrate an overrepresentation of the unresolved attachment status in the patient samples. A one‐way analysis of variance succeeded by Bonferroni post hoc tests indicated that adolescents with anorexia nervosa show more isolation and dissolution of boundaries between life and death when confronted with situations of solitude. Although they report moderate to severe levels of traumatic childhood experiences, they tend to minimize those. Adolescents with a major depressive episode report higher levels of emotional abuse and neglect in their childhood, leaving them in a state of failed protection and danger during attachment distress. Integrating these attachment‐related characteristics into specific psychotherapeutic interventions might be associated with a better outcome in that age group.
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Affiliation(s)
- Manuela Gander
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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27
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Gailledrat L, Rousselet M, Venisse JL, Lambert S, Rocher B, Remaud M, Guilleux A, Sauvaget A, Eyzop E, Grall-Bronnec M. Marked Body Shape Concerns in Female Patients Suffering from Eating Disorders: Relevance of a Clinical Sub-Group. PLoS One 2016; 11:e0165232. [PMID: 27776159 PMCID: PMC5077091 DOI: 10.1371/journal.pone.0165232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/07/2016] [Indexed: 12/30/2022] Open
Abstract
Concerns about body shape and weight are core diagnostic criteria for eating disorders although intensity varies between patients. Few studies have focused on the clinical differences relative to the intensity of these concerns. Nonetheless, they might have a prognostic value. This study was aimed at identifying the characteristics associated with marked body shape concerns in patients with an eating disorder. Data was collected from a systematic and standardized clinical assessment of outpatients seeking treatment in our department for eating disorders. Only female patients, suffering from anorexia nervosa or bulimia nervosa, and with "no / mild" or "marked" body shape concerns according to the Body Shape Questionnaire, were included for the present study. We focused on sociodemographic characteristics, eating disorder characteristics, axis 1 disorders, types of attachment, self-esteem and dissociation. A multiple logistic regression was performed to identify factors related to "marked" body shape concerns. In our sample (123 participants, with a mean age of 24.3 years [range 16-61]), 56.9% had marked concerns with body shape. Marked body shape concerns were associated with a major depressive episode (OR = 100.3), the use of laxatives (OR = 49.8), a high score on the item "body dissatisfaction" of the Eating Disorders Inventory scale (OR = 1.7), a higher minimum body mass index (OR = 1.73), and a high score on the item "loss of control over behavior, thoughts and emotions" from the dissociation questionnaire (OR = 10.74). These results are consistent with previous studies, and highlight the importance of denial.
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Affiliation(s)
- Lucie Gailledrat
- Clinical Investigation Unit “Behavior Addictions / Complex Affective Disorders”, Addictology and Psychiatry Department, Nantes University Hospital, Hôpital Saint Jacques, 85 rue Saint Jacques, 44 093 Nantes cedex 1, France
| | - Morgane Rousselet
- Clinical Investigation Unit “Behavior Addictions / Complex Affective Disorders”, Addictology and Psychiatry Department, Nantes University Hospital, Hôpital Saint Jacques, 85 rue Saint Jacques, 44 093 Nantes cedex 1, France
- EA 4275 "Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences", Nantes University, Institute of Health Research IRS, 22 boulevard Bénoni Goullin, 44 200 Nantes, France
| | - Jean-Luc Venisse
- Clinical Investigation Unit “Behavior Addictions / Complex Affective Disorders”, Addictology and Psychiatry Department, Nantes University Hospital, Hôpital Saint Jacques, 85 rue Saint Jacques, 44 093 Nantes cedex 1, France
| | - Sylvain Lambert
- Clinical Investigation Unit “Behavior Addictions / Complex Affective Disorders”, Addictology and Psychiatry Department, Nantes University Hospital, Hôpital Saint Jacques, 85 rue Saint Jacques, 44 093 Nantes cedex 1, France
| | - Bruno Rocher
- Clinical Investigation Unit “Behavior Addictions / Complex Affective Disorders”, Addictology and Psychiatry Department, Nantes University Hospital, Hôpital Saint Jacques, 85 rue Saint Jacques, 44 093 Nantes cedex 1, France
| | - Manon Remaud
- Clinical Investigation Unit “Behavior Addictions / Complex Affective Disorders”, Addictology and Psychiatry Department, Nantes University Hospital, Hôpital Saint Jacques, 85 rue Saint Jacques, 44 093 Nantes cedex 1, France
| | - Alice Guilleux
- EA 4275 "Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences", Nantes University, Institute of Health Research IRS, 22 boulevard Bénoni Goullin, 44 200 Nantes, France
| | - Anne Sauvaget
- Clinical Investigation Unit “Behavior Addictions / Complex Affective Disorders”, Addictology and Psychiatry Department, Nantes University Hospital, Hôpital Saint Jacques, 85 rue Saint Jacques, 44 093 Nantes cedex 1, France
| | - Emeline Eyzop
- Clinical Investigation Unit “Behavior Addictions / Complex Affective Disorders”, Addictology and Psychiatry Department, Nantes University Hospital, Hôpital Saint Jacques, 85 rue Saint Jacques, 44 093 Nantes cedex 1, France
| | - Marie Grall-Bronnec
- Clinical Investigation Unit “Behavior Addictions / Complex Affective Disorders”, Addictology and Psychiatry Department, Nantes University Hospital, Hôpital Saint Jacques, 85 rue Saint Jacques, 44 093 Nantes cedex 1, France
- EA 4275 "Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences", Nantes University, Institute of Health Research IRS, 22 boulevard Bénoni Goullin, 44 200 Nantes, France
- * E-mail:
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28
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El Ghoch M, Benini L, Sgarbi D, Dalle Grave R. Solitary rectal ulcer syndrome in a patient with anorexia nervosa: A case report. Int J Eat Disord 2016; 49:731-5. [PMID: 27200516 DOI: 10.1002/eat.22548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/16/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
Abstract
This case report describes the clinical presentation, diagnosis, and management of a 26-year-old patient with anorexia nervosa (AN) diagnosed with Solitary Rectal Ulcer Syndrome (SRUS). To our knowledge, this is the first case report to document SRUS in AN, whose pathogenesis in this case seems to have been determined by the patient's malnourished and underweight state. Furthermore, SRUS symptoms appear to have interacted with the eating disorder psychopathology, increasing the need to exert control over eating. Cognitive behavioral strategies and procedures were accordingly used to address the eating disorder psychopathology and to promote complete weight restoration, which brought about a significant reduction in the size of the ulcer and the complete resolution of SRUS symptoms. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:731-735).
