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Abstract
SummaryAttitudes to sex and the perceived role of sexual activity are very strongly influenced by cultural values. Culturally determined gender roles influence relationships between different-sex partners, and cultural values affect attitudes towards sexual variation. Cultures define what is deviant and from where help is sought. Through differing patterns of child-rearing, cultures also affect individuals' cognitive development, world views and explanatory models of emotional distress. It is critical that clinicians are aware of the role of culture in defining sexual dysfunction and how cultural factors can be used in initiating treatment as well as in therapeutic engagement and alliance. Although epidemiological data on prevalence of sexual dysfunction across cultures are scanty, it is likely that prevalences vary, as will pathways into care and patterns of help-seeking. In this article we discuss the potential impact of culture on sexual dysfunction, and issues that clinicians, whether in specialist or in general services, need to be aware of in assessing and treating patients who present with sexual dysfunction.
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Schwarte R, Timmesfeld N, Dempfle A, Krei M, Egberts K, Jaite C, Fleischhaker C, Wewetzer C, Herpertz-Dahlmann B, Seitz J, Bühren K. Expressed Emotions and Depressive Symptoms in Caregivers of Adolescents with First-Onset Anorexia Nervosa-A Long-Term Investigation over 2.5 Years. EUROPEAN EATING DISORDERS REVIEW 2017; 25:44-51. [PMID: 27943533 DOI: 10.1002/erv.2490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/03/2016] [Accepted: 08/01/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE High levels of expressed emotions (EE) and depressive symptoms (DS) are often found in caregivers of patients with anorexia nervosa (AN). Both parameters are considered to influence AN symptoms of the patient. METHODS One hundred seventy adolescent women with AN and their caregivers were assessed at admission, discharge, at 1-year and 2.5-year follow up to evaluate AN symptoms of the patient and EE and DS of caregivers. RESULTS The EE and DS were elevated at admission and decreased during treatment, criticism (as part of EE) exhibited again at the 2.5-year follow up. Caregivers of more severely ill patients reported significantly greater levels of EE and DS. Mothers were more affected than fathers. EE and DS were interrelated. CONCLUSION Caregivers of adolescent AN patients suffer from elevated levels of EE and DS. Further studies are needed to examine whether therapeutic interventions to reduce caregivers' EE and DS might have a positive influence on treatment outcome. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Reinhild Schwarte
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Nina Timmesfeld
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
| | - Astrid Dempfle
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany.,Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Melanie Krei
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Karin Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité University Berlin, Berlin, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Clinics Freiburg, Freiburg, Germany
| | - Christoph Wewetzer
- Department of Child and Adolescent Psychiatry and Psychotherapy, Köln-Holweide, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
| | - Katharina Bühren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany
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Anastasiadou D, Sepulveda AR, Sánchez JC, Parks M, Álvarez T, Graell M. Family Functioning and Quality of Life among Families in Eating Disorders: A Comparison with Substance-related Disorders and Healthy Controls. EUROPEAN EATING DISORDERS REVIEW 2016; 24:294-303. [DOI: 10.1002/erv.2440] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 01/12/2016] [Accepted: 01/18/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Dimitra Anastasiadou
- Department of Biological and Health Psychology, Faculty of Psychology; Autonomous University of Madrid; Madrid Spain
| | - Ana R. Sepulveda
- Department of Biological and Health Psychology, Faculty of Psychology; Autonomous University of Madrid; Madrid Spain
| | | | - Melissa Parks
- Department of Biological and Health Psychology, Faculty of Psychology; Autonomous University of Madrid; Madrid Spain
| | - Tamara Álvarez
- Department of Biological and Health Psychology, Faculty of Psychology; Autonomous University of Madrid; Madrid Spain
| | - Montserrat Graell
- Eating Disorders Program, Child and Adolescence Psychiatry Department; Niño Jesus University Hospital, CIBERSAM; Madrid Spain
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Abstract
Best-practice guidelines for the treatment of child and adolescent eating disorders recommend the inclusion of parents. Family-based treatment (FBT) posits that families are not only important in supporting their children but are critical change agents in the recovery process. As originally developed for anorexia nervosa, parents take a central role in managing and disrupting eating disorder symptoms. The most evidence-based treatment model for adolescent anorexia nervosa, FBT has also recently been found to be useful in the treatment of adolescent bulimia nervosa. This article provides a summary of the theoretic model, evidence base, and application of FBT.
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Affiliation(s)
- Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
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Treasure J, Stein D, Maguire S. Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Interv Psychiatry 2015; 9:173-84. [PMID: 25263388 DOI: 10.1111/eip.12170] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 06/22/2014] [Indexed: 12/13/2022]
Abstract
AIM To examine the evidence to support using a staging heuristic for eating disorders, suggesting that the diagnosis of an eating disorder follows a trajectory across the life course. Specifically, to examine whether high-risk markers and prodromal features presenting in childhood and adolescence can later transition to the full manifestation of the illness in early adulthood, and whether over time, the illness can be described as becoming severe and enduring, often resistant to treatment. METHODS We conducted a comprehensive literature search on the MEDLINE, PubMed, PsycINFO, EMBASE and Cochrane databases from using the following terms: staging, duration of illness, early intervention, developmental epidemiology, neurobiological marker, phenotype, partial syndrome, severe enduring, chronic, prospective, longitudinal, cohort, epidemiology, adolescent, adult with anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder. The evidence was organized according to the staging heuristic defined by McGorry. RESULTS Evidence from epidemiological studies, neuropsychological findings, treatment responsivity and prognosis, support a specific staging trajectory for anorexia nervosa in that there is a longitudinal trajectory with evidence of neurobiological progression and evidence that interventions matched to stage of illness may optimize the benefit. There is less data at the moment to support such a model for bulimia nervosa and binge eating disorder. CONCLUSION The staging heuristic is a useful model for anorexia nervosa in terms of providing prognostic information and stage matched interventions. Although the evidence is encouraging, further research is needed before a similar model could be applied for bulimia nervosa and binge eating disorder.
