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Siegel JA, Mendoza RR, Tesselaar JM, DeJesus J, Elbe CI, Caravelli NS, Troy L, Fenton M, Victoria B, Herrera J, Blashill AJ. "I felt so powerful to have this love in me": A grounded theory analysis of the experiences of people living with and recovering from eating disorders while in diverse romantic relationships. Body Image 2024; 49:101709. [PMID: 38615591 DOI: 10.1016/j.bodyim.2024.101709] [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: 07/05/2023] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Abstract
Romantic partners have the potential to influence attitudes and behaviors related to body image and disordered eating. However, the role that romantic relationships can play in eating disorder (ED) recovery has not been comprehensively investigated. The present study aimed to explore the ways that people living with and recovering from EDs experience their romantic relationships, with the specific objective of developing a novel theoretical framework, grounded in the experiences of people in diverse romantic relationships, to guide future research on the topic. Semi-structured individual interviews were conducted with 66 people (45 cisgender women, 11 cisgender men, 9 nonbinary people, and 1 transgender man) living with and recovering from EDs while in romantic relationships. Our grounded theory analysis yielded a theoretical model of ED management in romantic relationships, revealing that Individual and Relationship Characteristics intersected with Relationship-Related Stressors and were navigated using Eating Disorder and Relationship Management Strategies. Combined with Partner Support and Tensions, these management strategies were related to Relationship and Mental Health Outcomes, which affected and were affected by Future Concerns. Future researchers should continue to build on, expand, and modify this model and further explore the role of romantic relationships in the experience of people living with EDs.
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Affiliation(s)
| | | | | | | | - Connor I Elbe
- Department of Psychology, San Diego State University, USA
| | | | - Lynae Troy
- Department of Psychology, San Diego State University, USA
| | - Margo Fenton
- Department of Psychology, San Diego State University, USA
| | | | | | - Aaron J Blashill
- Department of Psychology, San Diego State University, SDSU/UCSD Joint Doctoral Program in Clinical Psychology, USA
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2
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Tesselaar JM, Mendoza RR, Siegel JA, Elbe CI, Caravelli NS, DeJesus J, Fenton M, Victoria BS, Blashill AJ. A qualitative analysis of relationship advice from the perspective of people living with and recovering from eating disorders while in diverse romantic relationships. Eat Disord 2023; 31:632-650. [PMID: 37194296 DOI: 10.1080/10640266.2023.2206753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Eating disorders (EDs) have adverse consequences across life domains, ranging from physical health to interpersonal relationships. While research suggests that romantic partners have the potential to support ED recovery, partners to those with EDs often report feeling confused and helpless in the face of the condition. The extant literature on EDs in relationships centers on the experiences of cisgender, heterosexual women. The present study aimed to garner a more comprehensive understanding of the types of support people with EDs believe are most helpful from romantic partners by analyzing relationship advice from a diverse group of individuals with EDs who were in romantic relationships. As part of a larger study on romantic relationships in ED recovery, we analyzed responses to the question, "If you had to give one piece of advice to someone who learns that their partner has an ED, what would it be?" Through Consensual Qualitative Research-Modified, we identified 29 themes, which we grouped into 7 domains: Foster Open Communication, Create an Environment of Emotional Intimacy, Let Your Partner Guide You, Educate Yourself, Be Compassionate with Yourself, Use Caution when Discussing Food and Bodies, and a Miscellaneous domain. These findings highlight the importance of patience, flexibility, psychoeducation, and self-compassion for individuals working to support their partner's ED recovery, and can inform future couples-based treatments and interventions for EDs.
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Affiliation(s)
- Juliana M Tesselaar
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Rebecca R Mendoza
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jaclyn A Siegel
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Connor I Elbe
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Nicolas S Caravelli
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jennifer DeJesus
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Margo Fenton
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Brianna S Victoria
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
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3
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Ralph AF, Brennan L, Byrne S, Caldwell B, Farmer J, Hart LM, Heruc GA, Maguire S, Piya MK, Quin J, Trobe SK, Wallis A, Williams-Tchen AJ, Hay P. Management of eating disorders for people with higher weight: clinical practice guideline. J Eat Disord 2022; 10:121. [PMID: 35978344 PMCID: PMC9386978 DOI: 10.1186/s40337-022-00622-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population. AIM The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations. METHODS The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience. RECOMMENDATIONS Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed. CONCLUSIONS This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.
