1
|
Byrne SM, Fursland A. New understandings meet old treatments: putting a contemporary face on established protocols. J Eat Disord 2024; 12:26. [PMID: 38336928 PMCID: PMC10854196 DOI: 10.1186/s40337-024-00983-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
In the twenty years since the publication of the most widely used treatment manuals describing evidence-based therapies for eating disorders, there have been some substantial advances in the field. New methods of delivering treatments have been trialled and our perception of mental health has advanced; significant cultural changes have led to shifts in our societal landscape; and new technologies have allowed for more in-depth research to be conducted. As a result, our understanding of eating disorders and their treatment has broadened considerably. However, these new insights have not necessarily been translated into improved clinical practice. This paper highlights the changes we consider to have had the greatest impact on our work as experienced clinical psychologists in the field and suggests a list of new learnings that might be incorporated into clinical practice and research design.
Collapse
Affiliation(s)
- Susan M Byrne
- University of Western Australia, Perth, WA, Australia.
| | | |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Monthuy-Blanc J, Corno G, Abou Chabake S. Exploring the impact of the COVID-19 pandemic on perceptual disturbances and dysfunctional eating attitudes and behaviors: A review of the literature. Front Psychol 2023; 14:1139261. [PMID: 37008865 PMCID: PMC10050699 DOI: 10.3389/fpsyg.2023.1139261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
From the outbreak of the novel coronavirus 2019 (COVID-19) a new physical and social distancing environment has changed our lives and, more particularly, the way of perceiving oneself, as well as eating attitudes and behaviors. An increasing number of studies have highlighted a risky scenario in terms of negative perceptions of one’s body as well as disordered eating and eating disorder patterns in both clinical and general population. With regard to this postulate, this literature review posits two main concepts—perceptual disturbances and dysfunctional eating attitudes and behaviors—in the general and (sub-)clinical populations, to provide an understanding of these phenomena during the COVID-19 pandemic. The main objective of this article is to provide a comprehensive and critical review of published scientific literature about perceptual disturbances (i.e., negative body image, body image disturbances, low body esteem) and dysfunctional eating attitudes and behaviors, including disordered eating (e.g., restrictive eating, binge-eating episodes, overeating, emotional eating) and eating disorders features in community (i.e., general population) and clinical and sub-clinical samples worldwide during the COVID-19 pandemic. The PubMed, ScienceDirect, Ebsco, and Google Scholar databases were searched. The initial search produced 42 references. Scientific publications from March 2020 to April 2022 were included, and among the works compiled, only published research articles have been retained. Purely theoretical papers were also excluded. The final selection consisted of 21 studies, covering both community, clinical (i.e., eating disorder population), and sub-clinical samples. The details of the results are discussed taking into consideration the potential impact of changes in the way we perceive ourselves and interact with others (e.g., the popularity of videoconferencing and the over-use of social network sites due to social isolation) as well as changes in eating attitudes and behaviors, physical activity and exercise (e.g., as an emotional response to the insecurity generated by the pandemic context), in community and (sub-)clinical samples. The discussion sheds light on two outcomes: (1) a summary of findings with methodological considerations; (2) an intervention continuum to deal with the consequences of the COVID-19 pandemic; (3) and a final conclusion.
