Associations among eating disorder behaviors and eating disorder quality of life in adult women with anorexia nervosa

The effect of anorexia nervosa inpatient physiotherapy adapted program (ANIPAP): A clinical trial

PURPOSE

Anorexia nervosa (AN) is a mental health pathology with severe somatic consequences that increase the vital risk. The collateral effects by several undernourishment has been studied but the autonomy of within a physical activity context and muscle strength research are insufficient. The purpose of the study is to assess the effect of the adapted exercise physiotherapy program on AN inpatients to improve health-related quality of life (HRQOL), body mass index (BMI), cardiorespiratory endurance (CRE), peak-expiratory-flow (PEF), and both, muscle and manual strength.

METHODS

26 females hospitalized for AN, severely malnourished (mean age 22.21, and mean BMI 15.01), were divided into two groups: experimental treatment (EG) and control (CG). The treatment sessions were administered 3 days/week, for 4 weeks (including active and counter-resistance mobilizations of the limbs and trunk and breathing exercises).

RESULTS

There was a significant group-time interaction in BMI [F = 2.401, p = 0.04, η2 = 0.008], HRQOL [F = 10.877, p < 0.05, η2 = 0.097], PEF [F = 5.50, p = 0.0295, η2 = 0.20], the muscular strength of triceps brachii [F = 4.417, p = 0.005, η2 = 0.038], thumb opposition [F = 3.595, p = 0.015, η2 = 0.035] and quadriceps [F = 3.739, p = 0.013, η2 = 0.028]. Also showed a significant effect (p < 0.05) on time in CRE, manual strength, and muscular strength (left and right).

CONCLUSIONS

Following a 4-week treatment, the adapted physiotherapy program demonstrated significant improvements among patients with severe undernutrition due to AN.

Quality of Life and Clinical Impairment in Spanish Adolescent Anorexia Nervosa Patients

Eating disorders have serious physical, mental and social consequences that can affect the quality of life of the sufferer. This study aimed to evaluate the relationship between the severity of ED-related psychopathology and clinical impairment in adolescents with anorexia nervosa (AN) as well as their perception of health-related quality of life. Eighty-six Spanish young women with AN completed a set of questionnaires assessing eating disorder pathology, clinical impairment, and quality of life. The set included the following instruments: the Eating Disorder Examination Questionnaire, Clinical Impairment Assessment, Short Form-12 Item Health Survey, and the Eating Disorder-Specific Heath-Related Quality of Life instrument. Descriptive and regression analyses were applied to identify associations between variables. Higher scores on clinical impairment domains were associated with greater impairment of mental and physical health. Moreover, clinical impairment domains and concerns due to ED were related to a lower quality of life. In conclusion, adolescents with AN have a poor quality of life. Moreover, the findings suggest that the clinical features of impairment may serve as severity indicators of quality of life.

Reliability of gamified reinforcement learning in densely sampled longitudinal assessments

Reinforcement learning is a core facet of motivation and alterations have been associated with various mental disorders. To build better models of individual learning, repeated measurement of value-based decision-making is crucial. However, the focus on lab-based assessment of reward learning has limited the number of measurements and the test-retest reliability of many decision-related parameters is therefore unknown. In this paper, we present an open-source cross-platform application Influenca that provides a novel reward learning task complemented by ecological momentary assessment (EMA) of current mental and physiological states for repeated assessment over weeks. In this task, players have to identify the most effective medication by integrating reward values with changing probabilities to win (according to random Gaussian walks). Participants can complete up to 31 runs with 150 trials each. To encourage replay, in-game screens provide feedback on the progress. Using an initial validation sample of 384 players (9729 runs), we found that reinforcement learning parameters such as the learning rate and reward sensitivity show poor to fair intra-class correlations (ICC: 0.22-0.53), indicating substantial within- and between-subject variance. Notably, items assessing the psychological state showed comparable ICCs as reinforcement learning parameters. To conclude, our innovative and openly customizable app framework provides a gamified task that optimizes repeated assessments of reward learning to better quantify intra- and inter-individual differences in value-based decision-making over time.

Exploring the moderating role of mindfulness, mindful eating, and self-compassion on the relationship between eating-disordered quality of life and orthorexia nervosa

Orthorexia nervosa (ON) is characterised by an obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore mindfulness, mindful eating, self-compassion and quality of life in a female population. Two hundred eighty-eight participants completed Orthorexia, Self-Compassion, Mindful eating, Mindfulness and Eating Disorder Quality of Life scales. The results indicated that there was a negative relationship between ON and mindfulness, self-compassion and mindful eating. Furthermore, the present study found a positive relationship between lower quality of life and ON, while findings indicated that self-compassion and the awareness facet of mindfulness moderated the relationship between ON and QOL. The present results contribute to a better understanding of orthorexic eating behaviours in a female population, and identify the moderating capacity of self-compassion and mindfulness. Further implications and future directions are discussed.Level of evidence Level V, cross-sectional descriptive study.

