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Barr BL, McIntosh VVW, Britt EF, Jordan J, Carter JD. Clinical factors and early life experiences associated with therapeutic alliance development in treatment for depression or binge eating. Psychother Res 2024; 34:4-16. [PMID: 37079925 DOI: 10.1080/10503307.2023.2191800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 03/10/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE This study examines childhood and clinical factors theorized to impact therapeutic alliance development over the course of psychotherapy. METHOD Raters assessed the therapeutic alliance of 212 client-therapist dyads, participating in two randomized controlled trials of schema therapy and cognitive behavioural therapy for binge eating or major depression, at three time points. Linear mixed models were used to characterize therapeutic alliance development over time and assess the influence of childhood trauma, perceived parental bonding, diagnosis and therapy type on scores. RESULTS Participants differed in initial alliance ratings for all subscales but had similar growth trajectories in all but the patient hostility subscale. A diagnosis of bulimia nervosa or binge eating disorder predicted greater initial levels of client distress, client dependency and overall client contribution to a strong therapeutic alliance, compared with a diagnosis of depression. Therapy type, childhood trauma and perceived parental bonds did not predict alliance scores. CONCLUSION Findings highlight the potential influence of clinical and personal characteristics on alliance strength and development, with implications for maximizing treatment outcomes through anticipating and responding to these challenges.
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Affiliation(s)
- Brogan L Barr
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Virginia V W McIntosh
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Eileen F Britt
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Te Whatu Ora Health New Zealand - Waitaha, Canterbury, New Zealand
| | - Janet D Carter
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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2
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Srivastava P, Felonis C, Lin M, Clark K, Juarascio A. Weight status is associated with clinical characteristics among individuals with bulimia nervosa. Eat Disord 2023; 31:415-439. [PMID: 36419352 PMCID: PMC10050226 DOI: 10.1080/10640266.2022.2145258] [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] [Indexed: 11/25/2022]
Abstract
Recent studies have found increasing rates of overweight and obesity in bulimia nervosa (BN). However, the relationships between body mass index (BMI) and BN symptoms and other clinically relevant constructs are unknown. Participants (N = 152 adults with BN) were assigned to three groups by BMI: group with no overweight or obesity (NOW-BN; BMI <25; N = 32), group with overweight (OW-BN; BMI ≥25 and <30; N = 66), and group with obesity (O-BN; BMI ≥30; N = 54). We compared the groups on demographics, diet and weight histories, body esteem, BN symptoms, and depression using chi square, analysis of variance, analysis of covariance, and Poisson regression models. The O-BN group was older (d = 0.57) and OW-BN and O-BN groups had greater proportions of race/ethnic minorities than NOW-BN group. The O-BN group was significantly younger at first diet (d = 0.41) and demonstrated significantly higher cognitive dietary restraint (d = 0.31). Compared to NOW-BN, O-BN participants had lower incidence of objective binge eating (incidence rate ratio [IRR] = 4.86) and driven exercise (IRR = 7.13), and greater incidence of vomiting (IRR = 9.30), laxative misuse (IRR = 4.01), and diuretic misuse (d = 2.08). O-BN participants also experienced higher shape (d = 0.41) and weight (d = 0.42) concerns than NOW-BN and OW-BN, although NOW-BN experienced higher shape (d = 0.44) and weight (d = 0.39) concerns than OW-BN. Groups did not differ on depression scores. These results were replicated when examining BMI as a continuous predictor across the full sample, with the exception of objective binge eating and driven exercise, which were not significantly associated with BMI. Individuals with BN and comorbid obesity have distinct clinical characteristics. Existing interventions may need to be adapted to meet clinical needs of these individuals.
