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Toppino F, Martini M, Longo P, Caldas I, Delsedime N, Lavalle R, Raimondi F, Abbate-Daga G, Panero M. Inpatient treatments for adults with anorexia nervosa: a systematic review of literature. Eat Weight Disord 2024; 29:38. [PMID: 38767754 PMCID: PMC11106202 DOI: 10.1007/s40519-024-01665-5] [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: 03/12/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE Anorexia nervosa (AN) is a mental disorder for which hospitalization is frequently needed in case of severe medical and psychiatric consequences. We aim to describe the state-of-the-art inpatient treatment of AN in real-world reports. METHODS A systematic review of the literature on the major medical databases, spanning from January 2011 to October 2023, was performed, using the keywords: "inpatient", "hospitalization" and "anorexia nervosa". Studies on pediatric populations and inpatients in residential facilities were excluded. RESULTS Twenty-seven studies (3501 subjects) were included, and nine themes related to the primary challenges faced in hospitalization settings were selected. About 81.48% of the studies detailed the clinical team, 51.85% cited the use of a psychotherapeutic model, 25.93% addressed motivation, 100% specified the treatment setting, 66.67% detailed nutrition and refeeding, 22.22% cited pharmacological therapy, 40.74% described admission or discharge criteria and 14.81% follow-up, and 51.85% used tests for assessment of the AN or psychopathology. Despite the factors defined by international guidelines, the data were not homogeneous and not adequately defined on admission/discharge criteria, pharmacological therapy, and motivation, while more comprehensive details were available for treatment settings, refeeding protocols, and psychometric assessments. CONCLUSION Though the heterogeneity among the included studies was considered, the existence of sparse criteria, objectives, and treatment modalities emerged, outlining a sometimes ambiguous report of hospitalization practices. Future studies must aim for a more comprehensive description of treatment approaches. This will enable uniform depictions of inpatient treatment, facilitating comparisons across different studies and establishing guidelines more grounded in scientific evidence. LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- Federica Toppino
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Matteo Martini
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Paola Longo
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Inês Caldas
- Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Nadia Delsedime
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Raffaele Lavalle
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Francesco Raimondi
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Matteo Panero
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Via Cherasco 11, 10126, Turin, Italy.
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Ralph-Nearman C, Hooper MA, Hunt RA, Levinson CA. Dynamic relationships among feeling fat, fear of weight gain, and eating disorder symptoms in an eating disorder sample. Appetite 2024; 195:107181. [PMID: 38182054 PMCID: PMC10922613 DOI: 10.1016/j.appet.2023.107181] [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: 07/24/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024]
Abstract
Feeling fat and fear of weight gain are key cognitive-affective symptoms that are theorized to maintain eating disorders (EDs). Little research has examined the dynamic relationships among feeling fat, fear of weight gain, emotions, cognitions, and ED behaviors. Furthermore, it is unknown if these relations vary by ED diagnosis (e.g., anorexia nervosa (AN) vs other ED). The current study (N = 94 ED participants; AN n = 64) utilized ecological momentary assessments collected four times a day for 18 days (72 timepoints) asking about feeling fat, fear of weight gain, emotions (i.e., anxiety, guilt), cognitions (i.e., feelings of having overeaten, thoughts about dieting), and ED behaviors (i.e., vomiting, diuretic/laxative use, excessive exercise, body checking, self-weighing, binge-eating, restriction) at stressful timepoints (contemporaneous [mealtime], and prospective/temporal [next-meal]). Multilevel modeling was used to test for between and within-person associations. Higher feeling fat and fear of weight gain independently predicted higher next-meal emotions (i.e., anxiety, guilt), cognitions (i.e., feelings of having overeaten, thoughts about dieting, fear of weight gain, feeling fat), and ED behaviors (i.e., body checking, self-weighing [feeling fat]). There were relationships in the opposite direction, such that some emotions, cognitions, and ED behaviors prospectively predicted feeling fat and fear of weight gain, suggesting existence of a reciprocal cycle. Some differences were found via diagnosis. Findings pinpoint specific dynamic and cyclical relationships among feeling fat, fear of weight gain, and specific ED symptoms, and suggest the need for more research on how feeling fat, fear of weight gain and cognitive-affective-behavioral aspects of ED operate. Future research can test if treatment interventions targeted at feeling fat and fear of weight gain may disrupt these cycles.