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Affiliation(s)
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Wodonga, Australia
| | - Sue Byrne
- Department of Psychology, University of Western Australia, Perth, Australia
| | | | - Jo Farmer
- Lived Experience Advocate, Melbourne, Australia
| | - Laura M. Hart
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Gabriella A. Heruc
- Eating Disorders and Nutrition Research Group (ENRG), School of Medicine, Western Sydney University, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, Sydney, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Macarthur Clinical School, Sydney, Australia
- Camden and Campbelltown Hospitals, Sydney, Australia
| | - Julia Quin
- Lived Experience Advocate, Melbourne, Australia
| | - Sarah K. Trobe
- National Eating Disorders Collaboration, Sydney, Australia
| | - Andrew Wallis
- Sydney Children’s Hospitals Network, The Children’s Hospital Westmead, Sydney, Australia
| | | | - Phillipa Hay
- Eating Disorders and Body Image (EDBI), Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- South Western Sydney Local Health District, Sydney, Australia
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4
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Fleming C, Byrne J, Healy K, Le Brocque R. Working with families of adults affected by eating disorders: uptake, key themes, and participant experiences of family involvement in outpatient treatment-as-usual. J Eat Disord 2022; 10:88. [PMID: 35768840 PMCID: PMC9245299 DOI: 10.1186/s40337-022-00611-z] [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: 09/05/2021] [Accepted: 06/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Eating disorders are associated with significant personal and family costs. Clinical guidelines recommend family members be involved and supported during care, but little has been reported regarding the preferences of adults around carer involvement in treatment. The necessary intensity of family work with adults is also unknown. A trial of a standardised brief family involvement method was conducted in an adult eating disorder service offering treatment-as-usual. Uptake and feasibility of implementing the approach as part of standard outpatient care and the preliminary impact on issues identified by adult patients and carers were evaluated. METHODS Eligible referrals at an adult eating disorders outpatient clinic were offered as needed family consultation to address presenting interpersonal problems identified by patients and their family members, and outcomes were evaluated 4 weeks later. Pre and post intervention surveys identified participant self-reported change in (i) problem frequency, (ii) distress and disruption caused, and (iii) confidence regarding presenting problems. Open text responses provided an overview of patient and carer goals for family involvement and revealed how the novel method impacted these areas as well as overall experience of, and feedback regarding, the brief family intervention. RESULTS Twenty-four female participants aged 18-53, and 22 carers participated in 31 consultations. Common concerns raised were eating disorder related interpersonal and communication issues. The focused sessions, offered on a one-at-a-time basis, showed preliminary effectiveness for reducing both patients and carer concerns. For example, adult patients reported that life interference from interpersonal problems was lower and confidence to deal with them was higher following family consultation. Carers also reported that frequency, level of worry, and life interference around presenting problems were lower after the structured family intervention. CONCLUSIONS Brief family consultation, with a single focus on issues identified by family members and adult patients, was a safe and feasible procedure with adults affected by eating disorders. Effective at meeting the needs of participants, the framework investigated in the current study may also be a useful direction for adult services to consider when looking to support families and meet recommendations for their routine involvement in the outpatient care. TRIAL REGISTRATION Australian Clinical Trials Register number: ACTRN12621000047897 (www.anzctr.org.au).
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Affiliation(s)
- Carmel Fleming
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Qld, 4072, Australia. .,Queensland Eating Disorder Service, Queensland Health Metro North Hospital and Health Service, Brisbane, Australia.
| | - Jacqueline Byrne
- Queensland Eating Disorder Service, Queensland Health Metro North Hospital and Health Service, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Qld, 4122, Australia
| | - Karen Healy
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Qld, 4072, Australia
| | - Robyne Le Brocque
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Qld, 4072, Australia
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5
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A Retrospective Literature Review of Eating Disorder Research (1990–2021): Application of Bibliometrics and Topical Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137710. [PMID: 35805366 PMCID: PMC9265657 DOI: 10.3390/ijerph19137710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/24/2022]
Abstract
Despite the growing importance of eating disorders in society and academic literature, only a few bibliometric review studies using bibliometric analysis were available. Hence, this study aimed to explore and uncover hidden research topics and patterns in articles in terms of eating disorders over the last 30 years. In total, 4111 articles on eating disorders were analyzed using bibliometrics, network analyses, and structural topic modeling as the basis of mixed methods. In addition to general statistics about the journal, several key research topics, such as eating disorder (ED) treatment, ED symptoms, factors triggering ED, family related factors, eating behaviors, and social factors, were found based on topic correlations. This study found the key research variables that are frequently studied with EDs, such as AN, BN, BED, and ARFID. This study may help clinicians comprehend important risk factors associated with EDs. Moreover, the findings about key ED research topics and their association can be helpful for future studies to construct a comprehensive ED research framework. To our knowledge, this is the first study to use topic modeling in an academic journal on EDs and examine the diversity in ED research over 30 years of published research.
