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Elwyn R, Adams M, Sharpe SL, Silverstein S, LaMarre A, Downs J, Burnette CB. Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality. J Eat Disord 2024; 12:70. [PMID: 38831456 PMCID: PMC11145809 DOI: 10.1186/s40337-024-01016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
Eating disorders (EDs) are complex, multifaceted conditions that significantly impact quality-of-life, often co-occur with multiple medical and psychiatric diagnoses, and are associated with a high risk of medical sequelae and mortality. Fortunately, many people recover even after decades of illness, although there are different conceptualisations of recovery and understandings of how recovery is experienced. Differences in these conceptualisations influence categorisations of ED experiences (e.g., longstanding vs. short-duration EDs), prognoses, recommended treatment pathways, and research into treatment outcomes. Within recent years, the proposal of a 'terminal' illness stage for a subset of individuals with anorexia nervosa and arguments for the prescription of end-of-life pathways for such individuals has ignited debate. Semantic choices are influential in ED care, and it is critical to consider how conceptualisations of illness and recovery and power dynamics influence outcomes and the ED 'staging' discourse. Conceptually, 'terminality' interrelates with understandings of recovery, efficacy of available treatments, iatrogenic harm, and complex co-occurring diagnoses, as well as the functions of an individual's eating disorder, and the personal and symbolic meanings an individual may hold regarding suffering, self-starvation, death, health and life. Our authorship represents a wide range of lived and living experiences of EDs, treatment, and recovery, ranging from longstanding and severe EDs that may meet descriptors of a 'terminal' ED to a variety of definitions of 'recovery'. Our experiences have given rise to a shared motivation to analyse how existing discourses of terminality and recovery, as found in existing research literature and policy, may shape the conceptualisations, beliefs, and actions of individuals with EDs and the healthcare systems that seek to serve them.
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Affiliation(s)
- Rosiel Elwyn
- Neuroscience and psychiatry, Thompson Institute, Birtinya, QLD, Australia
- University of the Sunshine Coast, Birtinya, QLD, Australia
| | | | - Sam L Sharpe
- Fighting Eating Disorders in Underrepresented Populations (FEDUP, Collective), West Palm Beach, FL, USA
| | | | | | | | - C Blair Burnette
- Department of Psychology, Michigan State University, Lansing, MI, USA.
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2
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Kuehne C, Phillips MD, Moody S, Bryson C, Campbell IC, Conde P, Cummins N, Desrivières S, Dineley J, Dobson R, Douglas D, Folarin A, Gallop L, Hemmings A, İnce B, Mason L, Rashid Z, Bromell A, Sims C, Allen K, Bailie C, Bains P, Basher M, Battisti F, Baudinet J, Bristow K, Dawson N, Dodd L, Frater V, Freudenthal R, Gripton B, Kan C, Khor JWT, Kotze N, Laverack S, Martin L, Maxwell S, McDonald S, McKnight D, McKay R, Merrin J, Nash M, Nicholls D, Palmer S, Pearce S, Roberts C, Serpell L, Severs E, Simic M, Staton A, Westaway S, Sharpe H, Schmidt U, Bartel H, French T, Kelly J, Micali N, Raman S, Treasure J, Malik U, Rabelo-da-Ponte D, Stephens F, Opitz T, Trompeter N, Wilkins J, Parnell T, Abbas R, Bromell A, Davis G, Eadie C, Gracie L, Heslop B, McKenzie K, Odubanjo E, Sims C, Street T, Tavares-Semedo A, Wilkinson E, Zocek L. Characterising illness stages and recovery trajectories of eating disorders in young people via remote measurement technology (STORY): a multi-centre prospective cohort study protocol. BMC Psychiatry 2024; 24:409. [PMID: 38816707 PMCID: PMC11137943 DOI: 10.1186/s12888-024-05841-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) are serious, often chronic, conditions associated with pronounced morbidity, mortality, and dysfunction increasingly affecting young people worldwide. Illness progression, stages and recovery trajectories of EDs are still poorly characterised. The STORY study dynamically and longitudinally assesses young people with different EDs (restricting; bingeing/bulimic presentations) and illness durations (earlier; later stages) compared to healthy controls. Remote measurement technology (RMT) with active and passive sensing is used to advance understanding of the heterogeneity of earlier and more progressed clinical presentations and predictors of recovery or relapse. METHODS STORY follows 720 young people aged 16-25 with EDs and 120 healthy controls for 12 months. Online self-report questionnaires regularly assess ED symptoms, psychiatric comorbidities, quality of life, and socioeconomic environment. Additional ongoing monitoring using multi-parametric RMT via smartphones and wearable smart rings ('Ōura ring') unobtrusively measures individuals' daily behaviour and physiology (e.g., Bluetooth connections, sleep, autonomic arousal). A subgroup of participants completes additional in-person cognitive and neuroimaging assessments at study-baseline and after 12 months. DISCUSSION By leveraging these large-scale longitudinal data from participants across ED diagnoses and illness durations, the STORY study seeks to elucidate potential biopsychosocial predictors of outcome, their interplay with developmental and socioemotional changes, and barriers and facilitators of recovery. STORY holds the promise of providing actionable findings that can be translated into clinical practice by informing the development of both early intervention and personalised treatment that is tailored to illness stage and individual circumstances, ultimately disrupting the long-term burden of EDs on individuals and their families.
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Affiliation(s)
- Carina Kuehne
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Matthew D Phillips
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Sarah Moody
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Callum Bryson
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Iain C Campbell
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Pauline Conde
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
| | - Nicholas Cummins
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
| | - Sylvane Desrivières
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Judith Dineley
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
| | - Richard Dobson
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, London, UK
- University College London, Institute of Health Informatics, London, UK
| | - Daire Douglas
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Amos Folarin
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, London, UK
- University College London, Institute of Health Informatics, London, UK
| | - Lucy Gallop
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Amelia Hemmings
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Başak İnce
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
| | - Luke Mason
- Department of Forensic and Neurodevelopmental Science, IoPPN, King's College London, London, UK
| | - Zulqarnain Rashid
- Department of Biostatistics & Health Informatics, IoPPN, King's College London, London, UK
| | | | | | - Karina Allen
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Chantal Bailie
- Cornwall Partnership NHS Foundation Trus, Bodmin, Cornwall, UK
| | - Parveen Bains
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Mike Basher
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | | | - Julian Baudinet
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Katherine Bristow
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | - Nicola Dawson
- Bradford District Care NHS Foundation Trust, West Yorkshire, UK
| | - Lizzie Dodd
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Victoria Frater
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Robert Freudenthal
- Barnet, Enfield and Haringey Mental Health NHS Foundation Trust, London, UK
| | - Beth Gripton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Carol Kan
- Central and North West London NHS Foundation Trust, London, UK
| | - Joel W T Khor
- South West London & St. George's Mental Health NHS Trust, St George's Eating Disorders Service, London, UK
| | - Nicus Kotze
- Dorset Healthcare University NHS Foundation Trust, Poole, Dorset, UK
| | - Stuart Laverack
- Derbyshire Healthcare NHS Foundation Trust, Derby, Derbyshire, UK
| | - Lee Martin
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Sarah Maxwell
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Sarah McDonald
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Delysia McKnight
- North Staffordshire Combined Healthcare NHS Trust; Trentham, Staffordshire, UK
| | | | - Jessica Merrin
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Mel Nash
- Devon Partnership NHS Foundation Trust, Exeter, Devon, UK
| | - Dasha Nicholls
- Central and North West London NHS Foundation Trust, London, UK
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | | | - Samantha Pearce
- Cornwall Partnership NHS Foundation Trus, Bodmin, Cornwall, UK
| | | | - Lucy Serpell
- North East London NHS Foundation Trust, London, UK
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Amelia Staton
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sian Westaway
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Helen Sharpe
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, King's College London, Psychology & Neuroscience London (IoPPN), 103 Denmark Hill, First Floor, London, SE5 8AZ, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
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Muzi L, Carone N, Mirabella M, Franco A, Rugo MA, Mazzeschi C, Lingiardi V. Direct and indirect effects of psychological well-being and therapeutic alliance on therapy outcome in eating disorders. Front Psychol 2024; 15:1392887. [PMID: 38855305 PMCID: PMC11162114 DOI: 10.3389/fpsyg.2024.1392887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Outcome research in eating disorders (EDs) is commonly focused on psychopathological dysfunction. However, Ryff's model of psychological well-being (PWB) has shown promising-yet preliminary-results with ED patients. Additionally, despite substantial evidence highlighting the association between the therapeutic alliance and treatment outcome, findings in ED samples remain unclear. The present study aimed at exploring the direct effect of PWB dimensions and the early therapeutic alliance on ED patients' individual treatment responses, as well as the mediating role played by the early therapeutic alliance in the relationship between PWB dimensions and overall pre-post symptom change. Methods A sample of N = 165 ED patients assigned female at birth, who were receiving treatment in a residential program, completed the Psychological Well-Being Scale at treatment intake and the Working Alliance Inventory after the first four psychotherapy sessions. Patients also completed the Outcome Questionnaire-45.2 at the same time point and during the week prior to discharge. Results The PWB dimensions of autonomy, positive relations, and self-acceptance were associated with clinically significant change, while the dimensions of personal growth and self-acceptance were associated with reliable change. The early therapeutic alliance showed both direct and indirect effects on therapy outcome, predicting clinically significant and reliable symptom reduction. It also emerged as a significant mediator in the relationship between all PWB dimensions and overall symptomatic change. Conclusion The identification of individual, adaptive characteristics in ED patients that might influence their development of an early therapeutic alliance may help therapists to predict relationship ruptures and tailor their interventions to enhance treatment effectiveness.
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Affiliation(s)
- Laura Muzi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Nicola Carone
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Anna Franco
- Eating Disorder Clinic “Residenza Gruber”, Bologna, Italy
| | | | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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Romero-Márquez JM, Novo-Rodríguez M, Novo-Rodríguez C, Siles-Guerrero V, Herrera-Montes I, Navarro-Pelayo FG, López-de-la-Torre-Casares M, Muñoz-Garach A. Bioelectrical Impedance Vector Analysis, Nutritional Ultrasound ®, and Handgrip Strength as Innovative Methods for Monitoring Critical Anorexia Nervosa Physical Recovery: A Pilot Study. Nutrients 2024; 16:1539. [PMID: 38794777 PMCID: PMC11123858 DOI: 10.3390/nu16101539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Eating disorders (EDs) manifest as persistent disruptions in eating habits or related behaviors, significantly impacting physical health and psychosocial well-being. Nutritional assessment in ED patients is crucial for monitoring treatment efficacy. While dual-energy X-ray absorptiometry (DEXA) remains standard, interest in alternative methods such as bioelectrical impedance vector analysis (BIVA) and Nutritional Ultrasound® (NU) has risen due to their affordability and portability. Additionally, hand dynamometry offers a user-friendly approach to assessing grip strength (HGS), indicative of nutritional status. A prospective study was carried out to evaluate the utility of BIVA, NU®, and HGS in 43 female AN patients. Measurements were taken at baseline and hospital discharge. A total of 41 patients completed the study. After the intervention, numerous BIVA-related parameters such as fat (3.5 ± 2 kg vs. 5.3 ± 2.7 kg, p < 0.001) and free fat mass (33.9 ± 3.8 kg vs. 37.5 ± 4.1 kg, p < 0.001) were partially restored. Similarly, Nutritional Ultrasound® showed promising results in assessing body composition changes such as total abdominal fat tissue (0.5 ± 0.3 cm vs. 0.9 ± 0.3 cm, p < 0.05). In the same way, rectus femoris cross-sectional area values correlated with clinical outcomes such as free fat mass (0.883, p < 0.05) and appendicular muscle mass (0.965, p < 0.001). HGS reached the normality percentile after the intervention (21.6 ± 9.1 kg vs. 25.9 ± 12.3 kg, p < 0.05), demonstrating a significant association between grip strength and body composition parameters such as free fat mass (0.658, p < 0.001) and appendicular muscle mass (0.482, p < 0.001). Incorporating BIVA-, NU®-, and HGS-enhanced nutritional assessment into the treatment of AN patients offers cost-effective, portable, and non-invasive alternatives to DEXA. These techniques offer valuable insights into changes in body composition and nutritional status, which, in turn, facilitate treatment monitoring and contribute to improved patient outcomes.
