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Neipp MC, Ruiz Á, Manchón J, León-Zarceño E, Quiles MJ, Quiles Y. Quality of Life and Clinical Impairment in Spanish Adolescent Anorexia Nervosa Patients. Eur J Investig Health Psychol Educ 2024; 14:1425-1436. [PMID: 38785592 PMCID: PMC11120447 DOI: 10.3390/ejihpe14050094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Eating disorders have serious physical, mental and social consequences that can affect the quality of life of the sufferer. This study aimed to evaluate the relationship between the severity of ED-related psychopathology and clinical impairment in adolescents with anorexia nervosa (AN) as well as their perception of health-related quality of life. Eighty-six Spanish young women with AN completed a set of questionnaires assessing eating disorder pathology, clinical impairment, and quality of life. The set included the following instruments: the Eating Disorder Examination Questionnaire, Clinical Impairment Assessment, Short Form-12 Item Health Survey, and the Eating Disorder-Specific Heath-Related Quality of Life instrument. Descriptive and regression analyses were applied to identify associations between variables. Higher scores on clinical impairment domains were associated with greater impairment of mental and physical health. Moreover, clinical impairment domains and concerns due to ED were related to a lower quality of life. In conclusion, adolescents with AN have a poor quality of life. Moreover, the findings suggest that the clinical features of impairment may serve as severity indicators of quality of life.
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Affiliation(s)
- Marie-Carmen Neipp
- Department of Health Psychology, University of Miguel Hernández, 03202 Elche, Spain
| | - Álvaro Ruiz
- Department of Behavioural Sciences and Health, University of Miguel Hernández, 03202 Elche, Spain; (Á.R.); (J.M.); (E.L.-Z.); (M.J.Q.); (Y.Q.)
| | - Javier Manchón
- Department of Behavioural Sciences and Health, University of Miguel Hernández, 03202 Elche, Spain; (Á.R.); (J.M.); (E.L.-Z.); (M.J.Q.); (Y.Q.)
| | - Eva León-Zarceño
- Department of Behavioural Sciences and Health, University of Miguel Hernández, 03202 Elche, Spain; (Á.R.); (J.M.); (E.L.-Z.); (M.J.Q.); (Y.Q.)
| | - María José Quiles
- Department of Behavioural Sciences and Health, University of Miguel Hernández, 03202 Elche, Spain; (Á.R.); (J.M.); (E.L.-Z.); (M.J.Q.); (Y.Q.)
| | - Yolanda Quiles
- Department of Behavioural Sciences and Health, University of Miguel Hernández, 03202 Elche, Spain; (Á.R.); (J.M.); (E.L.-Z.); (M.J.Q.); (Y.Q.)
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2
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Kalika E, Hussain M, Egan H, Mantzios M. Exploring the moderating role of mindfulness, mindful eating, and self-compassion on the relationship between eating-disordered quality of life and orthorexia nervosa. Eat Weight Disord 2023; 28:18. [PMID: 36808014 PMCID: PMC9941235 DOI: 10.1007/s40519-023-01542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/12/2023] [Indexed: 02/23/2023] Open
Abstract
Orthorexia nervosa (ON) is characterised by an obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore mindfulness, mindful eating, self-compassion and quality of life in a female population. Two hundred eighty-eight participants completed Orthorexia, Self-Compassion, Mindful eating, Mindfulness and Eating Disorder Quality of Life scales. The results indicated that there was a negative relationship between ON and mindfulness, self-compassion and mindful eating. Furthermore, the present study found a positive relationship between lower quality of life and ON, while findings indicated that self-compassion and the awareness facet of mindfulness moderated the relationship between ON and QOL. The present results contribute to a better understanding of orthorexic eating behaviours in a female population, and identify the moderating capacity of self-compassion and mindfulness. Further implications and future directions are discussed.Level of evidence Level V, cross-sectional descriptive study.
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Affiliation(s)
- Eliza Kalika
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK.
| | - Misba Hussain
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK
| | - Helen Egan
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK
| | - Michail Mantzios
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK
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3
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Temizer R, Chen YW, Aoki C. Individual differences in the positive outcome from adolescent ketamine treatment in a female mouse model of anorexia nervosa involve drebrin A at excitatory synapses of the medial prefrontal cortex. Synapse 2023; 77:e22253. [PMID: 36121749 PMCID: PMC9691557 DOI: 10.1002/syn.22253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/16/2022] [Accepted: 09/04/2022] [Indexed: 01/29/2023]
Abstract
Anorexia nervosa (AN) is a mental illness with the highest rates of mortality and relapse, and no approved pharmacological treatment. Using an animal model of AN, called activity-based anorexia (ABA), we showed earlier that a single intraperitoneal injection of ketamine at a dose of 30 mg/kg (30mgKET), but not 3 mg/kg (3mgKET), has a long-lasting effect upon adolescent females of ameliorating anorexia-like symptoms through the following changes: enhanced food consumption and body weight; reduced running and anxiety-like behavior. However, there were also individual differences in the drug's efficacy. We hypothesized that individual differences in ketamine's ameliorative effects involve drebrin A, an F-actin-binding protein known to be required for the activity-dependent trafficking of NMDA receptors (NMDARs). We tested this hypothesis by electron microscopic quantifications of drebrin A immunoreactivity at excitatory synapses of pyramidal neurons (PN) and GABAergic interneurons (GABA-IN) in deep layer 1 of prefrontal cortex (PFC) of these mice. Results reveal that (1) the areal density of excitatory synapses on GABA-IN is greater for the 30mgKET group than the 3mgKET group; (2) the proportion of drebrin A+ excitatory synapses is greater for both PN and GABA-IN of 30mgKET than 3mgKET group. Correlation analyses with behavioral measurements revealed that (3) 30mgKET's protection is associated with reduced levels of drebrin A in the cytoplasm of GABA-IN and higher levels at extrasynaptic membranous sites of PN and GABA-IN; (5) altogether pointing to 30mgKET-induced homeostatic plasticity that engages drebrin A at excitatory synapses of both PN and GABA-IN.
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Affiliation(s)
- Rose Temizer
- Center for Neural Science, New York University, New York City, New York, USA
| | - Yi-Wen Chen
- Center for Neural Science, New York University, New York City, New York, USA
| | - Chiye Aoki
- Center for Neural Science, New York University, New York City, New York, USA
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4
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Vivarini P, Jenkins ZM, Castle DJ, Gwee K. Borderline personality disorder symptoms in individuals with eating disorder: Association with severity, psychological distress, and psychosocial function. Personal Ment Health 2022; 17:109-116. [PMID: 36038988 DOI: 10.1002/pmh.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/24/2022] [Accepted: 08/21/2022] [Indexed: 11/07/2022]
Abstract
We aimed to determine the prevalence of borderline personality disorder (BPD) symptoms in a sample of eating disorder (ED) outpatients and assess how BPD symptoms correlate with severity, distress, and function. A total of 119 individuals were assessed and divided into high BPD symptoms (H-BPD) and low BPD symptoms (L-BPD) using a cut-off score of seven on the McLean Screening for Borderline Personality Disorder (MSI-BPD). Groups were compared on ED diagnosis, age at ED onset, age at assessment, illness duration, body mass index (BMI), ED symptomatology, psychological distress, and psychosocial function. Correlation analyses were performed to assess the relationship between BPD symptoms and these variables. The 45.4% of the participants scored ≥7 on the MSI-BPD, indicating a diagnosis of BPD. There were no differences between the H-BPD (N = 54) and L-BPD (N = 65) groups on age at onset, age at assessment, duration of illness, BMI, or proportion of ED diagnosis. The H-BPD group reported significantly higher ED symptomatology, psychological distress, and poorer psychosocial functioning. MSI-BPD scores were positively associated with these variables. This study suggests a high prevalence of BPD symptoms within outpatients seeking ED treatment, and use of a brief screening instrument for BPD in this group may contribute to a greater understanding of the patient.
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Affiliation(s)
- Prudence Vivarini
- Mental Health Service, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Zoe M Jenkins
- Mental Health Service, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - David J Castle
- Mental Health Service, St Vincent's Hospital, Melbourne, Victoria, Australia
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Karen Gwee
- Mental Health Service, St Vincent's Hospital, Melbourne, Victoria, Australia
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5
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The longitudinal links between shame, eating disorders and social anxiety symptoms: a cross-lagged panel analysis. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03513-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mack RA, Stanton CE. Responding to "Terminal anorexia nervosa: three cases and proposed clinical characteristics". J Eat Disord 2022; 10:87. [PMID: 35752866 PMCID: PMC9233818 DOI: 10.1186/s40337-022-00612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
The treatment of eating disorders raises many ethical debates given the pervasiveness with which this illness impacts individuals, especially as the length of time with the illness increases. A recent case study supported the appropriateness of pursuing medical aid in dying for individuals with eating disorders who wish to end their fight with their disorder. This correspondence raises concerns related to this controversial proposal as the current authors dispute that the use of medical aid in dying for individuals with eating disorders is ethically judicious or appropriate. Additionally, this correspondence highlights additional treatment implications that should be considered when trying to provide individuals with eating disorders with the best evidence-based care possible, with the goal of promoting steps toward recovery.
