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Bevione F, Martini M, Longo P, Toppino F, Musetti A, Amodeo L, Abbate-Daga G, Panero M. Role of parental educational level as psychosocial factor in a sample of inpatients with anorexia nervosa and bulimia nervosa. Front Psychol 2024; 15:1408695. [PMID: 38827891 PMCID: PMC11140136 DOI: 10.3389/fpsyg.2024.1408695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Evidence on parental educational level (PEL) as a risk factor for Eating Disorders (EDs) is mixed, and no study has assessed its role in relation to the compliance and outcomes of treatments in EDs. Further, no study differentiated from the educational level of mothers and fathers, nor considered the possible mediation of perfectionism in fostering EDs. Methods A clinical sample of 242 first-ever admitted inpatients with EDs provided information on PEL and completed the following questionnaires: the Eating Disorder Examination Questionnaire (EDE-Q) and the Frost Multidimensional Perfectionism Scale (F-MPS). Clinicians also provided information on the Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Rating Scale for Depression (HAM-D) for each participant. Results Individuals with high PEL (whether mothers, fathers, or both parents) showed significantly higher scores on depressive symptoms and lower on parental criticism, were younger, had an earlier age of onset, had fewer years of illness, more were students and employed, and fewer had offspring. Individuals with fathers or both parents with high educational levels suffered more from Anorexia Nervosa rather than Bulimia Nervosa, had a longer length of stay during the current hospitalization, had less dietary restraint, and had higher personal standards. Individuals with mothers with high educational levels showed a lower rate of previous substance or alcohol addiction. Personal standards partially mediated the relationship between higher PEL and lower dietary restraint. Discussion PEL emerged to be a twofold psychosocial risk factor, being associated with higher depressive symptoms and a longer length of stay, but also with a shorter duration of illness and better scholar and working involvement. Higher PEL was related to higher personal standards but not to global perfectionism. Patterns of eating psychopathology emerged based on the high PEL of mothers or fathers.
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Affiliation(s)
- Francesco Bevione
- Eating Disorders Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Matteo Martini
- Eating Disorders Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Paola Longo
- Eating Disorders Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Federica Toppino
- Eating Disorders Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy
| | - Laura Amodeo
- Eating Disorders Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Matteo Panero
- Eating Disorders Unit, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Nielsen S, Vilmar JW. Educational attainment in eating disorders: What can we learn from visualising data. EUROPEAN EATING DISORDERS REVIEW 2024; 32:3-12. [PMID: 37501224 DOI: 10.1002/erv.3015] [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: 05/05/2023] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Educational attainment is an understudied outcome in eating disorders (ED). We compared the educational attainment of individuals with and without ED. METHODS This study is a nationwide, register-based, observational epidemiological study using record linkage. The studied cohorts were (1) all persons treated psychiatrically for ED from 1970 to 2014, and (2) a control population matched for sex, age, and place of residence. The International Standard Classification of Education 2011 was used to classify educational attainment. We employed ineqord, a series of graphical and analytical tools that are appropriate for comparing the distributions of ordinal data (Jenkins, 2020). RESULTS Females with ED attained higher educational levels than males with ED. Males with ED had lower average educational levels than controls. On average, female controls attained higher educational levels than patients with ED in the eating disorders not otherwise specified or overeating groups. Females with anorexia nervosa, differed from matched controls: While their median was the same, too many participants were in the lower and higher levels of educational attainment. Females with bulimia nervosa had higher educational levels than matched controls on average. CONCLUSIONS Educational attainment differs between individuals with and without out ED for all ED diagnoses and in both sexes.
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Affiliation(s)
- Søren Nielsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Janne Walløe Vilmar
- Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, Roskilde, Denmark
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Kim S, Smith K, Udo T, Mason T. Social support across eating disorder diagnostic groups: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Eat Behav 2023; 48:101699. [PMID: 36565528 PMCID: PMC9974791 DOI: 10.1016/j.eatbeh.2022.101699] [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: 07/29/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Previous studies have suggested the positive influence of social support on the treatment and recovery of eating disorders (EDs). Yet, more research is needed on how objective and subjective social support differ between ED diagnostic groups using nationally representative data. Therefore, the current secondary data analysis examined associations between EDs and objective and subjective social support using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) study. METHODS Participants completed measures of lifetime and past year diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and items assessing objective social support (i.e., number of close friends and close relatives) and subjective social support (i.e., perceptions of availability of support). RESULTS Compared to those without EDs, those with AN, BN, and BED had poorer subjective social support-or lower perceptions of social support. However, there were fewer differences regarding objective social support. Individuals with BN reported a lower number of close relatives compared to those without EDs and those with AN, but there were no differences in the number of close friends between ED groups. Those who experienced remission from EDs had higher perceptions of social support compared to those with past year EDs. DISCUSSION The findings show deficits in subjective social support across EDs but only lower objective social support in BN. This highlights the clinical utility of increasing perceptions of social support across EDs. The findings also show the importance of perceived social support in recovery from EDs.