Collapse
Affiliation(s)
- Johana Monthuy-Blanc
- Loricorps Research Unit, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
- Department of Sciences of Education, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- *Correspondence: Johana Monthuy-Blanc,
| | - Giulia Corno
- Loricorps Research Unit, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
- Department of Psychology and Psychoeducation, Laboratory of Cyberpsychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Sara Abou Chabake
- Loricorps Research Unit, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
- Department of Psychology, LESPOIR Research Laboratory, Université de Montréal, Montréal, QC, Canada
- Department of Psychology, TRAJETS Research Laboratory, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
4
|
Ouellet M, Monthuy-Blanc J, Pauzé R, Rousseau M, Bouchard S. What my body looks like and what my body can do: A self-perception explanation of excessive exercise in young adults with anorexia and/or bulimia. Front Psychol 2022; 13:916294. [PMID: 36324769 PMCID: PMC9620860 DOI: 10.3389/fpsyg.2022.916294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 09/27/2022] [Indexed: 11/27/2022] Open
Abstract
The present study examined the relationships between quantitative and qualitative dimensions of excessive exercise (EE) with the physical self-perception’s dimensions and perceptual perspectives of body image (i.e., allocentric/3rd person and egocentric/1st person perspectives). The eLoriCorps Immersive Body Rating Scale 1.1, the very short form version of the Physical Self-Inventory and the Exercise and Eating Disorder test were used. The study includes 36 people with anorexia and/or bulimia seeking an external and specialized transdisciplinary program for eating disorders. Results show a different correlational profile of physical self-perceptions depending on the dimension (qualitative or quantitative) used to define EE. Differences in the perspectives used to assess body dissatisfaction (allocentric or egocentric) were also found. Perceived physical appearance was the key predictor of the qualitative dimension of excessive exercise. Findings suggest that EE in patients with an eating disorder could be explained by the feeling of competence not only related to physical appearance but also to physical abilities.
Collapse
Affiliation(s)
- Marilou Ouellet
- GR2TCA-Loricorps-Groupe de Recherche Transdisciplinaire des Troubles du Comportement Alimentaire, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Research Center, Institut Paul Bocuse, Écully, France
| | - Johana Monthuy-Blanc
- GR2TCA-Loricorps-Groupe de Recherche Transdisciplinaire des Troubles du Comportement Alimentaire, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
- *Correspondence: Johana Monthuy-Blanc,
| | - Robert Pauzé
- Department of Psychoeducation, Education Faculty, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Michel Rousseau
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Stéphane Bouchard
- GR2TCA-Loricorps-Groupe de Recherche Transdisciplinaire des Troubles du Comportement Alimentaire, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
- Chaire de Recherche du Canada en Cyberpsychologie Clinique, Université du Québec en Outaouais, Gatineau, QC, Canada
| |
Collapse
|
5
|
Flatt RE, Miller AJ, Foreman T, Shannon J. Considerations for Athletes with Eating Disorders Based on Levels of Care. Curr Sports Med Rep 2022; 21:92-99. [PMID: 35245244 DOI: 10.1249/jsr.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT This article provides an overview of levels of care for eating disorders (EDs) and considerations that are specific to elite athletes. We discuss the following levels of care in terms of ED pathology and treatment aspects that may be unique to athletes: 1) inpatient and residential care, 2) intensive outpatient and partial hospitalization treatment, and 3) outpatient. Illustrative case studies also are presented to highlight distinctions between levels of care and athlete-specific nuances to treatment approaches and health care teams. Finally, we review aspects of return to play plans for elite athletes with EDs.
Collapse
Affiliation(s)
| | - Alexandra J Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tonya Foreman
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeni Shannon
- Department of Sports Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
6
|
Ouellet M, Monthuy-Blanc J. Quand bouger n’est plus synonyme de santé : une recension des traitements de l’exercice physique pathologique en troubles des conduites alimentaires. ANNALES MEDICO-PSYCHOLOGIQUES 2022. [DOI: 10.1016/j.amp.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
7
|
Gorrell S, Flatt RE, Bulik CM, Le Grange D. Psychosocial etiology of maladaptive exercise and its role in eating disorders: A systematic review. Int J Eat Disord 2021; 54:1358-1376. [PMID: 33942917 PMCID: PMC8811798 DOI: 10.1002/eat.23524] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Although maladaptive exercise (ME) is widely recognized as a clinical feature in transdiagnostic eating disorders, less is known about psychosocial factors that give rise to and perpetuate this behavior. This systematic review aimed to examine the empirical status of this association. METHOD We reviewed 46 full text articles examining longitudinal associations between psychosocial variables and ME. RESULTS Eighteen studies met full inclusion criteria. Based on our qualitative synthesis, evidence suggests reasonably consistent associations between early concern with weight and shape, and negative affect on later development of ME. DISCUSSION Inconsistent and insufficient assessment of ME across a majority of studies underscores caution in interpretation of results, but guides important discussion for future clinical and research efforts.
