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Gibbs EL, Runfola CD, Dickens CE, Welch H, Safer DL, Sadeh-Sharvit S. Parenting after Weight Loss Surgery: A Conceptual Model and Two Case Reports. Fam Process 2020; 59:1903-1913. [PMID: 31826298 DOI: 10.1111/famp.12518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ways families approach eating, shape, and weight can result in stress for individual family members and challenge the overall functioning of the family. This is further complicated among families with a parent who has history of obesity or undergone weight loss surgery (WLS). Although WLS can positively impact other family members, it can also exacerbate conflicts regarding feeding and weight. Such conflicts can involve uncertainty regarding the extent to which the entire family should make the dietary changes recommended for the post-WLS parent. Conflict might also center on the appropriate level of concern regarding the children's risk of developing (or maintaining) obesity. This paper uses two case examples to describe the application of a specialized, time-limited intervention: Parent-Based Prevention following Bariatric Surgery (PBP-B). The program was developed to address the unique challenges and concerns that arise after, or are exacerbated by, WLS. Each detailed case example illustrates a common child-feeding challenge and the employment of key PBP-B strategies throughout the course of treatment. In the first case, the parent who had undergone WLS believed the family's current eating behaviors were the same as those that had led to her own overeating, obesity, and co-occurring psychiatric symptoms, while her husband disagreed. In the second case, both parents were concerned about their son's weight, yet due to their prior eating histories, they felt unable to construct boundaries around the feeding experience. Both cases follow families through the entire intervention and illustrate key points and challenges. These cases underscore the need for novel treatment modalities to support families following parental WLS.
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Affiliation(s)
- Elise L Gibbs
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Cristin D Runfola
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Caroline E Dickens
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Hannah Welch
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Debra L Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
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2
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Sadeh-Sharvit S, Sacks MR, Runfola CD, Bulik CM, Lock JD. Interventions to Empower Adults with Eating Disorders and Their Partners around the Transition to Parenthood. Fam Process 2020; 59:1407-1422. [PMID: 31799711 DOI: 10.1111/famp.12510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The transition to parenthood is perceived as a stressful life event, when parents experience an immense change of their psychological focus and a reorientation of roles and responsibilities in the family system. This process may be even more challenging in the presence of a parental eating disorder history. This paper reviews the impact of parental eating disorders on the parents, the couple relationship, and their child during the perinatal period. A parental eating disorder is associated with more negative expectations of parental efficacy as well as specific difficulties in couple communication over the child's feeding, shape, and weight. Providers who better understand the effects of an eating disorder on parental functioning can more effectively intervene early on. We also present couple- or parent-based, empirically supported interventions for adults with eating disorders and their partners in the prenatal and postnatal periods: Uniting Couples in the treatment of Anorexia Nervosa (UCAN) and Uniting couples In the Treatment of Eating disorders (UNITE) both enhance recovery from the eating disorder through a couple-based intervention; the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) incorporates the support of partners, when appropriate; Parent-Based Prevention (PBP) focuses on improving parental functioning and reducing risk of negative parental and child outcomes. Finally, we discuss the clinical implications of addressing parental eating disorders and encourage more research on these families.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Madeline R Sacks
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Cristin D Runfola
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Cynthia M Bulik
- Department of Psychiatry, UNC Center of Excellence for Eating Disorders, The University of North Carolina School of Medicine, Chapel Hill, NC
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - James D Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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3
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Sadeh-Sharvit S, Runfola CD, Welch HA, Gibbs EL, Dickens CE, Lock J, Safer DL. Parent-based prevention after parental weight loss surgery: a pilot case-series trial. Surg Obes Relat Dis 2020; 16:1321-1327. [PMID: 32636177 DOI: 10.1016/j.soard.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Overeating and obesity are elevated in children of parents who have undergone weight loss surgery. Parents who have undergone weight loss surgery often report their personal history of obesity interferes with their knowledge, skills, and self-efficacy in developing their children's healthy habits, thus reducing the likelihood of addressing obesogenic environmental factors. OBJECTIVES This study examines whether a 6-session parent-based prevention after bariatric surgery online intervention is feasible and acceptable for parents. The study also explores the program's signal of efficacy in improving short-term outcomes related to decreased long-term risks for obesity by examining short-term impact on targeted parental cognitions, feeding practices, and child eating behaviors and physical activity habits. SETTING University Hospital, United States. METHODS Parents were recruited using flyers, clinician referrals, and social media. Measures assessed parental feeding practices, children's eating behaviors, daily hours of screen time, and outdoor play. RESULTS Ten families enrolled and 7 completed the study. Parents found the intervention relevant and suitable for addressing their parenting concerns. Parental feeding behaviors, such as restriction and pressure to eat, reduced while tracking of sweets and high-fat snacks increased. Children reduced both emotional overeating and undereating. Children's daily hours of screen time reduced as well as their outdoor play time. CONCLUSIONS Parent-based prevention after bariatric surgery aimed at helping parents who have undergone weight loss surgery engineer healthier family lifestyles is feasible, acceptable, and associated with reduced obesogenic risk factors.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California; Interdisciplinary Center, Baruch Ivcher School of Psychology, Herzliya, Israel.
