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Guala MM, Bikic A, Bul K, Clinton D, Mejdal A, Nielsen HN, Stenager E, Søgaard Nielsen A. "Maze Out": a study protocol for a randomised controlled trial using a mix methods approach exploring the potential and examining the effectiveness of a serious game in the treatment of eating disorders. J Eat Disord 2024; 12:35. [PMID: 38429839 PMCID: PMC10908122 DOI: 10.1186/s40337-024-00985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Eating Disorders (ED) are severe and costly mental health disorders. The effects of existing treatment approaches are limited and there is a need to develop novel interventions, including digital strategies that can increase engagement and effectiveness. Maze Out is a new serious game coproduced by patients and ED therapists, which allows patients to "play" with the reality of an ED and reflect on associated challenges. OBJECTIVES The present study has two main objectives: (1) to evaluate the effectiveness of adding Maze Out to treatment as usual (TAU) in a randomised controlled trial (RCT); and (2) to examine in depth the potential of Maze Out by examining how it is perceived and used in the context of an RCT. METHODS Participants will be recruited from mental health care services, endocrinology departments or Community Centres offering treatment for ED. Patients suffering from ED (N = 94) will be randomised to either TAU or TAU plus Maze Out. Primary outcome will be measured in terms of changes in self-efficacy, measured by a 5-item self-efficacy questionnaire (5-item SE_ED). Secondary outcome measures will include feelings of ineffectiveness and self-image, as measured by Eating Disorder Inventory, version 3 (EDI-3), Brief INSPIRE-O and Structural Analysis of Social Behaviour Intrex Questionnaire (SAS-B). Data will be collected at baseline (enrolment in the study), and subsequently 8 and 15 weeks after inclusion. Experiences of playing Maze Out will be examined in a sub-sample of participants, utilising both quantitative user analytics and qualitative interview data of patients, interview data of significant others, and healthcare professionals to explore the possible impact of Maze Out on disorder insight, communication patterns between patients and therapists and understanding of their disorder. DISCUSSION To our knowledge Maze Out is the first serious game coproduced by patients and therapists. It is a novel and theoretically grounded intervention that may significantly contribute to the healing process of ED. If found effective, the potential for wide-spread impact and scalability is considerable. Trial registration ClinicalTrials.gov NCT05621018.
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Affiliation(s)
- Maria Mercedes Guala
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark.
| | - Aida Bikic
- Department of Regional Health Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Services Southern Jutland, Region of Southern Denmark, Aabenraa, Denmark
| | - Kim Bul
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - David Clinton
- Department of Medical Epidemiology and Biostatistics (MEB), Centre for Eating Disorders Innovation (CEDI), Karolinska Institute, Stockholm, Sweden
| | - Anna Mejdal
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Helene Nygaard Nielsen
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
| | - Elsebeth Stenager
- Department of Regional Health Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
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Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:175. [PMID: 37794513 PMCID: PMC10548609 DOI: 10.1186/s40337-023-00886-w] [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: 02/26/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development. METHODS The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper. RESULTS 281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence. CONCLUSIONS Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.
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Affiliation(s)
- Haley Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
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Ibáñez-Caparrós A, Sánchez I, Granero R, Jiménez-Murcia S, Rosinska M, Thiel A, Zipfel S, de Pablo J, Camacho-Barcia L, Fernandez-Aranda F. Athletes with Eating Disorders: Analysis of Their Clinical Characteristics, Psychopathology and Response to Treatment. Nutrients 2023; 15:3003. [PMID: 37447333 DOI: 10.3390/nu15133003] [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: 06/08/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Eating disorders (ED) have frequently been described among athletes. However, their specific features and therapy responses are lacking in the literature. The aims of this article were to compare clinical, psychopathological and personality traits between ED patients who were professional athletes (ED-A) with those who were not (ED-NA) and to explore differences in response to treatment. The sample comprised n = 104 patients with ED (n = 52 ED-A and n = 52 matched ED-NA) diagnosed according to DSM-5 criteria. Evaluation consisted of a semi-structured face-to-face clinical interview conducted by expert clinicians and a psychometric battery. Treatment outcome was evaluated when the treatment program ended. ED-A patients showed less body dissatisfaction and psychological distress. No differences were found in treatment outcome among the groups. Within the ED-A group, those participants who performed individual sport activities and aesthetic sports presented higher eating psychopathology, more general psychopathology, differential personality traits and poor therapy outcome. Individual and aesthetic sports presented more severity and worse prognosis. Although usual treatment for ED might be similarly effective in ED-A and ED-NA, it might be important to develop preventive and early detection programs involving sports physicians and psychologists, coaches and family throughout the entire athletic career and afterwards.
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Affiliation(s)
- Ana Ibáñez-Caparrós
- Department of Psychiatry, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- Institut Recerca Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
- Department of Psychiatrics and Legal Medicine, School of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Isabel Sánchez
- Clinical Psychology Unit, Bellvitge University Hospital, 08907 Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Roser Granero
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Susana Jiménez-Murcia
- Clinical Psychology Unit, Bellvitge University Hospital, 08907 Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
| | - Magda Rosinska
- Body Image Assessment and Intervention Unit, Department of Clinical Psychology and Health, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Ansgar Thiel
- Interfaculty Research Institute for Sport and Physical Activity, University of Tübingen, 72074 Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine, University of Tübingen, 72074 Tübingen, Germany
- Centre of Excellence for Eating Disorders (KOMET), University of Tübingen, 72076 Tübingen, Germany
- German Centre of Mental Health (DZPG), University of Tübingen, 72076 Tübingen, Germany
| | - Joan de Pablo
- Department of Psychiatry, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- Institut Recerca Germans Trias i Pujol (IGTP), 08916 Badalona, Spain
- Department of Psychiatrics and Legal Medicine, School of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Lucia Camacho-Barcia
- Clinical Psychology Unit, Bellvitge University Hospital, 08907 Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Fernando Fernandez-Aranda
- Clinical Psychology Unit, Bellvitge University Hospital, 08907 Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
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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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5
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Munguía L, Lucas I, Jiménez-Murcia S, Mora-Maltas B, Granero R, Miranda-Olivos R, Sánchez I, Testa G, Lozano-Madrid M, Turton R, Menchon JM, Fernández-Aranda F. Executive functions in binge spectrum eating disorders with comorbid compulsive buying. EUROPEAN EATING DISORDERS REVIEW 2021; 29:854-867. [PMID: 34322952 DOI: 10.1002/erv.2855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/09/2021] [Accepted: 07/17/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aims were to explore if bulimic spectrum disorders (BSD) patients, who also present comorbid compulsive buying (CB), could represent a specific subtype considering its neuropsychological performance; to present a descriptive analysis of different clinical features; and to explore how these variables could influence treatment outcome. It was hypothesised that the comorbid group will present worse neuropsychological performance that will lead to a worse treatment outcome. METHOD The study has a longitudinal design. Women (N = 75) diagnosed with BSD, BSD + CB and Healthy Controls (HC); completed an evaluation of: cognitive flexibility, decision making, eating disorder (ED) symptomatology, psychopathological state and personality traits. RESULTS BSD + CB was the group with the most severe clinical profile, worst treatment outcome and higher neuropsychological impairment, than other groups. Path-analysis evidenced that deficits in decision making were associated with bad treatment outcome, while deficits in flexibility with the presence of the comorbidity. Self-directedness and novelty seeking were associated with the neuropsychological performance and the comorbidity. CONCLUSION BSD + CB exhibit a worse clinical and neuropsychological profile that seems to be related with the treatment outcome, which should be taken into account for the establishment of specific treatment approaches.
