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Ramjan LM, Smith BW, Miskovic-Wheatley J, Pathrose SP, Hay PJ. Social support for young people with eating disorders-An integrative review. Int J Ment Health Nurs 2024. [PMID: 38812085 DOI: 10.1111/inm.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/30/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
Eating disorder treatment should be underpinned by a recovery-oriented approach, be therapeutic, personalised and trauma informed. Within such models of care, social support is an important factor to explore in terms of its influence in supporting hope for recovery, reducing stigma, and mitigating life stressors. Limited research has been conducted to understand the types of social support that are available to young people formally diagnosed with an eating disorder, their feasibility and acceptability and the positive outcomes. This integrative review sought to explore the positive outcomes of social support or social support programs for young people with eating disorders. An integrative review was conducted based on a search of five electronic databases from inception to 31 March 2023. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools and findings have been narratively synthesised and presented in accordance with the review's aims and questions. Seven studies (total 429 individuals, range 3-160) published between 2001 and 2023 were included in the final synthesis. Overall social support interventions showed promising preliminary evidence as a feasible and acceptable adjunct to treatment for young people with an eating disorder motivated to change, with some clinical improvements in psychopathology. Social support augmented existing relationships, providing a human element of open dialogue, friendship and a sense of hope for recovery. Despite the small number and heterogeneity of the studies, this review has highlighted some promising preliminary benefits. Future treatment for eating disorders should embrace adjunct modalities that enhance psychosocial recovery for young people with eating disorders.
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Affiliation(s)
- Lucie M Ramjan
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brandon W Smith
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute, University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sheeja Perumbil Pathrose
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- New South Wales Centre for Evidence Based Health Care: A JBI Affiliated Group, Sydney, New South Wales, Australia
| | - Phillipa J Hay
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Campbelltown Hospital, Mental Health Services, South Western Sydney Local Health District, Sydney, New South Wales, Australia
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Rienecke RD, Mehler PS, Duffy A, Le Grange D, Blalock DV. A brief examination of treatment outcomes in higher levels of care for individuals with eating disorders across age groups. EUROPEAN EATING DISORDERS REVIEW 2024; 32:431-439. [PMID: 38013216 DOI: 10.1002/erv.3054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Although eating disorders (EDs) occur throughout the lifespan, little research has been conducted with midlife/older adults, particularly those in higher levels of care (HLOC). The current study examined outcomes among 2009 patients with EDs receiving HLOC treatment at a large multisite facility between January 2020 and June 2022, across different age groups (ages <18, 18-25, 26-39 and ≥40). It was hypothesised that patients aged 40+ would exhibit less improvement on measures of ED psychopathology and depression than other age groups. METHOD Participants completed the eating disorder examination-questionnaire (EDE-Q) and the patient health questionnaire-9 (PHQ-9) at admission and discharge. RESULTS Changes for all outcomes from admission to discharge were statistically significant at p < 0.001 across all age groups. Changes in the EDE-Q Restraint subscale were significantly less in patients ages 26-39 than in patients ages 18-25 (p < 0.01). Changes in PHQ-9 were significantly greater in patients ages 40+ than patients ages 18-25 (p = 0.03). CONCLUSIONS Contrary to hypotheses, patients ages 40+ did not show worse outcomes than younger patients, and showed greater improvements in depression than young adults. The therapeutic needs of midlife/older adults with EDs may be favourably met by a HLOC regimen as described in this study.
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Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
- ACUTE at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Rienecke RD, Blalock DV, Tallent CN, Duffy A, Mehler PS. Eating disorder virtual intensive outpatient program: patient satisfaction according to age group. Eat Disord 2024:1-16. [PMID: 38468571 DOI: 10.1080/10640266.2024.2325296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The COVID-19 pandemic has required a shift to telehealth services. However, not all patients are similarly satisfied with this shift, with some studies finding that midlife and older adults are less comfortable with telehealth. The current study examined patient satisfaction with a virtual intensive outpatient program (VIOP) for eating disorders (EDs) among 305 adults (ages 18-25, ages 26-39, and ages 40+), and compared adult satisfaction to satisfaction among children/adolescents (n = 33) receiving VIOP treatment between August 2020 and March 2022 from a large ED treatment facility. It was hypothesized that adults aged 40+ would report lower satisfaction than younger age groups. Patients completed several questions regarding satisfaction with treatment upon discharge, including a question about likelihood of recommending the program, which was used to calculate a Net Promoter Score (NPS). The NPS was 33.3 for children/adolescents, 33.3 for 18-25 year-olds, 57.7 for 26-39 year-olds, and 30.9 for the 40+ year age group. NPS of 31-50 = quality services; 51-70 = excellent customer experiences. Satisfaction was high, with no statistically significant differences between age groups after Bonferroni correction. The current study adds to the limited literature on the treatment experiences of midlife adults with EDs.
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Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, CO, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Casey N Tallent
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, CO, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, CO, USA
| | - Philip S Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, CO, USA
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
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Rienecke RD, Dimitropoulos G, Duffy A, Le Grange D, Manwaring J, Nieder S, Sauerwein J, Singh M, Watters A, Westmoreland P, Mehler PS. Involuntary treatment: A qualitative study from the perspectives of individuals with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023; 31:850-862. [PMID: 37424216 DOI: 10.1002/erv.3010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Involuntary treatment for anorexia nervosa (AN) is sometimes necessary and lifesaving but can be experienced negatively by some individuals. The purpose of this qualitative study was to better understand participants' perceptions about their experience with involuntary treatment for AN. METHOD Thirty adult participants, who had been treated involuntarily for AN in the past, completed self-report measures and qualitative interviews. Interview transcripts were coded using thematic analysis. RESULTS Three themes were identified: (1) mixed perceptions about involuntary treatment, (2) the impact of involuntary treatment on external factors, including relationships, education, and employment, and (3) lessons learned from the experience. Participants who endorsed a positive shift in perspective regarding the need for involuntary treatment also reported favorable changes in their eating disorder recovery, whereas individuals whose perspective about their involuntary treatment remained negative, showed no changes in their recovery post-treatment. CONCLUSIONS Involuntary treatment for AN was recognized, in retrospect, as being beneficial by individuals with AN who were doing well, but individuals who continued to struggle with their eating disorder reported negative consequences.