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Affiliation(s)
- Rebekah A Mack
- The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | - Caroline E Stanton
- The Medical University of South Carolina, 151 Rutledge Ave, Charleston, SC, 29425, USA
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7
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Meneguzzo P, Todisco P, Calonaci S, Mancini C, Dal Brun D, Collantoni E, Donini LM, Tenconi E, Favaro A. Health-related quality of life assessment in eating disorders: adjustment and validation of a specific scale with the inclusion of an interpersonal domain. Eat Weight Disord 2021; 26:2251-2262. [PMID: 33315213 PMCID: PMC8437832 DOI: 10.1007/s40519-020-01081-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Quality of life is a fundamental aspect of both clinical practice and research on eating disorders (ED) due to the significant impacts these disorders have on everyday life. Disorder-specific scales can improve the quality of research and findings and offer greater sensitivity and responsiveness. However, no specific instrument is available in Italian for ED. The aim of this paper is to adjust and to validate a reliable scale with specific items regarding physical and interpersonal well-being. METHODS The Italian version of the Eating Disorder Quality of Life (IEDQOL) scale was developed, on the basis of the original English scale, with the addition of items pertaining to physical well-being and interpersonal interactions. In this study, 180 ED patients and 190 healthy controls from the community were enrolled both from inpatient units and outpatient services. A statistical analysis with an exploratory factorial approach was performed in order to validate the tool. RESULTS The results showed that the IEDQOL has very good psychometric properties with test-retest validity and sensitivity between patients and controls (d = 2.17 for total score). Moreover, the interpersonal domain showed excellent psychometric values (Cronbach's α > 0.70 in all the subgroups) and a robust correlation with other quality of life constructs. CONCLUSION Future studies on the Italian population should use IEDQOL as outcome element that can be useful also with other disorder-specific psychopathological constructs and corroborate the reliability of the data. Future research in the ED field should only use this specific tool. LEVEL OF EVIDENCE Case-control analytic study, Level III.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padua, Italy. .,Eating Disorders Unit, Casa Di Cura "Villa Margherita", Arcugnano, VI, Italy.
| | - Patrizia Todisco
- Eating Disorders Unit, Casa Di Cura "Villa Margherita", Arcugnano, VI, Italy
| | - Sofia Calonaci
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padua, Italy
| | - Cecilia Mancini
- Experimental Medicine Department, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, Rome, Italy
| | - David Dal Brun
- Department of Linguistic and Literary Studies, University of Padova, Padua, Italy
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padua, Italy
| | - Lorenzo Maria Donini
- Experimental Medicine Department, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, Rome, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padua, Italy.,Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padua, Italy.,Padova Neuroscience Center, University of Padova, Padua, Italy
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van Elburg A, Danner UN, Sternheim LC, Lammers M, Elzakkers I. Mental Capacity, Decision-Making and Emotion Dysregulation in Severe Enduring Anorexia Nervosa. Front Psychiatry 2021; 12:545317. [PMID: 33776810 PMCID: PMC7991306 DOI: 10.3389/fpsyt.2021.545317] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
Severe and Enduring Anorexia Nervosa (SE-AN) is a chronic eating disorder characterized by long-term starvation and its physical and psychological sequelae, and severe loss of quality of life. Interactions between neurobiological changes caused by starvation, vulnerability (personality) traits, and eating behaviors play a role. Several other factors, such as increased fear and decreased social cognition, have also been found in relation to SE-AN. With this in mind, we aim to add to the understanding of SE-AN by introducing the concept of mental capacity (MC), which refers to the ability to understand and process information-both on a cognitive and an emotional level-and then make a well-informed choice. MC may be an important construct within the context of SE-AN. Furthermore, we will argue how impaired decision-making processes may underlie, fuel, or contribute to limited MC in SE-AN. We will speculate on the importance of dysfunctional emotion processing and anxiety-related processes (e.g., a high intolerance of uncertainty) and their potential interaction with decision-making. Lastly, we will propose how these aspects, which to our knowledge have previously received little attention, may advise research and treatment or help in dealing with the "want but cannot" situation of life-threatening AN.
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Affiliation(s)
- Annemarie van Elburg
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands.,Rintveld Center for Eating Disorders, Altrecht Mental Health Institute, Zeist, Netherlands
| | - Unna Nora Danner
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands.,Rintveld Center for Eating Disorders, Altrecht Mental Health Institute, Zeist, Netherlands
| | - Lot Catharina Sternheim
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Isis Elzakkers
- Rintveld Center for Eating Disorders, Altrecht Mental Health Institute, Zeist, Netherlands
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9
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Williams BM, Levinson CA. Negative beliefs about the self prospectively predict eating disorder severity among undergraduate women. Eat Behav 2020; 37:101384. [PMID: 32320928 PMCID: PMC7246166 DOI: 10.1016/j.eatbeh.2020.101384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 01/25/2023]
Abstract
Social anxiety disorder (SAD) and eating disorders (EDs) are highly comorbid. Negative self-portrayal, or 'perceived flaws in the self,' is a key feature of SAD and consists of three self-critical aspects that are presumed to be flawed: social competence, physical appearance, and signs of anxiety. Negative self-portrayal has yet to be studied among EDs, despite research suggesting that individuals with EDs have a greater negative self-image and self-criticism. The identification of negative self-portrayal as a shared risk factor for SAD and EDs may have important implications for both prevention and treatment. The current study (N = 300 undergraduate women) aimed to extend negative self-portrayal theory to the EDs. We found that several aspects of negative self-portrayal were related to ED severity and that physical appearance concerns predicted subsequent ED severity. In a cross-sectional model of shared vulnerability, we found that physical appearance concerns were a shared correlate of SAD and ED symptoms. In a prospective shared vulnerability model, we found that (a) physical appearance prospectively predicted ED severity and (b) symptoms of SAD prospectively predicted all aspects of negative self-portrayal. Concerns about flaws in appearance should be targeted in the treatment of EDs, as this aspect of negative self-portrayal was shown to predict subsequent ED severity. Future research should further investigate the theory of negative self-portrayal as it pertains to EDs.
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Perko VL, Forbush KT, Siew CSQ, Tregarthen JP. Application of network analysis to investigate sex differences in interactive systems of eating-disorder psychopathology. Int J Eat Disord 2019; 52:1343-1352. [PMID: 31608479 DOI: 10.1002/eat.23170] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Although men comprise 25% of persons with eating disorders (EDs), most research has focused on understanding EDs in women. The theoretical framework underlying common ED treatment has not been rigorously tested in men. The purpose of this study was to compare the interconnectivity among ED symptoms in men versus women. METHOD Participants (N = 1,348; 50% men) were individuals with anorexia nervosa, bulimia nervosa, binge-eating disorder, or other specified feeding or eating disorder who were users of Recovery Record, a smartphone app for monitoring ED symptoms. Participants were matched on age and duration of illness. Network analysis was used to create networks of symptoms for both sexes. Strength centrality, network stability, and bootstrapped centrality differences were tested. The network comparison test (NCT) was used to identify sex differences between networks. Key players analysis was used to compare fragmentation of each network. RESULTS For both sexes, items related to binge eating and restricting emerged as highest in strength centrality. The NCT identified significant differences global strength (p = .03) but not network invariance (p = .06) suggesting that although the structure of the networks was not statistically different, the strength of the connections within the network was greater for women. Key players analysis indicated that both networks were similarly disrupted when important nodes within the network were removed. DISCUSSION Findings suggested that there are more similarities than differences in networks of EDs in men and women. Results have important clinical implications by supporting theoretical underpinnings of cognitive-behavioral models of EDs in both men and women.
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Affiliation(s)
- Victoria L Perko
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Cynthia S Q Siew
- Department of Psychology, National University of Singapore, Singapore
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11
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Stockford C, Stenfert Kroese B, Beesley A, Leung N. Women's recovery from anorexia nervosa: a systematic review and meta-synthesis of qualitative research. Eat Disord 2019; 27:343-368. [PMID: 30247988 DOI: 10.1080/10640266.2018.1512301] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Anorexia nervosa (AN) is a complex and challenging condition and recovery can be a slow and difficult process. Predicting factors remain largely unknown. This paper aims to systematically review qualitative studies which have investigated female service users' experiences of recovering from AN and carry out a meta-synthesis of the themes they identified. Meta-ethnography was used to select and synthesize the studies. Articles published between 2002 and 2017 were searched in PsycInfo, EMBASE, CINAHL and Medline. Studies were included if they explored recovery from AN using a qualitative methodology. The methodological quality of the studies was systematically and critically appraised. Fourteen studies were selected for inclusion. Common themes reported by participants describe the process of recovery from AN as dealing with a fragmented sense of self, a turning point where insight and commitment to recovery is developed, and, in recovery, a reclamation of self through meaningful relationships, rebuilding identity and self-acceptance. Recovery from AN is experienced as a complex psychological process with many contributing factors. Findings highlight the need to reconsider clinical practice and treatment provision to incorporate the psychological components of self-identity into recovery programs.