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Affiliation(s)
| | - Kathryn Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Tomoko Udo
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Tyler Mason
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
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Bortes C, Nilsson K, Strandh M. Associations between children's diagnosed mental disorders and educational achievements in Sweden. Scand J Public Health 2022; 50:1140-1147. [PMID: 35416111 DOI: 10.1177/14034948221089056] [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: 11/17/2022]
Abstract
AIMS To examine associations between multiple clinically diagnosed mental disorders among children in Sweden and educational achievements at the end of ninth grade. METHODS Data from Swedish administrative registers were utilised. Diagnoses of specific mental disorders (unipolar depression, mood, anxiety, obsessive compulsive, eating, attention deficit hyperactivity disorder) were used as exposure variables. Educational achievements were assessed in terms of teacher-assigned school grades and eligibility for upper secondary education. The sample comprised 266,664 individuals (49% females) born in 2000 to 2002 who were alive and resident in Sweden in 2017. Exposed and unexposed individuals were compared in terms of outcome variables by fitting linear and logistic regression models. RESULTS The results revealed negative associations between all the examined mental disorders and educational achievements, except for positive associations between eating disorders and grades among female students. Attention deficit hyperactivity disorder was the most strongly associated disorder in terms of non-successful completion of compulsory education, among both male and female students (odds ratio (OR): 3.58 (95% confidence interval (CI), 3.42 to 3.74) and 4.31 (95% CI, 4.07 to 4.57), respectively). This was followed by unipolar depression among males (OR: 2.92 (95% CI, 2.60 to 3.28)) and anxiety disorder among females (OR: 2.68 (95% CI, 2.49 to 2.88)). Obsessive compulsive disorder had the weakest negative association with educational achievements among both males (OR: 1.48 (95% CI, 1.01 to 2.17)) and females (OR: 1.38 (95% CI, 1.11 to 1.72)). CONCLUSIONS Specific diagnosed mental disorders have varying, largely disadvantageous, associations with educational achievements of students in Sweden that differ between males and females.
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Awad E, Salameh P, Sacre H, Malaeb D, Hallit S, Obeid S. Association between impulsivity and orthorexia nervosa / healthy orthorexia: any mediating effect of depression, anxiety, and stress? BMC Psychiatry 2021; 21:604. [PMID: 34861836 PMCID: PMC8640965 DOI: 10.1186/s12888-021-03594-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is a lack of studies investigating the possible mediating role of psychological factors, such as depression, anxiety and stress on orthorexic eating behaviors. Given that personality attributes might affect the manifestation of psychological disorders, it was hypothesized that depression, anxiety and stress mediate the relationship between impulsivity-related traits and orthorexic eating, noting that previous research had evaluated the role of depression as a mediator between impulsivity and other pathological eating behaviors. The study objectives were to explore the mediating effect of depression, anxiety, and stress, on impulsivity and orthorexia nervosa, and healthy orthorexia. METHODS This cross-sectional study conducted between July and December 2019 recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists. RESULTS Our results showed that depression and anxiety were positively correlated with ON. We also found a notable gender difference in findings: higher anxiety and female gender were significantly associated with higher TOS healthy orthorexia, while higher stress was associated with lower TOS healthy orthorexia. Finally, higher urgency was associated with lower TOS healthy orthorexia, while higher perseverance was significantly associated with higher TOS healthy orthorexia. Depression and anxiety partially mediated the association between perseverance and ON while anxiety and stress partially mediated the association between urgency and healthy orthorexia. CONCLUSION Our study suggests that depression, anxiety and stress play a mediating role between impulsivity and orthorexia nervosa/healthy orthorexia. Our findings provide a ground for future investigations of impulsive behaviors, psychopathology, and orthorexia in different populations.
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Affiliation(s)
- Emmanuelle Awad
- grid.4514.40000 0001 0930 2361Faculty of Social Sciences, Psychology Department, Lund University, Lund, Sweden
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon ,grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Hadat, Lebanon ,grid.413056.50000 0004 0383 4764University of Nicosia Medical School, Nicosia, Cyprus
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
| | - Diana Malaeb
- grid.444421.30000 0004 0417 6142School of Pharmacy, Lebanese International University, Beirut, Lebanon ,grid.466400.0Life Sciences and Health Department, Paris-Est University, Paris, France
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon. .,Psychology Department, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
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Huryk KM, Drury CR, Loeb KL. Diseases of affluence? A systematic review of the literature on socioeconomic diversity in eating disorders. Eat Behav 2021; 43:101548. [PMID: 34425457 DOI: 10.1016/j.eatbeh.2021.101548] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/01/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
The stereotype that eating disorders (ED) primarily present among individuals of higher socioeconomic status (SES) has long persisted in popular and professional perception. This belief has likely contributed to disparities in ED identification and treatment, particularly among those of lower SES backgrounds. The objective of this article was to systematically review the literature investigating socioeconomic diversity in distinct ED diagnoses. A PRISMA search was conducted to identify studies that empirically assessed the association between ED pathology and indicators of SES via PubMed and PsycINFO. This search generated 13,538 articles, of which 62 articles published between 1973 and August 2020 met criteria for inclusion in the review. Included studies were primarily cross-sectional and covered diagnoses of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), with quality ratings of poor, fair, and good. Results are examined in the context of studies' sampling methods, operationalization of SES, and statistical analyses. There is no consistent pattern of evidence to suggest a relationship between high SES and ED. Instead, all ED present across a wide range of socioeconomic backgrounds. Limitations included the predominance of cross-sectional study designs and poor to fair quality ratings. Future research should include adequately powered, community-based longitudinal studies that examine how sociocultural factors, including SES, intersect to influence ED risk and treatment outcome. The existing data suggest an urgent need to prioritize affordable and accessible ED treatment.
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Affiliation(s)
- Kathryn M Huryk
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Catherine R Drury
- School of Psychology, Fairleigh Dickinson University, 1000 River Road, T-WH1-01, Teaneck, NJ 07666, USA.
| | - Katharine L Loeb
- Chicago Center for Evidence-Based Treatment, 25 E Washington St, Suite 1015, Chicago, IL 60602, USA.
