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Elwyn R, Adams M, Sharpe SL, Silverstein S, LaMarre A, Downs J, Burnette CB. Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality. J Eat Disord 2024; 12:70. [PMID: 38831456 PMCID: PMC11145809 DOI: 10.1186/s40337-024-01016-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
Eating disorders (EDs) are complex, multifaceted conditions that significantly impact quality-of-life, often co-occur with multiple medical and psychiatric diagnoses, and are associated with a high risk of medical sequelae and mortality. Fortunately, many people recover even after decades of illness, although there are different conceptualisations of recovery and understandings of how recovery is experienced. Differences in these conceptualisations influence categorisations of ED experiences (e.g., longstanding vs. short-duration EDs), prognoses, recommended treatment pathways, and research into treatment outcomes. Within recent years, the proposal of a 'terminal' illness stage for a subset of individuals with anorexia nervosa and arguments for the prescription of end-of-life pathways for such individuals has ignited debate. Semantic choices are influential in ED care, and it is critical to consider how conceptualisations of illness and recovery and power dynamics influence outcomes and the ED 'staging' discourse. Conceptually, 'terminality' interrelates with understandings of recovery, efficacy of available treatments, iatrogenic harm, and complex co-occurring diagnoses, as well as the functions of an individual's eating disorder, and the personal and symbolic meanings an individual may hold regarding suffering, self-starvation, death, health and life. Our authorship represents a wide range of lived and living experiences of EDs, treatment, and recovery, ranging from longstanding and severe EDs that may meet descriptors of a 'terminal' ED to a variety of definitions of 'recovery'. Our experiences have given rise to a shared motivation to analyse how existing discourses of terminality and recovery, as found in existing research literature and policy, may shape the conceptualisations, beliefs, and actions of individuals with EDs and the healthcare systems that seek to serve them.
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Affiliation(s)
- Rosiel Elwyn
- Neuroscience and psychiatry, Thompson Institute, Birtinya, QLD, Australia
- University of the Sunshine Coast, Birtinya, QLD, Australia
| | | | - Sam L Sharpe
- Fighting Eating Disorders in Underrepresented Populations (FEDUP, Collective), West Palm Beach, FL, USA
| | | | | | | | - C Blair Burnette
- Department of Psychology, Michigan State University, Lansing, MI, USA.
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2
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Rodríguez-Testal JF, Trinidad-Montero JM, Rosales Becerra Á, Faija C, Senín-Calderón C. Psychometric properties of the Pride in Eating Pathology Scale in a Spanish population. J Eat Disord 2023; 11:124. [PMID: 37507784 PMCID: PMC10386289 DOI: 10.1186/s40337-023-00847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND In its relation to eating disorders, pride is one of the self-conscious emotions least analyzed, and requires valid and reliable instruments for its measurement. This study aimed to examine the factor structure and the psychometric properties of the Pride in Eating Pathology Scale (PEP-S), in the Spanish general population, as well as between-sex differences in PEP-S scores. METHODS Of the 1483 participants aged 18 to 34 (M = 21.99; SD = 3.09), 954 were women (65.2%) and the majority were university students (78.8%). Psychometric properties of the scale were tested in a cross-sectional design using cross-validation, i.e., exploratory and confirmatory factor analysis, and estimation of invariance (sex). RESULTS The four-factor structure found was similar to the original scale with invariance across sex and internal consistency (ordinal alpha .99) and stability (.85). Evidence of convergent validity and differences between sexes were found. Specifically, women scored higher on all the factors, including the healthier sense of pride. CONCLUSIONS The PEP-S scale is an instrument with evidence of validity and reliability in the Spanish population. Although it still has to be tested in a clinical population, it constitutes a promising instrument for the evaluation of the self-conscious emotion, pride.
