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Marffy MJ, Fox J, Williams M. An exploration of the relationship between loneliness, the severity of eating disorder-related symptoms and the experience of the 'anorexic voice'. Psychol Psychother 2024; 97:122-137. [PMID: 37792343 DOI: 10.1111/papt.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Many individuals with eating disorders (EDs) report the experience of an 'Anorexic voice' (AV). Negative experiences of loneliness are also often associated with EDs. This study sought to explore the relationship between experiences of loneliness, the frequency of the AV and the impact of this on ED symptom severity. DESIGN 165 individuals (mean age 27.54 years) who accessed online forums relating to EDs participated in this study. The sample included individuals who have experienced an AV [AV group (N = 141)] and those who have not [non-AV group (N = 23)]. METHODS The study utilised self-report measures via an online questionnaire to explore the predictive validity of loneliness and frequency of the AV on ED symptom severity. RESULTS Confirmatory analysis (AV group only) demonstrated the significance of the independent variables individually predicting ED symptom severity. However, a significant interaction was not found between the two primary variables in predicting ED symptom severity, more significantly than the influence of either variable alone. Exploratory analysis considered the differences between the two groups (AV and Non-AV), as well as considering alternate predictors. CONCLUSIONS The findings offer insight into possible drivers behind engagement with the AV, as part of ED presentations in the community.
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Affiliation(s)
| | - John Fox
- DClinPsy, Cardiff University, Cardiff, UK
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2
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Heywood L, Conti J, Touyz S, Madden S, Hay P. Key-in-session identity negotiations in a first line treatment for adult anorexia nervosa. J Eat Disord 2024; 12:20. [PMID: 38297339 PMCID: PMC10832269 DOI: 10.1186/s40337-024-00979-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Exploration of client identity negotiations during treatment for Anorexia Nervosa (AN) is a relatively new area of research. Research suggests that difficulties with identity negotiations may present as a barrier to treatment. This study sought to explore individuals' identity negotiations during therapy sessions using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN). Analysis focused on moments in therapy where individuals' identities were dominated or defined by AN and where alternative identities could be generated. METHOD 40 in-session transcripts from sessions at early, mid and end points of the CBT-AN (with LEAP) treatment were qualitatively analysed for nine of the 78 participants in the original randomised control trial. Through a constructivist framework, thematic analysis was used to identify surface and latent meanings and discursive material participants used to negotiate their identities in the context of therapy sessions. RESULTS Analysis of in-therapy transcripts generated two themes pertaining to identity negotiations: (1) troubled identities and (2) rebuilding identities and lives outside of AN. Early therapy sessions explored fragmented and AN dominated identities, including how AN was troubling to participants' sense of self, contributed to conflicted identities, positioned them outside of normality, and was associated with isolated and othering identities. Within therapy sessions, participants engaged in a recursive process of shifting relationships with AN and themselves and building identities and lives outside of the AN identity. This included generating hopes for recovery and the future more frequently in mid- to late- therapy sessions. CONCLUSION Identity negotiations evident in the therapeutic conversations aligned with the key components of the CBT-AN intervention, including addressing (1) the characterisation of oneself as 'an anorexic' and (2) the diversification of roles and activities to broaden and enhance self-concepts. Future developments of therapeutic interventions for AN would benefit from greater consideration of ways to assist individuals to more comprehensively address problematic identities, including uncovering identities hidden by the AN identity and generating preferred identities. TRIAL REGISTRATION Ethics approval was obtained at the time of the initial study and for this embedded research by the HREC at the Western Sydney University (HR777332).
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Affiliation(s)
- Lauren Heywood
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Janet Conti
- School of Psychology, Western Sydney University, Sydney, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Stephen Touyz
- Inside Out Institute, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Sloan Madden
- School of Medicine and Heath, University of Sydney, Ramsay Clinic Northside, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
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3
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Zhu J, Hay PJ, Yang Y, Le Grange D, Lacey JH, Lujic S, Smith C, Touyz S. Specific psychological therapies versus other therapies or no treatment for severe and enduring anorexia nervosa. Cochrane Database Syst Rev 2023; 8:CD011570. [PMID: 37610143 PMCID: PMC10445422 DOI: 10.1002/14651858.cd011570.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Anorexia nervosa is a psychological condition characterised by self-starvation and fear or wait gain or other body image disturbance. The first line of treatment is specific psychological therapy; however, there is no consensus on best practice for treating people who develop severe and enduring anorexia nervosa (SEAN). Notably, there is no universal definition of SEAN. OBJECTIVES To evaluate the benefits and harms of specific psychological therapies for severe and enduring anorexia nervosa compared with other specific therapies, non-specific therapies, no treatment/waiting list, antidepressant medication, dietary counselling alone, or treatment as usual. SEARCH METHODS We used standard, extensive Cochrane search methods. The last search date was 22 July 2022. SELECTION CRITERIA We included parallel randomised controlled trials (RCTs) of people (any age) with anorexia nervosa of at least three years' duration. Eligible experimental interventions were any specific psychological therapy for improved physical and psychological health in anorexia nervosa, conducted in any treatment setting with no restrictions in terms of number of sessions, modality, or duration of therapy. Eligible comparator interventions included any other specific psychological therapy for anorexia nervosa, non-specific psychological therapy for mental health disorders, no treatment or waiting list, antipsychotic treatment (with or without psychological therapy), antidepressant treatment (with or without psychological therapy), dietary counselling, and treatment as usual as defined by the individual trials. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were clinical improvement (weight restoration to within the normal weight range for participant sample) and treatment non-completion. Results were presented using the GRADE appraisal tool. MAIN RESULTS We found two eligible studies, but only one study provided usable data. This was a parallel-group RCT of 63 adults with SEAN who had an illness duration of at least seven years. The trial compared outpatient cognitive behaviour therapy for SEAN (CBT-SEAN) with specialist supportive clinical management for SEAN (SSCM-SE) over eight months. It is unclear if there is any difference between the effect of CBT-SEAN versus SSCM-SE on clinical improvement at 12 months (risk ratio (RR) 1.42, 95% confidence interval (CI) 0.66 to 3.05) or treatment non-completion (RR 1.72, 95% CI 0.45 to 6.59). There were no reported data on adverse effects. The trial was at high risk of performance and detection bias. We rated the GRADE level of evidence as very low-certainty for both primary outcomes, downgrading for imprecision and risk of bias concerns. AUTHORS' CONCLUSIONS This review reports evidence from one trial that evaluated CBT-SEAN versus SSCM-SE. There was very low-certainty evidence of little or no difference in clinical improvement and treatment non-completion between the two therapies. There is a need for larger high-quality trials to determine the benefits of specific psychological therapies for people with SEAN. These should take into account the duration of illness as well as participants' previous experience with evidence-based psychological therapy for anorexia nervosa.
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Affiliation(s)
- James Zhu
- Sydney Local Health District, Sydney, NSW, Australia
| | - Phillipa J Hay
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
- Mental Health Services, WSLHD, Campbelltown, Australia
| | - Yive Yang
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | | | | | - Sanja Lujic
- Centre for Big Data Research in Health, UNSW, Sydney, Australia
| | - Caroline Smith
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Stephen Touyz
- School of Psychology and InsideOut Institute, University of Sydney, Sydney, Australia
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Davén J, Hellzen O, Häggström M. Encountering patients with anorexia nervosa - An emotional roller coaster. nurses’ lived experiences of encounters in psychiatric inpatient care. Int J Qual Stud Health Well-being 2022; 17:2069651. [PMID: 35481811 PMCID: PMC9068011 DOI: 10.1080/17482631.2022.2069651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose The aim of this study was to illuminate the meaning of nurses’ lived experiences of encounters with adult patients with anorexia nervosa in psychiatric inpatient care. Methods A qualitative phenomenological hermeneutical design was used. Personal interviews with a narrative approach were conducted with 11 nurses with experience of encountering patients with anorexia nervosa in psychiatric inpatient care. Results Three key themes were revealed: Being overwhelmed by emotions consisting of three subthemes: Bearing feelings of incomprehension, Navigating emotions, and Being disappointed and frustrated; Seeking strength to cope consisting of three subthemes: Relying on colleagues and routines, Feeling hope and motivation, and Building inner security; and Trying to build relations consisting of two subthemes: Getting closer to the patient and Relating to relatives. Conclusion Our findings illuminate the “emotional roller-coaster” which nurses are embedded in during their daily work experiences. Being able to balance one’s professional role, seeing the person behind the patient, and the illness is important in all nurse-patient encounters. An examination of nurses’ lived experiences can contribute new and important knowledge, an in-depth understanding of the nurses’ work situation, and can help identify any need for increased knowledge.