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Affiliation(s)
- Paakhi Srivastava
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3141 Chestnut St., Philadelphia, PA, 19104, USA
| | - Christina Felonis
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3141 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychology, Drexel University, 3141 Chestnut St., Philadelphia, PA, 19104, USA
| | - Mandy Lin
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3141 Chestnut St., Philadelphia, PA, 19104, USA
| | - Kelsey Clark
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3141 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychology, Drexel University, 3141 Chestnut St., Philadelphia, PA, 19104, USA
| | - Adrienne Juarascio
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, 3141 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychology, Drexel University, 3141 Chestnut St., Philadelphia, PA, 19104, USA
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3
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Söderqvist G, Naessén S. Androgens impact on psychopathological variables according to CPRS, and EDI 2 scores: In women with bulimia nervosa, and eating disorder not otherwise specified. J Steroid Biochem Mol Biol 2023; 226:106217. [PMID: 36368624 DOI: 10.1016/j.jsbmb.2022.106217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
Bulimia nervosa (BN) is characterized by binge eating, compensatory behavior, over-evaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. Depression is the most common comorbid diagnosis in women with eating disorders. The role of androgens in the pathophysiology of depression has been recognized in recent years. However, the research on psychopathological comorbidity and androgen levels in bulimic disease is sparse. This study aimed to investigate, if there were any correlations between the androgens, testosterone (T), dehydroepiandrosterone sulphate (DHEAS), androstenedione (A4), 5α-dihydrotestosterone, (5α-DHT), and test scores of psychopathological variables, in women with bulimia nervosa (BN), eating disorder not otherwise specified of purging subtype (EDNOS-P) assessed by CPRS, and EDI 2. Women with DSM-IV diagnosis of BN (n = 36), EDNOS-P (n = 27), and healthy control subjects (n = 58) evaluated for fifteen psychopathological variables, i.a. depressive symptoms, impulsivity, personal traits, as well as serum androgen levels. All women were euthyroid, and polycystic ovarian syndrome (PCOS) diagnosis was excluded. Although androgen levels were almost equal for all three groups, significant correlations between core psychopathological symptoms (9/15) of bulimia nervosa and the most potent endogenous androgen, 5α-DHT, was found only in the EDNOS-P group. The role of 5α-DHT in women is not fully elucidated. Both animal and human studies have shown that the brain is able to locally synthesize steroids de novo and is a target of steroid hormones. Maybe these results can be interpreted in the light of differences in androgen receptor variability, metabolism and origin of T and 5α-DHT.
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Affiliation(s)
- Gunnar Söderqvist
- Department of Women's, and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Sabine Naessén
- Department of Women's, and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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4
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Cleland L, Kennedy HL, Pettie MA, Kennedy MA, Bulik CM, Jordan J. Eating disorders, disordered eating, and body image research in New Zealand: a scoping review. J Eat Disord 2023; 11:7. [PMID: 36650575 PMCID: PMC9847028 DOI: 10.1186/s40337-022-00728-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/25/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The prevention and treatment of eating disorders relies on an extensive body of research that includes various foci and methodologies. This scoping review identified relevant studies of eating disorders, body image, and disordered eating with New Zealand samples; charted the methodologies, sample characteristics, and findings reported; and identified several gaps that should be addressed by further research. METHODS Using scoping review methodology, two databases were searched for studies examining eating disorders, disordered eating, or body image with New Zealand samples. Snowball methods were further used to identify additional relevant articles that did not appear in initial searches. Two independent reviewers screened the titles and abstracts of 473 records. Full text assessment of the remaining 251 records resulted in 148 peer-reviewed articles being identified as eligible for the final review. A search of institutional databases yielded 106 Masters and Doctoral theses for assessment, with a total of 47 theses being identified as eligible for the final review. The included studies were classified by methodology, and the extracted information included the study foci, data collected, sample size, demographic information, and key findings. RESULTS The eligible studies examined a variety of eating disorder categories including binge-eating disorder, bulimia nervosa, and anorexia nervosa, in addition to disordered eating behaviours and body image in nonclinical or community samples. Methodologies included treatment trials, secondary analysis of existing datasets, non-treatment experimental interventions, cross-sectional observation, case-control studies, qualitative and mixed-methods studies, and case studies or series. Across all of the studies, questionnaire and interview data were most commonly utilised. A wide range of sample sizes were evident, and studies often reported all-female or mostly-female participants, with minimal inclusion of males and gender minorities. There was also an underrepresentation of minority ethnicities in many studies, highlighting the need for future research to increase diversity within samples. CONCLUSION This study provides a comprehensive and detailed overview of research into eating disorders and body image in New Zealand, while highlighting important considerations for both local and international research.