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Affiliation(s)
| | | | - Ángela Rosales Becerra
- Personality, Evaluation and Psychological Treatment Department, University of Seville, Seville, Spain
| | - Cintia Faija
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
| | - Cristina Senín-Calderón
- Department of Psychology, University of Cádiz, Avda. República Árabe Saharaui S/N. Puerto Real, Cádiz, Spain.
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3
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Haynos AF, Koithan E, Hagan KE. Learned industriousness as a translational mechanism in anorexia nervosa. NATURE REVIEWS PSYCHOLOGY 2023; 2:112-126. [PMID: 37693302 PMCID: PMC10485812 DOI: 10.1038/s44159-022-00134-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 09/12/2023]
Abstract
It remains unexplained why some behaviours persist despite being non-hedonic and ostensibly aversive. This phenomenon is especially baffling when such behaviours are taken to excess in the form of psychopathology. Anorexia nervosa is one psychiatric disorder in which effortful behaviours that most people find unpleasant (suchas restrictive eating) are persistently performed. We propose thatthe social psychology theory of learned industriousness providesa novel mechanistic account for such phenomena. This theoryposits that high-effort behaviour can be conditioned to acquire secondary reinforcing properties through repeated pairing with reward. Accordingly, effort sensations become less aversive andmore appetitive, increasing willingness to engage in effortful behaviour. In this Perspective, we review pre-clinical behaviouraland biological data that support learned industriousness, contrast learned industriousness with other models of non-hedonic persistence (such as habit learning), highlight evidence that supports learned industriousness in individuals with anorexia nervosa and consider implications of the model, including translation to other psychiatric presentations.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Emily Koithan
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Kelsey E. Hagan
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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4
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van Doornik SFW, Ostafin BD, Jonker NC, Glashouwer KA, de Jong PJ. Satisfaction with normative life domains and the course of anorexia nervosa. Int J Eat Disord 2022; 55:553-563. [PMID: 35212004 PMCID: PMC9305581 DOI: 10.1002/eat.23691] [Citation(s) in RCA: 1] [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] [Received: 09/23/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Satisfaction with normative life domains has been proposed as an important factor in the persistence of anorexia nervosa (AN). Initial evidence from a cross-sectional study indicated that individuals with AN reported lower satisfaction with normative life domains than individuals without an eating disorder. As an important next step in understanding causal relations, the present study used a longitudinal design to examine whether an improvement in AN symptoms is paralleled by an increase in satisfaction with normative life domains from baseline to follow-up and whether relatively low satisfaction with normative life domains at baseline is related to less improvement in AN symptoms. METHODS During baseline and at 1-year follow-up, adolescents with AN (N = 69) completed the Brief Multidimensional Students' Life Satisfaction Scale to measure satisfaction with normative life domains (e.g., friendships, school experience). Furthermore, eating disorder symptoms and BMI were measured. RESULTS Improvement in eating disorder symptoms, but not in BMI, was paralleled by an increase in satisfaction with normative life domains. Relatively low satisfaction with normative life domains at baseline was not prospectively related to less improvement in eating disorder symptoms or BMI at follow-up. DISCUSSION Our findings provide initial evidence that satisfaction with normative life domains is a malleable factor which fluctuates with symptom severity in AN. The results of this exploratory study point to the relevance of examining whether targeting satisfactory engagement with specific life domains optimizes treatment effectiveness. PUBLIC SIGNIFICANCE We explored whether an improvement in anorexia nervosa symptoms from start of treatment to 1-year follow-up would be paralleled by an increase in satisfaction with normative life domains. Improvement in eating disorder symptoms (but not BMI) was indeed related to a concurrent increase in satisfaction with normative life domains. These preliminary results point to the promising possibility that targeting satisfactory engagement with specific life domains may potentially enhance treatment effectiveness.