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Affiliation(s)
- Christina Ralph-Nearman
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA.
| | - Madison A Hooper
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA; Vanderbilt University, Department of Psychology, Nashville, TN, USA
| | - Rowan A Hunt
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA
| | - Cheri A Levinson
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA; Unversity of Louisville, Department of Pediatrics, Louisville, KY, USA
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Styk W, Wojtowicz E, Zmorzynski S. I Don't Want to Be Thin! Fear of Weight Change Is Not Just a Fear of Obesity: Research on the Body Mass Anxiety Scale. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2888. [PMID: 36833584 PMCID: PMC9957053 DOI: 10.3390/ijerph20042888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Anxiety is one of the psychological factors associated with body weight experienced by people attempting to live up to expectations of an ideal body shape. The stigma of excessive or too low body weight and the stigmatization of people because of it is becoming a widespread problem with negative psychological and social consequences. One effect of the strong social pressure of beauty standards dependent on low body weight is the development of eating disorders and negative societal attitudes toward overweight or obese people. Research conducted to date has mainly focused on one dimension of weight-related anxiety-the fear of getting fat. Ongoing research has also revealed the other side of weight-related anxiety-fear of weight loss. Therefore, the purpose of the present project was to develop a two-dimensional scale to diagnose the level of weight-related anxiety and to preliminarily test the psychometric properties of the emerging constructs. Results: the BMAS-20 weight-related anxiety scale in both Polish and English versions was developed and its psychometric properties were confirmed. The components of body weight-change anxiety that emerged were: anxiety about getting fat and anxiety about losing weight. It was found that both AGF and ALW may have a protective function related to awareness of the negative consequences of poor eating and the health risks associated with it. Above-normal levels of anxiety may be a predictor of psychopathology. Both AGF and ALW are associated with symptoms of depression.
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Affiliation(s)
- Wojciech Styk
- Department of Psychology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Ewa Wojtowicz
- Polish Academy of Social Sciences and Humanities, 69 Banstead Road, Carshalton, London SM5 3NP, UK
| | - Szymon Zmorzynski
- Department of Cancer Genetics with Cytogenetic Laboratory, Medical University of Lublin, 20-059 Lublin, Poland
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4
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An examination of the factor structure of the Goldfarb Fear of Fat Scale in clinical and non-clinical samples of Polish women. Body Image 2022; 40:58-66. [PMID: 34847456 DOI: 10.1016/j.bodyim.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
Although associations between fear of fat and eating disorders (ED) have been frequently studied, it appears that the construct of fear of fat requires in-depth understanding to determine whether it is similar in individuals diagnosed with bulimia nervosa, anorexia nervosa, and individuals from the general population. The purpose of our study was to confirm the factor structure of the Goldfarb Fear of Fat Scale (GFFS) in clinical and non-clinical settings. This issue has not yet been investigated in the literature. Data were collected from 126 female patients diagnosed with ED and a total of 581 women from the general population. Our findings are highly consistent with the original single-factor structure of GFFS but only in the clinical sample. In the non-clinical sample, a good fit to the data has been achieved with a two-factor model composed of Fear of gaining weight and Fear of losing control over eating/weight. The Polish version of GFFS demonstrated good psychometric properties. It can be used as a fast screening tool to identify individuals with eating disorders and those at risk of developing such disorders. We recommend the two-factor model for non-clinical samples and the one-dimensional model for clinical samples for both research and practice.
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Borgers T, Krüger N, Vocks S, Thomas JJ, Plessow F, Hartmann AS. Overcoming limitations of self-report: an assessment of fear of weight gain in anorexia nervosa and healthy controls using implicit association tests. J Eat Disord 2021; 9:26. [PMID: 33602332 PMCID: PMC7890975 DOI: 10.1186/s40337-021-00379-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/09/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fear of weight gain is a characteristic feature of anorexia nervosa (AN), and reducing this fear is often a main target of treatment. However, research shows that 20% of individuals with AN do not report fear of weight gain. Studies are needed that evaluate the centrality of fear of weight gain for AN with a method less susceptible to deception than self-report. METHODS We approximated implicit fear of weight gain by measuring implicit drive for thinness using implicit association tests (IATs). We asked 64 participants (35 AN, 29 healthy controls [HCs]) to categorize statements as pro-dieting vs. non-dieting and true vs. false in a questionnaire-based IAT, and pictures of underweight vs. normal-weight models and positive vs. negative words in a picture-based IAT using two response keys. We tested for associations between implicit drive for thinness and explicitly reported psychopathology within AN as well as group differences between AN and HC groups. RESULTS Correlation analyses within the AN group showed that higher implicit drive for thinness was associated with more pronounced eating disorder-specific psychopathology. Furthermore, the AN group showed a stronger implicit drive for thinness than HCs in both IATs. CONCLUSION The results highlight the relevance of considering fear of weight gain as a continuous construct. Our implicit assessment captures various degrees of fear of weight gain in AN, which might allow for more individually tailored interventions in the future.
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Affiliation(s)
- Tiana Borgers
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Nathalie Krüger
- Unit of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Knollstr. 15, 49069, Osnabrück, Germany
| | - Silja Vocks
- Unit of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Knollstr. 15, 49069, Osnabrück, Germany
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Franziska Plessow
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea S Hartmann
- Unit of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Knollstr. 15, 49069, Osnabrück, Germany.
