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Ghosh S, Burger P, Simeunovic-Ostojic M, Maas J, Petković M. Review of machine learning solutions for eating disorders. Int J Med Inform 2024; 189:105526. [PMID: 38935998 DOI: 10.1016/j.ijmedinf.2024.105526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Eating Disorders (EDs) are one of the most complex psychiatric disorders, with significant impairment of psychological and physical health, and psychosocial functioning, and are associated with low rates of early detection, low recovery and high relapse rates. This underscores the need for better diagnostic and treatment methods. OBJECTIVE This narrative review explores current Machine Learning (ML) and Artificial Intelligence (AI) applications in the domain of EDs, with a specific emphasis on clinical management in treatment settings. The primary objective are to (i) decrease the knowledge gap between ED researchers and AI-practitioners, by presenting the current state-of-the-art AI applications (including models for causality) in different ED use-cases; (ii) identify limitations of these existing AI interventions and how to address them. RESULTS AI/ML methods have been applied in different ED use-cases, including ED risk factor identification and incidence prediction (including the analysis of social media content in the general population), diagnosis, monitoring patients and treatment response and prognosis in clinical populations. A comparative analysis of AI-techniques deployed in these use-cases have been performed, considering factors such as complexity, flexibility, functionality, explainability and adaptability to healthcare constraints. CONCLUSION Multiple restrictions have been identified in the existing methods in ML and Causality in terms of achieving actionable healthcare for ED, like lack of good quality and quantity of data for models to train on, while requiring models to be flexible, high-performing, yet being explainable and producing counterfactual explanations, for ensuring the fairness and trustworthiness of its decisions. We conclude that to overcome these limitations and for future AI research and application in clinical management of ED, (i) careful considerations are required with regards to AI-model selection, and (ii) joint efforts from ED researcher and patient community are essential in building better quality and quantity of dedicated ED datasets and secure AI-solution framework.
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Affiliation(s)
- Sreejita Ghosh
- Dept. M & CS, Technical University of Eindhoven, Groene Loper 5, 5612 AZ Eindhoven, the Netherlands.
| | - Pia Burger
- Center of Eating Disorders, GGZ Oost-Brabant, Wesselmanlaan 25a, 5707 HA Helmond, the Netherlands.
| | | | - Joyce Maas
- Center of Eating Disorders, GGZ Oost-Brabant, Wesselmanlaan 25a, 5707 HA Helmond, the Netherlands; Dept. Medical and Clinical Psychology, Tilburg University, Prof. Cobbenhagenlaan, 5037 AB Tilburg, the Netherlands
| | - Milan Petković
- Dept. M & CS, Technical University of Eindhoven, Groene Loper 5, 5612 AZ Eindhoven, the Netherlands; Philips Hospital Patient Monitoring, High Tech Campus 34, 5656 AE Eindhoven, the Netherlands
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Choquette EM, Flux MC, Moseman SE, Chappelle S, Naegele J, Upshaw V, Morton A, Paulus MP, Feinstein JS, Khalsa SS. The impact of floatation therapy on body image and anxiety in anorexia nervosa: a randomised clinical efficacy trial. EClinicalMedicine 2023; 64:102173. [PMID: 37936658 PMCID: PMC10626164 DOI: 10.1016/j.eclinm.2023.102173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 11/09/2023] Open
Abstract
Background Body image disturbance and anxiety are core features of anorexia nervosa (AN), a psychiatric disorder with one of the highest mortality rates. This study examined the efficacy of a novel non-pharmacological treatment, floatation-REST (Reduced Environmental Stimulation Therapy) on body image disturbance and anxiety in inpatients with AN. Methods This parallel group randomised controlled trial compared floatation-REST vs. care as usual in women and girls hospitalised for treatment of AN in Tulsa, Oklahoma, USA. Participants were randomised on a 2:1 ratio to receive eight, twice-weekly, 60-min floatation-REST sessions for 4 weeks, in addition to care as usual, or to receive care as usual. The primary outcome was the average change in body dissatisfaction from pre- to post-float as measured by the Photographic Figure Rating Scale. The secondary outcome was the average change in anxiety