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Affiliation(s)
- Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy
| | - Luigi Benini
- Unit of Gastroenterology, Casa di Cura Pederzoli, via Montebaldo, 24, 37019 Peschiera del Garda, Verona, Italy
| | - Daniela Sgarbi
- Service of Digestive Endoscopy, Casa di Cura Pederzoli, via Montebaldo, 24, 37019 Peschiera del Garda, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, Verona, Italy
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29
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Gorwood P, Blanchet-Collet C, Chartrel N, Duclos J, Dechelotte P, Hanachi M, Fetissov S, Godart N, Melchior JC, Ramoz N, Rovere-Jovene C, Tolle V, Viltart O, Epelbaum J. New Insights in Anorexia Nervosa. Front Neurosci 2016; 10:256. [PMID: 27445651 PMCID: PMC4925664 DOI: 10.3389/fnins.2016.00256] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/23/2016] [Indexed: 12/18/2022] Open
Abstract
Anorexia nervosa (AN) is classically defined as a condition in which an abnormally low body weight is associated with an intense fear of gaining weight and distorted cognitions regarding weight, shape, and drive for thinness. This article reviews recent evidences from physiology, genetics, epigenetics, and brain imaging which allow to consider AN as an abnormality of reward pathways or an attempt to preserve mental homeostasis. Special emphasis is put on ghrelino-resistance and the importance of orexigenic peptides of the lateral hypothalamus, the gut microbiota and a dysimmune disorder of neuropeptide signaling. Physiological processes, secondary to underlying, and premorbid vulnerability factors-the "pondero-nutritional-feeding basements"- are also discussed.
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Affiliation(s)
- Philip Gorwood
- Centre Hospitalier Sainte-Anne (CMME)Paris, France; UMR-S 894, Institut National de la Santé et de la Recherche Médicale, Centre de Psychiatrie et NeurosciencesParis, France; Université Paris Descartes, Sorbonne Paris CitéParis, France
| | | | - Nicolas Chartrel
- Institut National de la Santé et de la Recherche Médicale U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in BiomedicineRouen, France; Normandy UniversityCaen, France; University of RouenRouen, France
| | - Jeanne Duclos
- Adolescents and Young Adults Psychiatry Department, Institut Mutualiste MontsourisParis, France; CESP, Institut National de la Santé et de la Recherche Médicale, Université Paris-Descartes, USPCParis, France; University Reims, Champagne-Ardenne, Laboratoire Cognition, Santé, Socialisation (C2S)-EA 6291Reims, France
| | - Pierre Dechelotte
- Institut National de la Santé et de la Recherche Médicale U1073 IRIB Normandy UniversityRouen, France; Faculté de Médecine-PharmacieRouen, France
| | - Mouna Hanachi
- Université de Versailles Saint-Quentin-en-Yvelines, Institut National de la Santé et de la Recherche Médicale U1179, équipe Thérapeutiques Innovantes et Technologies Appliquées aux Troubles Neuromoteurs, UFR des Sciences de la Santé Simone VeilMontigny-le-Bretonneux, France; Département de Médecine (Unité de Nutrition), Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de ParisGarches, France
| | - Serguei Fetissov
- Institut National de la Santé et de la Recherche Médicale U1073 IRIB Normandy University Rouen, France
| | - Nathalie Godart
- Adolescents and Young Adults Psychiatry Department, Institut Mutualiste MontsourisParis, France; CESP, Institut National de la Santé et de la Recherche Médicale, Université Paris-Descartes, USPCParis, France
| | - Jean-Claude Melchior
- Université de Versailles Saint-Quentin-en-Yvelines, Institut National de la Santé et de la Recherche Médicale U1179, équipe Thérapeutiques Innovantes et Technologies Appliquées aux Troubles Neuromoteurs, UFR des Sciences de la Santé Simone VeilMontigny-le-Bretonneux, France; Département de Médecine (Unité de Nutrition), Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de ParisGarches, France
| | - Nicolas Ramoz
- UMR-S 894, Institut National de la Santé et de la Recherche Médicale, Centre de Psychiatrie et NeurosciencesParis, France; Université Paris Descartes, Sorbonne Paris CitéParis, France
| | - Carole Rovere-Jovene
- Institut de Pharmacologie Moléculaire et Cellulaire, UMR6097, Centre National de la Recherche Scientifique Valbonne, France
| | - Virginie Tolle
- UMR-S 894, Institut National de la Santé et de la Recherche Médicale, Centre de Psychiatrie et NeurosciencesParis, France; Université Paris Descartes, Sorbonne Paris CitéParis, France
| | - Odile Viltart
- Université Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer Lille, France
| | - Jacques Epelbaum
- UMR-S 894, Institut National de la Santé et de la Recherche Médicale, Centre de Psychiatrie et NeurosciencesParis, France; Université Paris Descartes, Sorbonne Paris CitéParis, France
