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Hay P, Mohsin M, Liu L, Touyz S, Meyer C, Arcelus J, Madden S, Attia E, Pike KM, Conti J. Impact of LEAP and CBT-AN Therapy on Improving Outcomes in Women with Anorexia Nervosa. Behav Sci (Basel) 2023; 13:651. [PMID: 37622791 PMCID: PMC10451721 DOI: 10.3390/bs13080651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Anorexia nervosa (AN) is a mental health disorder that has serious physical, emotional and social consequences. Whilst cognitive behavioural therapy for AN (CBT-AN) has demonstrated efficacy, there remains a global need to improve AN treatment. Compulsive exercise activity therapy (LEAP) is an active therapy consisting of the addition to CBT-AN of eight specific sessions that focus on exercise and motivation for behavioural change. This paper presents a secondary analysis of 74 female participants in a randomised control trial of LEAP plus CBT-AN versus CBT-AN alone. The main aim of this study was to explore putative predictors and to estimate the magnitude of changes due to LEAP for specific outcome measures. Participants (LEAP: n = 36; CBT-AN: n = 38) were assessed at three successive surveys: baseline, end of therapy, and 6 months post-therapy. The overall effect sizes for changes between baseline to end of therapy and baseline to 6-month follow-up assessment showed large effect sizes (Cohen's d > = 0.80) for mental-health-related quality of life (MHRQoL), weight concern, dietary restraint, eating concern, AN stage change, and psychological distress (all p < 0.05). The results also indicated that several pre-treatment characteristics, including body mass index (BMI), level of eating disorder (ED) symptoms, and MHRQoL are important for identifying whether a treatment is likely to be effective. Future treatment programs should aim to optimise early improvements in BMI, ED symptoms, and MHRQoL.
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Affiliation(s)
- Phillipa Hay
- Mental Health Research Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 2170, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Mohammed Mohsin
- Mental Health Research Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 2170, Australia
- Faculty of Medicine & Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Liquan Liu
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW 2560, Australia
| | - Stephen Touyz
- Inside Out Institute, University of Sydney, Sydney, NSW 2006, Australia
| | - Caroline Meyer
- International Digital Laboratory, The University of Warwick, Coventry CV4 7AL, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK
- Psychoneurobiology of Eating and Addictive Behaviors Group, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, University of Barcelona, 08908 Barcelona, Spain
| | - Sloane Madden
- The Sydney Children’s Hospitals Network, Westmead, Sydney, NSW 2145, Australia
| | - Evelyn Attia
- The New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA
| | - Kathleen M. Pike
- World Health Organization Collaborating Centre for Capacity Building and Training in Global Mental Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia
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2
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Liang C, Lee PF, Yeh PC. Relationship between Regular Leisure-Time Physical Activity and Underweight and Overweight Status in Taiwanese Young Adults: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:284. [PMID: 36612603 PMCID: PMC9819382 DOI: 10.3390/ijerph20010284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was to determine the association between regular leisure-time physical activity (LTPA) and various body mass index (BMI) categories in Taiwanese young adults. A total of 10,802 young adults (18−44 years) were enrolled in a national telephone survey. The questionnaire data from this survey included socio-demographic characteristics, zip code of residence, LTPA behaviors, self-reported health status, and self-evaluated anthropometric measurements, which included height, body weight, and BMI. Regular and non-regular LTPA behaviors were defined as follows: (1) Regular LTPA: participants who reported breathing quickly and sweating when participating in 150−300 min per week of moderate-intensity LTPA or 75−150 min per week of vigorous-intensity LTPA. (2) Non-regular LTPA: the rest of the participants. The various BMI categories were defined as (1) underweight (BMI < 18.5 kg/m2), (2) normal weight (18.5 ≤ BMI < 24 kg/m2), (3) overweight (24 ≤ BMI < 27 kg/m2), and (4) obese (BMI ≥ 27 kg/m2). When compared with participants with non-regular LTPA, participants with regular LTPA exhibited lower risks of being overweight (odds ratio [OR], 0.837; 95% confidence interval [CI] 0.738−0.948) and underweight (OR, 0.732; 95% CI 0.611−0.876). However, there was no significant relationship between regular LTPA and obesity risk when using non-regular LTPA as the baseline after adjusting for potential confounders. The study results revealed that regular LTPA effectively reduced the risks of being underweight and overweight. However, for people with obesity, regular LTPA was unable to significantly decrease their obesity risk.