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Affiliation(s)
- Sanne F. W. van Doornik
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands,Department of Eating DisordersAccare Child and Adolescent PsychiatryGroningenThe Netherlands
| | - Brian D. Ostafin
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Nienke C. Jonker
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Klaske A. Glashouwer
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands,Department of Eating DisordersAccare Child and Adolescent PsychiatryGroningenThe Netherlands
| | - Peter J. de Jong
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
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5
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Bryant E, Aouad P, Hambleton A, Touyz S, Maguire S. 'In an otherwise limitless world, I was sure of my limit.' † Experiencing Anorexia Nervosa: A phenomenological metasynthesis. Front Psychiatry 2022; 13:894178. [PMID: 35978851 PMCID: PMC9376373 DOI: 10.3389/fpsyt.2022.894178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia Nervosa (AN) has the highest mortality rate of the mental disorders, with still less than 50% of affected individuals achieving recovery. Recent calls to bring innovative, empirical research strategies to the understanding of illness and its core psychopathological features highlight the need to address significant paucity of efficacious treatment. The current study brings a phenomenological approach to this challenge, synthesizing lived experience phenomena as described by qualitative literature. Fifty-three studies published between the years 1998 and 2021 comprising a total of 1557 participants aged 12-66 suffering from AN or sub-threshold AN are included. Reciprocal and refutational analysis generated six key third-order constructs: "emotion experienced as overwhelming," "identity," "AN as a tool," "internal conflict relating to Anorexia," "interpersonal communication difficulties" and "corporeality." Twenty-six sub-themes were identified, the most common being fear, avoidance, AN as guardian/protector, and AN as intertwined with identity. Some themes associated with current treatment models such as low self-esteem, need for social approval and feelings of fatness were less common. We highlight the significant role of intense and confusing emotion in AN, which is both rooted in and engenders amplified fear and anxiety. Restrictive eating functions to numb these feelings and withdraw an individual from a chaotic and threatening world whilst providing a sense of self around which to build an illness identity. Results have implications for therapeutic practice and overly protective weight and shape focused medical treatment models, which may serve to reinforce the disease.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ashlea Hambleton
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
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6
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Solhaug Storli C, Alsaker S. Treatment of eating disorders: voices from a ward. Int J Qual Stud Health Well-being 2021; 16:1983948. [PMID: 34633917 PMCID: PMC8530473 DOI: 10.1080/17482631.2021.1983948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose The purpose of this study is to explore and develop knowledge about treatment experiences of people suffering from severe eating disorders, by highlighting the patient’s perspective in treatment. The study’s issue is: “How do patients with severe eating disorders experience everyday hospital/in-hospital treatment, and how do they value the impact of their experiences in treatment?” Method The study takes a qualitative approach, where patients wrote diaries that formed the data. There were 3 participants who wrote diaries twice a day for 2 weeks. In this study, thematic interpretative analysis of narrative data was used. Results and conclusion The results of this study indicate that several health-related experiences emerged during treatment. The results show that the experiences of in-hospital treatment for severe ED are mostly characterized by experiences that might reduce the participants' sense of meaning. The study suggests new arenas (besides taking control over food/their bodies) for individual patients experienced mastery in their own recovery process.