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Affiliation(s)
- Jose M. Romero-Márquez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Foundation for Biosanitary Research of Eastern Andalusia—Alejandro Otero (FIBAO), 18012 Granada, Spain
| | - María Novo-Rodríguez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Foundation for Biosanitary Research of Eastern Andalusia—Alejandro Otero (FIBAO), 18012 Granada, Spain
| | - Cristina Novo-Rodríguez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
| | - Víctor Siles-Guerrero
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
| | - Isabel Herrera-Montes
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
| | | | - Martín López-de-la-Torre-Casares
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
| | - Araceli Muñoz-Garach
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
- Network Biomedical Research Center Physiopathology of Obesity and Nutrition (CiberOBN), Carlos III Health Institute, 28029 Madrid, Spain
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Frank GKW, Stoddard JJ, Brown T, Gowin J, Kaye WH. Weight gained during treatment predicts 6-month body mass index in a large sample of patients with anorexia nervosa using ensemble machine learning. Int J Eat Disord 2024. [PMID: 38610100 DOI: 10.1002/eat.24208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE This study used machine learning methods to analyze data on treatment outcomes from individuals with anorexia nervosa admitted to a specialized eating disorders treatment program. METHODS Of 368 individuals with anorexia nervosa (209 adolescents and 159 adults), 160 individuals had data available for a 6-month follow-up analysis. Participants were treated in a 6-day-per-week partial-hospital program. Participants were assessed for eating disorder-specific and non-specific psychopathology. The analyses used established machine learning procedures combined in an ensemble model from support vector machine learning, random forest prediction, and the elastic net regularized regression with an exploration (training; 75%) and confirmation (test; 25%) split of the data. RESULTS The models predicting body mass index (BMI) at 6-month follow-up explained a 28.6% variance in the training set (n = 120). The model had good performance in predicting 6-month BMI in the test dataset (n = 40), with predicted BMI significantly correlating with actual BMI (r = .51, p = 0.01). The change in BMI from admission to discharge was the most important predictor, strongly correlating with reported BMI at 6-month follow-up (r = .55). Behavioral variables were much less predictive of BMI outcome. Results were similar for z-transformed BMI in the adolescent-only group. Length of stay was most predictive of weight gain in treatment (r = .56) but did not predict longer-term BMI. CONCLUSIONS This study, using an agnostic ensemble machine learning approach in the largest to-date sample of individuals with anorexia nervosa, suggests that achieving weight gain goals in treatment predicts longer-term weight-related outcomes. Other potential predictors, personality, mood, or eating disorder-specific symptoms were relatively much less predictive. PUBLIC SIGNIFICANCE The results from this study indicate that the amount of weight gained during treatment predicts BMI 6 months after discharge from a high level of care. This suggests that patients require sufficient time in a higher level of care treatment to meet their specific weight goals and be able to maintain normal weight.
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Affiliation(s)
- Guido K W Frank
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joel J Stoddard
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tiffany Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Josh Gowin
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
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Maurel L, MacKean M, Lacey JH. Factors predicting long-term weight maintenance in anorexia nervosa: a systematic review. Eat Weight Disord 2024; 29:24. [PMID: 38582784 PMCID: PMC10998787 DOI: 10.1007/s40519-024-01649-5] [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: 10/19/2023] [Accepted: 03/03/2024] [Indexed: 04/08/2024] Open
Abstract
PURPOSE Eating disorder recovery is a poorly defined concept, with large variations among researchers' definitions. Weight maintenance is a key aspect of recovery that remains relatively underexplored in the literature. Understanding the role of weight maintenance may help guide the development of treatments. This paper aims to address this by (1) investigating the factors predicting long-term weight maintenance in anorexia nervosa (AN) patients; (2) exploring differences in predictive factors between adolescent and adult populations; and (3) exploring how weight maintenance is conceptualised in the literature. METHODS We conducted a systematic review following PRISMA guidelines to address our research questions. Five databases were searched and filtered according to our exclusion criteria. RESULTS From the search, 1059 studies were yielded, and 13 studies were included for review. A range of weight, biological and psychological factors were found to predict weight maintenance among these papers. BMI at admission and discharge from inpatient treatment was the most common predictor among the papers. Few studies investigated biological factors and mixed evidence was found for psychological factors. We found no observable differences between adult and adolescent populations. Finally, weight maintenance was defined and measured differently across studies. CONCLUSION This review's findings can help contribute to a well-rounded understanding of weight maintenance, and ultimately, of recovery. This can help support clinicians in tailoring interventions to improve long-term outcomes in AN. Future research should aim to replicate studies to better understand the relationship between the factors identified and weight maintenance. LEVEL I Systematic review.
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Affiliation(s)
| | | | - J Hubert Lacey
- Schoen, Birmingham, UK.
- St George's, University of London, London, UK.
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7
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Eaton CM, Phillips KE. Posttraumatic growth in eating disorder recovery. Arch Psychiatr Nurs 2024; 49:38-46. [PMID: 38734453 DOI: 10.1016/j.apnu.2024.01.002] [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: 07/07/2023] [Revised: 12/10/2023] [Accepted: 01/01/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To investigate posttraumatic growth in individuals recovering from an eating disorder. DESIGN A convergent parallel mixed methods design was used. PARTICIPANTS The sample consisted of 28 participants who completed the entire study and an additional 10 who completed only the quantitative portion of this mixed methods study. METHODS The National Eating Disorders Association (NEDA) provided a link to the electronic survey via their website. Participants were asked to complete the Posttraumatic Growth Inventory (PTGI) and the Core Beliefs Inventory (CBI) in the quantitative strand. For the qualitative strand, participants were asked to describe any positive changes in their beliefs or life as the result of their eating disorder (ED). RESULTS Participants reported a high amount of posttraumatic growth as indicated by their mean score on the CBI (30.39, SD 7.89) and (71.26, SD 16.58) on the PTGI. Qualitative categories included relating to others, personal strength, new possibilities, appreciation of life, and spiritual change. CONCLUSION Participants described the transformation they experienced in the recovery process, with recovery from an eating disorder facilitating an opportunity for growth. Providing posttraumatic growth interventions may have the potential to help individuals with eating disorders find meaning in their pathway through recovery.
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Affiliation(s)
- Carrie Morgan Eaton
- University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT 06269, United States of America.
| | - Kathryn E Phillips
- Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, 1073 North Benson Road, Fairfield, CT 08824, United States of America
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Johnson-Munguia S, Negi S, Chen Y, Thomeczek ML, Forbush KT. Eating disorder psychopathology, psychiatric impairment, and symptom frequency of atypical anorexia nervosa versus anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2024; 57:761-779. [PMID: 37317625 DOI: 10.1002/eat.23989] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Restrictive eating disorders (EDs) occur across the weight spectrum, but historically more focus has been given to anorexia nervosa (AN) than atypical anorexia nervosa (atypAN). AtypAN's relegation to a diagnosis in the "other specified feeding and eating disorder" (OSFED) category and paucity of research surrounding atypAN invariably implies a less clinically severe ED. However, a growing body of research has begun to question the assumption that atypAN is less severe than AN. The current review and meta-analysis aimed to provide a comprehensive review to compare atypAN and AN on measures of eating disorder psychopathology, impairment, and symptom frequency to test whether atypAN is truly less clinically severe than AN. METHODS Twenty articles that reported on atypAN and AN for at least one of the variables of interest were retrieved from PsycInfo, PubMed, and ProQuest. RESULTS For eating-disorder psychopathology, results indicated that differences were nonsignificant for most indicators; however, atypAN was associated with significantly higher shape concern, weight concern, drive for thinness, body dissatisfaction, and overall eating-disorder psychopathology than AN. Results indicated that atypAN and AN did not significantly differ on clinical impairment or the frequency of inappropriate compensatory behaviors, whereas there was a significantly higher frequency of objective binge episodes in AN (vs. atypAN). DISCUSSION Overall, findings indicated that, in contrast to the current classification system, atypAN and AN were not clinically distinct. Results underscore the need for equal access to treatment and equal insurance coverage for restrictive EDs across the weight spectrum. PUBLIC SIGNIFICANCE The current meta-analysis found that atypAN was associated with higher drive for thinness, body dissatisfaction, shape concern, weight concern, and overall eating-disorder psychopathology than AN; whereas AN was associated with higher frequency of objective binge eating. Individuals with AN and atypAN did not differ on psychiatric impairment, quality-of-life, or frequency of compensatory behaviors, highlighting the need for equal access to care for restrictive EDs across the weight spectrum.
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Affiliation(s)
| | - Sonakshi Negi
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Yiyang Chen
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
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9
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Gura-Solomon M, Brener Yacobi R, Kushnir T, Heled E. Cognitive flexibility in women who recovered from anorexia nervosa - a model-based approach. J Psychiatr Res 2024; 171:38-42. [PMID: 38241968 DOI: 10.1016/j.jpsychires.2024.01.011] [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: 01/28/2023] [Revised: 12/13/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
Research findings on cognitive flexibility (CF) functioning in women who recovered from anorexia nervosa (RAN) were found to be inconsistent. This was attributed to the multiple definitions of CF and the diverse measuring tools used to assess it. Applying a deductive approach to explore CF function may address these inconsistencies; thus, we used a model that divides CF into three subtypes, namely, stimulus-response mapping, switching sets and task switching. Additionally, we explored the association between CF subtypes and the disorder's clinical measures to assess the relation of CF to recovery. Forty-three RAN and 54 healthy controls performed tasks designed to assess CF subtypes based on the model's division, and the RAN group completed the Eating Disorder Examination Questionnaire. The results showed that the RAN group performed significantly worse than controls only in the stimulus-response mapping subtype. Additionally, there were no correlations between CF subtypes and clinical symptoms or the disorder measures - current and nadir body mass index, age of onset, time since recovery, and disorder duration. In conclusion, the study revealed CF impairment after recovery from AN, specifically in stimulus-response mapping. The variability in performance of the CF subtypes supports the application of a theory-driven perspective viewing CF as a modular ability in RAN. Additionally, CF is unrelated to clinical measures post-recovery and thus may not be used as a criterion for evaluating recovery.
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Affiliation(s)
| | | | - Talma Kushnir
- Department of Psychology, Ariel University, Israel; Adelson School of Medicine, Ariel University, Israel
| | - Eyal Heled
- Department of Psychology, Ariel University, Israel; Neurological Rehabilitation Department, Sheba Medical Center, Israel.
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10
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Christian C, Butler RM, Burr EK, Levinson C. An Intensive time series investigation of the relationships across eating disorder-specific fear responses and behavior urges in partially remitted anorexia nervosa. J Anxiety Disord 2024; 102:102804. [PMID: 38128286 PMCID: PMC10923000 DOI: 10.1016/j.janxdis.2023.102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/25/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
Anorexia nervosa (AN) is a serious and persistent psychiatric illness. Many individuals with AN cycle between stages of remission (i.e., relapse), with research documenting that cognitive remission generally lags behind nutritional/weight restoration. Yet, little is known about which mechanisms promote movement from partial remission in AN (defined as nutritional, but not cognitive, recovery) to full remission. Fear-based processes, including avoidance and approach behaviors, likely contribute to the persistence of cognitive-behavioral AN symptoms after nutritional restoration. The current study used intensive longitudinal data to characterize these processes during partial remission (N = 41 participants with partially remitted AN; 4306 total observations). We aimed to a) characterize frequency of fear-based processes in real-time, b) investigate associations across fear-based processes and behavioral urges, and c) test if real-time associations among symptoms differed across commonly feared stimuli (e.g., food, social situations). On average, participants endorsed moderate fear and avoidance, with weight-gain fears rated higher than other feared stimuli. Momentary fear, avoidance, approach, and distress were all positively associated with AN behavior urges at one time-point and prospectively. Central symptoms and symptom connections differed across models with different feared stimuli. These findings provide empirical support for the theorized fear-avoidance-urge cycle in AN, which may contribute to the persistence of eating pathology during partial remission. Fear approach may be associated with temporary increases in urges, which should be considered during treatment. Future research should explore these associations in large, heterogeneous samples, and test the effectiveness of exposure-based interventions during partial remission.