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Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Gina Dimitropoulos
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Jamie Manwaring
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
- ACUTE, Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | | | - Jessica Sauerwein
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Manya Singh
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Ashlie Watters
- ACUTE, Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Patricia Westmoreland
- Department of Psychiatry, University of Colorado, Denver, Colorado, USA
- Aurora Medical Center, Aurora, Colorado, USA
| | - Philip S Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
- ACUTE, Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
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Miskovic-Wheatley J, Bryant E, Ong SH, Vatter S, Le A, Touyz S, Maguire S. Eating disorder outcomes: findings from a rapid review of over a decade of research. J Eat Disord 2023; 11:85. [PMID: 37254202 DOI: 10.1186/s40337-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality. METHODS This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review. RESULTS Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates. CONCLUSION Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.
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Affiliation(s)
- Jane Miskovic-Wheatley
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia.
- Sydney Local Health District, Sydney, Australia.
| | - Emma Bryant
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Shu Hwa Ong
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sabina Vatter
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Stephen Touyz
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
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Anorexia nervosa and familial risk factors: a systematic review of the literature. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractAnorexia Nervosa (AN) is a psychological disorder involving body manipulation, self-inflicted hunger, and fear of gaining weight.We performed an overview of the existing literature in the field of AN, highlighting the main intrafamilial risk factors for anorexia. We searched the PubMed database by using keywords such as “anorexia” and “risk factors” and “family”. After appropriate selection, 16 scientific articles were identified. The main intrafamilial risk factors for AN identified include: increased family food intake, higher parental demands, emotional reactivity, sexual family taboos, low familial involvement, family discord, negative family history for Eating Disorders (ED), family history of psychiatric disorders, alcohol and drug abuse, having a sibling with AN, relational trauma. Some other risk factors identified relate to the mother: lack of maternal caresses, dysfunctional interaction during feeding (for IA), attachment insecurity, dependence. Further studies are needed, to identify better personalized intervention strategies for patients suffering from AN.
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Kells M, Gregas M, Wolfe BE, Garber AK, Kelly-Weeder S. Factors associated with refeeding hypophosphatemia in adolescents and young adults hospitalized with anorexia nervosa. Nutr Clin Pract 2021; 37:470-478. [PMID: 34494697 DOI: 10.1002/ncp.10772] [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] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Refeeding hypophosphatemia (RH) in individuals with anorexia nervosa (AN) is a potentially fatal complication of nutrition restoration; yet, little is known about risk. This retrospective cohort study examined factors found in hospitalized youth with AN that may contribute to RH. METHODS We reviewed medical records of 300 individuals diagnosed with AN admitted between the years of 2010 and 2016. Logistic regression examined factors associated with RH. Multivariate regression examined factors associated with phosphorus nadir. RESULTS For 300 participants, the mean (SD) age was 15.5 (2.5) years, 88.3% were White, and 88.3% were female. Participants lost an average of 11.3 (9.7) kg of body weight and were 82% (12.1) of median body mass index (BMI). Age (P = .022), nasogastric (NG) tube feeding (P = .054), weight gain (P = .003), potassium level (P = .001), and magnesium level (P = .024) were contributors to RH. Odds of RH were 13.7 times higher for each unit reduction in magnesium, 9.2 times higher for each unit reduction in potassium, three times higher in those who received NG feeding, 1.5 times higher for each kg of weight gain, and 1.2 times higher for each year of age. Regarding phosphorus nadir, serum magnesium level (P < .001) and admission BMI (P = .002) contributed significantly. CONCLUSION The results indicate that age, NG feeding, weight gain, electrolyte abnormalities, and BMI on admission are potential indicators of the development of RH in youth. This study identifies clinical risk factors associated with RH and may guide further investigation.
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Affiliation(s)
- Meredith Kells
- Boston Children's Hospital, Division of Adolescent/Young Adult Medicine, Boston, Massachusetts, USA.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Matt Gregas
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Barbara E Wolfe
- College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA
| | - Andrea K Garber
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Susan Kelly-Weeder
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
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Hornberger LL, Lane MA. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics 2021; 147:peds.2020-040279. [PMID: 33386343 DOI: 10.1542/peds.2020-040279] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Eating disorders are serious, potentially life-threatening illnesses afflicting individuals through the life span, with a particular impact on both the physical and psychological development of children and adolescents. Because care for children and adolescents with eating disorders can be complex and resources for the treatment of eating disorders are often limited, pediatricians may be called on to not only provide medical supervision for their patients with diagnosed eating disorders but also coordinate care and advocate for appropriate services. This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights opportunities for advocacy.