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Affiliation(s)
- Lucero Munguía
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Ignacio Lucas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Bernat Mora-Maltas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Roser Granero
- Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Romina Miranda-Olivos
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Giulia Testa
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - María Lozano-Madrid
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Robert Turton
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jose M Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Ciber Salud Mental (CIBERsam), Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
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Lifetime Weight Course as a Phenotypic Marker of Severity and Therapeutic Response in Patients with Eating Disorders. Nutrients 2021; 13:nu13062034. [PMID: 34199265 PMCID: PMC8231878 DOI: 10.3390/nu13062034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/05/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022] Open
Abstract
The association between lifetime weight fluctuations and clinical characteristics has been widely studied in populations with eating disorders (ED). However, there is a lack of literature examining the potential role of weight course as a transdiagnostic factor in ED so far. Therefore, the aim of this study is to compare ED severity and treatment outcomes among four specific BMI profiles based on BMI-trajectories across the lifespan: (a) persistent obesity (OB-OB; (n = 74)), (b) obesity in the past but currently in a normal weight range (OB-NW; n = 156), (c) normal weight throughout the lifespan (NW-NW; n = 756), and (d) current obesity but previously at normal weight (NW-OB; n = 314). Lifetime obesity is associated with greater general psychopathology and personality traits such as low persistence and self-directedness, and high reward dependence. Additionally, greater extreme weight changes (NW-OB and OB-NW) were associated with higher psychopathology but not with greater ED severity. Higher dropout rates were found in the OB-OB group. These results shed new light on the BMI trajectory as a transdiagnostic feature playing a pivotal role in the severity and treatment outcome in patients with ED.
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Fernández-Aranda F, Treasure J, Paslakis G, Agüera Z, Giménez M, Granero R, Sánchez I, Serrano-Troncoso E, Gorwood P, Herpertz-Dahlmann B, Bonin EM, Monteleone P, Jiménez-Murcia S. The impact of duration of illness on treatment nonresponse and drop-out: Exploring the relevance of enduring eating disorder concept. EUROPEAN EATING DISORDERS REVIEW 2021; 29:499-513. [PMID: 33599348 DOI: 10.1002/erv.2822] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE There are no generally accepted definitions or markers of treatment nonresponse in eating disorders (EDs). The aim of this paper was to examine how the duration of illness and other potential prognostic markers impacted on nonresponse and drop-out from treatment across different EDs subtypes. METHODS A total sample of 1199 consecutively treated patients with EDs, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, participated in this study. Kaplan-Meier curves were calculated for each ED diagnosis in which the probability of recovery was plotted against the duration of illness. RESULTS Full remission was more likely for people with binge eating disorder (BED; 47.4%) and anorexia nervosa (AN; 43.9%) compared to bulimia nervosa (BN; 25.2%) and other specified feeding and EDs (OSFED; 23.2%). The cut-off points for the duration of the illness related with high likelihoods of poor response was 6-8 years among OSFED, 12-14 years among AN and BN and 20-21 years among BED. Other variables predicting nonresponse included dysfunctional personality traits. CONCLUSIONS Nonresponse to treatment is associated with duration of illness which is in turn associated with poor response to previous treatment. However, there was no evidence for staging the illness using specific duration of illness criteria. Nevertheless, the shorter temporal trajectory for OSFED suggests that early interventions may be of importance for this group.
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Affiliation(s)
- Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Georgios Paslakis
- Medical Faculty, University Clinic for Psychosomatic Medicine and Psychotherapy, Campus East-Westphalia, Ruhr-University of Bochum, Luebbecke, Germany
| | - Zaida Agüera
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Mónica Giménez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Eduardo Serrano-Troncoso
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu and Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Philip Gorwood
- CMME, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM, U1266, Paris, France
| | - Beate Herpertz-Dahlmann
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen, Aachen, Germany
| | - Eva-Maria Bonin
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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8
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Hilbert A, Petroff D, Herpertz S, Pietrowsky R, Tuschen-Caffier B, Vocks S, Schmidt R. Meta-analysis on the long-term effectiveness of psychological and medical treatments for binge-eating disorder. Int J Eat Disord 2020; 53:1353-1376. [PMID: 32583527 DOI: 10.1002/eat.23297] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Long-term effectiveness is a critical aspect of the clinical utility of a treatment; however, a meta-analytic evaluation of psychological and medical treatments for binge-eating disorder (BED), including weight loss treatments, is outstanding. This meta-analysis sought to provide a comprehensive evaluation of the long-term effectiveness in diverse treatments for BED regarding a range of clinically relevant outcomes. METHOD Based on a systematic search up to February 2018, 114 published and unpublished randomized-controlled (RCTs), nonrandomized, and uncontrolled treatment studies, totaling 8,862 individuals with BED (DSM-IV, DSM-5), were identified and analyzed using within-group random-effect modeling. RESULTS Effectiveness (regarding binge-eating episodes and abstinence, eating disorder and general psychopathology) up to 12 months following treatment was demonstrated for psychotherapy, structured self-help treatment, and combined treatment, while the results regarding body weight reduction were inconsistent. These results were confirmed in sensitivity analyses with RCTs on the most common treatments-cognitive-behavioral therapy and self-help treatment based on this approach. Follow-up intervals longer than 12 months were rarely reported, mostly supporting the long-term effectiveness of psychotherapy. Few follow-up data were available for pharmacotherapy, and behavioral and self-help weight loss treatment, while follow-up data were lacking for pharmacological and surgical weight loss treatment. Study quality varied widely. DISCUSSION This comprehensive meta-analysis demonstrated the medium-term effectiveness of psychotherapy, structured self-help treatment, and combined treatment for patients with BED, and supported the long-term effectiveness of psychotherapy. The results were derived from uncontrolled comparisons over time. Further long-term high quality research on psychological and medical treatments for BED is required.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - David Petroff
- Integrated Research and Treatment Center AdiposityDiseases, Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Stephan Herpertz
- Integrated Research and Treatment Center AdiposityDiseases, Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Reinhard Pietrowsky
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr-University Bochum, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology, Institute of Experimental Psychology, University of Düsseldorf, Düsseldorf, Germany
| | - Silja Vocks
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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9