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Affiliation(s)
- Chyi Liang
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, Taipei City 106, Taiwan
| | - Po-Fu Lee
- Department of Leisure Industry and Health Promotion, National Ilan University, Yilan County 260, Taiwan
- College of Humanities and Management, National Ilan University, Yilan County 260, Taiwan
- Exercise and Recreation Development Center, National Ilan University, Yilan County 260, Taiwan
| | - Ping-Chun Yeh
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Sports Medicine Center, Fu Jen Catholic University Hospital, New Taipei City 243, Taiwan
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3
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Thaler L, Booij L, Burnham N, Kenny S, Oliverio S, Israel M, Steiger H. Predictors of non-completion of a day treatment program for adults with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2021; 30:146-155. [PMID: 34971014 DOI: 10.1002/erv.2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/16/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
Abstract
Although treatment dropout is common among patients with eating disorders, very few studies have examined predictors of non-completion in day treatment. We investigated various potential predictors of dropout from adult day treatment. Participants were 295 adult patients with a diagnosis of Anorexia Nervosa (restricting or binge-eating/purging subtype), Bulimia Nervosa (BN), Other Specified Feeding or Eating Disorder, or Avoidant Restrictive Food Intake Disorder. Predictors included eating-disorder characteristics, motivation at the commencement of treatment, Body Mass Index (BMI), time spent in treatment and personality dimensions. Logistic regression analyses showed that for patients with a BMI of less than 20 at the start of treatment, low BMI was a significant predictor of staff-initiated termination due to not meeting weight gain goals. Furthermore, completing less than 6 weeks of treatment was associated with staff-initiated termination. For the whole sample, those with higher changes in weight over the course of treatment were less likely to terminate prematurely. None of the other predictor variables yielded significant results. Results of the current study highlight characteristics of patients who are more likely not to complete day treatment and can help identify patients who may be at risk for not succeeding in multi-diagnostic day treatment programs.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Department of Psychology, Concordia University, Montreal, Quebec, Canada.,Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Nuala Burnham
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Samantha Kenny
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada
| | - Stephanie Oliverio
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
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4
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Krug I, Giles SE, Granero R, Agüera Z, Sánchez I, Sánchez-Gonzalez J, Jimenez-Murcia S, Fernandez-Aranda F. Where does purging disorder lie on the symptomatologic and personality continuum when compared to other eating disorder subtypes? Implications for the DSM. EUROPEAN EATING DISORDERS REVIEW 2021; 30:36-49. [PMID: 34825434 DOI: 10.1002/erv.2872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess the clinical significance and distinctiveness of purging disorder (PD) from other eating disorder (ED) diagnoses. METHOD Participants included 3127 women consecutively admitted to an ED treatment centre (246 PD, 465 anorexia nervosa restrictive [AN-R], 327 AN-binge purging [AN-BP], 1436 bulimia nervosa [BN], 360 binge eating disorder [BED], 177 atypical AN and 116 unspecified feeding or eating disorder [UFED]) who were diagnosed according to DSM-5 criteria. Additionally, 822 control participants were recruited from the community. All participants completed measures assessing ED symptoms (EDI-2), general psychopathology (SCL-90-R) and personality (TCI-R). RESULTS Patients with PD, when compared to controls, scored significantly higher on the EDI-2 and SCL-90-R, and most TCI-R dimensions. Most of the significant differences between PD and the other ED diagnoses emerged between PD and AN-R, followed by Atypical-AN, UFED, AN-BP and BED, with patients with PD typically reporting higher scores on the EDI-2 and SCL-90-R subscales. Significant differences between PD and BN were also present, but to a lesser extent. The findings for personality varied amongst the different ED diagnoses. CONCLUSIONS PD is a clinically significant disorder, which seems to be more similar to BN than it is to AN and the other ED subtypes.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Elizabeth Giles
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Zaida Agüera
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