from pre- to post-float as measured by the state version of the State Trait Anxiety Inventory. Longitudinal effects of floatation-REST on body dissatisfaction were also examined. All analyses were conducted using the intention-to-treat principle. Planned linear mixed models tested the effect of floatation-REST vs. care as usual. The trial was preregistered (clinicaltrials.govNCT03610451). Findings Between March 16, 2018 and February 25, 2021, 133 participants were screened for eligibility, and 86 were consented. Eighteen were excluded after consent, for a final randomisation sample of 68 participants (45 floatation-REST; 23 care as usual). There were two session by condition interactions on body dissatisfaction (p = 0.00026) and state anxiety (p < 0.0001), such that the floatation-REST group exhibited acute (i.e., pre- to post-session) reductions in body dissatisfaction (floatation-REST group mean change (Δm) = -0.43; 95% CI -0.56 to -0.30, p < 0.0001, Cohen's d = 0.23), and acute reductions in anxiety (floatation-REST group Δm = -15.75; 95% CI -17.95 to -13.56, p < 0.0001, Cohen's d = 1.52); however, the care as usual group exhibited no significant changes. With regard to longitudinal results, there was a significant time by treatment interaction between baseline and immediately post intervention (p = 0.012) and baseline and six-month follow up (p = 0.0019). At immediately post intervention, there was a trending reduction in body dissatisfaction for the floatation-REST group (Δm = -0.41, 95% CI -0.86 to 0.03, p = 0.068) and care as usual group (Δm = 0.61; 95% CI -0.04 to 1.27, p = 0.070). At six-months post-intervention, the floatation-REST group exhibited lower body dissatisfaction (Δm = -0.91; 95% CI -1.37 to -0.45, p = 0.0020, Cohen's d = 0.53) whereas the care as usual group reported no change in body dissatisfaction (Δm = 0.35; 95% CI -0.28 to 0.98, p = 0.96) relative to baseline. There were no adverse events related to the trial during the study. Interpretation Our findings suggest that Floatation-REST decreased body dissatisfaction compared to care as usual acutely after each float session and at six-month follow-up. Floatation-REST has potential utility for the treatment of body image disturbance and anxiety in AN. These results may be limited by some generalisability concerns given the recruitment of a modest sample receiving inpatient treatment at a single site. Funding The William K. Warren Foundation.
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Affiliation(s)
| | | | - Scott E. Moseman
- Laureate Eating Disorders Program, Saint Francis Health System, Tulsa, Oklahoma, USA
| | | | | | - Valerie Upshaw
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Alexa Morton
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, USA
| | - Justin S. Feinstein
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Float Research Collective, Kihei, Hawaii, USA
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, USA
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Brooks J, Walker DC, Murray K. What can my body do for me? Guided body-functionality mirror gazing task improved college women's body appreciation and body functionality orientation. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-10. [PMID: 37207308 DOI: 10.1080/07448481.2023.2209195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/30/2023] [Accepted: 04/23/2023] [Indexed: 05/21/2023]
Abstract
Objective: Focusing on body functionality - what the body can do - may benefit women's body image. This pilot study examined the effects of focusing on body functionality appreciation during an audio-guided mirror gazing task (F-MGT). Participants: 101 college women, M(SD)AGE = 19.49(1.31), were alternately assigned to F-MGT or a comparison with no guidance on how to examine the body, directed attention mirror gazing task (DA-MGT). Methods: Participants self-reported pre- and post-MGT body appreciation, state appearance satisfaction, and orientation to and satisfaction with physical functionality. Results: Group interactions were significant for body appreciation and functionality orientation. DA-MGT decreased body appreciation from pre- to post-MGT; F-MGT did not change. There were no significant interactions in post-MGT state appearance satisfaction or functionality satisfaction, though state appearance satisfaction increased significantly in F-MGT. Conclusions: Integrating body functionality may buffer against harmful effects of mirror gazing. Given F-MGT's brevity, additional work must assess its potential as an intervention technique.
