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Eielsen HP, Ulvenes P, Hoffart A, Rø Ø, Rosenvinge JH, Vrabel K. Childhood trauma and outcome trajectories in patients with longstanding eating disorders across 17 years. Int J Eat Disord 2024; 57:81-92. [PMID: 37897047 DOI: 10.1002/eat.24067] [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: 05/02/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND A large proportion of patients with eating disorders (ED) report experiences of childhood trauma. Latent trajectory analysis in ED samples reveals the complexities in course and outcome and can explore the long-term impact of adverse experiences in childhood. METHOD A total of 84 patients with longstanding ED were included. ED symptoms were assessed by the Eating Disorder Examination interview at discharge from inpatient treatment, and at 1-, 2-, 5-, and 17-year follow-up, respectively. Change over time was examined using growth mixture modeling, allowing the number of trajectories to emerge through the data. Prevalence of childhood trauma was assessed, and its relation to class membership was tested. RESULTS We identified four distinct classes: patients with (a) a continuous improvement in the entire follow-up period, and scores within normal range at the end, "continuous improvement" (54.8%); (b) a high symptom level at baseline and moderate decrease over time, "high and declining" (22.6%); (c) initial ED scores below clinical cut-off and stable symptoms throughout the course, "consistently low" (14.3%); and (d) with high scores initially, and a significant increase in symptoms over time, "high and increasing" (8.3%). A history of childhood sexual abuse (CSA) was overrepresented in classes with persistently high symptom levels and poor long-term outcome DISCUSSION: Patients with longstanding ED displayed considerable diversity in trajectories of symptom change across 17 years. To improve long-term outcome, enhanced treatment of sequelae from CSA seems essential. PUBLIC SIGNIFICANCE Patients with longstanding eating disorders displayed four different trajectories of change in a 17-year follow-up study. Although there were significant changes over time, the majority of patients remained within similar symptom levels as they presented with at discharge from inpatient treatment. Exposure to childhood maltreatment was common within the sample. Childhood sexual abuse predicted poor long-term outcome, which highlights the importance of trauma informed care.
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Affiliation(s)
- Hanna Punsvik Eielsen
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
| | - Pål Ulvenes
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, Oslo, Norway
| | - Jan H Rosenvinge
- Institute of Psychology, Faculty of Health Sciences, UiT - The Artic University of Norway, Tromsø, Norway
| | - KariAnne Vrabel
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
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Carr MM, Grilo CM. Examining heterogeneity of binge-eating disorder using latent class analysis. J Psychiatr Res 2020; 130:194-200. [PMID: 32828025 PMCID: PMC7554082 DOI: 10.1016/j.jpsychires.2020.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/15/2022]
Abstract
There is significant variability in the type and severity of symptoms reported by individuals diagnosed with binge-eating disorder (BED). Using latent class analysis (LCA), the current study aimed to investigate potential sources of heterogeneity among individuals with BED. Participants were 775 treatment-seeking adults with DSM-IV-defined BED. Doctoral research clinicians reliably assessed participants for BED and associated eating-disorder psychopathology using the Structured Clinical Interview for DSM-IV Disorders and the Eating Disorder Examination (EDE) interview, measured weight and height, and participants completed a battery of self-report measures. Based on fit statistics and class interpretability, a 2-class model yielded the best overall fit to the data. The two classes were most distinct with respect to differences in body image concerns, distress about binge-eating, and depressive symptomology. Number of binge episodes were significantly different between classes, though the effect was much smaller. Body mass index was not a significant covariate in the majority of models. The results show that many of the features currently used to define BED (e.g., binge-eating frequency) are not helpful in explaining heterogeneity among individuals with BED. Instead, body image disturbances, which are not currently included as a part of the diagnostic classification system, appear to differentiate distinct subgroups of individuals with BED. Future research examining subgroups based on body image could be integral to resolving ongoing conflicting evidence related to the etiology and maintenance of BED.
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Affiliation(s)
- Meagan M. Carr
- Department of Psychiatry, Yale School of Medicine, 300
George Street New Haven CT 06511
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, 300
George Street New Haven CT 06511,Department of Psychology, Yale University, Box 208205 New
Haven CT 06520
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3
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Espel-Huynh H, Zhang F, Boswell JF, Thomas JG, Thompson-Brenner H, Juarascio AS, Lowe MR. Latent trajectories of eating disorder treatment response among female patients in residential care. Int J Eat Disord 2020; 53:1647-1656. [PMID: 32864806 PMCID: PMC7722162 DOI: 10.1002/eat.23369] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Eating disorder (ED) treatment outcomes are highly variable from beginning to end of treatment; however, little is known about differential trajectories during the course of treatment. This study sought to characterize heterogeneous patterns of ED treatment response during residential care. METHOD Participants were adolescent girls and adult women (N = 360) receiving residential ED treatment for anorexia nervosa, bulimia nervosa, binge-eating disorder, other specified feeding or eating disorder, unspecified feeding or eating disorder, or avoidant/restrictive food intake disorder. Self-report symptom assessments were completed at admission, discharge, and approximately weekly throughout the residential stay to assess curvilinear patterns of change. Latent growth mixture modeling was applied to identify subgroups of patients with similar treatment response trajectories. RESULTS Three latent groups emerged, including gradual response (58.3%; steady improvements from admission to discharge), rapid response (23.9%; steep early improvements that were maintained through discharge), and low-symptom static response (17.8%; nearly nonclinical self-reported symptoms at admission that remained static through discharge). Groups differed on important clinical characteristics, such as body mass index, endorsement of compensatory behaviors, severity of global ED psychopathology at admission, and degree of symptom improvement by end of treatment. DISCUSSION Patients follow heterogeneous response patterns in residential ED treatment, and these patterns are associated with differential treatment outcome. Future work should explore whether these trajectories are associated with differential outcomes at follow-up and whether tailoring clinical intervention to a patient's trajectory type can improve treatment response.
