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Wonderlich JA, Dodd DR, Sondag C, Jorgensen M, Blumhardt C, Evanson AN, Bjoralt C, Wonderlich SA. Clinical and scientific review of severe and enduring anorexia nervosa in intensive care settings: introducing an innovative treatment paradigm. J Eat Disord 2024; 12:131. [PMID: 39227928 DOI: 10.1186/s40337-024-01079-9] [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: 05/31/2024] [Accepted: 08/06/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Anorexia nervosa is a serious and potentially lethal psychiatric disorder. Furthermore, there is significant evidence that some individuals develop a very long-standing form of the illness that requires a variety of different treatment interventions over time. OBJECTIVE The primary goal of this paper was to provide a review of treatment strategies for severe and enduring anorexia nervosa (SE-AN) with the particular focus on treatments involving hospital care. Additionally, we wish to highlight a contemporary approach to such care and provide qualitative reactions to this model from both staff and patients. METHODS A selective and strategic review of the treatment literature for SE-AN was conducted for the current paper. Emphasis was placed on clinical or scientific papers related to hospital-based care. Additionally, staff who work on a specific inpatient eating disorder unit with a substantial treatment program for SE-AN, along with a number of SE-AN patients were surveyed regarding their experiences working on, or receiving treatment on the unit. Importantly, the staff of this unit created a specific treatment protocol for individuals receiving hospital care. The results of the highlight both advantages and challenges of a hospital-based protocol oriented toward emphasizing quality of life, medical stability, and a health-promoting meal plan. DISCUSSION While there is general inconsistency with the type of treatment that is best suited to individuals with SE-AN, this is particularly true for higher levels of care that rely on inpatient hospital units or residential treatment settings. This is a highly significant clinical topic in need of further clinical and scientific examination.
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Affiliation(s)
- Joseph A Wonderlich
- Sanford Research, Center for Biobehavioral Research, Fargo, ND, USA.
- Eating Disorders Unit, Sanford Health, Fargo, ND, USA.
| | - Dorian R Dodd
- Sanford Research, Center for Biobehavioral Research, Fargo, ND, USA
- Eating Disorders Unit, Sanford Health, Fargo, ND, USA
| | - Cindy Sondag
- Eating Disorders Unit, Sanford Health, Fargo, ND, USA
| | | | | | | | - Casey Bjoralt
- Eating Disorders Unit, Sanford Health, Fargo, ND, USA
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Sravanti L, Velusamy A, Karki U, Kommu JVS, Girimaji SC. Course and Outcome of Anorexia Nervosa in Adolescents from a Tertiary-level Mental Health Setting in India: A Retrospective Chart Review. Indian J Psychol Med 2024; 46:323-329. [PMID: 39056033 PMCID: PMC11268275 DOI: 10.1177/02537176231222574] [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] [Indexed: 07/28/2024] Open
Abstract
Background Anorexia nervosa is one of the least studied mental health conditions in the Indian setting. The objective of this study was to assess the course and outcome of anorexia nervosa in adolescents who had presented to a tertiary care child and adolescent psychiatry center over a period of 10 years. Methods The present study is a retrospective chart review of adolescents (up to the age of 18 years) with a diagnosis of anorexia nervosa, coded as F50.0 or F50.1 according to ICD 10, from 1st April 2009 to 31st March 2019. Data were extracted from the case records using standardized abstraction forms and evaluated using descriptive and nonparametric statistics. Results The average age at presentation and the average age at onset were 14.1 years and 13.1 years, respectively. The male-to-female ratio of the sample who got admitted was 1:9. The average duration of hospital stay was about 30 days. The duration of in-patient care and weight gain were positively correlated, with severe to extremely ill adolescents improving even in less than one month of in-patient care. Seventy per cent of the admitted adolescents followed up. The functional outcome as measured by a 'return to school' improved in 57.1% of the sample. Conclusions The present study highlights the collaborative multidisciplinary and individualized treatment approach employed for adolescents diagnosed with anorexia nervosa within an inpatient mental health facility in India. Adolescents who presented with more severe illness at the initial assessment, such as an early onset of symptoms and a low BMI, experienced substantial weight gain that exhibited a positive correlation with the length of their stay in the inpatient facility.
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Affiliation(s)
- Lakshmi Sravanti
- Dept. of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Arul Velusamy
- Oxfordshire CAMHS NDC Pathway Team, Oxford, United Kingdom
| | - Utkarsh Karki
- Dept. of Child and Adolescent Psychiatry, Kanti Children’s Hospital, Kathmandu, Bagmati, Nepal
| | - John Vijay Sagar Kommu
- Dept. of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Satish Chandra Girimaji
- Dept. of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Kuge R, Hasegawa A, Morino Y, Nakazato M. Group cognitive remediation therapy for adolescents with anorexia nervosa: Outcomes before, after, and during follow-up in a real-world setting in Japan. Clin Child Psychol Psychiatry 2024:13591045241259255. [PMID: 38849306 DOI: 10.1177/13591045241259255] [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: 06/09/2024]
Abstract
Objective: Cognitive remediation therapy (CRT) can be used as an adjunct treatment for adolescents with severe and complex anorexia nervosa (AN) requiring inpatient treatment. However, there has been only one study on CRT for adolescents with AN in Japan. This study explored group CRT as an adjunct to inpatient treatment for Japanese adolescents with severe and complex AN requiring inpatient care. Methods: Thirty-one adolescents with AN underwent group CRT. Neuropsychological (set-shifting and central coherence) and psychological assessments (motivation, self-esteem, and depressive symptoms) were measured before and after the intervention. Weight and AN symptoms were measured before and after the intervention and at follow-up, and the adolescents completed post-intervention and follow-up questionnaires. Results: Set-shifting led to medium to large effect size improvements. Medium effect size improvements in central coherence and depressive symptoms were also observed. The feedback from the adolescents was mainly positive, and the treatment completion rate was high. The patients also reported that the skills learned through group CRT could be applied in daily life. Conclusion: Group CRT may be beneficial for adolescents with severe and complex AN who require inpatient care.
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Affiliation(s)
- Rie Kuge
- Mental Health Clinic for Children, Shinshu University Hospital, Japan
| | - Ayano Hasegawa
- Clinical Psychology Unit, Tokyo Metropolitan Matsuzawa Hospital, Japan
| | - Yuriko Morino
- Narimasu Kousei Hospital, Narimasu Centre for Child and Adolescent Mental Health, Japan
| | - Michiko Nakazato
- Department of Psychiatry, International University of Health and Welfare, Japan
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Laboe AA, McGinnis CG, Fennig M, Zucker K, Wu E, Shah J, Levitan J, Firebaugh ML, Bardone-Cone AM, Pike KM, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Development and usability testing of a cognitive-behavioral therapy-guided self-help mobile app and social media group for the post-acute treatment of anorexia nervosa. Eat Behav 2024; 53:101865. [PMID: 38461772 DOI: 10.1016/j.eatbeh.2024.101865] [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: 11/07/2023] [Revised: 01/23/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) is often treated in the acute setting, but relapse after treatment is common. Cognitive-behavioral therapy (CBT) is useful in the post-acute period, but access to trained providers is limited. Social support is also critical during this period. This study utilized a user-centered design approach to develop and evaluate the usability of a CBT-based mobile app and social networking component for post-acute AN support. METHOD Participants (N = 19) were recently discharged from acute treatment for AN. Usability testing of the intervention was conducted over three cycles; assessments included the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), the Mobile Application Rating Scale (MARS), a social media questionnaire, and a semi-structured interview. RESULTS Interview feedback detailed aspects of the app that participants enjoyed and those needing improvement. Feedback converged on three themes: Logistical App Feedback, boosting recovery, and Real-World App/Social Media Use. USE and MARS scores were above average and SUS scores were "good" to "excellent" across cycles. CONCLUSION This study provides evidence of feasibility and acceptability of an app and social networking feature for post-acute care of AN. The intervention has potential for offering scalable support for individuals with AN in the high-risk period following discharge from acute care.
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Affiliation(s)
- Agatha A Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Claire G McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Molly Fennig
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kianna Zucker
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ellis Wu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie Levitan
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Anna M Bardone-Cone
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen M Pike
- Departments of Psychiatry, Epidemiology and Psychology, Columbia University, New York City, NY, USA
| | - C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Samara MT, Michou N, Lappas AS, Argyrou A, Mathioudaki E, Bakaloudi DR, Tsekitsidi E, Polyzopoulou ZA, Christodoulou N, Papazisis G, Chourdakis M. Is cognitive behavioral therapy more effective than pharmacotherapy for binge spectrum disorders? A systematic review and meta-analysis. Aust N Z J Psychiatry 2024; 58:308-319. [PMID: 38179705 DOI: 10.1177/00048674231219593] [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] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Binge spectrum disorders are prevalent worldwide. Psychiatric and medical comorbidities are common, and societal costs are significant. Evidence-based treatment remains underutilized. Cognitive behavioral therapy is the recommended first-line treatment, but pharmacotherapy may be easier to access. INTERVENTIONS Meta-analytic evidence directly comparing cognitive behavioral therapy with pharmacotherapy is lacking. We aimed to compare the effects of cognitive behavioral therapy interventions with any pharmacological treatment for binge spectrum disorders. We searched PubMed, Embase, CENTRAL, ClinicalTrials.gov and reference lists for randomized controlled trials comparing cognitive behavioral therapy with any pharmacotherapy for bulimia nervosa/binge eating disorder and performed pairwise meta-analytic evaluations. PRIMARY OUTCOMES Primary outcomes are remission and frequency of binges. Secondary outcomes are frequency of purges, response, eating disorder psychopathology, weight/body mass index, depression, anxiety, quality of life and dropouts. RESULTS Eleven randomized controlled trials comparing cognitive behavioral therapy with fluoxetine/imipramine/desipramine/methylphenidate/sibutramine were identified (N = 531). Cognitive behavioral therapy was superior to antidepressants in terms of remission, frequency of binges and eating disorder psychopathology. There were no statistically significant differences for any of the individual cognitive behavioral therapy vs drug comparisons in terms of response/depression/anxiety/weight/quality of life/dropouts. Cognitive behavioral therapy was not superior to sibutramine/methylphenidate for the primary outcomes. CONCLUSIONS Data are scarce, comparisons underpowered and, considering the inherent methodological limitations of psychotherapy trials, questions arise regarding the presumed superiority of cognitive behavioral therapy. Further research is needed.
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Affiliation(s)
- Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Niki Michou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas S Lappas
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
- Aneurin Bevan University Health Board, Wales, UK
| | - Aikaterini Argyrou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elissavet Mathioudaki
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zoi A Polyzopoulou
- Department of Psychology, University of Western Macedonia, Florina, Greece
| | - Nikos Christodoulou
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Merhbene G, Puttick A, Kurpicz-Briki M. Investigating machine learning and natural language processing techniques applied for detecting eating disorders: a systematic literature review. Front Psychiatry 2024; 15:1319522. [PMID: 38596627 PMCID: PMC11002203 DOI: 10.3389/fpsyt.2024.1319522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Recent developments in the fields of natural language processing (NLP) and machine learning (ML) have shown significant improvements in automatic text processing. At the same time, the expression of human language plays a central role in the detection of mental health problems. Whereas spoken language is implicitly assessed during interviews with patients, written language can also provide interesting insights to clinical professionals. Existing work in the field often investigates mental health problems such as depression or anxiety. However, there is also work investigating how the diagnostics of eating disorders can benefit from these novel technologies. In this paper, we present a systematic overview of the latest research in this field. Our investigation encompasses four key areas: (a) an analysis of the metadata from published papers, (b) an examination of the sizes and specific topics of the datasets employed, (c) a review of the application of machine learning techniques in detecting eating disorders from text, and finally (d) an evaluation of the models used, focusing on their performance, limitations, and the potential risks associated with current methodologies.