| | - Cristin D Runfola
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Hannah A Welch
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Elise L Gibbs
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Caroline E Dickens
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Debra L Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
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Dickens CE, Safer DL, Runfola CD, Gibbs EL, Welch H, Sadeh-Sharvit S. The offspring of parents undergoing a weight loss surgery: a systematic review. Surg Obes Relat Dis 2020; 16:806-815. [PMID: 32334972 DOI: 10.1016/j.soard.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 02/06/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022]
Abstract
The offspring of parents with obesity are at an increased risk of developing this condition themselves because of genetic and environmental factors. One subgroup that may be at particularly high risk of developing obesity is the offspring of parents who have undergone weight loss surgery (PWLS). To date, little research has focused on these offspring or their parents. This systematic review addresses this gap by integrating available literature and assessing the quality of the evidence. To be included, studies were required to have researched characteristics of the offspring of PWLS or parental feeding practices within this population. After review, 12 studies met inclusion criteria. Findings include evidence for heightened risk of obesity among children of PWLS. However, research suggests these children may experience positive, although time-limited, health outcomes after their parents' surgeries. Quality of the evidence was rated as low, primarily because of the lack of randomized controlled studies and information regarding available interventions specifically targeting this vulnerable population. This review underscores the need for research to improve understanding of PWLS families to better support them and capitalize on postbariatric surgery benefits.
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Affiliation(s)
- Caroline E Dickens
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Debra L Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Cristin D Runfola
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Elise L Gibbs
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Hannah Welch
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California; Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel.
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5
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Brown T, Nauman Vogel E, Adler S, Bohon C, Bullock K, Nameth K, Riva G, Safer DL, Runfola CD. Bringing Virtual Reality From Clinical Trials to Clinical Practice for the Treatment of Eating Disorders: An Example Using Virtual Reality Cue Exposure Therapy. J Med Internet Res 2020; 22:e16386. [PMID: 32324145 PMCID: PMC7206518 DOI: 10.2196/16386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/07/2019] [Accepted: 12/15/2019] [Indexed: 12/11/2022] Open
Abstract
Novel treatment options for eating disorders (EDs) are critically needed to enhance treatment outcomes and reduce the rates of treatment dropouts. On average, only 50% of individuals receiving evidence-based care remit, whereas 24% drop out before treatment completion. One particularly promising direction involves integrating virtual reality (VR) with existing evidence-based treatments (EBTs) such as cue exposure therapy (CET). Across psychiatric disorders, VR-based interventions are demonstrating at least preliminary efficacy and noninferiority to traditional treatments. Furthermore, VR technology has become increasingly portable, resulting in improved acceptance, increased access, and reductions in cost. However, more efficient research processes may be needed to uncover the potential benefits of these rapid technological advances. This viewpoint paper reviews existing empirical support for integrating VR with EBTs (with a focus on its use with EDs) and proposes key next steps to more rapidly bring this innovative technology-based intervention into real-world clinic settings, as warranted. VR-CET for EDs is used to illustrate a suggested process for developing such treatment enhancements. We recommend following a deployment-focused model of intervention development and testing to enable rapid implementation of robust, practice-ready treatments. In addition, our review highlights the need for a comprehensive clinical protocol that supports clinicians and researchers in the implementation and testing of VR-CET and identifies key missing protocol components with rationale for their inclusion. Ultimately, this work may lead to a more complete understanding of the full potential of the applications and integrations of VR into mental health care globally.
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Affiliation(s)
- Theresa Brown
- PGSP-Stanford PsyD Consortium, Palo Alto, CA, United States
| | | | - Sarah Adler
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Katherine Nameth
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy.,Centro Studi e Ricerche di Psicologia della Comunicazione, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Debra L Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Cristin D Runfola
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
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6
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Weber DM, Fischer MS, Baucom DH, Baucom BRW, Kirby JS, Runfola CD, Matherne CE, Bulik CM. The Association between Symptom Accommodation and Emotional Coregulation in Couples with Binge Eating Disorder. Fam Process 2019; 58:920-935. [PMID: 30229890 DOI: 10.1111/famp.12391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intense negative emotions and maladaptive behavioral strategies to reduce emotional distress occur not only in patients with various forms of psychopathology but also in their committed partners. One common strategy to reduce distress is for partners to accommodate to the symptoms of the disorder, which reduces distress short term but maintains symptoms long term. Accommodation is believed to be motivated by the partner reacting behaviorally to the patient's emotions, but the emotions of the partner in this context have yet to be examined. This pilot study examined how partner accommodation related to specific patterns of emotional coregulation between patients with binge eating disorder (BED) and their partners, before and after a couple-based intervention for BED. Vocally encoded emotional arousal was measured during couples' (n = 11) conversations about BED. As predicted, partners' emotional reactivity to patients' emotional arousal was associated with high accommodation before treatment. Thus, partners may use accommodation as a strategy to reduce both the patients' and their own distress. After treatment, partners' arousal was no longer associated with the patients' emotional arousal; instead, partners showed greater emotional stability over time, specifically when accommodation was low. Additionally, patients were less emotionally aroused after treatment. Therefore, treatment may have decreased overall emotionality of patients and altered the association between accommodation and partners' emotional reactivity. If replicated, this understanding of the emotional context associated with accommodation in BED can inform couple-based treatment by targeting specific emotional precipitants of behaviors that maintain symptoms.