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van der Kaap-Deeder J, Smets J, Boone L. The Impeding Role of Self-Critical Perfectionism on Therapeutic Alliance During Treatment and Eating Disorder Symptoms at Follow-up in Patients with an Eating Disorder. Psychol Belg 2016; 56:101-110. [PMID: 30479431 PMCID: PMC5854110 DOI: 10.5334/pb.297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study examines the impeding role of self-critical perfectionism at onset of treatment on therapeutic alliance during treatment and eating disorder symptoms at follow-up in patients with an eating disorder. Participants were 53 female patients with a mean age of 21.1 years treated for an eating disorder in a specialized inpatient treatment unit. Self-critical perfectionism was assessed at admission, therapeutic alliance was assessed during treatment (after three months of treatment), and eating disorder symptoms were assessed at admission, after three months and one year later. Self-critical perfectionism negatively related to treatment alliance with the therapist. Although self-critical perfectionism was not directly predictive of subsequent changes in eating disorder symptoms, it was indirectly related to less reduction in body dissatisfaction through the therapeutic alliance. These results point to the importance of self-critical perfectionism in the therapeutic alliance and in changes in body image problems. Treatment implications are discussed.
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Affiliation(s)
| | - Jos Smets
- Psychiatric nurse, Alexian Brothers Psychiatric Hospital (Unit Ter Berken), Tienen, Belgium
| | - Liesbet Boone
- Department of Developmental, Social, and Personality Psychology, Ghent University, Ghent, Belgium
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31
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Treasure J. Applying evidence-based management to anorexia nervosa. Postgrad Med J 2016; 92:525-31. [PMID: 26944338 DOI: 10.1136/postgradmedj-2015-133282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 02/11/2016] [Indexed: 12/28/2022]
Abstract
AIM This paper considers how the three principles of evidence based practice (clinical expertise, scientific evidence, and patient preference) can be applied to the complexity of treatment for anorexia nervosa AN. METHOD A narrative review of the evidence of these three domains is presented. Clinical cases are used to illustrate how the formulation and management can be put into practice at different stages of illness. RESULTS The management of anorexia nervosa is complex. First, individuals with the illness do not regard the manifestations of the illness as a source of concern rather they are embraced and integrated into their identity. This contrasts to the reaction of other people who are terrified by the overt signs of ill health. Thus engagement into treatment is problematic. Second, the core symptom restricted eating, produces malnutrition which impacts on brain, body, and the social network. Thus a mixture of psychological and physical problems gradually accumulates over the course of the illness. This means that the treatment targets increase over time. CONCLUSION Thus treatment has to work with motivation and readiness to change and tackle the various domains of ill health.
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Problematic Exercise in Anorexia Nervosa: Testing Potential Risk Factors against Different Definitions. PLoS One 2015; 10:e0143352. [PMID: 26618359 PMCID: PMC4664470 DOI: 10.1371/journal.pone.0143352] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/03/2015] [Indexed: 01/15/2023] Open
Abstract
“Hyperactivity” has a wide prevalence range of 31% to 80% in the anorexia nervosa literature that could be partly due to the plethora of definitions provided by researchers in this field. The purpose of this study was two-fold: 1) To assess the variance across prevalence rates of problematic exercise encountered in patients with anorexia nervosa, in relation to seven different definitions found in the literature. 2) To examine how core eating disorder symptoms and the dimensions of emotional profile are associated with these different definitions and the impact of these definitions on the assessment of patients’ quality of life. Exercise was evaluated in terms of duration, intensity, type and compulsion using a semi-structured questionnaire administered to 180 women suffering from severe anorexia nervosa. Seven different definitions of problematic exercise were identified in the literature: three entailing a single dimension of problematic exercise (duration, compulsion or intensity) and four combining these different dimensions. Emotional profile scores, obsessive-compulsive symptoms, eating disorder symptomatology, worries and concerns about body shape, self-esteem and quality of life were assessed using several established questionnaires. The prevalence of problematic exercise varied considerably from, 5% to 54%, depending on the number of criteria used for its definition. The type and level of eating disorder symptomatology was found to be associated with several definitions of problematic exercise. Surprisingly, a better self-reported quality of life was found among problematic exercisers compared to non-problematic exercisers in three of the definitions. The different definitions of problematic exercise explain the broad prevalence ranges and the conflicting associations generally reported in the literature between problematic exercise and eating disorder-related psychological parameters. There is an urgent need for a valid consensus on the definition of problematic exercise in anorexia nervosa. This will support the development of further research on the etiology and treatment of problematic exercise.