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6
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Gutiérrez E, Carrera O. Severe and Enduring Anorexia Nervosa: Enduring Wrong Assumptions? Front Psychiatry 2021; 11:538997. [PMID: 33658948 PMCID: PMC7917110 DOI: 10.3389/fpsyt.2020.538997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
To the extent that severe and lasting anorexia nervosa (SE-AN) is defined in terms of refractoriness to the best treatments available, it is mandatory to scrutinize the proven effectiveness of the treatments offered to patients. The array of so-called current evidence-based treatments for anorexia nervosa (AN) encompasses the entire spectrum of treatments ranging from specialized brand-type treatments to new treatments adapted to the specific characteristics of people suffering from AN. However, after several randomized control trials, parity in efficacy is the characteristic among these treatments. To further complicate the landscape of effective treatments, this "tie score" extends to the treatment originally conceived as control conditions, or treatment as usual conditions. In retrospection, one can understand that treatments considered to be the best treatments available in the past were unaware of their possible iatrogenic effects. Obviously, the same can be said of the theoretical assumptions underpinning such treatments. In either case, if the definition of chronicity mentioned above is applied, it is clear that the responsibility for the chronicity of the disorder says more about the flagrant inefficacy of the treatments and the defective assumptions underpinning them, than the nature of the disorder itself. A historical analysis traces the emergence of the current concept of "typical" AN and Hilde Bruch's contribution to it. It is concluded that today's diagnostic criteria resulting from a long process of acculturation distort rather than capture the essence of the disorder, as well as marginalizing and invalidating patients' perspectives.
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Affiliation(s)
- Emilio Gutiérrez
- Department of Clinical Psychology and Psychobiology, College of Psychology, University of Santiago, Santiago de Compostela, Spain
- Venres Clínicos Unit, College of Psychology, University of Santiago, Santiago de Compostela, Spain
| | - Olaia Carrera
- Venres Clínicos Unit, College of Psychology, University of Santiago, Santiago de Compostela, Spain
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AN-VR-BE. A Randomized Controlled Trial for Reducing Fear of Gaining Weight and Other Eating Disorder Symptoms in Anorexia Nervosa through Virtual Reality-Based Body Exposure. J Clin Med 2021; 10:jcm10040682. [PMID: 33578767 PMCID: PMC7916489 DOI: 10.3390/jcm10040682] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/18/2022] Open
Abstract
In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image.
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8
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Kan C, Hawkings YR, Cribben H, Treasure J. Length of stay for anorexia nervosa: Systematic review and meta-analysis. EUROPEAN EATING DISORDERS REVIEW 2021; 29:371-392. [PMID: 33548148 DOI: 10.1002/erv.2820] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 11/23/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Evidence regarding global trends in length of stay for patients with anorexia nervosa is limited. The aim of this study is to conduct a meta-analysis examining the length of stay for anorexia nervosa patients globally, and to investigate moderators of the variance. METHOD Medline, EMBASE and PsycINFO were searched for studies published up to January 2019. Two independent reviewers assessed the eligibility of each report based on predefined inclusion criteria. A meta-analysis was performed to calculate a pooled mean length of stay using the random-effects model. Subgroup analyses and meta-regression were conducted to explore potential sources of heterogeneity between studies. RESULTS Of 305 abstracts reviewed, 71 studies met the inclusion criteria, generating 111 datasets. The pooled mean length of stay (95% confidence interval) was 76.3 days (73.3, 79.4) using the random-effects model, with marked variation across countries and time. Heterogeneity between studies was explained by age and admission body mass index. CONCLUSIONS This meta-analysis found that although clinical features do contribute to length of admissions for anorexia nervosa, there are also global and temporal variations. Future research should provide an in-depth analysis of why and how this variation exists and what the impact is on the well-being of people with anorexia nervosa.
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Affiliation(s)
- Carol Kan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Hannah Cribben
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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9
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Porras-Garcia B, Ferrer-Garcia M, Serrano-Troncoso E, Carulla-Roig M, Soto-Usera P, Miquel-Nabau H, Shojaeian N, de la Montaña Santos-Carrasco I, Borszewski B, Díaz-Marsá M, Sánchez-Díaz I, Fernández-Aranda F, Gutiérrez-Maldonado J. Validity of Virtual Reality Body Exposure to Elicit Fear of Gaining Weight, Body Anxiety and Body-Related Attentional Bias in Patients with Anorexia Nervosa. J Clin Med 2020; 9:E3210. [PMID: 33027945 PMCID: PMC7600187 DOI: 10.3390/jcm9103210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022] Open
Abstract
Fear of gaining weight (FGW), body image disturbances, associated anxiety and body-related attentional bias are the core symptoms of anorexia nervosa (AN) and play critical roles in its development and maintenance. The aim of the current study is to evaluate the usefulness of virtual reality-based body exposure software for the assessment of important body-related cognitive and emotional responses in AN. Thirty female patients with AN, one of them subclinical, and 43 healthy college women, 25 with low body dissatisfaction (BD) and 18 with high BD, owned a virtual body that had their silhouette and body mass index. Full-body illusion (FBI) over the virtual body was induced using both visuo-motor and visuo-tactile stimulation. Once the FBI was induced, the FBI itself, FGW, body anxiety and body-related attentional bias toward weight-related and non-weight-related body areas were assessed. One-way analyses of covariance (ANCOVA), controlling for age, showed that AN patients reported higher FGW, body anxiety and body-related attentional bias than healthy controls. Unexpectedly, patients with AN reported significantly lower FBI levels than healthy participants. Finally, Pearson correlations showed significant relationships between visual analog scales and body-related attentional bias measures, compared to other eating disorder measures. These results provide evidence about the usefulness of virtual reality-based body exposure to elicit FGW and other body-related disturbances in AN patients. Thus, it may be a suitable intervention for reducing these emotional responses and for easing weight recovery.