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Romero X, Agüera Z, Granero R, Sánchez I, Riesco N, Jiménez-Murcia S, Gisbert-Rodriguez M, Sánchez-González J, Casalé G, Baenas I, Valenciano-Mendoza E, Menchon JM, Gearhardt AN, Dieguez C, Fernández-Aranda F. Is food addiction a predictor of treatment outcome among patients with eating disorder? EUROPEAN EATING DISORDERS REVIEW 2020; 27:700-711. [PMID: 31637816 DOI: 10.1002/erv.2705] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The study aimed to examine whether food addiction (FA) was associated with greater severity in both binge eating disorders (BED) and bulimia nervosa and, therefore, to determine if FA was predictive of treatment outcome. METHOD Seventy-one adult patients with bulimia nervosa and BED (42 and 29, respectively) participated in the study. FA was assessed by means of the Yale Food Addiction Scale. RESULTS The results confirmed a high prevalence of FA in patients with binge disorders (around 87%) and also its association with a greater severity of the disorder (i.e., related to an increased eating psychopathology and greater frequency of binge eating episodes). Although FA did not appear as a predictor of treatment outcome in general terms, when the diagnostic subtypes were considered separately, FA was associated with poor prognosis in the BED group. In this vein, FA appeared as a mediator in the relationship between ED severity and treatment outcome. DISCUSSIONS Our findings suggest that FA may act as an indicator of ED severity, and it would be a predictor of treatment outcome in BED but not in BN.
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Affiliation(s)
- Xandra Romero
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | | | - Jéssica Sánchez-González
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Gemma Casalé
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Isabel Baenas
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Jose M Menchon
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | | | - Carlos Dieguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain
| | - Fernando Fernández-Aranda
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
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10
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A review of binge eating disorder and obesity. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2020; 35:57-67. [PMID: 32346850 DOI: 10.1007/s40211-020-00346-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022]
Abstract
Binge eating disorder (BED) is a mental illness characterised by recurrent binge eating episodes in the absence of appropriate compensatory behaviours. Consequently, BED is strongly associated with obesity. The current review aims to provide an update of the most relevant aspects of BED (e.g., clinical profile, aetiology and treatment approaches), in order not only to facilitate a better understanding of the disorder and its clinical consequences, but also to identify potential targets of prevention and intervention. Patients with BED often present high comorbidity with other medical conditions and psychiatric disorders. Numerous risk factors have been associated with the development and maintenance of the disorder. Moreover, although some treatments for BED have proven to be effective in addressing different key aspects of the disorder, the rates of patients that have ever received specific treatment for BED are very low. The factors involved and how to implement effective treatments will be discussed for the purpose of addressing the eating symptomatology and comorbid obesity.
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11
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Polaprezinc (Zinc-L-Carnosine Complex) as an Add-on Therapy for Binge Eating Disorder and Bulimia Nervosa, and the Possible Involvement of Zinc Deficiency in These Conditions: A Pilot Study. J Clin Psychopharmacol 2020; 40:599-606. [PMID: 33044355 PMCID: PMC7643788 DOI: 10.1097/jcp.0000000000001284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Zinc plays an important role in appetite regulation. L-Carnosine, an endogenous dipeptide, may also regulate eating behavior via its histaminergic and antiglutamatergic properties. Polaprezinc (zinc-L-carnosine complex) is a medication for gastric ulcers. A small case series reported successful treatment of binge eating with add-on polaprezinc. METHODS This was an open trial of add-on polaprezinc in patients with binge eating disorder (BED; n = 22) or bulimia nervosa (BN; n = 7) receiving antidepressants. A 4-week baseline period was followed by a 16-week polaprezinc treatment at 150 mg/d (containing 34 mg zinc and 116 mg L-carnosine) in addition to ongoing psychotropic medications. We also assessed their zinc status via a laboratory index and zinc deficiency-related symptoms. RESULTS At the study end, both conditions showed a significant reduction in the 4-week frequency of combined objective and subjective binge eating episodes, the 4-week frequency of days when at least 1 such episode occurred (only in BED), several aspects of eating disorder psychopathology (rated by the Eating Disorder Examination-Questionnaire), and comorbid depressive symptoms (rated by the 16-item Quick Inventory of Depressive Symptomatology [Self-Report]). Serum copper/zinc ratio decreased from 1.4 to 1.1 on average in both conditions. All patients had multiple zinc deficiency-related symptoms at baseline that substantially improved after polaprezinc treatment. Overall, the effectiveness of polaprezinc was greater in BED patients than in BN patients, with minor adverse effects. CONCLUSIONS These findings offer preliminary evidence for the effectiveness of polaprezinc in treating BED and BN and suggest the involvement of zinc deficiency in these conditions.
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12
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Dakanalis A, Bartoli F, Caslini M, Crocamo C, Zanetti MA, Riva G, Clerici M, Carrà G. Validity and clinical utility of the DSM-5 severity specifier for bulimia nervosa: results from a multisite sample of patients who received evidence-based treatment. Eur Arch Psychiatry Clin Neurosci 2017; 267:823-829. [PMID: 27435722 DOI: 10.1007/s00406-016-0712-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023]
Abstract
A new "severity specifier" for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (IWCBs), was added to the DSM-5 as a means of documenting heterogeneity and variability in the severity of the disorder. Yet, evidence for its validity in clinical populations, including prognostic significance for treatment outcome, is currently lacking. Existing data from 281 treatment-seeking patients with DSM-5 BN, who received the best available treatment for their disorder (manual-based cognitive behavioural therapy; CBT) in an outpatient setting, were re-analysed to examine whether these patients subgrouped based on the DSM-5 severity levels would show meaningful and consistent differences on (a) a range of clinical variables assessed at pre-treatment and (b) post-treatment abstinence from IWCBs. Results highlight that the mild, moderate, severe, and extreme severity groups were statistically distinguishable on 22 variables assessed at pre-treatment regarding eating disorder pathological features, maintenance factors of BN, associated (current) and lifetime psychopathology, social maladjustment and illness-specific functional impairment, and abstinence outcome. Mood intolerance, a maintenance factor of BN but external to eating disorder pathological features (typically addressed within CBT), emerged as the primary clinical variable distinguishing the severity groups showing a differential treatment response. Overall, the findings speak to the concurrent and predictive validity of the new DSM-5 severity criterion for BN and are important because a common benchmark informing patients, clinicians, and researchers about severity of the disorder and allowing severity fluctuation and patient's progress to be tracked does not exist so far. Implications for future research are outlined.