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The Detection of Eating Disorder Symptoms in Adolescence: A Comparison Between the Children's Eating Disorder Examination and the Children's Eating Disorder Examination Questionnaire. BEHAVIOUR CHANGE 2015. [DOI: 10.1017/bec.2015.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: Eating disorder symptoms already occur in childhood and adolescence and are predictive of full-blown eating disorders and obesity later in life. To enhance the quality of assessment in youngsters, this study examined the convergence between the clinical interview, the Child Eating Disorder Examination (ChEDE), and the self-report questionnaire, the Child Eating Disorder Examination-Questionnaire (ChEDE-Q). Method: Both instruments were administered in 12- to 16-year-old boys and girls retrieved from the general population (N = 57, Mage = 13.4). Results: The results showed that there was a strong correlation between the interview and the questionnaire and that the subscale scores of the two research instruments did not significantly differ. Discussion: The present study is among the first to confirm the utility of the ChEDE-Q to screen for eating disorder symptoms in adolescents from the general population. Large-scale studies should further determine whether these preliminary findings can be generalised.
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Flament MF, Henderson K, Buchholz A, Obeid N, Nguyen HNT, Birmingham M, Goldfield G. Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents From the Community. J Am Acad Child Adolesc Psychiatry 2015; 54:403-411.e2. [PMID: 25901777 DOI: 10.1016/j.jaac.2015.01.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/09/2014] [Accepted: 02/12/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To estimate jointly the point prevalence of weight and eating disorders in a community sample of adolescents; to investigate psychosocial correlates of thinness, overweight, and obesity, and of full- and subthreshold eating disorders (EDs); and to examine the relationships between weight status and prevalence of EDs. METHOD A total of 3,043 Canadian adolescents (1,254 males and 1,789 females; mean age = 14.19 years, SD = 1.61 years) completed self-report questionnaires, including the Eating Disorder Diagnostic Scale, and measures of psychosocial functioning. Objective weight and height were collected, and weight status was defined according to the International Obesity Task Force body mass index growth curve centiles. RESULTS In all, 29.5% (95% CI = 26.7, 32.5) of males and 22.8% (95% CI = 20.5, 25.2) of females were overweight or obese. A total of 2.2% (95% CI = 1.5, 3.2) of males and 4.5% (95% CI = 4.4, 4.5) of females met DSM-5 criteria for an ED; in addition, 1.1% (95% CI = 0.7, 1.9) of males and 5.1% (95% CI = 4.0, 6.5) of females were identified with a subthreshold ED. Both full- and subthreshold EDs were significantly associated with markedly impaired psychosocial functioning. There was a significant relationship between prevalence of EDs and weight status, with an increased risk for a bulimic disorder in obese relative to normal-weight males (odds ratio [OR] = 7.86) and females (OR = 3.27). CONCLUSION This study provides estimates for the prevalence of DSM-5 EDs in adolescents, further support for their impact on mental health, and new evidence for an association between bulimic disorders and obesity. Results call for an integrated approach in research and prevention regarding the whole spectrum of eating- and weight-related disorders.
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Affiliation(s)
- Martine F Flament
- University of Ottawa Institute of Mental Health Research, Ottawa, Canada.
| | | | - Annick Buchholz
- Children's Hospital of Eastern Ontario (CHEO) Centre for Healthy Active Living, the CHEO Research Institute, and Carleton University, Ottawa
| | - Nicole Obeid
- CHEO Eating Disorders Program, the CHEO Research Institute, and the University of Ottawa, Ottawa
| | | | - Meagan Birmingham
- University of Ottawa Institute of Mental Health Research, Ottawa, Canada
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Wojtowicz AE, Alberga AS, Parsons CG, von Ranson KM. Perspectives of Canadian fitness professionals on exercise and possible anorexia nervosa. J Eat Disord 2015; 3:40. [PMID: 26581233 PMCID: PMC4650513 DOI: 10.1186/s40337-015-0074-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/26/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Many individuals with eating disorders, including anorexia nervosa (AN), engage in overexercise. Little is known about fitness professionals' perceptions of their responsibilities when interacting with clients with possible AN. The purpose of the current study was to examine Alberta fitness professionals' experiences with clients suspected of having AN, and their views on related ethical issues. Specifically, we aimed to examine (1) their experiences with fitness clients suspected of having AN; (2) their opinions about related ethical responsibilities of fitness professionals; and (3) their views on related training and ethical issues. METHODS We administered a 21-item online survey to 143 Canadian fitness professionals about their experiences and perspectives on encountering individuals with possible AN in exercise classes and at their exercise facilities. RESULTS Sixty-two percent of respondents had encountered a client they believed had AN. Three-quarters had never received any training on managing clients with AN and felt inadequately prepared for such situations. Although most felt ethically obliged to intervene with such a client, more than two-thirds reported no relevant guidelines in their professional training. CONCLUSIONS Many fitness professionals are faced with clients with possible AN, have the desire to help, feel ethically obligated to take action, but do not know what course of action to take, if any. Work is needed to clarify ethical issues and related training needs for certification programs for fitness professionals regarding AN.