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Affiliation(s)
- Danielle M Weber
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Melanie S Fischer
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian R W Baucom
- Department of Psychology, University of Utah, University of Utah, Salt Lake City, UT
| | - Jennifer S Kirby
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Cristin D Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Camden E Matherne
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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7
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Baker JH, Higgins Neyland MK, Thornton LM, Runfola CD, Larsson H, Lichtenstein P, Bulik C. Body dissatisfaction in adolescent boys. Dev Psychol 2019; 55:1566-1578. [PMID: 30985163 DOI: 10.1037/dev0000724] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Body dissatisfaction is a significant mental health symptom present in adolescent girls and boys. However, it is often either disregarded in adolescent boys or examined using assessments that may not resonate with males. The present study addresses these issues, examining the manifestation, etiology, and correlates of 3 facets of body dissatisfaction in adolescent boys. Adolescent male twins aged 16- to 17-years-old from the Swedish Twin Study of Child and Adolescent Development were included along with a female comparison group: 915 monozygotic and 671 dizygotic same-sex twins. Body dissatisfaction was defined using measures of height dissatisfaction, muscle dissatisfaction, and the body dissatisfaction subscale of the Eating Disorder Inventory (EDI-BD). We examined the prevalence of body dissatisfaction, whether the facets of body dissatisfaction were phenotypically and etiologically distinct, and associations with specific externalizing and internalizing symptoms. For boys, muscle dissatisfaction scores were greater than height dissatisfaction scores. Results also indicated that height and muscle dissatisfaction were phenotypically and etiologically distinct from the EDI-BD. Unique associations were observed with externalizing and internalizing symptoms: muscle dissatisfaction with symptoms of bulimia nervosa and the EDI-BD with internalizing symptoms, body mass index, and drive for thinness. The facets of body dissatisfaction were also largely distinct in girls and unique between-sex associations with externalizing and internalizing symptoms emerged. Overall, male-oriented aspects of body dissatisfaction are distinct from female-oriented aspects of body dissatisfaction. To capture the full picture of male body dissatisfaction, multiple facets must be addressed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Cynthia Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
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8
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Runfola CD, Kirby JS, Baucom DH, Fischer MS, Baucom BRW, Matherne CE, Pentel KZ, Bulik CM. A pilot open trial of UNITE-BED: A couple-based intervention for binge-eating disorder. Int J Eat Disord 2018; 51:1107-1112. [PMID: 30189106 DOI: 10.1002/eat.22919] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the feasibility, acceptability, and preliminary efficacy of a couple-based intervention for binge-eating disorder (BED), called UNiting couples In the Treatment of Eating disorders-BED edition (UNITE-BED). METHOD In an open pilot trial, 11 couples in which one or both adult partners had a diagnosis of DSM-5 threshold or sub-threshold BED participated in 22 weekly sessions of UNITE-BED. Patients also received individual treatment, outside of the context of the trial. Couples completed measures on treatment satisfaction, eating disorder symptom severity, depression, anxiety, emotion regulation, and relational functioning at post-treatment and 3-month follow-up. Statistical analyses were conducted to identify change over the course of treatment. RESULTS UNITE was feasible and acceptable to the majority of couples (9% dropout; high satisfaction ratings). Objective binge abstinence was 81.8% and subjective binge abstinence was 45.5% by post-treatment. Patient binge-eating symptomatology reduced over the course of treatment with results maintained at follow up. Patients' depression symptoms decreased and patients' emotion regulation improved at both time points. DISCUSSION Including partners in treatment for BED may be beneficial. Results support further evaluation of the efficacy of couple-based interventions for BED in larger randomized-controlled trials.
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Affiliation(s)
- Cristin D Runfola
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
| | - Jennifer S Kirby
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
| | - Melanie S Fischer
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | - Camden E Matherne
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
| | - Kimberly Z Pentel
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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9
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Watson HJ, McLagan N, Zerwas SC, Crosby RD, Levine MD, Runfola CD, Peat CM, Moessner M, Zimmer B, Hofmeier SM, Hamer RM, Marcus MD, Bulik CM, Crow SJ. Cost-Effectiveness of Internet-Based Cognitive-Behavioral Treatment for Bulimia Nervosa: Results of a Randomized Controlled Trial. J Clin Psychiatry 2018; 79:16m11314. [PMID: 29228517 PMCID: PMC5837958 DOI: 10.4088/jcp.16m11314] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/22/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of Internet-based cognitive-behavioral therapy for bulimia nervosa (CBT-BN) compared to face-to-face delivery of CBT-BN. METHODS This study is a planned secondary analysis of data from a randomized clinical trial. Participants were 179 adults (98% female, mean age = 28 years) meeting DSM-IV criteria for bulimia nervosa who were randomized to group face-to-face or group Internet-based CBT-BN for 16 sessions during 20 weeks. The cost-effectiveness analysis was conducted from a third-party payor perspective, and a partial societal perspective analysis was conducted to investigate cost-utility (ie, cost per gain in quality-adjusted life-years) and patient out-of-pocket travel-related costs. Net health care costs were calculated from protocol and nonprotocol health care services using third-party payor cost estimates. The primary outcome measure in the clinical trial was abstinence from binge eating and purging, and the trial start and end dates were 2008 and 2016. RESULTS The mean cost per abstinent patient at posttreatment was $7,757 (95% confidence limit [CL], $4,515, $13,361) for face-to-face and $11,870 (95% CL, $6,486, $22,188) for Internet-based CBT-BN, and at 1-year follow-up was $16,777 (95% CL, $10,298, $27,042) for face-to-face and $14,561 (95% CL, $10,165, $21,028) for Internet-based CBT-BN. There were no statistically significant differences between treatment arms in cost-effectiveness or cost-utility at posttreatment or 1-year follow-up. Out-of-pocket patient costs were significantly higher for face-to-face (mean [95% CL] = $178 [$127, $140]) than Internet-based ($50 [$50, $50]) therapy. CONCLUSIONS Third-party payor cost-effectiveness of Internet-based CBT-BN is comparable with that of an accepted standard. Internet-based dissemination of CBT-BN may be a viable alternative for patients geographically distant from specialist eating disorder services who have an unmet need for treatment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00877786.