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Affiliation(s)
- Janet Treasure
- PO59 Eating Disorder Unit, Kings College London, Institute of Psychiatry, London, UK
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Rienecke RD, Lebow J, Lock J, Le Grange D. Family Profiles of Expressed Emotion in Adolescent Patients With Anorexia Nervosa and Their Parents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 46:428-436. [PMID: 25945418 DOI: 10.1080/15374416.2015.1030755] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current study examined expressed emotion (EE) among families of adolescents with anorexia nervosa (AN) participating in a treatment study. EE ratings were made from 110 adolescents toward their parents and from parents toward their children using videotaped family interviews. Participants were 92% female and 75% Caucasian with a mean age of 14.41 years. Four family profiles were created (low patient EE/low parent EE, high patient EE/high parent EE, low patient EE/high parent EE, high patient EE/low parent EE). Family EE profile was not related to full remission at end of treatment. Groups were then combined according to EE level of parent. The low parent group (defined as low on criticism, hostility, and emotional overinvolvement) had significantly lower scores on a measure of eating disorder psychopathology than the high parent group at the end of treatment. Patients with AN in low EE families do better in treatment than those patients belonging to high EE families. These findings are true regardless of the EE status of the patient.
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Affiliation(s)
| | - Jocelyn Lebow
- b Department of Psychiatry & Behavioral Sciences , University of Miami.,c Department of Psychiatry and Psychology , Mayo Clinic
| | - James Lock
- d Department of Psychiatry & Behavioral Sciences , Stanford University
| | - Daniel Le Grange
- e Department of Psychiatry , University of California , San Francisco
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Forsberg S, Fitzpatrick KK, Darcy A, Aspen V, Accurso EC, Bryson SW, Agras S, Arnow KD, Grange DL, Lock J. Development and evaluation of a treatment fidelity instrument for family-based treatment of adolescent anorexia nervosa. Int J Eat Disord 2015; 48:91-9. [PMID: 25142619 PMCID: PMC4349507 DOI: 10.1002/eat.22337] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study provides data on the psychometric properties of a newly developed measure of treatment fidelity in Family-Based Treatment (FBT) for adolescent anorexia nervosa (AN). The Family Therapy Fidelity and Adherence Check (FBT-FACT) was created to evaluate therapist adherence and competency on the core interventions in FBT. METHOD Participants were 45 adolescents and their families sampled from three randomized clinical trials evaluating treatment for AN. Trained fidelity raters evaluated 19 therapists across 90 early session recordings using the FBT-FACT. They also rated an additional 15 session 1 recordings of an alternate form of family therapy-Systemic Family Therapy for the purpose of evaluating discriminant validity of the FBT-FACT. The process of development and the psychometric properties of the FBT-FACT are presented. RESULTS Overall fidelity ratings for each session demonstrated moderate to strong inter-rater agreement. Internal consistency of the measure was strong for sessions 1 and 2 and poor for session 3. Principal components analysis suggests sessions 1 and 2 are distinct interventions. DISCUSSION The FBT-FACT demonstrates good reliability and validity as a measure of treatment fidelity in the early phase of FBT.
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Affiliation(s)
- Sarah Forsberg
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Kathleen Kara Fitzpatrick
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Alison Darcy
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Vandana Aspen
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637
| | - Susan W. Bryson
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Stewart Agras
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Katherine D. Arnow
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637
| | - James Lock
- Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305
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Anastasiadou D, Medina-Pradas C, Sepulveda AR, Treasure J. A systematic review of family caregiving in eating disorders. Eat Behav 2014; 15:464-77. [PMID: 25064301 DOI: 10.1016/j.eatbeh.2014.06.001] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/09/2014] [Indexed: 12/12/2022]
Abstract
The objective of the study was to review systematically the available new evidence on family caregiving in eating disorders (ED), updating the study of Zabala, Macdonald, and Treasure (2009). Electronic databases were searched from October 2008 until May 2013. Selected studies included carers of people with ED and employed one or more measures of caregiving experience, accommodation and enabling behaviours, expressed emotion, and/or psychological distress. Twenty-nine studies were identified. Most of the studies examined these features in mothers of patients with anorexia. Only a few studies included a control group. The majority of studies found high levels of negative aspects of caregiving, accommodation and enabling behaviours, expressed emotion and psychological distress in carers of people with ED, although positive aspects and emotions were also reported. These features varied depending on some sociodemographic and clinical characteristics of carers and patients; moreover, interesting preliminary cultural and gender differences emerged. Progress has been made in research on family caregiving in ED and there is evidence that these factors can be associated with the outcome of ED. Theoretical, research and clinical implications of the findings are discussed.
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Affiliation(s)
- Dimitra Anastasiadou
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain.
| | - Cristina Medina-Pradas
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain.
| | - Ana R Sepulveda
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain.
| | - Janet Treasure
- FRCP, FRCPsych, Section of Eating Disorders, King's College of London, Institute of Psychiatry, London, UK.
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