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Affiliation(s)
- Clare Stockford
- a School of Psychology , University of Birmingham , West Midlands , United Kingdom
| | - Biza Stenfert Kroese
- a School of Psychology , University of Birmingham , West Midlands , United Kingdom
| | - Adam Beesley
- a School of Psychology , University of Birmingham , West Midlands , United Kingdom
| | - Newman Leung
- a School of Psychology , University of Birmingham , West Midlands , United Kingdom
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12
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Kane C, Tomotake M, Hamatani S, Chiba S, Kameoka N, Watanabe S, Nakataki M, Numata S, Ohmori T. Clinical factors influencing resilience in patients with anorexia nervosa. Neuropsychiatr Dis Treat 2019; 15:391-395. [PMID: 30787613 PMCID: PMC6365225 DOI: 10.2147/ndt.s190725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study was to elucidate clinical factors influencing resilience in anorexia nervosa (AN) patients. PATIENTS AND METHODS Twenty female patients with AN (median age =30.0 years, quartile deviation =6.8) and 40 female healthy controls (HCs) (median age =30.0 years, quartile deviation =8.6) participated in the present study. Resilience was assessed with the Connor- Davidson resilience scale (CD-RISC). Clinical symptoms were evaluated with the structured interview guide for the Hamilton depression rating scale (SIGH-D) and the eating disorder inventory-2 (EDI-2). RESULTS Scores of the CD-RISC in the AN group were lower than those in the HC group, and the SIGH-D score in the AN group was higher than that in the HC group. Scores of interoceptive confusion, interpersonal difficulty and negative self-image subscales of the EDI-2 negatively correlated with the CD-RISC score. Moreover, stepwise regression analysis showed that negative self-image score was an independent predictor of the CD-RISC score. CONCLUSION These results suggest that among these clinical factors including psychopathologies, self-dissatisfaction and feeling of being rejected by others are the most important influencing factors on an AN patients' resilience.
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Affiliation(s)
- Chikako Kane
- Department of Nursing, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan Email
| | - Masahito Tomotake
- Department of Mental Health, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development Chiba University, Chuouku, Chiba, Japan
| | - Shinichi Chiba
- Department of Mental Health, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Naomi Kameoka
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Shinya Watanabe
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Masahito Nakataki
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Shusuke Numata
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
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13
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Oliveira-Cardoso ÉA, Coimbra AC, Santos MA. Qualidade de Vida em Pacientes com Anorexia e Bulimia Nervosa. PSICOLOGIA: TEORIA E PESQUISA 2018. [DOI: 10.1590/0102.3772e34411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Este estudo teve por objetivo avaliar a qualidade de vida relacionada à saúde (QVRS) de pacientes com transtornos alimentares (TAs). A amostra foi composta por 40 pacientes consecutivos, em sua maioria mulheres jovens e adultas, com diagnóstico de Anorexia Nervosa e em tratamento ambulatorial. A coleta de dados foi realizada por meio da aplicação de um instrumento de QVRS (SF-36) e do Teste de Atitudes Alimentares (EAT-26). Os resultados evidenciaram QVRS rebaixada, especialmente nos Componentes Mentais. Constatou-se prejuízo em seis dos oito domínios de QV avaliados naqueles pacientes com maior pontuação no EAT-26, em cinco domínios nos pacientes com idade acima de 22 anos, nos domínios Estado Geral de Saúde (p = 0,02) e Saúde Mental (p = 0,03) naqueles pacientes com menos de cinco anos de tratamento e no domínio Aspectos Físicos (p = 0,02) naqueles que receberam diagnóstico de Bulimia Nervosa.
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14
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Dakanalis A, Alix Timko C, Colmegna F, Riva G, Clerici M. Evaluation of the DSM-5 severity ratings for anorexia nervosa in a clinical sample. Psychiatry Res 2018; 262:124-128. [PMID: 29428775 DOI: 10.1016/j.psychres.2018.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 01/11/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
We examined the validity and utility of the DSM-5 severity ratings for anorexia nervosa (AN) in a clinical (treatment-seeking) sample (N = 273; 95.6% women). Participants classified with mild, moderate, severe, and extreme severity of AN based on their measured body mass index, differed significantly from each other in eating disorder features, putative maintenance factors, and illness-specific functional impairment (medium effect sizes). However, they were statistically indistinguishable in psychiatric-disorder comorbidity and distress, demographics, and age-of-AN onset. The implications of our findings, providing limited support for the DSM-5 severity ratings for AN, and directions for future research are outlined.
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Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Italy.
| | - C Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA; Children's Hospital of Philadelphia, Philadelphia, USA
| | - Fabrizia Colmegna
- Mental Health Department, San Gerardo Monza Health and Social Care Trust, Monza, Italy
| | - Giuseppe Riva
- Department of Psychology, Catholic University of Milan, Italy; Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Mental Health Department, San Gerardo Monza Health and Social Care Trust, Monza, Italy
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15
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Reas DL, Rø Ø. Less symptomatic, but equally impaired: Clinical impairment in restricting versus binge-eating/purging subtype of anorexia nervosa. Eat Behav 2018; 28:32-37. [PMID: 29310054 DOI: 10.1016/j.eatbeh.2017.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/18/2017] [Accepted: 12/28/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study investigated subtype differences in eating disorder-specific impairment in a treatment-seeking sample of individuals with anorexia nervosa (AN). METHOD The Clinical Impairment Assessment (CIA) and the Eating Disorder Examination-Questionnaire (EDE-Q) were administered to 142 patients. Of these, 54.9% were classified as restricting type (AN-R) and 45.1% were classified as binge-eating/purging type (AN-B/P) based on an average weekly occurrence of binge eating and/or purging episodes (≥4 episodes/28days). RESULTS Individuals with AN-B/P exhibited higher levels of core ED psychopathology (dietary restraint, eating concern, shape/weight concerns) in addition to the expected higher frequency of binge/purge episodes. No significant differences existed between AN subtypes in the severity of ED-related impairment. Weight/shape concerns and binge eating frequency significantly predicted level of impairment. Differential associations were observed between the type of ED pathology that significantly contributed to impairment according to AN subtype. DISCUSSION Although those with AN-B/P displayed higher levels of core attitudinal and behavioral ED pathology than AN-R, no significant differences in ED-specific impairment were found between AN subtypes. Eating disorder-related impairment in AN was not related to the severity of underweight or purging behaviors, but was uniquely and positively associated with weight/shape concerns and binge eating frequency.
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Affiliation(s)
- Deborah Lynn Reas
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Norway.
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
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16
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Davidsen AH, Hoyt WT, Poulsen S, Waaddegaard M, Lau M. Eating disorder severity and functional impairment: moderating effects of illness duration in a clinical sample. Eat Weight Disord 2017; 22:499-507. [PMID: 27659175 DOI: 10.1007/s40519-016-0319-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/07/2016] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim was to examine duration of illness and body mass index as possible moderators of the relationship between eating disorder severity and functional impairment, as well as psychological distress as a possible mediator of this relationship. METHODS The study included 159 patients diagnosed with bulimia nervosa, binge eating disorder or eating disorder not otherwise specified. Regression analysis was applied to assess the effect of the hypothesized moderators and mediators. Eating disorder severity was measured with the Eating Disorder Examination Questionnaire, functional impairment was measured with the Sheehan Disability Scale, and psychological distress was measured with the Symptom Check List-90-R. Duration of illness and body mass index were assessed clinically. RESULTS Duration of illness significantly moderated the relationship between eating disorder severity and functional impairment; the relationship was strongest for patients with a shorter duration of illness. Psychological distress partly mediated the relationship between eating disorder severity and functional impairment. Duration of illness significantly moderated the relationship between psychological distress and functional impairment; the strongest relationship was seen for patients with a shorter duration of illness. Body mass index was not a significant moderator of the relationship between ED severity and functional impairment. CONCLUSIONS Overall, this study established a link between ED severity, psychological distress and functional impairment indicating that both eating disorder severity and psychological distress are more strongly related to impaired role functioning for patients with more recent onset of an eating disorder. More research in the complex relationship between ED severity and functional impairment is needed.
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Affiliation(s)
- Annika Helgadóttir Davidsen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Stolpegaardsvej 20, 2820, Gentofte, Denmark.