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Affiliation(s)
- Caroline Christian
- University of Louisville, Department of Psychological & Brain Sciences, Louisville, KY, USA.
| | - Rachel M Butler
- University of Louisville, Department of Psychological & Brain Sciences, Louisville, KY, USA
| | - Emily K Burr
- University of Central Florida, Department of Psychology, Orlando, FL, USA
| | - Cheri Levinson
- University of Louisville, Department of Psychological & Brain Sciences, Louisville, KY, USA
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11
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Solmi M, Monaco F, Højlund M, Monteleone AM, Trott M, Firth J, Carfagno M, Eaton M, De Toffol M, Vergine M, Meneguzzo P, Collantoni E, Gallicchio D, Stubbs B, Girardi A, Busetto P, Favaro A, Carvalho AF, Steinhausen HC, Correll CU. Outcomes in people with eating disorders: a transdiagnostic and disorder-specific systematic review, meta-analysis and multivariable meta-regression analysis. World Psychiatry 2024; 23:124-138. [PMID: 38214616 PMCID: PMC10785991 DOI: 10.1002/wps.21182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and meta-analysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICD-defined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, all-cause and ED-related hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean follow-up: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44-49, n=283, mean follow-up: 44.9±62.8 months, no significant ED-group difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at ≥10 years. Overall chronicity occurred in 25% of patients (95% CI: 23-29, n=170, mean follow-up: 59.3±71.2 months, no significant ED-group difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at ≥10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2-0.7, n=214, mean follow-up: 72.2±117.7 months, no significant ED-group difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 person-years (95% CI: 4.4-6.1, n=167, mean follow-up: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18-36, n=18, mean follow-up: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Self-injurious behaviors were associated with lower recovery rates in pooled EDs. A higher socio-demographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were family-based therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; self-help, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.
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Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Regional Centre for Treatment of Eating Disorders, and On Track: Champlain First Episode Psychosis Program, Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Francesco Monaco
- Department of Mental Health, Local Health Unit, Salerno, Italy
- European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark; Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Mike Trott
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
- Centre for Public Health, Queen's University, Belfast, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Marco Carfagno
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Melissa Eaton
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- School of Medical, Indigenous and Health Sciences Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Marco De Toffol
- Department of Mental Health, Local Health Unit, Lecce, Italy
| | | | - Paolo Meneguzzo
- Department of Neuroscience, University of Padua, Padua, Italy
| | | | | | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Anna Girardi
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Paolo Busetto
- Provincial Center for Eating Disorders, Local Health Unit, Treviso, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, Psychiatric University Clinic, Zurich, Switzerland
- Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Northwell Health, Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
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12
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Kiely L, Conti J, Hay P. Anorexia nervosa through the lens of a severe and enduring experience: 'lost in a big world'. J Eat Disord 2024; 12:12. [PMID: 38254163 PMCID: PMC10804804 DOI: 10.1186/s40337-023-00953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Severe and enduring anorexia nervosa (SE-AN), is a serious and persistent illness, despite 'state of the art' treatment. Criteria have been theoretically proposed, but not tested, and may not adequately capture illness complexity, which potentially inhibits treatment refinements. The clinical reality of death as an outcome for some people who experience SE-AN (1 in 20) and broadening access to voluntary assisted dying, further complicates the field, which is undeveloped regarding more fundamental concepts such as nosology, treatment, recovery definitions and alternative conceptualisations of SE-AN. The present paper is in response to this and aims to build upon qualitative literature to enhance phenomenological understandings of fatal SE-AN. METHOD A published book, being the legacy of a 32-year-old professional artist offers a rich account of a life lived with AN, for 18 years with continuous treatment. A polysemous narrative via the interrelationship between the languages of the artist's words and visual art is translated via interpretative phenomenological analysis (IPA), offering rich insight into the SE-AN experience. FINDINGS The process of analysis induced three superordinate themes (1) Disappearing Self (2) Dialectical Dilemma (3) Death and Dying: Finding Meaning. Two cross cutting themes traversed these themes: (a) Colour and (b) Shifting Hope, where the former produced a visual representation via the 'SE-AN Kaleidoscope'. Collectively the themes produce a concept of SE-AN, grounded in the data and depicted visually through the artist's paintings. CONCLUSIONS The picture of SE-AN revealed in the analysis extends upon conceptualisations of SE-AN, highlighting key processes which are thus far under explored. These factors are implicated in illness persistence eliciting opportunities for further research testing including diagnostic considerations and treatment directions. In SE-AN, distorted body image extends to a global distortion in the perception of self. Additional criteria for the severe and enduring stages of illness related to (1) self and identity processes (2) measures of 'global impoverishment' across life domains are proposed for consideration in the future testing of putative defining features of SE-AN.
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Affiliation(s)
- Laura Kiely
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Janet Conti
- School of Psychology, Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
- Mental Health Services, Camden and Campbelltown Hospitals, SWSLHD, Campbeltown, NSW, 2560, Australia
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13
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de Rijk ESJ, Almirabi D, Robinson L, Schmidt U, van Furth EF, Slof-Op 't Landt MCT. An overview and investigation of relapse predictors in anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2024; 57:3-26. [PMID: 37855175 DOI: 10.1002/eat.24059] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE An extensive number of predictors has been examined across the literature to improve knowledge of relapse in anorexia nervosa (AN). These studies provide various recovery and relapse definitions, follow-up durations and relapse rates. The current study summarizes these values and predictors of relapse in AN in a review and meta-analysis. METHOD The study was executed according to PRISMA guidelines. Different databases were searched and studies in which participants did not receive an official clinical diagnosis were excluded. A quality analysis was performed using the National Institute of Health's Study Quality Assessment Tool. Random-effects meta-analyses were conducted to summarize data. RESULTS Definitions of relapse and recovery were diverse. During an average follow-up period of 31 months an average relapse rate of 37% was found. Predictive variables from 28 studies were grouped in six categories: age and sex, symptoms and behaviors, AN subtype and duration, weight or weight change, comorbidity, and personality. The studies were characterized by non-significant and contradictory results. Meta-analyses were performed for the predictors age, AN duration, pre-treatment BMI, post-treatment BMI and depression. These yielded significant effects for post-treatment BMI and depression: higher pre-treatment depression (SMD = .40 CI [.21-.59] and lower post-treatment BMI (SMD = -.35 CI [-.63 to -.07]) increased relapse chances in AN. DISCUSSION Our results emphasized a lack of sufficiently powered studies, consistent results, and robust findings. Solely post-treatment BMI and pre-treatment depression predicted relapse. Future research should use uniform definitions, larger samples and better designs, to improve our understanding of relapse in AN. PUBLIC SIGNIFICANCE Knowledge about predictors is important to understand high relapse rates. Our study performed a review and meta-analysis of relapse predictors in AN. Related to the heterogeneity in studies examining predictors, an overview of relapse and recovery definitions, follow-up durations and relapse rates for AN was provided. Significant effects were found for post-treatment BMI and pre-treatment depression. More studies with uniform definitions are needed to improve clinical implications.
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Affiliation(s)
- Eline S J de Rijk
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Durr Almirabi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lauren Robinson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric F van Furth
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Margarita C T Slof-Op 't Landt
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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14
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Rösch SA, Schmidt R, Hilbert A. Predictors of neurofeedback treatment outcome in binge-eating disorder: An exploratory study. Int J Eat Disord 2023; 56:2283-2294. [PMID: 37737523 DOI: 10.1002/eat.24062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Knowledge on predictors for treatment response to psychotherapy in binge-eating disorder (BED) is mixed and not yet available for increasingly popular neurofeedback (NF) treatment targeting self-regulation of aberrant brain activity. This study examined eating disorder- and psychopathology-related predictors for NF treatment success in BED. METHOD Patients with BED (N = 78) were randomized to 12 sessions of real-time functional near-infrared spectroscopy (rtfNIRS)-NF, targeting individual prefrontal cortex signal up-regulation, electroencephalography (EEG)-NF, targeting down-regulation of fronto-central beta activity, or waitlist (WL). The few studies assessing predictors for clinical outcomes after NF and evidenced predictors for psychotherapy guided the selection of baseline eating disorder-related predictors, including objective binge-eating (OBE) frequency, eating disorder psychopathology (EDP), food cravings, and body mass index (BMI), and general psychopathology-related predictors, including depressive and anxiety symptoms, impulsivity, emotion dysregulation, and self-efficacy. These questionnaire-based or objectively assessed (BMI) predictors were regressed on outcomes OBE frequency and EDP as key features of BED at post-treatment (t1) and 6-month follow-up (t2) in preregistered generalized mixed models (https://osf.io/4aktp). RESULTS Higher EDP, food cravings, and BMI predicted worse outcomes across all groups at t1 and t2. General psychopathology-related predictors did not predict outcomes at t1 and t2. Explorative analyses indicated that lower OBE frequency and higher self-efficacy predicted lower OBE frequency, and lower EDP predicted lower EDP after the waiting period in WL. DISCUSSION Consistent with findings for psychotherapy, higher eating disorder-related predictors were associated with higher EDP and OBE frequency. The specificity of psychopathological predictors for NF treatment success warrants further examination. PUBLIC SIGNIFICANCE This exploratory study firstly assessed eating disorder- and psychopathology-related predictors for neurofeedback treatment outcome in binge-eating disorder and overweight. Findings showed an association between higher eating disorder symptoms and worse neurofeedback outcomes, indicating special needs to be considered in neurofeedback treatment for patients with a higher binge-eating disorder symptom burden. In general, outcomes and assignment to neurofeedback treatment may be improved upon consideration of baseline psychological variables.
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Affiliation(s)
- Sarah A Rösch
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Leipzig, Germany
- International Max Planck Research School NeuroCom, Leipzig, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Leipzig, Germany
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15
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Austin A, De Silva U, Ilesanmi C, Likitabhorn T, Miller I, Sousa Fialho MDL, Austin SB, Caldwell B, Chew CSE, Chua SN, Dooley-Hash S, Downs J, El Khazen Hadati C, Herpertz-Dahlmann B, Lampert J, Latzer Y, Machado PPP, Maguire S, Malik M, Moser CM, Myers E, Pastor IR, Russell J, Smolar L, Steiger H, Tan E, Trujillo-Chi Vacuán E, Tseng MCM, van Furth EF, Wildes JE, Peat C, Richmond TK. International consensus on patient-centred outcomes in eating disorders. Lancet Psychiatry 2023; 10:966-973. [PMID: 37769672 DOI: 10.1016/s2215-0366(23)00265-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 10/02/2023]
Abstract
The effectiveness of mental health care can be improved through coordinated and wide-scale outcome measurement. The International Consortium for Health Outcomes Measurement has produced collaborative sets of outcome measures for various mental health conditions, but no universal guideline exists for eating disorders. This Position Paper presents a set of outcomes and measures for eating disorders as determined by 24 international experts from professional and lived experience backgrounds. An adapted Delphi technique was used, and results were assessed through an open review survey. Final recommendations suggest outcomes should be tracked across four domains: eating disorder behaviours and cognitions, physical health, co-occurring mental health conditions, and quality of life and social functioning. Outcomes are collected using three to five patient-reported measures. For children aged between 6 years and 12 years, the measures include the Children's Eating Attitude Test (or, for those with avoidant restrictive food intake disorder, the Eating Disorder in Youth Questionnaire), the KIDSCREEN-10, and the Revised Children's Anxiety and Depression Screener-25. For adolescents aged between 13 years and 17 years, the measures include the Eating Disorder Examination Questionnaire (EDE-Q; or, for avoidant restrictive food intake disorder, the Nine-Item Avoidant Restrictive Food Intake Disorder Screener [NIAS]), the two-item Patient Health Questionnaire (PHQ-2), the nine-item Patient Health Questionnaire (PHQ-9), the two-item Generalised Anxiety Disorder (GAD-2), the seven-item Generalised Anxiety Disorder (GAD-7), and the KIDSCREEN-10. For adults older than 18 years, measures include the EDE-Q (or, for avoidant restrictive food intake disorder, the NIAS), the PHQ-2, the PHQ-9, the GAD-2, the GAD-7, the Clinical Impairment Assessment, and the 12-item WHO Disability Assessment Schedule 2.0. These questionnaires should be supplemented by information on patient characteristics and circumstances (ie, demographic, historical, and clinical factors). International adoption of these guidelines will allow comparison of research and clinical interventions to determine which settings and interventions work best, and for whom.