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Affiliation(s)
| | | | - Mascha Kurpicz-Briki
- Applied Machine Intelligence, Bern University of Applied Sciences, Biel/Bienne, Switzerland
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van Kaam FE, Rohrbach PJ, van den Akker-Van Marle ME, van Furth EF, Dingemans AE. Sensitivity to change in well-being and health-related quality of life in adults with eating disorder symptoms: ICECAP-A versus EQ-5D-5L. Int J Eat Disord 2024; 57:593-601. [PMID: 38240329 DOI: 10.1002/eat.24142] [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: 08/15/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Economic evaluations of treatments help to inform decisions on allocating health care resources. These evaluations involve comparing costs and effectiveness in terms of quality of life. To calculate quality-adjusted life years, generic health related quality of life is often used, but is criticized for not being sensitive to change in mental health populations. Another approach, using experienced well-being measured through capabilities with the ICECAP-A, has been proposed as an alternative. The aim of this study was to investigate whether changes in individuals with eating disorder (ED) symptoms can be better captured using health related quality of life (EQ-5D-5L) or well-being (ICECAP-A). METHOD Measurements at two time points with an interval of 1 year were used from a sample of 233 participants with self-reported ED symptoms. An analysis of variance was used to test whether the EQ-5D-5L and ICECAP-A differed in sensitivity to change over time. In order to compare the two questionnaires in terms of clinically significant outcome, the reliable change index and clinical cut-off score were calculated. RESULTS The two questionnaires did not differ in sensitivity to change. More individuals had recovered but also more had deteriorated according to the EQ-5D-5L compared to the ICECAP. DISCUSSION The present study revealed no differences in sensitivity to change in health-related quality of life or well-being in individuals with ED symptoms in the context of mild clinical change. Results corroborated the pervasiveness of low quality of life in this population, even after alleviation of ED symptoms. PUBLIC SIGNIFICANCE STATEMENT Measuring treatment benefits in terms of improvements in quality of life is an integral part of economic evaluations in health care. It was expected that these treatment benefits would be better captured as changes in well-being (measured with the ICECAP-A) than as changes in health-related quality of life (measured with the EQ-5D-5L) for individuals with ED symptoms. Based on the results of this study, no preference for one of the two approaches was found.
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Affiliation(s)
- Fleur E van Kaam
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - Pieter J Rohrbach
- Department of Clinical Psychology, Open University, Heerlen, The Netherlands
| | - M Elske van den Akker-Van Marle
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Eric F van Furth
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra E Dingemans
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Bigazzi F, De Pasquale CF, Maestro S, Corciulo C, Dal Pino B, Sbrana F, Sampietro T. PCSK9 and leptin plasma levels in anorexia nervosa. Hormones (Athens) 2024; 23:137-140. [PMID: 37999906 DOI: 10.1007/s42000-023-00504-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
AIM Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a regulator of low-density-lipoprotein cholesterol (LDL-C), a major risk factor for cardiovascular (CV) disease. Since the hormone leptin has been suggested as having a role in CV risk regulation, possibly by modulating LDL receptor expression through the PCSK9 pathway, nutritional status may represent a potential regulator. Thus, evaluation of PCSK9 levels in human eating disorders appears to be of interest. In this report, we evaluate the lipoprotein profile, PCSK9, and leptin levels in subjects affected by anorexia nervosa (AN) to improve our understanding of the metabolic alterations in this disease. METHODS AND RESULTS We designed a case-control observational study, enrolling 20 anorexic adolescent females and 20 adolescent females without AN as the control group, age- and sex-matched. Subjects affected by AN showed lower BMI, total cholesterol, and LDL-C in comparison to the control group, with lipoprotein levels in the normal range. Furthermore, adolescent girls with AN show significantly higher PCSK9 (+24%, p < 0.005) and lower leptin levels (-43%, p < 0.01), compared to the control group. CONCLUSIONS The findings of increased levels of PCSK9 and reduced leptin levels among AN subjects warrant further research in order to unravel the role of the liver and adipose tissue in the management of PCSK9/LDL metabolism in adolescents affected by AN.
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Affiliation(s)
- Federico Bigazzi
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Carlotta Francesca De Pasquale
- Fondazione Stella Maris, IRCCS Istituto Scientifico per la Neuropsichiatria dell'Infanzia e dell'Adolescenza, Pisa, Italy
| | - Sandra Maestro
- Fondazione Stella Maris, IRCCS Istituto Scientifico per la Neuropsichiatria dell'Infanzia e dell'Adolescenza, Pisa, Italy
| | - Carmen Corciulo
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Beatrice Dal Pino
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesco Sbrana
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | - Tiziana Sampietro
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Lewis YD, Bergner L, Steinberg H, Bentley J, Himmerich H. Pharmacological Studies in Eating Disorders: A Historical Review. Nutrients 2024; 16:594. [PMID: 38474723 PMCID: PMC11154472 DOI: 10.3390/nu16050594] [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: 12/28/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
Eating disorders (EDs) are serious mental health conditions characterised by impaired eating behaviours and nutrition as well as disturbed body image, entailing considerable mortality and morbidity. Psychopharmacological medication is an important component in the treatment of EDs. In this review, we performed a historic analysis of pharmacotherapeutic research in EDs based on the scientific studies included in the recently published World Federation of Societies for Biological Psychiatry (WFSBP) guidelines for ED treatment. This analysis focuses on early approaches and trends in the methods of clinical pharmacological research in EDs, for example, the sample sizes of randomised controlled trials (RCTs). We found the development of psychopharmacological treatments for EDs followed advancements in psychiatric pharmacotherapy. However, the application of RCTs to the study of pharmacotherapy for EDs may be an impediment as limited participant numbers and inadequate research funding impede generalisability and statistical power. Moreover, current medication usage often deviates from guideline recommendations. In conclusion, the RCT model may not effectively capture the complexities of ED treatment, and funding limitations hinder research activity. Novel genetically/biologically based treatments are warranted. A more comprehensive understanding of EDs and individualised approaches should guide research and drug development for improved treatment outcomes.
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Affiliation(s)
- Yael D. Lewis
- Hadarim Eating Disorders Unit, Shalvata Mental Health Centre, Hod Hasharon 4534708, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lukas Bergner
- Forschungsstelle für die Geschichte der Psychiatrie, Klinik und Poliklinik Psychiatrie und Psychotherapie, Medizinische Fakultät der Universität Leipzig, 04103 Leipzig, Germany; (L.B.); (H.S.)
| | - Holger Steinberg
- Forschungsstelle für die Geschichte der Psychiatrie, Klinik und Poliklinik Psychiatrie und Psychotherapie, Medizinische Fakultät der Universität Leipzig, 04103 Leipzig, Germany; (L.B.); (H.S.)
| | - Jessica Bentley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (J.B.); (H.H.)
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (J.B.); (H.H.)
- South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
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Almoraie NM, Alothmani NM, Alomari WD, Al-Amoudi AH. Addressing nutritional issues and eating behaviours among university students: a narrative review. Nutr Res Rev 2024:1-16. [PMID: 38356364 DOI: 10.1017/s0954422424000088] [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: 02/16/2024]
Abstract
University life is a critical period for establishing healthy eating habits and attitudes. However, university students are at risk of developing poor eating habits due to various factors, including economic conditions, academic stress and lack of information about nutritional concepts. Poor diet quality leads to malnutrition or overnutrition, increasing the risk of preventable diseases. Food environments on university campuses also play a significant role in shaping the dietary habits of students, with the availability of and accessibility to healthy food options being important factors influencing food choices and overall diet quality. Disordered eating habits and body dissatisfaction are prevalent among university students and can lead to eating disorders. Income and living arrangements also influence dietary habits, with low household income and living alone being associated with unhealthy eating habits. This study is a narrative review that aimed to address nutritional issues and eating behaviours, specifically among university students. We investigated the eating behaviours of university students, including their dietary patterns, food choices and food environments. The objective of this review was to provide insights into the nutritional issues and eating behaviours of university students, with the aim of identifying target areas for intervention to improve the overall health and wellbeing among college students. University food environments need to be restructured to promote healthy eating, including the availability, accessibility, affordability and labelling of healthy foods, and policies to limit the availability of unhealthy foods and drinks on campus.
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Affiliation(s)
- Noha M Almoraie
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Noor M Alothmani
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wajd D Alomari
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amal H Al-Amoudi
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, Saudi Arabia
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Manhapra A, Zhou B, Rhee TG, Rosenheck RA. Is psychiatric diagnostic remission associated with reduced prevalence of moderate to severe pain interference and improved functioning among adults with lifetime psychiatric disorders? J Affect Disord 2024; 344:585-591. [PMID: 37863364 DOI: 10.1016/j.jad.2023.10.094] [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: 03/28/2023] [Revised: 09/23/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Chronic pain and non-substance use psychiatric disorders (PD) are common comorbidities, both associated with impaired functioning. However, whether and how the prevalence of pain differs in remitted PD compared to past-year PD has been little studied. METHODS In this observational study using data from the National Epidemiologic Survey on Alcohol and Related Conditions III, we compared the prevalence of moderate/severe pain interference (PI) in past-year Vs remitted PD among adults with any lifetime PD. We further studied the association of both PI and PD remission with mental and physical function. RESULTS In a sample representative of 77.9 million US adults with lifetime PDs, 31.7 % met criteria for PD remission. The prevalence and adjusted odds of PI was substantially lower among those with remitted PD compared to past-year PD (21.97 % Vs 35.02 %; p < .0001; Odds ratio 0.58, 95 % confidence interval = 0.51-0.66). While PI was independently associated with poorer mental functioning (Regression coefficient (RC) = -4.43, standard error (SE) = 0.33; p < .0001), PD remission was associated with higher mental functioning (RC = 4.79, SE = 0.24; p < .0001). Both PI and PD remission were independently associated with lower physical functioning, but the association was substantially stronger with PI (RC = -15.04, SE 0.27; p < .0001) than PD remission (RC = -0.37, SE 0.15; p = .016). CONCLUSIONS The negative association of PD remission with PI and their strong associations with mental functioning, albeit in opposite directions, raises the need to further examine PD as a contributing factor in chronic pain and as a target in its treatment.
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Affiliation(s)
- Ajay Manhapra
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Hampton VA Medical center, Hampton, VA, United States of America; Departments of Physical Medicine & Rehabilitation and Psychiatry, Eastern Virginia Medical School, Norfolk, VA, United States of America.
| | - Bin Zhou
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, United States of America
| | - Robert A Rosenheck
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
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12
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Dehghan M, Tantbirojn D, Harrison J, Stewart CW, Johnson N, Tolley EA, Zhang YH. Oral Health and Behavior Patterns of Women with Eating Disorders-A Clinical Pilot Study. Life (Basel) 2023; 13:2297. [PMID: 38137898 PMCID: PMC10744595 DOI: 10.3390/life13122297] [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: 10/24/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Chronic stomach regurgitation associated with eating disorders (EDs) poses a high risk for tooth erosion. This study investigated oral health conditions, behavioral patterns, and tooth erosion in women with EDs. METHODS 16 ED and 13 healthy women were enrolled; 14 ED and 10 healthy control subjects completed the study. Subjects completed demographic, medical, oral, and behavioral health history questionnaires. Dental caries status was recorded as Decayed, Missing and Filled Teeth (DMFT)index and the severity of tooth erosion as Basic Erosive Wear Examination (BEWE) scores. Saliva was collected for flow rate, pH, and buffering capacity analysis. RESULTS The ED group had a lower stimulated saliva flow rate and higher DMFT index but no significant difference in BEWE scores compared to the controls (t-test, significance level 0.05). Five of the fourteen ED subjects exhibited extensive tooth erosion, which may have been exacerbated by their tooth-brushing behavior. CONCLUSIONS Although some ED subjects showed extensive tooth erosion in this pilot study, the average BEWE score of the ED group was not significantly different from the controls. Extensive tooth erosion in ED may relate to the low stimulated salivary flow. A larger-scale clinical study is necessary to validate these results.