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Affiliation(s)
- Julia Brooks
- Union College Psychology Department, Union College, Schenectady, New York, USA
| | - D Catherine Walker
- Union College Psychology Department, Union College, Schenectady, New York, USA
| | - Kristen Murray
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
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Schreyer CC, Pletch A, Vanzhula IA, Guarda AS. Evaluating individual- and sample-level response to treatment for inpatients with eating disorders: Is change clinically significant? Int J Eat Disord 2023; 56:452-457. [PMID: 36300553 DOI: 10.1002/eat.23842] [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: 05/25/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Evaluating treatment efficacy solely on whether sample-level change is statistically significant does not indicate whether clinically significant change (CSC) has occurred at the individual-level. We assessed whether change in measures of eating disorder psychopathology was statistically significant at the sample-level and clinically significant at the individual-level for inpatients treated in a hospital-based eating disorder program. METHOD Participants (N = 143) were consecutive underweight distinct admissions diagnosed with anorexia nervosa or other specified feeding and eating disorder. The Eating Disorder Examination Questionnaire (EDEQ) and Eating Disorder Recovery Self-efficacy Questionnaire (EDRSQ) were assessed at admission and program discharge. CSC was defined as individual score change that was both statistically reliable and shifted from dysfunctional to normative. RESULTS Mean EDRSQ and EDEQ scores significantly improved with treatment across the sample; effect sizes were moderate to large. Individual-level analyses demonstrated that 85%, 50%, and 20-35% of participants had CSC or statistically reliable change in BMI, eating symptomatology, and body image respectively. One-third of participants showed CSC on BMI and on at least one self-report measure. DISCUSSION Individual-level analyses offer more nuanced outcome data that could identify patients at higher risk of relapse who may benefit from adjunctive interventions during or immediately post-discharge. PUBLIC SIGNIFICANCE STATEMENT This study examined change in eating pathology for inpatients with eating disorders using sample- and individual-level analyses, including whether change was statistically reliable and clinically significant (scores statistically improved and moved into the healthy range). Only half of patients responded robustly to treatment, which may be related to high relapse rates following discharge. Individual-level analyses provided a detailed view of treatment response and may identify patients at higher relapse risk.
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Affiliation(s)
| | - Allisyn Pletch
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Irina A Vanzhula
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angela S Guarda
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Flatt RE, Thornton LM, Smith T, Mitchell H, Argue S, Baucom BRW, Deboeck PR, Adamo C, Kilshaw RE, Shi Q, Tregarthen J, Butner JE, Bulik CM. Retention, engagement, and binge-eating outcomes: Evaluating feasibility of the Binge-Eating Genetics Initiative study. Int J Eat Disord 2022; 55:1031-1041. [PMID: 35502471 PMCID: PMC9357123 DOI: 10.1002/eat.23726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Using preliminary data from the Binge-Eating Genetics Initiative (BEGIN), we evaluated the feasibility of delivering an eating disorder digital app, Recovery Record, through smartphone and wearable technology for individuals with binge-type eating disorders. METHODS Participants (n = 170; 96% female) between 18 and 45 years old with lived experience of binge-eating disorder or bulimia nervosa and current binge-eating episodes were recruited through the Recovery Record app. They were randomized into a Watch (first-generation Apple Watch + iPhone) or iPhone group; they engaged with the app over 30 days and completed baseline and endpoint surveys. Retention, engagement, and associations between severity of illness and engagement were evaluated. RESULTS Significantly more participants in the Watch group completed the study (p = .045); this group had greater engagement than the iPhone group (p's < .05; pseudo-R2 McFadden effect size = .01-.34). Overall, binge-eating episodes, reported for the previous 28 days, were significantly reduced from baseline (mean = 12.3) to endpoint (mean = 6.4): most participants in the Watch (60%) and iPhone (66%) groups reported reduced binge-eating episodes from baseline to endpoint. There were no significant group differences across measures of binge eating. In the Watch group, participants with fewer episodes of binge eating at baseline were more engaged (p's < .05; pseudo-R2 McFadden = .01-.02). Engagement did not significantly predict binge eating at endpoint nor change in binge-eating episodes from baseline to endpoint for both the Watch and iPhone groups. DISCUSSION Using wearable technology alongside iPhones to deliver an eating disorder app may improve study completion and app engagement compared with using iPhones alone.
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Affiliation(s)
- Rachael E. Flatt
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Psychology and NeuroscienceUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Laura M. Thornton
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Tosha Smith
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Hannah Mitchell
- Department of PsychologyEast Tennessee State UniversityJohnson CityTennesseeUSA
| | | | | | | | - Colin Adamo
- Department of PsychologyUniversity of UtahSalt Lake CityUtahUSA
| | | | - Qinxin Shi
- Department of PsychologyUniversity of UtahSalt Lake CityUtahUSA
| | | | | | - Cynthia M. Bulik
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
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Walker DC, Murray K. A Pilot Clinical Case Series of Functionality-Focused Mirror Exposure in Women With Clinically Elevated Body Dissatisfaction. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kinkel-Ram SS, Grunewald W, Ortiz SN, Magee JM, Smith AR. Examining weekly relationships between obsessive-compulsive and eating disorder symptoms. J Affect Disord 2022; 298:9-16. [PMID: 34728287 DOI: 10.1016/j.jad.2021.10.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite the severity and high rate of co-occurrence between eating disorders (ED) and obsessive-compulsive disorder (OCD), less is known regarding the longitudinal sequencing of their comorbidity and whether and how their symptoms may influence one another over time. The current study sought to answer these questions by testing if a bidirectional, longitudinal relationship exists between ED symptoms and OCD obsessions and compulsions. METHODS We examined the relationship between ED symptoms, obsessions and compulsions across five time points, each one week apart using auto-regressive cross-lagged panel modeling. The final sample consisted of 358 individuals from the community with moderate levels of ED and OCD symptoms, the majority of whom identified as White and male. RESULTS Bivariate correlations revealed that ED symptoms, obsessions and compulsions were associated with one another across the five weeks. Two cross-lagged panel models indicated that ED symptoms predicted OCD symptoms at numerous time points and vice versa. However, we found this significant longitudinal associations across only certain weeks. Notably, the models found that only ED symptoms and OCD obsessions predicted one another across different time points across the five weeks; ED symptoms and OCD compulsions did not predict one another. LIMITATIONS Due to the non-clinical nature of the sample, there is limited generalizability to clinical populations. CONCLUSIONS Our results provide preliminary evidence that there is a bidirectional, longitudinal relationship between ED symptoms and OCD symptoms among a community sample, particularly with respect to cognitive as opposed to behavioral symptoms.