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Affiliation(s)
- Amelia Austin
- Department of Community Health Sciences, and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Psychological Medicine, King's College London, London, UK.
| | - Umanga De Silva
- International Consortium for Health Outcomes Measurement, Boston, MA, USA
| | | | | | - Isabel Miller
- International Consortium for Health Outcomes Measurement, Boston, MA, USA
| | | | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Chu Shan Elaine Chew
- Adolescent Medicine Service, Department of Paediatrics, Kandang Kerbau Women's and Children's Hospital, Singapore
| | | | - Suzanne Dooley-Hash
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen, Aachen, Germany
| | - Jillian Lampert
- The Emily Program, St Paul, MN, USA; REDC Consortium, New York, NY, USA
| | - Yael Latzer
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Eating Disorders Institution, Psychiatric Division, Rambam Health Care Campus, Haifa, Israel
| | - Paulo P P Machado
- Psychotherapy and Psychopathology Research Lab, Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The University of Sydney, Sydney, NSW, Australia; Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Madeeha Malik
- Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan; Cyntax Health Projects, Islamabad, Pakistan
| | - Carolina Meira Moser
- Programa de Transtornos Alimentares em Adultos, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, UFRGS, Porto Alegre, Brazil
| | | | | | - Janice Russell
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; NSW Statewide Eating Disorder Service, Peter Beumont Unit, Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Lauren Smolar
- National Eating Disorders Association, White Plains, NY, USA
| | - Howard Steiger
- Eating Disorder Continuum, Douglas Mental Health University Institute, Montreal, QC, Canada; Psychiatry Department, McGill University, Montreal, QC, Canada
| | - Elizabeth Tan
- InsideOut Institute for Eating Disorders, The University of Sydney, Sydney, NSW, Australia
| | - Eva Trujillo-Chi Vacuán
- Comenzar de Nuevo Eating Disorders Research and Treatment Center, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Mei-Chih Meg Tseng
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eric F van Furth
- Rivierduinen Eating Disorders Ursula, Leiden, Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Christine Peat
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tracy K Richmond
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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16
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Lacalaprice D, Mocini E, Frigerio F, Minnetti M, Piciocchi C, Donini LM, Poggiogalle E. Effects of mealtime assistance in the nutritional rehabilitation of eating disorders. Eat Weight Disord 2023; 28:73. [PMID: 37688675 PMCID: PMC10492868 DOI: 10.1007/s40519-023-01605-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/29/2023] [Indexed: 09/11/2023] Open
Abstract
PURPOSE The aim of the study was to examine the effects of meal supervision, provided by health professionals, volunteers or family members, on anthropometric, nutritional, psychological, and behavioural outcomes in patients with eating disorders (EDs). METHODS The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The last search was conducted in three databases (PubMed, Scopus, and the Cochrane library). Inclusion criteria considered paediatric and adult patients suffering from EDs, regardless of ethnicity, and treated in different therapeutic settings. The quality of the studies was evaluated using the Newcastle Ottawa Scale (NOS) adapted for cross-sectional studies and Version 2 of the Cochrane risk-of-bias assessment tool for randomised trials. RESULTS 3282 articles were retrieved, out of which only 6 met the eligibility criteria. A marked heterogeneity in definitions and approaches to supervised mealtime was observed. This variability emerged in the methodologies used in the supervised meal, and in the reference values for the outcome measures that were used, such as the analysis of different parameters. Based on these observations, mealtime assistance provided to patients with EDs shows an overall positive effect on eating behaviour and dysfunctional attitudes. Future research should be prompted to provide a thorough definition of a structured procedure for meal assistance to be potentially and systematically included in the nutritional rehabilitation protocols for patients with EDs. LEVEL OF EVIDENCE Level IV systematic reviews of uncontrolled trials.
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Affiliation(s)
- Doriana Lacalaprice
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Edoardo Mocini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
| | - Francesco Frigerio
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marianna Minnetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Claudia Piciocchi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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17
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Ålgars M, Oshukova S, Suokas J. A novel outpatient treatment model for patients with severe and enduring anorexia nervosa: an observational study of patient characteristics, treatment goals, and treatment course. J Eat Disord 2023; 11:150. [PMID: 37674214 PMCID: PMC10481592 DOI: 10.1186/s40337-023-00877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Approximately 20-30% of people with anorexia nervosa develop an enduring form of the disorder. In the present study a newly developed outpatient treatment unit for patients with severe and enduring anorexia nervosa was described. The treatment model is flexible, patient-centered, and aims at enhancing quality of life, maintaining medical stability, and minimizing harm. Treatment contents, patient characteristics, treatment goals, and course of treatment from the first five years of operation were described and analyzed. METHODS The participants (N = 22) consisted of all referrals resulting in an assessment or treatment period at the unit between May 2017 and May 2022. All participants were women. The study was a registry study. Information regarding patient characteristics, treatment goals, and the course of treatment was gathered from medical records. RESULTS On average, the participants had had a diagnosed eating disorder for 12.80 years, and self-reported eating disorder symptoms for 19 years. Their symptomatology included severe eating disorder symptoms, psychiatric comorbidities, extreme underweight, and co-occurring medical conditions. Their treatment goals commonly concerned improving physical health, reducing eating disorder symptoms, improving psychological well-being, and improving quality of life. The majority of participants for whom this information was available benefited from the treatment (60%) and their treatment goals were met or partly met (66.6%), as measured by evaluations made by the patient or the treatment team. More than two thirds (69.2%) of the participants for whom this information was available remained weight stable or showed an increase in BMI. CONCLUSIONS This observational study suggests that many individuals with severe and enduring anorexia nervosa may benefit from flexible treatment, aiming at supporting quality of life. The results highlight the importance of coordinating and integrating the treatment of severe and enduring anorexia nervosa and co-occurring psychiatric disorders as well as medical complications. Further research and international dialogue about the how treatment for this vulnerable patient group should best be organized is called for. Trial registration Trial registration number: NCT05708404. Date of registration: 01/23/2023 (retrospectively registered).
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Affiliation(s)
- Monica Ålgars
- Eating Disorder Unit, HUS Helsinki University Hospital, PB 282, 00029, Helsinki, Finland.
- Department of Psychology, University of Helsinki, PB 21, 00014, Helsinki, Finland.
| | - Svetlana Oshukova
- Eating Disorder Unit, HUS Helsinki University Hospital, PB 282, 00029, Helsinki, Finland
| | - Jaana Suokas
- Eating Disorder Unit, HUS Helsinki University Hospital, PB 282, 00029, Helsinki, Finland
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18
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Kiely L, Conti J, Hay P. Conceptualisation of severe and enduring anorexia nervosa: a qualitative meta-synthesis. BMC Psychiatry 2023; 23:606. [PMID: 37596588 PMCID: PMC10439651 DOI: 10.1186/s12888-023-05098-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Severe and enduring anorexia nervosa (SE-AN) is amongst the most impairing of all mental illnesses. Collective uncertainties about SE-AN nosology impacts treatment refinement. Qualitative research, particularly lived experience literature, can contribute to a process of revision and enrichment of understanding the SE-AN experience and further develop treatment interventions. Poor outcomes to date, as evidenced in clinical trials and mortality for people with SE-AN (1 in 20) demonstrate the need for research that informs conceptualisations and novel treatment directions. This interpretative, meta-ethnographic meta-synthesis aimed to bridge this gap. METHODS A systematic search for qualitative studies that explored the AN experiences of people with a duration of greater than 3 years was undertaken. These studies included those that encompassed phenomenology, treatment experiences and recovery. RESULTS 36 papers, comprising 382 voices of SE-AN experiences informed the meta-ethnographic findings. Four higher order constructs were generated through a synthesis of themes and participant extracts cited in the extracted papers: (1) Vulnerable sense of self (2) Intra-psychic processes (3) Global impoverishment (4) Inter-psychic temporal processes. Running across these meta-themes were three cross cutting themes (i) Treatment: help versus harm, (ii) Shifts in control (iii) Hope versus hopelessness. These meta-themes were integrated into conceptualisations of SE-AN that was experienced as a recursive process of existential self-in-relation to other and the anorexia nervosa trap. CONCLUSIONS The alternative conceptualisation of SE-AN proposed in this paper poses a challenge to current conceptualisations of AN and calls for treatments to engage with the complex intra and inter-psychic processes of the SE-AN, more fully. In doing so, clinicians and researchers are asked to continue to be bold in testing novel ideas that may challenge our own rigidity and attachment to dominant paradigms to best serve the individual person with SE-AN. The 'global impoverishment of self', found in this synthesis of AN experiences, should inform proposed diagnostic criteria for SE-AN.
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Affiliation(s)
- Laura Kiely
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
| | - Janet Conti
- School of Psychology, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University. Mental Health Services, Camden and Campbelltown Hospitals, SWSLHD, Campbeltown, NSW, Australia
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19
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Svendsen VG, Wijnen BFM, De Vos JA, Veenstra R, Evers SMAA, Lokkerbol J. A roadmap for applying machine learning when working with privacy-sensitive data: predicting non-response to treatment for eating disorders. Expert Rev Pharmacoecon Outcomes Res 2023; 23:933-949. [PMID: 37366051 DOI: 10.1080/14737167.2023.2230368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Applying machine-learning methodology to clinical data could present a promising avenue for predicting outcomes in patients receiving treatment for psychiatric disorders. However, preserving privacy when working with patient data remains a critical concern. METHODS In showcasing how machine-learning can be used to build a clinically relevant prediction model on clinical data, we apply two commonly used machine-learning algorithms (Random Forest and least absolute shrinkage and selection operator) to routine outcome monitoring data collected from 593 patients with eating disorders to predict absence of reliable improvement 12 months after entering outpatient treatment. RESULTS An RF model trained on data collected at baseline and after three months made 31.3% fewer errors in predicting lack of reliable improvement at 12 months, in comparison with chance. Adding data from a six-month follow-up resulted in only marginal improvements to accuracy. CONCLUSION We were able to build and validate a model that could aid clinicians and researchers in more accurately predicting treatment response in patients with EDs. We also demonstrated how this could be done without compromising privacy. ML presents a promising approach to developing accurate prediction models for psychiatric disorders such as ED.
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Affiliation(s)
- Vegard G Svendsen
- Center of Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
- Department of Health Services Research, Care and Public Health Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
- Norwegian Centre for Addiction Research, SERAF, University of Oslo, Oslo, Norway
| | - Ben F M Wijnen
- Center of Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Alexander De Vos
- Human Concern, Centre for Eating Disorders, Human Concern, Amsterdam, The Netherlands
| | - Ravian Veenstra
- Human Concern, Centre for Eating Disorders, Human Concern, Amsterdam, The Netherlands
| | - Silvia M A A Evers
- Center of Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joran Lokkerbol
- Center of Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
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20
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Schloesser L, Lotter LD, Offermann J, Borucki K, Biemann R, Seitz J, Konrad K, Herpertz-Dahlmann B. Sex-dependent clinical presentation, body image, and endocrine status in long-term remitted anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 37319038 DOI: 10.1002/erv.2997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Although anorexia nervosa (AN) in males has recently gained attention, knowledge of its psychological and physiological outcomes is still scarce. We explore sex-specific characteristics of long-term remitted AN with respect to residual eating disorder (ED) psychopathology, body image, and endocrinology. METHOD We recruited 33 patients with AN in remission for at least 18 months (24 women, 9 men) and 36 matched healthy controls (HCs). Eating disorder psychopathology and body image ideals were assessed via clinical interviews, questionnaires, and an interactive 3D body morphing tool. Plasma levels of leptin, free triiodothyronine, cortisol, and sex hormones were quantified. Univariate models controlled for age and weight were used to test for the effects of diagnosis and sex. RESULTS Both patient groups showed residual ED psychopathology but normal weight and hormone levels relative to HCs. Male remitted patients demonstrated significantly stronger muscularity-focused body image ideals, evident in interviews, self-reports, and behavioural data, than both female patients and HCs. CONCLUSIONS Sex-specific body image characteristics in patients with remitted AN point towards the need to adjust test instruments and diagnostic criteria to male-specific psychopathology. In the future, sufficiently powered studies should evaluate the risk of men with AN developing muscle dysmorphia in the long term.
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Affiliation(s)
- Louisa Schloesser
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Leon D Lotter
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Jülich Research Centre, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Max Planck School of Cognition, Leipzig, Germany
| | - Jan Offermann
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Katrin Borucki
- Institute for Clinical Chemistry and Pathobiochemistry, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Ronald Biemann
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
- JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Jülich Research Centre, Jülich, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
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21
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Rankin R, Conti J, Ramjan L, Hay P. A systematic review of people's lived experiences of inpatient treatment for anorexia nervosa: living in a "bubble". J Eat Disord 2023; 11:95. [PMID: 37296440 DOI: 10.1186/s40337-023-00820-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Treatment for anorexia nervosa (AN) is typically delivered on a continuum of care, starting with outpatient treatment, and moving onto intensive outpatient, day or residential treatment and/or inpatient hospitalisation. However, minimal attention has been afforded to the lived experiences of persons undergoing inpatient treatment for AN. In particular, qualitative literature pertaining to the lived experiences of specialist inpatient or residential treatment of AN remains fragmented and incomplete. The aim of this review was to synthesise current literature exploring patients' lived experiences of residential and inpatient treatment for AN within eating disorder-specific treatment services. METHODS Five databases were searched and a qualitative thematic systematic review and meta-synthesis of 11 studies were conducted. RESULTS Eleven studies of 159 participants were included. Four meta-themes were constructed from the data: (1) a medical discourse-"I don't think it's individualised here"; (2) restrictive practice-living in a "bubble"; (3) myself, others and "a similar demon"; and (4) I am "not just another anorexic". The data also revealed two cross-cutting themes: (1) more than a single experience; and (2) meaning making and identity. CONCLUSIONS These findings highlight the complex and multifaceted nature of the inpatient treatment experience as well as the inherent conflicts in balancing the necessity of medical and psychological intervention with person-centred treatment approaches in the treatment of AN.