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Schilder CMT, Sternheim LC, Aarts E, van Elburg AA, Danner UN. Relationships between educational achievement, intelligence, and perfectionism in adolescents with eating disorders. Int J Eat Disord 2021; 54:794-801. [PMID: 33554341 DOI: 10.1002/eat.23482] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE High performance at school is associated with the risk of eating disorders (EDs), and perfectionism is proposed as an explanatory factor for this association. This study aims to evaluate (a) potential discrepancies between the measured IQ of adolescents with EDs and the IQ that is expected given their educational track, and (b) to what extent perfectionism was associated with educational achievement independent from IQ. METHOD WISC-III Verbal IQ, Performance IQ, and Full Scale IQ of 386 adolescent ED patients were compared with population norms for their educational track, using one-sample t tests. The association between self-oriented perfectionism (Eating Disorder Inventory-2) and educational achievement, adjusted for IQ, was determined with sequential ordinal regression analyses. RESULTS Over 50% of the patients received pre-university education, the most complex educational track. For patients receiving education in the second most complex track, IQ-scores were lower than normative data for that track. For patients receiving pre-university education, the verbal IQ was lower than the norm for that track. Self-oriented perfectionism was associated with educational achievement independent from intelligence. DISCUSSION This study suggests that high educational achievement is common in adolescents with EDs. Particularly for patients who receive education in the most complex tracks the demands at school may be higher than they can handle, based on their IQ. Self-oriented perfectionism contributed to educational achievement independent from IQ. Our results indicate that treatment for EDs should include awareness for the possibility of a too high target level of patients at school and perfectionism.
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Affiliation(s)
| | - Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Emmeke Aarts
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
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Quiles Y, Quiles MJ, León E, Manchón J. Illness Perception in Adolescent Patients With Anorexia: Does It Play a Role in socio-Emotional and Academic Adjustment? Front Psychol 2020; 11:1730. [PMID: 32793063 PMCID: PMC7385588 DOI: 10.3389/fpsyg.2020.01730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022] Open
Abstract
People’s beliefs about their illness have been shown to affect their adjustment. The aim of this study was to describe illness perception in adolescent patients with anorexia nervosa (AN) and assess its relationship with socio-emotional and academic adjustment following Leventhal’s Self-Regulation Model. Thirty-four female AN patients, with a mean age of 15.76 (SD = 2.00), completed the Revised Illness Perception Questionnaire (IPQ-R), the Psychosocial Adjustment to Illness Scale (PAIS) and the Hospital Anxiety and Depression Scale (HAD). Adolescent anorexia patients perceived that they had control over their illness and treatment would improve their condition. However, they also believed that it was highly distressing, going to last a long time and would have serious consequences. As for the causes of the disorder, they were attributed primarily to a specific eating disorder and psychological factors. The results showed that anorexia patients’ illness perceptions were related to socio-emotional and academic adjustment. In this sense, identity with the illness was associated with a worse academic adjustment, while emotional representation was associated with a worse emotional and social adjustment. These findings highlight how important it is for patients’ beliefs about their disease to be considered in the treatment of anorexia. In this respect, clinicians treating these patients should consider how certain beliefs affect their academic and socio-emotional adjustment. It would be interesting for patients to become aware of how these beliefs influence the strategies they use to cope with their disease as well as their adjustment to it.
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Affiliation(s)
- Yolanda Quiles
- Department of Behavioral Sciences and Health, Miguel Hernández University, Elche, Spain
| | - Maria José Quiles
- Department of Behavioral Sciences and Health, Miguel Hernández University, Elche, Spain
| | - Eva León
- Department of Behavioral Sciences and Health, Miguel Hernández University, Elche, Spain
| | - Javier Manchón
- Department of Behavioral Sciences and Health, Miguel Hernández University, Elche, Spain
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Steiger H, Booij L. Eating Disorders, Heredity and Environmental Activation: Getting Epigenetic Concepts into Practice. J Clin Med 2020; 9:jcm9051332. [PMID: 32375223 PMCID: PMC7291135 DOI: 10.3390/jcm9051332] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/21/2020] [Accepted: 04/30/2020] [Indexed: 12/15/2022] Open
Abstract
Epigenetic mechanisms are believed to link environmental exposures to alterations in gene expression, and in so doing, to provide a physical substrate for the activation of hereditary potentials by life experiences. In keeping with this idea, accumulating data suggest that epigenetic processes are implicated in eating-disorder (ED) etiology. This paper reviews literature on putative links between epigenetic factors and EDs, and examines ways in which epigenetic programming of gene expression could account for gene-environment interactions acting in the EDs. The paper also presents evidence suggesting that epigenetic processes link malnutrition and life stresses (gestational, perinatal, childhood, and adult) to risk of ED development. Drawing from empirical evidence and clinical experience, we propose that an epigenetically informed understanding of ED etiology can benefit patients, caregivers, and clinicians alike, in the sense that the perspective can reduce judgmental or blameful attitudes on the part of clinicians and caregivers, and increase self-acceptance and optimism about recovery on the part of those affected.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Montreal, Quebec H4H 1R3, Canada
- Douglas Institute Research Centre, McGill University, Montreal, Quebec H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec H3A 1A1, Canada
- Correspondence: (H.S.); (L.B.)
| | - Linda Booij
- Department of Psychiatry, McGill University, Montreal, Quebec H3A 1A1, Canada
- Department of Psychology, Concordia University, Montreal, Quebec H4B 1R6, Canada
- Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec H3T 1C5, Canada
- Correspondence: (H.S.); (L.B.)
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Claydon E, Zullig KJ. Eating disorders and academic performance among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:320-325. [PMID: 30615578 DOI: 10.1080/07448481.2018.1549556] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/31/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
Objective: There is a paucity of research exploring eating disorders (EDs) and academic performance (AP). This study aimed to understand the effect of ED treatment on AP, hypothesizing that students receiving treatment for EDs would have a higher GPA. Participants: The Spring 2010 - Spring 2011 National College Health Assessment data (N = 231,586) was utilized. Methods: Ordinal logistic regressions, controlling for key confounders, analyzed the association between those diagnosed with anorexia or bulimia and GPA. Results: Students diagnosed with anorexia or bulimia and treated with medication and psychotherapy were respectively 1.49 (1.24, 1.80; p < .0001) or 1.35 (1.13, 1.61; p = .0009) times more likely to have a higher GPA (p < .0001) compared to students without EDs. Conclusion: Findings expand the literature on EDs and AP among college students. Additional research is needed to determine whether the combination of medication and psychotherapy is the most effective way to improve AP among students with EDs.