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Affiliation(s)
- Bruno Porras-Garcia
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain; (B.P.-G.); (M.F.-G.); (H.M.-N.); (N.S.)
| | - Marta Ferrer-Garcia
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain; (B.P.-G.); (M.F.-G.); (H.M.-N.); (N.S.)
| | - Eduardo Serrano-Troncoso
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Sant Joan de Déu of Barcelona; Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain; (E.S.-T.); (M.C.-R.); (P.S.-U.)
| | - Marta Carulla-Roig
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Sant Joan de Déu of Barcelona; Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain; (E.S.-T.); (M.C.-R.); (P.S.-U.)
| | - Pau Soto-Usera
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Sant Joan de Déu of Barcelona; Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain; (E.S.-T.); (M.C.-R.); (P.S.-U.)
| | - Helena Miquel-Nabau
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain; (B.P.-G.); (M.F.-G.); (H.M.-N.); (N.S.)
| | - Nazilla Shojaeian
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain; (B.P.-G.); (M.F.-G.); (H.M.-N.); (N.S.)
| | - Isabel de la Montaña Santos-Carrasco
- Department of Psychiatry and Mental Health, Hospital Clínico San Carlos, Madrid, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (I.d.l.M.S.-C.); (B.B.); (M.D.-M.)
| | - Bianca Borszewski
- Department of Psychiatry and Mental Health, Hospital Clínico San Carlos, Madrid, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (I.d.l.M.S.-C.); (B.B.); (M.D.-M.)
| | - Marina Díaz-Marsá
- Department of Psychiatry and Mental Health, Hospital Clínico San Carlos, Madrid, Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain; (I.d.l.M.S.-C.); (B.B.); (M.D.-M.)
| | - Isabel Sánchez-Díaz
- Department of Psychiatry and Mental Health, Hospital Universitario de Bellvitge- IDIBELL and CIBEROBN, Barcelona; Carrer Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Spain; (I.S.-D.); (F.F.-A.)
| | - Fernando Fernández-Aranda
- Department of Psychiatry and Mental Health, Hospital Universitario de Bellvitge- IDIBELL and CIBEROBN, Barcelona; Carrer Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Spain; (I.S.-D.); (F.F.-A.)
| | - José Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Passeig de la Vall d’Hebron 171, 08035 Barcelona, Spain; (B.P.-G.); (M.F.-G.); (H.M.-N.); (N.S.)
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10
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Disgust and fear: common emotions between eating and phobic disorders. Eat Weight Disord 2020; 25:79-86. [PMID: 29766462 DOI: 10.1007/s40519-018-0512-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/01/2018] [Indexed: 10/16/2022] Open
Abstract
Eating disorders (ED) are prevalent mental illnesses composed mainly of anorexia nervosa, bulimia nervosa and binge eating disorders. Anxiety disorders are another set of mental illnesses, with phobic disorder (PD) being the most prevalent disorder. ED and PD are highly comorbid. The aim of this study is to assess, in 131 individuals attending an outpatient clinic for different health issues, the level of fear related to situations generating avoidance such as in social anxiety and specific phobias according to the fear questionnaire (FQ), the level of disgust according to the disgust scale (DS-R) and the vulnerability towards ED according to the SCOFF scale to demonstrate that high levels of both fear and disgust increase the vulnerability towards ED. The study demonstrated that the level of disgust increased when fear increases (r = 0.377, p < 0.001 for the first part of the FQ; r = 0.225, p = 0.01 for the second part of the FQ). Moreover, individuals with vulnerability towards having an ED presented a higher level of disgust than individuals without this vulnerability (p = 0.009). Furthermore, individuals with vulnerability towards ED have a higher level of anxiety related to PD subtypes (p = 0.008 for agoraphobia; p = 0.001 for injection/blood phobia) as well as to social anxiety (p = 0.01), independently from having a depressive or another anxiety disorder. In the multivariate analysis, a history of psychiatric consultation has been the only significantly different parameter between individuals with or without vulnerability towards ED (p = 0.0439). Accordingly, fear and disgust are negative emotions that seem to be clinically associated which better explains the comorbidity of ED with PD. LEVEL OF EVIDENCE: Level III. Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
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11
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Korn J, Vocks S, Rollins LH, Thomas JJ, Hartmann AS. Fat-Phobic and Non-Fat-Phobic Anorexia Nervosa: A Conjoint Analysis on the Importance of Shape and Weight. Front Psychol 2020; 11:90. [PMID: 32082227 PMCID: PMC7005216 DOI: 10.3389/fpsyg.2020.00090] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022] Open
Abstract
With the introduction of new diagnostic criteria in DSM-5, fear of weight gain no longer represents a sine qua non-criterion for the diagnosis of anorexia nervosa (AN). This is of relevance as a subgroup of individuals with AN denies fear of weight gain as the reason for restrictive eating but still remain at a very low weight. As self-reports are susceptible to bias, other methods are needed to confirm the existence of the subtype in order to provide adapted treatment. Therefore, we aimed to measure fear of weight gain using a novel method in clinical psychology, the conjoint analysis (CA). Relative importance and preference scores for various life aspects, including appearance/shape and weight were assessed in women with fat-phobic AN (FP-AN, n = 30), NFP-AN (n = 7), and healthy controls (n = 29). Individuals with FP-AN showed a significant lower preference for weight gain versus weight maintenance than HC (p = 0.011, ηp2 = 0.107). Correlation between explicitly assessed drive for thinness and CA score was low. As expected, in FP-AN the explicitly endorsed fear of weight gain was confirmed by the marked preference for weight maintenance compared to HC, while for NFP-AN explicit and implicit measures diverged, indicating that against their self-report they may experience at least some fear of weight gain. The utility of CA as a tool to measure fear of weight gain — and potentially other psychopathological constructs —requires further confirmation.