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Affiliation(s)
- Rebekah Rankin
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia.
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Lucie Ramjan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Campbelltown Hospital, South West Sydney Local Health District (SWSLHD), Sydney, Australia
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22
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Miskovic-Wheatley J, Bryant E, Ong SH, Vatter S, Le A, Touyz S, Maguire S. Eating disorder outcomes: findings from a rapid review of over a decade of research. J Eat Disord 2023; 11:85. [PMID: 37254202 DOI: 10.1186/s40337-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality. METHODS This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review. RESULTS Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates. CONCLUSION Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.
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Affiliation(s)
- Jane Miskovic-Wheatley
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia.
- Sydney Local Health District, Sydney, Australia.
| | - Emma Bryant
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Shu Hwa Ong
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sabina Vatter
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Stephen Touyz
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
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23
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Gorrell S, Hail L, Reilly EE. Predictors of Treatment Outcome in Eating Disorders: A Roadmap to Inform Future Research Efforts. Curr Psychiatry Rep 2023; 25:213-222. [PMID: 36995577 PMCID: PMC10360436 DOI: 10.1007/s11920-023-01416-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE OF REVIEW With the current review, we provide a brief summary of recent literature that tests clinically observable characteristics at baseline that may impact treatment response, across eating disorder diagnoses. We then provide a critical discussion regarding how researchers may shift their approach to this research to improve treatment implications and generalizability of these findings. RECENT FINDINGS Recent work has broadly replicated prior findings suggesting a negative impact of lower weight status, poor emotion regulation, and early-life trauma on eating disorder treatment outcomes. Findings are more mixed for the relative contributions of illness duration, psychiatric comorbidity, and baseline symptom severity. Recent studies have begun to explore more specific domains of previously tested predictors (e.g., specific comorbidities) as well as previously neglected identity-related and systemic factors. However, recent research continues to use similar sampling techniques and approaches to analysis used in prior work. We propose that resolving remaining questions and illuminating predictors of treatment outcome in eating disorders requires a new approach to research sampling and study design. Suggested changes that can be applied within a traditional clinical trial framework may yield new insights with relevance across transdiagnostic eating disorder presentations.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18Th St, CA, 94143, San Francisco, USA.
| | - Lisa Hail
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18Th St, CA, 94143, San Francisco, USA
| | - Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18Th St, CA, 94143, San Francisco, USA
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24
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Kenny TE, Lewis SP. More than an outcome: a person-centered, ecological framework for eating disorder recovery. J Eat Disord 2023; 11:45. [PMID: 36949489 PMCID: PMC10032254 DOI: 10.1186/s40337-023-00768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/08/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Eating disorder recovery is a complex phenomenon. While historical understandings focused on weight and behaviours, the importance of psychological factors is now widely recognized. It is also generally accepted that recovery is a non-linear process and is impacted by external factors. Recent research suggests a significant impact of systems of oppression, though these have not yet been named in models of recovery. BODY: In this paper, we propose a research-informed, person-centered, and ecological framework of recovery. We suggest that there are two foundational tenets of recovery which apply broadly across experiences: recovery is non-linear and ongoing and there is no one way to do recovery. In the context of these tenets, our framework considers individual changes in recovery as determined by and dependent on external/personal factors and broader systems of privilege. Recovery cannot be determined by looking solely at an individual's level of functioning; one must also consider the broader context of their life in which changes are being made. To conclude, we describe the applicability of the proposed framework and offer practical considerations for incorporating this framework in research, clinical, and advocacy settings.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada.
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada
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25
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Velkoff EA, Brown TA, Kaye WH, Wierenga CE. Using clinical cutoff scores on the eating disorder examination-questionnaire to evaluate eating disorder symptoms during and after naturalistic intensive treatment. Eat Disord 2023:1-15. [PMID: 36935579 DOI: 10.1080/10640266.2023.2191488] [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] [Indexed: 03/21/2023]
Abstract
Clinical cutoff scores for self-report measures provide a means of evaluating clinically significant pathology during and after treatment. A cutoff of 2.8 on the Eating Disorder Examination-Questionnaire (EDE-Q) has been recommended to screen for eating disorders (ED). We used this cutoff to assess ED symptoms in adolescents (n = 444) and adults (n = 592) through ED treatment and follow-up. Most patients scored above 2.8 at intake (adolescents 67%, M = 3.21; adults 78%, M = 4.20) and below 2.8 at discharge (adolescents 65%, M = 1.87; adults 66%, M = 2.67), with gains often maintained through follow-up (40% of adolescents and 35% of adults at 12-month follow-up). EDE-Q scores were higher in adults than adolescents and in patients with binge/purge disorders. Results suggest a cutoff of 2.8 on the EDE-Q effectively tracks ED symptom improvement through treatment and discharge. This supports the need for the development of culture-specific and empirically developed clinical cutoffs and their widespread use to evaluate program effectiveness.
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Affiliation(s)
- Elizabeth A Velkoff
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Tiffany A Brown
- Department of Psychology, Auburn University, Auburn, Alabama, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
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26
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Jewell T, Apostolidou E, Sadikovic K, Tahta-Wraith K, Liston S, Simic M, Eisler I, Fonagy P, Yorke I. Attachment in individuals with eating disorders compared to community controls: A systematic review and meta-analysis. Int J Eat Disord 2023; 56:888-908. [PMID: 36916409 DOI: 10.1002/eat.23922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Individuals with eating disorders are known to have higher rates of insecure attachment compared to community controls, but the factors underlying this finding are poorly understood. We conducted the first meta-analysis comparing attachment in eating disorder samples compared to community controls that included quality assessment, publication bias and moderation analysis. METHOD We pre-registered our meta-analysis (CRD42019146799) and followed PRISMA guidelines. We searched PsychINFO, Embase, Medline, CINAHL, and Scopus for publications. Attachment scores were extracted, and Cohen's d calculated for each study using a random effects model. RESULTS In total, 35 studies were included in the meta-analysis and six studies were summarized in a narrative review. Eating disorder samples showed higher rates of insecure attachment compared to community controls, with a large effect size, across measurement methods and different attachment dimensions. Blinding of assessors moderated effect sizes for attachment interview studies, but no other moderators were significant. DISCUSSION Risk of insecure attachment is elevated in individuals with eating disorders, albeit heterogeneity is high and largely unexplained. Clinicians may need to take this into account in their work, particularly given the association between attachment insecurity and challenges to therapeutic alliance. Future studies comparing eating disorder samples with community samples should control for general psychopathology. PUBLIC SIGNIFICANCE Attachment is a broad concept referring to a person's thoughts, feelings and behaviors in relation to close others. This systematic review and meta-analysis found that individuals with eating disorders are lower in attachment security than community controls, regardless of attachment construct or measurement approach. Attachment may be relevant in influencing eating disorder recovery, the development of therapeutic alliance, and potentially clinical outcomes, although more research is needed.
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Affiliation(s)
- Tom Jewell
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Eleni Apostolidou
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kevser Sadikovic
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Sarah Liston
- Leicestershire Partnership NHS Foundation Trust, Leicester, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud Centre, London, UK
| | - Isabel Yorke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Pegram G, Craddock N, Lewis-Smith H. "Like putting on an old pair of gloves" or "realising i am actually over it": a qualitative study exploring the impact of the COVID-19 pandemic lockdown restrictions on eating disorder recovery in the UK. CURRENT PSYCHOLOGY 2023:1-12. [PMID: 36845206 PMCID: PMC9944788 DOI: 10.1007/s12144-023-04353-2] [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: 04/12/2022] [Revised: 11/17/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
The COVID-19 pandemic lockdown restrictions posed unique challenges for people living with eating disorders (EDs), particularly relating to social isolation and changes in treatment access. However, less is known about the experience of lockdown for people 'in recovery' from EDs or disordered eating (DE) (i.e., with an ED/DE history). This study explored: (i) how people with a self-reported ED/DE history responded to and managed the experience of lockdown, specifically in relation to their recovery, and (ii) coping strategies for the management of recovery. Semi-structured interviews were conducted between June and August 2020 with 20 adults with a self-reported ED/DE history living in the UK. Data were analysed using inductive thematic analysis within a critical realist framework. Three overarching themes were identified: (1) Seeking safety and stability during a pandemic, (2) Lockdown prompting realisations about recovery, and (3) Exploring self-compassion as a more adaptive approach. While most participants experienced a resurgence in ED symptoms during lockdown, many reflected on the successful management of these as reinforcing their recovery. These findings have important implications for understanding ED recovery, in addition to informing interventions to better promote recovery during the COVID-19 pandemic and beyond. Supplementary information The online version contains supplementary material available at 10.1007/s12144-023-04353-2.
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Affiliation(s)
- Georgina Pegram
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, BS16 1QY Bristol, UK
| | - Nadia Craddock
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, BS16 1QY Bristol, UK
| | - Helena Lewis-Smith
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, BS16 1QY Bristol, UK
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28
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Barko EB, Moorman SM. Weighing in: qualitative explorations of weight restoration as recovery in anorexia nervosa. J Eat Disord 2023; 11:14. [PMID: 36721222 PMCID: PMC9887881 DOI: 10.1186/s40337-023-00736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) continues to capture the public's imagination, centered around physical appearance, particularly weight. Clinical conceptions of AN also emphasize weight. The objective of this study was to explore how individuals with lived AN experience thought about the role of weight in illness and recovery. METHODS The current study employed a grounded theory approach through qualitative inductive inquiry and analysis of 150 anonymous narratives, exploring firsthand experience of AN and recovery of adult individuals, based in the United States of America. RESULTS Individuals with AN histories contested intersecting popular cultural and medical presumptions of their health and illness positioned in weight. Respondents indicated that while weight does not measure recovery, it matters to recovery in unanticipated ways. Others' expectations for a low weight served as a gatekeeper to various forms of social and institutional support. Respondents felt that the weight obsessions of other people made it difficult to earn the illness legitimacy to access sufficient care. CONCLUSIONS Research findings bear implications for future AN research, advocacy, and clinical practice, as respondents pivot research emphasis from weight as a sociocultural motivation for AN, to weight as a sociocultural obstacle to AN recovery.
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Affiliation(s)
- Emily B Barko
- Department of Sociology, Boston College, 140 Commonwealth Avenue, McGuinn Hall 426, Chestnut Hill, MA, 02467, USA.
| | - Sara M Moorman
- Department of Sociology, Boston College, 140 Commonwealth Avenue, McGuinn Hall 426, Chestnut Hill, MA, 02467, USA
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29
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LaMarre A, Gilbert K, Scalise PA. What are we aiming for? Exploring tensions in healthcare provider perspectives on and communications about eating disorder recovery. FEMINISM & PSYCHOLOGY 2022. [DOI: 10.1177/09593535221141712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Eating disorder recovery is differently understood in multi-disciplinary healthcare contexts. In this study, we sought to better understand how healthcare providers (HCPs) describe recovery and communicating about recovery. We conducted an anonymous, online, qualitative survey with 41 eating disorder HCPs. In their responses, HCPs noted that communicating about recovery was core to their practice of establishing collaboration and communication with clients, as well as enabling “realistic hope” in clinical encounters. Recovery was described as related to the concept of attaining “normalcy” in life. We identified several tensions across HCP accounts, including what “normalcy” might look like, differences in the role of diagnostic and other contextual factors in determining recovery and different perspectives on how symptom remission figures in recovery. Our findings suggest that attending to differences in communication about recovery is an important direction for eating disorders research and treatment.