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Affiliation(s)
- Elizabeth Claydon
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virgina, USA
| | - Keith J Zullig
- Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virgina, USA
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Potterton R, Richards K, Allen K, Schmidt U. Eating Disorders During Emerging Adulthood: A Systematic Scoping Review. Front Psychol 2020; 10:3062. [PMID: 32082210 PMCID: PMC7005676 DOI: 10.3389/fpsyg.2019.03062] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/26/2019] [Indexed: 01/20/2023] Open
Abstract
Background: Eating disorders (EDs) during the transition to adulthood can derail social, psychological, and vocational development. Effective treatment is of paramount importance, yet young adults' treatment needs are typically less well met than those of adolescents. In recent years, there has been a considerable shift in how developmental psychologists understand the transition to adulthood, with this life-phase reconceptualized as "emerging adulthood" (EA) (~18-25 years). Engagement with burgeoning developmental research is likely key to providing more effective care for young people experiencing EDs. Aims: To review ED research which has utilized the concept of EA, and to assess the usefulness of this concept for ED research and practice. Methods: A systematic scoping review was conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. Three databases (Psychinfo, PubMed, Embase) were searched for papers which explicitly focused on EDs during EA. No restrictions as to publication type, language, study design, or participants were applied. Included studies were assessed for developmental "informedness," and findings were qualitatively synthesized. Results: Thirty-six studies (N = 25,475) were included in the review. Most studies used quantitative methodologies, were cross-sectional in design and focused on identifying psychological and social factors which contribute to etiology of EDs. Many studies (N = 22) used well-defined samples of emerging adults (EAs); few studies (N = 8) included developmental measures relevant to EAs. Findings indicate that whilst factors implicated in EDs in adolescence and adulthood are relevant to EAs, EA-specific factors (e.g., identity exploration) may also contribute. Conventional ED services and treatments present difficulties for EAs, whilst those adapted to EAs' needs are feasible, acceptable, and more effective than treatment-as-usual. Directions for future research and clinical implications are discussed. Conclusion: Existing research indicates that the EA concept is relevant for understanding EDs during the transition to adulthood, and ED services should implement adaptations which exploit the opportunities and overcome the challenges of this developmental stage. EA is currently an underused concept in ED research, and future engagement with the developmental literature by both researchers and clinicians may be key to understanding and treating EDs during transition to adulthood.
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Affiliation(s)
- Rachel Potterton
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katie Richards
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Karina Allen
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- School of Psychological Science, The University of Western Australia, Crawley, WA, Australia
| | - Ulrike Schmidt
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Grammer AC, Fitzsimmons-Craft EE, Laing O, Pietro BD, Wilfley DE. Eating Disorders on College Campuses in the United States: Current Insight on Screening, Prevention, and Treatment. CURRENT PSYCHOPHARMACOLOGY 2020; 9:91-102. [PMID: 32905358 PMCID: PMC7470246 DOI: 10.2174/2211556009999200416153022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eating disorders are prevalent on college campuses and pose significant risks to student health, well-being, and academic performance. However, few students receive access to evidence-based prevention and treatment. OBJECTIVE The present review synthesizes the recent literature on ED screening, prevention, and treatment approaches on college campuses in the United States. We provide an overview of ED screening efforts on college campuses, including relevant screening tools, summarize the extant literature on prevention programming, as well psychological and pharmacological treatment approaches, and outline limitations of current programming and provide future directions for research. CONCLUSION Recent advances in ED screening, prevention, and treatment efforts highlight the importance of early detection and intervention. Innovative approaches to screening and dissemination of evidence-based prevention and treatment programs on college campuses are warranted. Implications for future research are discussed.
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Affiliation(s)
- Anne C. Grammer
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Olivia Laing
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Bianca De Pietro
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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[Symptoms of eating disorders in children and adolescents: frequencies and risk factors : Results from KiGGS Wave 2 and trends]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1195-1204. [PMID: 31529180 DOI: 10.1007/s00103-019-03005-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Eating disorders are of high clinical and societal relevance. They are among the most common chronic mental illnesses in adulthood, but show a high incidence rate and peak of disease onset even in adolescence. Eating disorders are associated with far-reaching costs, such as acute or chronic comorbidities and educational or professional attainment.Thus, from a public mental health perspective, it is essential to explore symptoms and risk factors of eating disorders and to monitor prevalence rates across time to evaluate the relevance and effectiveness of prevention measures.In the present study, the recent prevalence of eating disorder symptoms among 11- to 17-year-old children and adolescents living in Germany is reported based on the Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017, N = 6599, 51.7% boys) and compared to the prevalence rates 10 years ago (KiGGS Baseline, 2003-2006, N = 6633, 51.5% boys). Moreover, we investigate a selection of risk factors for eating disorder symptoms.In KiGGS Wave 2, 19.8% of the children and adolescents showed eating disorder symptoms, a drop of 2.8 percentage points in the prevalence rate as compared to the KiGGS Baseline. The drop in the prevalence rate pertains to 11- to 13-year-old boys while the risk for 14- to 17-year-old adolescents and particularly among girls remained comparably high. Children and adolescents with emotional problems, low family cohesion, low self-efficacy, or who perceive themselves as too thick or thin, show an increased risk for eating disorder symptoms.Previous approaches and possible supplements for the prevention of eating disorders are discussed.