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Affiliation(s)
- Antonios Dakanalis
- Department of Brain and Behavioral Sciences, University of Pavia, P.Za Botta 11, 27100, Pavia, Italy. .,Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Francesco Bartoli
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Manuela Caslini
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Maria Assunta Zanetti
- Department of Brain and Behavioral Sciences, University of Pavia, P.Za Botta 11, 27100, Pavia, Italy
| | - Giuseppe Riva
- Department of Psychology, Catholic University, Largo Gemelli 1, 20123, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Via Ariosto 13, 20145, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery Translational, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.,Division of Psychiatry, Faculty of Brain Sciences, University College of London, Gower Street, London, WC1E 6BT, UK
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13
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Preuss H, Pinnow M, Schnicker K, Legenbauer T. Improving Inhibitory Control Abilities (ImpulsE)-A Promising Approach to Treat Impulsive Eating? EUROPEAN EATING DISORDERS REVIEW 2017; 25:533-543. [DOI: 10.1002/erv.2544] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 07/24/2017] [Accepted: 08/09/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Hanna Preuss
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology; Johannes Gutenberg University Mainz; Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center; Johannes Gutenberg University Mainz; Germany
| | - Marlies Pinnow
- Motivation Lab, Institute of Cognitive Neurosciences; Ruhr-University Bochum; Germany
| | - Katja Schnicker
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology; Johannes Gutenberg University Mainz; Germany
| | - Tanja Legenbauer
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology; Johannes Gutenberg University Mainz; Germany
- Department of Research and Diagnostics, Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine; LWL-University Hospital; Germany
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14
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Ferrer-García M, Gutiérrez-Maldonado J, Pla-Sanjuanelo J, Vilalta-Abella F, Riva G, Clerici M, Ribas-Sabaté J, Andreu-Gracia A, Fernandez-Aranda F, Forcano L, Riesco N, Sánchez I, Escandón-Nagel N, Gomez-Tricio O, Tena V, Dakanalis A. A Randomised Controlled Comparison of Second-Level Treatment Approaches for Treatment-Resistant Adults with Bulimia Nervosa and Binge Eating Disorder: Assessing the Benefits of Virtual Reality Cue Exposure Therapy. EUROPEAN EATING DISORDERS REVIEW 2017; 25:479-490. [PMID: 28804985 DOI: 10.1002/erv.2538] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/25/2017] [Accepted: 07/10/2017] [Indexed: 12/22/2022]
Abstract
A question that arises from the literature on therapy is whether second-level treatment is effective for patients with recurrent binge eating who fail first-level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive-behavioural treatment (CBT) programme benefit from additional CBT (A-CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge-related cues). We assessed the effectiveness of virtual reality-CET as a second-level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A-CBT. The significant differences observed between the two groups at post-treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality-CET over A-CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Marta Ferrer-García
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Spain
| | | | - Joana Pla-Sanjuanelo
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Spain
| | | | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Italy
| | - Joan Ribas-Sabaté
- Department of Psychiatry and Mental Health, Igualada General Hospital, Spain
| | | | - Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | - Laura Forcano
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN)-ISCIII, Spain
| | | | | | | | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
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15
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Agüera Z, Sánchez I, Granero R, Riesco N, Steward T, Martín-Romera V, Jiménez-Murcia S, Romero X, Caroleo M, Segura-García C, Menchon JM, Fernández-Aranda F. Short-Term Treatment Outcomes and Dropout Risk in Men and Women with Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2017; 25:293-301. [PMID: 28474473 DOI: 10.1002/erv.2519] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 12/20/2022]
Abstract
This study compared treatment outcomes between men and women with eating disorders (EDs) and analysed clinical predictors of treatment outcome. Our sample consisted of 131 male and 131 female ED patients who underwent cognitive behavioural therapy treatment. ED severity, personality and psychopathology were assessed using standard instruments. We found that the risk of dropout was higher for men with bulimia nervosa (BN) than for women with BN and that men with BN and other specified feeding and EDs were more likely to obtain full remission in comparison with their female counterparts. Predictive models of treatment outcome indicated that higher scores in novelty seeking were a shared factor associated with higher risk of dropout and not obtaining full remission for both men and women with ED. However, only in men, younger age and lower scores in reward dependence predicted higher dropout. Contrastingly, higher persistence scores were predictors of full remission. This study reinforces the effectiveness of using outpatient cognitive behavioural therapy as treatment as usual for men with ED. Nonetheless, placing greater emphasis on strategies targeting gender-specific issues could enhance outcomes. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Zaida Agüera
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain
| | - Trevor Steward
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain
| | - Virginia Martín-Romera
- Departament de Psicologia Clínica i Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Xandra Romero
- Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain
| | - Mariarita Caroleo
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Cristina Segura-García
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy.,Ambulatory for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, Catanzaro, Italy
| | - José Manuel Menchon
- Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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16
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Watson HJ, Levine MD, Zerwas SC, Hamer RM, Crosby RD, Sprecher CS, O'Brien A, Zimmer B, Hofmeier SM, Kordy H, Moessner M, Peat CM, Runfola CD, Marcus MD, Bulik CM. Predictors of dropout in face-to-face and internet-based cognitive-behavioral therapy for bulimia nervosa in a randomized controlled trial. Int J Eat Disord 2017; 50:569-577. [PMID: 27862108 PMCID: PMC5429209 DOI: 10.1002/eat.22644] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We sought to identify predictors and moderators of failure to engage (i.e., pretreatment attrition) and dropout in both Internet-based and traditional face-to-face cognitive-behavioral therapy (CBT) for bulimia nervosa. We also sought to determine if Internet-based treatment reduced failure to engage and dropout. METHOD Participants (N = 191, 98% female) were randomized to Internet-based CBT (CBT4BN) or traditional face-to-face group CBT (CBTF2F). Sociodemographics, clinical history, eating disorder severity, comorbid psychopathology, health status and quality of life, personality and temperament, and treatment-related factors were investigated as predictors. RESULTS Failure to engage was associated with lower perceived treatment credibility and expectancy (odds ratio [OR] = 0.91, 95% CI: 0.82, 0.97) and body mass index (BMI) (OR = 1.10; 95% CI: 1.03, 1.18). Dropout was predicted by not having a college degree (hazard ratio [HR] = 0.55; 95% CI: 0.37, 0.81), novelty seeking (HR = 1.02; 95% CI: 1.01, 1.03), previous CBT experience (HR = 1.77; 95% CI: 1.16, 2.71), and randomization to the individual's nonpreferred treatment format (HR = 1.95, 95% CI: 1.28, 2.96). DISCUSSION Those most at risk of failure to engage had a higher BMI and perceived treatment as less credible and less likely to succeed. Dropout was associated with less education, higher novelty seeking, previous CBT experience, and a mismatch between preferred and assigned treatment. Contrary to expectations, Internet-based CBT did not reduce failure to engage or dropout. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:569-577).