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6
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Mason TB, Dayag R, Dolgon-Krutolow A, Lam K, Zhang D. A systematic review of maladaptive interpersonal behaviors and eating disorder psychopathology. Eat Behav 2022; 45:101601. [PMID: 35221209 DOI: 10.1016/j.eatbeh.2022.101601] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 01/08/2023]
Abstract
While maladaptive interpersonal behaviors have been implicated in models of psychopathology, particularly depression, maladaptive interpersonal behaviors have received limited attention in the eating disorder (ED) literature. Further, the extant literature on maladaptive interpersonal behaviors in relation to ED psychopathology has yet to be synthesized. Therefore, the aim of this systematic review was to characterize the literature on maladaptive interpersonal behaviors and ED psychopathology. Inclusion criteria for the review were: availability of the study in English, empirical journal article, inclusion of human subjects, and reporting an association between at least one maladaptive interpersonal behavior and one measure of ED psychopathology. Databases searched were PsycInfo and PubMed across all dates (up to September 2020). Data was extracted from articles, and main findings were synthesized; quality scores were provided using a modified version of the Newcastle Ottawa Scale. There were 35 studies with 36 independent samples included in the review. Most studies evidenced significant bivariate associations between maladaptive interpersonal behaviors and ED psychopathology. That is, higher levels of maladaptive interpersonal behaviors were generally associated with greater disordered eating, bulimic symptoms, and body image concerns. Although limited to a minority of studies, some studies identified prospective associations and significant mediators and moderators of associations. This systematic review supports further research on maladaptive interpersonal behaviors and ED psychopathology. Given a number of significant limitations in the literature identified in this review, there are an array of avenues for future research on maladaptive interpersonal behaviors and ED psychopathology.
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Affiliation(s)
- Tyler B Mason
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
| | - Rachel Dayag
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Anna Dolgon-Krutolow
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Kathy Lam
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Diana Zhang
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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7
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Giel KE, Bulik CM, Fernandez-Aranda F, Hay P, Keski-Rahkonen A, Schag K, Schmidt U, Zipfel S. Binge eating disorder. Nat Rev Dis Primers 2022; 8:16. [PMID: 35301358 PMCID: PMC9793802 DOI: 10.1038/s41572-022-00344-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/30/2022]
Abstract
Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018-2020 is estimated to be 0.6-1.8% in adult women and 0.3-0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first-line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence-based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics.
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Affiliation(s)
- Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany.
| | - Cynthia M Bulik
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Camden and Campbelltown Hospitals, SWSLHD, Campbelltown, NSW, Australia
| | | | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
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8
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Burke NL, Frank GKW, Hilbert A, Hildebrandt T, Klump KL, Thomas JJ, Wade TD, Walsh BT, Wang SB, Weissman RS. Open science practices for eating disorders research. Int J Eat Disord 2021; 54:1719-1729. [PMID: 34555191 PMCID: PMC9107337 DOI: 10.1002/eat.23607] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/07/2022]
Abstract
This editorial seeks to encourage the increased application of three open science practices in eating disorders research: Preregistration, Registered Reports, and the sharing of materials, data, and code. For each of these practices, we introduce updated International Journal of Eating Disorders author and reviewer guidance. Updates include the introduction of open science badges; specific instructions about how to improve transparency; and the introduction of Registered Reports of systematic or meta-analytical reviews. The editorial also seeks to encourage the study of open science practices. Open science practices pose considerable time and other resource burdens. Therefore, research is needed to help determine the value of these added burdens and to identify efficient strategies for implementing open science practices.