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Affiliation(s)
- Laurie L Hornberger
- Division of Adolescent Medicine, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Margo A Lane
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Calugi S, Sartirana M, Misconel A, Boglioli C, Dalle Grave R. Eating disorder psychopathology in adults and adolescents with anorexia nervosa: A network approach. Int J Eat Disord 2020; 53:420-431. [PMID: 32314382 DOI: 10.1002/eat.23270] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess and compare eating disorder feature networks in adult and adolescent patients with anorexia nervosa. METHODS Patients seeking treatment for anorexia nervosa in inpatient and outpatient settings were consecutively recruited from January 2008 to September 2019. Body mass index was measured, and each patient completed the Eating Disorder Examination Questionnaire. RESULTS The sample comprised 547 adolescent and 724 adult patients with anorexia nervosa. Network analysis showed that in both adults and adolescents, the most central and highly interconnected nodes in the network were related to shape overvaluation and desiring weight loss. The network comparison test identified similar global strength and network invariance, confirming the similarity of the two network structures. DISCUSSION The network structures in adult and adolescent patients with anorexia nervosa are similar, and lend weight to the cognitive behavioral theory that overvaluation of shape and weight is the core feature of anorexia nervosa psychopathology.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | | | - Arianna Misconel
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | - Camilla Boglioli
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
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Braude MR, Con D, Clayton‐Chubb D, Nandurkar R, Chua L, Newnham ED. Acute medical stabilisation of adults with anorexia nervosa: experience of a defined interdisciplinary model of care. Intern Med J 2020; 50:77-85. [DOI: 10.1111/imj.14329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Michael R. Braude
- Department of Gastroenterology and HepatologyMonash University Melbourne Victoria Australia
| | - Danny Con
- Department of Gastroenterology and HepatologyMonash University Melbourne Victoria Australia
| | - Daniel Clayton‐Chubb
- Department of Gastroenterology and HepatologyMonash University Melbourne Victoria Australia
| | - Ruchira Nandurkar
- Department of General Medicine, Eastern Health Clinical SchoolMonash University Melbourne Victoria Australia
| | - Ling‐Ern Chua
- Department of PsychiatryEastern Health Melbourne Victoria Australia
| | - Evan D. Newnham
- Department of Gastroenterology and HepatologyMonash University Melbourne Victoria Australia
- Department of General Medicine, Eastern Health Clinical SchoolMonash University Melbourne Victoria Australia
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Frederiksen TC, Krogh Christiansen M, Charmoth Østergaard P, Hove Thomsen P, Graff C, Clausen L, Kjærulf Jensen H. QTc Interval and Risk of Cardiac Events in Adults With Anorexia Nervosa: A Long-Term Follow-Up Study. Circ Arrhythm Electrophysiol 2019; 11:e005995. [PMID: 30030265 DOI: 10.1161/circep.117.005995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/17/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The literature contains several cases of anorexia nervosa (AN) patients with prolonged QTc interval. However, the risk of prolonged QTc interval is controversial and the risk of cardiac events in AN patients has yet to be investigated. METHODS We estimated the difference in mean QTc interval and relative risk of borderline prolonged QTc (>440 ms) and prolonged QTc (>460 ms) between 430 adult women AN patients and 123 healthy controls using 3 correction formulas. In a follow-up study, we estimated the risk of a primary end point (a composite of ventricular tachycardia, aborted cardiac arrest, and cardiac arrest) in AN patients compared with a population-based cohort derived from the Danish Civil Register. RESULTS Mean QTc for AN patients was 408 ms (Hodges), 402 ms (Fridericia), and 399 ms (Bazett). Hodges' found a slightly increased mean QTc (6.8 ms, 95% confidence interval, 1.6-12.0; P=0.01) and percentage with QTc >440 ms in AN patients (relative risk, 3.7, 95% confidence interval, 1.4-10.3; P=0.01), not observed with Fridericia's and Bazett's formulas. There was no difference in the risk of QTc >460 ms between AN patients and healthy controls. During a median follow-up of 10.1 years, AN patients had an increased risk of the primary end point compared with the population-based cohort (hazard ratio, 10.4, 95% confidence interval, 2.6-41.6; P=0.001). However, absolute numbers were small with cumulative incidences of 0.5% and 0.07%, respectively, after 10 years. No events occurred in any AN patient with QTc >440 ms. All-cause mortality was also significantly increased in AN patients compared with the population-based cohort (hazard ratio, 11.2, 95% confidence interval, 5.1-24.5; P<0.001). CONCLUSIONS Overall, there was no difference in mean QTc interval or risk of prolonged QTc between AN patients and healthy controls. However, AN patients had a notably increased all-cause mortality, as well as an increased risk of cardiac events, which was not related to the baseline QTc interval.
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Affiliation(s)
| | - Morten Krogh Christiansen
- Department of Cardiology (T.C.F., M.K.C., H.K.J.).,and Centre for Child and Adolescent Psychiatry (P.C.O., P.H.T., L.C.)
| | - Pernille Charmoth Østergaard
- and Centre for Child and Adolescent Psychiatry (P.C.O., P.H.T., L.C.).,Department of Public Health Medicine and Rehabilitation, Western Hospital Unit, Herning, Denmark (P.C.O.)
| | - Per Hove Thomsen
- and Centre for Child and Adolescent Psychiatry (P.C.O., P.H.T., L.C.)
| | - Claus Graff
- Aarhus University, Denmark. Department of Health Science and Technology, Aalborg University, Denmark (C.G.)
| | - Loa Clausen
- and Centre for Child and Adolescent Psychiatry (P.C.O., P.H.T., L.C.).,Department of Public Health (L.C.).,Department of Psychology and Behavioral Sciences (L.C.)
| | - Henrik Kjærulf Jensen
- Department of Cardiology (T.C.F., M.K.C., H.K.J.).,and Department of Clinical Medicine (H.K.J.)