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Affiliation(s)
- Amy E Wojtowicz
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Angela S Alberga
- Werklund School of Education, University of Calgary, Calgary, Canada
| | - Colleen G Parsons
- Health and Fitness Programs, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Psychopathological and personality traits underlie decision making in recent onset medication naïve anorexia nervosa: a pilot study. Psychiatry Res 2014; 216:89-96. [PMID: 24512735 DOI: 10.1016/j.psychres.2013.12.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/21/2013] [Accepted: 12/29/2013] [Indexed: 01/08/2023]
Abstract
The Iowa Gambling Task (IGT) analyzes the ability of participants to sacrifice immediate rewards in view of a long term gain. Anorexia Nervosa (AN) in addition to weight loss and body image disturbances is also characterized by the tendency to make decisions that may result in long-term negative outcomes. Studies that analyzed IGT performance in patients with AN were not consistent with each other. Fifteen adolescents with AN and 15 matched controls carried out IGT after being clinically and neuropsychologically evaluated. An interesting generalized estimating equation approach showed that four independent clinical variables, and not the group, explained IGT performances, such as blocks repetition, anxiety, psychogenic eating disorders and self transcendence. The impairment of decision making is not related to the diagnosis of AN, but it is driven by high levels of anxiety and self transcendence. Instead, some psychogenic eating disorders traits, related to illness severity, positively affected IGT performance in the whole sample. IGT impairment in AN found by prior studies could be related to these clinical features which are not always taken into account.
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The role of maternal perceptions and ethnic background in the mental health help-seeking pathway of adolescent girls. J Immigr Minor Health 2014; 15:292-9. [PMID: 22527744 PMCID: PMC3599171 DOI: 10.1007/s10903-012-9621-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Mothers play a crucial role in the help-seeking pathway of adolescents. This study examined how mothers with different ethnic backgrounds perceive the issue of help-seeking for internalizing problems (e.g. depression) in adolescent girls. Seven focus group discussions were conducted with 41 Dutch, Moroccan and Turkish mothers with a teenage daughter. Discussions were conceptually framed within a model of help-seeking and facilitated by a vignette. The internalizing problems sketched in the vignette were recognized as severe nonetheless; identified long term consequences varied per ethnic group. Negative attitudes towards General Practitioners, inaccessible mental health services and denial by daughters would hamper help-seeking. Fear of negative judgments/gossiping was considered a barrier by Turkish and Moroccan participants. Participants identified themselves and schools as primary sources of help. Turkish participants also named chaplains. To enhance utilization of mental health services by (minority) youth it is important to also address maternal barriers.
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Alman J, Hoiles KJ, Watson HJ, Egan SJ, Hamilton M, McCormack J, Potts J, Forbes DA, Shu C. A decade of data from a specialist statewide child and adolescent eating disorder service: does local service access correspond with the severity of medical and eating disorder symptoms at presentation? J Eat Disord 2014; 2:32. [PMID: 25400911 PMCID: PMC4232640 DOI: 10.1186/s40337-014-0032-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders affect up to 3% of children and adolescents, with recovery often requiring specialist treatment. A substantial literature has accrued suggesting that lower access to health care services, experienced by rural populations, has a staggering effect on health-related morbidity and mortality. The aim of this study was to evaluate whether lower service access foreshadowed a more severe medical and symptom presentation among children and adolescents presenting to a specialist eating disorders program. METHOD The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry (N ~1000), a prospective ongoing registry study comprising consecutive paediatric tertiary eating disorder referrals. The sample consisted of 399 children and adolescents aged 8 to 16 years (M =14.49, 92% female) meeting criteria for a DSM-5 eating disorder. RESULTS Consistent with the hypotheses, lower service access was associated with a lower body mass index z-score and a higher likelihood of medical complications at intake assessment. Contrary to our hypothesis, eating pathology assessed at intake was associated with higher service access. No relationship was observed between service access and duration of illness or percentage of body weight lost. CONCLUSIONS Lower service access is associated with more severe malnutrition and medical complications at referral to a specialist eating disorder program. These findings have implications for service planning and provision for rural communities to equalize health outcomes.