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Affiliation(s)
- Lana Cleland
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Hannah L Kennedy
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Michaela A Pettie
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Martin A Kennedy
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand. .,Mental Health Clinical Research Unit, Te Whatu Ora, Waitaha, Christchurch, New Zealand.
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Rekkers ME, Aardenburg L, Scheffers M, van Elburg AA, van Busschbach JT. Shifting the Focus: A Pilot Study on the Effects of Positive Body Exposure on Body Satisfaction, Body Attitude, Eating Pathology and Depressive Symptoms in Female Patients with Eating Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11794. [PMID: 36142068 PMCID: PMC9517204 DOI: 10.3390/ijerph191811794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
One of the most commonly used techniques for the treatment of body image problems in eating disorders (ED) is body exposure (BE). However, evidence of its effectiveness in clinical populations is scarce. In the Positive Body Experience (PBE) protocol, the focus of positive BE is on aesthetic, functional and tactile aspects of the body. The current study evaluates the outcomes of positive BE with regard to changes in attitudinal body image and eating pathology, as well as the factors that influence these changes, in a sample of 84 adult female patients with different EDs who did not receive any other treatment for their EDs during the period in which BE treatment occurred. The results show significant positive changes in attitudinal body image, ED behaviors and depressive symptoms, with depressive symptoms at baseline mediating the changes in attitudinal body image. This study indicates that the PBE protocol is a suitable intervention for reducing negative attitudinal body image in anorexia and bulimia nervosa patients, as well as those with binge eating disorder. Furthermore, the results suggest that positive non-weight-related and functional body satisfaction are strong catalysts for change and that depressive symptoms play an important role in the ability to change. Additional RCTs are needed to gain more insight into the effects of PBE.
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Affiliation(s)
- Marlies E. Rekkers
- Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
| | - Lisanne Aardenburg
- GGZ inGeest, Mental Health Institute, Laan van de Helende Meesters 433, 1186 DL Amstelveen, The Netherlands
| | - Mia Scheffers
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
| | - Annemarie A. van Elburg
- Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
- Rintveld, Centre for Eating Disorders, Altrecht Mental Health Institute, 3705 WE Zeist, The Netherlands
| | - Jooske T. van Busschbach
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Rob Giel Onderzoekcentrum, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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6
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Jones H, McIntosh VV, Britt E, Carter JD, Jordan J, Bulik CM. The effect of temperament and character on body dissatisfaction in women with bulimia nervosa: The role of low self‐esteem and depression. EUROPEAN EATING DISORDERS REVIEW 2022; 30:388-400. [PMID: 35368118 PMCID: PMC9325425 DOI: 10.1002/erv.2899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 11/09/2022]
Abstract
Objective Method Results Conclusions Low self‐esteem and depression were examined as mediators of associations between temperament and character dimensions and body dissatisfaction in women with bulimia nervosa. Harm avoidance contributed significantly to body dissatisfaction. The association between harm avoidance and body dissatisfaction was mediated by low self‐esteem alone and depression and low self‐esteem in serial.