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Affiliation(s)
- Hunna J. Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
- Eating Disorders Program, Child and Adolescent Health Service, Department of Health in Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Australia
- School of Psychology and Speech Pathology, Curtin University, Australia
| | - Michele D. Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, United States
| | - Stephanie C. Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
- Department of Biostatistics, University of North Carolina at Chapel Hill, United States
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, United States
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, United States
| | - Caroline S. Sprecher
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Amy O'Brien
- Eating Disorders Program, Child and Adolescent Health Service, Department of Health in Western Australia, Australia
| | - Benjamin Zimmer
- Center for Psychotherapy Research, University Hospital Heidelberg, Germany
| | - Sara M. Hofmeier
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Hans Kordy
- Center for Psychotherapy Research, University Hospital Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Germany
| | - Christine M. Peat
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Cristin D. Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Marsha D. Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, United States
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
- Department of Nutrition, University of North Carolina at Chapel Hill, United States
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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17
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Avargues-Navarro ML, Borda-Mas M, Asuero-Fernández R, Pérez-San-Gregorio MÁ, Martín-Rodríguez A, Beato-Fernández L, Bardone-Cone AM, Sánchez-Martín M. Purging behaviors and therapeutic prognosis of women with eating disorders treated in a healthcare context. Int J Clin Health Psychol 2017; 17:120-127. [PMID: 30487887 PMCID: PMC6220928 DOI: 10.1016/j.ijchp.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/16/2017] [Indexed: 11/19/2022] Open
Abstract
Background/Objective: The evidence on efficacy of cognitive-behavioral interventions in Eating Disorders (ED) still shows inconclusive results with respect to the role of purging behaviors, more so in uncontrolled situations. Evolution of ED patients with and without purging behavior was studied 30 months after start of a multicomponent treatment. Method: 162 women (87 purging, 75 non-purging) treated in outpatient or hospitals + outpatient care units in Spain participated. The evaluation instruments were: BSQ, EAT-40, EDI, STAI, BDI and BITE. Results: At the beginning of the treatment, participants with purging behavior showed higher bulimic symptomatology, more body dissatisfaction, drive for thinness, perfectionism and ineffectiveness, anxiety and depressive symptomatology. After thirty months, intervention produced improvement in ED characteristics, emotional alterations and personal development variables, in both groups, but less in patients with no purging behavior. The effect of intervention was stronger in purging patients and variables with larger effect size: body dissatisfaction, bulimic symptomatology and anxiety. Conclusions: Purging behaviors must be considered in the design of these treatments with a view to prognosis.
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Affiliation(s)
- María Luisa Avargues-Navarro
- Universidad de Sevilla, Spain
- Corresponding author. Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Sevilla, C/Camilo José Cela s/n. 41018 Sevilla.
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18
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Testing the DSM-5 severity indicator for bulimia nervosa in a treatment-seeking sample. Eat Weight Disord 2017; 22:161-167. [PMID: 27650858 DOI: 10.1007/s40519-016-0324-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study tested the new DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors in a treatment-seeking sample. METHODS Participants were 345 adults with DSM-5 BN presenting for treatment. They were sub-grouped based on DSM-5 severity levels and compared on a range of variables of clinical interest and demographics. RESULTS Based on DSM-5 severity definitions, 27.2 % of the sample was categorized with mild, 26.1 % with moderate, 24.9 % with severe, and 21.8 % with extreme severity of BN. Analyses revealed that the four (mild, moderate, severe, and extreme) severity groups of BN significantly differed from each other in eating disordered and body-related attitudes and behaviors, factors involved in the maintenance process of the disorder, comorbid psychiatric disorders, psychological distress, and psychosocial impairment (medium-to-large effect sizes). No significant between-group differences were observed in demographics, body mass index, or at the age when BN first occurred, lending some credence to recent suggestions that age-at-onset of BN may be more a disorder- than a severity-dependent variable. CONCLUSIONS Collectively, our findings provide support for the severity indicator for BN introduced in the DSM-5 as a means of addressing heterogeneity and variability in the severity of the disorder.
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Okamoto Y, Miyake Y, Nagasawa I, Shishida K. A 10-year follow-up study of completers versus dropouts following treatment with an integrated cognitive-behavioral group therapy for eating disorders. J Eat Disord 2017; 5:52. [PMID: 29177049 PMCID: PMC5693579 DOI: 10.1186/s40337-017-0182-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) has been recommended for the treatment of eating disorders, and group therapy is known to have certain advantages over individual therapy. The aim of the current study was to compare the 10-year prognosis of patients who completed integrated group CBT with those who dropped out and to examine the effect of completion of group CBT on the prognosis. METHODS The participants were 65 adult patients with eating disorders. All patients were women and Japanese. The average age (19-37) of the patients was 25.1 ± 3.8 years, and the average body mass index (BMI) was 17.7 ± 2.0. We conducted integrated group CBT with the patients and compared eating disorder symptoms, mood states, coping styles, and self-esteem before and after therapy. Furthermore, we compared clinical features and the 10-year prognosis of patients who completed the treatment and those who dropped out. RESULTS After 10 sessions of group therapy, Eating Attitudes Test scores, Profile of Mood States depression scores, and Coping Inventory for Stressful Situations emotion-oriented scores decreased, while Rosenberg's Self-Esteem Scale scores increased. Regarding the results of the 10-year follow up, the completer group had more patients with a good prognosis. In contrast, the dropout group had more patients with a poor prognosis. CONCLUSIONS Those who completed the integrated group CBT had a good prognosis. Group therapy gives the patients an opportunity to form peer relationships, and helps them to develop communication and socialization skills. Furthermore, in the group therapy sessions, the patients develop self-awareness by listening to other members of the group and they also develop interpersonal relationships. This effect may be temporary, but experience of group therapy may provide hope for the patient and increase the chance of the patient continuing treatment. TRIAL REGISTRATION Retrospectively registered in University Hospital Medical Information Network in Japan: No. 000028868 (May 19th, 2017).