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Affiliation(s)
- Jeremy Alman
- Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia
| | - Kimberley J Hoiles
- Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia
| | - Hunna J Watson
- Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia ; School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia Australia ; UNC Center of Excellence for Eating Disorders, Department of Psychiatry, Neurosciences Hospital, 101 Manning Drive, Chapel Hill, North Carolina USA ; Princess Margaret Hospital for Children Eating Disorders Program, GPO Box D184, Perth, 6840 Western Australia Australia
| | - Sarah J Egan
- School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia
| | - Matthew Hamilton
- Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia
| | - Julie McCormack
- Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia
| | - Julie Potts
- Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia
| | - David A Forbes
- Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia Australia
| | - Chloe Shu
- Eating Disorders Program, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Roberts Road, Subiaco, Western Australia Australia ; School of Psychology and Speech Pathology, Division of Health Sciences, Curtin University, Kent St, Bentley, Western Australia Australia
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Abbate-Daga G, Amianto F, Delsedime N, De-Bacco C, Fassino S. Resistance to treatment and change in anorexia nervosa [corrected]: a clinical overview. BMC Psychiatry 2013; 13:294. [PMID: 24199620 PMCID: PMC3879222 DOI: 10.1186/1471-244x-13-294] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 10/25/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current literature on Eating Disorders (EDs) is devoid of evidence-based findings providing support to effective treatments, mostly for anorexia nervosa (AN). This lack of successful guidelines may play a role in making these disorders even more resistant. In fact, many individuals do not respond to the available treatments and develop an enduring and disabling illness. With this overview we aimed to highlight and discuss treatment resistance in AN--with an in-depth investigation of resistance-related psychological factors.A literature search was conducted on PubMed and PsychINFO; English-language articles published between 1990 and 2013 investigating the phenomenon of resistance to treatment in AN have been considered. DISCUSSION The selected papers have been then grouped into four main thematic areas: denial of illness; motivation to change; maintaining factors and treatment outcome; and therapeutic relationship. Eating symptomatology was found to only partially explain resistance to treatment. The role of duration of illness has been questioned whilst some maintaining factors seemed promising in providing a useful framework for this phenomenon. Emotive and relational aspects have been investigated on their role in resistance as well as therapists' countertransference. SUMMARY Remarkably there has been little research done on resistance to treatment in the ED field, in spite of its clinical relevance. Motivation, insight and subjective meaning of the illness can be useful tools to manage the resistance phenomenon when coupled with a wider approach. The latter enables the therapists to be aware of their role in the therapeutic alliance through countertransference aspects and to consider the EDs as disorders of the development of both personality and self, entailing severe impairments as regards identity and relationships.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Nadia Delsedime
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Carlotta De-Bacco
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
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El Ghoch M, Calugi S, Pellegrini M, Milanese C, Busacchi M, Battistini NC, Bernabè J, Dalle Grave R. Measured physical activity in anorexia nervosa: features and treatment outcome. Int J Eat Disord 2013; 46:709-12. [PMID: 23712420 DOI: 10.1002/eat.22140] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 04/10/2013] [Accepted: 04/13/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the role of measured physical activity (PA) in anorexia nervosa treatment outcome, and to compare the PA of patients with anorexia nervosa with age-matched controls. METHOD PA was assessed by means of Sense Wear Armband before and after a cognitive-behavioral inpatient treatment in 53 consecutive females with anorexia nervosa, and in 53 healthy age-matched controls. RESULTS At baseline, patients with anorexia nervosa exhibited a higher duration of moderate-vigorous PA (MVPA≥3 Metabolic Equivalent Tasks (METs)) than controls (t = 2.91; p = .004). Dropouts had higher duration (sec) and expenditure (kcal·day(-1)) of MVPA than completers. At the end of treatment, completers had a higher number of daily steps, MVPA duration, and expenditure than controls. However, PA was not correlated to eating disorder psychopathology either before or after treatment. DISCUSSION PA is higher in patients with anorexia nervosa than age-matched controls both before and after treatment, and is associated with treatment dropout.
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Affiliation(s)
- Marwan El Ghoch
- Department of Eating Disorders and Obesity, Villa Garda Hospital, 37016, Garda (Verona), Italy
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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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Forsberg S, LoTempio E, Bryson S, Fitzpatrick KK, Le Grange D, Lock J. Parent-therapist alliance in Family-Based Treatment for adolescents with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2013; 22:53-8. [PMID: 23861093 DOI: 10.1002/erv.2242] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/22/2013] [Accepted: 05/27/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to describe the role of parent alliance in Family-Based Treatment (FBT) for adolescents with anorexia nervosa (AN). Differences between parent and child alliance with the therapist, mothers' and fathers' alliance, and their relationship to outcome were examined. METHOD Independent observers rated audiotapes of early therapy sessions to assess the therapeutic alliance of parents and adolescents with AN in FBT. Outcome was defined using a previously established cut-point for recovery from AN. RESULTS Mothers' and fathers' alliance scores with the therapist were similar and significantly higher than adolescent alliance scores early in treatment. Combined parent alliance did not predict recovery at the end of treatment. Difference in alliance scores between mothers and fathers, and parents and their child also did not predict recovery at the end of treatment. CONCLUSIONS In FBT, parents developed a strong alliance with the therapist early in treatment. These scores were consistent with the focus in FBT on parental management of eating disorder symptoms, as was the fact that alliance between adolescents and therapists was lower. Although parental therapeutic alliance was likely important in FBT, its role in treatment response remains uncertain.
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Affiliation(s)
- Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Bourion-Bedes S, Baumann C, Kermarrec S, Ligier F, Feillet F, Bonnemains C, Guillemin F, Kabuth B. Prognostic value of early therapeutic alliance in weight recovery: a prospective cohort of 108 adolescents with anorexia nervosa. J Adolesc Health 2013; 52:344-50. [PMID: 23299014 DOI: 10.1016/j.jadohealth.2012.06.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/23/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine whether patients' perception of early therapeutic alliance (TA) could predict time to achieve a target weight among adolescents undergoing treatment for anorexia nervosa. METHOD TA was assessed in a prospective cohort recruited from both inpatient and outpatient settings by self-administered and validated questionnaires. Kaplan-Meier survival curves were compared by log rank test, and Cox regression was used to test whether patients' perception of early TA predicted time to achieve a target weight. RESULTS In total, 108 patients were included, and 79.6% achieved a target weight. Better patient perception of early TA increased the hazard ratio (HR) of achieving a target weight (HR = 2.7, 95% confidence interval: 1.7-4.4, p < .001) such as being in the inpatient setting by 6.7. Being very severely underweight at admission decreased the HR of achieving the target weight. CONCLUSION Patients' perception of early TA is a good predictor of achieving a target weight. Because TA is a modifiable construct, it could be a target for intervention.