Collapse
Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Rachael E. Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cynthia M. Bulik
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| |
Collapse
|
8
|
Hockin-Boyers H, Warin M. Women, Exercise, and Eating Disorder Recovery: The Normal and the Pathological. QUALITATIVE HEALTH RESEARCH 2021; 31:1029-1042. [PMID: 33593178 PMCID: PMC8114432 DOI: 10.1177/1049732321992042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The appropriate form, regularity, and intensity of exercise for individuals recovering from eating disorders is not agreed upon among health care professionals or researchers. When exercise is permitted, it is that which is mindful, embodied, and non-competitive that is considered normative. Using Canguilhem's concepts of "the normal and the pathological" as a theoretical frame, we examine the gendered assumptions that shape medical understandings of "healthy" and "dysfunctional" exercise in the context of recovery. The data set for this article comes from longitudinal semi-structured interviews with 19 women in the United Kingdom who engaged in weightlifting during their eating disorder recovery. We argue that women in recovery navigate multiple and conflicting value systems regarding exercise. Faced with aspects of exercise that are pathologized within the eating disorder literature (such as structure/routine, body transformations, and affect regulation), women re-inscribe positive value to these experiences, thus establishing exercise practices that serve them.
Collapse
Affiliation(s)
| | - Megan Warin
- University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
9
|
Mang L, Garghan A, Grant J, Lacey H, Matthews R. An evaluation of efficacy and acceptability of a novel manualised JuniorLEAP group programme for compulsive exercise, for children and adolescents with anorexia nervosa, within an inpatient setting. Eat Weight Disord 2021; 26:591-597. [PMID: 32232776 DOI: 10.1007/s40519-020-00884-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/26/2020] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Compulsive exercise is a symptom and a maintenance factor of eating disorders, which increases the risk of relapse. It has been considered a target for treatment, particularly for anorexia nervosa (AN). This audit aims to review the efficacy and acceptability of a new seven-week JuniorLEAP group therapy programme, for children and adolescents with anorexia nervosa. JuniorLEAP was adapted by the authors and based on the Loughborough Eating Disorder Activity Programme (LEAP) for adults. METHODS 32 children and adolescents with anorexia nervosa were allocated to the group in an in-patient setting using entry criteria. All children and adolescents completed seven weekly sessions of the JuniorLEAP programme, as well as pre- and post-treatment questionnaires, including the Eating Disorder Examination Questionnaire (EDE-Q) and the Compulsive Exercise Test (CET). The children and adolescents were also asked to provide qualitative responses about the acceptability of the group. A paired t test was conducted to review the efficacy of the JuniorLEAP programme. RESULTS Significant changes in eating disorder psychopathology was observed, as measured by the EDE-Q, with total mean scores reducing from 3.53 to 2.77 (p = 0.001). Compulsive exercise attitudes were also observed to reduce, as measured by the CET, with total mean scores reducing from 15.39 to 10.90 (p ≤ 0.001). Furthermore, there was a significant reduction in all five subscales of the CET following completion of the group. Qualitative results also demonstrate the group to be acceptable to the patients. CONCLUSION This study finds that a new manualised JuniorLEAP group therapy, specifically adapted for adolescents and children with AN, when used as an adjuvant with other therapies in a residential setting, significantly reduces their compulsive exercise, as measured by CET. The patients reported that the treatment was acceptable. Further research testing the new treatment in a randomised controlled trial is now needed, particularly to disentangle the impact of other aspects of standard treatment in reducing compulsive exercise. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
| | | | | | - Hubert Lacey
- Newbridge House, Birmingham, UK. .,St. George's, University of London, London, UK.