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Affiliation(s)
- Yuri Okamoto
- Health Service Center, Hiroshima University, 1-7-1, Kagamiyama, Higashihiroshima, Hiroshima, 739-8514 Japan
| | - Yoshie Miyake
- Health Service Center, Hiroshima University, 1-7-1, Kagamiyama, Higashihiroshima, Hiroshima, 739-8514 Japan
| | - Ichie Nagasawa
- Health Service Center, Hiroshima University, 1-7-1, Kagamiyama, Higashihiroshima, Hiroshima, 739-8514 Japan
| | - Kazuhiro Shishida
- Department of Psychiatry and Neurosciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
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Nazar BP, Gregor LK, Albano G, Marchica A, Coco GL, Cardi V, Treasure J. Early Response to treatment in Eating Disorders: A Systematic Review and a Diagnostic Test Accuracy Meta-Analysis. EUROPEAN EATING DISORDERS REVIEW 2016; 25:67-79. [PMID: 27928853 DOI: 10.1002/erv.2495] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/21/2016] [Accepted: 11/10/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Early response to eating disorders treatment is thought to predict a later favourable outcome. A systematic review of the literature and meta-analyses examined the robustness of this concept. METHOD The criteria used across studies to define early response were summarised following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Diagnostic Test Accuracy methodology was used to estimate the size of the effect. RESULTS Findings from 24 studies were synthesized and data from 14 studies were included in the meta-analysis. In Anorexia Nervosa, the odds ratio of early response predicting remission was 4.85(95%CI: 2.94-8.01) and the summary Area Under the Curve (AUC) = .77. In Bulimia Nervosa, the odds ratio was 2.75(95%CI:1.24-6.09) and AUC = .67. For Binge Eating Disorder, the odds ratio was 5.01(95%CI: 3.38-7.42) and AUC = .71. CONCLUSION Early behaviour change accurately predicts later symptom remission for Anorexia Nervosa and Binge Eating Disorder but there is less predictive accuracy for Bulimia Nervosa. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Bruno Palazzo Nazar
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK.,Federal University of Rio de Janeiro, Institute of Psychiatry (IPUB-UFRJ), Brazil
| | - Louise Kathrine Gregor
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Gaia Albano
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK.,University of Palermo, Department of Psychology and Educational Sciences, Palermo, Italy
| | - Angelo Marchica
- University of Palermo, Department of Psychology and Educational Sciences, Palermo, Italy
| | - Gianluca Lo Coco
- University of Palermo, Department of Psychology and Educational Sciences, Palermo, Italy
| | | | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
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Hilker I, Sánchez I, Steward T, Jiménez-Murcia S, Granero R, Gearhardt AN, Rodríguez-Muñoz RC, Dieguez C, Crujeiras AB, Tolosa-Sola I, Casanueva FF, Menchón JM, Fernández-Aranda F. Food Addiction in Bulimia Nervosa: Clinical Correlates and Association with Response to a Brief Psychoeducational Intervention. EUROPEAN EATING DISORDERS REVIEW 2016; 24:482-488. [DOI: 10.1002/erv.2473] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Ines Hilker
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Department of Child and Adolescent Psychiatry and Psychology; Hospital Clínic of Barcelona; Barcelona Spain
| | - Isabel Sánchez
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Trevor Steward
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn); Instituto Salud Carlos III; Barcelona Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn); Instituto Salud Carlos III; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn); Instituto Salud Carlos III; Barcelona Spain
- Department of Psychobiology and Methodology; University Autònoma of Barcelona; Spain
| | | | | | - Carlos Dieguez
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn); Instituto Salud Carlos III; Barcelona Spain
- Department of Physiology, CIMUS; University of Santiago de Compostela-Instituto de Investigación Sanitaria; Santiago de Compostela Spain
| | - Ana B. Crujeiras
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn); Instituto Salud Carlos III; Barcelona Spain
- Laboratory of Molecular and Cellular Endocrinology, Research Area; Complejo Hospitalario Universitario de Santiago de Compostela; A Coruña Spain
| | - Iris Tolosa-Sola
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Felipe F. Casanueva
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn); Instituto Salud Carlos III; Barcelona Spain
- Laboratory of Molecular and Cellular Endocrinology, Research Area; Complejo Hospitalario Universitario de Santiago de Compostela; A Coruña Spain
| | - José M. Menchón
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Spain
- Ciber Salud Mental (CIBERSAM); Instituto Salud Carlos III; Barcelona Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn); Instituto Salud Carlos III; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Spain
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22
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Kornstein SG, Kunovac JL, Herman BK, Culpepper L. Recognizing Binge-Eating Disorder in the Clinical Setting: A Review of the Literature. Prim Care Companion CNS Disord 2016; 18:15r01905. [PMID: 27733955 DOI: 10.4088/pcc.15r01905] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/29/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Review the clinical skills needed to recognize, diagnose, and manage binge-eating disorder (BED) in a primary care setting. DATA SOURCES A PubMed search of English-language publications (January 1, 2008-December 11, 2014) was conducted using the term binge-eating disorder. Relevant articles known to the authors were also included. STUDY SELECTION/DATA EXTRACTION Publications focusing on preclinical topics (eg, characterization of receptors and neurotransmitter systems) without discussing clinical relevance were excluded. A total of 101 publications were included in this review. RESULTS Although BED is the most prevalent eating disorder, it is underdiagnosed and undertreated. BED can be associated with medical (eg, type 2 diabetes and metabolic syndrome) and psychiatric (eg, depression and anxiety) comorbidities that, if left untreated, can impair quality of life and functionality. Primary care physicians may find diagnosing and treating BED challenging because of insufficient knowledge of its new diagnostic criteria and available treatment options. Furthermore, individuals with BED may be reluctant to seek treatment because of shame, embarrassment, and a lack of awareness of the disorder. Several short assessment tools are available to screen for BED in primary care settings. Pharmacotherapy and psychotherapy should focus on reducing binge-eating behavior, thereby reducing medical and psychiatric complications. CONCLUSIONS Overcoming primary care physician- and patient-related barriers is critical to accurately diagnose and appropriately treat BED. Primary care physicians should take an active role in the initial recognition and assessment of suspected BED based on case-finding indicators (eg, eating habits and being overweight), the initial treatment selection, and the long-term follow-up of patients who meet DSM-5 BED diagnostic criteria.