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Affiliation(s)
- Julia Korn
- Department of Psychiatry and Psychology, Universität zu Lübeck, Lübeck, Germany
| | - Silja Vocks
- Department of Psychology, University of Osnabrück, Osnabrück, Germany
| | - Lisa H Rollins
- Department of Psychology, University of Osnabrück, Osnabrück, Germany
| | - Jennifer J Thomas
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Andrea S Hartmann
- Department of Psychology, University of Osnabrück, Osnabrück, Germany
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12
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Cognitive Behavioral Therapy Management of a Patient with Atypical Anorexia Nervosa. Case Rep Psychiatry 2019; 2019:4736419. [PMID: 31687246 PMCID: PMC6811801 DOI: 10.1155/2019/4736419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 11/17/2022] Open
Abstract
Eating disorders are becoming more common in nonwestern societies and some of these presentations are atypical variants such as atypical anorexia nervosa. There is very little data on how to treat these patients. This case study reports the treatment of a young adult female in Sri Lanka who presented with atypical anorexia nervosa and moderate depressive disorder. She was successfully treated with nine sessions of enhanced cognitive-behavioural therapy (CBT-E). According to our knowledge this is the first case report that describes the management of a patient with atypical anorexia nervosa using psychological therapy specifically adapted to nonwestern context.
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13
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Calugi S, El Ghoch M, Conti M, Dalle Grave R. Preoccupation with shape or weight, fear of weight gain, feeling fat and treatment outcomes in patients with anorexia nervosa: A longitudinal study. Behav Res Ther 2018; 105:63-68. [PMID: 29689516 DOI: 10.1016/j.brat.2018.04.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study aimed to evaluate the trajectories of change over time in body-image concern components in patients with anorexia nervosa treated by means of intensive enhanced cognitive behavioural therapy. Moreover, it aimed to study the role of body-image concern components in changes in eating and general psychopathology as well as work and social functioning. METHOD Sixty-six adult patients with anorexia nervosa were recruited. Body mass index (BMI); Eating Disorder Examination 'Dietary Restraint' and 'Eating Concern' subscales; Brief Symptom Inventory (BSI); and Work and Social Adjustment Scale (WSAS) scores were recorded at admission, end of treatment, and at 6- and 12-month follow-ups. The trajectories of change of three components of body image concern, namely 'preoccupation with shape or weight', 'fear of weight gain' and 'feeling fat', were assessed. RESULTS The treatment was associated with a significant improvement in outcome variables and body-image concern components. Baseline 'preoccupation with shape or weight' predicted improvement in Eating Concern, BSI and WSAS scores, while the change in 'fear of weight gain' was associated with improvement in dietary restraint. Baseline and end-of-therapy scores for all three measured body-image concern components predicted achievement of BMI ≥18.5 kg/m2 at 6- and 12-month follow-ups. DISCUSSION These findings highlight the importance of assessing and addressing body-image concern in the management of patients with anorexia nervosa.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy.