| | | | - Susana Jimenez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fernando Fernandez-Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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5
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Vall E, Wade TD. Predictors and moderators of outcomes and readmission for adolescent inpatients with anorexia nervosa: A pilot study. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12091] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Eva Vall
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
| | - Tracey D. Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
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Li N, Mitchison D, Touyz S, Hay P. Cross-sectional comparison of health-related quality of life and other features in people with and without objective and subjective binge eating using a general population sample. BMJ Open 2019; 9:e024227. [PMID: 30787086 PMCID: PMC6398903 DOI: 10.1136/bmjopen-2018-024227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Evidence suggests that while objective binge eating (OBE) and subjective binge eating (SBE) differ in the amount of food consumed, both are associated with impairment in people with eating disorders. However, only OBE is accounted for in the diagnostic criteria of eating disorders. This study compared the sociodemographic profile and burden of OBE versus SBE at a population level. DESIGN Population-based survey. PARTICIPANTS A representative sample of 3028 men and women. Participants were categorised into four groups based on their reporting of binge eating in the past 3 months: non-binge eating group (no OBE or SBE), OBE group, SBE group and OSBE group (both OBE and SBE). OUTCOME MEASURES Demographics (age, genderand body mass index, BMI), binge eating, distress, weight/shape overvaluation and health-related quality of life. Groups were compared on sociodemographic information, overvaluation and health-related quality of life. The OBE and SBE groups were also compared on the distress related to binge eating. RESULTS No differences were found between the SBE group and OBE group in age, gender, BMI, mental health-related quality of life and overvaluation (all p>0.05). However, differences were found in the OSBE participants, namely that they were younger, had a higher mean BMI, lower mental health-related quality of life and higher overvaluation of weight/shape than the non-binge-eating participants (all p<0.001). Proportions of participants who reported distress related to binge eating in the OBE and SBE groups also did not differ (p=0.678). CONCLUSION There is little difference in the demographic profile or burden of people who engage in OBE versus SBE, supporting the proposed inclusion of SBE in the diagnostic criteria for eating disorders in International Classification of Diseases-11. People who experience both OBE and SBE may experience a relatively higher eating disorder severity and impairment.
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Affiliation(s)
- Natalie Li
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Deborah Mitchison
- Psychology Department, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Touyz
- Clinical Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institure, School of Medicine, Western Sydney, Penrith, New South Wales, Australia
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7
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Nyman-Carlsson E, Birgegård A, Engström I, Gustafsson SA, Nevonen L. Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial. EUROPEAN EATING DISORDERS REVIEW 2018; 27:76-85. [PMID: 30094893 DOI: 10.1002/erv.2630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/17/2018] [Accepted: 07/04/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The prognosis in cases of anorexia nervosa (AN) is unsatisfactory, and it is therefore important to examine pretreatment predictors of outcome. METHODS Female AN patients (N = 74) included in a randomised controlled trial receiving individual cognitive behavioural therapy (CBT) or family-based treatment (FBT) were included. Predictors of the outcome were explored using pretreatment eating disorder psychopathology. RESULTS In the CBT group, lower levels of emotional dysregulation and greater deficits in identifying and coping with inner states were predictors of weight increase, explaining 37.7% of the variance. In the FBT group, lower interoceptive deficits predicted an increase in weight (explaining 17.7% of the variance), whereas bulimic behaviour (32.4%) and problems with emotional regulation (23.3%) were predictors of increased diagnostic symptoms. CONCLUSIONS Bulimic symptoms and the ability to identify and cope with emotional states appear to be important aspects that should be addressed in the treatment of young adult patients with AN.