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Affiliation(s)
- Mojdeh Dehghan
- College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Memphis, TN 38163, USA
| | - Daranee Tantbirojn
- Department of General Dentistry, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Memphis, TN 38163, USA
| | - Janet Harrison
- Department of General Dentistry, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Memphis, TN 38163, USA
| | - Colette W. Stewart
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Memphis, TN 38163, USA
| | - Nancy Johnson
- Transformation Center, 1088 Rogers Road, Cordova, TN 38018, USA
| | - Elizabeth A. Tolley
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, 66 N Pauline, Memphis, TN 38163, USA
| | - Yanhui H. Zhang
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Memphis, TN 38163, USA
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13
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Sader M, Waiter GD, Williams JHG. The cerebellum plays more than one role in the dysregulation of appetite: Review of structural evidence from typical and eating disorder populations. Brain Behav 2023; 13:e3286. [PMID: 37830247 PMCID: PMC10726807 DOI: 10.1002/brb3.3286] [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: 01/17/2023] [Revised: 09/14/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Dysregulated appetite control is characteristic of anorexia nervosa (AN), bulimia nervosa (BN), and obesity (OB). Studies using a broad range of methods suggest the cerebellum plays an important role in aspects of weight and appetite control, and is implicated in both AN and OB by reports of aberrant gray matter volume (GMV) compared to nonclinical populations. As functions of the cerebellum are anatomically segregated, specific localization of aberrant anatomy may indicate the mechanisms of its relationship with weight and appetite in different states. We sought to determine if there were consistencies in regions of cerebellar GMV changes in AN/BN and OB, as well as across normative (NOR) variation. METHOD Systematic review and meta-analysis using GingerALE. RESULTS Twenty-six publications were identified as either case-control studies (nOB = 277; nAN/BN = 510) or regressed weight from NOR data against brain volume (total n = 3830). AN/BN and OB analyses both showed consistently decreased GMV within Crus I and Lobule VI, but volume reduction was bilateral for AN/BN and unilateral for OB. Analysis of the NOR data set identified a cluster in right posterior lobe that overlapped with AN/BN cerebellar reduction. Sensitivity analyses indicated robust repeatability for NOR and AN/BN cohorts, but found OB-specific heterogeneity. DISCUSSION Findings suggest that more than one area of the cerebellum is involved in control of eating behavior and may be differentially affected in normal variation and pathological conditions. Specifically, we hypothesize an association with sensorimotor and emotional learning via Lobule VI in AN/BN, and executive function via Crus I in OB.
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Affiliation(s)
- Michelle Sader
- Biomedical Imaging CentreUniversity of AberdeenAberdeenUK
| | | | - Justin H. G. Williams
- Biomedical Imaging CentreUniversity of AberdeenAberdeenUK
- School of MedicineGriffith UniversityGold CoastQueenslandAustralia
- Gold Coast Mental Health and Specialist ServicesGold CoastQueenslandAustralia
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14
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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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15
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Chen L, Liu Z, Zheng Y. Acute liver failure and aplastic crisis due to anorexia nervosa in an adolescent girl: a case report. J Int Med Res 2023; 51:3000605231214922. [PMID: 38017360 PMCID: PMC10686022 DOI: 10.1177/03000605231214922] [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: 07/16/2023] [Accepted: 10/17/2023] [Indexed: 11/30/2023] Open
Abstract
Anorexia nervosa (AN) has a high mortality rate due to the widespread organ dysfunction caused by the underlying severe malnutrition. Malnutrition-induced hepatitis is common among individuals with AN especially as body mass index decreases, while acute liver failure and aplastic crisis related to coagulation disease and encephalopathy rarely occur in AN patients. The supervised increase of caloric intake can quickly improve the elevated aminotransferases caused by starvation and aplastic crisis. This current case report describes a 12-year-old adolescent girl who was admitted with a 3-month history of weight loss. Within 3 months, she had lost 10 kg of weight. The girl was diagnosed with AN, acute liver failure, severe malnutrition with emaciation, electrolyte disorder, bradycardia and aplastic crisis. She was gradually supplemented with vitamins and enteral nutrition to avoid refeeding syndrome. After treatment, her liver function and haematopoietic function returned to normal. In conclusion, acute liver failure and aplastic crisis are rare but potentially life-threatening complications of AN, which could be improved by supervised feeding and timely rehydration. AN should be considered as the potential aetiology of acute liver failure and aplastic crisis.
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Affiliation(s)
- Leilei Chen
- Department of Paediatrics, Yancheng No.1 People’s Hospital, Affiliated Hospital of Medical School, Nanjing University, Yancheng, Jiangsu Province, China
| | - Zhifeng Liu
- Department of Gastroenterology, Nanjing Children’s Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
| | - Yucan Zheng
- Department of Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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16
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West ML, Hart S, Loughman A, Jacka FN, Staudacher HM, Abbaspour A, Phillipou A, Ruusunen A, Rocks T. Challenges and priorities for researching the gut microbiota in individuals living with anorexia nervosa. Int J Eat Disord 2023; 56:2001-2011. [PMID: 37548294 DOI: 10.1002/eat.24033] [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: 05/16/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE The gut microbiota is implicated in several symptoms and biological pathways relevant to anorexia nervosa (AN). Investigations into the role of the gut microbiota in AN are growing, with a specific interest in the changes that occur in response to treatment. Findings suggest that microbial species may be associated with some of the symptoms common in AN, such as depression and gastrointestinal disturbances (GID). Therefore, researchers believe the gut microbiota may have therapeutic relevance. Whilst research in this field is rapidly expanding, the unique considerations relevant to conducting gut microbiota research in individuals with AN must be addressed. METHOD We provide an overview of the published literature investigating the relationship between the gut microbiota and symptoms and behaviors present in AN, discuss important challenges in gut microbiota research, and offer recommendations for addressing these. We conclude by summarizing research design priorities for the field to move forward. RESULTS Several ways exist to reduce participant burden and accommodate challenges when researching the gut microbiota in individuals with AN. DISCUSSION Recommendations from this article are foreseen to encourage scientific rigor and thoughtful protocol planning for microbiota research in AN, including ways to reduce participant burden. Employing such methods will contribute to a better understanding of the role of the gut microbiota in AN pathophysiology and treatment. PUBLIC SIGNIFICANCE The field of gut microbiota research is rapidly expanding, including the role of the gut microbiota in anorexia nervosa. Thoughtful planning of future research will ensure appropriate data collection for meaningful interpretation while providing a positive experience for the participant. We present current challenges, recommendations for research design and priorities to facilitate the advancement of research in this field.
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Affiliation(s)
- Madeline L West
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Susan Hart
- Eating and Nutrition Research Group, School of Medicine, Western Sydney University, Cambelltown, Australia
- Nutrition Services, St Vincent's Health Network, Darlinghurst, Australia
- Translational Health Research Institute, Eating Disorders and Body Image, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Amy Loughman
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Felice N Jacka
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
- James Cook University, Townsville, Queensland, Australia
| | - Heidi M Staudacher
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
| | - Afrouz Abbaspour
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutetet, Solna, Stockholm, Sweden
| | - Andrea Phillipou
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Mental Health, Austin Health, Melbourne, Victoria, Australia
| | - Anu Ruusunen
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Tetyana Rocks
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Geelong, Australia
- Translational Health Research Institute, Eating Disorders and Body Image, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
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17
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Chmiel J, Gladka A, Leszek J. The Effect of Transcranial Direct Current Stimulation (tDCS) on Anorexia Nervosa: A Narrative Review. Nutrients 2023; 15:4455. [PMID: 37892530 PMCID: PMC10610104 DOI: 10.3390/nu15204455] [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: 09/18/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Introduction: Anorexia nervosa (AN) is a severe, debilitating disease with high incidence and high mortality. The methods of treatment used so far are moderately effective. Evidence from neuroimaging studies helps to design modern methods of therapy. One of them is transcranial direct current stimulation (tDCS), a non-invasive brain neuromodulation technique. (2) Methods: The purpose of this narrative review is to bring together all studies investigating the use of tDCS in the treatment of AN and to evaluate its effect and efficiency. Searches were conducted in the Pubmed/Medline, Research Gate, and Cochrane databases. (3) Results: The literature search resulted in five articles. These studies provide preliminary evidence that tDCS has the potential to alter eating behaviour, body weight, and food intake. Additionally, tDCS reduced symptoms of depression. Throughout all trials, stimulation targeted the left dorsolateral prefrontal cortex (DLPFC). Although the number of studies included is limited, attempts were made to elucidate the potential mechanisms underlying tDCS action in individuals with AN. Recommendations for future tDCS research in AN were issued. (4) Conclusions: The included studies have shown that tDCS stimulation of the left DLPFC has a positive effect on AN clinical symptoms and may improve them, as measured by various assessment measures. It is important to conduct more in-depth research on the potential benefits of using tDCS for treating AN. This should entail well-designed studies incorporating advanced neuroimaging techniques, such as fMRI. The aim is to gain a better understanding of how tDCS works in AN.
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Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | - Anna Gladka
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
| | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
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18
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Cadwallader JS, Orri M, Barry C, Falissard B, Hassler C, Huas C. Description of patients with eating disorders by general practitioners: a cohort study and focus on co-management with depression. J Eat Disord 2023; 11:185. [PMID: 37858179 PMCID: PMC10585727 DOI: 10.1186/s40337-023-00901-0] [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: 03/17/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND International guidelines often state that general practitioners (GPs) provide early management for most patients with eating disorders (EDs). GP management of EDs has not been studied in France. Depressive disorders are often a comorbidity of EDs. The aims of this study were to describe in France the characteristics of people with all subcategories of EDs (Anorexia Nervosa, Bulimia Nervosa, ED Not Otherwise Specified) managed by their GPs and to study the management temporality between depression and all subcategories of EDs. METHODS Retrospective cohort study of patients with EDs visiting French GPs. Data collected from 1994 through 2009 were extracted from the French society of general electronic health record. A descriptive analysis of the population focused on depression, medication such as antidepressants and anxiolytics, and the management temporality between depression and EDs. RESULTS 1310 patients aged 8 years or older were seen at least once for an ED by a GP participating in the database out of 355,848 patients, with a prevalence rate of 0.3%. They had a mean age of 35.19 years, 82.67% were women. 41.6% had anorexia nervosa, 26.4% bulimia nervosa, and 32% an ED not otherwise specified. Overall, 32.3% had been managed at least once for depression, and 18.4% had been prescribed an antidepressant of any type at least once. Benzodiazepines had been prescribed at least once for 73.9% of the patients treated for depression. Patients with an ED seen regularly by their GP ("during" profile) received care for depression more frequently than those with other profiles. 60.9% had a single visit with the participating GP for their ED Treatment and management for depression did not precede care for EDs. CONCLUSIONS Data extracted from the French society of general practice were the only one available in France in primary care about EDs and our study was the only one on this topic. The frequency of visits for EDs was very low in our general practice-based sample. Depressive disorders were a frequent comorbidity of EDs. GPs could manage common early signs of depression and EDs, especially if they improved their communication skills and developed collaborative professional management.
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Affiliation(s)
- Jean Sébastien Cadwallader
- School of Medicine, Department of General Practice, Sorbonne Université, Paris, France.
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France.
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Caroline Barry
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Bruno Falissard
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Christine Hassler
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Caroline Huas
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
- Fondation Santé des Etudiants de France (FSEF), Service Hospitalo-Universitaire de Santé Mentale de l'Adolescent et du Jeune Adulte (SAMAJA), Paris, France
- Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles-Saint-Quentin-en-Yvelines (UVSQ), 78180, Montigny le Bretonneux, France
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19
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Sharma A, Vidal C. A scoping literature review of the associations between highly visual social media use and eating disorders and disordered eating: a changing landscape. J Eat Disord 2023; 11:170. [PMID: 37752611 PMCID: PMC10521472 DOI: 10.1186/s40337-023-00898-6] [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: 03/30/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Although the etiology of eating disorders (ED) and disorder eating (DE) is multifactorial, exposure to highly visual social media (HVSM) may be an important contributor to the onset or worsening of DE and ED symptoms. We aim to understand HVSM use, ED, and DE with a particular focus on gender differences, as well as details of engagement on "selfies" in adolescents and young adults (AYA) through a scoping review of the literature. METHODS We conducted a literature search in Psycho ED, PubMed, MEDLINE of articles, including participants with DE/ED and users of HVSM, focused on AYA. Studies in which the study population did not include AYA, the SM platforms used did not include HVSM platforms, and the methodology to assess ED/HVSM use was not robust were excluded. RESULTS We found a strong relationship between HVSM and ED and DE with existing gender differences related to the nature of engagement and preference of content. The literature also shows effects of the specific mechanisms of use of these platforms involving "selfie" preparation and posting. Existing research is limited and consists of mostly cross-sectional studies with no uniform methodology and with participant populations that are not well-defined. CONCLUSIONS The use of unregulated and profit-driven SM platforms can increase risk for ED. To use these HVSM platforms for positive influence, there is a need to have more transparency, and involvement of clinicians, researchers, and educators. PUBLIC SIGNIFICANCE Due to HVSM's popularity among the AYA population, it is important to identify its effects on the development of DE and ED, as well as recognize any gender differences. Clinicians, parents, and other adults working with youth should be aware of HVSM's impact on DE/ED, as described in this review.