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Affiliation(s)
- Natasha L. Burke
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Guido K. W. Frank
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Anja Hilbert
- Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig, Germany
| | - Thomas Hildebrandt
- Center of Excellence in Eating and Weight Disorders, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracey D. Wade
- Blackbird Initiative, Órama Institute for Mental Health and Well-Being, Flinders University, Adelaide, South Australia, Australia
| | - B. Timothy Walsh
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Shirley B. Wang
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
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9
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Reyes-Rodríguez ML, Watson HJ, Smith TW, Baucom DH, Bulik CM. Promoviendo una Alimentación Saludable (PAS) results: Engaging Latino families in eating disorder treatment. Eat Behav 2021; 42:101534. [PMID: 34217036 PMCID: PMC8380698 DOI: 10.1016/j.eatbeh.2021.101534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/05/2021] [Accepted: 06/17/2021] [Indexed: 12/23/2022]
Abstract
Latinos/as are underrepresented in eating disorders clinical trials. This study compared results of a culturally adapted individual cognitive-behavioral treatment (CBT) for binge-spectrum eating disorders that included or excluded a family enhanced module (CBT + FE), in a proof-of-principle pilot study with a sample of Latina adults and one family member per patient. Twenty-five patients (Mage = 37 yrs) and 25 family members (Mage = 40 yrs) were randomized to CBT (n = 13) or CBT+ FE (n = 12). DSM-IV eating disorder diagnoses were: 48% (n = 12) bulimia nervosa, 28% (n = 7) binge-eating disorder, and 24% (n = 6) eating disorder not otherwise specified. Effect sizes favored CBT + FE on adherence and retention, and scores on treatment satisfaction and therapeutic alliance were high, indicating treatment acceptability. In spite of the hypothesis that family outcomes such as support, familism, cohesion, pride, family cultural conflict, burden, and marital satisfaction (in couples) would be superior in CBT + FE, the preliminary data were inconclusive and results were mixed. The hypothesis that eating disorder outcomes including global eating psychopathology, binge eating, and purging would improve in CBT + FE was not supported. There was some evidence that patients in CBT improved more particularly on binge eating, otherwise the groups had no differences. In conclusion, the results suggest that CBT + FE could enhance treatment adherence and retention, although this did not automatically translate to better family and symptom outcomes.
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Affiliation(s)
- Mae Lynn Reyes-Rodríguez
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America.
| | - Hunna J. Watson
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC,Division of Paediatrics, The University of Western Australia, Perth, Australia,School of Psychology, Curtin University, Perth, Australia
| | - Tosha Woods Smith
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Donald H. Baucom
- Department of Psychology, University of North Carolina, Chapel Hill, NC
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC,Department of Nutrition, University of North Carolina, Chapel Hill, NC,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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10
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Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study. J Clin Med 2021; 10:jcm10071511. [PMID: 33916374 PMCID: PMC8038593 DOI: 10.3390/jcm10071511] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023] Open
Abstract
Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.
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11
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Fleming C, Le Brocque R, Healy K. How are families included in the treatment of adults affected by eating disorders? A scoping review. Int J Eat Disord 2021; 54:244-279. [PMID: 33345319 DOI: 10.1002/eat.23441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The involvement of families in the treatment of adults with eating disorders is recommended as a core component of comprehensive care, yet little is known about the optimal way to implement or routinely facilitate this. This article evaluates the recent evidence on the inclusion of families in treatment programs for adults with eating disorders. METHOD A systematic literature search was conducted to identify evidence of family inclusive treatment approaches for adults with eating disorders. A scoping review framework was applied to assess and synthesize findings. RESULTS Sixty-eight studies were identified. Substantial conceptual research contributing to the theoretical basis of current practice with families of adults with eating disorders and clinical applications in current use were identified. Most research used uncontrolled studies with few experimental designs, reflecting the standing of the extant literature. Common elements of existing approaches have been distinguished and shared core components of interventions identified. DISCUSSION Results confirmed that family members of adults were willing to be involved with eating disorder treatment services and appeared to respond to interventions of varying intensity and duration. The impact on individual patients, and effect on treatment outcomes, are yet to be established. The localized settings of existing studies, the homogenous nature of interventions used, and the limited diversity in research subjects, make it difficult to generalize from the results to the wide range of adult eating disorder presentations seen in practice. Suggestions for future research and further clinical developments are discussed.