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Affiliation(s)
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Resource Centre for Eating Disorders, Karolinska Institute, Stockholm, Sweden
| | - Ingemar Engström
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,University Health Care Research Centre and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sanna Aila Gustafsson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Clinical Neuroscience, Resource Centre for Eating Disorders, Karolinska Institute, Stockholm, Sweden.,University Health Care Research Centre and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lauri Nevonen
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Praktikertjänst Psychiatry AB, Stockholm, Sweden
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8
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Goldschmidt AB. Are loss of control while eating and overeating valid constructs? A critical review of the literature. Obes Rev 2017; 18:412-449. [PMID: 28165655 PMCID: PMC5502406 DOI: 10.1111/obr.12491] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Binge eating is a marker of weight gain and obesity, and a hallmark feature of eating disorders. Yet its component constructs - overeating and loss of control (LOC) while eating - are poorly understood and difficult to measure. OBJECTIVE The objective of this study is to critically review the human literature concerning the validity of LOC and overeating across the age and weight spectrum. DATA SOURCES English-language articles addressing the face, convergent, discriminant and predictive validity of LOC and overeating were included. RESULTS Loss of control and overeating appear to have adequate face validity. Emerging evidence supports the convergent and predictive validity of the LOC construct, given its unique cross-sectional and prospective associations with numerous anthropometric, psychosocial and eating behaviour-related factors. Overeating may be best conceptualized as a marker of excess weight status. LIMITATIONS Binge eating constructs, particularly in the context of subjectively large episodes, are challenging to measure reliably. Few studies addressed overeating in the absence of LOC, thereby limiting conclusions about the validity of the overeating construct independent of LOC. Additional studies addressing the discriminant validity of both constructs are warranted. DISCUSSION Suggestions for future weight-related research and for appropriately defining binge eating in the eating disorders diagnostic scheme are presented.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
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9
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Linardon J, de la Piedad Garcia X, Brennan L. Predictors, Moderators, and Mediators of Treatment Outcome Following Manualised Cognitive-Behavioural Therapy for Eating Disorders: A Systematic Review. EUROPEAN EATING DISORDERS REVIEW 2016; 25:3-12. [DOI: 10.1002/erv.2492] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/11/2016] [Accepted: 10/15/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Jake Linardon
- School of Psychology; Australian Catholic University; Melbourne Victoria Australia
| | | | - Leah Brennan
- School of Psychology; Australian Catholic University; Melbourne Victoria Australia
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10
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Farstad SM, McGeown LM, von Ranson KM. Eating disorders and personality, 2004–2016: A systematic review and meta-analysis. Clin Psychol Rev 2016. [DOI: 10.1016/j.cpr.2016.04.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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11
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Palavras MA, Hay PJ, Lujic S, Claudino AM. Comparing symptomatic and functional outcomes over 5 years in two nonclinical cohorts characterized by binge eating with and without objectively large episodes. Int J Eat Disord 2015; 48:1158-65. [PMID: 26414868 DOI: 10.1002/eat.22466] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 08/27/2015] [Accepted: 08/30/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim was to compare symptomatic and functional outcomes over 5 years in women with regular subjective (SBEs), objective (OBEs), and no regular binge eating episodes. METHOD Data were derived from two cohorts of 330 women with high levels of eating disorders symptoms followed over 5 years. Three groups were formed: (a) regular SBEs but no regular OBEs (N = 68), (b) regular OBEs with or without regular SBEs (N = 154), and (c) with no regular binge eating episodes (N = 108). RESULTS At baseline, the groups did not differ significantly in restraint scores and quality of life. People in the OBE group scored higher than those in the SBE group in body mass index (BMI). Those who had no regular binge eating had lower global Eating Disorder Examination Questionnaire (EDE-Q) and weight and shape concern scores than those with regular SBEs, and lower eating concern scores than either binge eating groups. Across the follow-up, there were no significant effects of being in either binge eating or the nonbinge eating group on the rates of change in BMI, general psychological distress, quality of life, or EDE-Q scores with the exception that OBE group had a significantly different rate of change in eating concern and psychological distress compared to the group without regular binge eating. DISCUSSION Individuals that report regular SBEs without regular OBEs represent a group with similar mental hardship and outcomes to those with regular OBEs. The findings support inclusion of regular SBEs in criteria for eating disorder diagnostic categories characterized by recurrent binge eating.