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Jaite C, Pfeiffer E, Lehmkuhl U, Salbach-Andrae H. [Childhood abuse in adolescents with anorexia nervosa compared to a psychiatric and healthy control group]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2013; 41:99-107; quiz 107-8. [PMID: 23425612 DOI: 10.1024/1422-4917/a000217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Some studies suggest that both early sexual and early physical abuse are non-specific risk factors for the later development of eating disorders (EDs). However, only little is known about the role of emotional abuse in EDs. METHODS The sample included 77 inpatients with Anorexia nervosa (AN-R: n = 50; AN-BP: n = 27), 26 psychiatric control participants and 44 healthy control participants, all of whom were females. The diagnosis of AN and the diagnosis of psychiatric control participants were confirmed by structured interviews (SIAB-EX, Fichter & Quadflieg, 1999; CIDI-DIA-X,Wittchen & Pfister, 1997). Childhood traumatization was assessed by a self-report questionnaire [Childhood Trauma Questionnaire (CTQ) German Version, Krischer & Sevecke, 2011]. RESULTS The results indicated there were higher rates of sexual and physical abuse as well as physical and emotional neglect in patients with AN-BP than in patients with AN-R and in healthy control participants, with no significant differences between patients with AN-R and control participants. Furthermore, patients with AN-BP had significantly higher rates on the CTQ subscale "emotional abuse" than patients with AN-R, psychiatric control participants and healthy control participants. CONCLUSIONS Future studies should investigate whether emotional abuse is specific to adolescents with AN-BP compared to adolescents with other psychiatric disorders.
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Affiliation(s)
- Charlotte Jaite
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité-Universitätsmedizin Berlin.
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Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa. Behav Res Ther 2013; 51:216-20. [PMID: 23435122 DOI: 10.1016/j.brat.2013.01.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/20/2013] [Accepted: 01/25/2013] [Indexed: 12/28/2022]
Abstract
This study examined the relationship between therapeutic alliance and primary symptom change (weight gain) during CBT for anorexia nervosa. The aims were threefold: (1) to establish the strength of the therapeutic alliance across the treatment, (2) to determine whether early therapeutic alliance is associated with the completion of CBT for this client group, and (3) to determine the direction of the relationship between therapeutic alliance and weight gain. Adult outpatients (N=65) with a diagnosis of anorexia nervosa (or atypical anorexia nervosa) completed a measure of alliance at session six and at the end of treatment. Weight was recorded at the start of treatment, session six and at the end of treatment. The strength of the alliance was consistently high in the sample. However, early therapeutic alliance was not associated with either the likelihood of completing treatment or subsequent weight gain. In contrast, both early and later weight gain were associated with the strength of subsequent alliance. These findings indicate that it might be advisable to focus on techniques to drive weight gain rather than rely on the therapeutic alliance to bring about therapeutic change.
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Forsberg S, LoTempio E, Bryson S, Fitzpatrick KK, Le Grange D, Lock J. Therapeutic alliance in two treatments for adolescent anorexia nervosa. Int J Eat Disord 2013; 46:34-8. [PMID: 22836506 PMCID: PMC3499671 DOI: 10.1002/eat.22047] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between therapeutic alliance and treatment outcome (remission status) in family-based treatment (FBT) and adolescent-focused therapy (AFT) for adolescents with anorexia nervosa (AN). METHOD Independent observers rated audiotapes of early therapy sessions using the Working Alliance Inventory-Observer Version (WAI-o). Outcome was defined using established cut-points for full and partial remission. To control for effects of early symptom improvement, changes in weight- and eating-related psychopathology prior to the alliance session were calculated and entered as a covariate in each analysis. RESULTS Participants in AFT had significantly higher alliance scores; however, overall scores were high in both therapies. The alliance was not a predictor of full remission for either treatment, though it was a non-specific predictor for partial remission. DISCUSSION Therapeutic alliance is achievable in adolescents with AN in both AFT and FBT, but demonstrated no relationship to full remission of the disorder.