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Affiliation(s)
- Josefine Davén
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Ove Hellzen
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Marie Häggström
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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5
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Johnson C, Cook L, Cadman K, Andersen T, Williamson P, Wade TD. Evaluating an implementation model of evidence-based therapy for eating disorders in non-specialist regional mental health settings. J Eat Disord 2022; 10:170. [PMID: 36397157 PMCID: PMC9670061 DOI: 10.1186/s40337-022-00695-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many people with eating disorders (EDs) either do not access treatment, access it well after symptoms first start, or drop out of treatment. This study evaluated ways to improve early access to evidence-based interventions for those with EDs in a non-specialist community setting. METHODS In an Australian regional community, links were formed between general medical practitioners and treatment providers (psychologists, mental health social workers and dietitians), who received ongoing training, feedback and support. Service users had access to 20-40 subsidised treatment sessions. Data were collected from 143 patients over 18 months. Our outcomes are reported according to the RE-AIM implementation framework: Reach (we measured uptake and treatment completion); Effectiveness (impact on disordered eating cognitions, body mass index, remission, and moderators of effectiveness including illness duration, previous treatment, presence of comorbidities, presence of a normative level of disordered eating, presence of any ED behaviours, weighing in treatment, multidisciplinary case conferencing, number of dietetic sessions); Adoption (drop-out and predictors); Implementation (barriers encountered); Maintenance (subsequent activity designed to embed new practices). RESULTS Treatment was completed by 71%; significant large decreases in eating disorder cognitions were achieved; remission was obtained by 37% (intent-to-treat). Treatment completion was predicted by lower baseline levels of disordered eating, uptake of ≥ 3 dietetic sessions, and ≥ 2 team case conferences. Greater improvement over time was predicted by regular case conferencing and in-session weighing. CONCLUSIONS Implementation of this model in a regional community setting produced completion rates and outcomes comparable to those found in specialist clinical trials of ED treatments. Service providers identified care coordination as the most important factor to connect users to services and help navigate barriers to ongoing treatment. TRIAL REGISTRATION This research was an invited evaluation of a project implemented by the Australian Department of Health. The project did not introduce any new clinical practice but sought to improve access to evidence-based multidisciplinary treatment for people with EDs by removing four known systemic barriers: securing an accurate diagnosis, availability of multidisciplinary treatment, cost of treatment, and intensity of treatment. As such, the project did not require trial registration. Notwithstanding, this evaluation obtained ethics approval (Bellberry Human Research Ethics Committee, Application No: 2018-09-728-FR-1).
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Affiliation(s)
| | | | - Kath Cadman
- The Butterfly Foundation, Crows Nest, Australia
| | | | - Paul Williamson
- Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Tracey D Wade
- Blackbird Initiative, Flinders University, Adelaide, SA, Australia
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Reay M, Holliday J, Stewart J, Adams J. Creating a care pathway for patients with longstanding, complex eating disorders. J Eat Disord 2022; 10:128. [PMID: 36038898 PMCID: PMC9421634 DOI: 10.1186/s40337-022-00648-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery rates for people with eating disorders are low; fewer than half recover and approximately 20% develop a longstanding eating disorder. Patients with longstanding eating disorders are often referred to as "SEED" (severe and enduing eating disorders) although this remains controversial and is not acknowledged in the British treatment guidance. This project aimed to generate recommendations for a longstanding eating disorder care pathway by identifying what proportion of patients have longstanding eating disorders and how to best identify and support them. METHODS Initially, a literature review was completed, followed by interviews with service-users who consider themselves to have longstanding eating disorders, and focus groups with staff members. The results were combined to create a definition of a longstanding eating disorder which was used to establish how many service-users could benefit from the pathway. The qualitative data was used to produce recommendations for a tailored pathway for those with longstanding eating disorders. RESULTS The results highlighted that, although "SEED" is often used, participants preferred to be referred to as "longstanding" or having no label. Qualitative analysis identified four themes in relation to supporting this population group which described how to structure the service and individualise care, as well as patients' relationship to the service, and how to build a life after eating disorder services. CONCLUSIONS Recommendations included promoting a hopeful message, focusing on quality of life and introducing peer support. Crucially, accessing the pathway should not result in being labelled "SEED", nor should it prevent access to recovery focused interventions including weight restoration. The full list of recommendations are included as well as the implications of the project and limitations.
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Affiliation(s)
- Megan Reay
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | | | - Joanna Adams
- The Oxford Institute for Clinical Psychology Training and Research, Oxford, UK
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Frostad S, Bentz M. Anorexia nervosa: Outpatient treatment and medical management. World J Psychiatry 2022; 12:558-579. [PMID: 35582333 PMCID: PMC9048449 DOI: 10.5498/wjp.v12.i4.558] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/20/2021] [Accepted: 02/22/2022] [Indexed: 02/06/2023] Open
Abstract
Anorexia nervosa (AN) is a disabling, costly and potentially deadly illness. Treatment failure and relapse are common after completing treatment, and a substantial proportion of patients develop severe and enduring AN. The time from AN debut to the treatment initiation is normally unreasonably long. Over the past 20 years there has been empirical support for the efficacy of several treatments for AN. Moreover, outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients. Early intervention improves outcomes and should be a priority for all patients. Outpatient treatment is usually the best format for early intervention, and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable. Inpatient care is more disruptive, more costly, and usually has a longer waiting list than does outpatient care. The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult. The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN. The scientific essentials for outpatient treatment are described, including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated. The following aspects are discussed: early intervention, outpatient treatment of AN, including outpatient psychotherapy for severe and extreme AN, how to determine when outpatient treatment is safe, and when transfer to inpatient healthcare is indicated. Emerging treatments, ethical issues and outstanding research questions are also addressed.
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Affiliation(s)
- Stein Frostad
- Department of Mental Health Research, Division of Psychiatry, Haukeland University Hospital, Bergen 5021, Norway
| | - Mette Bentz
- Child and Adolescent Mental Health Centre, Capital Region of Denmark, University of Copenhagen, Copenhagen 2400, Denmark
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8
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Agne A, Quesnel DA, Larumbe-Zabala E, Olmedillas H, Graell-Berna M, Perez M, Fernandez-del-Valle M. Progressive resistance exercise as complementary therapy improves quality of life and body composition in anorexia nervosa: A randomized controlled trial. Complement Ther Clin Pract 2022; 48:101576. [DOI: 10.1016/j.ctcp.2022.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/03/2022]
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9
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Why Do Women with Eating Disorders Decline Treatment? A Qualitative Study of Barriers to Specialized Eating Disorder Treatment. Nutrients 2021; 13:nu13114033. [PMID: 34836288 PMCID: PMC8623214 DOI: 10.3390/nu13114033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Despite the fact that eating disorders (EDs) are conditions that are potentially life-threatening, many people decline treatment. The aim of this study was to investigate why women decline specialized ED treatment, including their viewpoints on treatment services. Eighteen semi-structured qualitative interviews were conducted with women who had declined inpatient or outpatient specialized ED treatment. A thematic analysis revealed five main themes: (1) Disagreement on treatment needs, (2) rigid standard procedures, (3) failure to listen, (4) deprivation of identity, and (5) mistrust and fear. The women had declined ED treatment because they believed that treatment was only focused on nutritional rehabilitation and that it failed to address their self-identified needs. From their perspectives treatment was characterized by rigid standard procedures that could not be adapted to their individual situations and preferences. They felt that the therapists failed to listen to them, and they felt deprived of identity and reduced to an ED instead of a real person. This investigation is one of the first of its kind to provide clues as to how treatment could be moderated to better meet the needs of women who decline specialized ED treatment.