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Characteristics of patients in an eating disorder sample who dropped out: 2-year follow-up. Eat Weight Disord 2019; 24:767-775. [PMID: 28717972 DOI: 10.1007/s40519-017-0416-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/04/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This manuscript explores the characteristics of individuals diagnosed with an eating disorder who dropped out of treatment, compared with those who completed it. METHOD The participants were 196 patients diagnosed with eating disorders (according to DSM-IV-TR criteria) who consecutively began treatment for the first time in an eating disorders unit. They were assessed at baseline with a set of questionnaires evaluating eating habits, temperament, and general psychopathology. During the follow-up period, patients who dropped out were re-assessed via a telephone interview. RESULTS In the course of a 2-year follow-up, a total of 80 (40.8%) patients were labeled as dropouts, and 116 (59.2%) remaining subjects were considered completers. High TCI scores in the character dimensions of Disorderliness (NS4) (p < .01) and total Novelty Seeking (NST), along with low scores in Dependency (RD4), were significantly associated with dropout in the course of 2 years. Once the results were submitted to logistic regression analysis, dropout only remained associated with high scores in Disorderliness (NS4) and, inversely, with an initial Anorexia Nervosa (AN) diagnosis (p < .05). Reasons for dropout stated by the patients included logistic difficulties, subjective improvement of their condition, and lack of motivation. DISCUSSION Clinicians should handle the first therapeutic intervention with particular care in order to enhance their understanding of clients and their ability to rapidly identify those who are at risk of dropping out of treatment. LEVEL OF EVIDENCE Level III: Cohort Study.
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Himmerich H, Hotopf M, Shetty H, Schmidt U, Treasure J, Hayes RD, Stewart R, Chang CK. Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa. Soc Psychiatry Psychiatr Epidemiol 2019; 54:813-821. [PMID: 30756148 DOI: 10.1007/s00127-019-01667-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality. METHODS We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score. RESULTS A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates. CONCLUSIONS These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D Hayes
- Department of Psychological Medicine, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- Department of Psychological Medicine, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Jhongcheng Rd, Shilin District, Taipei, 111, Taiwan.
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14
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Quadflieg N, Fichter MM. Long-term outcome of inpatients with bulimia nervosa-Results from the Christina Barz Study. Int J Eat Disord 2019; 52:834-845. [PMID: 31002430 DOI: 10.1002/eat.23084] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the long-term outcome and identify outcome predictors in a very large sample of inpatients treated for bulimia nervosa (BN). METHOD Out of a total of 2,033 patients admitted consecutively to specialized treatment, 1,351 patients (mean age at treatment 25.94) were assessed for follow-up on average 11 (SD 6) years after admission. Also a very long-term (21 years) subsample (N = 147; mean age 25.92) was defined. Bivariate and logistic regression analyses identified predictors of poor outcome. RESULTS For more than 70% of the patients follow-up information could be gathered. Severity of eating disorder (ED) and other symptoms decreased over time but remained higher than in healthy controls, using published normative data. Remission rate was 38% after 11 years and 42% in the subsample after 21 years. Out of the total sample of N = 2,033 patients, 49 had died (2.4%). Persistent BN was found in 14.2% and the most frequent crossover was to ED not otherwise specified. Predictors of poor outcome were fewer follow-up years, higher drive for thinness, higher age at treatment, and less global functioning. DISCUSSION Based on clinical indicators, patients presented with a high level of ED and psychiatric symptomatology. With less than half of the patients remitted after 22 years, efforts are needed to improve treatment outcome.
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Affiliation(s)
- Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
| | - Manfred M Fichter
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany.,Schön Klinik Roseneck affiliated with the Medical Faculty of the University of Munich(LMU), Prien, Germany
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15
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Weigel TJ, Wang SB, Thomas JJ, Eddy KT, Pierce C, Zanarini MC, Fitzmaurice G, Busch A. Residential eating disorder outcomes associated with screening positive for substance use disorder and borderline personality disorder. Int J Eat Disord 2019; 52:309-313. [PMID: 30746736 DOI: 10.1002/eat.23028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/28/2018] [Accepted: 01/06/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We examined whether eating disorder (ED) outcome trajectories during residential treatment differed for patients screening positive for comorbid borderline personality disorder (BPD) and/or substance use disorders (SUDs) than those who do not. METHOD We examined data from patients in a residential ED treatment program. Patients completed validated self-report surveys to screen for SUDs and BPD on admission, and the ED Examination-Questionnaire (EDE-Q) on admission and every 2 weeks until discharge (N = 479 females). RESULTS Fifty-four percent screened positive for at least one co-occurring condition. At admission, patients screening positive for SUD and/or BPD had significantly greater eating pathology than patients screening negative for both (t[477] = 8.23, p < .001). Patients screening positive for SUD (independent of BPD screening status) had a significantly faster rate of symptom improvement during the initial 4 weeks than patients screening positive for BPD only and those with no comorbidities. DISCUSSION Screening positive for SUD and/or BPD was common in residential ED treatment, and associated with more severe ED symptoms. Screening positive for SUD was associated with faster ED symptom improvement than screening positive for BPD. These findings suggest that intensive ED treatment, even in the absence of intensive SUD treatment, may enhance patient outcomes for those with SUDs.