| | | |
Collapse
|
10
|
Chubbs-Payne A, Lee J, Isserlin L, Norris ML, Spettigue W, Spence K, Longmuir PE. Attitudes toward physical activity as a treatment component for adolescents with anorexia nervosa: An exploratory qualitative study of patient perceptions. Int J Eat Disord 2021; 54:336-345. [PMID: 33185901 DOI: 10.1002/eat.23411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/15/2020] [Accepted: 10/31/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) with compulsive exercise is associated with poor treatment outcomes. This study sought to understand the attitudes of adolescents with AN from various stages of treatment, toward physical activity research practices and physical activity as a component of treatment. METHOD Seventeen adolescents 12-18 years old (15 female) with AN (10 with acknowledged history of compulsive exercise) were recruited from a Canadian Tertiary Care Hospital's Eating Disorder Program. Six inpatients, 5-day program patients, and six outpatients treated by either the inpatient and/or day treatment program in the past 2 years completed individual, semi-structured interviews that were audio-recorded and transcribed. Results were analyzed deductively using qualitative techniques. RESULTS Participants recognized both benefits (psychological, sociological, and physiological) and risks (trigger negative thoughts, increase competitive behavior) of implementing physical activity into acute AN treatment. Patient characteristics, such as stage of treatment and exercise history, had an impact on participants' perceptions toward physical activity in AN. Participants suggested that the ideal physical activity program would be focused on fun, individualized and progressively integrated, group-based, and directly supported by staff. Although the majority of participants stated that they would wear an activity monitor for research purposes, concerns were voiced regarding compliance and the potential impact on eating disorder symptomatology. DISCUSSION Participants overwhelmingly supported the careful implementation of structured physical activity and physical activity psychoeducation into the acute treatment of adolescents with AN. This study allows for the inclusion of patient voices in the conversation surrounding the role of physical activity in AN treatment.
Collapse
Affiliation(s)
- Adam Chubbs-Payne
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Ottawa's Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jacqueline Lee
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Leanna Isserlin
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Mark L Norris
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Kelly Spence
- Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Ottawa's Faculty of Medicine, Ottawa, Ontario, Canada
| |
Collapse
|
11
|
Brunet J, Del Duchetto F, Wurz A. Physical activity behaviors and attitudes among women with an eating disorder: a qualitative study. J Eat Disord 2021; 9:20. [PMID: 33568228 PMCID: PMC7877068 DOI: 10.1186/s40337-021-00377-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity (PA) is an integral part of healthcare for the general population and individuals with psychiatric disorders. However, PA is significantly more complex for and related to both healthy (e.g., reduced anxiety and depressive symptoms) and unhealthy outcomes (e.g., intrusive, repetitive thoughts that lead to abnormally high levels of PA) among women with an eating disorder (ED). Consequently, many healthcare professionals recommend abstinence from PA during ED treatment. Despite this, women may remain engaged in PA during ED treatment or resume PA shortly thereafter. Little has been done to understand women's PA behaviors and attitudes and to explore how they integrate PA into their lives during and after ED treatment. Thus, this study sought to explore PA behaviors and attitudes among women with an ED. METHODS Nine women who self-reported receiving an ED diagnosis participated in semi-structured interviews, which were transcribed and analysed thematically. RESULTS Six interrelated themes were constructed to represent participants' PA experiences: PA as a lifestyle, PA can be beneficial, How I feel when I can't do PA, Being cautious about PA, Reactions to healthcare professionals' practice of recommending abstinence from PA during ED treatment, and PA programming thoughts. CONCLUSIONS Overcoming dysfunctional PA behaviors (e.g., engaging in abnormally high levels of PA) and attitudes (e.g., associating PA with caloric expenditure) can be a long and complicated journey for women with an ED. Nevertheless, women with an ED want PA to be integrated into their ED treatment protocol for two key reasons, namely to accrue the benefits associated with PA and to learn how to engage in PA in adaptive and healthy ways.