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Meneguzzo P, Todisco P, Calonaci S, Mancini C, Dal Brun D, Collantoni E, Donini LM, Tenconi E, Favaro A. Health-related quality of life assessment in eating disorders: adjustment and validation of a specific scale with the inclusion of an interpersonal domain. Eat Weight Disord 2021; 26:2251-2262. [PMID: 33315213 PMCID: PMC8437832 DOI: 10.1007/s40519-020-01081-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Quality of life is a fundamental aspect of both clinical practice and research on eating disorders (ED) due to the significant impacts these disorders have on everyday life. Disorder-specific scales can improve the quality of research and findings and offer greater sensitivity and responsiveness. However, no specific instrument is available in Italian for ED. The aim of this paper is to adjust and to validate a reliable scale with specific items regarding physical and interpersonal well-being. METHODS The Italian version of the Eating Disorder Quality of Life (IEDQOL) scale was developed, on the basis of the original English scale, with the addition of items pertaining to physical well-being and interpersonal interactions. In this study, 180 ED patients and 190 healthy controls from the community were enrolled both from inpatient units and outpatient services. A statistical analysis with an exploratory factorial approach was performed in order to validate the tool. RESULTS The results showed that the IEDQOL has very good psychometric properties with test-retest validity and sensitivity between patients and controls (d = 2.17 for total score). Moreover, the interpersonal domain showed excellent psychometric values (Cronbach's α > 0.70 in all the subgroups) and a robust correlation with other quality of life constructs. CONCLUSION Future studies on the Italian population should use IEDQOL as outcome element that can be useful also with other disorder-specific psychopathological constructs and corroborate the reliability of the data. Future research in the ED field should only use this specific tool. LEVEL OF EVIDENCE Case-control analytic study, Level III.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padua, Italy. .,Eating Disorders Unit, Casa Di Cura "Villa Margherita", Arcugnano, VI, Italy.
| | - Patrizia Todisco
- Eating Disorders Unit, Casa Di Cura "Villa Margherita", Arcugnano, VI, Italy
| | - Sofia Calonaci
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padua, Italy
| | - Cecilia Mancini
- Experimental Medicine Department, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, Rome, Italy
| | - David Dal Brun
- Department of Linguistic and Literary Studies, University of Padova, Padua, Italy
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padua, Italy
| | - Lorenzo Maria Donini
- Experimental Medicine Department, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, Rome, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padua, Italy.,Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padua, Italy.,Padova Neuroscience Center, University of Padova, Padua, Italy
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Broomfield C, Rhodes P, Touyz S. Lived experience perspectives on labeling and defining long-standing anorexia nervosa. J Eat Disord 2021; 9:101. [PMID: 34391479 PMCID: PMC8364069 DOI: 10.1186/s40337-021-00457-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/03/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Since efforts to stage anorexia nervosa (AN) revealed the existence of various presentations, research into the long-standing subgroup has increased. A change in treatment has been proposed with the intention to use more effective evidence-based methods that target symptoms of the long-standing presentation and improve prognosis. A barrier in achieving this goal in both research and clinical contexts is the lack of a consistent label and definition. This makes the ability to assess, recruit and treat these presentations difficult. Investigations into how this subgroup may be differentiated from other stages of the disorder have included the opinions of practitioners and researchers with little consideration for the perspectives of individuals living with this illness. It was the aim of the current study to investigate lived experience perspectives on the way long-standing AN should be labeled and defined. METHODS Data were collected through a semi-structured interview within a narrative inquiry framework. This approach is beneficial when examining processes that occur over time, such as investigations into a long-term illness. A total of 11 women with a presentation of long-standing AN participated in an interview. Data were divided into two categories for analysis based on the association to labeling or defining the features of the long-standing AN illness. RESULTS Two labels emerged during the analysis with participants describing a preference for the use of 'severe and enduring' over 'chronic' when referring to their presentation of AN. When defining the illness, the most preferred criterion was illness duration with mixed perspectives for the use of previously failed treatment attempts. Participants described a consistent dislike for the use of low body weight as a feature in the defining of the illness. CONCLUSIONS The current study describes how individuals with a lived experience prefer to have the long-standing AN presentation labeled and defined. It is the hope of the authors that these insights will be adopted into any guidelines developed to ensure individuals most affected by this disorder have a voice and continue to be given the opportunity to contribute to topics related to their illness. Anorexia nervosa (AN) is a complex illness that has been divided into stages based on the severity of symptoms. Little is known about the AN stage that persists over lengthy periods of time with research pursuits underway to determine characteristics that allow this disorder to persevere. A barrier in researching and treating these individuals is the lack of a consistent label to refer to these presentations and criteria that will allow us to identify this stage of AN. The aim of the current study was to determine how individuals with a lived experience of long-standing AN prefer to have their illness labeled and defined. A total of 11 women who had experienced this stage of AN were interviewed with the majority of participants reporting to prefer the label 'severe and enduring' over the term 'chronic'. Additionally, most of the participants had a preference for defining their illness based on the duration of time the illness had persisted with mixed opinions for using the number of previously unsuccessful treatment attempts as criterion. The authors are hopeful that any guidelines established for labeling and defining long-standing AN will incorporate the perspectives of individuals with a lived experience of the illness.
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Affiliation(s)
- Catherine Broomfield
- School of Psychology, Griffith Taylor Building, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Paul Rhodes
- School of Psychology, Griffith Taylor Building, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Stephen Touyz
- InsideOut Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
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Broomfield C, Stedal K, Touyz S. The Neuropsychological Profile of Severe and Enduring Anorexia Nervosa: A Systematic Review. Front Psychol 2021; 12:708536. [PMID: 34408714 PMCID: PMC8365190 DOI: 10.3389/fpsyg.2021.708536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Characteristics of Severe and Enduring Anorexia Nervosa (SE-AN) are being investigated to differentiate the patients experiencing SE-AN from those at earlier stages of the AN disease. The current systematic review was the first step in exploring neuropsychological functioning as a potentially identifying characteristic for long-term presentations. With a subgroup of AN patients reflecting a unique neuropsychological profile that is proportionate to the quantity of patients that go on to develop SE-AN, it was the aim of this review to assess neuropsychological functioning in the later stage of the disease. In accordance with PRISMA guidelines, a literature search was conducted using four electronic databases (PsycINFO, MEDLINE, Web of Science, and Scopus) for neuropsychological research on AN participants with a seven or more year illness duration. Datasets that met inclusion criteria were screened for SE-AN participants (N = 166) and neuropsychological data extracted together with potentially confounding variables and information required to conduct a quality assessment. In research investigating decision-making, participants with a SE-AN presentation demonstrated significantly lower functioning compared to healthy controls. There was conflicting evidence for differences in intellectual functioning and set-shifting abilities with no variability indicated in central coherence, memory, attention, reasoning, or processing speed. If findings from this preliminary analysis are confirmed through empirical research, implications include earlier identification of SE-AN patients and more effective treatment development.
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Affiliation(s)
| | - Kristin Stedal
- Regional Department for Eating Disorders, Oslo University Hospital, Ullevål, Norway
| | - Stephen Touyz
- Inside Out Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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13
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Bianchi A, Stanley K, Sutandar K. The Ethical Defensibility of Harm Reduction and Eating Disorders. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:46-56. [PMID: 33370215 DOI: 10.1080/15265161.2020.1863509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Eating disorders are mental illnesses that can have a significant and persistent physical impact, especially for those who are not treated early in their disease trajectory. Although many persons with eating disorders may make a full recovery, some may not; this is especially the case when it comes to persons with severe and enduring anorexia nervosa (SEAN), namely, those who have had anorexia for between 6 and 12 years or more. Given that persons with SEAN are less likely to make a full recovery, a different treatment philosophy might be ethically warranted. One potential yet scarcely considered way to treat persons with SEAN is that of a harm reduction approach. A harm reduction philosophy is deemed widely defensible in certain contexts (e.g. in the substance use and addictions domain), and in this paper we argue that it may be similarly ethically defensible for treating persons with SEAN in some circumstances.
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Duriez P, Kaya Lefèvre H, Di Lodovico L, Viltart O, Gorwood P. Increased cognitive flexibility mediates the improvement of eating disorders symptoms, depressive symptoms and level of daily life functioning in patients with anorexia nervosa treated in specialised centres. EUROPEAN EATING DISORDERS REVIEW 2021; 29:600-610. [PMID: 33851482 DOI: 10.1002/erv.2829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Poor cognitive flexibility has been highlighted in patients with anorexia nervosa (AN), contributing to the development and maintenance of symptoms. The aim of the present study is to investigate how enhanced cognitive flexibility is involved in treatment outcomes in patients with AN. METHOD One hundred thirty female out-patients treated for AN have been assessed at baseline and after 4 months of treatment. Path analyses were used to investigate the mediating role of cognitive flexibility, measured through the Brixton test, on a wide range of outcomes: body mass index, eating disorder symptoms, daily life functioning, anxiety, depression, emotions, self-rated silhouette. RESULTS Cognitive flexibility was improved during treatment, and enhanced cognitive flexibility explains a significant part of level of the improvement in daily life functioning (26%), reduction of eating disorder symptoms (18%) and reduction of depressive symptoms (17%). Others outcomes were also improved, but these improvements were not mediated by cognitive flexibility. CONCLUSIONS Results suggest that enhancing cognitive flexibility could help reduce rigid cognitive and behavioural patterns involved in AN, thus improving everyday functioning and clinical severity. Further studies combining different types of cognitive flexibility evaluation as well as neuroimaging may be necessary to better establish which of its aspects are involved in patients' improvement.