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Affiliation(s)
- Hannah Jones
- School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Virginia V.W. McIntosh
- School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Eileen Britt
- School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Janet D. Carter
- School of Psychology, Speech and Hearing University of Canterbury Christchurch New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine University of Otago Christchurch New Zealand
- Clinical Research Unit Canterbury District Health Board Christchurch New Zealand
| | - Cynthia M. Bulik
- Department of Psychiatry University of North Carolina Chapel Hill North Carolina USA
- Department of Nutrition University of North Carolina Chapel Hill North Carolina USA
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
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7
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Individuals Diagnosed with Binge-Eating Disorder Have DNA Hypomethylated Sites in Genes of the Metabolic System: A Pilot Study. Nutrients 2021; 13:nu13051413. [PMID: 33922358 PMCID: PMC8145109 DOI: 10.3390/nu13051413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/06/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
Binge-eating disorder, recently accepted as a diagnostic category, is differentiated from bulimia nervosa in that the former shows the presence of binge-eating episodes and the absence of compensatory behavior. Epigenetics is a conjunct of mechanisms (like DNA methylation) that regulate gene expression, which are dependent on environmental changes. Analysis of DNA methylation in eating disorders shows that it is reduced. The present study aimed to analyze the genome-wide DNA methylation differences between individuals diagnosed with BED and BN. A total of 46 individuals were analyzed using the Infinium Methylation EPIC array. We found 11 differentially methylated sites between BED- and BN-diagnosed individuals, with genome-wide significance. Most of the associations were found in genes related to metabolic processes (ST3GAL4, PRKAG2, and FRK), which are hypomethylated genes in BED. Cg04781532, located in the body of the PRKAG2 gene (protein kinase AMP-activated non-catalytic subunit gamma 2), was hypomethylated in individuals with BED. Agonists of PRKAG2, which is the subunit of AMPK (AMP-activated protein kinase), are proposed to treat obesity, BED, and BN. The present study contributes important insights into the effect that BED could have on PRKAG2 activation.
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8
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Lacey C, Cunningham R, Rijnberg V, Manuel J, Clark MTR, Keelan K, Pitama S, Huria T, Lawson R, Jordan J. Eating disorders in New Zealand: Implications for Māori and health service delivery. Int J Eat Disord 2020; 53:1974-1982. [PMID: 32869323 DOI: 10.1002/eat.23372] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Lifetime prevalence rates in Te Rau Hinengaro (The New Zealand Mental Health Survey) suggest eating disorders are at least as common in the Māori population as the non-Māori population, yet little is known at a population level about those accessing specialist mental health treatment for eating disorders in New Zealand. The aim of this study was to describe the population undergoing specialist mental health treatment for eating disorders and compare Māori and non-Māori clinical characteristics and service use. METHOD This study uses the Programme for the Integration of Mental Health Data data set, managed by the New Zealand Ministry of Health to describe the characteristics of people with eating disorders and their use of specialist mental health services from 2009 to 2016. RESULTS There were 3,835 individuals with a diagnosed eating disorder who had contact with specialist mental health services in this time period, 7% of whom were Māori. Within the cohort, Māori had a higher prevalence for a bulimia nervosa diagnosis, fewer diagnosed with anorexia nervosa, and a higher prevalence of other psychiatric comorbidity than non-Māori. DISCUSSION There is discrepancy between the proportion of service users accessing specialist mental health services who are Māori and the assessed crude prevalence of eating disorders for Māori in national estimates. Once Māori are in specialist services; however, their use of services is comparable to non-Māori. Further research is needed to highlight the experiences of those Māori with eating disorders and address barriers to accessing services for Māori with eating disorders.