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Affiliation(s)
| | | | - Susan Bryson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Kathleen Kara Fitzpatrick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Konstantakopoulos G, Varsou E, Dikeos D, Ioannidi N, Gonidakis F, Papadimitriou G, Oulis P. Delusionality of body image beliefs in eating disorders. Psychiatry Res 2012; 200:482-8. [PMID: 22494704 DOI: 10.1016/j.psychres.2012.03.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 12/26/2011] [Accepted: 03/17/2012] [Indexed: 11/17/2022]
Abstract
Preoccupation with body shape and weight is characteristic of both anorexia nervosa and bulimia nervosa. Despite their diagnostic and clinical significance, evidence on the nature of the underlying beliefs is relatively scarce. We used the Brown Assessment of Beliefs Scale (BABS) to assess the degree of delusionality of body image beliefs in seventy-two participants: 39 with anorexia and 33 with bulimia nervosa. We also investigated the relationship between body image delusionality and other clinical characteristics in eating disorders. Only patients with anorexia nervosa (28.8%) had delusional body image beliefs, whereas overvalued ideas appeared to be frequent in both anorexia and bulimia nervosa. Body image delusionality in anorexia nervosa was associated with restrictive eating pathology, early onset of the disorder and body dissatisfaction, whereas in the bulimia group it was linked to shorter duration of the illness, more intense dieting behaviors and specific psychological factors: ineffectiveness and maturity fears. Results suggest that a delusional variant of anorexia nervosa represents the one end of a continuum of insight among patients with eating disorders. Categorization of patients with eating disorders based on the level of delusionality of body image beliefs could facilitate further research on the role of insight deficits in these disorders.
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Affiliation(s)
- George Konstantakopoulos
- Athens University Medical School, First Department of Psychiatry, Greece; King's College, London, Institute of Psychiatry, Section of Cognitive Neuropsychiatry, UK.
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Disordered eating attitudes in Egyptian antipsychotic naive patients with schizophrenia. Compr Psychiatry 2012; 53:259-68. [PMID: 21640339 DOI: 10.1016/j.comppsych.2011.04.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 04/09/2011] [Accepted: 04/29/2011] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The study aimed to test in a sample of Egyptian antipsychotic naive patients the hypotheses that the disordered eating attitudes co-occur with schizophrenia in a higher frequency than would be expected by chance in the general population and that the disordered eating comorbidity would be associated with more severe schizophrenia psychopathology. Previous studies have been mostly concerned with the impact of the antipsychotics. Studies relating abnormal eating behavior to the schizophrenia psychopathology rather than to its treatment are lacking. METHOD In this case-control cross-sectional study, 50 consecutive antipsychotic naive patients, newly attending the psychiatric outpatient clinic, University Hospital, Zagazig, Egypt, with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of schizophrenia, were assessed by the Positive and Negative Syndrome Scale and compared with 50 nonpsychiatric controls using the Eating Attitudes Test (EAT40). RESULTS Patients with schizophrenia had an EAT40 mean score (23.4 ± 7.8) higher than that of controls (19.7 ± 7.2) (P = .015). Prevalence of disordered eating (defined by a score of ≥ 30 on the EAT40) in these patients was higher than in the control group (30% vs 12%, P = .027). Comparison between schizophrenia patients with and without disordered eating showed no significant differences in demographic and a number of clinical variables, but they differed in their scores on lifestyle characteristics and anthropometric measures. The group of patients with disordered eating had also higher scores on total and all scale factors but not on the negative symptom scale. CONCLUSIONS Data of this study show, perhaps for the first time, that "disordered" eating attitudes, as measured by the EAT40, are higher in a group of Egyptian patients with schizophrenia than in controls. However, the lack of difference between patients with and without disordered eating in terms of demographic and a number of clinical characteristics fail to explain the hypothesis that schizophrenia with disordered eating is a distinct subtype of schizophrenia. Data indicate, on the other hand, that the presence of disordered eating behavior in patients with schizophrenia is associated with the expression of more active psychotic symptoms.
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Jaite C, Schneider N, Hilbert A, Pfeiffer E, Lehmkuhl U, Salbach-Andrae H. Etiological role of childhood emotional trauma and neglect in adolescent anorexia nervosa: a cross-sectional questionnaire analysis. Psychopathology 2012; 45:61-6. [PMID: 22123517 DOI: 10.1159/000328580] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 04/18/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most studies on the relationship between childhood trauma and anorexia nervosa (AN) have focused on the role of childhood sexual and physical trauma in adult patients. Little is known about the role of emotional trauma and eating disorders. The aim of the present study was to examine childhood sexual, physical, and emotional traumatization in adolescents with anorexia nervosa restricting type (AN-R) in comparison to those with anorexia nervosa binge-eating/purging type (AN-BP) and a healthy control group. SAMPLING AND METHODS The sample included 50 patients with AN-R (mean age = 15.8 ± 1.6 years), 27 with AN-BP (mean age = 16.1 ± 1.1 years), and 44 healthy female control participants (mean age = 15.7 ± 1.3 years). AN diagnosis was confirmed by the Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-EX). Childhood sexual, physical, and emotional traumatization was assessed by a self-report questionnaire (Childhood Trauma Questionnaire; CTQ). RESULTS The results indicated higher rates of sexual, physical, and emotional abuse and physical and emotional neglect in patients with AN-BP than in patients with AN-R and healthy control participants. No significant differences in childhood traumatization were found between patients with AN-R and control participants. CONCLUSIONS Our results underline the importance of detecting the full range of possible childhood traumatic experiences in adolescents with AN, rather than focusing simply on childhood sexual traumatization. Sexual, physical, and emotional childhood traumatization are particularly important in the history of adolescent patients with AN-BP, in contrast to patients with AN-R, and should be screened for in the diagnosis and therapy of eating disorders.
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Affiliation(s)
- Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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