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30
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Plasma Concentrations of Short-Chain Fatty Acids in Active and Recovered Anorexia Nervosa. Nutrients 2022; 14:nu14245247. [PMID: 36558405 PMCID: PMC9781195 DOI: 10.3390/nu14245247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Anorexia nervosa (AN) is one of the most lethal psychiatric disorders. To date, we lack adequate knowledge about the (neuro)biological mechanisms of this disorder to inform evidence-based pharmacological treatment. Gut dysbiosis is a trending topic in mental health, including AN. Communication between the gut microbiota and the brain is partly mediated by metabolites produced by the gut microbiota such as short-chain fatty acids (SCFA). Previous research has suggested a role of SCFA in weight regulation (e.g., correlations between specific SCFA-producing bacteria and BMI have been demonstrated). Moreover, fecal SCFA concentrations are reported to be altered in active AN. However, data concerning SCFA concentrations in individuals who have recovered from AN are limited. In the present study, we analyzed and compared the plasma concentrations of seven SCFA (acetic-, butyric-, formic-, isobutyric-, isovaleric-, propionic-, and succinic acid) in females with active AN (n = 109), recovered from AN (AN-REC, n = 108), and healthy-weight age-matched controls (CTRL, n = 110), and explored correlations between SCFA concentrations and BMI. Significantly lower plasma concentrations of butyric, isobutyric-, and isovaleric acid were detected in AN as well as AN-REC compared with CTRL. We also show significant correlations between plasma concentrations of SCFA and BMI. These results encourage studies evaluating whether interventions directed toward altering gut microbiota and SCFA could support weight restoration in AN.
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Hower H, LaMarre A, Bachner-Melman R, Harrop EN, McGilley B, Kenny TE. Conceptualizing eating disorder recovery research: Current perspectives and future research directions. J Eat Disord 2022; 10:165. [PMID: 36380392 PMCID: PMC9664434 DOI: 10.1186/s40337-022-00678-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the "what" of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the "how" of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an overview of the ED field's current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological "toolkits" in order to form a more complete picture of recovery. BODY: This paper examines commonly used methodologies in research, and explores how incorporating different perspectives can add to our understanding of the recovery process. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) suggest that broadening our methodological "toolkits" could spur more nuanced and specific insights about ED recoveries. We propose a potential future research model that would ideally have a multi-methods design, incorporate different perspectives (e.g., expanding recruitment of diverse participants, including supportive others, in study co-creation), and a longitudinal course (e.g., capturing cognitive and emotional recovery, which often comes after physical). In this way, we hope to move the field towards different, more comprehensive, perspectives on ED recovery. CONCLUSION Our current perspectives on studying ED recovery leave critical gaps in our knowledge about the process. The traditional research methodologies impact our conceptualization of recovery definitions, and in turn limit our understanding of the phenomenon. We suggest that we expand our range of methodologies, perspectives, and timeframes in research, in order to form a more complete picture of what is possible in recovery; the multiple aspects of an individual's life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin, and successfully continue, their ED recovery process.
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Affiliation(s)
- Heather Hower
- Department of Psychiatry, Eating Disorders Center for Treatment and Research, University of California at San Diego School of Medicine, 4510 Executive Drive, San Diego, CA, 92121, USA. .,Department of Health Services, Policy, and Practice, Hassenfeld Child Innovation Institute, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
| | - Andrea LaMarre
- School of Psychology, Massey University, North Shore, Private Bag 102-904, Auckland, 0632, New Zealand
| | - Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, 4025000, Emek-Hefer, Israel.,School of Social Work, Hebrew University of Jerusalem, Mt. Scopus, 9190501, Jerusalem, Israel
| | - Erin N Harrop
- Graduate School of Social Work, University of Denver, 2148 S High Street, Denver, CO, 80208, USA
| | - Beth McGilley
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Therese E Kenny
- Department of Psychology, Clinical Child and Adolescent Psychology, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
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Yakın E, Obeid S, Fekih-Romdhane F, Soufia M, Sawma T, Samaha S, Mhanna M, Azzi R, Mina A, Hallit S. "In-between orthorexia" profile: the co-occurrence of pathological and healthy orthorexia among male and female non-clinical adolescents. J Eat Disord 2022; 10:155. [PMID: 36329509 PMCID: PMC9633027 DOI: 10.1186/s40337-022-00673-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The profile of adolescents with orthorexic eating behaviors remains to be explored. This study is the first to explore the typology of Lebanese adolescents from a large non-clinical sample based on orthorexia nervosa (ON) and healthy orthorexia (HO). METHOD A total of 555 adolescents (aged between 15 and 18 years) completed a set of questionnaires assessing orthorexic behaviors, self-esteem, stress, depressive and anxiety symptoms. Cluster analysis based on ON and HO scores was used to identify the typology of the sample. More precisely, this analysis was used to reveal and distinguish between naturally occurring subgroups of individuals with different orthorexic eating profiles, within the studied sample. Further, a series of one-way ANOVA was used to compare observed clusters based on their scores on used questionnaires. This analysis was used to capture the behavioral and psychological differences between previously yielded subgroups of individuals. RESULTS Cluster analysis based on ON and HO scores yielded 3 distinct groups: "Low orthorexia", "Moderate in-between orthorexia" and "High in-between orthorexia". While the first group represented individuals with no particular (healthy or pathological) interest in healthy eating, the two latter groups represented those with respectively moderate and high degrees of an interest in healthy eating that has both pathological and healthy aspects. Significant differences between clusters regarding their levels of stress, depression, anxiety and self-esteem was observed, yet they were found to be negligible due to poor effect sizes. CONCLUSION Findings from this study suggest that ON and HO can indeed co-occur among adolescents, that this co-occurrence can be experienced at different severity levels. Low effect sizes for ANOVA comparisons may suggest the possibility of the co-occurrence of ON and HO reducing the negative effects of ON behavior to some degree. The potential role of confusion around what constitutes "healthy eating" in the emergence of these "in-between orthorexia" profiles is put forward.
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Affiliation(s)
- Ecem Yakın
- Centre d'Études et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, UT2J, 5 allées Antonio Machado, 31058, Toulouse, France
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Toni Sawma
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Serena Samaha
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Mariam Mhanna
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Reine Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Anthony Mina
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Kenny TE, Trottier K, Lewis SP. Lived experience perspectives on a definition of eating disorder recovery in a sample of predominantly white women: a mixed method study. J Eat Disord 2022; 10:149. [PMID: 36224653 PMCID: PMC9558402 DOI: 10.1186/s40337-022-00670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There has recently been a push for recovery-focused research in the eating disorder (ED) field, starting with a consensus definition of recovery. One definition, in particular, proposed by Bardone-Cone et al. [21] has received considerable attention given its transdiagnostic nature and validation studies. However, no studies to date have elicited lived experience views of this definition. The goal of the current study was to examine perspectives on this definition of recovery from individuals with a past or present ED and to determine whether participant agreement with the model differed based on diagnostic history or current symptom severity. METHODS Sixty-two individuals (95.2% women; 91.9% White/European) participated in a 1-2 h interview aimed at capturing their perspectives on ED recovery. Transcripts were analyzed using qualitative content analysis and codebook thematic analysis to examine agreement with and thoughts on Bardone-Cone's definition of recovery, respectively. Chi-squared tests of independence and binary logistic regression were computed to determine whether agreement with the definition differed across diagnostic history and self-reported symptoms. RESULTS Although some participants indicated acceptance of the definition, the majority expressed concerns related to its categorical nature, proposed criteria, feasibility, language, and applications. There were no differences in acceptance based on diagnostic history or current symptom severity. CONCLUSION A single definition of recovery does not seem to fit individuals' lived ED experience. Future research may benefit from distinguishing between recovery as an individually-defined phenomenon and related constructs such as remission (i.e., loss of diagnosis or absence of clinical symptoms). A more comprehensive multi-faceted, and person-centered model of recovery may have merit in clinical settings.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada
| | - Kathryn Trottier
- University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada
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Breithaupt L, Kahn DL, Slattery M, Plessow F, Mancuso C, Izquierdo A, Dreier MJ, Becker K, Franko DL, Thomas JJ, Holsen L, Lawson EA, Misra M, Eddy KT. Eighteen-month Course and Outcome of Adolescent Restrictive Eating Disorders: Persistence, Crossover, and Recovery. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:715-725. [PMID: 35476589 PMCID: PMC9444807 DOI: 10.1080/15374416.2022.2034634] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE In adults, low-weight restrictive eating disorders, including anorexia nervosa (AN), are marked by chronicity and diagnostic crossover from restricting to binge-eating/purging. Less is known about the naturalistic course of these eating disorders in adolescents, particularly atypical AN (atyp-AN) and avoidant/restrictive food intake disorder (ARFID). To inform nosology of low-weight restrictive eating disorders in adolescents, we examined outcomes including persistence, crossover, and recovery in an 18-month observational study. METHOD We assessed 82 women (ages 10-23 years) with low-weight eating disorders including AN (n = 40; 29 restricting, 11 binge-eating/purging), atyp-AN (n = 26; 19 restricting, seven binge-eating/purging), and ARFID (n = 16) at baseline, nine months (9 M; 75% retention), and 18 months (18 M; 73% retention) via semi-structured interviews. First-order Markov modeling was used to determine diagnostic persistence, crossover, and recovery occurring at 9 M or 18 M. RESULTS Among all diagnoses, the likelihood of remaining stable within a given diagnosis was greater than that of transitioning, with the greatest probability among ARFID (0.84) and AN-R (0.62). Persistence of BP and atypical presentations at follow-up periods was less stable (AN-BP probability 0.40; atyp-AN-R probability 0.48; atyp-AN-BP probability, 0.50). Crossover from binge-eating/purging to restricting occurred 72% of the time; crossover from restricting to binge-eating/purging occurred 23% of the time. The likelihood of stable recovery (e.g., recovery at both 9 M and 18 M) was between 0.00 and 0.36. CONCLUSION Across groups, intake diagnosis persisted in about two-thirds, and recovery was infrequent, underscoring the urgent need for innovative treatment approaches to these illnesses. Frequent crossover between AN and atyp-AN supports continuity between typical and atypical presentations, whereas no crossover to ARFID supports its distinction.
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Affiliation(s)
- Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Danielle L. Kahn
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Franziska Plessow
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Alyssa Izquierdo
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Melissa J. Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kendra Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura Holsen
- Harvard Medical School, Boston, MA, USA
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elizabeth A. Lawson
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Madhusmita Misra
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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35
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Svendsen VG, Lokkerbol J, Danner U, Jansingh A, Evers SM, Wijnen BF. Design and testing of a health economic Markov model for treatment of anorexia nervosa. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1243-1251. [PMID: 36047856 DOI: 10.1080/14737167.2022.2119130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Anorexia Nervosa (AN) is a severe psychiatric disorder and knowledge about the cost-effectiveness of potential interventions is limited. The aim of this paper is to introduce the Trimbos Institute health economic cost-effectiveness model for Anorexia Nervosa (AnoMod-TI), a flexible modelling tool for assessing the long-term cost-effectiveness of interventions for AN in late adolescent and adult patients, which could support clinical decision making. METHODS AnoMod-TI is a state-transition cohort simulation (Markov) model developed from a Dutch societal perspective, which consists of four health states - namely full remission (FR), partial remission (PR), AN and death. Results are expressed as total healthcare costs, QALYs and incremental cost-effectiveness ratio. RESULTS For the purpose of demonstrating AnoMod-TI and how it could be used to estimate cost-effectiveness over a 20-year time horizon, it was applied to a hypothetical treatment scenario. Results illustrate how a relatively costly intervention with only modest effects can still be cost-effective in the long term. CONCLUSIONS AnoMod -TI can be used to examine long-term cost-effectiveness of various interventions aimed at either treating AN or preventing relapse from a state of partial or full remission. AnoMod-TI is freely available upon request to the authors.