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Affiliation(s)
- Ashley Sharma
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Carol Vidal
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
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Argyrou A, Lappas AS, Bakaloudi DR, Tsekitsidi E, Mathioudaki E, Michou N, Polyzopoulou Z, Christodoulou N, Papazisis G, Chourdakis M, Samara MT. Pharmacotherapy compared to placebo for people with Bulimia Nervosa: A systematic review and meta-analysis. Psychiatry Res 2023; 327:115357. [PMID: 37562154 DOI: 10.1016/j.psychres.2023.115357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
Bulimia Nervosa is a disorder with high rates of psychiatric and medical comorbidity and substantial societal costs. Cognitive Behavioural Therapy is considered the preferred treatment, but access can be problematic. Pharmacotherapy is more accessible but remains significantly underutilised. We aimed to assess the efficacy, tolerability, and safety of all available forms of pharmacotherapy for the treatment of bulimia nervosa. We conducted a comprehensive search of PubMed, EMBASE, CENTRAL, ClinicalTrials.gov, and reference lists of relevant articles up until April 2023. The primary outcomes were remission and binge frequency. 52 randomised controlled trials (RCTs) involving 3313 participants were included in the meta-analysis. Overall, no significant difference was observed between drugs and placebo in terms of remission; however, the available data were limited. Notably, drugs, particularly antidepressants, demonstrated a significant reduction in the frequency of binge episodes compared to placebo. Antidepressants were also found to be more effective than placebo in terms of treatment response and other clinically meaningful outcomes. An important limitation is that few RCTs were available for individual drugs. Our findings provide evidence supporting the increased utilisation of pharmacotherapy in clinical practice and underscore the need for further research involving larger populations and a broader range of outcomes.
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Affiliation(s)
- Aikaterini Argyrou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Andreas S Lappas
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa 41334, Greece; Department of Geriatric Liaison Psychiatry, Royal Gwent Hospital, Aneurin Bevan University Health Board, United Kingdom
| | - Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Elissavet Mathioudaki
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Niki Michou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Zoi Polyzopoulou
- Department of Psychology, University of Western Macedonia, Florina 53100, Greece
| | - Nikos Christodoulou
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa 41334, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, Department of Medicine, School of Medicine, Faculty of Health Sciences, School of Health Sciences, Aristotle University, University Campus, Thessaloniki 54124, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa 41334, Greece; Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich 81675, Germany.
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Miletta MC, Horvath TL. Construction of Activity-based Anorexia Mouse Models. Bio Protoc 2023; 13:e4730. [PMID: 37575391 PMCID: PMC10415190 DOI: 10.21769/bioprotoc.4730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/13/2023] [Accepted: 05/09/2023] [Indexed: 08/15/2023] Open
Abstract
Anorexia nervosa (AN) is a psychiatric disorder mainly characterized by extreme hypophagia, severe body weight loss, hyperactivity, and hypothermia. Currently, AN has the highest mortality rate among psychiatric illnesses. Despite decades of research, there is no effective cure for AN nor is there a clear understanding of its etiology. Since a complex interaction between genetic, environmental, social, and cultural factors underlines this disorder, the development of a suitable animal model has been difficult so far. Here, we present our protocol that couples a loss-of-function mouse model to the activity-based anorexia model (ABA), which involves self-imposed starvation in response to exposure to food restriction and exercise. We provide insights into a neural circuit that drives survival in AN and, in contrast to previous protocols, propose a model that mimics the conditions that mainly promote AN in humans, such as increased incidence during adolescence, onset preceded by negative energy balance, and increased compulsive exercise. This protocol will be useful for future studies that aim to identify neuronal populations or brain circuits that promote the onset or long-term maintenance of this devastating eating disorder.
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Affiliation(s)
- Maria Consolata Miletta
- Larsson-Rosenquist Foundation Center for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University of Zurich and University Hospital Zurich, 8006 Zurich, Switzerland
| | - Tamas L. Horvath
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Program in Integrative Cell Signaling and Neurobiology of Metabolism, Yale University School of Medicine, New Haven, CT 06520, USA
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22
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Goldschmidt AB, Tortolani CC, Accurso EC, Dunbar EMP, Egbert AH, Donaldson D, Donaldson AA. Adapting family-based treatment for adolescent anorexia nervosa delivered in the home: A novel approach for improving access to care and generalizability of skill acquisition. J Eat Disord 2023; 11:130. [PMID: 37543601 PMCID: PMC10403819 DOI: 10.1186/s40337-023-00850-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach. RESULTS Adaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills. CONCLUSIONS Implementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Christina C Tortolani
- Department of Counseling, Educational Leadership, and School Psychology, Rhode Island College, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | | | - Amy H Egbert
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
- Department of Psychological Sciences, University of Connecticut, Connecticut, Storz, USA
| | - Deidre Donaldson
- Department of Family Medicine, Warren Alpert Medical School of Brown University/Gateway Healthcare, Providence, RI, USA
| | - Abigail A Donaldson
- Department of Pediatrics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
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23
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Anderson KE, Han SC, Kavlich SG, Brown S, Ho J, Everhart SA. Adaptation of family-based treatment within an inpatient medical stabilization program for children with eating disorders. Int J Eat Disord 2023; 56:1511-1519. [PMID: 37129459 DOI: 10.1002/eat.23979] [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: 12/28/2022] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Eating disorders are serious psychiatric conditions predominantly affecting children, adolescents, and young adults. While family-based treatment (FBT) is the gold standard outpatient treatment approach for adolescents with restrictive eating disorders, there is not a universally recognized best practice within higher levels of care. There is a particular dearth of literature detailing recommended psychological and behavioral interventions in the inpatient medical setting. METHOD The present article provides an account of how FBT principles have been incorporated in Children's Hospital of Orange County at Mission's inpatient medical stabilization program for children and adolescents with restrictive eating disorders. Practical examples illustrate how key FBT tenets are successfully translated into the inpatient multidisciplinary setting. RESULTS The use of FBT can encourage a unified approach among medical and psychosocial providers and serves to destigmatize patients with eating disorders and associated behaviors. The successes and challenges of FBT implementation are discussed. DISCUSSION Though anecdotal evidence and preliminary findings support positive outcomes from the implementation of FBT within a pediatric medical stabilization program for patients, families, and staff, research is needed to understand best practices within higher levels of care. Additional research efforts will also help elucidate whether adapted FBT can become a standard of care for patients with restrictive eating disorders in inpatient settings. PUBLIC SIGNIFICANCE This article describes how a children's hospital has adopted family-based treatment (FBT) for youth who are hospitalized due to an eating disorder. FBT is the most efficacious treatment for youth with eating disorders. This article describes specific examples of how FBT can be implemented within a medical setting. This article will support a greater understanding of FBT principles and guide providers to translate FBT into higher level of care settings.
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Affiliation(s)
| | - Sohyun C Han
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Sarah G Kavlich
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Shonda Brown
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Jennifer Ho
- Children's Hospital of Orange County, Mission Viejo, California, USA
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Peebles I, Cronje JL, Clark L, Sharpe H, Duffy F. Experiences of inpatient eating disorder admissions: A systematic review and meta-synthesis. Eat Behav 2023; 50:101753. [PMID: 37329771 DOI: 10.1016/j.eatbeh.2023.101753] [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: 12/08/2022] [Revised: 03/22/2023] [Accepted: 05/18/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE There has been a significant increase in the number of inpatient admissions for individuals with eating disorders and, with the most critical cases requiring inpatient treatment, it is essential that we continue to improve associated outcomes. The aim of the study was to synthesise the available qualitative literature on the experiences of inpatient admissions for eating disorders to understand individuals' experiences and identify areas that may require further research and/or service development. METHOD Searches were performed on the following online databases: PsycINFO, PsycArticles, PsycTherapy MEDLINE, Embase, CINAHL, ASSIA, Scopus and Proquest Open Access Theses. Only papers with qualitative data regarding individuals' experiences of inpatient eating disorder treatment were considered. The CASP qualitative checklist was used to assess studies and relevant data items were extracted. Thematic synthesis was used to integrate the findings in the identified studies. GRADE-CERQual was used to rate the confidence in the findings. RESULTS Twenty-eight studies were identified which the CASP assessment considered to be adequate. The synthesis produced 5 main themes; 'Care and control', 'Inpatient bubble', 'Being supported and understood', 'Challenges of living with others' eating disorders' and finally 'Relationship to eating disorder'. The GRADE CERQual framework rated findings with high or moderate confidence. CONCLUSIONS Findings reaffirmed the importance of patient-centred care and the significant impact of being separated from normal life with others also experiencing an eating disorder.
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Affiliation(s)
- Imogen Peebles
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland; CAMHS NHS Lothian, United Kingdom of Great Britain and Northern Ireland.
| | - Jamie-Lee Cronje
- CAMHS NHS Lothian, United Kingdom of Great Britain and Northern Ireland.
| | - Lilli Clark
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland.
| | - Helen Sharpe
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland.
| | - Fiona Duffy
- University of Edinburgh, United Kingdom of Great Britain and Northern Ireland; CAMHS NHS Lothian, United Kingdom of Great Britain and Northern Ireland.
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25
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Schopf K, Schneider S, Meyer AH, Lennertz J, Humbel N, Bürgy NM, Wyssen A, Biedert E, Isenschmid B, Milos G, Claussen M, Trier S, Whinyates K, Adolph D, Teismann T, Margraf J, Assion HJ, Überberg B, Juckel G, Müller J, Klauke B, Munsch S. Eating disorder treatment in routine clinical care: A descriptive study examining treatment characteristics and short-term treatment outcomes among patients with anorexia nervosa and bulimia nervosa in Germany and Switzerland. PLoS One 2023; 18:e0280402. [PMID: 37390075 PMCID: PMC10313003 DOI: 10.1371/journal.pone.0280402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/27/2022] [Indexed: 07/02/2023] Open
Abstract
This descriptive study examined patient characteristics, treatment characteristics, and short-term outcomes among patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in routine clinical care. Results for patients receiving full-time treatment were contrasted with results for patients receiving ambulatory treatment. Data of a clinical trial including 116 female patients (18-35 years) diagnosed with AN or BN were subjected to secondary analyses. Patients were voluntarily admitted to one of nine treatment facilities in Germany and Switzerland. Patients received cognitive-behavioral interventions in accordance with the national clinical practice guidelines for the treatment of EDs under routine clinical care conditions, either as full-time treatment or ambulatory treatment. Assessments were conducted after admission and three months later. Assessments included a clinician-administered diagnostic interview (DIPS), body-mass-index (BMI), ED pathology (EDE-Q), depressive symptoms (BDI-II), symptoms of anxiety (BAI), and somatic symptoms (SOMS). Findings showed that treatment intensity differed largely by setting and site, partly due to national health insurance policies. Patients with AN in full-time treatment received on average 65 psychotherapeutic sessions and patients with BN in full-time treatment received on average 38 sessions within three months. In comparison, patients with AN or BN in ambulatory treatment received 8-9 sessions within the same time. Full-time treatment was associated with substantial improvements on all measured variables for both women with AN (d = .48-.83) and BN (d = .48-.81). Despite the relatively small amount of psychotherapeutic sessions, ambulatory treatment was associated with small increases in BMI (d = .37) among women with AN and small improvements on all measured variables among women with BN (d = .27-.43). For women with AN, reduction in ED pathology were positively related to the number of psychotherapeutic sessions received. Regardless of diagnosis and treatment setting, full recovery of symptoms was rarely achieved within three months (recovery rates ranged between 0 and 4.4%). The present study shows that a considerable amount of patients with EDs improved after CBT-based ED treatment in routine clinical care within three months after admission. Intensive full-time treatment may be particularly effective in quickly improving ED-related pathology, although full remission of symptoms is typically not achieved. A small amount of ambulatory sessions may already produce considerable improvements in BN pathology and weight gain among women with AN. As patient characteristics and treatment intensity differed largely between settings, results should not be interpreted as superiority of one treatment setting over another. Furthermore, this study shows that treatment intensity is quite heterogeneous, indicating the possibility for increasing effectiveness in the treatment of EDs in routine clinical care.