Collapse
Affiliation(s)
- Jennifer Brunet
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, Ottawa, Ontario, K1N 6N5, Canada. .,Cancer Therapeutics Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada. .,Institut du savoir Montfort, Hôpital Montfort, 713 Montreal Road, Ottawa, Ontario, K1K 0T2, Canada.
| | - Francis Del Duchetto
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, Ottawa, Ontario, K1N 6N5, Canada.,Present address: Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, Québec, G8Z 4M3, Canada
| | - Amanda Wurz
- Faculty of Kinesiology, University of Calgary, 2500 University Drive, Calgary, Alberta, T2N 1N4, Canada
| |
Collapse
|
12
|
Martenstyn JA, Touyz S, Maguire S. Treatment of compulsive exercise in eating disorders and muscle dysmorphia: protocol for a systematic review. J Eat Disord 2021; 9:19. [PMID: 33568203 PMCID: PMC7877054 DOI: 10.1186/s40337-021-00375-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/29/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Compulsive exercise is a core feature of both eating disorders and muscle dysmorphia. Earlier models of treatment recommended complete abstinence from exercise in eating disorder populations, but recent guidelines advocate for the gradual inclusion of healthier forms of exercise into an overall treatment plan where appropriate. Given the association between problematic exercise behaviour and poorer prognosis, there has been a recent upsurge in the number of treatment interventions for compulsive exercise in eating disorders. However, no systematic review has been published summarising this existing treatment literature. The aim of this review is to determine the efficacy of existing treatments for compulsive exercise in eating disorders and muscle dysmorphia. METHODS A systematic review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five electronic databases (PsycInfo, MEDLINE, Embase, Web of Science, and Scopus) will be searched from database inception until November 2020. We will include studies that: (a) sampled adolescents and/or adults with either an eating disorder or muscle dysmorphia; (b) assessed changes in compulsive exercise from pre- to post-intervention; and (c) used a standardised instrument to measure compulsive exercise or related constructs. We will include studies with a comparison group (e.g., randomised controlled trials) and without a comparison group (e.g., pilot studies and case studies) to provide a comprehensive overview of the literature. One reviewer will screen all titles and abstracts against eligibility criteria, with 20% of excluded articles cross-referenced by another reviewer. Full texts will be obtained for articles deemed relevant or where inclusion was uncertain, and will be screened by both reviewers. We will also evaluate the quality of the included studies using a modified Downs and Black (J Epidemiol Community Health 52:377-384, 1998) assessment checklist. DISCUSSION Results from this review will help to determine the most efficacious treatment components for compulsive exercise in eating disorders and muscle dysmorphia. We hope that our results will help inform clinical practice guidelines in recommending targeted interventions for the treatment of compulsive exercise.
Collapse
Affiliation(s)
- Jordan Andre Martenstyn
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia.
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia.