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Affiliation(s)
- Thomas J Weigel
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Shirley B Wang
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Jennifer J Thomas
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Kamryn T Eddy
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Casey Pierce
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Mary C Zanarini
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts.,Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts
| | - Garrett Fitzmaurice
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts.,Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Alisa Busch
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Health Services Research Division, Partners Psychiatry and Mental Health, Boston, Massachusetts.,Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Clinical Services Administration, McLean Hospital, Belmont, Massachusetts
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16
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Breithaupt L, Eickman L, Byrne CE, Fischer S. REbeL peer education: A model of a voluntary, after-school program for eating disorder prevention. Eat Behav 2019; 32:111-116. [PMID: 27825587 DOI: 10.1016/j.eatbeh.2016.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dissonance-based eating disorder prevention leads to decreases in risk factors for these disorders. Although controlled trials have demonstrated that targeted, manualized programs reduce eating disorder risk, concerns regarding implementation and dissemination remain. A primary concern is the difficulty in adapting programs for a high school setting for populations at highest risk: adolescents. This paper describes the REbeL Peer Education model and assesses the initial pilot trials of the intervention. The program is novel in that it utilizes a voluntary, self-selection model that is sustainable in a high school setting, and focuses on empowerment and effective cognitive dissonance based prevention activities. High school peer-educators self-selected into the semi-manualized dissonance based intervention. Group activities were peer led, designed to critique the thin ideal, and designed to empower macro (school and larger community wide) changes in the pilot trial (N=47) assess the effectiveness and feasibility of the intervention. Results of the initial pilot study revealed preliminary support for the feasibility of the program, increases in feelings of empowerment, and decreases in eating disorder cognitions and behaviors with moderate to large effect sizes. Feedback from participants indicated that the intervention was enjoyable, educational, and empowering. This study is the first to adapt dissonance-based prevention models to a semi-manualized, peer-led, prevention program integrated into high school settings.
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Affiliation(s)
- Lauren Breithaupt
- George Mason University, Department of Psychology, 4400 University Drive, 3F5, Fairfax, VA 22030, United States; REbeL, Inc. 12980 Metcalf, Suite 325, Overland Park, KS 66213, United States.
| | - Laura Eickman
- REbeL, Inc. 12980 Metcalf, Suite 325, Overland Park, KS 66213, United States
| | - Catherine E Byrne
- George Mason University, Department of Psychology, 4400 University Drive, 3F5, Fairfax, VA 22030, United States
| | - Sarah Fischer
- George Mason University, Department of Psychology, 4400 University Drive, 3F5, Fairfax, VA 22030, United States
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17
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de Paz A, Vidal P, Pellón R. Exercise, diet, and the reinforcing value of food in an animal model of anorexia nervosa. Q J Exp Psychol (Hove) 2018; 72:1692-1703. [PMID: 30282528 DOI: 10.1177/1747021818807865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Activity-based anorexia (ABA) develops when laboratory rats are subjected to a single meal per day and have access to an activity wheel for the remaining time. Here, we studied the contribution of exercise and diet to the reinforcing value of food during ABA development. Three groups of eight adult male Wistar rats were used: an ABA group with 21.5 hr (then 22 hr) of wheel access and 1 hr (then 30 min) of food access, a control group with the same time exposure to food but without exercise, and a yoked group to the ABA in terms of weight loss. Rats were daily tested on a progressive-ratio schedule to measure their motivation for food. ABA rats gradually reduced their body weight more than the food control group. Animals steadily increased their breaking points in parallel to losses in body weight, but no significant differences were found between groups. Adult rats can develop ABA, but their loss in weight neither resulted in a decrease of food intake nor in the motivation to obtain it.
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Affiliation(s)
- Ana de Paz
- 1 Laboratorios de Conducta Animal, Departamento de Psicología Básica I, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Pedro Vidal
- 1 Laboratorios de Conducta Animal, Departamento de Psicología Básica I, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Ricardo Pellón
- 1 Laboratorios de Conducta Animal, Departamento de Psicología Básica I, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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18
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Balottin L, Mannarini S, Mensi MM, Chiappedi M, Balottin U. Are family relations connected to the quality of the outcome in adolescent anorexia nervosa? An observational study with the Lausanne Trilogue Play. Clin Psychol Psychother 2018; 25:785-796. [PMID: 30051637 DOI: 10.1002/cpp.2314] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 11/07/2022]
Abstract
The study aims to explore the connection between the family interactive patterns, investigated with a standardized observational tool based on a recorded play session, the Lausanne Trilogue Play, and the outcome of adolescent patients with anorexia nervosa after a 6 months treatment, based on the Morgan-Russel Outcome Assessment Schedule. Seventy-two parents and adolescent daughters with anorexia nervosa, consecutively referred to an adolescent neuropsychiatric service, participated in the study and underwent an integrated model of treatment, based on constant neuropsychiatric and dietary monitoring, weekly individual psychotherapy for the daughter, and parental counselling and support. A better adolescents' functioning in family relationships, in particular in the triadic ones, at first assessment, was associated with a better outcome. Data on family interactions may help predict the most appropriate intervention for the patient and his family.
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Affiliation(s)
- Laura Balottin
- Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Stefania Mannarini
- Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | | | - Matteo Chiappedi
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Umberto Balottin
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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19
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Jenkins PE, Price T. Eating pathology in midlife women: Similar or different to younger counterparts? Int J Eat Disord 2018; 51:3-9. [PMID: 29205410 DOI: 10.1002/eat.22810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/12/2017] [Accepted: 11/20/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study examined potential similarities and differences between women with eating disorders (EDs) in midlife and their younger counterparts. METHOD Seven hundred and three women assessed by a specialist eating disorder service were divided into three groups based on age (18-25, 25-40, and 40+) and compared on a number of clinical and demographic measures. Distribution of ED diagnoses was also examined between groups. RESULTS Midlife women were less likely to receive a diagnosis of anorexia nervosa and more likely to receive a diagnosis of binge-eating disorder than their younger counterparts. Duration of illness was longer and age of ED onset later in the midlife group but no differences were seen on measures of global ED pathology, psychosocial impairment, or psychological distress. DISCUSSION This study adds to the developing literature concerning EDs in midlife women, although further work is needed to support the findings presented here and to examine profiles of males presenting to treatment centers.