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Affiliation(s)
- Kathrin Schopf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Andrea Hans Meyer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | | | - Nadine Humbel
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Nadine-Messerli Bürgy
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
- Institute of Psychology, Clinical Child and Adolescent Psychology, University of Lausanne, Lausanne, Switzerland
| | - Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Esther Biedert
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Bettina Isenschmid
- Center for Eating Disorders and Obesity, Clinic Zofingen, Zofingen, Switzerland
| | - Gabriella Milos
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, Switzerland
| | - Malte Claussen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Dirk Adolph
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Hans-Jörg Assion
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, LWL-Klinik Dortmund, Dortmund, Germany
| | - Bianca Überberg
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, LWL-Klinik Dortmund, Dortmund, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Judith Müller
- Christoph-Dornier-Klinik for Psychotherapy, Münster, Germany
| | - Benedikt Klauke
- Christoph-Dornier-Klinik for Psychotherapy, Münster, Germany
| | - Simone Munsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
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Riva A, Purpura G, Di Guardo S, Falbo M, Pigni M, Nacinovich R. Psychological features in male and female adolescents with eating disorders: is it the same condition? Eat Weight Disord 2023; 28:56. [PMID: 37378688 DOI: 10.1007/s40519-023-01583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE Eating disorders (EDs) are psychiatric disorders with a typical prevalence in adolescence. EDs have long been wrongly considered female gender-bound disorders, resulting in a systematic underrepresentation of males in EDs research. The main goal of the present study is exploring the clinical and psychological characteristics of adolescent males with EDs in comparison with females. METHODS In this observational and retrospective study, 14 males and 28 females hospitalized for eating disorders during the adolescent age (from 12 to 17.11 years) were recruited. Main clinical data (age, BMI, duration of illness), behavioural characteristic of the disorder (over-exercising, self-harm, purging-behaviours) and psychological symptoms (Eating Disorders Inventory-3rd edition-EDI-3, Symptom Checklist-90-Revised-SCL-90, Children's Global Assessment Scale-C-GAS) were collected and examined for significant correlations with severity of body mass index (BMI). RESULTS Adolescent males show a peculiar and more severe psychopathological profiles partially influenced by BMI and characterized by purging-behaviours, over-exercising, obsessive-compulsive behaviour, anxiety, and psychoticism. CONCLUSION This study suggests a gender-specific profile of adolescent males with EDs, which may be considered in diagnosis and treatment. LEVEL III Evidence obtained from retrospective well-designed case-control study.
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Affiliation(s)
- Anna Riva
- School of Medicine and Surgery, University of Milano Bicocca, 20900, Monza, Italy
- Child and Adolescent Health Department, Fondazione IRCCS San Gerardo dei Tintori, 20900, Monza, Italy
| | - Giulia Purpura
- School of Medicine and Surgery, University of Milano Bicocca, 20900, Monza, Italy.
| | - Simona Di Guardo
- Child and Adolescent Health Department, Fondazione IRCCS San Gerardo dei Tintori, 20900, Monza, Italy
| | - Mariella Falbo
- Child and Adolescent Health Department, Fondazione IRCCS San Gerardo dei Tintori, 20900, Monza, Italy
| | - Maria Pigni
- School of Medicine and Surgery, University of Milano Bicocca, 20900, Monza, Italy
- Child and Adolescent Health Department, Fondazione IRCCS San Gerardo dei Tintori, 20900, Monza, Italy
| | - Renata Nacinovich
- School of Medicine and Surgery, University of Milano Bicocca, 20900, Monza, Italy
- Child and Adolescent Health Department, Fondazione IRCCS San Gerardo dei Tintori, 20900, Monza, Italy
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Francesconi M, Flouri E, Harrison A. Decision-making difficulties mediate the association between poor emotion regulation and eating disorder symptoms in adolescence. Psychol Med 2023; 53:3701-3710. [PMID: 35227340 PMCID: PMC10277753 DOI: 10.1017/s003329172200037x] [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: 03/31/2021] [Revised: 12/14/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The emergence of eating problems during childhood increases the risk for eating disorders (EDs) during young adulthood. Previous studies highlight a relationship between poor self-regulation and onset of eating pathology. In this study, we investigated whether this association is mediated by decision-making difficulties. METHODS To test this hypothesis, we used data from the Millennium Cohort Study. Decision-making performance was assessed with the Cambridge Gambling Task at age 11. Principal components analysis was used to derive an index of ED symptoms at age 14. The trajectories of scores of two subscales of the Child Social Behaviour Questionnaire, Independence and Self-Regulation (ISR) and Emotional Dysregulation (EmotDy), were modelled from ages 3 to 7 years in a latent growth curve analysis. The individual predicted values of the intercept (set at baseline, 3 years) and the slope (rate of annual change) were then used in the mediation analysis. RESULTS In our sample of 11 303 individuals, there was evidence for mediation by three measures of decision-making at age 11 (poor quality of decision-making, delay aversion and low risk-adjustment) in the association between EmotDy across ages 3-7 and ED symptoms at age 14 even after the adjustment for relevant covariates. We found no evidence of association between ISR and ED symptoms. CONCLUSION Our findings suggest that emotion regulation processes during childhood may be relevant for the future onset of ED symptoms via their association with decision-making skills. These findings, obtained from a large, representative, sample, shed light on the relationship between self-regulation, decision-making and symptoms of EDs.
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Affiliation(s)
- Marta Francesconi
- Department of Psychology and Human Development, Institute of Education, University College London, 25 Woburn Square, London WC1H 0AA, UK
| | - Eirini Flouri
- Department of Psychology and Human Development, Institute of Education, University College London, 25 Woburn Square, London WC1H 0AA, UK
| | - Amy Harrison
- Department of Psychology and Human Development, Institute of Education, University College London, 25 Woburn Square, London WC1H 0AA, UK
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Uziel O, Dickstein H, Beery E, Lewis Y, Loewenthal R, Uziel E, Shochat Z, Weizman A, Stein D. Differences in Telomere Length between Adolescent Females with Anorexia Nervosa Restricting Type and Anorexia Nervosa Binge-Purge Type. Nutrients 2023; 15:2596. [PMID: 37299559 PMCID: PMC10255620 DOI: 10.3390/nu15112596] [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: 05/13/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Physiological and psychological distress may accelerate cellular aging, manifested by shortening of telomere length (TL). The present study focused on TL shortening in anorexia nervosa (AN), an illness combining physiological and psychological distress. For that purpose, we measured TL in 44 female adolescents with AN at admission to inpatient treatment, in a subset of 18 patients also at discharge, and in 22 controls. No differences in TL were found between patients with AN and controls. At admission, patients with AN-binge/purge type (AN-B/P; n = 18) showed shorter TL compared with patients with AN-restricting type (AN-R; n = 26). No change in TL was found from admission to discharge, despite an improvement in body mass index standard deviation score (BMI-SDS) following inpatient treatment. Older age was the only parameter assessed to be correlated with greater TL shortening. Several methodological changes have to be undertaken to better understand the putative association of shorter TL with B/P behaviors, including increasing the sample size and the assessment of the relevant pathological eating disorder (ED) and non-ED psychological correlates in the two AN subtypes.
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Affiliation(s)
- Orit Uziel
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 69978, Israel; (O.U.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Hadar Dickstein
- Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Einat Beery
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 69978, Israel; (O.U.)
| | - Yael Lewis
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Shalvatah Mental Health Center, Hod Hasahron 45100, Israel
| | - Ron Loewenthal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Eran Uziel
- Research Unit, Geha Mental Health Center, Petah Tikva 49100, Israel
| | - Zipi Shochat
- Research Unit, Geha Mental Health Center, Petah Tikva 49100, Israel
| | - Abraham Weizman
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 69978, Israel; (O.U.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Statistical Service, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Daniel Stein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
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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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Confirmatory factor analysis of Acute Suicidal Affective Disturbance in a sample of treatment-seeking eating disorder patients. J Affect Disord 2023; 326:155-162. [PMID: 36724842 DOI: 10.1016/j.jad.2023.01.089] [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: 06/15/2022] [Revised: 12/29/2022] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We examined the factor structure of Acute Suicidal Affective Disturbance (ASAD) in individuals with eating disorders. ASAD is a proposed diagnosis with four symptoms: rapidly increasing suicidal intent, social or self-alienation, hopelessness regarding the previous symptoms, and overarousal. METHODS Patients with eating disorders (N = 378) completed self-report symptom questionnaires at admission to a partial hospitalization program for eating disorders. Using proxy measures, we conducted a confirmatory factor analysis (CFA) of the one-factor model of ASAD. RESULTS Initial model fit was poor. We iteratively revised the model to include theoretically-justified correlated residuals (i.e., those between items intended to measure the same ASAD symptom). After these modifications, model fit remained mediocre. We next conducted a multiple-group CFA to compare ASAD between individuals with the restricting subtype of anorexia nervosa (the "ANR" model, n = 145) and individuals with binge/purge disorders (i.e., bulimia nervosa and the binge-purge subtype of anorexia nervosa; the "BP" model, n = 234). The final model had mediocre fit with partial invariance between subgroups; the ASAD factor mean was higher in the BP model. We additionally tested a bifactor model, with similar findings. LIMITATIONS Our use of proxy measures of ASAD items may have resulted in imprecise measurement of ASAD symptoms, pointing to the importance of future research using validated measures of ASAD. CONCLUSIONS We found moderate support for ASAD in an eating disorder sample, with invariance between eating disorder phenotypes. Our findings suggest that the ASAD diagnosis may not fully generalize to eating disorder samples.
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Fitzsimmons-Craft EE, Laboe AA, McGinnis C, Firebaugh ML, Shah J, Wallendorf M, Jacobi C, Bardone-Cone AM, Pike KM, Taylor CB, Wilfley DE. A pilot randomized controlled trial of a cognitive-behavioral therapy guided self-help mobile app for the post-acute treatment of anorexia nervosa: A registered report. Int J Eat Disord 2023; 56:654-661. [PMID: 36609861 PMCID: PMC10019771 DOI: 10.1002/eat.23891] [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: 08/29/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Relapse following acute treatment for anorexia nervosa (AN) is common. Evidence suggests cognitive-behavioral therapy (CBT) may be useful in the post-acute period, but few patients have access to trained providers. mHealth technologies have potential to increase access to high-quality care for AN, including in the post-acute period. The aim of this study is to estimate the preliminary feasibility and effectiveness of a CBT-based mobile intervention plus treatment as usual (TAU), offered with and without an accompanying social networking feature. METHOD In the current pilot randomized controlled trial, women with AN who have been discharged from acute treatment in the past 2 months (N = 90) will be randomly assigned to a CBT-based mobile intervention plus treatment as usual (TAU), a CBT-based mobile intervention including social networking plus TAU, or TAU alone. We will examine feasibility, acceptability, and preliminary effectiveness of the three conditions in terms of reducing eating disorder psychopathology, reducing frequency of eating disorder behaviors, achieving weight maintenance, reducing depression and suicidal ideation, and reducing clinical impairment. We will examine rehospitalization and full recovery rates in an exploratory fashion. We will also examine whether the mobile intervention and social networking feature change the proposed targets and whether changes in targets are associated with benefit, as well as conduct exploratory analyses to identify within-mobile intervention predictors and moderators of outcome. DISCUSSION Ultimately, this research may lead to increased access to evidence-based treatment for individuals with AN and prevention of the extreme negative consequences that can result from this serious disorder. PUBLIC SIGNIFICANCE Relapse after acute treatment for anorexia nervosa is common, and few patients have access to trained providers to support them following acute care. This study will pilot a coached mobile app, including a social networking component, for this population. If ultimately successful, our approach could greatly increase access to evidence-based treatment for individuals with anorexia nervosa and ultimately prevent the extreme negative consequences that can result from this serious disorder.