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Affiliation(s)
- Cathrine Solhaug Storli
- Social Educator in Mental Health, Crisis Resolution Team, Helgeland Hospital, Mo I Rana, Norway
| | - Sissel Alsaker
- Department of Mental Health, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
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7
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Schell SE, Banica I, Weinberg A, Racine SE. Hunger games: Associations between core eating disorder symptoms and responses to rejection by peers during competition. Int J Eat Disord 2021; 54:802-811. [PMID: 33605485 DOI: 10.1002/eat.23487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Individuals with eating disorder (ED) symptoms are sensitive to social threat and report maladaptive interpersonal styles that may contribute to and exacerbate negative evaluation from others. Research in this area has relied primarily on self-report. The current study examined associations between behavioral responses to social threat and core ED symptoms using a behavioral paradigm. Based on previous findings that individuals with binge-eating report being more reactive and confrontational, whereas individuals with dietary restriction tend to be more submissive and avoidant of conflict, we hypothesized that binge eating would be associated with a greater tendency to retaliate against rejection perpetrators, whereas dietary restriction would be associated with a lower tendency to retaliate when rejected. METHOD Undergraduate women (N = 132) completed a self-report measure of ED symptoms and participated in an online "Survivor"-type game in which they voted to either accept or reject computerized coplayers, while also receiving acceptance or rejection feedback from others. RESULTS Neither ED symptom was associated with how often participants retaliated against coplayers who rejected them. However, dietary restriction was related to more rejection votes overall (i.e., the tendency to reject others regardless of how others voted). DISCUSSION Findings suggest that individuals with dietary restriction may rely on a maladaptive defensive strategy aimed at pre-empting rejection, or alternatively, have difficulty shifting from habitual self-isolating behavior that results from over-involvement with restricting symptoms. Interventions targeting hypersensitivity to social threat or interpersonal flexibility may help reduce interpersonal stress and mitigate its impact on restricting symptoms.
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Affiliation(s)
- Sarah E Schell
- Department of Psychology, McGill University, Montreal, Canada
| | - Iulia Banica
- Department of Psychology, McGill University, Montreal, Canada
| | - Anna Weinberg
- Department of Psychology, McGill University, Montreal, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Canada
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8
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van Doornik SFW, Ostafin BD, Jonker NC, Glashouwer KA, de Jong PJ. Low satisfaction with normative life domains in adolescents with anorexia nervosa. Clin Psychol Psychother 2021; 28:1266-1274. [PMID: 33608934 PMCID: PMC8596741 DOI: 10.1002/cpp.2574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Low satisfaction with normative life domains might be an important factor in the persistence of anorexia nervosa (AN). Initial evidence in non-clinical samples showed that lower satisfaction with normative life domains was related to more intense eating disorder symptoms. As a critical next step, the current study examined satisfaction with normative life domains in a clinical sample. Specifically, the present study tested whether adolescents with AN reported lower satisfaction with normative life domains than adolescents without an eating disorder. METHOD Adolescents with AN (n = 69) and adolescents without an eating disorder matched on age, gender and educational level (n = 69) completed the Brief Multidimensional Students' Life Satisfaction Scale to assess satisfaction with five life domains (family, friendships, school, self and living location) and life in general. RESULTS Adolescents with AN reported significantly lower satisfaction with normative life domains than the comparison group. Subsequent analyses showed that this overall group difference was primarily driven by adolescents with AN reporting lower satisfaction with the self, school experience and life in general. CONCLUSIONS Findings supported the hypothesis that adolescents with AN show relatively low satisfaction with meaningful, non-AN-related life domains. This points to the potential relevance of enhancing satisfaction with specific life domains to optimize treatment effectiveness.
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Affiliation(s)
- Sanne F W van Doornik
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Brian D Ostafin
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Nienke C Jonker
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Klaske A Glashouwer
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.,Department of Eating Disorders, Accare Child and Adolescent Psychiatry, Groningen, Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
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9
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Schaumberg K, Reilly EE, Gorrell S, Levinson CA, Farrell NR, Brown TA, Smith KM, Schaefer LM, Essayli JH, Haynos AF, Anderson LM. Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clin Psychol Rev 2020; 83:101952. [PMID: 33221621 DOI: 10.1016/j.cpr.2020.101952] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
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Affiliation(s)
| | | | - Sasha Gorrell
- University of California, San Francisco, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | | | - Tiffany A Brown
- University of California, San Diego, United States of America
| | - Kathryn M Smith
- Sanford Health, United States of America; University of Southern California, United States of America
| | | | | | - Ann F Haynos
- University of Minnesota, United States of America
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10
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Mortimer R. Pride Before a Fall: Shame, Diagnostic Crossover, and Eating Disorders. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:365-374. [PMID: 31264137 PMCID: PMC6831528 DOI: 10.1007/s11673-019-09923-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/12/2019] [Indexed: 05/20/2023]
Abstract
This paper discusses the findings of qualitative research that examined the accounts of five "mostly recovered" ex-patients who had experienced transition between two or more eating disorder diagnoses. This study found that, in the minds of participants, the different diagnostic labels were associated with various good or bad character traits. This contributed to the belief in a diagnostic hierarchy, whereby individuals diagnosed with anorexia nervosa were viewed as morally better than those diagnosed with bulimia nervosa or binge eating disorder. Consequently, diagnostic crossover from a "better" to a "worse" eating disorder was often experienced as shameful moral failing, and a new diagnosis impacted the individual's sense of self-identity. These findings are of significance for both ethicists and clinicians; the paper concludes by outlining the relevance and possible clinical implications of shame in diagnostic crossover and suggesting avenues for future research.