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Affiliation(s)
- Vegard G Svendsen
- Center for Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,Department of Clinical and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands.,Norwegian Centre for Addiction Research, SERAF, University of Oslo, Oslo, Norway
| | - Joran Lokkerbol
- Center for Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Unna Danner
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Silvia Maa Evers
- Center for Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,Department of Clinical and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Health Services Research, Care and Public Health Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Ben Fm Wijnen
- Center for Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,Department of Clinical and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
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Experiencing eight psychotherapy approaches devoted to eating disorders in a single-day workshop increases insight and motivation to engage in care: a pilot study. Eat Weight Disord 2022; 27:2213-2222. [PMID: 35133642 DOI: 10.1007/s40519-022-01365-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE For patients with eating disorders (EDs), early engagement in care is usually considered a positive prognostic factor. The aim of the study was to investigate how a single-day intervention devoted to early, brief, experiential exposure to a variety of psychotherapy approaches might support commitment to change and the decision to engage in care in patients with EDs. METHODS One hundred and sixty-nine adult outpatients newly diagnosed with an ED took part in a single-day workshop for groups of up to ten patients, where they experienced eight psychotherapeutic approaches. Motivation to change care and level of insight were assessed at baseline and 10 days after the intervention. RESULTS Motivation and commitment to take active steps toward change (expressed by the "Committed Action" composite score) significantly improved after the intervention (p < 0.001), and a significant number of patients specifically moved from "contemplation" to "action" stage (p < 0.001). The improvement of motivation to change was significantly associated with an increase in insight capacity (p < 0.001), and this increase was observed for almost all related dimensions such as recognition of illness or awareness of need for psychological treatment. CONCLUSION A single-day session devoted to experiencing a range of group psychotherapies increased patients' insight and motivation to actively engage in care. To confirm potential longer-term benefits of this intervention, further studies are needed to explore the contribution of each approach and process specifically involved in patients' increased motivation for care, as well as the clinical characteristics of patients associated with better outcomes. LEVEL OF EVIDENCE V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Examination of perfectionism and self-concept constructs across stages of eating disorder recovery in men: An exploratory study. Eat Behav 2022; 46:101658. [PMID: 35981487 PMCID: PMC9812292 DOI: 10.1016/j.eatbeh.2022.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study examined perfectionism and self-concept constructs across eating disorder recovery stages in men, using a conceptualization of recovery that encompasses physical, behavioral, and cognitive recovery. METHOD Participants were 35 men with an eating disorder history (Mage = 26.60 years, SD = 10.81), categorized as in full recovery, in partial recovery, or with a current eating disorder diagnosis/pathology, and 27 men with no eating disorder history (controls; Mage = 26.44 years, SD = 10.08). Data for determining recovery status were collected from surveys, interviews, and measured weight and height; perfectionism and self-concept were assessed via surveys. RESULTS Among the perfectionism constructs, the greatest magnitude of effect sizes involving the fully recovered group was for socially prescribed perfectionism where this group had lower levels of perfectionism than the eating disorder diagnosis/pathology group (Hedge's g = -1.72) or the partially recovered group (Hedge's g = -1.56). For the self-concept constructs, effect sizes involving the fully recovered group and the other recovery status groups were all large (absolute values: 0.76-1.58) and reflected a large magnitude of difference with fully recovered men having higher self-esteem and self-efficacy and lower social comparison than men with a current eating disorder diagnosis or pathology or those partially recovered. CONCLUSION Full recovery in men was associated with healthy self-concept constructs and with low socially prescribed perfectionism. Future research with larger samples should seek to replicate these findings and, using a longitudinal design, examine these constructs as potential predictors or maintenance factors of comprehensive eating disorder recovery in men.
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Fogelkvist M, Aila Gustafsson S, Kjellin L, Parling T. Predictors of outcome following a body image treatment based on acceptance and commitment therapy for patients with an eating disorder. J Eat Disord 2022; 10:90. [PMID: 35778769 PMCID: PMC9250252 DOI: 10.1186/s40337-022-00615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is important to target body image in individuals with an eating disorder (ED). Acceptance and commitment therapy (ACT) has been trialed in a few studies for individuals with an ED. Although ACT outcomes in ED patients hold promise, studies of predictors are scarce. The aim of the present study was to explore differences in ED symptom outcome at two-year follow-up in subgroups of participants attending either treatment as usual (TAU), or a group intervention based on ACT targeting body image. Additionally, we aimed to compare subjective recovery experiences between groups. METHODS The study took place at a specialized ED outpatient clinic, and included patients diagnosed with an ED that had received prior treatment and achieved a somewhat regular eating pattern. Study participants were randomly assigned to continue TAU or to participate in a group intervention based on ACT for body image issues. Only participants that completed the assigned intervention and had completed follow up assessment by two-years were included. The total sample consisted of 77 women. RESULTS In general, ACT participants showed more favorable outcomes compared to TAU, and results were more pronounced in younger participants with shorter prior treatment duration and lower baseline depression ratings. Participants with restrictive ED psychopathology had three times higher ED symptom score change if participating in ACT in comparison to TAU. CONCLUSIONS An ACT group intervention targeting body image after initial ED treatment may further enhance treatment effects. There is a need for further investigation of patient characteristics that might predict response to body image treatment, particularly regarding ED subtypes and depression ratings.
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Affiliation(s)
- Maria Fogelkvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.
| | - Sanna Aila Gustafsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
| | - Lars Kjellin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education and Research, Liljeholmstorget 7, 117 63, Stockholm, Sweden
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A Retrospective Literature Review of Eating Disorder Research (1990–2021): Application of Bibliometrics and Topical Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137710. [PMID: 35805366 PMCID: PMC9265657 DOI: 10.3390/ijerph19137710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/24/2022]
Abstract
Despite the growing importance of eating disorders in society and academic literature, only a few bibliometric review studies using bibliometric analysis were available. Hence, this study aimed to explore and uncover hidden research topics and patterns in articles in terms of eating disorders over the last 30 years. In total, 4111 articles on eating disorders were analyzed using bibliometrics, network analyses, and structural topic modeling as the basis of mixed methods. In addition to general statistics about the journal, several key research topics, such as eating disorder (ED) treatment, ED symptoms, factors triggering ED, family related factors, eating behaviors, and social factors, were found based on topic correlations. This study found the key research variables that are frequently studied with EDs, such as AN, BN, BED, and ARFID. This study may help clinicians comprehend important risk factors associated with EDs. Moreover, the findings about key ED research topics and their association can be helpful for future studies to construct a comprehensive ED research framework. To our knowledge, this is the first study to use topic modeling in an academic journal on EDs and examine the diversity in ED research over 30 years of published research.
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Monsour DL, Kimball TG, Henley EL. Navigating challenges to providing eating disorder support in collegiate recovery programs. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:984-987. [PMID: 32693709 DOI: 10.1080/07448481.2020.1790576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
There is a significant need for eating disorder support on college campuses. Collegiate recovery programs (CRPs) are providing specialized support for students in recovery from substance use disorders (SUDs) but struggle to support students with eating disorders, despite the high co-occurring rates of SUDs and eating disorders. This is a brief report describing Texas Tech University's experience in delivering eating disorder support in their CRP, outlining the challenges they have recognized, and providing recommendations and resources for overcoming them.
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Affiliation(s)
- Diana L Monsour
- Center for Collegiate Recovery Communities, Texas Tech University, Lubbock, Texas, USA
| | - Thomas G Kimball
- Community Family and Addiction, Sciences, Center for Collegiate Recovery Communities, Texas Tech University, Lubbock, Texas, USA
| | - Emmy Lu Henley
- Center for Collegiate Recovery Communities, Texas Tech University, Lubbock, Texas, USA
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LaMarre A, Levine MP, Holmes S, Malson H. An open invitation to productive conversations about feminism and the spectrum of eating disorders (part 2): Potential contributions to the science of diagnosis, treatment, and prevention. J Eat Disord 2022; 10:55. [PMID: 35440024 PMCID: PMC9019954 DOI: 10.1186/s40337-022-00572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
The role of feminism in eating disorders research, treatment, and advocacy continues to be debated, with little agreement in sight about the role-or lack thereof-of feminist eating disorders work. In these debates, the opportunity to open fruitful conversations about eating disorders that generate new possibilities for researching, treating, and preventing them is missed. This article is the second in a series of two papers that invite such a discussion. In this article, we focus on five key contributions that feminist eating disorder work has made and can make moving forward. These are contextualizing treatment, attending to lived experiences, expanding the meanings of "sociocultural influences," diversifying methodologies, and situating recoveries. We do not propose to offer a "final word" on feminisms and eating disorders, but instead to start conversations about how we understand, research, and treat eating disorders.
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Affiliation(s)
- Andrea LaMarre
- School of Psychology, Massey University Auckland, Private Bag 102904, North Shore, Auckland, 0745, New Zealand.
| | | | - Su Holmes
- University of East Anglia, Norwich, UK
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Simic M, Stewart CS, Konstantellou A, Hodsoll J, Eisler I, Baudinet J. From efficacy to effectiveness: child and adolescent eating disorder treatments in the real world (part 1)-treatment course and outcomes. J Eat Disord 2022; 10:27. [PMID: 35189967 PMCID: PMC8862310 DOI: 10.1186/s40337-022-00553-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Findings from randomised control trials inform the development of evidence-based eating disorder (ED) practice guidelines internationally. Only recently are data beginning to emerge regarding how these treatments perform outside of research settings. This study aimed to evaluate treatment pathways and outcomes for a specialist child and adolescent ED service across a five-year period. METHODS All consecutive referrals between August 2009 and January 2014 seen at the Maudsley Centre for Child and Adolescent Eating Disorders in London were included. Data are reported on for all young people who were offered treatment (N = 357). RESULTS Most young people referred to the service were diagnosed with anorexia nervosa (AN)/Atypical AN (81%). Treatment for AN/Atypical AN (median 11 months) was predominantly ED focused family therapy (99%). Treatment for bulimia nervosa (BN)/Atypical BN (median seven months) was most commonly a combination of cognitive behavioural therapy and ED focused family therapy (87%). At discharge, 77% of the AN/Atypical AN group had a good or intermediate outcome and 59% of the BN/Atypical BN group reported no or fewer than weekly bulimic episodes. 27% of the AN/Atypical AN group had enhanced treatment with either day- and/or inpatient admissions (AIM group). The %mBMI at 3 months of treatment was strongest predictor of the need for treatment enhancement and more modestly EDE-Q and age at assessment. The AIM group at assessment had significantly lower weight, and higher ED and comorbid symptomatology and went on to have significantly longer treatment (16 vs. 10 months). At discharge, this group had significantly fewer good and more poor outcomes on the Morgan Russell criteria, but similar outcomes regarding ED and comorbid symptoms and quality of life. When analysis was adjusted for %mBMI at assessment, 1 and 3 months of treatment, differences in Morgan Russell outcomes and %mBMI were small and compatible with no difference in outcome by treatment group. CONCLUSIONS This study shows that outcomes in routine clinical practice in a specialist community-based service compare well to those reported in research trials. The finding from research trials that early weight gain is associated with improved outcomes was also replicated in this study. Enhancing outpatient treatment with day treatment and/or inpatient care is associated with favourable outcome for most of the young people, although a longer duration of treatment is required.
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Affiliation(s)
- Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
| | - Catherine S Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - John Hodsoll
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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Stewart CS, Baudinet J, Munuve A, Bell A, Konstantellou A, Eisler I, Simic M. From efficacy to effectiveness: child and adolescent eating disorder treatments in the real world (Part 2): 7-year follow-up. J Eat Disord 2022; 10:14. [PMID: 35123587 PMCID: PMC8817149 DOI: 10.1186/s40337-022-00535-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders are often characterised as disabling, chronic or relapsing conditions with high mortality rates. This study reports follow-up outcomes for patients seen at the Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), whose end of treatment outcomes are reported in a separate paper. METHODS Three-hundred-and-fifty-seven former patients, who received evidence-based treatment for an eating disorder as a child or adolescent in MCCAED between 2009 and 2014 were eligible to participate. Current contact information was available for 290, of whom 149 (51.4%) consented to follow-up. Participants were sent links to online questionnaires, with additional demographic information extracted from medical records. Descriptive analyses of key socioeconomic and health outcomes were performed on data collected. RESULTS Mean length of follow-up was 6 years 11 months. Ten (6.7%) participants reported a current diagnosis of an eating disorder at follow-up. The great majority reported no (63.8%) or minimal (26.8%) interference from eating disorder difficulties. More than half (53.6%) reported other mental health diagnoses with most reporting no (33.8%) or minimal (50.7%) interference from those difficulties. One third (33.3%) had sought help for an eating disorder and around 20% received prolonged/intensive treatment during the follow-up period. Approximately 70% had sought treatment for other mental health difficulties (mostly anxiety or depression) and 35.4% had substantial treatment. At follow-up more than half (55.5%) reported doing generally well, and around two-thirds reported general satisfaction with their social well-being (65%). The majority (62.7%) had a good outcome on the Morgan Russell criteria, which was consistent with low self-reported ratings on EDE-Q, and low impact of eating disorder or mental health symptoms on work and social engagement. Most of the former patients who had day and/or inpatient treatment as a part of their comprehensive integrated care at MCCAED did well at follow-up. CONCLUSIONS Young people seen in specialist eating disorder services do relatively well after discharge at longer-term follow-up especially regarding eating disorders but less favourably regarding other mental health difficulties. Few reported a diagnosable eating disorder, and the great majority went on to perform similarly to their peers in educational and vocational achievements.