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Affiliation(s)
- Paul E Jenkins
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, United Kingdom.,School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Tom Price
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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20
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Kwan MY, Minnich AM, Douglas V, Gordon KH, Castro Y. Bulimic symptoms and interpersonal functioning among college students. Psychiatry Res 2017; 257:406-411. [PMID: 28837928 DOI: 10.1016/j.psychres.2017.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/04/2017] [Accepted: 08/12/2017] [Indexed: 11/26/2022]
Abstract
Integrating interpersonal theory and the stress generation hypothesis, two studies investigated the association between bulimic symptoms and interpersonal distress and the mechanism underlying this association. In Study 1, 36 pairs of female roommates completed self-report questionnaires in a laboratory while Study 2 recruited 539 undergraduate men and women to participate in a longitudinal online study by completing self-report measures at two time points. Multilevel modeling revealed that targets' bulimic symptoms predicted roommates' intention to continue living with them in Study 1. Greater bulimic symptoms predicted lower intention. In Study 2, bulimic symptoms had a direct and an indirect effect on interpersonal distress, with reassurance-seeking as a mediator in the indirect effect. Findings replicated previous studies showing that bulimic symptoms generate further distress and, in our studies, interpersonal distress specifically. Moreover, reassurance-seeking was a newly identified mechanism underlying this association. These findings provide support for the usefulness of interpersonal theory and the stress generation hypothesis as a framework for understanding bulimic symptomatology. Clinicians may find it useful to target reassurance-seeking behaviors during the treatment of bulimic symptoms in order to improve treatment outcomes.
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Affiliation(s)
- Mun Yee Kwan
- Department of Psychology, North Dakota State University, Minard 232, Fargo, ND 58108, USA.
| | - Allison M Minnich
- Department of Psychology, North Dakota State University, Minard 232, Fargo, ND 58108, USA
| | - Valerie Douglas
- Department of Psychology, North Dakota State University, Minard 232, Fargo, ND 58108, USA
| | - Kathryn H Gordon
- Department of Psychology, North Dakota State University, Minard 232, Fargo, ND 58108, USA; Neuropsychiatric Research Institute, 120 8th Street S., Fargo, ND 58102, USA
| | - Yessenia Castro
- School of Social Work, The University of Texas at Austin, HLP 295D, Austin, TX 78712, USA
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21
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Forbush KT, Gould SR, Chapa DAN, Bohrer BK, Hagan KE, Clark KE, Sorokina DA, Perko VL. New Horizons in Measurement: a Review of Novel and Innovative Approaches to Eating-Disorder Assessment. Curr Psychiatry Rep 2017; 19:76. [PMID: 28891029 DOI: 10.1007/s11920-017-0826-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Eating disorders are serious mental-health concerns that will affect over 30 million individuals in the USA at some point in their lives. Eating disorders occur across the lifespan, in a variety of ethnicities and races, in both men and women, and across the socioeconomic spectrum. Given the prevalence and severity of eating disorders, it is important that clinicians and researchers have access to appropriate assessment tools to aid in the early identification and treatment referral, differential diagnosis, treatment planning, and progress monitoring, and to ensure valid research findings. In this review, we describe novel and innovative assessment tools that were developed within the past 5 years for utilization in research and/or clinical practice with individuals with eating disorders. RECENT FINDINGS We identified six multidimensional assessments for eating disorders, all of which can be administered online (with some also offering paper-and-pencil versions). Strengths of the measures included good internal consistency, test-retest reliability, and convergent validity. However, in part, due to problematic scale construction methods, certain scales had poor discriminant validity and most were developed and validated in mostly female samples. There are promising new eating disorder measures from which to choose; however, many measures continue to be limited by poor discriminant validity and need additional validation prior to incorporation into routine research and clinical practice.
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Affiliation(s)
- Kelsie T Forbush
- Department of Psychology, University of Kansas, Fraser Hall, 1415 Jayhawk Boulevard, Lawrence, KS, 66045, USA.
| | - Sara R Gould
- Children's Mercy Kansas City, Kansas City, MO, USA
| | - Danielle A N Chapa
- Department of Psychology, University of Kansas, Fraser Hall, 1415 Jayhawk Boulevard, Lawrence, KS, 66045, USA
| | - Brittany K Bohrer
- Department of Psychology, University of Kansas, Fraser Hall, 1415 Jayhawk Boulevard, Lawrence, KS, 66045, USA
| | - Kelsey E Hagan
- Department of Psychology, University of Kansas, Fraser Hall, 1415 Jayhawk Boulevard, Lawrence, KS, 66045, USA
| | - Kelsey E Clark
- Department of Psychology, University of Kansas, Fraser Hall, 1415 Jayhawk Boulevard, Lawrence, KS, 66045, USA
| | - Daria A Sorokina
- Department of Psychology, University of Kansas, Fraser Hall, 1415 Jayhawk Boulevard, Lawrence, KS, 66045, USA
| | - Victoria L Perko
- Department of Psychology, University of Kansas, Fraser Hall, 1415 Jayhawk Boulevard, Lawrence, KS, 66045, USA
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22
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Abbate-Daga G, Marzola E. Psychodynamic psychotherapies for bulimia nervosa: trend and perspectives. Eat Weight Disord 2017; 22:557-558. [PMID: 28755083 DOI: 10.1007/s40519-017-0423-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
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23
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Anderson CN, Holody KJ, Flynn MA, Hussa-Farrell R. An exploratory evaluation of the feasibility, acceptability, and efficacy of the mental fitness disordered eating program in schools. Eat Disord 2017; 25:230-245. [PMID: 28441121 DOI: 10.1080/10640266.2017.1289793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The present study examines the feasibility, acceptability, and efficacy of a tiered professional development disordered eating prevention program. A pretest/posttest quasi-experimental design assessed elementary and junior high school faculty and staff's disordered eating knowledge and attitudes. Findings indicate participants experienced increased awareness of students' susceptibility to and the severity of disordered eating, increased self-efficacy about referring students to appropriate resources, and overall perceived acceptability of the training. Improved knowledge and attitudes suggest faculty and staff are better equipped to identify at-risk individuals at an early stage, increasing the likelihood of recovery from disordered eating behaviors or disordered eating.