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Maddalena Conti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
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14
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Schaumberg K, Welch E, Breithaupt L, Hübel C, Baker JH, Munn-Chernoff MA, Yilmaz Z, Ehrlich S, Mustelin L, Ghaderi A, Hardaway AJ, Bulik-Sullivan EC, Hedman AM, Jangmo A, Nilsson IAK, Wiklund C, Yao S, Seidel M, Bulik CM. The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2017; 25:432-450. [PMID: 28967161 PMCID: PMC5711426 DOI: 10.1002/erv.2553] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In 2015, the Academy for Eating Disorders collaborated with international patient, advocacy, and parent organizations to craft the 'Nine Truths About Eating Disorders'. This document has been translated into over 30 languages and has been distributed globally to replace outdated and erroneous stereotypes about eating disorders with factual information. In this paper, we review the state of the science supporting the 'Nine Truths'. METHODS The literature supporting each of the 'Nine Truths' was reviewed, summarized and richly annotated. RESULTS Most of the 'Nine Truths' arise from well-established foundations in the scientific literature. Additional evidence is required to further substantiate some of the assertions in the document. Future investigations are needed in all areas to deepen our understanding of eating disorders, their causes and their treatments. CONCLUSIONS The 'Nine Truths About Eating Disorders' is a guiding document to accelerate global dissemination of accurate and evidence-informed information about eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Katherine Schaumberg
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elisabeth Welch
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lauren Breithaupt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Christopher Hübel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jessica H Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Zeynep Yilmaz
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Linda Mustelin
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Public Health and Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Andrew J Hardaway
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emily C Bulik-Sullivan
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna M Hedman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Jangmo
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ida A K Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden
| | - Camilla Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Seidel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Murray HB, Coniglio K, Hartmann AS, Becker AE, Eddy KT, Thomas JJ. Are eating disorders "all about control?" The elusive psychopathology of nonfat phobic presentations. Int J Eat Disord 2017; 50:1306-1312. [PMID: 28963796 DOI: 10.1002/eat.22779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There are a subset of individuals with eating disorders (EDs) who do not overevaluate body shape/weight (i.e., nonfat phobic ED; NFP-ED). According to the transdiagnostic cognitive-behavioral conceptualization of EDs, a need for control, in general, is hypothesized as the core psychopathology of NFP-EDs, with shape- and weight-related motivations for ED behavior merely superimposed in FP-ED presentations. This study tested the need for control as motivation for restriction in NFP-ED, using items aimed at assessing control from the Eating Disorder Examination (EDE) Restraint scale. METHOD Females ages 13-27 years consecutively admitted to residential treatment completed the EDE, Eating Disorder Inventory-3 Drive for Thinness subscale (EDI-DFT), and other self-report measures of psychopathology. We included patients with DSM-5 EDs, but excluded patients with avoidant/restrictive food intake disorder. Twenty participants had NFP-ED (≤14 on EDI-DFT) and 124 had fatphobic ED (FP-ED; >14 on EDI-DFT). RESULTS NFP-ED scored significantly lower than FP-ED on EDE Restraint scale shape/weight [χ2 (1) = 10.73-35.62, p's < .01] and on control items [χ2 (1) = 10.72-20.62, p's < .01], in addition to scoring lower on measures of general psychopathology and impairment. DISCUSSION Findings suggest those with NFP-ED report lower psychopathology overall and the new EDE Restraint scale control items do not capture additional motivation for restriction beyond that captured in the original Restraint scale shape/weight items. Future research should examine whether this latter finding is due to a minimizing response style in NFP-ED, an incomplete capture of desire for control by the EDE assessment method, or indeed reflects that need for control does not motivate restriction in NFP-EDs.
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Affiliation(s)
- Helen B Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Psychology, Drexel University, 3141 Chestnut Street, Stratton Hall 119, Philadelphia, Pennsylvania, 19104
| | - Kathryn Coniglio
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Andrea S Hartmann
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, 02115.,Osnabrück University, Knollstr. 15, Osnabrück, 49076, Germany
| | - Anne E Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, 02115.,Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts, 02115
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, 02115
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts, 02115
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16
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Mitsui T, Yoshida T, Komaki G. Psychometric properties of the eating disorder examination-questionnaire in Japanese adolescents. Biopsychosoc Med 2017; 11:9. [PMID: 28392830 PMCID: PMC5379552 DOI: 10.1186/s13030-017-0094-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/12/2017] [Indexed: 12/23/2022] Open
Abstract
Background Although the Eating Disorder Examination Questionnaire version 6.0 (EDE-Q) is one of the most widely used questionnaires for eating disorders in Western countries, no research has addressed the psychometric properties of the EDE-Q in a Japanese sample. Methods We explored the factor structure of the EDE-Q and examined the internal consistency of the derived scales for Japanese participants (Study I), the convergent validity with other eating disorder-related psychological measures (Study II) and the distinction between the derived two body image-related factors with psychological measures (StudyIII). The EDE-Q was administered to 1,430 undergraduate students in Study I and in Study II was subsequently assessed by two self-report measures of eating pathology, the Eating Attitudes Test (EAT-26) for 558 undergraduate students and the Eating Disorders Inventory-II (EDI-II) 111. In StudyIII, another 225 undergraduate students participated in an examination of the relationships of the derived body image-related subscales of the EDE-Q with the psychological measures of the Rosenberg Self-Esteem Scale, Beck Depression Inventory, Public Self-Consciousness Scale, and Multidimensional Perfectionism Scale. Results Exploratory factor analysis of the EDE-Q identified four meaningful factors. Of the original four EDE-Q factors, “Restriction” and “Eating Concern” were retained. However, the other two factors, “Shape” and “Weight” Concerns, were combined into two different factors: “Fear of Obesity” and “Self-Esteem Based on Shape and Weight”. Internal consistency of the derived four factors was adequate, and the relationships with EDI-II and EAT-26 measures demonstrated convergent validity. Analysis of the distinction between “Fear of Obesity” and “Self-Esteem Based on Shape and Weight” revealed that only “Self-Esteem Based on Shape and Weight” was significantly associated with the measures assessing psychopathology related to eating disorders. Conclusions This study describes restructured factors of the EDE-Q that were tested with undergraduate students. The distinction between two factors, “Fear of Obesity” and “Self-Esteem Based on Shape and Weight”, may further the understanding of the psychopathology of the eating disorders of adolescent Japanese subjects to facilitate future developments in research and treatment.