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Fitzsimmons-Craft EE, Karam AM, Monterubio GE, Taylor CB, Wilfley DE. Screening for Eating Disorders on College Campuses: a Review of the Recent Literature. Curr Psychiatry Rep 2019; 21:101. [PMID: 31522343 PMCID: PMC7025756 DOI: 10.1007/s11920-019-1093-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This paper provides a review of the recent literature on screening for eating disorders (EDs) on college campuses, and reports on methodology, prevalence rates, treatment receipt, and ED screening tools. RECENT FINDINGS Recent research highlights relatively high prevalence rates of EDs among students on college campuses, with the majority of studies demonstrating elevated prevalence compared to the general population. Among students who screened positive for an ED, approximately 20% or less reported having received treatment for their ED. Findings also revealed various recruitment strategies, methods, ED screening tools, and clinical cutoffs used to study this topic, making it challenging to draw firm conclusions about prevalence of EDs on college campuses. Recent research on ED screening on college campuses reveals that EDs are a significant problem among college students, and there is a marked treatment gap between those who need care and those who receive it. Implications and future research are discussed.
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Affiliation(s)
- Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Anna M Karam
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
| | - Grace E Monterubio
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
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Clausen L, Larsen JT, Bulik CM, Petersen L. A Danish register-based study on involuntary treatment in anorexia nervosa. Int J Eat Disord 2018; 51:1213-1222. [PMID: 30414329 DOI: 10.1002/eat.22968] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Involuntary treatment is controversial and widely debated, but remains a significant component of treatment for severe anorexia nervosa. Given how little is known about this topic, we describe the frequency of various involuntary measures in a national cohort of all patients diagnosed with anorexia nervosa. In a subsample of patients, we explored predictors of the first involuntary measure recorded. METHOD Descriptive statistics and Cox proportional hazard analyses were conducted using the national registers of Denmark covering the total population. Data from the National Patient Register and the Psychiatric Central Research Register including all psychiatric visits from 1969 onwards were merged with data from the National Register on Coercion covering 1999 onward. Involuntary measures registered between 2000 and 2013 were analyzed. RESULTS A total of 4,727 patients with a diagnosis of anorexia nervosa representing 16,592 admissions were included. Eighteen percent experienced at least one involuntary measure. A variety of measures were used with tube feeding being the most frequent followed by mechanical restraint, involuntary medication, physical restraint, constant observation, and sedative medication. A subsample of 2% of AN patients had more than 100 involuntary measures recorded. The first recorded involuntary measure was predicted by most but not all psychiatric comorbidities, especially schizophrenia, autism spectrum, and personality disorders, older age at first diagnosis, and previous admissions. DISCUSSION It is important to develop a more granular understanding of patients at risk of requiring involuntary treatment and to determine how best to treat them effectively with minimal use of involuntary measures.
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Affiliation(s)
- L Clausen
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - J T Larsen
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
| | - C M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - L Petersen
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
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Tabler J, Utz RL, Smith KR, Hanson HA, Geist C. Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest-aged sisters. Int J Eat Disord 2018; 51:102-111. [PMID: 29331083 PMCID: PMC6599590 DOI: 10.1002/eat.22827] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study seeks to examine the long-term reproductive consequences of eating disorders (ED), to assess variation in reproductive outcomes by ED type, and to examine reproductive differences between women with previous ED diagnosis and their discordant sisters. METHOD Using a sample of women with previous ED diagnosis generated by the Utah Population Database, this study compares the fecundity (parity) and age at first birth of women by ED subtype (bulimia nervosa [BN], anorexia nervosa [AN], and ED not otherwise specified [EDNOS]) (n = 1,579). We also employed general population match case-control, and discordant sibling pair analyses, to estimate the magnitude of association between EDs and reproductive outcomes. RESULTS Women previously diagnosed with AN or EDNOS experienced delayed first birth (HRR = 0.33, HRR = 0.34, respectively) and lower parity (IRR = 0.19, IRR = 0.22, respectively) relative to BN (p < .05), the general population (p < .05), and closest-aged sisters (p < .05). Women previously diagnosed with BN experienced more moderate reductions and delays to their reproduction, and had similar reproductive outcomes as their discordant sisters. DISCUSSION Clinicians should consider ED type and family fertility histories when addressing the long-term reproductive health needs of women with prior AN, BN, or EDNOS diagnosis. Women previously diagnosed with AN or EDNOS likely experience the greatest reductions and delays in reproduction across their lifespan. Reproductive health screenings may be especially critical for the wellbeing of women with a history of AN or EDNOS.