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K., Denmark.
| | - William T Hoyt
- Department of Counseling Psychology, School of Education, UW-Madison, Madison, USA
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Mette Waaddegaard
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Stolpegaardsvej 20, 2820, Gentofte, Denmark
| | - Marianne Lau
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Stolpegaardsvej 20, 2820, Gentofte, Denmark
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17
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Martín J, Padierna A, Loroño A, Muñoz P, Quintana JM. Predictors of quality of life in patients with eating disorders. Eur Psychiatry 2017; 45:182-189. [PMID: 28957785 DOI: 10.1016/j.eurpsy.2017.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/30/2017] [Accepted: 07/08/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The aims of this study were to analyse the quality of life (QoL) of a broad sample of patients with eating disorders (ED) and to identify potential factors that predict QoL. METHODS This prospective cohort study involved 528 patients diagnosed with ED and treated over a 15-year period in the Eating Disorders Outpatient Clinic. Information on sociodemographic and clinical data were gathered. Patients completed five self-administered instruments: the Eating Attitudes Test-26 (EAT-26); the Eating Disorder Diagnostic Scale (EDDS); the Hospital Anxiety and Depression Scale (HADS); the Short-Form 12 (SF-12); and the Quality of Life in ED-short form (HeRQoLED-s). Descriptive, univariate analyses and multivariate linear regression models were applied to identify factors associated with QoL. RESULTS Predictive variables for a low level of QoL in patients with anorexia nervosa (AN) included antidepressant treatment (P=0.009), substance abuse disorder, (P=0.03) and other organic comorbidities (P<0.0001). For patients with bulimia nervosa (BN), they included osteoporosis (P≤0.0001), obesity (P=0.0004) or being a student (P=0.04). For patients with eating disorders not otherwise specified (EDNOS), they included anxiolytic treatment (P=0.003), having circulatory disease (P=0.001), more years since start of ED treatment (P=0.03) and living alone (P<0.0001). CONCLUSIONS We found a significant difference in QoL between the diagnostic ED groups. With regard to the variables predicting QoL in ED patients, the findings of this study suggest that organic or psychiatric comorbidities and some data of social normality might be more relevant to QoL in ED than age, type of compensatory behaviour, BMI or number of visits to hospital emergency department.
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Affiliation(s)
- J Martín
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao, 48960 Bizkaia, Spain; Health Services Research on Chronic Diseases Network-REDISSEC, 48960 Galdakao, Spain.
| | - A Padierna
- Department of Psychiatry, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao, 48960 Bizkaia, Spain; Health Services Research on Chronic Diseases Network-REDISSEC, 48960 Galdakao, Spain
| | - A Loroño
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao, 48960 Bizkaia, Spain; Health Services Research on Chronic Diseases Network-REDISSEC, 48960 Galdakao, Spain
| | - P Muñoz
- Department of Psychiatry, Ortuella Mental Health Center, Avda. Del Minero 1, Ortuella, 48530 Bizkaia, Spain
| | - J M Quintana
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, Galdakao, 48960 Bizkaia, Spain; Health Services Research on Chronic Diseases Network-REDISSEC, 48960 Galdakao, Spain
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18
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Martinussen M, Friborg O, Schmierer P, Kaiser S, Øvergård KT, Neunhoeffer AL, Martinsen EW, Rosenvinge JH. The comorbidity of personality disorders in eating disorders: a meta-analysis. Eat Weight Disord 2017; 22:201-209. [PMID: 27995489 DOI: 10.1007/s40519-016-0345-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/28/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The present meta-analysis summarized the proportion of comorbid personality disorders (PDs) in patients with anorexia (AN) and bulimia nervosa (BN), respectively, and examined possible moderating variables. METHODS A search of the databases PsychINFO, Embase, and Medline for the period 1980-2016 identified 87 studies from 18 different countries. RESULTS The mean proportion of PDs among patients with any type of eating disorder (ED) was .52 compared to .09 in healthy controls. There were no statistically significant differences between AN (.49) and BN (.54) in proportions of any PD or PD clusters except for obsessive-compulsive PD (.23 vs .12 in AN and BN, respectively). CONCLUSIONS Both ED diagnoses had a similar comorbidity profile with a high prevalence of borderline and avoidant PDs. Moderator analyses conducted for any ED and any PD yielded significant differences for diagnostic systems with respect to EDs, method for assessing PD as well as patient weight and age.
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Affiliation(s)
- Monica Martinussen
- Regional Center for Child and Youth Mental Health and Child Welfare (RKBU-Nord), UiT The Arctic University of Norway, 9037, Tromsø, Norway.
| | - Oddgeir Friborg
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Psychiatric Research, University Hospital of North Norway, Tromsø, Norway
| | - Phöbe Schmierer
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Sabine Kaiser
- Regional Center for Child and Youth Mental Health and Child Welfare (RKBU-Nord), UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - Karl Tore Øvergård
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Egil W Martinsen
- Division of Mental Health and Addiction, Department of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Jan H Rosenvinge
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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Hamatani S, Tomotake M, Takeda T, Kameoka N, Kawabata M, Kubo H, Tada Y, Tomioka Y, Watanabe S, Inoshita M, Kinoshita M, Ohta M, Ohmori T. Influence of cognitive function on quality of life in anorexia nervosa patients. Psychiatry Clin Neurosci 2017; 71:328-335. [PMID: 27973723 DOI: 10.1111/pcn.12491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/27/2016] [Accepted: 12/05/2016] [Indexed: 12/24/2022]
Abstract
AIM The purpose of this study was to elucidate determinants of quality of life (QOL) in anorexia nervosa (AN) patients. METHODS Twenty-one female patients with AN participated in the study. QOL was assessed with the 36-Item Short Form Health Survey (SF-36), and cognitive function was evaluated using the Wisconsin Card Sorting Test Keio version, the Rey Complex Figure Test, and the Social Cognition Screening Questionnaire. Clinical symptoms were evaluated with the Beck Depression Inventory-II, the State-Trait Anxiety Inventory-Form JYZ (STAI-JYZ), and the Maudsley Obsessive Compulsive Inventory. RESULTS The Difficulty Maintaining Set score of the Wisconsin Card Sorting Test Keio version was negatively correlated to the SF-36 Physical Component Summary. Scores of the Beck Depression Inventory-II and the STAI-JYZ State and Trait were negatively correlated to the SF-36 Mental Component Summary (MCS), and the Central Coherence Index 30-min Delayed Recall score of the Rey Complex Figure Test was positively correlated with the MCS. Stepwise regression analysis showed that the Difficulty Maintaining Set score was an independent predictor of the Physical Component Summary and scores for Central Coherence Index 30-min Delayed Recall and the STAI-JYZ Trait-predicted MCS. CONCLUSION These results suggest that not only trait anxiety but also poor central coherence and impaired ability to maintain new rule worsen AN patients' QOL.
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Affiliation(s)
- Sayo Hamatani
- Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Masahito Tomotake
- Department of Mental Health, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomoya Takeda
- Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Naomi Kameoka
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Masashi Kawabata
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Hiroko Kubo
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Yukio Tada
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Yukiko Tomioka
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shinya Watanabe
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masatoshi Inoshita
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Makoto Kinoshita
- Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
| | - Masashi Ohta
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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20
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Byrne ME, Eichen DM, Fitzsimmons-Craft EE, Taylor CB, Wilfley DE. Perfectionism, emotion dysregulation, and affective disturbance in relation to clinical impairment in college-age women at high risk for or with eating disorders. Eat Behav 2016; 23:131-136. [PMID: 27673706 PMCID: PMC5124520 DOI: 10.1016/j.eatbeh.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/10/2016] [Accepted: 09/13/2016] [Indexed: 01/24/2023]
Abstract
Individuals with eating disorders (EDs) demonstrate impaired quality of life; however, less than one-third report severe clinical impairment. Thus, it is important to determine factors that may identify those who are most likely to report marked impairment. Perfectionism, emotion dysregulation, and aspects of affective disturbance, such as anxiety and depression, are independently associated with eating pathology and clinical impairment in eating and other disorders. However, little research has explored these three factors concurrently in relation to eating pathology. It is possible that the combined interaction effect of these constructs could be especially harmful. The current study examined the influence of these constructs and their interactions on clinical impairment in college-aged women at high risk for or with a DSM-5 clinical or subclinical ED. Although the three-way interaction of perfectionism, emotion dysregulation, and affective disturbance (i.e., anxiety or depression) was not significant, the two-way interaction between perfectionism and emotion dysregulation was significant such that those who were high in both perfectionism and emotion dysregulation reported the highest levels of clinical impairment. This suggests that the combination of perfectionism and emotion dysregulation may be especially problematic for those with or at high risk for EDs. Interestingly, perfectionism alone was not a predictor of clinical impairment when accounting for the other constructs, implying that perfectionism may have a greater impact when in conjunction with emotion dysregulation. Understanding the impact of combined perfectionistic tendencies and emotion dysregulation on clinical impairment may better inform treatment and more directly target contributors to impaired quality of life.