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Affiliation(s)
- Hunna J. Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia,School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia,Corresponding author: Hunna J. Watson, PhD, Department of Psychiatry, The University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, North Carolina, USA (). Ph: 919-966-5546
| | - Nicole McLagan
- Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Stephanie C. Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota, United States,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, United States
| | - Michele D. Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Cristin D. Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California, United States
| | - Christine M. Peat
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Benjamin Zimmer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Sara M. Hofmeier
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Marsha D. Marcus
- Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, United States,The Emily Program, St Paul, Minnesota, United States
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10
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Yau RK, Golightly YM, Richardson DB, Runfola CD, Waller AE, Marshall SW. Potential Predictors of Injury Among Pre-Professional Ballet and Contemporary Dancers. J Dance Med Sci 2017; 21:53-63. [PMID: 28535848 DOI: 10.12678/1089-313x.21.2.53] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Injuries occur frequently among ballet and contemporary dancers. However, limited literature exists on injuries to pre-professional dancers in the USA. The goals of this study were to 1. provide a descriptive epidemiology of the incidence of musculoskeletal injuries in an adolescent and young adult dance population and 2. identify parsimonious regression models that could be potentially used to predict injury incidence. The study was based at the University of North Carolina School of the Arts (UNCSA) from Fall 2009 to Spring 2015. An injury was defined as any event that caused a dancer to be seen at the UNCSA Student Health Services and caused the dancer to modify or curtail dance activity for at least 1 day. Injury rate ratios (IRRs) were calculated using negative binomial generalized estimating equations. Models predicting injury rates were built using forward selection, stratified by sex. Among 480 dancers, 1,014 injuries were sustained. Most injuries were to the lower extremity and the result of overuse. There were differences in upper extremity, lower extremity, and traumatic injury rates by demographic subgroups. Among females, the most parsimonious predictive model for injury rates included a self-reported history of depression, age at time of injury, and number of injuries sustained at UNCSA prior to the semester of current injury. Among males, the most parsimonious model was a univariate model with family history of alcohol or drug problems. Strategies for traumatic injury prevention among dancers should be both sex- and style-specific. No differences were observed in overuse injury rates by sex or style, suggesting that generic overuse prevention strategies may not need to be guided by these factors. It is concluded that strategies can be implemented to reduce and mitigate the consequences of injuries if not the injuries themselves.
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Affiliation(s)
- Rebecca K Yau
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina, Chapel Hill, and School of Public Health, University of California, Berkeley, Prevention Research Center, Oakland, California;,
| | - Yvonne M Golightly
- Department of Epidemiology, Injury Prevention Research Center, and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill
| | | | - Cristin D Runfola
- Department of Psychiatry, University of North Carolina, Chapel Hill, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Anna E Waller
- Carolina Center for Health Informatics, University of North Carolina, Chapel Hill
| | - Stephen W Marshall
- Department of Epidemiology and Injury Prevention Research Center, University of North Carolina, Chapel Hill
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Levinson CA, Zerwas S, Calebs B, Forbush K, Kordy H, Watson H, Hofmeier S, Levine M, Crosby RD, Peat C, Runfola CD, Zimmer B, Moesner M, Marcus MD, Bulik CM. The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis. J Abnorm Psychol 2017; 126:340-354. [PMID: 28277735 DOI: 10.1037/abn0000254] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bulimia nervosa (BN) is characterized by symptoms of binge eating and compensatory behavior, and overevaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. However, there is little research identifying which specific BN symptoms maintain BN psychopathology and how they are associated with symptoms of depression and anxiety. Network analyses represent an emerging method in psychopathology research to examine how symptoms interact and may become self-reinforcing. In the current study of adults with a Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) diagnosis of BN (N = 196), we used network analysis to identify the central symptoms of BN, as well as symptoms that may bridge the association between BN symptoms and anxiety and depression symptoms. Results showed that fear of weight gain was central to BN psychopathology, whereas binge eating, purging, and restriction were less central in the symptom network. Symptoms related to sensitivity to physical sensations (e.g., changes in appetite, feeling dizzy, and wobbly) were identified as bridge symptoms between BN, and anxiety and depressive symptoms. We discuss our findings with respect to cognitive-behavioral treatment approaches for BN. These findings suggest that treatments for BN should focus on fear of weight gain, perhaps through exposure therapies. Further, interventions focusing on exposure to physical sensations may also address BN psychopathology, as well as co-occurring anxiety and depressive symptoms. (PsycINFO Database Record
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Affiliation(s)
| | - Stephanie Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | | | | | - Hans Kordy
- Center for Psychotherapy Research, University of Heidelberg
| | - Hunna Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | | | - Michele Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center
| | | | - Christine Peat
- Department of Psychiatry and Neurosurgery, University of North Carolina at Chapel Hill
| | - Cristin D Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | | | - Markus Moesner
- Center for Psychotherapy Research, University of Heidelberg
| | - Marsha D Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center
| | - Cynthia M Bulik
- Department of Psychiatry and Nutrition, University of North Carolina at Chapel Hill
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13
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Zerwas SC, Watson HJ, Hofmeier SM, Levine MD, Hamer RM, Crosby RD, Runfola CD, Peat CM, Shapiro JR, Zimmer B, Moessner M, Kordy H, Marcus MD, Bulik CM. CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa. Psychother Psychosom 2017; 86:47-53. [PMID: 27883997 PMCID: PMC5143175 DOI: 10.1159/000449025] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). METHOD In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. RESULTS At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. CONCLUSIONS CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.