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Affiliation(s)
- Philibert Duriez
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France
| | - Héline Kaya Lefèvre
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Université de Paris, LPPS, Boulogne-Billancourt, France
| | - Laura Di Lodovico
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France
| | - Odile Viltart
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France.,Cité scientifique, SN4, Université de Lille, Villeneuve d'Ascq, France
| | - Philip Gorwood
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France
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15
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Winkler LAD, Gudex C, Lichtenstein MB, Røder ME, Adair CE, Sjögren JM, Støving RK. Explanatory Factors for Disease-Specific Health-Related Quality of Life in Women with Anorexia Nervosa. J Clin Med 2021; 10:1592. [PMID: 33918786 PMCID: PMC8069859 DOI: 10.3390/jcm10081592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 12/05/2022] Open
Abstract
A better understanding of explanatory factors for disease-specific health-related quality of life (HRQoL) in anorexia nervosa (AN) could help direct treatment providers to aspects of the most relevance for patient wellbeing and recovery. We aimed to investigate whether factors associated with HRQoL are the same for women with AN and normal-weight controls. The participants in this study were women with AN recruited from specialized eating disorder centers in Denmark and healthy, normal-weight controls invited via online social media. Participants completed online questionnaires on medical history, disease-specific HRQoL (Eating Disorders Quality of Life Scale, EDQLS) and generic HRQoL (SF-36), eating disorder symptomatology, depression, psychological wellbeing, and work and social adjustment. Questionnaires were fully completed by 211 women with AN (median age 21.7 years) and 199 controls (median age 23.9 years). Women with AN had poorer scores on all measures, i.e., worse HRQoL, psychological health, and work/social functioning. Eating disorder symptomatology affected EDQLS score in both groups, but poorer HRQoL in women with AN was also significantly associated with worse scores on bulimia, maturity fears, depression, vitality, and with older age. The factors investigated together explained 79% of the variance in EDQLS score. Management of disordered self-assessment and thought processes may be of particular importance to women with AN. Greater emphasis on these aspects alongside weight gain could enhance patient-clinician alliance and contribute to better treatment outcomes.
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Affiliation(s)
- Laura Al-Dakhiel Winkler
- Center for Eating Disorders, Research Unit for Medical Endocrinology, Odense University Hospital, Mental Health Services in the Region of Southern Denmark, DK-5000 Odense, Denmark; (L.A.-D.W.); (R.K.S.)
| | - Claire Gudex
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, DK-5000 Odense, Denmark
| | - Mia Beck Lichtenstein
- Centre for Telepsychiatry, Region of Southern Denmark, Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark;
| | - Michael Ejnar Røder
- Steno Diabetes Center Odense, Odense University Hospital, DK-5000 Odense, Denmark;
| | - Carol E. Adair
- Departments of Community Health Sciences and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Jan Magnus Sjögren
- Center for Eating Disorders, Ballerup Psychiatric Center, DK-2750 Ballerup, Denmark;
- Institute for Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - René Klinkby Støving
- Center for Eating Disorders, Research Unit for Medical Endocrinology, Odense University Hospital, Mental Health Services in the Region of Southern Denmark, DK-5000 Odense, Denmark; (L.A.-D.W.); (R.K.S.)
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16
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Dann KM, Hay P, Touyz S. Are poor set-shifting and central coherence associated with everyday function in anorexia nervosa? A systematic review. J Eat Disord 2021; 9:40. [PMID: 33781337 PMCID: PMC8008586 DOI: 10.1186/s40337-021-00392-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 03/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is increasing interest in associations between cognitive impairments and clinical symptoms in Anorexia Nervosa (AN), however, the relationship with everyday function is unclear. The current review synthesizes existing data regarding associations between scores on tests of set-shifting and central coherence and functional outcome measures for individuals with AN. METHOD A systematic electronic database search yielded 13 studies which included participants with current or lifetime AN where scores on a neuropsychological test of set-shifting or central coherence were directly or indirectly compared to a functional outcome measure. RESULTS Associations between set-shifting and central coherence performance measures and functional outcomes were limited in number and noted only in adult or mixed-age cohorts. Associations were noted at subscale level, suggesting they are specific in nature. In younger cohorts, assessments of executive functioning in everyday life appear sensitive to cognitive-behavioral flexibility issues. CONCLUSIONS Associations between cognitive performance and functional outcome have not been as systematically assessed in AN as in other psychiatric disorders. Key factors to address in future research include: (a) the use of function measures which are sensitive to both the level of impairment, and specific rather than general impairments (b) the ecological validity of measures, (c) the task impurity problem, especially in regard to cognitive flexibility assessment, and (d) the need to measure both cognitive deficits and strengths, because tests of specific cognitive processes may underestimate the ability to function in daily life due to compensatory strategies.
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Affiliation(s)
- Kelly M Dann
- School of Psychology, University of Sydney, Sydney, Australia.
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute and School of Psychology, University of Sydney, Sydney, Australia
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17
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Morris J, Anderson S. An update on eating disorders. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2020.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYEating disorders are heterogeneous disorders characterised by a maladaptive drive to lose weight and, for the most part, by extreme fear of weight gain and overvaluation of thin body image. Calorie restriction, overexercise and purging behaviours put some sufferers at high risk of physical morbidity and mortality. Mental preoccupations interfere with social, professional and general quality of life. Patients’ defensive secrecy and compulsivity can make it hard to diagnose and treat such disorders despite the suffering they involve. Integrated medical and psychiatric intervention can save life and safely improve nutrition. Behavioural support – with family and carer involvement when appropriate – can counter the dysregulation that leads to vicious cycles of restriction–binge–purge, helping patients develop new skills to regulate emotion without weight losing. In the future, exciting developments in neuroimaging, neurosurgery and pharmacology may lead to ways to make the brain more responsive to therapy. Insights into risk factors may also improve preventive strategies in a climate of highly sophisticated international electronic communication.
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18
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Blackburn B, O'Connor J, Parsons H. Becoming needless: A psychoanalytically informed qualitative study exploring the interpersonal and intrapsychic experiences of longstanding anorexia nervosa. INTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES 2020. [DOI: 10.1002/aps.1679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Bríd Blackburn
- Department of Clinical Psychology School of Psychology, Trinity College Dublin Dublin Ireland
| | - John O'Connor
- Department of Clinical Psychology School of Psychology, Trinity College Dublin Dublin Ireland
| | - Harriet Parsons
- Bodywhys, The Eating Disorders Association of Ireland Dublin Ireland
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19
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Strand M, Bulik CM, Gustafsson SA, von Hausswolff-Juhlin Y, Welch E. Self-admission to inpatient treatment in anorexia nervosa: Impact on healthcare utilization, eating disorder morbidity, and quality of life. Int J Eat Disord 2020; 53:1685-1695. [PMID: 32666605 DOI: 10.1002/eat.23346] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Little evidence exists concerning the optimal model of inpatient care for patients with longstanding anorexia nervosa (AN). Self-admission has been developed as a treatment tool whereby patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. The aim of this study was to evaluate the impact of a self-admission program on healthcare utilization, eating disorder morbidity, health-related quality of life (HRQoL), and sick leave for patients with AN. METHOD In this cohort study, 29 participants with AN in a Swedish self-admission program were compared to 113 patients with longstanding illness but low previous utilization of inpatient treatment, matched based on age, illness duration, and body-mass index (BMI). Data on healthcare utilization, eating disorder morbidity, and sick leave were obtained from national population and eating disorder quality registers. RESULTS Participants displayed a >50% reduction in time spent hospitalized at 12-month follow-up, compared to nonsignificant changes in the comparison group. A sensitivity analysis comparing participants to a moderate-utilization comparison subgroup strengthened this observation. In contrast, the approach did not affect participants' BMI or eating disorder morbidity. Regarding HRQoL, mixed results were observed. In terms of sick leave, a beneficial but nonsignificant pattern was seen for participants. DISCUSSION These findings indicate that self-admission is a viable and helpful tool within a recovery model framework, even though it does not lead to symptom remission. In its proper context, self-admission could potentially transform healthcare from crisis-driven to pre-emptive, and promote autonomy for severely ill patients.