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Affiliation(s)
| | - Agatha A. Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Claire McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Wallendorf
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Anna M. Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen M. Pike
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Stalujanis E, Zeeck A, Euler S. Mentalisieren und Mentalisierungsbasierte Therapie (MBT) bei Essstörungen. PDP - PSYCHODYNAMISCHE PSYCHOTHERAPIE 2023. [DOI: 10.21706/pdp-22-1-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Staller K, Abber SR, Burton Murray H. The intersection between eating disorders and gastrointestinal disorders: a narrative review and practical guide. Lancet Gastroenterol Hepatol 2023; 8:565-578. [PMID: 36868254 DOI: 10.1016/s2468-1253(22)00351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 03/04/2023]
Abstract
Eating disorders include a spectrum of disordered thinking patterns and behaviours around eating. There is increasing recognition of the bi-directional relationship between eating disorders and gastrointestinal disease. Gastrointestinal symptoms and structural issues might arise from eating disorders, and gastrointestinal disease might be a risk factor for eating disorder development. Cross-sectional research suggests that individuals with eating disorders are disproportionately represented among people seeking care for gastrointestinal symptoms, with avoidant-restrictive food intake disorder in particular garnering attention for high rates among individuals with functional gastrointestinal disorders. This Review aims to describe the research to date on the relationship between gastrointestinal disorders and eating disorders, highlight research gaps, and provide brief, practical guidance for the gastroenterology provider in detecting, potentially preventing, and treating gastrointestinal symptoms in eating disorders.
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Affiliation(s)
- Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Sophie R Abber
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Helen Burton Murray
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Garcia-Burgos D, Wilhelm P, Vögele C, Munsch S. Food Restriction in Anorexia Nervosa in the Light of Modern Learning Theory: A Narrative Review. Behav Sci (Basel) 2023; 13:bs13020096. [PMID: 36829325 PMCID: PMC9952578 DOI: 10.3390/bs13020096] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Improvements in the clinical management of anorexia nervosa (AN) are urgently needed. To do so, the search for innovative approaches continues at laboratory and clinical levels to translate new findings into more effective treatments. In this sense, modern learning theory provides a unifying framework that connects concepts, methodologies and data from preclinical and clinical research to inspire novel interventions in the field of psychopathology in general, and of disordered eating in particular. Indeed, learning is thought to be a crucial factor in the development/regulation of normal and pathological eating behaviour. Thus, the present review not only tries to provide a comprehensive overview of modern learning research in the field of AN, but also follows a transdiagnostic perspective to offer testable explanations for the origin and maintenance of pathological food rejection. This narrative review was informed by a systematic search of research papers in the electronic databases PsycInfo, Scopus and Web of Science following PRISMA methodology. By considering the number and type of associations (Pavlovian, goal-directed or habitual) and the affective nature of conditioning processes (appetitive versus aversive), this approach can explain many features of AN, including why some patients restrict food intake to the point of life-threatening starvation and others restrict calorie intake to lose weight and binge on a regular basis. Nonetheless, it is striking how little impact modern learning theory has had on the current AN research agenda and practice.
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Affiliation(s)
- David Garcia-Burgos
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
- Department of Psychobiology, The “Federico Olóriz” Institute of Neurosciences, Biomedical Research Centre, University of Granada, 18071 Granada, Spain
- Correspondence:
| | - Peter Wilhelm
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
| | - Claus Vögele
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Simone Munsch
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
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Abstract
LEARNING OBJECTIVES After completing this activity, practitioners will be better able to:• Discuss the growing body literature emphasizing moderation and harm-reduction in patients with severe and enduring anorexia nervosa (SE-AN)• Outline and discuss the legal, ethical, and medical challenges inpatient providers face when treating patients with SE-AN. ABSTRACT Patients with severe and enduring anorexia nervosa (SE-AN) present numerous clinical and ethical challenges for the hospital psychiatrist. Patients typically come to the hospital in a state of severe medical compromise. Common difficulties in the period of acute medical stabilization include assessment of decision-making capacity and the right to decline treatment, as well as legally complex decisions pertaining to administering artificial nutrition over the patient's objection. Following acute medical stabilization, the psychiatric consultant must decide whether psychiatric hospitalization for continued treatment is indicated, and if so, whether involuntary hospitalization is indicated. The standard of care in these situations is unclear. Pragmatic issues such as lack of appropriate facilities for specialized treatment are common. If involuntary hospitalization is not approved or not pursued, there may be difficulty in determining whether, when, and how to involve palliative care consultants to guide further management. These cases are complex and largely reside in a medico-legal and ethical gray area. This article discusses the difficulties associated with these cases and supports a growing body of literature emphasizing moderation and harm-reduction in patients with SE-AN. Physician-assisted dying (PAD) is also discussed.
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Terache J, Wollast R, Simon Y, Marot M, Van der Linden N, Franzen A, Klein O. Promising effect of multi-family therapy on BMI, eating disorders and perceived family functioning in adolescent anorexia nervosa: an uncontrolled longitudinal study. Eat Disord 2023; 31:64-84. [PMID: 35649125 DOI: 10.1080/10640266.2022.2069315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This contribution reports on the results of an uncontrolled longitudinal study investigating the effects of a Multi-Family Therapy (MFT) as treatment for adolescent Anorexia Nervosa (AN) and the role played by perceived family functioning in these effects. 150 patients (144 females) and their families took part in an MFT and were assessed at the beginning, middle, end of the therapy, as well as 6 and 12 months after the end of therapy. BMI, eating disorders symptomatology (EDI-II) and perceived family functioning (FAD) all improved over the time of MFT, and these benefits remained at both times of follow-up. Ultimately, we found that the improvement of some dimensions of family functioning (i.e., roles, communication, and general family functioning) mediated the improvement of several dimensions of symptomatology (i.e., ineffectiveness, impulsivity, social insecurity, interpersonal distrust). These observations provide further support for MFT as useful for improving mental health, weight restoration, and perceived family functioning of adolescents with AN.
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Affiliation(s)
- Julie Terache
- Department of Psychology, Center for Social and Cultural Psychology, Université libre de Bruxelles, Brussels, Belgium
| | - Robin Wollast
- Department of Psychology, Stanford University, Stanford, California, United States
| | - Yves Simon
- Laboratory of Medical Psychology, Department of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Medhi Marot
- Department of Psychology, Laboratoire de Psychologie Sociale et Cognitive, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Van der Linden
- Department of Psychology, Center for Social and Cultural Psychology, Université libre de Bruxelles, Brussels, Belgium
| | - Aurélie Franzen
- Department of Psychology, Center for Social and Cultural Psychology, Université libre de Bruxelles, Brussels, Belgium
| | - Olivier Klein
- Department of Psychology, Center for Social and Cultural Psychology, Université libre de Bruxelles, Brussels, Belgium
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Claudat K, Reilly EE, Convertino AD, Trim J, Cusack A, Kaye WH. Integrating evidence-based PTSD treatment into intensive eating disorders treatment: a preliminary investigation. Eat Weight Disord 2022; 27:3599-3607. [PMID: 36401788 PMCID: PMC9803734 DOI: 10.1007/s40519-022-01500-9] [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: 07/17/2022] [Accepted: 10/19/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Given data suggesting common co-occurrence and worse outcomes for individuals with eating disorders (EDs) and post-traumatic stress disorder (PTSD), it is critical to identify integrated treatment approaches for this group of patients. Past work has explored the feasibility and initial efficacy of intervention approaches that draw on evidence-based treatments for both EDs and PTSD; however, this work remains limited in scope. In the current study, we explored the feasibility and naturalistic outcomes of PTSD treatment delivered within the context of intensive ED treatment. METHOD Participants were 57 adult men and women with DSM-5 EDs and comorbid PTSD who completed a course of either Prolonged Exposure (PE; n = 22) or Cognitive Processing Therapy (CPT; n = 35) (Msessions = 10.40; SD = 5.13) and weekly validated measurements of clinical symptoms while enrolled in ED programming. RESULTS Multi-level models for PTSD symptoms indicated a significant linear effect of time, such that participants demonstrated significant decreases over time in PTSD symptoms, regardless of treatment modality. CONCLUSION Our preliminary investigation provides support for the feasibility and efficacy of an integrated approach to treating EDs and PTSD. It is critical for future work to undertake randomized tests of this integrated approach using large, heterogeneous samples. LEVEL OF EVIDENCE Level IV, multiple time series with intervention.
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Affiliation(s)
- Kimberly Claudat
- Department of Psychiatry, University of California, San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA.
| | - Erin E Reilly
- Department of Psychiatry, University of California, San Francisco, USA
| | - Alexandra D Convertino
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Julie Trim
- Department of Psychiatry, University of California, San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA
| | - Anne Cusack
- Department of Psychiatry, University of California, San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, 4510 Executive Drive, Suite 315, San Diego, CA, 92121, USA
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Kaa BS, Bünemann JMN, Clausen L. A benchmark study of a combined individual and group anorexia nervosa therapy program. Nord J Psychiatry 2022:1-8. [PMID: 36398931 DOI: 10.1080/08039488.2022.2143558] [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: 11/19/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a treatment-resistant illness. Up to half of the patients show limited or no significant treatment response. First, we aimed to describe a new stepped-care outpatient treatment combining group and individual therapy (CIGAN) with a strong focus on normalizing eating and weight and in vivo meal support for adults with moderate to severe AN. Second, we aimed to compare CIGAN with specialized treatments of Specialized Supportive Clinical Management (SSCM) and the Maudsley model of AN (MANTRA). METHOD The study includes 137 adults with moderate to severe AN and the primary outcome (BMI) at six and twelve months was compared with the outcomes published for SSCM and MANTRA using the Chi-squared test and Student's t-test. The paired t-test and Cohen's d were used to compare the within-group follow-up data with the baseline data. RESULTS CIGAN patients changed significantly on all outcome measures at 6 and 12 months, with effect sizes on BMI of 1.37 and 1.51 and on the weight of 1.36 and 1.60, respectively. Except for the 12-month comparison with MANTRA, patients had a higher BMI and larger BMI increase at both 6 and 12 months than SSCM (BMI p = 0.002 and 0.023, BMI increase p < 0.001 and 0.003) and MANTRA (BMI p = 0.031 and 0.168, BMI increase p < 0.001 and 0.037). DISCUSSION CIGAN, including a stepped care approach, is a promising treatment, and further research on the effective elements is warranted.
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Affiliation(s)
- Bo Skytte Kaa
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | | | - Loa Clausen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Leenaerts N, Jongen D, Ceccarini J, Van Oudenhove L, Vrieze E. The neurobiological reward system and binge eating: A critical systematic review of neuroimaging studies. Int J Eat Disord 2022; 55:1421-1458. [PMID: 35841198 DOI: 10.1002/eat.23776] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Changes in reward processing are hypothesized to play a role in the onset and maintenance of binge eating (BE). However, despite an increasing number of studies investigating the neurobiological reward system in individuals who binge eat, no comprehensive systematic review exists on this topic. Therefore, this review has the following objectives: (1) identify structural and functional changes in the brain reward system, either during rest or while performing a task; and (2) formulate directions for future research. METHODS A search was conducted of articles published until March 31, 2022. Neuroimaging studies were eligible if they wanted to study the reward system and included a group of individuals who binge eat together with a comparator group. Their results were summarized in a narrative synthesis. RESULTS A total of 58 articles were included. At rest, individuals who binge eat displayed a lower striatal dopamine release, a change in the volume of the striatum, frontal cortex, and insula, as well as a lower frontostriatal connectivity. While performing a task, there was a higher activity of the brain reward system when anticipating or receiving food, more model-free reinforcement learning, and more habitual behavior. Most studies only included one patient group, used general reward-related measures, and did not evaluate the impact of comorbidities, illness duration, race, or sex. DISCUSSION Confirming previous hypotheses, this review finds structural and functional changes in the neurobiological reward system in BE. Future studies should compare disorders, use measures that are specific to BE, and investigate the impact of confounding factors. PUBLIC SIGNIFICANCE STATEMENT This systematic review finds that individuals who binge eat display structural and functional changes in the brain reward system. These changes could be related to a higher sensitivity to food, relying more on previous experiences when making decisions, and more habitual behavior. Future studies should use a task that is specific to binge eating, look across different patient groups, and investigate the impact of comorbidities, illness duration, race, and sex.