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Affiliation(s)
- Rose Mortimer
- Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Lane, Oxford, OX3 7JX, England.
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11
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Kroplewski Z, Szcześniak M, Furmańska J, Gójska A. Assessment of Family Functioning and Eating Disorders - The Mediating Role of Self-Esteem. Front Psychol 2019; 10:921. [PMID: 31068882 PMCID: PMC6491868 DOI: 10.3389/fpsyg.2019.00921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 04/05/2019] [Indexed: 12/25/2022] Open
Abstract
The aim of the study was to measure whether people at increased risk for eating disorders (EDs) and people without an increased risk of EDs differ from each other in the assessment of family functioning (FF) and self-esteem (SE) dimensions. Moreover, the correlations between FF, EDs, and SE were verified, looking for the mediating role of SE in the context of the FF and EDs. The research was conducted on the group of 160 people aged from 18 to 47 years, including 74 people at increased risk for EDs. We used: The Family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve); The SCOFF Questionnaire; The Multidimensional Self-Esteem Inventory, MSEI. Analyses indicate that the compared groups differ significantly in terms of EDs, assessment of FF, and all components of SE, in such a way that people without an increased risk of EDs are characterized by a more positive assessment of FF and higher SE in all its dimensions. All SE dimensions, except defensive high SE, are mediators in the relationship of FF with EDs. In therapeutic interactions, it is worth focusing on the SE dimensions, as they are one of the mediation elements in the relationship between the assessment of FF and EDs.
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Affiliation(s)
- Zdzisław Kroplewski
- Faculty of Humanities, Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Małgorzata Szcześniak
- Faculty of Humanities, Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Joanna Furmańska
- Faculty of Humanities, Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Anita Gójska
- Faculty of Humanities, Institute of Psychology, University of Szczecin, Szczecin, Poland
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12
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Mac Neil BA, Hudson CC. Patient Experience and Satisfaction With Acceptance and Commitment Therapy Delivered in a Complimentary Open Group Format for Adults With Eating Disorders. J Patient Exp 2018; 5:189-194. [PMID: 30214925 PMCID: PMC6134549 DOI: 10.1177/2374373517748640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We examined patient experiences and satisfaction with acceptance and commitment therapy (ACT) delivered in a novel weekly open-group therapy format immediately following psychiatric intake assessment into a hospital-based outpatient adult eating disorders program. Participants were 68 adults with a Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnosis of an eating disorder who reported their experiences and satisfaction with the ACT group. Participants reported that they were somewhat satisfied to very satisfied with the open ACT group and that the treatment content was helpful. Specifically, participants reported that ACT group helped them to recognize their personal values and learn strategies for behavior change. Satisfaction with ACT group was associated with engagement in the broader group therapy program. Results suggest that ACT delivered in an open group format is well liked by adults in an outpatient program for eating disorders. ACT is a promising complimentary treatment for individuals with eating disorders that can be easily integrated by clinicians into outpatient care.