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Affiliation(s)
- Tomoyo Mitsui
- Department of Psychology, Faculty of Human Development and Education, Kobe Shinwa Women's University, 7-13-1 Suzurandai-Kitamachi, Kita-ku, Kobe, Hyogo Japan
| | - Toshiyuki Yoshida
- School of Health Sciences, Fukuoka, International University of Health &Welfare, 137-1 Enokizu, Ohkawa, Fukuoka Japan
| | - Gen Komaki
- School of Health Sciences, Fukuoka, International University of Health &Welfare, 137-1 Enokizu, Ohkawa, Fukuoka Japan
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17
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Tabri N, Murray HB, Thomas JJ, Franko DL, Herzog DB, Eddy KT. Overvaluation of body shape/weight and engagement in non-compensatory weight-control behaviors in eating disorders: is there a reciprocal relationship? Psychol Med 2015; 45:2951-2958. [PMID: 25994276 DOI: 10.1017/s0033291715000896] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Overvaluation of body shape/weight is thought to be the core psychopathology underlying eating disorders, which propels engagement in non-compensatory weight-control behaviors. In turn, these behaviors lead to binge eating and/or maintenance of low weight thereby reinforcing overvaluation. The present study investigated the reciprocal relationship between overvaluation and engagement in non-compensatory weight-control behaviors (defined in two ways: restrictive eating and compulsive exercise) among women diagnosed with anorexia nervosa or bulimia nervosa (N = 237). METHOD Participants completed clinical interviews in which weekly eating disorder symptoms and behaviors were assessed over 2 years. RESULTS Overvaluation on a given week was associated with greater engagement in non-compensatory weight-control behaviors during the following week. Further, engagement in non-compensatory weight-control behaviors on a given week was associated with greater overvaluation during the following week. These findings held true regardless of participants' shape/weight concerns (feelings of fatness and fat phobia), and eating disorder diagnosis. CONCLUSIONS Our data provide empirical support for key aspects of the transdiagnostic cognitive-behavioral model of eating disorders and suggest that targeting non-compensatory weight-control behaviors in treatment may help alleviate overvaluation and shape/weight concerns.
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Affiliation(s)
- N Tabri
- Department of Psychiatry,Massachusetts General Hospital Eating Disorders Clinical and Research Program,Boston,MA,USA
| | - H B Murray
- Department of Psychiatry,Massachusetts General Hospital Eating Disorders Clinical and Research Program,Boston,MA,USA
| | - J J Thomas
- Department of Psychiatry,Massachusetts General Hospital Eating Disorders Clinical and Research Program,Boston,MA,USA
| | - D L Franko
- Department of Psychiatry,Massachusetts General Hospital Eating Disorders Clinical and Research Program,Boston,MA,USA
| | - D B Herzog
- Department of Psychiatry,Harvard Medical School,Boston,MA,USA
| | - K T Eddy
- Department of Psychiatry,Massachusetts General Hospital Eating Disorders Clinical and Research Program,Boston,MA,USA
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18
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Wildes JE, Forbush KT, Markon KE. Characteristics and stability of empirically derived anorexia nervosa subtypes: towards the identification of homogeneous low-weight eating disorder phenotypes. JOURNAL OF ABNORMAL PSYCHOLOGY 2014; 122:1031-41. [PMID: 24364605 DOI: 10.1037/a0034676] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Anorexia nervosa (AN) is characterized by within-group heterogeneity in symptom presentation, which poses problems for research on etiology and treatment. This study sought to identify homogeneous subtypes of AN, and examine their short-term stability, using empirical methods. A treatment-seeking sample with AN (n = 194) was assessed at baseline and 6- and 12-month follow-ups. Latent class analysis was used to identify homogeneous AN subgroups, and latent transition analysis was used to examine the stability of latent classes. Three low-weight eating disorder classes were identified: 1) fat-phobic restricting (AN-R-FP); 2) fat-phobic binge-eating/purging (AN-BP-FP); and 3) non-fat-phobic restricting (AN-R-NFP). Subtype membership was stable over follow-up, with .68 to .88 probabilities of remaining in the same class from baseline to 6 months, and .87 to 1.00 from 6 months to 12 months. The most common transition pattern was between AN-R-FP and AN-R-NFP (56.8% of transitions); the majority of these participants transitioned from AN-R-FP to AN-R-NFP (n = 20/21). Predictors of latent class membership included lifetime mood and substance use disorder comorbidities, negative temperament, illness duration, and body mass index at treatment presentation. Disinhibition (vs. constraint), history of overweight or obesity, and illness duration decreased the probability of latent transition. Findings support the presence of 3 low-weight eating disorder phenotypes that are highly stable over short-term follow-up. Identification of a stable non-fat-phobic AN phenotype is intriguing and highlights the importance of studying mechanisms that differentiate fat-phobic and non-fat-phobic eating disorders.