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Affiliation(s)
- Nicolas Leenaerts
- Mind-body Research, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Daniëlle Jongen
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Jenny Ceccarini
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.,Cognitive & Affective Neuroscience Laboratory, Department of Psychological & Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Elske Vrieze
- Mind-body Research, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
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Naess CR, Kolnes LJ. A preliminary exploration of experiences of integrating the body in the self in two women with anorexia nervosa in view of phenomenological conceptualisations. J Eat Disord 2022; 10:153. [PMID: 36320024 PMCID: PMC9628077 DOI: 10.1186/s40337-022-00675-x] [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: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND People with anorexia nervosa often present with confusions around bodily sensations and difficulties in experiencing their body as a place of their own. Many existing models understand anorexia nervosa as a disorder of behaviour and thoughts about eating and body size, and treatments typically focus on modifying thoughts and psychological processes. They leave aside the subject as she experiences the body from a first-person perspective. Inspired by phenomenology and the embodied mind thesis, this explorative study examines in depth the experiences of individuals with anorexia nervosa as they engage in Norwegian psychomotor physiotherapy. Through release of bodily tension and restricted breathing, this method aims to help subjects tune into the body and accept that difficult experiences, relationships and feelings are also bodily. METHODS Qualitative in-depth interviews were conducted with two women who had been attending Norwegian psychomotor physiotherapy for more than two years. Thematic analysis was used to identify, analyse and interpret themes within the data. RESULTS Three main overarching themes that structure the subjects' experiences were identified: the meaning of the therapeutic relationship, changes in bodily connectedness and ways of moving, and improved ability to articulate and reflect on feelings. CONCLUSION The subjects described a greater tendency to experience the body in the self and as a place of their own, a more flexible and vital body, and an increased capacity to identify, express and make sense of feelings. These changes enriched their interactions with the social world. Feeling acknowledged and accepted by the therapist throughout the process was essential. The study illustrates how difficult experiences, thoughts and feelings can, over time, manifest in the body as withheld breathing and diverse bodily constraints affecting both self- and body awareness. The study endorses the phenomenological concepts that our experiences of the self and the world are essentially bodily, and emphasizes the importance of the first-person perspective when investigating the contribution of the body to the self and to our interactions with the social world. Physio- and body awareness therapies that help patients relate to, understand and integrate bodily experiences may complement other treatment approaches and help patients with anorexia proceed with the recovery process. Having anorexia nervosa involve changes in the way one experiences the body. The condition has been linked to confusions around bodily sensations and reduced experience of the body as an integrated place of their own. The purpose of this study was to gain a richer understanding of bodily experiences in subjects with anorexia nervosa having attended a specialized physiotherapy approach. In depth interviews were conducted with two women who had anorexia nervosa and who had engaged in Norwegian Psychomotor Physiotherapy for more than two years. Three themes that structure the subjects' experiences were identified: the meaning of the therapeutic relationship, changes in bodily connectedness and ways of moving, and improved ability to articulate and reflect on feelings. The subjects described a greater tendency to experience the body in the self and as a place of their own, a more flexible and vital body, and an increased capacity to identify, express and make sense of feelings. Feeling acknowledged and accepted by the therapist throughout the process was essential. The study illustrates how difficult experiences, thoughts and feelings can manifest in the body as withheld breathing and diverse bodily constraints affecting both self- and body awareness in people with anorexia nervosa.
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Shaker NM, Azzam LA, Zahran RM, Hashem RE. Frequency of binge eating behavior in patients with borderline personality disorder and its relation to emotional regulation and impulsivity. Eat Weight Disord 2022; 27:2497-2506. [PMID: 35301691 DOI: 10.1007/s40519-022-01358-x] [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: 08/10/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Eating disorders are common among patients with borderline personality disorder (BPD), contributing to their lack of treatment response and bad prognosis. In this context, it is helpful to examine the relevance of eating behavior and to understand whether borderline traits are higher in those individuals. In this study, a sample of patients with BPD screened to determine the frequency of binge eating (BE) behaviors and its relation to impulsivity and emotional dysregulation. METHOD Seventy participants aged 25.81 ± 6.34 years were recruited from Okasha Institute of psychiatry, Cairo, Egypt. Diagnosed by the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), assessed for impulsivity, emotion regulation using the Barratt Impulsiveness Scale and the Trait Meta Mood Scale (TMMS), respectively, and screened for BE behaviors by Binge Eating Scale. RESULTS All of the participants had medium emotional regulation propensity 82.63 ± 10.81 and showed variable degrees of impulsivity, mainly moderate 42 (60%). More than half of the participants had BE behavior 37 (~ 53%), with a significant negative correlation with clarity of feeling, total score of TMMS, and age. Similarly, on comparing the participant with binging versus no binging group, a significant relation between BE behavior, fear of abandonment (p value 0.02), clarity of feeling, and total score of TMMS was found. However, no significant relation between BE behavior & impulsivity demonstrated. CONCLUSION A substantial number of patients with BPD suffering from BE, showing relation between binging, emotion dysregulation, and fear of abandonment. LEVEL OF EVIDENCE III, evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Nermin Mahmoud Shaker
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Lobna AbuBakr Azzam
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Randa Mohamad Zahran
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Reem Elsayed Hashem
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt.
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Rose KL, Negrete CE, Sellinger G, Chang T, Sonneville KR. Adolescent and emerging adult perceptions of eating disorder severity and stigma. Int J Eat Disord 2022; 55:1296-1304. [PMID: 35866318 DOI: 10.1002/eat.23772] [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: 09/27/2021] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Eating disorders are one of the deadliest mental health conditions, yet most individuals with eating disorders never receive treatment. Previous research has explored barriers to treatment among individuals diagnosed with eating disorders, but little is known about general adolescent and emerging adult perceptions of eating disorders, as compared to other mental health illnesses, a population at greatest risk for developing an eating disorder, and a population that may be important sources of information or support for peers. METHOD A sample of adolescents and emerging adults aged 14-24 years (mean age 19 years) from MyVoice, a national text-message-based cohort (53% female, 38% male, 9% other, race/ethnicity 63% White, 10% Black or African American, 13% Asian, 9% Mixed Race, and 5% Other) provided open-ended responses to questions on the severity of eating disorders as compared to other mental health diagnoses, others' perceptions of eating disorders and potential treatment barriers. Responses were collected using a secure online platform and analyzed using content analysis. RESULTS Among respondents (n = 792/1283), 91% felt that eating disorders were a mental health condition and 65% felt that eating disorders were as serious as other mental health conditions, while 21% said they were more serious than other mental health conditions. Responses to questions related to perception and barriers illustrated that beliefs of eating disorders involve blame, stigma, and overall lack of understanding. DISCUSSION Findings from this study illustrate that there is a lack of understanding around eating disorders that could be addressed in youth-focused initiatives. PUBLIC SIGNIFICANCE Adolescents and emerging adults understand that eating disorders are severe mental illnesses that are not taken seriously by others, especially in comparison with other mental health diagnoses. Adolescents and emerging adults report that individuals with eating disorders are blamed for their condition and face shame and stigma. The lack of understanding around eating disorders should be addressed in youth-focused prevention initiatives.
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Affiliation(s)
- Kelsey L Rose
- Department of Adolescent Health, Department of Primary Care, Michigan Medicine
| | | | | | - Tammy Chang
- Department of Family Medicine, Michigan Medicine, Institute for Healthcare Policy and Innovation, University of Michigan
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Koppenburg C, Saxer F, Vach W, Lüchtenberg D, Goesele A. Eating disorder risks and awareness among female elite cyclists: an anonymous survey. BMC Sports Sci Med Rehabil 2022; 14:172. [PMID: 36151580 PMCID: PMC9502946 DOI: 10.1186/s13102-022-00563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022]
Abstract
Background Eating disorders (EDs) are an increasingly recognized concern in professional sports. Previous studies suggests that both female gender and endurance sports put athletes at risk. Female elite cyclists are hence of specific interest. The present study aimed at evaluating the distribution of the individual risk of ED in this group. Further the association between individual risk and both the awareness for the topic ED and the deviation from “normal” weight was depicted. Methods Female cyclists registered with the Union Cycliste Internationale were contacted via email or facebook and asked to complete a survey comprising age, weight, the Eating-Attitude-Test (EAT-26), and questions regarding ED awareness. The observed distribution of the EAT-26 score was compared to results from previous studies in normal subjects and athletes. The distribution of the ED awareness was described and ED awareness was correlated with the EAT-26 score. Both the deviation from ideal weight and the body mass index (BMI) were correlated with the EAT-26 score. Results Of the 409 registered athletes 386 could be contacted, 122 completed the questionnaire. Age ranged from 20-44yrs, BMI from 17.0 to 24.6 kg/m2. In the EAT-26, 39 cyclists (32.0%) scored above 20 points indicating a potential benefit from clinical evaluation, 34 cyclists (27.9%) scored 10–19 points suggesting disordered eating. Sixteen athletes (13.2%) had been treated for an ED. About 70% of athletes had been pressured to lose weight. The mean EAT-26 score was above the average observed in normal female populations. It was also above the average observed in many female athlete populations, but lower than in other leanness focussed sports. More than 80%of athletes perceived elite cyclists at risk for developing ED. Increased ED awareness and deviation from the ideal weight were associated with higher EAT-26 scores, but not the body mass index. Conclusion Female cyclists are at risk of developing ED and they are aware of this risk. To improve their health and well-being, increased efforts to support elite cyclists and their teams in preventive activities and early detection are crucial. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00563-6.
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Affiliation(s)
- C Koppenburg
- Department of Sport Sciences, University of Konstanz, Postfach 30, D-78457, Konstanz, Germany.,Crossklinik Basel, Bundesstr. 1, CH-4054, Basel, Switzerland
| | - F Saxer
- Basel Academy for Quality and Research in Medicine, Steinenring 6, CH- 4051, Basel, Switzerland.,University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland.,Novartis Institutes for Biomedical Research, Novartis Campus, CH-4051, Basel, Switzerland
| | - W Vach
- Basel Academy for Quality and Research in Medicine, Steinenring 6, CH- 4051, Basel, Switzerland.
| | - D Lüchtenberg
- Department of Sport Sciences, University of Konstanz, Postfach 30, D-78457, Konstanz, Germany
| | - A Goesele
- Crossklinik Basel, Bundesstr. 1, CH-4054, Basel, Switzerland.,University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland
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Lozano-Muñoz N, Borrallo-Riego Á, Guerra-Martín MD. [Impact of social network use on anorexia and bulimia in female adolescents: a systematic review]. An Sist Sanit Navar 2022; 45:e1009. [PMID: 35972299 PMCID: PMC10130796 DOI: 10.23938/assn.1009] [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: 11/11/2021] [Revised: 12/10/2021] [Accepted: 01/14/2022] [Indexed: 11/18/2022]
Abstract
Systematic review of published studies on the impact of social networks (SN) use on anorexia and bulimia in female adolescents. We selected articles published over the past 10 years, written in English, Spanish or Portu-guese found in The Cochrane Library Plus, PubMed, WOS, PsycINFO, and Scopus databases and with enough methodological quality. Nine studies were included in this review with a sample of 2,069 adolescents; 75.3% were female, mean age was 18 years, and mostly used Facebook and Instagram. Despite some positive aspects, SNs promote beauty standards in terms of thinness, allow comparisons between peers increasing concerns about weight, and create spaces that encourage anorexia and bulimia. Therefore, SN use plays a role in the development of eating disorders. The promotion of extreme thinness in girls makes this population more vulnerable.
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Affiliation(s)
- N Lozano-Muñoz
- Área de Salud de Cáceres. Servicio Extremeño de Salud. Cáceres. España..
| | - Á Borrallo-Riego
- Departamento de Enfermería. Universidad de Sevilla. Sevilla. España..
| | - M D Guerra-Martín
- Departamento de Enfermería. Universidad de Sevilla. Sevilla. España..