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Affiliation(s)
- Meghan E Byrne
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States.
| | - Dawn M Eichen
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Department of Psychiatry and Behavioral Sciences, Palo Alto University, Palo Alto, CA, United States
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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21
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Ágh T, Kovács G, Supina D, Pawaskar M, Herman BK, Vokó Z, Sheehan DV. A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eat Weight Disord 2016; 21:353-364. [PMID: 26942768 PMCID: PMC5010619 DOI: 10.1007/s40519-016-0264-x] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/17/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To perform a systematic review of the health-related quality of life (HRQoL) and economic burdens of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHODS A systematic literature search of English-language studies was performed in Medline, Embase, PsycINFO, PsycARTICLES, Academic Search Complete, CINAHL Plus, Business Source Premier, and Cochrane Library. Cost data were converted to 2014 Euro. RESULTS Sixty-nine studies were included. Data on HRQoL were reported in 41 studies (18 for AN, 17 for BN, and 18 for BED), on healthcare utilization in 20 studies (14 for AN, 12 for BN, and 8 for BED), and on healthcare costs in 17 studies (9 for AN, 11 for BN, and only 2 for BED). Patients' HRQoL was significantly worse with AN, BN, and BED compared with healthy populations. AN, BN, and BED were associated with a high rate of hospitalization, outpatient care, and emergency department visits. However, patients rarely received specific treatment for their eating disorder. The annual healthcare costs for AN, BN, and BED were €2993 to €55,270, €888 to €18,823, and €1762 to €2902, respectively. CONCLUSIONS AN, BN, and BED have a serious impact on patient's HRQoL and are also associated with increased healthcare utilization and healthcare costs. The burden of BED should be examined separately from that of BN. The limited evidence suggests that further research is warranted to better understand the differences in long-term HRQoL and economic burdens of AN, BN, and BED.
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Affiliation(s)
- Tamás Ágh
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary.
| | - Gábor Kovács
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary
| | - Dylan Supina
- Formerly of Shire, 300 Shire Way, Lexington, MA, 02421, USA
| | | | | | - Zoltán Vokó
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary.,Department of Health Policy and Health Economics, Faculty of Social Sciences, Eötvös Loránd University, 1/a Pázmány Péter Street, 1117, Budapest, Hungary
| | - David V Sheehan
- University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, Tampa, FL, 33612, USA
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22
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Danner UN, Sternheim L, Bijsterbosch JM, Dingemans AE, Evers C, van Elburg AA. Influence of negative affect on decision making in women with restrictive and binge-purge type anorexia nervosa. Psychiatry Res 2016; 239:39-46. [PMID: 27137960 DOI: 10.1016/j.psychres.2016.02.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 01/26/2023]
Abstract
The present study aims to examine the influence of negative affect on decision making in women with anorexia nervosa (AN) compared to healthy control women and, secondly, to assess differences between the restrictive (ANR) and binge-purge (ANBP) subtypes. One hundred four women (32 with ANR, 32 with ANBP, and 40 healthy controls) participated. All women were asked to watch either a negative or a control film fragment, both followed by the Bechara Gambling Task (BGT). Before and after the fragments negative affect was measured. Additionally, relevant characteristics (e.g., overall depressive symptoms) were assessed. Differences in negative affect did not influence decision making performance. Independent of affective state, decision making was found to be impaired in women with ANBP (no learning effect on the BGT), but not in women with ANR. These findings highlight the importance of considering different AN subtypes when examining decision making processes. However, the role of negative affect on decision making remains uncertain. Since other affect related factors such as affect dysregulation may also play a role, future studies on decision making in AN should take the role of affect into account.
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Affiliation(s)
- Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands
| | - Lot Sternheim
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, The Netherlands
| | - Jojanneke M Bijsterbosch
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands
| | | | - Catharine Evers
- Department of Clinical and Health Psychology, Utrecht University, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, The Netherlands
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23
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Long-term health-related quality of life in eating disorders. Qual Life Res 2016; 25:2341-6. [DOI: 10.1007/s11136-016-1250-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 01/22/2023]
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24
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Robinson PH, Kukucska R, Guidetti G, Leavey G. Severe and enduring anorexia nervosa (SEED-AN): a qualitative study of patients with 20+ years of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2016; 23:318-26. [PMID: 26059633 DOI: 10.1002/erv.2367] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/28/2015] [Accepted: 03/05/2015] [Indexed: 11/10/2022]
Abstract
Little is known about how patients with long-term eating disorders manage their clinical problems. We carried out a preliminary qualitative study (using Thematic Analysis) of patients with severe and enduring anorexia nervosa (SEED-AN) in which we undertook recorded interviews in eight participants whose conditions had lasted 20-40 years. We found 15 principle features in physical, psychological, social, family, occupational and treatment realms. Psychological and social realms were most affected. Severe physical problems were reported. They described feelings of unworthiness, frugality regarding money and obsessive time-keeping. Persisting with negligible social networks, participants described depression and hopelessness, while somehow achieving a sense of pride at their endurance and survival in spite of the eating disorder. They emphasized the importance of professional help in managing their care. The severe and enduring description, often reserved for people with psychotic illness, is appropriately applied to SEED-AN, which has major impacts in all realms.
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Affiliation(s)
- Paul H Robinson
- Barnet Enfield and Haringey Mental Health Trust, UK.,University College London, UK
| | | | | | - Gerard Leavey
- University College London, UK.,Ulster University, UK
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25
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Weltzin T, Bean P, Klosterman E, Lee HJ, Welk-Richards R. Sex differences in the effects of residential treatment on the quality of life of eating disorder patients. Eat Weight Disord 2015; 20:301-10. [PMID: 25380978 DOI: 10.1007/s40519-014-0162-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 10/16/2014] [Indexed: 11/26/2022] Open
Abstract
AIMS This study compared the effects of residential treatment on improving health-related quality of life (HRQOL) between males and females diagnosed with eating disorders (EDs) from admission to discharge and at follow-up. This study also analyzed the association between changes in HRQOL and changes in the severity of ED pathology, depression, and trait anxiety. METHODS 145 consecutive patients (34 males and 111 females) admitted to a residential ED unit completed a panel of surveys at admission and discharge. The survey panel included the Eating Disorders Quality of Life Survey (EDQLS), the Eating Disorder Examination Questionnaire, the Quick Inventory of Depressive Symptomatology and the State-Trait Anxiety Inventory. An online follow-up survey was also conducted for the EDQLS. Mixed-factorial ANOVA was used to examine sex differences and changes in HRQOL between admission, discharge and post-treatment follow-up. Multiple regression analysis was used to investigate the relationship between sex, change in HRQOL, and changes in all other variables studied. RESULTS By the end of residential treatment, both males and females had made similar statistically significant improvements in HRQOL from admission to discharge, which persisted after treatment. Greater decreases in ED pathology and trait anxiety significantly predicted greater increases in HRQOL during residential treatment while sex and changes in depression did not. CONCLUSION The data show that residential treatment is an effective approach to improving HRQOL in both males and females with EDs. Greater improvements in trait anxiety and ED pathology contributed to greater improvement in HRQOL in these patients.
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Affiliation(s)
- Theodore Weltzin
- Eating Disorder Center, Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI, 53066, USA,
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26
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Hovrud L, De Young KP. Unique contributions of individual eating disorder symptoms to eating disorder-related impairment. Eat Behav 2015; 18:103-6. [PMID: 26026614 DOI: 10.1016/j.eatbeh.2015.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 02/17/2015] [Accepted: 05/13/2015] [Indexed: 11/28/2022]
Abstract
This study examined the unique contribution of individual eating disorder symptoms and related features to overall eating disorder-related impairment. Participants (N=113) from the community with eating disorders completed assessments including the Clinical Impairment Assessment (CIA) and the Eating Disorder Examination Questionnaire. A multiple linear regression analysis indicated that 58.6% of variance in the CIA was accounted for by binge eating frequency, weight and shape concerns, and depression. These findings indicate that certain eating disorder symptoms uniquely account for impairment and that depression is a substantial contributor. It is possible that purging, restrictive eating, and body mass index did not significantly contribute to impairment because these features are consistent with many individuals' weight and shape goals. The results imply that eating disorder-related impairment may be more a result of cognitive features and binge eating rather than body weight and compensatory behaviors.
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Affiliation(s)
- Lindsey Hovrud
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
| | - Kyle P De Young
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA.