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Affiliation(s)
- Jennifer E Wildes
- Department of Psychiatry, University of Pittsburgh School of Medicine
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19
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Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal "orthorexia nervosa" and proposed diagnostic criteria. PSYCHOSOMATICS 2014; 56:397-403. [PMID: 25016349 DOI: 10.1016/j.psym.2014.03.003] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/12/2014] [Accepted: 03/13/2014] [Indexed: 12/12/2022]
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20
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Nakai Y, Nin K, Teramukai S, Taniguchi A, Fukushima M, Wonderlich SA. Typical and atypical anorexia nervosa in a Japanese sample. Int J Eat Disord 2014; 47:130-7. [PMID: 24488836 DOI: 10.1002/eat.22208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/11/2013] [Accepted: 09/19/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We examined the existence of nonfat-phobic anorexia nervosa (NFP-AN) and fat-phobic AN, with no evidence of distortions related to body shape and weight (AN-NED), in a Japanese sample and studied eating disorder pathology and psychopathology in NFP-AN and AN-NED. METHOD The study participants were 200 (52.2%) women with typical AN, 86 (22.5%) women with NFP-AN, and 97 (25.3%) women with AN-NED. Diagnosis of the three types of AN was made by structured clinical interviews. The Eating Attitudes Test (EAT) and the Eating Disorder Inventory (EDI) were administered to all the participants. RESULTS There were significant differences among the three groups in terms of duration of illness, maximum and minimum BMIs and AN subtypes. There was no transition from the NFP-AN and AN-NED groups to the typical AN group during the 2- to 7-year follow-up period. There were significant differences among the three groups in scores of the EAT, the EDI total, and all the subscales of the EDI. DISCUSSION Besides typical AN, there were two types of atypical AN in terms of fat phobia and body image disturbance in this Japanese sample. The findings of the current study suggest that there may be significant differences among the three groups in terms of eating disorder pathology and psychopathology.
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21
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Lee S, Ng KL, Kwok KPS, Thomas JJ, Becker AE. Gastrointestinal dysfunction in Chinese patients with fat-phobic and nonfat-phobic anorexia nervosa. Transcult Psychiatry 2012; 49:678-95. [PMID: 23002113 DOI: 10.1177/1363461512459487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although gastrointestinal and other somatic symptoms are common in patients with anorexia nervosa (AN), and a growing cross-national literature indicates that not all anorexic patients exhibit the core diagnostic symptom of fat phobia, the relationship between somatic symptoms and anorexic illness remains unclear. Our objective was to evaluate gastrointestinal dysfunction (GD) in Chinese patients with fat phobic (FP) and nonfat phobic (NFP) anorexia nervosa. A total of 113 FP- and 28 NFP-AN outpatients underwent standardized clinical assessment and completed a new 8-item GD scale and other psychopathological measures. A majority (79.4%) of AN patients reported at least some gastrointestinal complaints on the GD scale (Cronbach's alpha = 0.78). FP-AN patients scored significantly higher than NFP-AN patients. The FP-AN with high GD group reported a higher level of specific and general psychopathology than the FP- and NFP-AN with low GD groups. Contrary to expectations, gastrointestinal symptoms were more common in FP-AN than NFP-AN patients. FP-AN with high GD was more severe than FP- and NFP-AN with low GD. The current fat phobic conceptualization of the anorexic illness may overlook its phenomenologic heterogeneity and reify a dichotomy that is inconsistent with patients' varied experience of food restriction.
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Affiliation(s)
- Sing Lee
- Hong Kong Eating Disorders Center, 7A, Block E, Staff Quarters, Prince of Wales Hospital,Shatin, N.T., Hong Kong.
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22
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Nakai Y, Fukushima M, Taniguchi A, Nin K, Teramukai S. Comparison of DSM-IV Versus Proposed DSM-5 Diagnostic Criteria for Eating Disorders in a Japanese Sample. EUROPEAN EATING DISORDERS REVIEW 2012; 21:8-14. [DOI: 10.1002/erv.2203] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Mitsuo Fukushima
- Division of Clinical Nutrition and Internal Medicine; Okayama Prefectural University; Okayama; Japan
| | | | - Kazuko Nin
- School of Health Sciences, Faculty of Medicine; Kyoto University; Japan
| | - Satoshi Teramukai
- Department of Clinical Trial Design and Management Translational Research Center; Kyoto University Hospital; Kyoto; Japan
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