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Affiliation(s)
- Brad A Mac Neil
- Adult Eating Disorders Program (AEDP), Kingston Health Sciences Centre (KHSC), Kingston, Ontario, Canada
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | - Chloe C Hudson
- Adult Eating Disorders Program (AEDP), Kingston Health Sciences Centre (KHSC), Kingston, Ontario, Canada
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
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13
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Gregertsen EC, Mandy W, Serpell L. The Egosyntonic Nature of Anorexia: An Impediment to Recovery in Anorexia Nervosa Treatment. Front Psychol 2017; 8:2273. [PMID: 29312100 PMCID: PMC5743910 DOI: 10.3389/fpsyg.2017.02273] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/14/2017] [Indexed: 11/28/2022] Open
Abstract
A serious problem faced by clinicians treating anorexia nervosa is the egosyntonic nature of the illness, wherein individuals with anorexia nervosa value their disorder, thereby hindering motivation for recovery and engagement with treatment. The objective of this review article is to elucidate the nature of egosyntonicity in anorexia nervosa, reviewing both qualitative and quantitative research pertaining to this topic, and, importantly, to present methods to overcome this impediment to recovery in anorexia nervosa treatment. The authors elucidate functions of anorexia nervosa for patients, both within psychological and social spheres, as well as highlight the detrimental effect of egosyntonicity in terms of illness severity and motivation for recovery. The final part of the paper contains suggestions as to methods of bypassing pitfalls linked with the influence of the egosyntonic nature of anorexia nervosa within a treatment setting, as well as an examination of three current treatments (enhanced cognitive-behavioral therapy for eating disorders, Maudsley Model of Anorexia Nervosa Treatment for Adults, and Specialist Supportive Clinical Management) in terms of the degree to which they target egosyntonicity.
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Affiliation(s)
- Eva C Gregertsen
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - William Mandy
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Lucy Serpell
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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14
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Dada G, Izu S, Montebruno C, Grau A, Feixas G. Content Analysis of the Construction of Self and Others in Women with Bulimia Nervosa. Front Psychol 2017; 8:480. [PMID: 28428765 PMCID: PMC5382152 DOI: 10.3389/fpsyg.2017.00480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 03/14/2017] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to explore the content of personal constructs in people diagnosed with bulimia nervosa (BN). We expected to find differences in the predominant content of the construct systems between women with and without BN. We analyzed the constructs elicited using the repertory grid technique from 120 women aged between 18 to 45 years, divided into two groups: a clinical group of women diagnosed with bulimia (n = 62) and a control group of university students (n = 58). The constructs were categorized using the Classification System for Personal Constructs (CSPC), composed of six themes which are broken down into 45 categories. For this study, a new area called “Physical” was included, and it consists of three categories. The results indicated that women diagnosed with bulimia used significantly more constructs related to the body, while the control group used more constructs from the personal area. In addition, the congruent constructs from the clinical sample were predominantly moral, or related to values and interests, while discrepant constructs were personal and physical. The findings provide evidence for the clinical use of the CSPC as an instrument for exploring the content of personal meaning systems. Understanding the patient’s personal constructions about herself and others is useful for treatment. Moreover, it is important for clinicians to explore the content of constructs related to symptomatic areas, which could be hindering change, and focus on them to facilitate improvement.
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Affiliation(s)
- Gloria Dada
- Werklund School of Education - Counselling Psychology, University of Calgary, CalgaryAB, Canada.,Clinical Psychology, Centro ArboretumSan Salvador, El Salvador
| | - Sheila Izu
- Department of Personality, Assessment and Psychological Treatment, Universitat de BarcelonaBarcelona, Spain
| | | | - Antoni Grau
- Institut de Trastorns AlimentarisBarcelona, Spain
| | - Guillem Feixas
- Department of Personality, Assessment and Psychological Treatment, Universitat de BarcelonaBarcelona, Spain
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