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27
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Pollack LO, McCune AM, Mandal K, Lundgren JD. Quantitative and Qualitative Analysis of the Quality of Life of Individuals With Eating Disorders. Prim Care Companion CNS Disord 2015; 17:14m01667. [PMID: 26445689 DOI: 10.4088/pcc.14m01667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 01/27/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To examine the quality of a broad range of life domains using both quantitative and qualitative methodologies. METHOD Forty-eight individuals seeking inpatient treatment for an eating disorder (mean age = 29.8 years, female = 100%, white = 96.4%) from 2007 to 2009 completed the Quality of Life Inventory (QOLI) and the Eating Disorder Examination Questionnaire; a medical chart review confirmed diagnosis and treatment history. Patients diagnosed with anorexia nervosa (n = 24) and bulimia nervosa (n = 24) were compared. Body mass index (kg/m(2)), treatment history, number of comorbid psychiatric conditions, and eating disorder severity were used to predict quality of life. Finally, an inductive content analysis was performed on qualitative QOLI responses to contextualize the quantitative findings. RESULTS Participants with anorexia nervosa, compared to those with bulimia nervosa, reported significantly less satisfaction with the domain of relatives (F 1,46 = 5.35; P = .025); no other significant group differences were found. The only significant predictor of QOLI global score was number of previous treatments (F 1,41 = 8.67; P = .005; R (2) = 0.175). Content analysis of qualitative data yielded complementary findings to the quantitative data; interesting group differences emerged for satisfaction with health with implications for measuring quality of life domains. CONCLUSIONS Across several life domains, individuals seeking treatment for anorexia nervosa and bulimia nervosa appear to have similar levels of satisfaction, as evidenced by numeric and descriptive responses. Satisfaction with relatives, however, appears to differ between groups and suggests a specific target for intervention among patients in treatment for anorexia nervosa (eg, a family-based intervention such as the Maudsley approach). The use of quantitative and qualitative assessments, such as the QOLI, provides more clinically meaningful, contextualized information about quality of life than traditional self-report assessments alone.
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Affiliation(s)
- Lauren O Pollack
- Department of Psychology, University of Missouri-Kansas City, Kansas City (Mss Pollack and McCune and Dr Lundgren); and Centennial Peaks Hospital, St Louisville, Colorado (Dr Mandal)
| | - Ashley M McCune
- Department of Psychology, University of Missouri-Kansas City, Kansas City (Mss Pollack and McCune and Dr Lundgren); and Centennial Peaks Hospital, St Louisville, Colorado (Dr Mandal)
| | - Konoy Mandal
- Department of Psychology, University of Missouri-Kansas City, Kansas City (Mss Pollack and McCune and Dr Lundgren); and Centennial Peaks Hospital, St Louisville, Colorado (Dr Mandal)
| | - Jennifer D Lundgren
- Department of Psychology, University of Missouri-Kansas City, Kansas City (Mss Pollack and McCune and Dr Lundgren); and Centennial Peaks Hospital, St Louisville, Colorado (Dr Mandal)
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Pohjolainen V, Ryynänen OP, Räsänen P, Roine RP, Koponen S, Karlsson H. Bayesian prediction of treatment outcome in anorexia nervosa: a preliminary study. Nord J Psychiatry 2015; 69:210-5. [PMID: 25286982 DOI: 10.3109/08039488.2014.962612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Knowledge of the prognostic factors predicting treatment outcome in anorexia nervosa (AN) measured with health-related quality of life (HRQoL) is limited. AIMS We performed a novel statistical analysis to identify factors predicting treatment outcome in AN. METHODS 39 patients entering treatment of an ICD-10-defined AN completed the 15D HRQoL survey, the Eating Disorder Inventory (EDI) and a questionnaire evaluating self reported health status and eating habits before and 2 years after the start of treatment. The analysis was based on a Bayesian approach, which allows analyses of small data sets, and was performed using a naïve Bayes classifier. RESULTS An impaired follow-up HRQoL score was associated with three baseline risk factors: low self-reported vitality, high scores in eating control and a poor reported health status. Low baseline body mass index (BMI) and a high score in the eating dimension of the 15D predicted low follow-up BMI. CONCLUSIONS In our preliminary study, we identified a set of variables predicting poor HRQoL in AN. An effort to treat these symptoms effectively in the beginning of AN treatment may influence the outcome.
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Affiliation(s)
- Veera Pohjolainen
- Veera Pohjolainen, Hospital District of Helsinki and Uusimaa, Department of Psychiatry, Helsinki, Health Centre, Department of Psychiatry, Helsinki, and University of Helsinki , Helsinki , Finland
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Bamford B, Barras C, Sly R, Stiles-Shields C, Touyz S, Le Grange D, Hay P, Crosby R, Lacey H. Eating disorder symptoms and quality of life: where should clinicians place their focus in severe and enduring anorexia nervosa? Int J Eat Disord 2015; 48:133-8. [PMID: 25049195 DOI: 10.1002/eat.22327] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/30/2014] [Accepted: 06/14/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between quality of life (QoL), weight, and eating disorder symptoms across treatment in individuals with severe and enduring anorexia nervosa (SE-AN). METHOD Participants were 63 adult females with SE-AN presenting to an outpatient, multisite randomized clinical trial. QoL was assessed using three well-validated QoL questionnaire measures, the EDQOL, SF-12, and WSAS. Participants' weight and severity of symptoms was assessed by Eating Disorder Examination (EDE) and weekly BMI change. RESULTS Predictors of QoL were evaluated in the context of concurrent, prospective,1 and lagged mixed-effects models. Changes in both BMI and EDE were found to significantly affect current and future QoL ratings. DISCUSSION Findings suggest that improvements in QoL may be dependent on symptom change and weight gain. Treatments seeking solely to improve QoL may be unlikely to produce lasting change and clinicians should maintain a focus on weight and behavioral symptoms as much as on improvements in QoL.
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Affiliation(s)
- Bryony Bamford
- St George's, University of London, Eating Disorders Research Team, London, United Kingdom
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Juarascio AS, Schumacher LM, Shaw J, Forman EM, Herbert JD. Acceptance-based treatment and quality of life among patients with an eating disorder. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2015; 4:42-47. [PMID: 31828007 DOI: 10.1016/j.jcbs.2014.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study assessed the relationship between acceptance-based constructs and quality of life (QOL) among patients with an eating disorder, as well as whether an acceptance-based treatment group could improve QOL. Patients (n = 105) at a residential treatment center received treatment as usual (TAU) or TAU plus twice-weekly acceptance and commitment therapy groups (TAU+ACT), and completed assessments at admission and discharge. Higher scores on several acceptance-related constructs at admission were associated with better psychological QOL, and pre- to post-treatment improvements in the ability to defuse from distressing internal experiences were associated with improved QOL. However, no differences in pre- to post-treatment changes in QOL were observed between treatment conditions. These results suggest that while some acceptance-related variables (e.g. defusion, impulse control, access to emotion regulation skills) may contribute to QOL, ACT does not appear to incrementally improve these variables or QOL beyond standard treatment programs. Additional research is needed to evaluate whether ACT may confer greater benefit for improving QOL in an outpatient setting where patients have more opportunity to utilize ACT skills, or when a stronger dose of treatment is administered.
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Affiliation(s)
| | | | - Jena Shaw
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Evan M Forman
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - James D Herbert
- Department of Psychology, Drexel University, Philadelphia, PA, USA
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Baiano M, Salvo P, Righetti P, Cereser L, Baldissera E, Camponogara I, Balestrieri M. Exploring health-related quality of life in eating disorders by a cross-sectional study and a comprehensive review. BMC Psychiatry 2014; 14:165. [PMID: 24898768 PMCID: PMC4058000 DOI: 10.1186/1471-244x-14-165] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 02/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with eating disorders (ED) often report poor health-related quality of life (HRQoL), which is explicitly correlated to illness' severity and its effects on cognitive performance. We aimed to analyze health-related quality of life (HRQoL) in subgroups of eating disorder (ED) patients by using the brief version of WHOQoL questionnaire (WHOQoL-BREF) before treatment administration. Moreover, in order to compare our findings with other published data, we carried out a comprehensive review of the literature on HRQoL in ED patients. METHODS Our review was carried out by means of an accurate data mining of PsychInfo and Medline databases and other available sources. In our cross-sectional study, eighty female ED patients (26 with bulimia nervosa, 33 with anorexia nervosa, 7 with binge eating disorder and 14 with ED not otherwise specified) completed the WHOQoL-BREF. HRQoL scores were compared among ED subgroups and clinical information (presence of previous contacts, length of illness, psychiatric comorbidity) was considered in the analysis. RESULTS Our review shows that with few exceptions ED patients have a poorer HRQoL than the healthy population of control and sometimes the mental component of HRQoL is the most involved dimension. Moreover, there are no differences in the HRQoL among ED groups, even if AN patients in some studies have a lower HRQoL scores. Furthermore, BED patients have a poorer HRQoL than obese patients who do not have binge episodes. Finally, all treatments were positively correlated with an improvement on general and specific QoL dimensions. In our sample, ED subgroups differed only for Psychological Health HRQoL scores (F = 4.072, df = 3; p = 0.01). No differences were found between inpatients and outpatients, treatment naïve and previously treated patients and patients with or without psychiatric comorbidity. Moreover, HRQoL scores were not correlated to length of illness within each ED subgroup. CONCLUSIONS The analysis of the literature adds some relevant information on HRQoL in ED and may address the future research toward the exploration of specific questions. One of these may be the prominent role of Psychological Health domain in HRQoL, since our study confirms that this component is able to differentiate eating disorders.