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Affiliation(s)
- Mattias Strand
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Transcultural Centre, Northern Stockholm Psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sanna A Gustafsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yvonne von Hausswolff-Juhlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Elisabeth Welch
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Stockholm Centre for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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20
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Yoneda R, Otani M, Hiraide M, Horie T, Mitsui T, Yoshida T, Komaki G, Yoshiuchi K. Reliability and validity of the Japanese translation of the Eating Disorders Quality of Life (ED-QOL) scale for Japanese healthy female university undergraduate students and patients with eating disorders. Biopsychosoc Med 2020; 14:16. [PMID: 32765642 PMCID: PMC7395422 DOI: 10.1186/s13030-020-00189-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/24/2020] [Indexed: 11/11/2022] Open
Abstract
Background The Eating Disorder Quality of Life (ED-QOL) scale is a 25-item self-report measure that assesses health-related quality of life (HRQoL) of eating-disorder patients. Although the ED-QOL is one of the most widely used questionnaires in many countries, no prior research has addressed the psychometric properties of the Japanese translation of the ED-QOL. Therefore, the aim of the present study was to assess its reliability and validity. Methods A total of 99 Japanese female eating disorder patients and 469 female healthy university undergraduate students completed the Japanese translation of the ED-QOL in addition to the Eating Attitudes Test-26 (EAT-26) and Eating Disorder Inventory-2 (EDI-2). The patient group consisted of 37 patients with anorexia nervosa restricting type (AN-R), 35 patients with binge-eating/purge type (AN-BP), and 27 patients with bulimia nervosa (BN). We performed confirmatory factor analyses on the ED-QOL subscales both for Japanese eating disorder patients and for healthy university undergraduate students. Reliability was assessed using internal consistency indicated by Cronbach alpha coefficients and convergent validity was assessed using Pearson’s correlation coefficients. To assess group differences between the eating disorder patients and healthy university undergraduate students, Student’s t-tests were conducted. Results The CFA showed that the CFI was .90 and RMSEA was .084 (90% confidence interval = .079–.088). The internal consistency of the ED-QOL varied from good to excellent. The EAT-26 total score and three subscales and the EDI-2 subscales had significant correlations with the ED-QOL global QOL score and four subscales. There were no significant correlations between the EDI-2 subscale “Body Dissatisfaction” and the ED-QOL subscales “Physical/Cognitive” and “Work/School”. Eating disorder patients scored significantly higher than healthy university undergraduate students on all ED-QOL subscales and the global QOL score. Conclusions Based on this study, the Japanese translation of the ED-QOL can be regarded as reliable, valid, and functional for female eating-disorder patients and female healthy university undergraduate students.
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Affiliation(s)
- Ryo Yoneda
- Department of Psychosomatic Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Makoto Otani
- Department of Psychosomatic Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Maiko Hiraide
- Department of Psychosomatic Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Takeshi Horie
- Department of Psychosomatic Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Tomoyo Mitsui
- Department of Psychology, Faculty of Human Development and Education, Kobe Shinwa Women's University, 7-13-1 Suzurandaikitamachi Kita-Ku, Kobe, Hyogo 651-1111 Japan
| | - Toshiyuki Yoshida
- School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa, Fukuoka, 831-8501 Japan
| | - Gen Komaki
- School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa, Fukuoka, 831-8501 Japan
| | - Kazuhiro Yoshiuchi
- Department of Psychosomatic Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan.,Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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21
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Steinglass JE, Glasofer DR, Dalack M, Attia E. Between wellness, relapse, and remission: Stages of illness in anorexia nervosa. Int J Eat Disord 2020; 53:1088-1096. [PMID: 32031292 PMCID: PMC7384605 DOI: 10.1002/eat.23237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Psychiatric illnesses, like medical illnesses, can sometimes be considered as progressing through stages. Understanding these stages can lead to a better understanding of pathophysiology, and clarification of prognosis and treatment needs. Opinions from experts in the field of anorexia nervosa (AN) were sought to create a model of stages of illness. METHOD The Delphi approach was used to achieve consensus from a panel of 31 individuals from a range of disciplines with expertise in AN. Over three iterative rounds, participants rated agreement with statements about an overall staging framework and definitions of specific stages. RESULTS Agreement was reached about a longitudinal progression including Subsyndromal, Full Syndrome, Persistent Illness, and Partial and Full Remission. The panel achieved consensus in defining Subsyndromal AN as characterized by body image disturbance and mild to moderate restrictive eating. Overall, there was consensus that restrictive eating is central to the behavioral features of all stages of AN, and agreement that its absence is essential to any stage of health. There was little consensus about biological markers, other than body mass index, and no consensus about quality of life indices associated with different stages. DISCUSSION This panel discussion yielded an expert-informed staging model for AN. This model now needs to be tested for its validity. The lack of consensus in several areas highlighted other research questions to address in order to develop an empirically valid and scientifically useful model of the progression of AN.
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Affiliation(s)
- Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Deborah R. Glasofer
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Maya Dalack
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York,Weill Cornell Medical Center, Presbyterian Hospital, White Plains, New York
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22
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Zhu J, Yang Y, Touyz S, Park R, Hay P. Psychological Treatments for People With Severe and Enduring Anorexia Nervosa: A Mini Review. Front Psychiatry 2020; 11:206. [PMID: 32265758 PMCID: PMC7106475 DOI: 10.3389/fpsyt.2020.00206] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/03/2020] [Indexed: 12/26/2022] Open
Abstract
This Mini-Review presents recent research into evidence for psychological treatments for people with severe and enduring anorexia nervosa (SEAN). Two psychological therapies, specialist supportive clinical management (SSCM), and cognitive behavior therapy for anorexia nervosa (CBT-AN) have limited (one randomized controlled study) evidence of efficacy. Both have had adaptations for SEAN, notably with revision of the primary treatment goal of improved quality of life and full weight recovery a secondary goal. A major issue with existing studies is poor definition of SEAN, and the large deficit in research that has used an agreed definition of SEAN. In particular, it may be problematic to extrapolate from studies of people with either severe and/or enduring but not intractable or "resistant" illness. People with longstanding AN who have not received evidence based care should be offered this with an expectation of recovery. Similarly, people with SEAN may be offered care with judicious mitigation of expectations. In the future, trials should include people with SEAN clearly defined. Trials with a subsample of participants likely to have SEAN, if identified at randomisation, are an opportunity for secondary analyses of such participants. This would widen the evidence base for psychological treatments providing hope for people with this devastating illness. Finally, there is an urgent need not only to strengthen our existing knowledge with studies of sufficient power, but also, fundamentally, to derive novel conceptualizations of what "treatment" involves.
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Affiliation(s)
- James Zhu
- South West and North Coast Psychiatry Training Network, Sydney Local Health District, Sydney, NSW, Australia
| | - Yive Yang
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Rebecca Park
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Phillipa Hay
- Western Sydney University, Translational Health Research Institute, Sydney, NSW, Australia
- South Western Sydney Local Health District, Camden and Campbelltown Hospitals, Sydney, NSW, Australia
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23
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Marzola E, Albini E, Delsedime N, Fassino S, Abbate-Daga G. Therapeutic alliance in inpatients with severe anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2019; 27:671-681. [PMID: 31172605 DOI: 10.1002/erv.2687] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 03/11/2019] [Accepted: 05/09/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Therapeutic alliance (TA) is a relevant aspect in anorexia nervosa (AN), but data on inpatients are lacking. We aimed to evaluate the influence of motivation to change, diagnostic subtypes, and duration of illness on TA at hospital discharge; we also investigated if baseline clinical characteristics were associated with discharge TA, and the TA-outcome association. METHOD We enrolled 137 adult inpatients with AN completing Eating Disorder Examination-Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Anorexia Nervosa Stages of Change-Questionnaire, EuroQoL-Quality of Life Scale-Visual Analogue Scale, and Working Alliance Inventory-Short Revised. RESULTS Patients with different AN subtypes and duration of illness reported similar TA. Baseline depression, state anxiety, and motivation to change were statistically significantly associated with TA at discharge. After controlling for all these variables and duration of illness, only motivation to change remained statistically significant. Statistically significant correlations were also found between improvements in body mass index and quality of life and discharge TA. CONCLUSIONS Few data exist on TA in inpatients with AN and a long duration of illness. Our findings suggest that baseline motivation to change correlates with TA at discharge independently of other variables. Future studies should ascertain as to whether a causal link exists or not.