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Affiliation(s)
- Cameron Lacey
- Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand.,Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Vivienne Rijnberg
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jenni Manuel
- Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | | | - Karen Keelan
- Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Tania Huria
- Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Rachel Lawson
- South Island Eating Disorders Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Clinical Research Unit, Canterbury District Health Board, Christchurch, New Zealand
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9
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Nakai Y, Nin K, Noma S, Teramukai S, Fujikawa K, Wonderlich SA. The impact of DSM-5 on the diagnosis and severity indicator of eating disorders in a treatment-seeking sample. Int J Eat Disord 2017; 50:1247-1254. [PMID: 28857236 DOI: 10.1002/eat.22777] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/18/2017] [Accepted: 08/20/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the impact of the DSM-5 on the diagnoses and severity indicators of eating disorders, we conducted a comparative study on the classification of eating disorders including subtypes of anorexia nervosa (AN) between the DSM-IV and DSM-5 criteria. In addition, we studied the association of the DSM-5 severity criteria and clinical variables. METHOD Participants were 304 outpatients, aged 16-45 years, with eating disorders, diagnosed using semi-structured clinical interviews and the eating disorder examination questionnaire (EDE-Q). The severity of AN, bulimia nervosa (BN), and binge-eating disorder (BED) was rated from mild to extreme using the DSM-5 severity criteria. RESULTS The DSM-5 remarkably reduced the number of diagnoses in the residual category from 37.5% to 9.2% and effectively differentiated the diagnostic groups in eating disorder psychopathology. Unexpectedly, however, the scores of all the EDE-Q subscales significantly decreased as severity ratings increased in the DSM-5 AN. Furthermore, while the AN binge-eating/purging group reported significantly lower severity ratings than the AN restricting group, the former displayed more severe eating disorder psychopathology than the latter. In the BN and BED groups, the level of eating concern increased as severity ratings increased, but the severity groups did not differ on other eating pathology variables. DISCUSSION The DSM-5 effectively reduced the reliance on residual categories and differentiated the diagnostic groups in eating disorder psychopathology. However, our findings show limited support for the DSM-5 severity specifiers for eating disorders. It is necessary to test additional clinical or functional variables for severity specifiers across eating disorders.
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Affiliation(s)
| | - Kazuko Nin
- School of Health Sciences, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Shun'ichi Noma
- Department of Psychiatry, School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Kei Fujikawa
- The Center for Quality Assurance in Research and Development, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Stephen A Wonderlich
- Department of Clinical Neuroscience, University of North Dakota, School of Medicine and Health Sciences, Fargo, North Dakota
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10
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McIntosh VVW, Jordan J, Carter JD, Frampton CMA, McKenzie JM, Latner JD, Joyce PR. Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural therapy, and schema therapy. Psychiatry Res 2016; 240:412-420. [PMID: 27149410 DOI: 10.1016/j.psychres.2016.04.080] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/05/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
Abstract
Cognitive-behavioural therapy (CBT) is the recommended treatment for binge eating, yet many individuals do not recover, and innovative new treatments have been called for. The current study compares traditional CBT with two augmented versions of CBT; schema therapy, which focuses on early life experiences as pivotal in the history of the eating disorder; and appetite-focused CBT, which emphasises the role of recognising and responding to appetite in binge eating. 112 women with transdiagnostic DSM-IV binge eating were randomized to the three therapies. Therapy consisted of weekly sessions for six months, followed by monthly sessions for six months. Primary outcome was the frequency of binge eating. Secondary and tertiary outcomes were other behavioural and psychological aspects of the eating disorder, and other areas of functioning. No differences among the three therapy groups were found on primary or other outcomes. Across groups, large effect sizes were found for improvement in binge eating, other eating disorder symptoms and overall functioning. Schema therapy and appetite-focused CBT are likely to be suitable alternative treatments to traditional CBT for binge eating.
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Affiliation(s)
- Virginia V W McIntosh
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand.