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Affiliation(s)
- Carmel Fleming
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Health Metro North Hospital and Health Service, Queensland Eating Disorder Service, Brisbane, Australia
| | - Robyne Le Brocque
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Karen Healy
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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12
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Norberg MM, Handford CM, Magson NR, Basten C. Reevaluating Cue Exposure and Response Prevention in a Pilot Study: An Updated Treatment for Binge Eating Disorder. Behav Ther 2021; 52:195-207. [PMID: 33483117 DOI: 10.1016/j.beth.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/14/2022]
Abstract
Approximately half of individuals with binge eating disorder (BED) fail to improve when treated with cognitive behavioral therapy; thus, better treatments are needed. Cue exposure and response prevention (CERP) may be one option, but its full potential for reducing binge eating remains unknown because prior applications for binge eating have not utilized the broad range of strategies believed to optimize exposure therapy. The current single-subject AB design investigated the acceptability and effectiveness of a comprehensive CERP treatment among 8 women who met DSM-5 criteria for binge eating disorder. Changes in the number of binges were measured from baseline to the end of treatment, and desire to eat, salivation, and idiographic expectancies of aversive outcomes to food-cue exposure (idiographic CS-US expectancies), including expectancies about ability to tolerate distress when exposed to food cues were measured across the course of treatment. Statistical analysis revealed a significant reduction in the number of binges from baseline to the end of treatment. Across the course of treatment, desire to eat and idiographic CS-US expectancies reduced, and distress tolerance expectancies increased. No participants dropped out and all reported being maximally satisfied with the treatment. Based on these findings, future randomized-control trials with larger samples should examine the efficacy of CERP and mechanisms underlying change with the aim of establishing a more effective treatment for binge eating disorder.
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Sadeh-Sharvit S, Sacks MR, Runfola CD, Bulik CM, Lock JD. Interventions to Empower Adults with Eating Disorders and Their Partners around the Transition to Parenthood. FAMILY PROCESS 2020; 59:1407-1422. [PMID: 31799711 DOI: 10.1111/famp.12510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The transition to parenthood is perceived as a stressful life event, when parents experience an immense change of their psychological focus and a reorientation of roles and responsibilities in the family system. This process may be even more challenging in the presence of a parental eating disorder history. This paper reviews the impact of parental eating disorders on the parents, the couple relationship, and their child during the perinatal period. A parental eating disorder is associated with more negative expectations of parental efficacy as well as specific difficulties in couple communication over the child's feeding, shape, and weight. Providers who better understand the effects of an eating disorder on parental functioning can more effectively intervene early on. We also present couple- or parent-based, empirically supported interventions for adults with eating disorders and their partners in the prenatal and postnatal periods: Uniting Couples in the treatment of Anorexia Nervosa (UCAN) and Uniting couples In the Treatment of Eating disorders (UNITE) both enhance recovery from the eating disorder through a couple-based intervention; the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) incorporates the support of partners, when appropriate; Parent-Based Prevention (PBP) focuses on improving parental functioning and reducing risk of negative parental and child outcomes. Finally, we discuss the clinical implications of addressing parental eating disorders and encourage more research on these families.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Madeline R Sacks
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Cristin D Runfola
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Cynthia M Bulik
- Department of Psychiatry, UNC Center of Excellence for Eating Disorders, The University of North Carolina School of Medicine, Chapel Hill, NC
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - James D Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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Tosyali AF, Harma M. The role of co-regulation of stress in the relationship between perceived partner responsiveness and binge eating: A dyadic analysis. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2020; 56:435-443. [PMID: 32959904 DOI: 10.1002/ijop.12712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 07/17/2020] [Indexed: 11/06/2022]
Abstract
The main aim of this study is to investigate whether there are relationships between perceived partner responsiveness (PPR), co-regulation of negative affect between romantic partners and binge eating. Data were collected from 148 opposite-sex romantic partners (18-61 years old) with the mean relationship duration being 8.04 years. Dyadic data were analysed through the actor-partner interdependence model framework. We proposed a model where co-regulation between partners has indirect effects on the relationship between PPR and binge eating. Results showed that there was no direct association between PPR and binge eating scores of the participants. However, significant direct associations were found regarding both actor and partner effects of PPR on co-regulation between romantic partners. In addition, there were four significant indirect effects: Women's co-regulation had an indirect effect on the link between PPR and women's binge eating scores. Similarly, women's co-regulation had also a significant indirect effect on the link between PPR and men's binge eating. These findings are the first to illustrate a relationship between PPR and binge eating. This study is the first attempt to examine binge eating in terms of co-regulation processes.