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Affiliation(s)
- Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Erica Albini
- 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
| | - Secondo Fassino
- 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
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24
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Russell J, Mulvey B, Bennett H, Donnelly B, Frig E. Harm minimization in severe and enduring anorexia nervosa. Int Rev Psychiatry 2019; 31:391-402. [PMID: 31074662 DOI: 10.1080/09540261.2019.1601073] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
For many sufferers of anorexia nervosa, the time course is long, and the prospect of disability and family burden great. This is all too often the case, even with early diagnosis and treatment. The term severe and enduring anorexia nervosa has been applied to these survivors. Yet, a majority of patients do eventually recover and, even where this is not the case, adaptive medical stability and function can be maintained despite alarming dilapidation. Managing the years of illness so as to have the best outcome physically and psychologically, even where full weight recovery does not occur, or has not yet occurred, is the topic of this article. Literature pertaining to harm minimization in chronic, severe, enduring, and long-standing anorexia nervosa was selectively reviewed using an Ovid data base and Google Scholar. The authors' own clinical experience over almost four decades in public and private hospital and community settings has also informed much of what has been written. The authors would like to think that it is possible to do better than the familiar injunction (variously attributed to Hippocrates, Galen, and others) of 'primum non nocere'-although this is a good place to start.
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Affiliation(s)
- Janice Russell
- a Professor Marie Bashir Centre , Royal Prince Alfred Hospital , Camperdown , NSW , Australia
| | - Bridget Mulvey
- a Professor Marie Bashir Centre , Royal Prince Alfred Hospital , Camperdown , NSW , Australia
| | - Hayley Bennett
- a Professor Marie Bashir Centre , Royal Prince Alfred Hospital , Camperdown , NSW , Australia
| | - Brooke Donnelly
- a Professor Marie Bashir Centre , Royal Prince Alfred Hospital , Camperdown , NSW , Australia
| | - Elizabeth Frig
- a Professor Marie Bashir Centre , Royal Prince Alfred Hospital , Camperdown , NSW , Australia
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25
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Kane C, Tomotake M, Hamatani S, Chiba S, Kameoka N, Watanabe S, Nakataki M, Numata S, Ohmori T. Clinical factors influencing resilience in patients with anorexia nervosa. Neuropsychiatr Dis Treat 2019; 15:391-395. [PMID: 30787613 PMCID: PMC6365225 DOI: 10.2147/ndt.s190725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study was to elucidate clinical factors influencing resilience in anorexia nervosa (AN) patients. PATIENTS AND METHODS Twenty female patients with AN (median age =30.0 years, quartile deviation =6.8) and 40 female healthy controls (HCs) (median age =30.0 years, quartile deviation =8.6) participated in the present study. Resilience was assessed with the Connor- Davidson resilience scale (CD-RISC). Clinical symptoms were evaluated with the structured interview guide for the Hamilton depression rating scale (SIGH-D) and the eating disorder inventory-2 (EDI-2). RESULTS Scores of the CD-RISC in the AN group were lower than those in the HC group, and the SIGH-D score in the AN group was higher than that in the HC group. Scores of interoceptive confusion, interpersonal difficulty and negative self-image subscales of the EDI-2 negatively correlated with the CD-RISC score. Moreover, stepwise regression analysis showed that negative self-image score was an independent predictor of the CD-RISC score. CONCLUSION These results suggest that among these clinical factors including psychopathologies, self-dissatisfaction and feeling of being rejected by others are the most important influencing factors on an AN patients' resilience.
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Affiliation(s)
- Chikako Kane
- Department of Nursing, Tokushima University Hospital, Tokushima-shi, Tokushima, Japan Email
| | - Masahito Tomotake
- Department of Mental Health, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development Chiba University, Chuouku, Chiba, Japan
| | - Shinichi Chiba
- Department of Mental Health, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Naomi Kameoka
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Shinya Watanabe
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Masahito Nakataki
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Shusuke Numata
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima-shi, Tokushima, Japan
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Knyahnytska YO, Blumberger DM, Daskalakis ZJ, Zomorrodi R, Kaplan AS. Insula H-coil deep transcranial magnetic stimulation in severe and enduring anorexia nervosa (SE-AN): a pilot study. Neuropsychiatr Dis Treat 2019; 15:2247-2256. [PMID: 31496707 PMCID: PMC6689531 DOI: 10.2147/ndt.s207630] [Citation(s) in RCA: 9] [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: 03/10/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Anorexia nervosa (AN) is a complex disorder of unknown etiology, characterized by obsessions and compulsions around body shape, weight, and calorie intake. In the course of AN, 10%-30% will recover, while the rest will develop a treatment-resistant course with a high mortality rate due to AN-related complications. The insula is a region in the brain of considerable interest to its role in gustatory modulation, feeding behavior, and processing of interoceptive stimuli. OBJECTIVE Recent advances in the neurophysiology of AN suggest insula dysfunction as a potential biomarker for people with severe and enduring AN (SE-AN). Deep transcranial magnetic stimulation (dTMS) is of particular interest in SE-AN because of its ability to target deep areas of the brain. DESIGN We conducted a pilot study to investigate the feasibility and safety of insula dTMS in subjects with SE-AN. RESULTS We found that dTMS is a safe and well-tolerated treatment. We also found a reduction in AN-related obsessions and compulsions, as well as depression and anxiety scores from baseline to the end of the trial. Due to small sample size, the results of this study should be interpreted with great caution. DISCUSSION The results suggest that dTMS is safe and well tolerated and may be of some clinical interest in patients with SE-AN. However, to determine the true efficacy of dTMS for SE-AN, there is a need to conduct a randomized controlled trial comparing real versus sham dTMS in a larger number of AN subjects.
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Affiliation(s)
- Yuliya O Knyahnytska
- Temerty Centre for Therapeutic- Brain Intervention, Centre for Addiction and Mental Health , Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic- Brain Intervention, Centre for Addiction and Mental Health , Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Geriatric Division, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic- Brain Intervention, Centre for Addiction and Mental Health , Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic- Brain Intervention, Centre for Addiction and Mental Health , Toronto, Ontario, Canada
| | - Allan S Kaplan
- Temerty Centre for Therapeutic- Brain Intervention, Centre for Addiction and Mental Health , Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Mason TB, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Crow SJ, Grange DL, Smith KE, Peterson CB. Associations among eating disorder behaviors and eating disorder quality of life in adult women with anorexia nervosa. Psychiatry Res 2018; 267:108-111. [PMID: 29886272 PMCID: PMC6760249 DOI: 10.1016/j.psychres.2018.05.077] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 05/22/2018] [Accepted: 05/27/2018] [Indexed: 11/16/2022]
Abstract
The study examined associations between eating disorder behaviors measured via ecological momentary assessment (EMA) and eating disorder quality of life (EDQOL) in anorexia nervosa (AN). Women with AN (N = 82) completed an EDQOL measure and two-weeks of EMA. Greater frequency of EMA-assessed restriction and bulimic behavior were independently related to lower EDQOL scores. Lower psychological EDQOL was associated with increased EMA dietary restriction; lower work-related EDQOL was associated with increased EMA binge eating; aspects of EDQOL were unrelated to EMA purging. Findings suggest that severity of restriction and bulimic behaviors may serve as severity indicators of EDQOL in AN.
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Affiliation(s)
- Tyler B. Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Stephen A. Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Ross D. Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Scott G. Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN,The Emily Program, St. Paul, MN
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA
| | - Kathryn E. Smith
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN,The Emily Program, St. Paul, MN
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Diedrichs PC, von Ranson KM, Thomas JJ. Innovation in eating disorders research and practice: Expanding our community and perspectives at the 2018 International Conference on Eating Disorders: Editorial to accompany IJED Virtual Issue in honor of the 2018 International Conference on Eating Disorders. Int J Eat Disord 2018; 51:585-587. [PMID: 29740841 DOI: 10.1002/eat.22881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This virtual issue of the International Journal of Eating Disorders (IJED) highlights the excellent and innovative research and practice discussed at the 2018 International Conference on Eating Disorders held in Chicago, Illinois, USA. METHOD AND RESULTS The virtual issue contains a series of articles recently published in IJED, which we have curated to reflect and expand on the insights delivered during the conference keynote and plenary presentations. DISCUSSION In line with the conference theme of Innovation in Research and Practice: Expanding our Community and Perspectives, we hope this collection of articles will spark new ideas for research, practice, and collaboration to accelerate knowledge on eating disorder risk factors and recovery, and the reach and impact of evidence-based treatment, prevention, and policy efforts.