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand
| | - Janet D Carter
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | | | - Janice M McKenzie
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Janet D Latner
- Psychology Department, University of Hawaii at Manoa, Hawaii, USA
| | - Peter R Joyce
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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11
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Incorporating positive body image into the treatment of eating disorders: A model for attunement and mindful self-care. Body Image 2015; 14:158-67. [PMID: 25886712 DOI: 10.1016/j.bodyim.2015.03.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/05/2015] [Accepted: 03/12/2015] [Indexed: 01/09/2023]
Abstract
This article provides a model for understanding the role positive body image can play in the treatment of eating disorders and methods for guiding patients away from symptoms and toward flourishing. The Attuned Representational Model of Self (Cook-Cottone, 2006) and a conceptual model detailing flourishing in the context of body image and eating behavior (Cook-Cottone et al., 2013) are discussed. The flourishing inherent in positive body image comes hand-in-hand with two critical ways of being: (a) having healthy, embodied awareness of the internal and external aspects of self (i.e., attunement) and (b) engaging in mindful self-care. Attunement and mindful self-care thus are considered as potential targets of actionable therapeutic work in the cultivation of positive body image among those with disordered eating. For context, best-practices in eating disorder treatment are also reviewed. Limitations in current research are detailed and directions for future research are explicated.
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12
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Lammers MW, Vroling MS, Ouwens MA, Engels RCME, van Strien T. Predictors of outcome for cognitive behaviour therapy in binge eating disorder. EUROPEAN EATING DISORDERS REVIEW 2015; 23:219-28. [PMID: 25802175 DOI: 10.1002/erv.2356] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/04/2015] [Accepted: 02/22/2015] [Indexed: 12/12/2022]
Abstract
The aim of this naturalistic study was to identify pretreatment predictors of response to cognitive behaviour therapy in treatment-seeking patients with binge eating disorder (BED; N = 304). Furthermore, we examined end-of-treatment factors that predict treatment outcome 6 months later (N = 190). We assessed eating disorder psychopathology, general psychopathology, personality characteristics and demographic variables using self-report questionnaires. Treatment outcome was measured using the bulimia subscale of the Eating Disorder Inventory 1. Predictors were determined using hierarchical linear regression analyses. Several variables significantly predicted outcome, four of which were found to be both baseline predictors of treatment outcome and end-of-treatment predictors of follow-up: Higher levels of drive for thinness, higher levels of interoceptive awareness, lower levels of binge eating pathology and, in women, lower levels of body dissatisfaction predicted better outcome in the short and longer term. Based on these results, several suggestions are made to improve treatment outcome for BED patients.
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Affiliation(s)
- Mirjam W Lammers
- Amarum, Expertise Centre for Eating Disorders, GGNet Network for Mental Health Care, The Netherlands
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13
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Thomas JJ, Eddy KT, Ruscio J, Ng KL, Casale KE, Becker AE, Lee S. Do recognizable lifetime eating disorder phenotypes naturally occur in a culturally asian population? A combined latent profile and taxometric approach. EUROPEAN EATING DISORDERS REVIEW 2015; 23:199-209. [PMID: 25787700 DOI: 10.1002/erv.2357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 02/17/2015] [Accepted: 02/22/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND We examined whether empirically derived eating disorder (ED) categories in Hong Kong Chinese patients (N = 454) would be consistent with recognizable lifetime ED phenotypes derived from latent structure models of European and American samples. METHOD We performed latent profile analysis (LPA) using indicator variables from data collected during routine assessment, and then applied taxometric analysis to determine whether latent classes were qualitatively versus quantitatively distinct. RESULTS Latent profile analysis identified four classes: (i) binge/purge (47%); (ii) non-fat-phobic low-weight (34%); (iii) fat-phobic low-weight (12%); and (iv) overweight disordered eating (6%). Taxometric analysis identified qualitative (categorical) distinctions between the binge/purge and non-fat-phobic low-weight classes, and also between the fat-phobic and non-fat-phobic low-weight classes. Distinctions between the fat-phobic low-weight and binge/purge classes were indeterminate. CONCLUSION Empirically derived categories in Hong Kong showed recognizable correspondence with recognizable lifetime ED phenotypes. Although taxometric findings support two distinct classes of low weight EDs, LPA findings also support heterogeneity among non-fat-phobic individuals.
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Affiliation(s)
- Jennifer J Thomas
- Department of Psychiatry, Harvard Medical School, MA, USA; Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA, USA
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