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Affiliation(s)
- Christina N Anderson
- a Department of Communication, Languages, & Cultures , Coastal Carolina University , Conway , South Carolina , USA
| | - Kyle J Holody
- a Department of Communication, Languages, & Cultures , Coastal Carolina University , Conway , South Carolina , USA
| | - Mark A Flynn
- b English Department , Emmanuel College , Boston , Massachusetts , USA
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24
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Abstract
Dissonance-based eating disorder prevention leads to decreases in risk factors for these disorders. Although controlled trials have demonstrated that targeted, manualized programs reduce eating disorder risk, concerns regarding implementation and dissemination remain. A primary concern is the difficulty in adapting programs for a high school setting for populations at highest risk: adolescents. This paper describes the REbeL Peer Education model and assesses the initial pilot trials of the intervention. The program is novel in that it utilizes a voluntary, self-selection model that is sustainable in a high school setting, and focuses on empowerment and effective cognitive dissonance based prevention activities. High school peer-educators self-selected into the semi-manualized dissonance based intervention. Group activities were peer led, designed to critique the thin ideal, and designed to empower macro (school and larger community wide) changes in The pilot trial (N=47) assess the effectiveness and feasibility of the intervention. Results of the initial pilot study revealed preliminary support for the feasibility of the program, increases in feelings of empowerment, and decreases in eating disorder cognitions and behaviors with moderate to large effect sizes. Feedback from participants indicated that the intervention was enjoyable, educational, and empowering. This study is the first to adapt dissonance-based prevention models to a semi-manualized, peer-led, prevention program integrated into high school settings.
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25
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Balottin L, Mannarini S, Rossi M, Rossi G, Balottin U. The parental bonding in families of adolescents with anorexia: attachment representations between parents and offspring. Neuropsychiatr Dis Treat 2017; 13:319-327. [PMID: 28203082 PMCID: PMC5295792 DOI: 10.2147/ndt.s128418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The attachment theory is widely used in order to explain anorexia nervosa origin, course and treatment response. Nevertheless, very little literature specifically investigated parental bonding in adolescents with anorexia, as well as the parents' own bonding and intergenerational transmission within the family. PURPOSE This study aims to identify any specific pattern of parental bonding in families of adolescents newly diagnosed with restricting-type anorexia, comparing them to the families of the control group. PATIENTS AND METHODS A total of 168 participants, adolescents and parents (78 belonging to the anorexia group and 90 to the control one), rated the perceived parental styles on the parental bonding instrument. The latent class analysis allowed the exploration of a maternal bonding latent variable and a paternal one. RESULTS The main findings showed that a careless and overcontrolling parental style was recalled by the patients' parents, and in particular by the fathers. As far as the adolescents' responses were concerned, patients with anorexia did not seem to express differently their parental bonding perception from participants of the control group. CONCLUSION Clinical implications driven from the results suggest that a therapeutic intervention working on how the parents' own attachment representations influence current relationships may help to modify the actual family functioning and thus the outcome of patients with anorexia.
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Affiliation(s)
- Laura Balottin
- Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova
| | - Stefania Mannarini
- Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova
| | - Maura Rossi
- Child Neuropsychiatry Unit, C Mondino National Neurological Institute, Pavia
| | - Giorgio Rossi
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese
| | - Umberto Balottin
- Child Neuropsychiatry Unit, C Mondino National Neurological Institute, Pavia; Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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26
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Hill L, Peck SK, Wierenga CE, Kaye WH. Applying neurobiology to the treatment of adults with anorexia nervosa. J Eat Disord 2016; 4:31. [PMID: 27980771 PMCID: PMC5137219 DOI: 10.1186/s40337-016-0119-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/30/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Anorexia nervosa is a severe, biologically based brain disorder with significant medical complications. It is critical that new, effective treatments are developed to interrupt the persistent course of the illness due to the medical and psychological sequelae. Several psychosocial, behavioral and pharmacologic interventions have been investigated in adult anorexia nervosa; however, evidence shows that their impact is weak and treatment effects are generally small. METHOD This paper describes a new neurobiological anorexia nervosa model that shifts focus from solely external influences, such as social and family, to include internal influences that integrate genetic and neurobiological contributions, across the age span. The model serves as a theoretical structure for a new, five-day treatment, outlined in this paper, targeting anorexia nervosa temperament, which integrates neurobiological dimensions into evidence-based treatment interventions. The treatment is in two phases. Phase I is a five day, 40 hour treatment for anorexia nervosa adults. Phase II is the follow-up and is currently being developed. RESULTS Preliminary qualitative acceptability data on 37 adults with anorexia nervosa and 60 supports (e.g., spouses, parents, aunts, friends, partners, children of anorexia nervosa adults) are promising from Phase I. Clients with anorexia nervosa and their supports report that learning neurobiological facts improved their understanding of the illness and helped equip them with better tools to manage anorexia nervosa traits and symptoms. In addition, nutritional knowledge changed significantly. CONCLUSIONS This is the first neurobiologically based, five-day treatment for adults with anorexia nervosa and their supports. It is a new model that outlines underlying genetic and neurobiological contributions to anorexia nervosa that serves as a foundation to treat both traits and symptoms. Preliminary qualitative findings are promising, with both clients and supports reporting that the neurobiological treatment approach helped them better understand the illness, while better conceptualizing how to respond to their traits and manage their symptoms. Data in Phase I shows promise as a neurobiologically based intervention for anorexia nervosa, and it serves as a foundation for the development of Phase II. Evidence of ongoing program efficacy will be described as data are reported on Phase II. TRIAL REGISTRATION NCT NCT02852538 Registered 1 August 2016.