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Affiliation(s)
- Phillippa C Diedrichs
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Jennifer J Thomas
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Dakanalis A, Alix Timko C, Colmegna F, Riva G, Clerici M. Evaluation of the DSM-5 severity ratings for anorexia nervosa in a clinical sample. Psychiatry Res 2018; 262:124-128. [PMID: 29428775 DOI: 10.1016/j.psychres.2018.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 01/11/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
We examined the validity and utility of the DSM-5 severity ratings for anorexia nervosa (AN) in a clinical (treatment-seeking) sample (N = 273; 95.6% women). Participants classified with mild, moderate, severe, and extreme severity of AN based on their measured body mass index, differed significantly from each other in eating disorder features, putative maintenance factors, and illness-specific functional impairment (medium effect sizes). However, they were statistically indistinguishable in psychiatric-disorder comorbidity and distress, demographics, and age-of-AN onset. The implications of our findings, providing limited support for the DSM-5 severity ratings for AN, and directions for future research are outlined.
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Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Italy.
| | - C Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA; Children's Hospital of Philadelphia, Philadelphia, USA
| | - Fabrizia Colmegna
- Mental Health Department, San Gerardo Monza Health and Social Care Trust, Monza, Italy
| | - Giuseppe Riva
- Department of Psychology, Catholic University of Milan, Italy; Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Mental Health Department, San Gerardo Monza Health and Social Care Trust, Monza, Italy
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Haracz K, Robson E. A bidirectional relationship between eating disorder symptoms and quality of life supports a recovery focussed approach to treatment. Aust Occup Ther J 2017; 64:345-347. [PMID: 28836332 DOI: 10.1111/1440-1630.12413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kirsti Haracz
- School of Health Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Emma Robson
- School of Health Science, The University of Newcastle, Callaghan, New South Wales, Australia
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31
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Eddy KT, Tabri N, Thomas JJ, Murray HB, Keshaviah A, Hastings E, Edkins K, Krishna M, Herzog DB, Keel PK, Franko DL. Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up. J Clin Psychiatry 2017; 78:184-189. [PMID: 28002660 PMCID: PMC7883487 DOI: 10.4088/jcp.15m10393] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/27/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The course of eating disorders is often protracted, with fewer than half of adults achieving recovery from anorexia nervosa or bulimia nervosa. Some argue for palliative management when duration exceeds a decade, yet outcomes beyond 20 years are rarely described. This study investigates early and long-term recovery in the Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa. METHODS Females with DSM-III-R/DSM-IV anorexia nervosa or bulimia nervosa were assessed at 9 and at 20 to 25 years of follow-up (mean [SD] = 22.10 [1.10] years; study initiated in 1987, last follow-up conducted in 2013) via structured clinical interview (Longitudinal Interval Follow-Up Evaluation of Eating Disorders [LIFE-EAT-II]). Seventy-seven percent of the original cohort was re-interviewed, and multiple imputation was used to include all surviving participants from the original cohort (N = 228). Kaplan-Meier curves estimated recovery by 9-year follow-up, and McNemar test examined concordance between recovery at 9-year and 22-year follow-up. RESULTS At 22-year follow-up, 62.8% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa recovered, compared to 31.4% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa by 9-year follow-up. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long-term recovery in anorexia nervosa (odds ratio [OR] = 10.5; 95% CI, 3.77-29.28; McNemar χ²₁ = 31.39; P < .01) but not in bulimia nervosa (OR = 1.0; 95% CI, 0.49-2.05; McNemar χ²₁ = 0; P = 1.0). CONCLUSION At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders.
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Affiliation(s)
- Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Corresponding author: Kamryn T. Eddy, PhD, Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Pl, Ste 200, Boston, MA 02114 ()
| | - Nassim Tabri
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Helen B. Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston
| | - Aparna Keshaviah
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston
| | - Elizabeth Hastings
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston
| | - Katherine Edkins
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston
| | - Meera Krishna
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston
| | - David B. Herzog
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee
| | - Debra L. Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston,Department of Applied Psychology, Northeastern University, Boston, Massachusetts
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Ulian MD, Sato PDM, Benatti FB, Campos-Ferraz PLD, Roble OJ, Unsain RF, Gualano B, Scagliusi FB. Adaptação transcultural para o português dos Questionários de Desejos Intensos por Comida – Estado ou Traço (QDIC-E e QDIC-T) dos State and Trait Food-Cravings Questionnaires (FCQ-S and FCQ-T). CIENCIA & SAUDE COLETIVA 2017. [DOI: 10.1590/1413-81232017222.18272015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo objetivou apresentar a adaptação transcultural dos Questionários de Desejos Intensos por Comida – Estado ou Traço (QDIC-E e QDIC-T) dos State and Trait Food-Cravings Questionnaires (FCQ-S and FCQ-T) para o Português. Fez-se a tradução e a retradução dos instrumentos, a avaliação da equivalência conceitual, operacional e de itens por especialistas da área e a avaliação dos instrumentos por uma amostra de universitários, por meio da avaliação do grau de compreensão e análise da consistência interna dos instrumentos pelo coeficiente Alpha de Cronbach. Ademais, fez-se a avaliação da equivalência semântica pelo coeficiente de correlação intraclasse entre os escores obtidos por bilíngues em cada questão das versões em inglês e português. Os instrumentos foram considerados de fácil compreensão (para os especialistas foi de 95,4% e 97%, para o QDIC-T e QDIC-E, respectivamente, e, para os universitários, 81,8% os consideraram de fácil compreensão), e demonstraram valores de consistência interna satisfatórios (QDIC-T: variaram de 0,6 a 0,8; QDIC-E: variaram de 0,5 a 0,8). A partir do processo de adaptação transcultural, os resultados satisfatórios possibilitam a recomendação da versão brasileira dos QDICs.
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Lee EB, Smith BM, Twohig MP, Lensegrav-Benson T, Quakenbush-Roberts B. Assessment of the body Image-Acceptance and Action Questionnaire in a female residential eating disorder treatment facility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2016.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Patel K, Tchanturia K, Harrison A. An Exploration of Social Functioning in Young People with Eating Disorders: A Qualitative Study. PLoS One 2016; 11:e0159910. [PMID: 27458808 PMCID: PMC4961427 DOI: 10.1371/journal.pone.0159910] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022] Open
Abstract
Previous research indicates adults with eating disorders (EDs) report smaller social networks, and difficulties with social functioning, alongside demonstrating difficulties recognising and regulating emotions in social contexts. Concurrently, those recovered from the illness have discussed the vital role offered by social support and interaction in their recovery. To date, little is known about the social skills and social networks of adolescents with EDs and this study aimed to conduct focus groups to explore the social functioning of 17 inpatients aged 12-17. Data were analysed using thematic analysis and six core themes were identified: group belonging, self-monitoring, social sensitivity, impact of hospitalisation, limited coping strategies and strategies for service provision. Key areas for service provision were: management of anxiety, development and/or maintenance of a social network and development of inter and intrapersonal skills. The most salient finding was that adolescents with EDs reported social difficulties which appeared to persist over and above those typically experienced at this point in the lifespan and therefore a key area for future focus is the development of appropriate coping strategies and solutions to deal with these reported difficulties.
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Affiliation(s)
- Krisna Patel
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Amy Harrison
- Regent’s University London, Faculty of Humanities, Arts and Social Sciences, School of Psychotherapy and Psychology, London, United Kingdom
- Ellern Mede Service for Eating Disorders, London, United Kingdom
- * E-mail:
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Caring for Patients With Severe and Enduring Eating Disorders (SEED): Certification, Harm Reduction, Palliative Care, and the Question of Futility. J Psychiatr Pract 2016; 22:313-20. [PMID: 27427843 DOI: 10.1097/pra.0000000000000160] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anorexia nervosa is a serious mental illness with a high mortality rate. The body image distortion inherent to this disorder and the impaired judgment and cognition due to malnutrition frequently result in patients refusing treatment. Treatment is most effective if patients are treated early in the course of their illness and undergo a full course of treatment. Involuntary treatment may therefore be both life-saving and critical to recovery. Between April 2012 and March 2016, 109 patients (5.2% of patients admitted to the Eating Recovery Center in Denver, CO) were certified, 39% of whom were transferred from the ACUTE Center for Eating Disorders at Denver Health Medical Center. Of these 109 certified patients, 31% successfully completed treatment, and 42% returned for a further episode of care; 24% of the certifications were terminated as involuntary treatment was not found to be helpful. Conclusions supported by these data are that patients with anorexia nervosa who are the most medically ill often require involuntary treatment. In addition, although many patients who are certified successfully complete treatment, involuntary treatment is not helpful approximately 25% of the time. Many of the patients for whom certification is ineffective are those who suffer from a lifetime of illness that is severe and enduring. Patients with severe and enduring eating disorders (SEED) typically undergo cyclical weight restoration and weight loss. Many of these patients question the value of serial treatments, especially when they have few (if any) illness-free intervals. Patients, families, and treating physicians often wish to explore other models of care, including harm reduction and palliative care. In addition, patients with SEED may also contemplate whether a compassionate death would be better than an ongoing lifetime of suffering. In this review, we outline arguments for and against the concept of futility in SEED, and explore whether (or when) patients are competent to make the decision to die.