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, St Leonards, Australia
| |
Collapse
|
13
|
Danielsen M, Bjørnelv S, Weider S, Myklebust TÅ, Lundh H, Rø Ø. The outcome at follow-up after inpatient eating disorder treatment: a naturalistic study. J Eat Disord 2020; 8:67. [PMID: 33292634 PMCID: PMC7709321 DOI: 10.1186/s40337-020-00349-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/03/2020] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Patients with eating disorders may experience a severe and enduring course of illness. Treatment outcome for patients provided with inpatient treatment is reported as poor. Research to date has not provided consistent results for predictors of treatment outcome. The aims of the study were to investigate rates of remission at follow-up after inpatient treatment, symptom change from admission to follow-up, and predictors of treatment outcome. METHODS The follow-up sample consisted of 150 female adult former patients (69.4% of all eligible female patients) with eating disorders. Mean age at admission was 21.7 (SD = 4.9) years. Diagnostic distribution: 66% (n = 99) anorexia nervosa, 21.3% (n = 32) bulimia nervosa and 12.7% (n = 19) other specified feeding or eating disorder, including binge eating. Data were collected at admission, discharge and follow-up (mean 2.7 (SD = 1.9) years). Definition of remission was based on the EDE-Q Global score, body mass index and binge/purge behavior. Paired T-tests were performed to investigate change over time. Univariate and multivariate logistic regressions were estimated to investigate predictors of remission. RESULTS At follow-up, 35.2% of the participants were classified as in remission. Significant symptom reduction (in all patients) (p < 0.001) and significant increase in body mass index (BMI) (in underweight participants at admission) (p < 0.001) was found. Increased BMI (p < 0.05), the level of core eating disorder symptoms at admission (p < 0.01) and reduced core eating disorder symptoms (p < 0.01) during inpatient treatment were found significant predictors of outcome in the multivariate model. CONCLUSIONS All participants had an eating disorder requiring inpatient treatment. Approximately one-third of all participants could be classified as in remission at follow-up. However, most participants experienced significant symptom improvement during inpatient treatment and the improvements were sustained at follow-up. Increased probability of remission at follow-up was indicated by lower core ED symptoms at admission for all patients, raised BMI during admission for patients with AN, and reduced core ED symptoms during inpatient treatment for all patients. This finding contributes important information and highlights the importance of targeting these core symptoms in transdiagnostic treatment programs.
Collapse
Affiliation(s)
- Marit Danielsen
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Hospital Trust Nord-Trøndelag, NO-7600, Levanger, Norway. .,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Sigrid Bjørnelv
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Hospital Trust Nord-Trøndelag, NO-7600, Levanger, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Siri Weider
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Hospital Trust Nord-Trøndelag, NO-7600, Levanger, Norway.,Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Henrik Lundh
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Hospital Trust Nord-Trøndelag, NO-7600, Levanger, Norway
| | - Øyvind Rø
- Regional Eating Disorder Service, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
14
|
Savidaki M, Demirtoka S, Rodríguez-Jiménez RM. Re-inhabiting one's body: A pilot study on the effects of dance movement therapy on body image and alexithymia in eating disorders. J Eat Disord 2020; 8:22. [PMID: 32426135 PMCID: PMC7212562 DOI: 10.1186/s40337-020-00296-2] [Citation(s) in RCA: 10] [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: 11/05/2019] [Accepted: 04/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Body image disturbance and alexithymia are two core aspects of Eating Disorders (EDs). However, standard treatments for EDs do not include specific techniques to approach these issues on a bodily level. This pilot study evaluated the effects of a Dance Movement Therapy (DMT) intervention on body image and alexithymia in patients with EDs, and also explored their experience of the therapeutic process. METHOD 14 patients with EDs were recruited from a private clinic. Seven were assigned via quasi-randomization to the DMT group and the others (n = 5) continued their treatment as usual. The length of the intervention was 14 weeks. All participants completed the Multidimensional Body Self Relations Questionnaire (MBSRQ) and the Toronto Alexithymia Scale (TAS-20) at the beginning and at the end of the intervention. Additionally, the DMT group wrote reflective diaries about their experience at the end of each session, which were analyzed using qualitative methods. RESULTS Between the pre- and post-intervention, the participants of the DMT group significantly improved in Body Areas Satisfaction (effect size: 0.95) and Appearance Evaluation (effect size: 1.10), and they decreased significantly in Appearance Orientation (effect size: 1.30). A decrease in Overweight Preoccupation was observed (effect size: 0.75), however this was not statistically significant. The control group did not show significant changes in any of the MBSRQ subscales. Neither the DMT group nor the control group improved significantly in the alexithymia scores. The qualitative analysis revealed valuable insights into the participants' processes throughout the sessions. In general, participants received the DMT intervention positively. They reported improvements in their mood states and an increase in their self-awareness. They also appreciated the relationship with the group and the therapist. CONCLUSION These results indicate that DMT might be a complementary treatment option for EDs, as it may be able to address body image issues more effectively than verbal therapies. More studies with larger samples are needed to confirm these promising preliminary results.