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Affiliation(s)
- Jennifer Tabler
- Department of Sociology and Anthropology, The University of Texas Rio Grande Valley, Edinburg, Texas
| | - Rebecca L. Utz
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Ken R. Smith
- Department of Family and Consumer Studies, Pedigree and Population Resource, University of Utah, Salt Lake City, Utah,Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Heidi A. Hanson
- Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah,Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Claudia Geist
- Department of Sociology, University of Utah, Salt Lake City, Utah,Division of Gender Studies, University of Utah, Salt Lake City, Utah
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Baucom DH, Kirby JS, Fischer MS, Baucom BR, Hamer R, Bulik CM. Findings from a couple-based open trial for adult anorexia nervosa. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2017; 31:584-591. [PMID: 28318287 PMCID: PMC5555805 DOI: 10.1037/fam0000273] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Adult anorexia nervosa (AN) often is persistent, significantly erodes quality of life for both the patient and loved ones, and carries high medical and psychiatric comorbidity. Whereas individual psychotherapy for adult AN leads to improvement in some patients, recent findings indicate that the magnitude of improvement is limited: Only a small percentage of individuals fully recover and dropout rates are high. Thus, it is important to build upon current interventions to improve treatment response. We present results from an open trial of a couple-based intervention for adult anorexia nervosa as an adjunct treatment to standard multidisciplinary care. Twenty couples received treatment over approximately 26 weeks, including a couple-based intervention, individual CBT sessions, psychiatry visits for medication management, and nutritional counseling sessions. The results indicate that patients improved at posttest and 3-month follow-up on a variety of AN-related measures, anxiety and depression, and relationship adjustment. Partners also improved on anxiety, depression, and relationship adjustment. In an exploratory analysis, the multicomponent couple treatment intervention was benchmarked to well-conducted randomized controlled trials of individual therapy for AN; the couple intervention seems to compare favorably on AN-related measures and was associated with a lower dropout rate. In spite of methodological limitations, the findings suggest that including partners in the treatment of adult AN holds potential for bolstering treatment outcomes. (PsycINFO Database Record
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18
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Effortful control as a moderator in the association between punishment and reward sensitivity and eating styles in adolescent boys and girls. Appetite 2017; 111:177-186. [DOI: 10.1016/j.appet.2017.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/23/2016] [Accepted: 01/04/2017] [Indexed: 11/16/2022]
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19
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Kirby JS, Fischer MS, Raney TJ, Baucom DH, Bulik CM. Couple-based interventions in the treatment of adult anorexia nervosa: A brief case example of UCAN. ACTA ACUST UNITED AC 2017; 53:241-50. [PMID: 27267510 DOI: 10.1037/pst0000053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adult anorexia nervosa (AN) is a serious and often fatal illness that significantly erodes quality of life for both the patient and loved ones. Treatment of adults with AN has focused largely on individual therapy, with recent findings suggesting that improvement is limited and dropout rates are high. In an effort to improve treatment response, we developed a couple-based intervention, Uniting Couples in the treatment of Anorexia Nervosa (UCAN) as an adjunct treatment to standard multidisciplinary care. UCAN leverages the support of a partner and the relationship in treatment by decreasing avoidance around AN, teaching the couple how to effectively address the eating disorder, and helping to foster a more satisfying relationship. This paper presents a case study of a couple who completed UCAN, "Laura and Steve," including their experiences in treatment and outcome measures at pretest, posttest, and 3-month follow-up. Laura showed clinically significant change on the Restraint subscale of the Eating Disorders Examination at follow-up, and both partners showed clinically significant improvements in relationship satisfaction, as well as on self-reported and observed communication. Both partners reported very high satisfaction with the treatment. A discussion of therapists' experiences in delivering UCAN is provided, including common challenges for therapists with primarily a couple therapy or an individual CBT for eating disorders background, as well as important factors for therapists to consider in order to optimally leverage the benefits of including partners in treatment for AN. (PsycINFO Database Record
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Affiliation(s)
- Jennifer S Kirby
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Melanie S Fischer
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Thomas J Raney
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Donald H Baucom
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill
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20
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Eating Disorders in Lebanon: Directions for Public Health Action. Community Ment Health J 2017; 53:117-125. [PMID: 26286080 DOI: 10.1007/s10597-015-9917-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
Research in the field of eating disorders (ED) is limited in the Middle East. The aim of the present study was to profile Lebanese ED outpatients. A mixed-method design was used. Clinicians across Lebanon filled individual questionnaires about their 2013 ED outpatients (n = 104) and participated in focus groups. Results showed that bulimia nervosa was the most prevalent ED (46.1 %) followed by anorexia nervosa (39.4 %) and binge eating (14.4 %). The emerging socio-demographic profile of the Lebanese ED patient was that of a single female young adult of middle to high socio-economic status with severe ED symptoms (amenorrhea, multiple purging behaviors) and depression. Also, there was a general delay in seeking help which made patient recovery more difficult. The present study emphasizes the critical need for a public health approach to ED awareness and could help in developing preventive and remedial educational programs targeting youth in Lebanon and the Middle East.
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Antoine P, Flinois B, Doba K, Nandrino JL, Dodin V, Hendrickx M. Living as a couple with anorexia nervosa: A dyadic interpretative phenomenological analysis. J Health Psychol 2016; 23:1842-1852. [DOI: 10.1177/1359105316672095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined the difficulties couples face in relation to anorexia nervosa. Using interpretative phenomenological analysis, five couples in which one of the partners lives with anorexia nervosa were interviewed separately. The findings are conceptualized into three areas: first, the encounter ‘at the crossroads between remission and relapse’; second, the way that ‘anorexia reveals itself’; and finally, the way the ‘ménage à trois’ works, including the illness fully as part of the couple. Psychotherapists should take into account the context of the couple and the complex interaction between the couple and the illness to support both partners’ development of appropriate responses.