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Affiliation(s)
- Catherine S Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.,Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Alfonce Munuve
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Antonia Bell
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.,Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
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Roberts E, Skipsey J. Exploring occupation in recovery from bulimia nervosa: An interpretative phenomenological analysis. Br J Occup Ther 2021. [DOI: 10.1177/03080226211045289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Recovering from bulimia nervosa challenges a person to learn, revise, and do occupations that contribute to rather than detract from health. This study utilized Interpretative Phenomenological Analysis to (a) explore the recovery experiences of six adult women with histories of bulimia nervosa and (b) interpret how their accounts reflected the assumptions and characteristics of occupation. Methods Data were collected via audio-recorded, semi-structured interviews. Data analysis within and between cases identified six superordinate themes, which included interpretation in terms of criteria of occupation. Findings Superordinate themes reflect (1) occupation emerged in recovering from bulimia nervosa through committed action, not doing what fueled bulimia nervosa, adopting new ways of living, prioritizing self-care, connecting with others, and creating supportive environments and (2) recovery from bulimia nervosa can be construed as an occupation. Conclusion This study provides insight into nuances of recovery from bulimia nervosa. Results offer novel implications distinct to an occupational therapy lens, for example, consideration of self-care beyond eating and meal preparation; modification of the home, work, and social environment; and setting goals associated with not doing versus doing. Further, the interpretative finding of recovery as occupation holds implications for the evolving philosophical considerations within occupational science and therapy.
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Affiliation(s)
- Elysa Roberts
- Occupational Therapy, College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - Jessica Skipsey
- Occupational Therapy, College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Callaghan, Australia
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Bachner-Melman R, Lev-Ari L, Zohar AH, Linketsky M. The Eating Disorders Recovery Questionnaire: psychometric properties and validity. Eat Weight Disord 2021; 26:2633-2643. [PMID: 33582972 DOI: 10.1007/s40519-021-01139-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 01/29/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE There is no standardized measurement of recovery from an eating disorder (ED). We examined the psychometric properties and construct validity of the "Eating Disorders Recovery Questionnaire" (EDRQ), which defines recovery beyond symptoms to include self-acceptance, social emotional and physical health. METHODS Twenty-eight recovery-related items were administered to 978 people (9.5% men) aged 18-76. 172 participants had a current ED diagnosis (AN, BN or BED), 104 had a past ED diagnosis (AN, BN, BED or > one diagnosis), 105 had another past or present ED, and 579 had no lifetime ED. Participants also completed the Eating Disorders Examination Questionnaire, Dresden Body Image Questionnaire-35, Positive and Negative Affect Schedule-Short Form, Patient Health Questionnaire-9, Satisfaction with Life Scale and Positive Eating Scale. RESULTS Exploratory and confirmatory factor analyses yielded four factors (CFI = 0.93, RMSEA = 0.07): lack of symptomatic behavior, acceptance of self and body, social and emotional connection, and physical health. Group comparisons showed that currently ill women scored lower on EDRQ and positive indices and higher on negative indices than controls and previously ill women. Previously ill women scored similarly to controls on ED symptomatology, positive body experiences, depression, and positive and negative affect but had lower BMI, life satisfaction and positive eating. The EDRQ-EDEQ correlation was r = 0.67, indicating both overlap and distinct variance. CONCLUSION The EDRQ is a valid, reliable measure of ED recovery, defined more broadly than symptom remission. We recommend its incorporation into a standardized operationalization of recovery and its use by consumers, carers and service providers to monitor ED recovery status. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Rachel Bachner-Melman
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel. .,Hebrew University of Jerusalem (School of Social Work), Jerusalem, Israel.
| | - Lilac Lev-Ari
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel.,The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Ada H Zohar
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel.,The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Michal Linketsky
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel
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Using shape and weight overvaluation to empirically differentiate severity of other specified feeding or eating disorder. J Affect Disord 2021; 295:446-452. [PMID: 34507225 DOI: 10.1016/j.jad.2021.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although no severity specifiers are noted in the Diagnostic and Statistical Manual of Mental Disorders - 5 for other specified feeding or eating disorder (OSFED), shape/weight overvaluation is a proposed eating disorder (ED) severity specifier. We used structural equation modeling (SEM) Trees to empirically determine values of shape/weight overvaluation that differentiate OSFED severity. We additionally tested whether the SEM Tree-defined thresholds or a clinical cutoff for shape/weight overvaluation differentiated severity more meaningfully. METHODS Participants were 690 females with OSFED presenting to residential ED treatment. SEM Tree analyses specified an outcome model of OSFED severity and then recursively partitioning the outcome model into severity groups. The SEM Tree-defined and clinical cutoff severity groups were compared on clinical characteristics. RESULTS SEM Trees identified one split that occurred at value 5.12 on our shape/weight overvaluation items from the Eating Disorder Examination Questionnaire. The subgroup with higher overvaluation had significantly greater intensity of ED and depressive symptoms and longer lengths of stay. The subgroups created from the shape/weight overvaluation clinical-cut off value of 4 differed on the same clinical characteristics as the SEM Tree-derived groups, with the exception of laxative use frequency. Effect sizes were larger for the clinical cutoff as compared to the SEM Tree severity specification scheme. LIMITATIONS These cross-sectional data were used from a predominately white and female residential treatment sample; this likely skewed the subgroups and may limit generalizability. CONCLUSIONS Shape/weight overvaluation can meaningfully differentiate OSFED severity. The clinical cutoff slightly outperformed the empirically determined thresholds for shape/weight overvaluation.
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Abstract
Attending to the shades of grey in eating disorder recovery may help to illuminate possibilities for navigating recoveries in their full complexity and diversity. There is a need for more complexity and flexibility in understandings of the timelines, processes, endpoints, and versions of eating disorder recoveries. In this article, we explore eating disorder recovery as a dynamic, intercorporeal, and non-linear process. Drawing on interviews with 20 people doing significantly better than they were during a time of acute distress around food and body, we articulate "recoveries" in relation to four themes: Fuzzy Logics of Time, Not Only Recovered, Recovery is Not All Sunshine and Rainbows, and The Life of Recovery. These themes speak to the ways in which participants struggled to articulate the temporalities of their recoveries, situated recovery as one among many events and processes that shaped their being in the world, resisted "too perfect" articulations of recovery journeys/ endpoints, and described preferred versions of and open-ended guidelines for recovery. We argue that eating disorder recoveries are as complicated and messy as lives themselves and are equally entangled in social contexts. We suggest that articulations of recovery be attuned to power dynamics as they operate in dictating which performances of eating disorders and recovery will be honoured as "legitimate" and whose pathways to recovery will be respected.
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Affiliation(s)
- Andrea LaMarre
- School of Psychology, Massey University Albany Campus, Auckland, New Zealand.
| | - Carla Rice
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
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Eiring K, Wiig Hage T, Reas DL. Exploring the experience of being viewed as "not sick enough": a qualitative study of women recovered from anorexia nervosa or atypical anorexia nervosa. J Eat Disord 2021; 9:142. [PMID: 34717760 PMCID: PMC8557476 DOI: 10.1186/s40337-021-00495-5] [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: 06/24/2021] [Accepted: 10/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite common misconceptions, an individual may be seriously ill with a restrictive eating disorder without an outwardly recognizable physical sign of the illness. The aim of this qualitative study was to investigate the perspectives of individuals who have previously battled a restrictive eating disorder who were considered "not sick enough" by others (e.g., peers, families, healthcare professionals) at some point during their illness, and to understand the perceived impact on the illness and recovery. Such misconceptions are potentially damaging, and have been previously linked with delayed help-seeking and poorer clinical outcomes. METHODS Seven women who had recovered from anorexia nervosa or atypical anorexia nervosa participated in semi-structured interviews. Interviews were transcribed and interpretive phenomenological analysis was used. RESULTS Three main themes emerged: (1) dealing with the focus upon one's physical appearance while battling a mental illness, (2) "project perfect": feeling pressure to prove oneself, and (3) the importance of being seen and understood. Participants reported that their symptoms were occasionally met with trivialization or disbelief, leading to shame, confusion, despair, and for some, deterioration in eating disorder symptoms which drove further weight loss. In contrast, social support and being understood were viewed as essential for recovery. CONCLUSION To facilitate treatment seeking and engagement, and to optimize chances of recovery, greater awareness of diverse, non-stereotypical presentations of restrictive eating disorders is needed which challenge the myth that weight is the sole indicator of the presence or severity of illness.
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Affiliation(s)
- Kari Eiring
- Institute of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Trine Wiig Hage
- Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital-Ullevål, P.O. Box 4956, 0424 Nydalen, Oslo, Norway
| | - Deborah Lynn Reas
- Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital-Ullevål, P.O. Box 4956, 0424 Nydalen, Oslo, Norway.
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Bentz M, Pedersen SH, Moslet U. An evaluation of family-based treatment for restrictive-type eating disorders, delivered as standard care in a public mental health service. J Eat Disord 2021; 9:141. [PMID: 34715920 PMCID: PMC8555240 DOI: 10.1186/s40337-021-00498-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family-based treatment (FBT) has demonstrated efficacy for anorexia nervosa (AN) in youth in randomized, controlled trials. It is important to assess if it shows a similar effectiveness when implemented in standard care. AIM To evaluate outcomes of FBT for restrictive-type eating disorders, delivered as standard care in a public mental health service. Outcomes are remission, frequency of hospital admissions and day-patient treatment, and frequency of other adaptations within 12 months from commencement of treatment. Second, to compare the collaborative clinical decisions of successful treatment in standard care made by family therapist at the end of treatment, with more objective definitions of recovery. METHODS The design is a prospective, uncontrolled study of a consecutive series of patients with restrictive-type eating disorders, treated with FBT in a specialty unit at the Child and Adolescent Mental Health Centre in the Capital Region of Denmark. RESULTS FBT was successfully completed within 12 months by 57% of participants, and 47% completed with 20 sessions or fewer. Weight restoration was achieved by 75% within 12 months, and 46% achieved both normalisation of body weight and behavioural symptoms of AN within 12 months. A total of 20% needed intensified treatment. All aspects of remission were often not present simultaneously, and the collaborative clinical decisions of successful treatment only partly aligned with other parameters of remission. CONCLUSION FBT showed good results when implemented as standard care, and it can be adapted to the specifics of local service organisation without compromising effectiveness.
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Affiliation(s)
- Mette Bentz
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Bispebjerg Bakke 30, 2400, Copenhagen NV, Denmark.
| | - Signe Holm Pedersen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Bispebjerg Bakke 30, 2400, Copenhagen NV, Denmark
| | - Ulla Moslet
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Bispebjerg Bakke 30, 2400, Copenhagen NV, Denmark
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Ruchkin V, Isaksson J, Schwab-Stone M, Stickley A. Prevalence and early risk factors for bulimia nervosa symptoms in inner-city youth: gender and ethnicity perspectives. J Eat Disord 2021; 9:136. [PMID: 34674763 PMCID: PMC8529812 DOI: 10.1186/s40337-021-00479-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research on risk factors associated with bulimia nervosa symptoms (BN) in ethnic minorities has been limited. This study adds to the existing literature by providing the ethnicity- and gender-specific prevalence of BN in US inner-city youth and by exploring the longitudinal associations between a clinical level of BN and early risk factors assessed one year previously. METHODS The study was conducted on a representative sample of predominantly ethnic minority youth (N = 2794; 54.1% female; age 11-16 years old (M(SD) = 12.77(1.29)); 60.0% African-American, 26.1% Hispanic American, 13.9% White). Self-reported information was obtained on BN and early risk factors (e.g., depressive and anxiety symptoms, posttraumatic stress, somatic complaints). Multivariate analysis of covariance was used to examine the longitudinal associations. RESULTS The 3-month BN prevalence was higher in girls (5.1%) than in boys (2.3%) (ratio 2.22:1). Significant differences in BN rates were found between White and African American students (higher in Whites), whereas Hispanic-Americans did not differ significantly from either group. Individuals with BN had significantly higher levels of early risk factors one year prior. CONCLUSIONS Timely recognition of BN and associated early risk factors is important for early prevention and intervention strategies.
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Affiliation(s)
- Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, 751 85, Uppsala, Sweden. .,Child Study Center, Yale University Medical School, New Haven, CT, 06520, USA. .,Säter Forensic Psychiatric Clinic, 783 27, Säter, Sweden.
| | - Johan Isaksson
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, 751 85, Uppsala, Sweden.,Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Mary Schwab-Stone
- Child Study Center, Yale University Medical School, New Haven, CT, 06520, USA
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.,Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
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