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Affiliation(s)
- Shruti S Kinkel-Ram
- Department of Psychology, Miami University, 90 Patterson Avenue, Oxford, OH, United States.
| | - William Grunewald
- Department of Psychology, Auburn University, Auburn, AL, United States
| | - Shelby N Ortiz
- Department of Psychology, Miami University, 90 Patterson Avenue, Oxford, OH, United States
| | - Joshua M Magee
- Department of Psychology, Miami University, 90 Patterson Avenue, Oxford, OH, United States
| | - April R Smith
- Department of Psychology, Auburn University, Auburn, AL, United States
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Wu YK, Brownley KA, Bardone-Cone AM, Bulik CM, Baker JH. Associations of Stress and Appetite Hormones with Binge Eating in Females with Anorexia Nervosa after Weight Restoration: A Longitudinal Study. J Pers Med 2021; 11:jpm11101020. [PMID: 34683161 PMCID: PMC8538976 DOI: 10.3390/jpm11101020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/29/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023] Open
Abstract
Binge eating is a transdiagnostic eating disorder symptom that can occur in patients with anorexia nervosa (AN), persisting after weight restoration, and impeding their recovery. However, little is known about the biological predictors of binge eating after AN weight restoration. The goals of this exploratory study of 73 females with AN were: (1) to examine changes in cortisol, the adrenocorticotropic hormone, norepinephrine, ghrelin (total and active), and leptin levels across the admission, discharge, and 3 months post-discharge from the inpatient AN weight restoration; and (2) to determine whether the target hormones were associated with objective or subjective binge eating (OBE or SBE). The participants completed the self-reported Eating Disorder Examination Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory-II, and provided fasting whole blood samples for hormone assays. The results showed significant changes in body mass index (BMI), cortisol, total ghrelin, and leptin levels over the three time points. The cortisol levels at admission and discharge were significantly associated with the number of SBE episodes at 3 months post-discharge. Findings suggest the need to replicate and confirm the role of cortisol in predicting the emergence of SBE and uncover the mechanisms underlying SBE and cortisol to prevent SBE and its negative consequences.
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Affiliation(s)
- Ya-Ke Wu
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.A.B.); (C.M.B.)
| | - Kimberly A. Brownley
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.A.B.); (C.M.B.)
| | - Anna M. Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.A.B.); (C.M.B.)
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jessica H. Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.A.B.); (C.M.B.)
- Correspondence: ; Tel.: +1-984-974-3834
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Change in normative eating self-efficacy is associated with six-month weight restoration following inpatient treatment for anorexia nervosa. Eat Behav 2021; 42:101518. [PMID: 33989938 DOI: 10.1016/j.eatbeh.2021.101518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 11/22/2022]
Abstract
Anorexia nervosa (AN) is a disorder characterized by rigid and restrictive eating behaviors, resulting in significantly low body weight. While specialized behavioral intensive treatment programs can reliably support individuals with AN to normalize eating and weight control behaviors and achieve weight restoration, prognostic factors predicting relapse following treatment are unclear. We examined whether changes in (i) normative eating self-efficacy, (ii) body image self-efficacy, (iii) drive for thinness, and (iv) body dissatisfaction from inpatient admission to six-month follow-up were associated with weight restoration status at program discharge and at six-month follow-up. The sample comprised 146 participants with AN admitted to a meal-based inpatient-partial hospitalization program. Participants completed questionnaires at inpatient admission and six months following program discharge. Additionally, at follow-up, participants reported the frequency of engaging in normalized eating behaviors since discharge (e.g. eating with others and preparing a balanced meal). The majority (73.3%) of participants attained a BMI > 19 at discharge and 59.6% were weight restored at six-month follow-up. Change in normative eating self-efficacy was significantly associated with weight restoration at follow-up, whereas change in body image self-efficacy, drive for thinness, and body dissatisfaction were not. For each one unit increase in normative eating self-efficacy, patients were 4.65 times more likely to be weight restored at follow-up (p = .002). Additionally, individuals reporting a higher frequency of normalized eating behaviors at follow-up were more likely to be weight restored. Normative eating self-efficacy and normalized eating behaviors may represent vital treatment targets for relapse prevention interventions for this high-risk population.