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Affiliation(s)
- Marly A Palavras
- Eating Disorders Program (PROATA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Ministry of Education (CAPES) Foundation, São Paulo, Brazil.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Phillipa J Hay
- School of Medicine, Western Sydney University, Sydney, Australia.,Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia.,School of Medicine, James Cook University, Sydney, Australia
| | - Sanja Lujic
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia.,Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Angélica M Claudino
- Eating Disorders Program (PROATA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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12
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Amianto F, Ercole R, Abbate Daga G, Fassino S. Exploring Parental Bonding in BED and Non-BED Obesity Compared with Healthy Controls: Clinical, Personality and Psychopathology Correlates. EUROPEAN EATING DISORDERS REVIEW 2015; 24:187-96. [DOI: 10.1002/erv.2419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 09/25/2015] [Accepted: 10/26/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Federico Amianto
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
| | - Roberta Ercole
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
| | - Giovanni Abbate Daga
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
| | - Secondo Fassino
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
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13
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Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. Int J Eat Disord 2015; 48:946-71. [PMID: 26171853 DOI: 10.1002/eat.22411] [Citation(s) in RCA: 309] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Understanding the factors that predict a favourable outcome following specialist treatment for an eating disorder may assist in improving treatment efficacy, and in developing novel interventions. This review and meta-analysis examined predictors of treatment outcome and drop-out. METHOD A literature search was conducted to identify research investigating predictors of outcome in individuals treated for an eating disorder. We organized predictors first by statistical type (simple, meditational, and moderational), and then by category. Average weighted mean effect sizes (r) were calculated for each category of predictor. RESULTS The most robust predictor of outcome at both end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment. Simple baseline predictors associated with better outcomes at both EoT and follow-up included higher BMI, fewer binge/purge behaviors, greater motivation to recover, lower depression, lower shape/weight concern, fewer comorbidities, better interpersonal functioning and fewer familial problems. Drop-out was predicted by more binge/purge behaviors and lower motivation to recover. For most predictors, there was large interstudy variability in effect sizes, and outcomes were operationalized in different ways. There were generally insufficient studies to allow analysis of predictors by eating disorder subtype or treatment type. DISCUSSION To ensure that this area continues to develop with robust and clinically relevant findings, future studies should adopt a consistent definition of outcome and continue to examine complex multivariate predictor models. Growth in this area will allow for stronger conclusions to be drawn about the prediction of outcome for specific diagnoses and treatment types.
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Affiliation(s)
- Eva Vall
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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14
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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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Dalle Grave R, Calugi S, El Ghoch M, Marzocchi R, Marchesini G. Personality Traits in Obesity Associated with Binge Eating and/or Night Eating. Curr Obes Rep 2014; 3:120-6. [PMID: 26626474 DOI: 10.1007/s13679-013-0076-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Specific personality traits, as assessed by the Temperament and Character Inventory (TCI), have been identified in individuals with obesity, but their association with binge and/or night eating has scarcely been reported. Indeed, our systematic search of Medline (1987 to 2013) yielded only five studies on the issue. Taken together, they suggest that personality traits do not have any significant role in determining body mass index, and therefore obesity class. However, obese individuals, in comparison with normal weight individuals, do seem to have a distinctive personality profile, characterized by low self-directedness and cooperativeness, and obese individuals with binge eating show lower self-directedness than those without. Moreover obese individuals with binge eating and/or night eating share a temperament profile characterized by high novelty-seeking and harm-avoidance, two traits also observed in other eating disorder categories and in clinical depression. Future longitudinal studies are needed to investigate the role of personality traits in the onset of binge eating and night eating in obese individuals, and to clarify their influence, if any, on treatment outcomes. Such information will enable us to determine whether the evaluation of personality traits should be included in the comprehensive assessment of obese individuals.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016, Garda, VR, Italy.
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016, Garda, VR, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016, Garda, VR, Italy
| | - Rebecca Marzocchi
- Unit of Metabolic Diseases & Clinical Dietetics, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Marchesini
- Unit of Metabolic Diseases & Clinical Dietetics, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Watson HJ, Fursland A, Bulik CM, Nathan P. Subjective binge eating with compensatory behaviors: a variant presentation of bulimia nervosa. Int J Eat Disord 2013; 46:119-26. [PMID: 22911884 DOI: 10.1002/eat.22052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine whether a variant bulimic-type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., "subjective bulimia nervosa," SBN), has comparable clinical severity to established eating disorders, particularly BN. METHOD Treatment-seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN-R) (N = 45), and AN-binge/purge type (AN-B/P) (N = 24) were compared. RESULTS Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN-R and AN-B/P. DISCUSSION Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment-seeking, and outcomes.
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Affiliation(s)
- Hunna J Watson
- Center for Clinical Interventions, Department of Health in Western Australia, Perth, Australia.
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