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Affiliation(s)
| | - Mehmet Harma
- Department of Psychology, Kadir Has University, Istanbul, Turkey
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Christensen KA, Haynos AF. A theoretical review of interpersonal emotion regulation in eating disorders: enhancing knowledge by bridging interpersonal and affective dysfunction. J Eat Disord 2020; 8:21. [PMID: 32514350 PMCID: PMC7262763 DOI: 10.1186/s40337-020-00298-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/23/2020] [Indexed: 01/10/2023] Open
Abstract
Individuals with eating disorders (EDs) frequently report interpersonal and affective dysfunction. A useful lens for uniting these ideas is through the framework of interpersonal emotion regulation (IER), which consists of the ways others assist a distressed individual and how this shapes his or her subsequent emotional, behavioral, and cognitive responses. In this theoretical review, we provide an overview of the rationale for exploring IER and review IER processes in this population using the framework of the Process Model of Emotion Regulation. Finally, we offer suggestions for next steps in conducting research. IER offers a parsimonious way to explore social and emotional constructs related to ED pathology and may provide potential targets for prevention and intervention in these difficult-to-treat disorders.
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Affiliation(s)
- Kara A. Christensen
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd Rm 440, Lawrence, KS 66045 USA
| | - Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave, F253, Minneapolis, MN 55454 USA
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Hildebrandt T, Michaeledes A, Mayhew M, Greif R, Sysko R, Toro-Ramos T, DeBar L. Randomized Controlled Trial Comparing Health Coach-Delivered Smartphone-Guided Self-Help With Standard Care for Adults With Binge Eating. Am J Psychiatry 2020; 177:134-142. [PMID: 32008396 DOI: 10.1176/appi.ajp.2019.19020184] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT) has shown efficacy in the treatment of eating disorders. The authors conducted a randomized controlled telemedicine trial of CBT-guided self-help (CBT-GSH) assisted with a smartphone app, Noom Monitor, for binge eating with or without purging. They hypothesized that coach-delivered CBT-GSH telemedicine sessions plus Noom Monitor would yield greater reductions in symptoms of binge eating, purging, and eating disorders compared with standard care. METHODS Fifty-two-week outcomes for CBT-GSH plus Noom Monitor (N=114) were compared with outcomes for standard care (N=111) among members of an integrated health care system in the Pacific Northwest. Patients in the health system who met inclusion criteria were ≥18 years old, had a body mass index ≥18.5, met criteria for DSM-5 binge eating disorder or bulimia nervosa, had 12 months of continuous health care enrollment in Kaiser Permanente Northwest, and had a personal smartphone. Participants received eight CBT-GSH telemedicine sessions over 12 weeks administered by health coaches, and outcomes were assessed at baseline and at weeks 4, 8, 12, 26, and 52. The use of available treatment offered within the Kaiser Permanente health care system was permitted for participants assigned to standard care. RESULTS Participants who received CBT-GSH plus Noom Monitor reported significant reductions in objective binge-eating days (β=-0.66, 95% CI=-1.06, -0.25; Cohen's d=-1.46, 95% CI=-4.63, -1.09) and achieved higher rates of remission (56.7% compared with 30%; number needed to treat=3.74) at 52 weeks compared with participants in standard care, none of whom received any eating disorder treatment during the intervention period (baseline and weeks 1-12). Similar patterns emerged for compensatory behaviors (vomiting, use of laxatives, and excessive exercise; 76.3% compared with 56.8%; number needed to treat=5.11), eating disorder symptoms (body shape, weight, eating concerns, and dietary restraint), and clinical impairment (Cohen's d=-10.07, -2.15). CONCLUSIONS These results suggest that CBT-GSH plus Noom Monitor delivered via telemedicine by routine-practice health coaches in a nonacademic health care system yields reductions in symptoms and impairment over 52 weeks compared with standard care.
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Affiliation(s)
- Tom Hildebrandt
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Andreas Michaeledes
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Meghan Mayhew
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Rebecca Greif
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Robyn Sysko
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Tatiana Toro-Ramos
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Lynn DeBar
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
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Abstract
The authors present the theoretic model, structure of treatment, and preliminary evidence for several emerging treatments that are increasingly being used and studied in eating disorders treatment, including dialectical behavior therapy, acceptance and commitment therapy, integrative cognitive-affective therapy, and neuromodulation. In addition, the article discusses treatments that address mindfulness, interpersonal factors, and habit.
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Affiliation(s)
- Emily M Pisetsky
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA.
| | - Lauren M Schaefer
- Sanford Center for Biobehavioral Research, 120 South Eighth Street, Fargo, ND 58103, USA
| | - Stephen A Wonderlich
- Sanford Center for Biobehavioral Research, 120 South Eighth Street, Fargo, ND 58103, USA; University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
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