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Weigel A, König HH, Gumz A, Löwe B, Brettschneider C. Correlates of health related quality of life in anorexia nervosa. Int J Eat Disord 2016; 49:630-4. [PMID: 26841271 DOI: 10.1002/eat.22512] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/30/2015] [Accepted: 12/30/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined the association between disorder specific factors, comorbidity and health related quality of life (HRQoL) in anorexia nervosa (AN). METHOD HRQoL was assessed using the EuroQol-5D visual analog scale (EQ-VAS) in this cross-sectional study. Three regression models were estimated to determine the association between AN subtype (restrictive vs. binge/purge), duration of the eating disorder (ED), age (adolescents vs. adults), ED pathology (EDE-Q), Body Mass Index (BMI), depressive symptoms (PHQ-9), somatic complaints (PHQ-15), anxiety (GAD-7) and EQ-VAS. RESULTS The sample comprised 218 female AN patients (mean age = 23.3 years [SD = 8.2]; mean EQ-VAS score = 53.4 [SD = 21.4]). A lower BMI, higher levels of depressive symptoms, and somatic complaints were significantly associated with lower EQ-VAS scores. DISCUSSION Findings of the present study suggest that BMI and comorbidity might be more relevant to HRQoL impairments in AN than age, diagnostic subtype, duration of the ED or current psychopathology. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:630-634).
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Affiliation(s)
- Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg- Eppendorf
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf
| | - Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg- Eppendorf
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg- Eppendorf
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf
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Abstract
Recent years have seen substantial consolidation and development of the evidence base for psychological therapies for eating disorders. This review summarises the key changes over that time period. Specific forms of cognitive behavioural therapy and family-based treatment have consolidated and extended their positions as treatments of choice despite the development of novel approaches. However, there is still a significant need for further development and testing to improve recovery rates, particularly in anorexia nervosa.
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Affiliation(s)
- Glenn Waller
- Clinical Psychology Unit, Department of Psychology, Western Bank, University of Sheffield, Sheffield, UK
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Gaudiani JL, Brinton JT, Sabel AL, Rylander M, Catanach B, Mehler PS. Medical outcomes for adults hospitalized with severe anorexia nervosa: An analysis by age group. Int J Eat Disord 2016; 49:378-85. [PMID: 26332494 DOI: 10.1002/eat.22437] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Relatively little has been written about the outcomes of medical stabilization, analyzed specifically across the age spectrum, in adults with severe anorexia nervosa (AN). METHOD We retrospectively evaluated clinical parameters relevant to acuity of illness and outcomes of early refeeding in 142 adults with severe AN, admitted for definitive inpatient medical stabilization from October 1, 2008 to December 31, 2012. Patients were categorized into three age groups: 17 to 29, 30 to 40, and 41+ years. RESULTS The study included 142 patients with median age of 28 years old (range 17-65 years). Fifty-four percent (n = 78) were under 30 years old, 23% (n = 32) between 30 and 40 years old, and 23% (n = 32) were over 40 years old. Average admission BMI did not differ among age groups, ranging from 12.7 to 13.2 kg/m(2). Of the admission parameters, only low serum albumin levels (more prevalent in older patients), high international normalized ratio (INR) levels (more prevalent in younger patients), and neutropenia (more prevalent in the <30 age group) varied with age. During hospitalization, rates of bradycardia, hypoglycemia, liver dysfunction, very low %IBW, refeeding hypophosphatemia, refeeding edema, length of stay, and discharge BMI did not differ with age. Age group was associated with rate of weekly weight gain only in patients with AN-binge purge subtype. DISCUSSION Results demonstrate medical abnormalities and response to medical stabilization in severely ill AN patients during hospitalization were mostly similar across the age span. This information should allay fears that the effect of age will make medical stabilization more difficult.
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Affiliation(s)
- Jennifer L Gaudiani
- Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado
| | - John T Brinton
- Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado
| | - Allison L Sabel
- Department of Patient Safety and Quality, Denver Health, Denver, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, Colorado
| | - Melanie Rylander
- Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado.,Department of Psychiatry, University of Colorado, Denver, Colorado
| | | | - Philip S Mehler
- Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado.,Eating Recovery Center, Denver, Colorado
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Molin M, von Hausswolff-Juhlin Y, Norring C, Hagberg L, Gustafsson SA. Case management at an outpatient unit for severe and enduring eating disorder patients at Stockholm Centre for Eating Disorders- a study protocol. J Eat Disord 2016; 4:24. [PMID: 27800159 PMCID: PMC5080765 DOI: 10.1186/s40337-016-0121-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with severe and enduring eating disorders (SEED) are seriously ill and have a low quality of life. Case management (CM), originally developed for adult patients with severe mental disabilities, has been shown to enhance social functioning and improve quality of life, while reducing the number and length of hospitalizations. In 2014, a special unit based on CM, for patients with SEED (the Eira unit) was started at Stockholm Centre for Eating Disorders, Sweden. METHOD/DESIGN This study aims to investigate if CM can improve SEED patients' quality of life, and reduce their eating disorder symptoms as well as their health care consumption. Methods for data collection are a semi-structured diagnostic interview, self-report questionnaires, and a qualitative interview. The diagnostic interview and the self-report assessments will be done at start of treatment and at follow-ups after 1, 2, and 3years. The qualitative interview will be conducted 1 year after start of treatment. The study is approved by the ethical review board in Stockholm in compliance with the Helsinki Declaration. DISCUSSION CM is a possible new contribution to the treatment methods for SEED. It does not aim at remission, but rather to accept life as it is, and to enhance quality of life in the presence of the ED. This study will investigate the potential benefits of this novel intervention in a special unit for SEED patients. TRIAL REGISTRATION Clinicaltrials.gov Id: NCT02897622.
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Affiliation(s)
- M Molin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Centre for Eating Disorders, Research & Development, Wollmar Yxkullsgatan 25, S-118 50 Stockholm, Sweden
| | - Y von Hausswolff-Juhlin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Centre for Eating Disorders, Research & Development, Wollmar Yxkullsgatan 25, S-118 50 Stockholm, Sweden
| | - C Norring
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Centre for Eating Disorders, Research & Development, Wollmar Yxkullsgatan 25, S-118 50 Stockholm, Sweden
| | - L Hagberg
- School of Health Sciences, University Health Care Research Centre, Örebro University, 701 82 Örebro, Sweden
| | - S A Gustafsson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, 701 82 Örebro, Sweden
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Treasure J, Zipfel S, Micali N, Wade T, Stice E, Claudino A, Schmidt U, Frank GK, Bulik CM, Wentz E. Anorexia nervosa. Nat Rev Dis Primers 2015; 1:15074. [PMID: 27189821 DOI: 10.1038/nrdp.2015.74] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes; however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of 'thinness' and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.
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Affiliation(s)
- Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AF, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine, University of Tuebingen, Tuebingen, Germany
| | - Nadia Micali
- University College London, Institute of Child Health, Behavioural and Brain Sciences Unit, London, UK.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tracey Wade
- School of Psychology, Flinders University, Adelaide, Australia
| | - Eric Stice
- Oregon Research Institute, Eugene, Oregon, USA
| | - Angélica Claudino
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Ulrike Schmidt
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AF, UK
| | - Guido K Frank
- Eating Disorder Centre of Denver, University of Colorado, Denver, Colorado, USA
| | - Cynthia M Bulik
- University of North Carolina at Chapel Hill, North Carolina, USA.,Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Wentz
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg Sweden
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