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Affiliation(s)
- Stephanie C. Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Hunna J. Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,School of Paediatrics and Child Health, Faculty of Medicine, Dentistry, and Health Sciences, The University of Western Australia, Stirling Highway, Crawley, Western Australia, Australia 6009,School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Western Australia, Australia 6102
| | - Sara M. Hofmeier
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Michele D. Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Biostatistics, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, 120 Eighth Street South Fargo, ND 58107,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND 58102
| | | | - Christine M. Peat
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Jennifer R. Shapiro
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Benjamin Zimmer
- Center for Psychotherapy Research, University of Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University of Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Hans Kordy
- Center for Psychotherapy Research, University of Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Marsha D. Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Nutrition, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Hofmeier SM, Runfola CD, Sala M, Gagne DA, Brownley KA, Bulik CM. Body image, aging, and identity in women over 50: The Gender and Body Image (GABI) study. J Women Aging 2016; 29:3-14. [PMID: 27399268 DOI: 10.1080/08952841.2015.1065140] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We conducted a qualitative study of 1,849 women over age 50 to capture the thoughts, feelings, and attitudes that women at middle age have about their bodies and the experience of aging. Via an open-ended question online survey, four primary themes emerged: (a) the physical and psychological experience of aging; (b) the injustices, inequities, and challenges of aging; (c) the importance of self-care; and (d) a plea for recognition of the need to maintain a contributory role in society. Results highlight the complexities of women's psychological and physical aspects of aging and point toward important topics worthy of further study in this growing population.
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Affiliation(s)
- Sara M Hofmeier
- a Department of Psychiatry , University of North Carolina at Chapel Hill, Chapel Hill , North Carolina , USA.,b Veritas Collaborative , Durham , North Carolina , USA
| | - Cristin D Runfola
- a Department of Psychiatry , University of North Carolina at Chapel Hill, Chapel Hill , North Carolina , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Margarita Sala
- a Department of Psychiatry , University of North Carolina at Chapel Hill, Chapel Hill , North Carolina , USA.,d Department of Psychology , Southern Methodist University , Dallas , Texas , USA
| | - Danielle A Gagne
- a Department of Psychiatry , University of North Carolina at Chapel Hill, Chapel Hill , North Carolina , USA.,e Department of Psychology , Saint Louis University , Saint Louis , Missouri , USA
| | - Kimberly A Brownley
- a Department of Psychiatry , University of North Carolina at Chapel Hill, Chapel Hill , North Carolina , USA
| | - Cynthia M Bulik
- a Department of Psychiatry , University of North Carolina at Chapel Hill, Chapel Hill , North Carolina , USA.,f Department of Nutrition , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA.,g Department of Medical Epidemiology and Biostatistics , Karolinska Institute , Stockholm , Sweden
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15
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Yao S, Kuja-Halkola R, Thornton LM, Runfola CD, D'Onofrio BM, Almqvist C, Lichtenstein P, Sjölander A, Larsson H, Bulik CM. Familial Liability for Eating Disorders and Suicide Attempts: Evidence From a Population Registry in Sweden. JAMA Psychiatry 2016; 73:284-91. [PMID: 26764185 DOI: 10.1001/jamapsychiatry.2015.2737] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Suicide attempts are common in individuals with eating disorders. More precise understanding of the mechanisms underlying their concomitant occurrence is needed. OBJECTIVE To examine the association between eating disorders and suicide attempts and whether familial risk factors contribute to the association. DESIGN, SETTING, AND PARTICIPANTS A Swedish birth cohort including individuals born in Sweden between January 1, 1979, and December 31, 2001, was followed up from age 6 years to December 31, 2009 (N = 2,268,786). Information was acquired from Swedish national registers. All individuals were linked to their biological full siblings, maternal half siblings, paternal half siblings, full cousins, and half cousins. Data analysis was conducted from October 5, 2014, to April 28, 2015. MAIN OUTCOMES AND MEASURES Eating disorders were captured by 3 variables (any eating disorder, anorexia nervosa, and bulimia nervosa) identified by any lifetime diagnoses recorded in the registers. Suicide attempts were defined as any suicide attempts, including death by suicide, recorded in the registers. We examined the association between eating disorders and death by suicide separately, but the study was underpowered to explore familial liability for this association. RESULTS Of 2,268,786 individuals, 15,457 females (1.40% of all females) and 991 males (0.09% of all males) had any eating disorder, 7680 females (0.70%) and 453 males (0.04%) had anorexia nervosa, and 3349 females (0.30%), and 61 males (0.01%) had bulimia nervosa. Individuals with any eating disorder had an increased risk (reported as odds ratio [95% CI]) of suicide attempts (5.28 [5.04-5.54]) and death by suicide (5.39 [4.00-7.25]). The risks were attenuated but remained significant after adjusting for comorbid major depressive disorder, anxiety disorder, and substance use disorder (suicide attempts: 1.82 [1.72-1.93]; death by suicide: 2.04 [1.49-2.80]). Similar results were found for anorexia nervosa (suicide attempts: crude, 4.42 [4.12-4.74] vs adjusted, 1.70 [1.56-1.85]; death by suicide: crude, 6.46 [4.38-9.54] vs adjusted, 2.67 [1.78-4.01]) and bulimia nervosa (suicide attempts: crude, 6.26 [5.73-6.85] vs adjusted, 1.88 [1.68-2.10]; death by suicide: crude, 4.45 [2.44-8.11] vs adjusted, 1.48 [0.81-2.72]). Individuals (index) who had a full sibling with any eating disorder had an increased risk of suicide attempts (1.41 [1.29-1.53]). The risk was attenuated for any eating disorder in more-distant relatives (maternal half siblings, 1.10 [0.90-1.34]; paternal half siblings, 1.21 [0.98-1.49]; full cousins, 1.11 [1.06-1.18]; half cousins, 0.90 [0.78-1.03]). This familial pattern remained stable after adjusting for the index individuals' eating disorders. Similar patterns were found for anorexia nervosa and bulimia nervosa. CONCLUSIONS AND RELEVANCE These results suggest an increased risk of suicide attempts in individuals with lifetime eating disorders and their relatives. The pattern of familial coaggregation suggests familial liability for the association between eating disorders and suicide. Psychiatric comorbidities partially explain this association, suggesting particularly high-risk presentations.