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Affiliation(s)
- Monica Baiano
- Centre for Weight and Eating Disorders, Azienda Socio-Sanitaria Locale n. 10 “Veneto Orientale”, Venice, Portogruaro, Italy
| | - Pierandrea Salvo
- Centre for Weight and Eating Disorders, Azienda Socio-Sanitaria Locale n. 10 “Veneto Orientale”, Venice, Portogruaro, Italy
| | - Pierluigi Righetti
- Centre for Weight and Eating Disorders, Azienda Socio-Sanitaria Locale n. 10 “Veneto Orientale”, Venice, Portogruaro, Italy
| | - Lucia Cereser
- Centre for Weight and Eating Disorders, Azienda Socio-Sanitaria Locale n. 10 “Veneto Orientale”, Venice, Portogruaro, Italy
| | - Erika Baldissera
- Centre for Weight and Eating Disorders, Azienda Socio-Sanitaria Locale n. 10 “Veneto Orientale”, Venice, Portogruaro, Italy
| | - Ilenia Camponogara
- Centre for Weight and Eating Disorders, Azienda Socio-Sanitaria Locale n. 10 “Veneto Orientale”, Venice, Portogruaro, Italy
| | - Matteo Balestrieri
- Unit of Psychiatry, Dept, of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
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Ackard DM, Richter S, Egan A, Engel S, Cronemeyer CL. The meaning of (quality of) life in patients with eating disorders: a comparison of generic and disease-specific measures across diagnosis and outcome. Int J Eat Disord 2014; 47:259-67. [PMID: 24123164 DOI: 10.1002/eat.22193] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Compare general and disease-specific health-related quality of life (HRQoL) among female patients with an eating disorder (ED). METHOD Female patients (n = 221; 95.3% Caucasian; 94.0% never married) completed the Medical Outcome Short Form Health Survey (SF-36) and Eating Disorders Quality of Life (EDQoL) as part of a study of treatment outcomes. Multivariate regression models were used to compare HRQoL differences across initial ED diagnosis (85 AN-R, 19 AN-B/P, 27 BN, 90 EDNOS) and ED diagnostic classification at time of outcome assessment (140 no ED, 38 subthreshold ED, 43 full threshold ED). RESULTS There were no significant differences across ED diagnosis at initial assessment on either of the SF-36 Component Summary scores. However, patients with AN-B/P scored poorer on the work/school EDQoL subscales than other ED diagnoses, and on the psychological EDQoL subscale compared to AN-R and EDNOS. At outcome assessment, comparisons across full threshold, subthreshold and no ED classification indicated that those with no ED reported better HRQoL than those with full threshold ED on the SF-36 Mental Components Summary and three of four EDQoL subscales. Furthermore, those with no ED reported better psychological HRQoL than those with subthreshold ED. DISCUSSION Disease-specific HRQOL measures are important to use when comparing HRQoL in ED patients across treatment and outcome, and may have the sensitivity to detect meaningful differences by diagnosis more so than generic instruments. EDQoL scores from patients remitted from symptoms approach but do not reach scores for unaffected college females; thus, treatment should continue until quality of life is restored.
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Affiliation(s)
- Diann M Ackard
- Park Nicollet Melrose Center, 3525 Monterey Drive, St. Louis Park, Minnesota, 55416; Private Practice, 5101 Olson Memorial Highway Suite 4001, Golden Valley, Minnesota, 55422
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Developmental trends of eating disorder symptoms and comorbid internalizing symptoms in children and adolescents. Eat Behav 2014; 15:275-9. [PMID: 24854818 PMCID: PMC4048817 DOI: 10.1016/j.eatbeh.2014.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 12/18/2013] [Accepted: 03/11/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine when gender differences in disordered eating symptoms emerge, when correlations between disordered eating and internalizing symptoms develop, and whether the relationship between internalizing and disordered eating symptoms varies based on age and/or gender. METHOD We used questionnaire data from a community sample (N = 424) of third, sixth, and ninth grade girls and boys. RESULTS Gender differences in eating pathology emerge between 12 and 15 years. The relationship between anxiety symptoms and eating pathology among both genders is weak and remains constant between the third and ninth grades. The relationship between depressive symptoms and eating pathology increases between the third and sixth grades for boys, and the sixth and ninth grades for girls. CONCLUSION Before age 12, prevention programs for eating disorders should be given to both genders, whereas after age 12, they should target girls. Further, providers should offer intervention for comorbid depressive symptoms by third grade for boys and sixth grade for girls.
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Bamford BH. Assessing quality of life in the eating disorders: the HeRQoLED-S. Expert Rev Pharmacoecon Outcomes Res 2014; 10:513-6. [DOI: 10.1586/erp.10.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Health-related quality of life among adolescents with eating disorders. J Psychosom Res 2014; 76:1-5. [PMID: 24360133 DOI: 10.1016/j.jpsychores.2013.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/05/2013] [Accepted: 11/08/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) is an emerging area of research in eating disorders (EDs) that has not been examined in adolescents in detail. The aim of the current study is to investigate HRQoL in an adolescent ED sample, examining the impact of ED symptoms on HRQoL. METHODS Sixty-seven treatment-seeking adolescents (57 females) with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) completed self-report measures of HRQoL and ED symptoms. RESULTS Participants reported poorer HRQoL in mental health domains than in physical health domains. Disordered attitudes, binge eating, and compensatory behaviors were associated with poorer mental health HRQoL, and body dissatisfaction was associated with poorer physical health HRQoL. CONCLUSION The current study assessed HRQoL among adolescents with EDs, finding several consistencies with the literature on adults with EDs. Future research should compare adolescents and adults with EDs on HRQoL.
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Abstract
We examined the relative contribution of different forms of eating disorder (ED) pathology to impairment in mental and physical health-related quality of life (QOL) in women with a wide range of ED symptoms. Female participants from an outpatient ED clinic (n = 53) and the local community (n = 214) completed measures of ED features and mental and physical health-related QOL. Across the sample, ED features were significantly associated with most mental and physical domains of QOL. In multiple regression analyses controlling for age and body mass index, ED features significantly predicted impairment in mental and physical QOL. Extreme shape and weight concern significantly and independently predicted most QOL subscales (β range = 0.19-0.44). The prominent contribution of shape and weight concern to both mental and physical QOL impairment underlines the importance of addressing body dissatisfaction in the treatment and prevention of EDs.
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Sly R, Morgan JF, Mountford VA, Lacey JH. Predicting premature termination of hospitalised treatment for anorexia nervosa: the roles of therapeutic alliance, motivation, and behaviour change. Eat Behav 2013; 14:119-23. [PMID: 23557806 DOI: 10.1016/j.eatbeh.2013.01.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/18/2012] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study aims to investigate treatment drop-out, and the associated roles of motivation, alliance, and behaviour change exhibited over the first four weeks of hospitalised treatment for anorexia. METHODS 90 participants meeting DSM-IV criteria for anorexia nervosa completed questionnaires at admission, and four weeks into treatment. Weight data was collected over this same time period. At the end of treatment, participants were categorised into completer or premature termination groups. RESULTS The overall rate of premature termination was 57.8%. Those who prematurely terminated treatment demonstrated lower discharge BMI (p<.0005), and weight gain (p<.0005) than those who completed. Therapeutic alliance proved significantly different between outcome groups at admission (p=.004). DISCUSSION End-of-treatment outcomes for those who do not complete treatment are invariably poor. Therapeutic alliance appears to be a particularly important factor in this area.
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Affiliation(s)
- Richard Sly
- Population Health Sciences and Education, St. George's University of London, London, UK.