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Affiliation(s)
- Pascal Antoine
- Lille University, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives,Lille, France
| | - Bérengère Flinois
- Lille University, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives,Lille, France
| | - Karyn Doba
- Lille University, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives,Lille, France
| | - Jean-Louis Nandrino
- Lille University, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives,Lille, France
| | - Vincent Dodin
- Department of Psychiatry, Hôpital Saint Vincent de Paul, GHICL, F-59000 Lille, France
| | - Marion Hendrickx
- Department of Psychiatry, Hôpital Saint Vincent de Paul, GHICL, F-59000 Lille, France
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22
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Sadeh-Sharvit S, Zubery E, Mankovski E, Steiner E, Lock JD. Parent-based prevention program for the children of mothers with eating disorders: Feasibility and preliminary outcomes. Eat Disord 2016; 24:312-25. [PMID: 26940552 DOI: 10.1080/10640266.2016.1153400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The children of mothers with eating disorders are at high risk of feeding and eating problems and broader developmental difficulties. The Parent-Based Prevention (PBP) of eating disorders targets risk factors and facilitates behavioral change in parents to mitigate potentially negative outcomes of their children. This pre/post uncontrolled study evaluated the feasibility and preliminary outcomes of PBP. PBP was found to be a feasible intervention for mothers with eating disorders and their spouses, with satisfactory retention rates. A total of 16 intact families were assessed at three measurement points for parents' feeding practices, child outcomes, and maternal functioning. Both parents reported improved feeding practices as well as more positive perceptions of their children in comparison to baseline. These pilot findings suggest that PBP is linked with decreased risk of eating and mental problems among the offspring of mothers with eating disorders.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- a Department of Psychiatry and Behavioral Sciences , School of Medicine, Stanford University , Stanford , California , USA.,b Eating Disorders Treatment and Research Center, Hanotrim (Davidson) Clinic, Raanana , Shalvata Mental Health Center , Hod Hasharon , Israel
| | - Eynat Zubery
- b Eating Disorders Treatment and Research Center, Hanotrim (Davidson) Clinic, Raanana , Shalvata Mental Health Center , Hod Hasharon , Israel
| | - Esty Mankovski
- b Eating Disorders Treatment and Research Center, Hanotrim (Davidson) Clinic, Raanana , Shalvata Mental Health Center , Hod Hasharon , Israel
| | - Evelyne Steiner
- b Eating Disorders Treatment and Research Center, Hanotrim (Davidson) Clinic, Raanana , Shalvata Mental Health Center , Hod Hasharon , Israel
| | - James D Lock
- a Department of Psychiatry and Behavioral Sciences , School of Medicine, Stanford University , Stanford , California , USA
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23
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Mustelin L, Raevuori A, Bulik CM, Rissanen A, Hoek HW, Kaprio J, Keski-Rahkonen A. Long-term outcome in anorexia nervosa in the community. Int J Eat Disord 2015; 48:851-9. [PMID: 26059099 DOI: 10.1002/eat.22415] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 02/27/2015] [Accepted: 03/27/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Few studies have assessed outcomes of anorexia nervosa (AN) outside clinical settings. We aimed to assess mortality, recovery, and socio-demographic outcomes of AN in a community sample. METHOD Women in the nationwide FinnTwin16 cohort (born 1975-1979) were followed for 10 years after baseline diagnostic assessment (mean age at follow-up 34 years, N = 2188). We compared women with lifetime DSM-IV AN (N = 40) with unaffected women from the same cohort. RESULTS None of the women with AN had died and 88% were weight-recovered (BMI ≥ 18.5 kg/m(2) ), but their mean BMI (22.0 kg/m(2) ) was lower than among unaffected women (24.0 kg/m(2) , p = 0.008). University degrees (38 vs. 29%, p = 0.26), sickness absence during the past year (median 5 vs. 3 days, p = 0.21), or unemployment or disability pension (5 vs. 4%, p = 0.62) did not significantly differ between AN probands and their unaffected peers. More women with AN were still studying (15 vs. 4%, p = 0.003), and half of them had children, as compared to 66% of unaffected women (p = 0.05). DISCUSSION The long-term prognosis of AN in the community appears promising. Weight-restoration is common and socio-demographic outcomes are generally favorable. However, women with a history of AN may be less likely to have children.
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Affiliation(s)
- Linda Mustelin
- Department of Public Health, University of Helsinki, Finland.,Departments of Psychiatry and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anu Raevuori
- Department of Public Health, University of Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.,Institute of Clinical Medicine, Child Psychiatry, University of Turku, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Cynthia M Bulik
- Departments of Psychiatry and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Aila Rissanen
- Department of Psychiatry, Helsinki University Central Hospital, Finland
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Psychiatry, Groningen University, The Netherlands.,Department of Epidemiology, Columbia University, New York
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland.,Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
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Abstract
A significant number of adults with eating disorders fail to achieve relief from the disorder, with many dropping out of treatment or relapsing. The standard treatment remains individual therapy despite partners being negatively affected and typically wanting to help in an effective and loving way. We propose that couple-based interventions, which leverage the support of a partner and the relationship in treatment, may improve outcome and recovery rates for adults with eating disorders. In this article, we survey the empirical literature supporting the treatment of adults in a couple context and describe our existing and emerging couple-based interventions for eating disorders.
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Affiliation(s)
- Jennifer S Kirby
- a Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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25
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Gonçalves S, Freitas F, Freitas-Rosa MA, Machado BC. Dysfunctional eating behaviour, psychological well-being and adaptation to pregnancy: A study with women in the third trimester of pregnancy. J Health Psychol 2015; 20:535-42. [DOI: 10.1177/1359105315573432] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study evaluated the prevalence and predictors of dysfunctional eating. Women in the third trimester of pregnancy participated in this study ( N = 105). Dysfunctional eating was associated with a higher body mass index, enhanced negative body image, more somatic symptoms, poorer marital relationships, more negative attitudes regarding pregnancy and the baby and more emotional problems. A higher body mass index prior to the pregnancy, higher weight gain during pregnancy and a more negative perception of body image predicted dysfunctional eating. Clinicians must be aware of the presence of dysfunctional eating during pregnancy to prevent relevant physiological and psychosocial consequences during this stage.
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26
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von Hausswolff-Juhlin Y, Brooks SJ, Larsson M. The neurobiology of eating disorders--a clinical perspective. Acta Psychiatr Scand 2015; 131:244-55. [PMID: 25223374 DOI: 10.1111/acps.12335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide a neurobiological basis of eating disorders for clinicians and to enlighten how comparing neurobiology and eating disorders with neurobiology of other psychiatric illnesses can improve treatment protocols. METHOD A selective review on the neurobiology of eating disorders. The article focuses on clinical research on humans with consideration of the anatomical, neural, and molecular basis of eating disorders. RESULTS The neurobiology of people with eating disorders is altered. Many of the neurobiological regions, receptors, and chemical substrates that are affected in other mental illnesses also play an important role in eating disorders. More knowledge about the neurobiological overlap between eating disorders and other psychiatric populations will help when developing treatment protocols not the least regarding that comorbidity is common in patients with EDs. CONCLUSION Knowledge about the underlying neurobiology of eating disorders will improve treatment intervention and will benefit from comparisons with other mental illnesses and their treatments.