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Lindgreen P, Lomborg K, Clausen L. Patient use of a self-monitoring app during eating disorder treatment: Naturalistic longitudinal cohort study. Brain Behav 2021; 11:e02039. [PMID: 33459532 PMCID: PMC8035428 DOI: 10.1002/brb3.2039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore patients' use of the self-monitoring app Recovery Record during 26 weeks of naturalistic eating disorder treatment. METHODS Selected patient characteristics at baseline were explored as predictors of app use using linear regression. Patients were grouped according to diagnosis (anorexia versus bulimia), and mixed-effects analyses were used to explore differences in app use between diagnoses across four time periods (weeks 1-4; weeks 5-8; weeks 9-12; weeks 13-26). RESULTS Eighty-four patients were included of which 41 had anorexia and 43 had bulimia. The total number of logs varied greatly (mean (SD): 592 (628.50)), and patient app activity almost ceased at week 13. Increasing age and no previous eating disorder treatment predicted increased app activity (p = .007; p = .039, respectively). Patients with anorexia logged over four times more often than patients with bulimia in the last time period (median (CI): 4.27 (1.28;14.31); p = .018). Time predicted declining app use (all p ≤ .007). CONCLUSION Future research on long-term app engagement should investigate associations between patients' app use and changes in their eating disorder symptom severity over time.
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Affiliation(s)
- Pil Lindgreen
- Department of Child and Adolescent PsychiatryAarhus University HospitalAarhusDenmark
| | - Kirsten Lomborg
- Clinical ResearchSteno Diabetes Center CopenhagenGentofteDenmark
- Department of Clinical MedicineFaculty of HealthAarhus UniversityAarhusDenmark
| | - Loa Clausen
- Department of Child and Adolescent PsychiatryAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineFaculty of HealthAarhus UniversityAarhusDenmark
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Chapa DAN, Kite BA, Forbush KT, Tregarthen JP, Argue S. Eating-disorder psychopathology and driven exercise change models: A latent change score analysis. Int J Eat Disord 2020; 53:2013-2025. [PMID: 33141971 DOI: 10.1002/eat.23392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Approximately 50% of people with eating disorders (EDs) engage in driven exercise to influence their weight or shape and/or to compensate for loss-of-control eating. When present, driven exercise is associated with a lower quality-of-life, longer hospital stays, and faster rates-of-relapse. Despite the seriousness of driven exercise, most treatments for EDs do not target maladaptive exercise behaviors directly. Given the large proportion of patients with an ED who engage in driven exercise and its effect on treatment outcomes, it is critical to understand what predicts change in driven exercise. The purpose of this study was to test whether ED symptoms prospectively predicted change in driven exercise and vice versa. METHOD Participants were Recovery Record (RR) users (N = 4,568; 86.8% female) seeking treatment for an ED. Participants completed the Eating Pathology Symptoms Inventory (EPSI) monthly for 3 months. RESULTS In the full sample, dynamic bivariate latent change score analyses indicated that high levels of dietary restraint and restricting prospectively predicted reductions in driven exercise. Among persons with anorexia nervosa (AN), high levels of binge eating predicted increased driven exercise. Among persons with bulimia nervosa (BN), high levels of body dissatisfaction predicted increased driven exercise. Among persons with binge-eating disorder (BED), high levels of binge eating, purging, and restricting predicted reductions in driven exercise. DISCUSSION Results highlight changes that may predict increased or decreased driven exercise relative to other ED symptoms for AN, BN, and BED groups. These preliminary findings could inform future research on ED treatment efforts to manage driven exercise.
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Affiliation(s)
| | - Benjamin A Kite
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Stuart Argue
- Recovery Record, Inc, Palo Alto, California, USA
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