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Phonological working memory is adversely affected in adults with anorexia nervosa: a systematic literature review. Eat Weight Disord 2022; 27:1931-1952. [PMID: 35133643 PMCID: PMC9287223 DOI: 10.1007/s40519-022-01370-1] [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: 10/29/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Cognitive restraint has potentiating and deleterious effects on working memory (WM) in anorexia nervosa (AN). Conflicting evidence may be due to heterogeneity of tasks examining different WM components (e.g., verbal/auditory versus visuospatial), and differences in adolescent versus adult AN. Additionally, differential cognitive profiles of restricting versus binge/purging subtypes, comorbid psychiatric disorders and psychotropic medication use may confound findings. METHODS To address these conflicts, 25 studies, published between 2016 and 2021, investigating WM in children, adolescents and adults with AN were systematically reviewed using PRISMA guidelines. RESULTS In 71% of WM tasks, no difference in performance between AN patients and age-matched controls was reported, while 29% of WM tasks showed worse performance. Adults with AN displayed deficits in 44% of the verbal/auditory tasks, while performance remained unaffected in 86% of visuospatial tasks. CONCLUSION Examining age groups and WM subsystems separately revealed novel findings of differentially affected WM components in AN. Comorbidities and psychotropic medications were common among AN participants and should be regarded as critical confounding factors for WM measures. Future studies examining different components of WM, acknowledging these confounding factors, may reveal specific deficits in AN to aid treatment improvement strategies. LEVEL OF EVIDENCE I, systematic review.
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Development, validation and clinical use of the Eating Behaviors Assessment for Obesity (EBA-O). Eat Weight Disord 2022; 27:2143-2154. [PMID: 35092002 PMCID: PMC8799412 DOI: 10.1007/s40519-022-01363-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/08/2022] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Obesity is a major health problem with an increasing risk of mortality, associated with comorbidities and high rates of dropout. Research demonstrated that pathological eating behaviors could help to phenotype obese patients thus tailoring clinical interventions. Therefore, our aim was to develop (study 1), validate (study 2), and test in a clinical setting (study 3) the Eating Behaviors Assessment for Obesity (EBA-O). METHOD Study 1 included the exploratory factor analysis (EFA) and McDonald's ω in a general population sample (N = 471). Study 2 foresaw the confirmatory factor analysis (CFA) and convergent validity in 169 participants with obesity. Study 3 tested the capability of the EBA-O to characterize eating behaviors in a clinical sample of 74 patients with obesity. RESULTS Study 1. EFA identified five factors (i.e., food addiction, night eating, binge eating, sweet eating, and prandial hyperphagia), explaining 68.3% of the variance. The final EBA-O consisted of 18 items. McDonald's ω ranged between 0.80 (hyperphagia) and 0.92 (binge eating), indicating very good reliability. STUDY 2 A second-order five-factor model, through CFA, showed adequate fit: relative chi-square (χ2/df) = 1.95, CFI = 0.93, TLI = 0.92, RMSEA = 0.075, and SRMR = 0.06, thus suggesting the appropriateness of the EBA-O model. Significant correlations with psychopathological questionnaires demonstrated the convergent validity. Study 3. Significant associations between EBA-O factors and emotional-related eating behaviors emerged. CONCLUSION The EBA-O demonstrated to be a reliable and easy-to-use clinical tool to identify pathological eating behaviors in obesity, particularly useful for non-experts in eating disorders. LEVEL OF EVIDENCE Level V, descriptive research.
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Rohrbach PJ, Dingemans AE, van Furth EF, Spinhoven P, van Ginkel JR, Bauer S, van den Akker‐Van Marle ME. Cost-effectiveness of three internet-based interventions for eating disorders: A randomized controlled trial. Int J Eat Disord 2022; 55:1143-1155. [PMID: 35748112 PMCID: PMC9546196 DOI: 10.1002/eat.23763] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The primary aim was assessing the cost-effectiveness of an internet-based self-help program, expert-patient support, and the combination of both compared to a care-as-usual condition. METHOD An economic evaluation from a societal perspective was conducted alongside a randomized controlled trial. Participants aged 16 or older with at least mild eating disorder symptoms were randomly assigned to four conditions: (1) Featback, an online unguided self-help program, (2) chat or e-mail support from a recovered expert patient, (3) Featback with expert-patient support, and (4) care-as-usual. After a baseline assessment and intervention period of 8 weeks, five online assessments were conducted over 12 months of follow-up. The main result constituted cost-utility acceptability curves with quality-of-life adjusted life years (QALYs) and societal costs over the entire study duration. RESULTS No significant differences between the conditions were found regarding QALYs, health care costs and societal costs. Nonsignificant differences in QALYs were in favor of the Featback conditions and the lowest societal costs per participant were observed in the Featback only condition (€16,741) while the highest costs were seen in the care-as-usual condition (€28,479). The Featback only condition had the highest probability of being efficient compared to the alternatives for all acceptable willingness-to-pay values. DISCUSSION Featback, an internet-based unguided self-help intervention, was likely to be efficient compared to Featback with guidance from an expert patient, guidance alone and a care-as-usual condition. Results suggest that scalable interventions such as Featback may reduce health care costs and help individuals with eating disorders that are currently not reached by other forms of treatment. PUBLIC SIGNIFICANCE STATEMENT Internet-based interventions for eating disorders might reach individuals in society who currently do not receive appropriate treatment at low costs. Featback, an online automated self-help program for eating disorders, was found to improve quality of life slightly while reducing costs for society, compared to a do-nothing approach. Consequently, implementing internet-based interventions such as Featback likely benefits both individuals suffering from an eating disorder and society as a whole.
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Affiliation(s)
- Pieter J. Rohrbach
- GGZ Rivierduinen Eetstoornissen UrsulaLeidenNetherlands,Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
| | | | - Eric F. van Furth
- GGZ Rivierduinen Eetstoornissen UrsulaLeidenNetherlands,Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
| | - Philip Spinhoven
- Department of PsychiatryLeiden University Medical CenterLeidenNetherlands,Institute of PsychologyLeiden UniversityLeidenNetherlands
| | | | - Stephanie Bauer
- Center for Psychotherapy ResearchUniversity of HeidelbergHeidelbergGermany
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Bryant E, Spielman K, Le A, Marks P, Touyz S, Maguire S, Brennan L, Bryant E, Byrne S, Caldwell B, Calvert S, Carroll B, Castle D, Caterson I, Chelius B, Chiem L, Clarke S, Conti J, Crouch L, Dammery G, Dzajkovski N, Fardouly J, Feneley J, Foroughi N, Fuller-Tyszkiewicz M, Fursland A, Gonzalez-Arce V, Gouldthorp B, Griffin K, Griffiths S, Hambleton A, Hannigan A, Hart M, Hart S, Hay P, Hickie I, Kay-Lambkin F, King R, Kohn M, Koreshe E, Krug I, Le A, Linardon J, Long R, Long A, Madden S, Maguire S, Maloney D, Marks P, McLean S, Meddick T, Miskovic-Wheatley J, Mitchison D, O’Kearney R, Paterson R, Paxton S, Pehlivan M, Pepin G, Phillipou A, Piccone J, Pinkus R, Raykos B, Rhodes P, Rieger E, Rodan S, Rockett K, Russell J, Russell H, Salter F, Sawyer S, Shelton B, Singh U, Smith S, Smith E, Spielman K, Squire S, Thomson J, Tiggemann M, Touyz S, Utpala R, Vartanian L, Wallis A, Ward W, Wells S, Wertheim E, Wilksch S, Williams M, Touyz S, Maguire S. Screening, assessment and diagnosis in the eating disorders: findings from a rapid review. J Eat Disord 2022; 10:78. [PMID: 35672777 PMCID: PMC9175461 DOI: 10.1186/s40337-022-00597-8] [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: 03/15/2022] [Accepted: 05/21/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems. METHODS This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, 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 mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review. RESULTS Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males. CONCLUSIONS A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many. Limited screening in healthcare settings and low rates of eating disorder training in the healthcare professions are just some of the barriers to help-seeking which may contribute to delayed intervention and diagnosis in the eating disorders. This has significant impacts, prolonging treatment when it is finally received, and increasing healthcare costs for both the individual and the healthcare system. The current review is part of a larger Rapid Review series conducted to inform the development of Australia's National Eating Disorders Research and Translation Strategy 2021-2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe, often to guide policy-making and address urgent health concerns. The Rapid Review synthesises the current evidence-base and identifies gaps in eating disorder research and care, in order to guide decision making and address urgent health concerns. This paper gives a critical overview of the scientific literature relating to the current state of screening, assessment, and diagnosis of eating disorders within Western healthcare systems that may inform health policy and research in an Australian context. It covers screening initiatives in both general and high-risk populations; personal, clinician and healthcare system challenges relating to help-seeking; and obstacles to accurate and timely clinical diagnosis across the eating disorders.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Karen Spielman
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, New South Wales Health, Sydney, Australia
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Kilshaw RE, Adamo C, Butner JE, Deboeck PR, Shi Q, Bulik CM, Flatt RE, Thornton LM, Argue S, Tregarthen J, Baucom BRW. Passive Sensor Data for Characterizing States of Increased Risk for Eating Disorder Behaviors in the Digital Phenotyping Arm of the Binge Eating Genetics Initiative: Protocol for an Observational Study. JMIR Res Protoc 2022; 11:e38294. [PMID: 35653175 PMCID: PMC9204566 DOI: 10.2196/38294] [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: 03/29/2022] [Revised: 04/10/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data that can be easily, efficiently, and safely collected via cell phones and other digital devices have great potential for clinical application. Here, we focus on how these data could be used to refine and augment intervention strategies for binge eating disorder (BED) and bulimia nervosa (BN), conditions that lack highly efficacious, enduring, and accessible treatments. These data are easy to collect digitally but are highly complex and present unique methodological challenges that invite innovative solutions. OBJECTIVE We describe the digital phenotyping component of the Binge Eating Genetics Initiative, which uses personal digital device data to capture dynamic patterns of risk for binge and purge episodes. Characteristic data signatures will ultimately be used to develop personalized models of eating disorder pathologies and just-in-time interventions to reduce risk for related behaviors. Here, we focus on the methods used to prepare the data for analysis and discuss how these approaches can be generalized beyond the current application. METHODS The University of North Carolina Biomedical Institutional Review Board approved all study procedures. Participants who met diagnostic criteria for BED or BN provided real time assessments of eating behaviors and feelings through the Recovery Record app delivered on iPhones and the Apple Watches. Continuous passive measures of physiological activation (heart rate) and physical activity (step count) were collected from Apple Watches over 30 days. Data were cleaned to account for user and device recording errors, including duplicate entries and unreliable heart rate and step values. Across participants, the proportion of data points removed during cleaning ranged from <0.1% to 2.4%, depending on the data source. To prepare the data for multivariate time series analysis, we used a novel data handling approach to address variable measurement frequency across data sources and devices. This involved mapping heart rate, step count, feeling ratings, and eating disorder behaviors onto simultaneous minute-level time series that will enable the characterization of individual- and group-level regulatory dynamics preceding and following binge and purge episodes. RESULTS Data collection and cleaning are complete. Between August 2017 and May 2021, 1019 participants provided an average of 25 days of data yielding 3,419,937 heart rate values, 1,635,993 step counts, 8274 binge or purge events, and 85,200 feeling observations. Analysis will begin in spring 2022. CONCLUSIONS We provide a detailed description of the methods used to collect, clean, and prepare personal digital device data from one component of a large, longitudinal eating disorder study. The results will identify digital signatures of increased risk for binge and purge events, which may ultimately be used to create digital interventions for BED and BN. Our goal is to contribute to increased transparency in the handling and analysis of personal digital device data. TRIAL REGISTRATION ClinicalTrials.gov NCT04162574; https://clinicaltrials.gov/ct2/show/NCT04162574. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38294.
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Affiliation(s)
- Robyn E Kilshaw
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Colin Adamo
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Jonathan E Butner
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Pascal R Deboeck
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Qinxin Shi
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rachael E Flatt
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stuart Argue
- Recovery Record, San Francisco, CA, United States
| | | | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
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Walker DC, Murray K. A Pilot Clinical Case Series of Functionality-Focused Mirror Exposure in Women With Clinically Elevated Body Dissatisfaction. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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