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Affiliation(s)
- Y von Hausswolff-Juhlin
- Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Stockholm, Sweden
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27
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Kaye WH, Wierenga CE, Knatz S, Liang J, Boutelle K, Hill L, Eisler I. Temperament-based treatment for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 23:12-8. [PMID: 25377622 DOI: 10.1002/erv.2330] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/19/2014] [Accepted: 10/02/2014] [Indexed: 11/10/2022]
Abstract
Anorexia nervosa (AN) tends to be a chronic and deadly disorder with no proven treatments that reverse core symptoms in adults. New insight into neurobiological mechanisms that contribute to symptoms may support development of more effective interventions. We describe the development of a temperament-based treatment for AN on the basis of empirically supported models. It uses a systemized approach and takes into consideration an understanding of how neurobiological mechanisms are expressed through behaviour and personality and contribute to specific AN symptomatology. This model integrates the development of AN-focused constructive coping strategies with carer-focused strategies to manage temperament traits that contribute to AN symptomatology. This intervention is consistent with the recent Novel Interventions for Mental Disorders initiative mandating that treatment trials follow an experimental medicine approach by identifying underlying mechanisms that are directly targeted by the intervention to influence symptoms.
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Affiliation(s)
- Walter H Kaye
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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28
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Baucom DH, Belus JM, Adelman CB, Fischer MS, Paprocki C. Couple-based interventions for psychopathology: a renewed direction for the field. FAMILY PROCESS 2014; 53:445-461. [PMID: 24773298 DOI: 10.1111/famp.12075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article provides a rationale and empirical support for providing couple-based interventions when one partner in a relationship is experiencing individual psychopathology. Several investigations indicate that relationship distress and psychopathology are associated and reciprocally influence each other, such that the existence of relationship distress predicts the development of subsequent psychopathology and vice versa. Furthermore, findings indicate that for several disorders, individual psychotherapy is less effective if the client is in a distressed relationship. Finally, even within happy relationships, partners often inadvertently behave in ways that maintain or exacerbate symptoms for the other individual. Thus, within both satisfied and distressed relationships, including the partner in a couple-based intervention provides an opportunity to use the partner and the relationship as a resource rather than a stressor for an individual experiencing some form of psychological distress. The authors propose that a promising approach to including the partner in treatment involves (a) integrating intervention principles from empirically supported interventions for individual therapy for specific disorders with (b) knowledge of how to employ relationships to promote individual and dyadic change. Based on this logic, the article includes several examples to demonstrate how couple-based interventions can be focused on a specific type of psychopathology, including encouraging empirical findings for these interventions. The article concludes with recommendations for how clinicians and researchers can adapt their knowledge of couple therapy to assist couples in which one partner is experiencing notable psychological distress or diagnosable psychopathology.
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Affiliation(s)
- Donald H Baucom
- Psychology Department, University of North Carolina, Chapel Hill, NC
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Work and social adjustment in patients with anorexia nervosa. Compr Psychiatry 2013; 54:41-5. [PMID: 22534033 DOI: 10.1016/j.comppsych.2012.03.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 02/26/2012] [Accepted: 03/11/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE AND METHODS The Work and Social Adjustment Scale (WSAS) assesses patients' perceptions of impairment in everyday functioning and has been reported as a simple and reliable self-report measure in different psychiatric disorders. This study compared WSAS data from an anorexia nervosa (AN) patient group with that from healthy controls (HCs) and published data from other patient groups. A total of 160 female participants (AN, 77; HC, 83) completed the WSAS as well as measures of eating disorder symptom severity and brief assessments of anxiety and depression. RESULTS Work and Social Adjustment Scale scores for the AN group were found to be in the severely impaired range, whereas the scores for those within the HC group indicated very little, or no impairment. Total WSAS scores in the AN group were significantly correlated with severity of clinical symptoms, and eating disorder-specific symptoms were the best predictor of social and occupational functional impairment. The greatest impairment in the AN group was reported in the realm of social leisure. CONCLUSIONS Consistent with reports in other clinical populations, it is suggested that the WSAS could be an extremely useful and meaningful measure to assess social and occupational functioning in people with eating disorders, in addition to eating disorder-specific assessments.
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Abstract
Anorexia nervosa is a serious mental illness that affects women and men of all ages. Despite the gravity of its chronic morbidity, risk of premature death, and societal burden, the evidence base for its treatment-especially in adults-is weak. Guided by the finding that family-based interventions confer benefit in the treatment of anorexia nervosa in adolescents, we developed a cognitive-behavioral couple-based intervention for adults with anorexia nervosa who are in committed relationships that engages both the patient and her/his partner in the treatment process. This article describes the theoretical rationale behind the development of Uniting Couples in the treatment of Anorexia nervosa (UCAN), practical considerations in delivering the intervention, and includes reflections from the developers on the challenges of working with couples in which one member suffers from anorexia nervosa. Finally, we discuss future applications of a couple-based approach to the treatment of adults with eating disorders.
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Easter A, Treasure J, Micali N. Fertility and prenatal attitudes towards pregnancy in women with eating disorders: results from the Avon Longitudinal Study of Parents and Children. BJOG 2011; 118:1491-8. [DOI: 10.1111/j.1471-0528.2011.03077.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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