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Affiliation(s)
- Susan G Kornstein
- Department of Psychiatry and Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Larry Culpepper
- Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts
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23
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Fernandez-Aranda F, Jimenez-Murcia S, Santamaría JJ, Giner-Bartolomé C, Mestre-Bach G, Granero R, Sánchez I, Agüera Z, Moussa MH, Magnenat-Thalmann N, Konstantas D, Lam T, Lucas M, Nielsen J, Lems P, Tarrega S, Menchón JM. The Use of Videogames as Complementary Therapeutic Tool for Cognitive Behavioral Therapy in Bulimia Nervosa Patients. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2015; 18:744-51. [DOI: 10.1089/cyber.2015.0265] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Susana Jimenez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Juan J. Santamaría
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
| | - Cristina Giner-Bartolomé
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
| | - Maher H. Moussa
- Faculty of Social Sciences and Economics, University of Geneva, Geneva, Switzerland
| | | | - Dimitri Konstantas
- Faculty of Social Sciences and Economics, University of Geneva, Geneva, Switzerland
| | | | - Mikkel Lucas
- Serious Game Interactive (SGI), Copenhagen, Denmark
| | | | | | - Salomé Tarrega
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- CIBER Salud Mental (CIBERSam), Instituto Salud Carlos III, Barcelona, Spain
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24
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Utzinger LM, Mitchell JE, Cao L, Crosby RD, Crow SJ, Wonderlich SA, Peterson CB. Clinical utility of subtyping binge eating disorder by history of anorexia or bulimia nervosa in a treatment sample. Int J Eat Disord 2015; 48:785-9. [PMID: 25959549 PMCID: PMC4860342 DOI: 10.1002/eat.22422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined whether having a history of anorexia nervosa (AN) or bulimia nervosa (BN) is associated with response to treatment in adults with binge eating disorder (BED). METHOD Data from 189 adults diagnosed with BED who were randomly assigned to one of three group cognitive-behavioral (CBT) treatments were analyzed to compare those with and without a history of AN/BN. RESULTS A total of 16% of the sample had a history of AN/BN. The BED subgroup with a history of AN/BN presented with higher rates of mood disorders and greater eating-related symptom severity at baseline. Participants with a history of AN/BN also had higher global eating disorder (ED) symptoms at end of treatment (EOT), and more frequent objective binge-eating episodes at EOT and 12-month follow-up. DISCUSSION These findings suggest that in adults with BED, a history of AN/BN is predictive of greater eating-related symptom severity following group-based CBT and poorer short- and long-term binge-eating outcomes. These findings suggest that considering ED history in the treatment of adults with BED may be clinically useful.
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Affiliation(s)
- Linsey M. Utzinger
- Neuropsychiatric Research Institute, Fargo, North Dakota
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - James E. Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Li Cao
- Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
- The Emily Program, St. Paul, MN
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, Fargo, North Dakota
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
- The Emily Program, St. Paul, MN
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Giner-Bartolomé C, Fagundo AB, Sánchez I, Jiménez-Murcia S, Santamaría JJ, Ladouceur R, Menchón JM, Fernández-Aranda F. Can an intervention based on a serious videogame prior to cognitive behavioral therapy be helpful in bulimia nervosa? A clinical case study. Front Psychol 2015; 6:982. [PMID: 26236261 PMCID: PMC4500862 DOI: 10.3389/fpsyg.2015.00982] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa (BN). Cognitive behavioral therapy (CBT) is the treatment of choice for BN, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with BN, examining the effectiveness of using a videogame (VG; Playmancer) as an additional intervention designed to address impulsivity. DESIGN Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an "A-B-A-C-A" single case experimental design. Impulsivity levels were assessed with the Conner's Continuous Performance Test II (CPT-II). After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure. RESULTS After the VG intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II) progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the VG intervention. DISCUSSION This case report suggests that using the Playmancer VG to reduce impulsivity prior to CBT may enhance the final results of the treatment for BN.
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Affiliation(s)
- Cristina Giner-Bartolomé
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | - Ana B Fagundo
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain
| | - Juan J Santamaría
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | | | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain ; Ciber Salud Mental, Instituto de Salud Carlos III , Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain
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26
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Athilingam P, Edwards JD, Valdes EG, Ji M, Guglin M. Computerized auditory cognitive training to improve cognition and functional outcomes in patients with heart failure: Results of a pilot study. Heart Lung 2015; 44:120-8. [PMID: 25592205 DOI: 10.1016/j.hrtlng.2014.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Feasibility and efficacy of computerized auditory cognitive training (ACT) was examined among patients with heart failure (HF). BACKGROUND Individuals with HF have four times increased risk of cognitive impairment, yet cognitive intervention studies are sparse. METHODS A pilot randomized controlled design was used. RESULTS The ACT group (n = 9) and control group (n = 8) had similar baseline characteristics. Seven participants (78%) completed ≥ 18 hours of ACT. Medium effect sizes were observed for improved cognition as indicated by auditory processing speed (d = 0.78), speech processing (d = 0.88), and working memory (d = 0.44-0.50). Small effect sizes were found for improved functional outcomes including HF selfcare (d = 0.34), Timed Instrumental Activities of Daily Living (d = 0.32), Six-Minute Walk Test (d = 0.38) and Short-Form-36 (d = 0.22) relative to controls. CONCLUSION Results indicated ACT is feasible among persons with HF. Despite a small sample size, ACT showed potential for improved speed of processing and working memory and improved functional outcomes, and warrants further exploration.