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Affiliation(s)
- Hallie Espel-Huynh
- Drexel University, Philadelphia, PA;,Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI;,Alpert Medical School of Brown University, Providence RI
| | | | | | - J. Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI;,Alpert Medical School of Brown University, Providence RI
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Schäfer L, Hübner C, Carus T, Herbig B, Seyfried F, Kaiser S, Schütz T, Dietrich A, Hilbert A. Identifying prebariatric subtypes based on temperament traits, emotion dysregulation, and disinhibited eating: A latent profile analysis. Int J Eat Disord 2017; 50:1172-1182. [PMID: 28815744 DOI: 10.1002/eat.22760] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The efficacy of bariatric surgery has been proven; however, a subset of patients fails to achieve expected long-term weight loss postoperatively. As differences in surgery outcome may be influenced by heterogeneous psychological profiles in prebariatric patients, previous subtyping models differentiated patients based on temperament traits. The objective of this study was to expand these models by additionally considering emotion dysregulation and disinhibited eating behaviors for subtyping, as these factors were associated with maladaptive eating behaviors and poor postbariatric weight loss outcome. METHOD Within a prospective multicenter registry, N = 370 prebariatric patients were examined using interview and self-report questionnaires. A latent profile analysis was performed to identify subtypes based on temperament traits, emotion dysregulation, and disinhibited eating behaviors. RESULTS Five prebariatric subtypes were identified with specific profiles regarding self-control, emotion dysregulation, and disinhibited eating behaviors. Subtypes were associated with different levels of eating disorder psychopathology, depression, and quality of life. The expanded model increased variance explanation compared to temperament-based models. CONCLUSION By adding emotion dysregulation and disinhibited eating behaviors to previous subtyping models, specific prebariatric subtypes emerged with distinct psychological deficit patterns. Future investigations should test the predictive value of these subtypes for postbariatric weight loss and health-related outcomes.
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Affiliation(s)
- Lisa Schäfer
- Medical Psychology and Medical Sociology, Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases, Philipp-Rosenthal-Strasse 27, Leipzig, 04103, Germany
| | - Claudia Hübner
- Medical Psychology and Medical Sociology, Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases, Philipp-Rosenthal-Strasse 27, Leipzig, 04103, Germany
| | - Thomas Carus
- Department of General Surgery, Asklepios Clinic, Suurheid 20, Hamburg, 22559, Germany
| | - Beate Herbig
- Schön Klinik Hamburg Eilbek Bariatric Clinic, Dehnhaide 120, Hamburg, 22081, Germany
| | - Florian Seyfried
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Oberdürrbacher Strasse 6, Würzburg, 97080, Germany
| | - Stefan Kaiser
- Department of Visceral, Pediatric and Vascular Surgery, Hospital Konstanz, Luisenstrasse 7, Konstanz, 78464, Germany
| | - Tatjana Schütz
- Core Unit Nutrition and Clinical Phenotyping, Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases, Philipp-Rosenthal-Strasse 27, Leipzig, 04103, Germany
| | - Arne Dietrich
- Medical Psychology and Medical Sociology, Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases, Philipp-Rosenthal-Strasse 27, Leipzig, 04103, Germany
| | - Anja Hilbert
- Medical Psychology and Medical Sociology, Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases, Philipp-Rosenthal-Strasse 27, Leipzig, 04103, Germany
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Herman BK, Safikhani S, Hengerer D, Atkins N, Kim A, Cassidy D, Babcock T, Agus S, Lenderking WR. The patient experience with DSM-5-defined binge eating disorder: characteristics, barriers to treatment, and implications for primary care physicians. Postgrad Med 2014; 126:52-63. [PMID: 25295650 DOI: 10.3810/pgm.2014.09.2800] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Binge eating disorder (BED) is now a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). However, post-DSM-5 patient profiles and viewpoints on BED diagnosis and treatment remain unclear. This study used a focus group methodology to examine demographic and clinical characteristics, as well as perceptions of diagnosis and treatment from patients with BED symptoms who were either formally diagnosed with BED or undiagnosed. METHODS Binge eating disorder-diagnosed individuals (n = 11) or those meeting the DSM-5 BED diagnostic criteria but were undiagnosed (n = 14) participated in 6 semistructured focus groups conducted by trained staff at 3 geographic locations in the United States. Patients completed a series of demographic and clinical measures and then engaged in a moderated discussion focused on identifying factors associated with their experiences with BED. RESULTS Sixty percent of the patients were female, 48% were white and 40% were black, and 76% were employed. The diagnosed group had a slightly higher socioeconomic status; undiagnosed patients had a higher average body mass index. In the overall sample, comorbid anxiety (40%) and depression (40%) were the most common psychiatric comorbidities. Even in the diagnosed group, only half of the patients (54.5%) became aware of BED through their health care provider (HCP; n = 6). Patients perceived that HCPs were focused more on physical ailments, were judgmental about weight, and were unable to distinguish BED from obesity. They also expressed a desire for safe, nonjudgmental interactions with HCPs. CONCLUSIONS Education and income may be factors affecting access to care and BED diagnosis. Both patient groups reported considerable psychopathology and medical comorbidities. Moreover, the patient groups perceived HCPs as both having inadequate understanding of BED and providing insensitive and ineffective communication regarding eating behaviors. The study findings in diagnosed and undiagnosed patient groups underscore the need for greater BED disease state awareness and patient sensitivity among HCPs.
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