Collapse
Affiliation(s)
- Maria Savidaki
- Psychology Department, Autonomus University of Barcelona, Plaça Cívica, Barcelona, 08193 Spain
| | - Sezin Demirtoka
- Psychology Department, Autonomus University of Barcelona, Plaça Cívica, Barcelona, 08193 Spain
| | | |
Collapse
|
15
|
Marzola E, Panero M, Cavallo F, Delsedime N, Abbate-Daga G. Body shape in inpatients with severe anorexia nervosa. Eur Psychiatry 2020; 63:e2. [PMID: 32093789 PMCID: PMC7315881 DOI: 10.1192/j.eurpsy.2019.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/16/2019] [Accepted: 10/26/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a severe mental disorder. Body shape disturbances are key in the development and maintenance of AN. Only few data are available on inpatients with life-threatening AN. Therefore, we aimed to investigate if body shape difficulties-with a focus on both body checking and avoidance-could improve during hospitalization in both subtypes of AN and to ascertain eventual associations between body shape concerns upon admission and clinical outcome. METHODS Upon hospital admission and end of treatment (EOT), 139 inpatients with AN completed Body Shape Questionnaire (BSQ), Body Checking Questionnaire (BCQ), and Body Image Avoidance Questionnaire (BIAQ) in addition to measures of eating and general psychopathology. RESULTS Patients with severe AN reported improved BSQ and BIAQ scores at EOT while BCQ did not significantly change. Diagnostic subtypes differed only in baseline BSQ scores and had an impact on the improvement in BSQ at EOT. Baseline BCQ was associated with patients' clinical improvement at EOT, even after controlling for age, duration of illness, Body Mass Index, depression, and anxiety scores. CONCLUSIONS Data on body shape concerns and their trajectory during hospitalization for severe AN are lacking; our findings provide support to the effectiveness of hospitalization in improving body shape concerns and body avoidance, but not body checking. Also, baseline body shape concerns (especially body checking) impacted on clinical improvement. Future research is needed to identify treatments that could further improve the therapeutic approach to severe patients of AN in the acute setting.
Collapse
Affiliation(s)
- Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Panero
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Fabio Cavallo
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Nadia Delsedime
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| |
Collapse
|
16
|
Cuerda C, Vasiloglou MF, Arhip L. Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa. J Clin Med 2019; 8:E1042. [PMID: 31319585 PMCID: PMC6679071 DOI: 10.3390/jcm8071042] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a psychiatric disorder characterised by a physical and psychosocial deterioration due to an altered pattern on the intake and weight control. The severity of the disease is based on the degree of malnutrition. The objective of this article is to review the scientific evidence of the refeeding process of malnourished inpatients with AN; focusing on the clinical outcome. METHODS We conducted an extensive search in Medline and Cochrane; on April 22; 2019; using different search terms. After screening all abstracts; we identified 19 papers that corresponded to our inclusion criteria. RESULTS The article focuses on evidence on the characteristics of malnutrition and changes in body composition; energy and protein requirements; nutritional treatment; physical activity programmes; models of organisation of the nutritional treatment and nutritional support related outcomes in AN patients. CONCLUSION Evidence-based standards for clinical practice with clear outcomes are needed to improve the management of these patients and standardise the healthcare process.
Collapse
Affiliation(s)
- Cristina Cuerda
- Nutrition Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain.
| | - Maria F Vasiloglou
- Diabetes Technology Research Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008 Bern, Switzerland
| | - Loredana Arhip
- Nutrition Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain
| |
Collapse
|