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Affiliation(s)
- Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Cristin D Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Brian M D'Onofrio
- Department of Psychological and Brain Science, Indiana University, Bloomington
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden4Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden2Department of Psychiatry, University of North Carolina at Chapel Hill5Department of Nutrition, University of North Carolina at Chapel Hill
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16
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Baker JH, Runfola CD. Eating disorders in midlife women: A perimenopausal eating disorder? Maturitas 2016; 85:112-6. [PMID: 26857889 DOI: 10.1016/j.maturitas.2015.12.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/11/2015] [Accepted: 12/12/2015] [Indexed: 11/27/2022]
Abstract
Eating disorders afflict women across the lifespan with peak onset during critical or sensitive developmental periods of reproductive hormone change, such as puberty. A growing body of research supports the role of reproductive hormones, specifically estrogen, in the risk for eating disorders and related symptomatology in adolescence and young adulthood. Like puberty, perimenopause is characterized by estrogen change and may also present a window of vulnerability to eating disorder development. Here, we discuss the evidence that suggests perimenopause indeed may be a vulnerable period for the development or redevelopment of an eating disorder for midlife women. Drawing from what is known about the influence of estrogen on eating disorders at younger ages and from other psychiatric disorders with similar risk trajectories (i.e., perimenopausal depression), we describe a potential mechanism of risk for a perimenopausal eating disorder and how this can be explored in future research. Investigating vulnerability to perimenopausal eating disorders will clarify eating disorder etiology, identify reproductive stage-specific risk profiles, and guide future treatment directions.
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Affiliation(s)
- Jessica H Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Cristin D Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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17
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Javaras KN, Runfola CD, Thornton LM, Agerbo E, Birgegård A, Norring C, Yao S, Råstam M, Larsson H, Lichtenstein P, Bulik CM. Sex- and age-specific incidence of healthcare-register-recorded eating disorders in the complete swedish 1979-2001 birth cohort. Int J Eat Disord 2015; 48:1070-81. [PMID: 26769444 PMCID: PMC5028825 DOI: 10.1002/eat.22467] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the sex- and age-specific incidence of healthcare-register-recorded anorexia nervosa (AN) and other eating disorders (OED) in a complete birth cohort, and assess whether incidence varies by diagnostic period and (sub-) birth cohort. METHOD We used the actuarial method and Poisson models to examine the incidence of AN and OED from 1987 to 2009 (when individuals were 8-30 years old) for a cohort of 2.3 million individuals (48.7% female) born from 1979 to 2001 in Sweden, identified using Swedish registers. RESULTS For both sexes, incidences of AN and OED increased considerably for diagnostic periods after 2000, but differed little by birth cohort. In 2009, AN incidence in the peak age category was 205.9 cases/100,000 persons (95% CI: 178.2, 233.5) for females (14-15 years), versus 12.8 cases/100,000 (95% CI: 5.6, 20.1) for males (12-13 years). OED incidence in the peak age category was 372.1 cases/100,000 (95% CI: 336.4, 407.9) for females (16-17 years), versus 22.2 cases/100,000 (95% CI: 13.3, 31.1) for males (14-15 years). DISCUSSION Our finding of an increase in healthcare-register-recorded eating disorders for diagnostic periods after 2000 likely reflects improved detection and expanded register coverage in Sweden. The peak of eating disorder incidence in adolescence, which began unexpectedly early for AN in males, suggests the importance of vigilance for signs of AN in young boys and early primary prevention efforts. Waiting until later could miss critical windows for intervention that could prevent disorders from taking root.
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Affiliation(s)
- Kristin N Javaras
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.,Division of Women's Mental Health, McLean Hospital, Belmont, Massachusetts and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Cristin D Runfola
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Esben Agerbo
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.,CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Claes Norring
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Råstam
- Department of Clinical Sciences, University of Lund, Lund, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
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18
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Abstract
A significant number of adults with eating disorders fail to achieve relief from the disorder, with many dropping out of treatment or relapsing. The standard treatment remains individual therapy despite partners being negatively affected and typically wanting to help in an effective and loving way. We propose that couple-based interventions, which leverage the support of a partner and the relationship in treatment, may improve outcome and recovery rates for adults with eating disorders. In this article, we survey the empirical literature supporting the treatment of adults in a couple context and describe our existing and emerging couple-based interventions for eating disorders.