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Affiliation(s)
| | | | - Elise G Valdes
- School of Aging Studies, University of South Florida, USA
| | - Ming Ji
- College of Nursing, University of South Florida, USA
| | - Maya Guglin
- Cardiovascular Medicine, University of Kentucky, Lexington, USA
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27
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Fagundo AB, Via E, Sánchez I, Jiménez-Murcia S, Forcano L, Soriano-Mas C, Giner-Bartolomé C, Santamaría JJ, Ben-Moussa M, Konstantas D, Lam T, Lucas M, Nielsen J, Lems P, Cardoner N, Menchón JM, de la Torre R, Fernandez-Aranda F. Physiological and brain activity after a combined cognitive behavioral treatment plus video game therapy for emotional regulation in bulimia nervosa: a case report. J Med Internet Res 2014; 16:e183. [PMID: 25116416 PMCID: PMC4155921 DOI: 10.2196/jmir.3243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/29/2014] [Accepted: 07/22/2014] [Indexed: 12/20/2022] Open
Abstract
Background PlayMancer is a video game designed to increase emotional regulation and reduce general impulsive behaviors, by training to decrease arousal and improve decision-making and planning. We have previously demonstrated the usefulness of PlayMancer in reducing impulsivity and improving emotional regulation in bulimia nervosa (BN) patients. However, whether these improvements are actually translated into brain changes remains unclear. Objective The aim of this case study was to report on a 28-year-old Spanish woman with BN, and to examine changes in physiological variables and brain activity after a combined treatment of video game therapy (VGT) and cognitive behavioral therapy (CBT). Methods Ten VGT sessions were carried out on a weekly basis. Anxiety, physiological, and impulsivity measurements were recorded. The patient was scanned in a 1.5-T magnetic resonance scanner, prior to and after the 10-week VGT/CBT combined treatment, using two paradigms: (1) an emotional face-matching task, and (2) a multi-source interference task (MSIT). Results Upon completing the treatment, a decrease in average heart rate was observed. The functional magnetic resonance imaging (fMRI) results indicated a post-treatment reduction in reaction time along with high accuracy. The patient engaged areas typically active in healthy controls, although the cluster extension of the active areas decreased after the combined treatment. Conclusions These results suggest a global improvement in emotional regulation and impulsivity control after the VGT therapy in BN, demonstrated by both physiological and neural changes. These promising results suggest that a combined treatment of CBT and VGT might lead to functional cerebral changes that ultimately translate into better cognitive and emotional performances.
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Affiliation(s)
- Ana Beatriz Fagundo
- University Hospital of Bellvitge-IDIBELL, Department of Psychiatry, Barcelona, Spain
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28
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Custal N, Arcelus J, Agüera Z, Bove FI, Wales J, Granero R, Jiménez-Murcia S, Sánchez I, Riesco N, Alonso P, Crespo JM, Virgili N, Menchón JM, Fernandez-Aranda F. Treatment outcome of patients with comorbid type 1 diabetes and eating disorders. BMC Psychiatry 2014; 14:140. [PMID: 24885411 PMCID: PMC4030033 DOI: 10.1186/1471-244x-14-140] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/06/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Co-morbidity between Type 1 Diabetes Mellitus (T1DM) and eating disorders (ED) has been previously described; however the effect of this illness on the outcomes for conventional ED treatments has not been previously investigated. This study aims to compare clinical, psychopathological and personality features between two samples of ED individuals: those with comorbid T1DM and those without (No-DM); and to identify differences in treatment outcomes between the groups. METHODS This study compares treatment outcome, dropouts, ED psychopathology and personality characteristics for 20 individuals with ED and T1DM and 20 ED patients without diabetes, matched for diagnostic and treatment type. RESULTS The study found higher dropout rates from therapy in individuals with T1DM and worse treatment outcome in spite of having no significant differences in eating disorder psychopathology, although individuals with T1DM report misusing insulin. CONCLUSIONS The low levels of motivation to change, and insulin abuse in T1DM patients, may suggest that treatment for patients with ED and T1DM should consider the individual's personality and role of insulin abuse when determining the appropriate intervention.
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Affiliation(s)
- Nuria Custal
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Jon Arcelus
- Leicester Eating Disorder Service, Bennion Centre, Leicester Glenfield Hospital, Leicester, UK,Loughborough University Centre for Research into Eating Disorders, Loughborough University, Loughborough, UK
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
| | - Francesca I Bove
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Jackie Wales
- Leicester Eating Disorder Service, Bennion Centre, Leicester Glenfield Hospital, Leicester, UK
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain,Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,Ciber Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain,Departament of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Pino Alonso
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,Departament of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Ciber Salud Mental (CIBERsam), Instituto Salud Carlos III, Barcelona, Spain
| | - José M Crespo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,Departament of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Ciber Salud Mental (CIBERsam), Instituto Salud Carlos III, Barcelona, Spain
| | - Nuria Virgili
- Endocrinology and Clinical Nutrition Unit, University Hospital of Bellvitge- IDIBELL, Barcelona, Spain
| | - Jose M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,Departament of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Ciber Salud Mental (CIBERsam), Instituto Salud Carlos III, Barcelona, Spain
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29
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Villarejo C, Jiménez-Murcia S, Álvarez-Moya E, Granero R, Penelo E, Treasure J, Vilarrasa N, Gil-Montserrat de Bernabé M, Casanueva FF, Tinahones FJ, Fernández-Real JM, Frühbeck G, de la Torre R, Botella C, Agüera Z, Menchón JM, Fernández-Aranda F. Loss of control over eating: a description of the eating disorder/obesity spectrum in women. EUROPEAN EATING DISORDERS REVIEW 2013; 22:25-31. [PMID: 24338827 DOI: 10.1002/erv.2267] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/08/2013] [Accepted: 10/11/2013] [Indexed: 11/11/2022]
Abstract
GOALS This study aimed to analyse the association, commonalities and differences between obesity and eating disorders (ED). METHOD A total of 150 female patients [50 obese with bulimia nervosa (OB + BN), 50 obese with binge eating disorders (OB + BED), 50 obese without eating disorders (OB)] and 50 female healthy-eating/weight control (CG) volunteers participated in this study. ASSESSMENT All participants were assessed by the Eating Disorders Inventory-2 (EDI-2), the Symptom Checklist-Revised (SCL-90-R) and the Temperament and Character Inventory-Revised. RESULTS In general, all the groups differed significantly and showed linear trends (OB + BN > OB + BED > OB > CG) on general and eating psychopathology (SCL-90-R and EDI-2). Regarding personality traits, statistically significant differences across all four groups were found on Harm Avoidance and Self-Directedness. Whereas some symptoms were shared in extreme weight conditions, others were specifically related to ED. CONCLUSIONS The presence of binge and purge symptomatology in obese patients is clinically relevant. These findings help to understand the relationship between Obesity and ED.
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Affiliation(s)
- Cynthia Villarejo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
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30
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Fassino S, Abbate-Daga G. Resistance to treatment in eating disorders: a critical challenge. BMC Psychiatry 2013; 13:282. [PMID: 24229426 PMCID: PMC4225668 DOI: 10.1186/1471-244x-13-282] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 10/29/2013] [Indexed: 01/29/2023] Open
Abstract
The Special Issue "Treatment resistance in Eating Disorders" gathers together the contributions provided by several experienced groups of researchers in the field of Eating Disorders (EDs). The main topic is addressed from multiple perspectives ranging from pathogenesis (including developmental and maintaining factors) to treatment. An explicative model of resistance in EDs is also proposed.
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Affiliation(s)
- Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 15, Turin 10126, Italy.
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 15, Turin 10126, Italy
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