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Leung SF, Ma JLC, Russell J. Enhancing quality of life in people with disordered eating using an online self-help programme. J Eat Disord 2013; 1:9. [PMID: 24999391 PMCID: PMC4081804 DOI: 10.1186/2050-2974-1-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/05/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders are serious mental illnesses that have a significant effect on afflicted individuals' quality of life. Evidence has shown that they can be improved with treatment. Internet-based interventions are useful in engaging individuals with eating disorders in self-management and treatment. This study aimed primarily to identify the change in quality of life of individuals with disordered eating after participating in an open trial of an Internet-based self-help programme, and compared their quality of life at assessment with that of healthy controls. Factors affecting their quality of life were examined. Secondary outcomes related to symptom improvement were also reported. METHODS This study included 194 individuals with disordered eating and 50 healthy controls. The former group was recruited from eating disorder outpatient clinics and treatment units, as well as via information disseminated through various Internet websites, while the healthy controls were recruited from university student newspapers and university campuses. The Medical Outcomes Study Short Form Survey (SF-36v2) was used to assess participants' quality of life. Other measures were used to assess their symptoms and motivational stages of change to recover from an eating disorder. The Wilcoxon signed ranks test and one-way repeated measures ANOVA were used to identify the change in quality of life of individuals with disordered eating from baseline to 1-, 3- and 6-month follow-ups. The Mann-Whitney U test was employed to compare the difference in quality of life between participants with disordered eating and the healthy controls. Spearman rank order correlations were performed to examine the factors associated with quality of life. RESULTS The participants with disordered eating had significantly poorer quality of life than the healthy controls in both physical and psychological domains. The factors associated with their poor quality of life included dieting behaviour, use of laxatives, severe eating disorder psychopathology, depression and anxiety. Over a six-month follow-up period, a significant number of participants engaged in self-help behaviours using the Internet-based programme. They experienced improvements in their quality of life, eating disorder psychopathology, depression severity, anxiety level and motivational stages of change. CONCLUSIONS Internet-based self-help programmes have the potential to enhance quality of life in individuals with disordered eating and could be useful adjuncts to professional treatment.
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Affiliation(s)
- Sau F Leung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Joyce LC Ma
- Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Janice Russell
- Discipline of Psychiatry, Faculty of Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
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Magallares A. Well-Being and Prejudice toward Obese People in Women at Risk to Develop Eating Disorders. SPANISH JOURNAL OF PSYCHOLOGY 2013; 15:1293-302. [DOI: 10.5209/rev_sjop.2012.v15.n3.39415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The literature has found that eating disorders (ED) patients usually have a depression and anxiety diagnosis. However, not many investigations have studied the relationship between ED and well-being. One of the main problems of patients with ED is their body image. These individuals usually see themselves too big but there are not many investigations that focus on how these patients see people with real weight problems. For this reason in this study it is analyzed how women in risk to develop ED see obese people. 456 female students were selected. It was found that women with high scores in the different subscales of the Eating Attitudes Test 26 (EAT-26; dieting, bulimia and oral control) had lower well-being (both subjective and psychological) and worse attitudes toward obese people (measured with Antifat Attitudes Test, AFA, Beliefs About Obese People Scale, BAOP, and Attitudes Toward Obese People Scale, ATOP) compared with women with low scores in the EAT-26.
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Affiliation(s)
- Alejandro Magallares
- Departamento de Psicología Social y de las Organizaciones, Facultad de Psicología UNED, C/ Juan del Rosal, 10, 28040 - Madrid, Spain.
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DeJong H, Oldershaw A, Sternheim L, Samarawickrema N, Kenyon MD, Broadbent H, Lavender A, Startup H, Treasure J, Schmidt U. Quality of life in anorexia nervosa, bulimia nervosa and eating disorder not-otherwise-specified. J Eat Disord 2013; 1:43. [PMID: 24999421 PMCID: PMC4081766 DOI: 10.1186/2050-2974-1-43] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/31/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study aimed to assess differences in Quality of Life (QoL) across eating disorder (ED) diagnoses, and to examine the relationship of QoL to specific clinical features. RESULTS 199 patients with a diagnosed ED completed the Clinical Impairment Assessment (CIA) [Cognitive Behavior Therapy and Eating Disorders, 315-318, 2008] and the Eating Disorders Examination (EDE) [Int J Eat Disord 6:1-8]. Differences between diagnostic groups were examined, as were differences between restrictive and binge-purge subtypes. CIA scores and EDE scores were positively correlated and higher in groups with binge-purge behaviours. CIA scores were not correlated with BMI, illness duration or frequency of bingeing/purging behaviours, except in the binge-purge AN group, where CIA scores negatively correlated with BMI. CONCLUSIONS Patients with EDs have poor QoL and impairment increases with illness severity. Patients with binge/purge diagnoses are particularly impaired. It remains unclear which clinical features best predict the degree of impairment experienced by patients with EDs.
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Affiliation(s)
- Hannah DeJong
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Anna Oldershaw
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Lot Sternheim
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Nelum Samarawickrema
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Martha D Kenyon
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Hannah Broadbent
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Anna Lavender
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen Startup
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, PO 59, London SE5 8AF, England
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Abstract
The aim of this study was to compare quality of life in anorexia nervosa patients to that of subjects without eating disorders, with other eating disorders, or with other psychiatric disorders. Results showed reduced quality of life for eating disorder patients, including anorexia nervosa, as compared to normal controls and individuals with other psychiatric disorders; however, whether anorexia nervosa treatment resulted in improved quality of life remains controversial. Furthermore, anorexia nervosa had a modest impact in the physical domain, although this may reflect self-report limitations as well as the psychopathology of the disorder rather than healthy functioning.
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Affiliation(s)
- Rachel Sy
- Department of Psychiatry, University of Hawai'i at Mānoa, Mānoa, Hawai'i, USA
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Latner JD, Mond JM, Vallance JK, Gleaves DH, Buckett G. Body checking and avoidance in women: associations with mental and physical health-related quality of life. Eat Behav 2012; 13:386-9. [PMID: 23121794 DOI: 10.1016/j.eatbeh.2012.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 04/11/2012] [Accepted: 05/31/2012] [Indexed: 11/25/2022]
Abstract
Body checking and body avoidance have demonstrated clinical significance in a number of populations. However, the associations between these behaviors and mental and physical health-related quality of life have not been examined. This study investigated the associations between body checking and avoidance and quality of life in 214 community women. Body checking and body avoidance were significantly correlated with mental and physical quality of life, as well as with eating disturbances. Frequency of body checking significantly predicted impairment in mental quality of life, and frequency of body avoidance significantly predicted impairment in physical quality of life, over and above the contributions of depressive symptoms and related demographic characteristics. Targeting checking and avoidance in prevention and treatment programs may improve quality of life and reduce health-related functional impairment.
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Affiliation(s)
- Janet D Latner
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, United States.
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Self-reported history of anorexia nervosa and current quality of life: findings from a community-based study. Qual Life Res 2012; 22:273-81. [DOI: 10.1007/s11136-012-0157-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2012] [Indexed: 11/26/2022]
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Ackard DM, Fulkerson JA, Neumark-Sztainer D. Stability of eating disorder diagnostic classifications in adolescents: five-year longitudinal findings from a population-based study. Eat Disord 2011; 19:308-22. [PMID: 22352971 DOI: 10.1080/10640266.2011.584804] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined the stability of eating disorder (ED) classifications among a population-based sample of male and female adolescents (n = 2,516) who participated in Project EAT-II, a five-year longitudinal study. Cross-tabulations using weighted data identified diagnostic stability across six classifications (Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Binge Eating and/or Compensatory Behaviors not meeting ED diagnosis, Body Image Disturbance without disordered eating, and Asymptomatic). One-third (32.6%) of adolescents who were asymptomatic at baseline and over half of those who were symptomatic at baseline reported symptoms five years later. All males and 82% of females with a threshold diagnosis at baseline remained symptomatic five years later, but rarely within the same classification. In conclusion, the presence of ED symptoms in adolescence strongly predicts ED symptoms five years later. ED diagnoses and classifications were unstable over time, underscoring the critical need for prevention efforts and periodic assessment and encouraging early detection and intervention among adolescents.
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Affiliation(s)
- Diann M Ackard
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55422, USA.
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Is being underweight associated with impairments in quality of life in the absence of significant eating disorder pathology? Eat Weight Disord 2011; 16:e61-4. [PMID: 21727784 DOI: 10.1007/bf03327523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Few studies have compared low-weight individuals with eating disorder (ED) pathology with similar-weight individuals without significant pathology despite the fact that body weight is often used as a key outcome within ED research. This study compared quality of life (QoL) in one group with high levels of ED pathology to a group with low ED pathology, matched by body mass index (BMI). The high ED group reported significantly lower ED-specific quality of life (EDQoL) than the low ED group. These findings suggest that young women with high levels of ED pathology report significantly more impaired QoL than comparable young women with no ED pathology, and that being underweight alone is not a primary contributor to poorer EDQoL.
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Jenkins PE, Hoste RR, Meyer C, Blissett JM. Eating disorders and quality of life: A review of the literature. Clin Psychol Rev 2011; 31:113-21. [DOI: 10.1016/j.cpr.2010.08.003] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 08/04/2010] [Accepted: 08/04/2010] [Indexed: 10/19/2022]
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Fogarty S, Harris D, Zaslawski C, McAinch AJ, Stojanovska L. Acupuncture as an adjunct therapy in the treatment of eating disorders: A randomised cross-over pilot study. Complement Ther Med 2010; 18:233-40. [DOI: 10.1016/j.ctim.2010.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 08/20/2010] [Accepted: 09/17/2010] [Indexed: 11/30/2022] Open
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