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Affiliation(s)
- Jennifer S Kirby
- a Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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19
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Runfola CD, Allison KC, Hardy KK, Lock J, Peebles R. Prevalence and clinical significance of night eating syndrome in university students. J Adolesc Health 2014; 55:41-8. [PMID: 24485551 PMCID: PMC4065810 DOI: 10.1016/j.jadohealth.2013.11.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/19/2013] [Accepted: 11/19/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Most studies of night eating syndrome (NES) fail to control for binge eating, despite moderate overlap between the two conditions. Establishing the independent clinical significance of NES is imperative for it to be considered worthy of clinical attention. We compared students with and without NES on eating disorder symptomatology, quality of life, and mental health, while exploring the role of binge eating in associations. METHODS Students (N = 1,636) ages 18-26 years (M = 20.9) recruited from 10 U.S. universities completed an online survey including the Night Eating Questionnaire (NEQ), Eating Disorder Examination-Questionnaire (EDE-Q), Project Eating Among Teens, and the Health-Related Quality of Life-4. NES was diagnosed according to endorsement of proposed diagnostic criteria on the NEQ. Groups (NES vs. non-NES) were compared on all dependent variables and stratified by binge eating status in secondary analyses. RESULTS The prevalence of NES in our sample was 4.2%; it decreased to 2.9% after excluding those with binge eating. Body mass index did not differ between groups, but students with NES were significantly more likely to have histories of underweight and anorexia nervosa. In students with NES, EDE-Q scores were significantly higher; purging, laxative use, and compulsive exercise were more frequent; quality of life was reduced; and histories of depression, attention-deficit/hyperactivity disorder, and self-injury were more common. Binge eating did not account for all of these differences; the presence of it and NES was associated with additive risk for psychopathology on some items. CONCLUSIONS NES may be a distinct clinical entity from other DSM-5 eating disorders.
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Affiliation(s)
| | | | | | | | - Rebecka Peebles
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
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20
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Runfola CD, Thornton LM, Pisetsky EM, Bulik CM, Birgegård A. Self-image and suicide in a Swedish national eating disorders clinical register. Compr Psychiatry 2014; 55:439-49. [PMID: 24332388 PMCID: PMC3965622 DOI: 10.1016/j.comppsych.2013.11.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/23/2013] [Accepted: 11/09/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Using a prospective design, to examine the relation between self-image (assessed using the Structural Analysis of Social Behavior) and suicide attempts/completions in women with anorexia nervosa-restricting type (ANR), anorexia nervosa-binge/purge type (ANBP), bulimia nervosa (BN), binge eating disorder (BED), and eating disorder not otherwise specified (EDNOS); and to assess whether these self-image variables add unique predictive value to suicide when considering other baseline predictors. METHOD Women (N=2269) aged 12 to 45 (M=22.1) presenting to specialist eating disorders clinics in Sweden between 2005 and 2009 were identified through the Stepwise Eating Disorders Quality Register. Data on age, body mass index, eating disorder severity (Eating Disorder Examination-Questionnaire scores), psychiatric comorbidity, global assessment of functioning, and self-image were abstracted from Stepwise and included as baseline predictors or covariates. Suicide information (prior attempt and attempt/completion after Stepwise registration) was obtained from the National Patient Register and Cause of Death Register. RESULTS Prevalence of detected suicide attempts/completions over the study period was 9.2%. Negative self-image variables were associated with prior suicide attempts in ANR and EDNOS and later suicide attempts/completions in women with BN. In a stepwise Cox proportional hazards model, only low self-affirmation predicted time to suicide attempts/completions in women with BN when accounting for age and prior suicide attempt. CONCLUSION Assessing self-image might assist with identifying women with BN at elevated risk for suicide.
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Affiliation(s)
- Cristin D Runfola
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Emily M Pisetsky
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA; Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Runfola CD, Zucker NL, Von Holle A, Mazzeo S, Hodges EA, Perrin EM, Bentley ME, Ulman TF, Hoffman ER, Forsberg S, Ålgars M, Zerwas S, Pisetsky EM, Taico Colie L, Kuhns RA, Hamer RM, Bulik CM. NURTURE: development and pilot testing of a novel parenting intervention for mothers with histories of an eating disorder. Int J Eat Disord 2014; 47:1-12. [PMID: 23983082 PMCID: PMC4009482 DOI: 10.1002/eat.22178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/20/2013] [Accepted: 07/20/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the treatment development and pilot testing of a group parenting intervention, NURTURE (Networking, Uniting, and Reaching out To Upgrade Relationships and Eating), for mothers with histories of eating disorders. METHOD Based on focus group findings, extant research, and expert opinion, NURTURE was designed to be delivered weekly over 16 (1.5 h) sessions via an interactive web conferencing forum. It comprises four modules: (1) laying the foundation, (2) general parenting skills, (3) eating and feeding, and (4) breaking the cycle of risk. Pilot testing was conducted with three groups of 3-6 mothers (N = 13) who had children ages 0-3 years to determine feasibility (e.g., retention), acceptability (e.g., feedback questionnaire responses), and preliminary efficacy. Maternal satisfaction with NURTURE and changes in mother-child feeding relationship measures, maternal feeding style, maternal self-efficacy, and maternal psychopathology (eating disorder, depression, and anxiety symptoms) across three time points (baseline, post-treatment, 6-month follow-up) were examined. All outcomes were exploratory. RESULTS The intervention was well tolerated with a 100% retention rate. Feedback from mothers was generally positive and indicated that the groups provided an engaging, supportive experience to participants. We observed changes suggestive of improvement in self-reported maternal self-efficacy and competence with parenting. There were no notable changes in measures of maternal feeding style or psychopathology. DISCUSSION NURTURE is a feasible, acceptable, and potentially valuable intervention for mothers with eating disorder histories. Results of this pilot will inform a larger randomized-controlled intervention to determine efficacy and impact on child outcomes.