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Affiliation(s)
- Laura Hill
- The Center for Balanced Living, 8001 Ravines Edge Court, Suite 201, Columbus, OH 43235 USA
| | | | | | - Walter H. Kaye
- Department of Psychiatry, University of California San Diego, San Diego, CA USA
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Fichter MM, Quadflieg N. Mortality in eating disorders - results of a large prospective clinical longitudinal study. Int J Eat Disord 2016; 49:391-401. [PMID: 26767344 DOI: 10.1002/eat.22501] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report on long-term mortality in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and eating disorder not otherwise specified (ED-NOS), causes of death, and predictors of early death. METHOD A large sample of consecutively admitted inpatients (N = 5,839) was followed-up on vital status through the German civil registry office. Of these patients 1,639 were treated for AN, 1,930 for BN, 363 for BED, and 1,907 for ED-NOS. Data from the main inpatient hospital treatment were applied to bivariate and multivariate Cox regression analyses on survival time from onset of eating disorder to death or end of observation. Standardized mortality ratios (SMR) were computed matched for age, gender, and person-years. RESULTS SMR were 5.35 for AN, 1.49 for BN, 1.50 for BED, 2.39 for narrowly defined ED-NOS, and 1.70 for widely defined ED-NOS. Patients with AN died earlier than patients with BN, BED, or ED-NOS who did not differ. A diagnosis of AN, chronicity, later age of onset, not living in a relationship, and an irregular type of discharge from index inpatient treatment were major predictors of a shorter time to death. Suicidality was a univariate predictor of a shorter time to death in BN only. AN patients mostly died from natural causes related to their eating disorder. DISCUSSION Mortality in AN is excessive and considerably higher than in BN, BED, and ED-NOS.
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Affiliation(s)
- Manfred Maximilian Fichter
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU), Munich, 80336, Germany.,Schön Klinik Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), Prien, 83209, Germany
| | - Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU), Munich, 80336, Germany
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Kameoka N, Iga JI, Tamaru M, Tominaga T, Kubo H, Watanabe SY, Sumitani S, Tomotake M, Ohmori T. Risk factors for refeeding hypophosphatemia in Japanese inpatients with anorexia nervosa. Int J Eat Disord 2016; 49:402-6. [PMID: 26446402 DOI: 10.1002/eat.22472] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Refeeding in patients with anorexia nervosa (AN) is associated with a risk of refeeding syndrome, which is a disruption in metabolism with a variety of features including hypophosphatemia. We evaluated the risk factors for refeeding hypophosphatemia (RH) during nutritional replenishment in Japanese patients with AN. METHODS We retrospectively examined clinical data for 99 female inpatients (mean age 30.9 ± 10.7 years; range, 9 - 56 years). RESULTS RH (phosphate < 2.3 mg/dL) occurred within 4.8 ± 3.7 days of hospital admission and was still observed at 28 days after admission in 21 of the 99 cases (21.2%). Oral or intravenous phosphate was given to some patients to treat or prevent RH. Patients with RH had a significantly lower body mass index, were older, and had higher blood urea nitrogen than those without RH. Severe complications associated with RH were recorded in only one patient who showed convulsions and disturbed consciousness at Day 3 when her serum phosphate level was 1.6 mg/dL. CONCLUSIONS The significant risk factors for RH that we identified were lower body mass index, older age, and higher blood urea nitrogen at admission. No significant difference in total energy intake was seen between the RH and no RH groups, suggesting that RH may not be entirely correlated with energy intake. Precisely predicting and preventing RH is difficult, even in patients with AN who are given phosphate for prophylaxis. Thus, serum phosphate levels should be monitored for more than 5 days after admission.
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Affiliation(s)
- Naomi Kameoka
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima, 770-8503, Japan
| | - Jun-ichi Iga
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima, 770-8503, Japan
| | - Mai Tamaru
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima, 770-8503, Japan
| | - Takeo Tominaga
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima, 770-8503, Japan
| | - Hiroko Kubo
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima, 770-8503, Japan
| | - Shin-Ya Watanabe
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima, 770-8503, Japan
| | - Satsuki Sumitani
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima, 770-8503, Japan
| | - Masahito Tomotake
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima, 770-8503, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima, 770-8503, Japan
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Södersten P, Bergh C, Leon M, Zandian M. Dopamine and anorexia nervosa. Neurosci Biobehav Rev 2016; 60:26-30. [DOI: 10.1016/j.neubiorev.2015.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/30/2015] [Accepted: 11/01/2015] [Indexed: 01/13/2023]
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