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Affiliation(s)
| | | | - Ann Von Holle
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Suzanne Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Eric A. Hodges
- School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Eliana M. Perrin
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | - T. Frances Ulman
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | | | - Sarah Forsberg
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | | | - Stephanie Zerwas
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Emily M. Pisetsky
- Department of Psychology; University of North Carolina, Chapel Hill, NC
| | | | - Rebecca A. Kuhns
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC,Department of Pediatrics, University of North Carolina, Chapel Hill, NC,Correspondence to: Dr. Bulik, Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, Chapel Hill, NC 27599-7160, Voice: (919) 843-1689 Fax: (919) 843-8802,
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Runfola CD, Von Holle A, Peat CM, Gagne DA, Brownley KA, Hofmeier SM, Bulik CM. Characteristics of women with body size satisfaction at midlife: results of the Gender and Body Image (GABI) Study. J Women Aging 2013; 25:287-304. [PMID: 24116991 PMCID: PMC3816007 DOI: 10.1080/08952841.2013.816215] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study characterizes the profile of women (N = 1,789) ages 50 and over who report body size satisfaction on a figure rating scale. Satisfied women (12.2%) had a lower body mass index and reported fewer eating disorder symptoms, dieting behaviors, and weight and appearance dissatisfaction. Interestingly, satisfied women exercised more than dissatisfied women, and weight and shape still played a primary role in their self-evaluation. Weight monitoring and appearance-altering behaviors did not differ between groups. Body satisfaction was associated with better overall functioning. This end point appears to represent effortful body satisfaction rather than passive contentment.
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Affiliation(s)
- Cristin D. Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Christine M. Peat
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Danielle A. Gagne
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Kimberly A. Brownley
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Sara M. Hofmeier
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Runfola CD, Von Holle A, Trace SE, Brownley KA, Hofmeier SM, Gagne DA, Bulik CM. Body dissatisfaction in women across the lifespan: results of the UNC-SELF and Gender and Body Image (GABI) studies. Eur Eat Disord Rev 2013; 21:52-9. [PMID: 22949165 PMCID: PMC3745223 DOI: 10.1002/erv.2201] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
To explore age differences in current and preferred silhouette and body dissatisfaction (current - preferred silhouette discrepancy) in women aged 25-89 years using figural stimuli [range: 1 (very small) to 9 (very large)]. Data were abstracted from two online convenience samples (N = 5868). t-tests with permutation-adjusted p-values examined linear associations between mean silhouette scores (current, preferred, discrepancy score) and age with/without stratification by body mass index (BMI). Modal current silhouette was 5; modal preferred silhouette was 4; mean discrepancy score was 1.8. There was no significant association between current silhouette and age, but a positive linear association between preferred silhouette and age remained after stratification by BMI. A significant inverse linear association of silhouette discrepancy score and age was found only prior to stratification by BMI. Body dissatisfaction exists in women across the adult life span and is influenced by BMI.
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Affiliation(s)
- Cristin D. Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Sara E. Trace
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Kimberly A. Brownley
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Sara M. Hofmeier
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Danielle A. Gagne
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Gagne DA, Von Holle A, Brownley KA, Runfola CD, Hofmeier S, Branch KE, Bulik CM. Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: results of the Gender and Body Image (GABI) study. Int J Eat Disord 2012; 45:832-44. [PMID: 22729743 PMCID: PMC3459309 DOI: 10.1002/eat.22030] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Limited research exists on eating disorder symptoms and attitudes and weight and shape concerns in women in midlife to older adulthood. We conducted an online survey to characterize these behaviors and concerns in women ages 50 and above. METHOD Participants (n = 1,849) were recruited via the Internet and convenience sampling. RESULTS Eating disorder symptoms, dieting and body checking behaviors, and weight and shape concerns were widely endorsed. Younger age and higher body mass index (BMI) were associated with greater endorsement of eating disorder symptoms, behaviors, and concerns. DISCUSSION Weight and shape concerns and disordered eating behaviors occur in women over 50 and vary by age and BMI. Focused research on disordered eating patterns in this age group is necessary to develop age-appropriate interventions and to meet the developmental needs of an important, growing, and underserved population.
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Affiliation(s)
- Danielle A. Gagne
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | | | | | - Sara Hofmeier
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | | | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, Department of Nutrition, University of North Carolina, Chapel Hill, NC
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Abstract
OBJECTIVE We examined the association among current self-reported sleep problems, lifetime binge eating (BE), and current obesity in women from the Swedish Twin study of Adults: Genes and Environment. METHOD Logistic regression analyses were used to evaluate these associations in 3,790 women aged 20-47 years. RESULTS BE was reported by 244 (6.4%) women and was positively associated with not getting enough sleep (p < .015), sleeping poorly (p < .001), problems falling asleep (p < .001), feeling sleepy during work or free time (p < .001), and disturbed sleep (p < .001). These same sleep variables, as well as napping and being a night person, were also significantly associated with obesity. The associations between BE and sleep remained after accounting for obesity. DISCUSSION This investigation offers empirical support for an independent association between sleep problems and BE, which is likely due to complex psychological, biological, neuroendocrine, and metabolic factors.
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Affiliation(s)
- Sara E. Trace
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Cristin D. Runfola
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
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