Depression, perceived disability and unemployment are associated with reduced life satisfaction in anorexia nervosa

Life satisfaction is a core aspect of an individual's wellbeing and describes the subjective assessment of their quality of life. Reduced life satisfaction is frequently reported in anorexia nervosa (AN),  but the factors contributing to this are still unclear. This study sought to extend previous work by examining 12 potential correlates of AN life satisfaction. One hundred and five female AN patients were administered questionnaires assessing life satisfaction, depression, anxiety, stress, employment status, marital status, body mass index, eating disorder symptomatology, perceived disability and readiness for change. A stepwise linear regression revealed that only depression, perceived disability and employment status were significantly associated with AN life satisfaction. The findings thus highlight prevailing mood and personal functioning as critical foci for clinical management strategies in people with AN. Addressing depressive symptoms and perceived disability while bettering employment prospects could facilitate improved AN life satisfaction.

Rethinking emotional eating: Retrospective and momentary indices of emotional eating represent distinct constructs

Emotional eating (EE) has been proposed as a key weight loss barrier. However, most investigations of EE rely on retrospective self-reports, which may have poor construct validity. This study evaluated concordance between a common self-report EE measure and a novel method for assessing momentary EE using ecological momentary assessment (EMA). We further assessed the utility of both measures for predicting both BMI and weight outcomes. Participants with overweight or obesity enrolled in a weight loss trial (N = 163) completed a self-report measure of EE and underwent an EMA protocol that assessed momentary emotions and eating behaviors. Momentary EE was derived from EMA data using generalized linear mixed-effects models. Linear regression models examined associations between both EE measures and concurrent BMI as well as weight losses over 30 months. Retrospectively self-reported EE and momentary EE were negatively correlated with one another (r = -0.27). Higher momentary EE and higher retrospectively reported EE both predicted higher concurrent BMI, and higher retrospectively reported EE predicted poorer weight loss outcomes at all time points (p < 0.05). By contrast, higher momentary EE predicted improved weight outcomes at 1-year and 2-year follow-up (p < 0.05). Our findings extend prior research suggesting that retrospective self-report EE measures capture a different construct than intended and suggest that momentary EE could predict improved weight loss outcomes.

Mental Pain in Eating Disorders: An Exploratory Controlled Study

Mental pain (MP) is a transdiagnostic feature characterized by depression, suicidal ideation, emotion dysregulation, and associated with worse levels of distress. The study explores the presence and the discriminating role of MP in EDs in detecting patients with higher depressive and ED-related symptoms. Seventy-one ED patients and 90 matched controls completed a Clinical Assessment Scale for MP (CASMP) and the Mental Pain Questionnaire (MPQ). ED patients also completed the Beck Depression Inventory-II (BDI-II), Clinical Interview for Depression (CID-20), and Eating Attitudes Test (EAT-40). ED patients exhibited significantly greater severity and higher number of cases of MP than controls. Moreover, MP resulted the most important cluster predictor followed by BDI-II, CID-20, and EAT-40 in discriminating between patients with different ED and depression severity in a two-step cluster analysis encompassing 87.3% (n = 62) of the total ED sample. Significant positive associations have been found between MP and bulimic symptoms, cognitive and somatic-affective depressive symptoms, suicidal tendencies, and anxiety-related symptoms. In particular, those presenting MP reported significantly higher levels of depressive and anxiety-related symptoms than those without. MP represents a clinical aspect that can help to detect more severe cases of EDs and to better understand the complex interplay between ED and mood symptomatology.

Ecological momentary assessment in eating disorders research: recent findings and promising new directions

PURPOSE OF REVIEW

Ecological momentary assessment (EMA) is an important tool for clarifying common precipitants and consequences of eating disorder symptoms that might be meaningfully targeted in treatments for these pernicious disorders. This article reviews recent advances in EMA work conducted within clinical eating disorder samples.

RECENT FINDINGS

Published studies from the past 2.5 years can broadly be categorized as involving functional analysis of eating disorder behaviors, examining hypothesized predictors of eating disorder symptoms, or applying novel approaches to EMA data. Examples of the latter category include the use of latent profile analysis with EMA data, integration of neurocognitive (e.g., ambulatory inhibitory control task) or biological indicators (e.g., fMRI, plasma leptin), and examining changes in associations between momentary variables over time through multiwave EMA data collection.

SUMMARY

EMA studies in eating disorders have advanced significantly in recent years, with findings demonstrating strong support for the emotion regulation function of eating disorder behaviors and momentary predictors of distinct eating disorder symptoms. The use of novel statistical and data collection approaches represent exciting areas of growth, with likely implications for intervention approaches, including those that utilize ambulatory technology to deliver treatment.

Long-Term Outcomes from a 10-Year Follow-Up of Women Living with a Restrictive Eating Disorder: A Brief Report

BACKGROUND

This study aimed to evaluate several socio-demographic and long-term clinical outcomes in a cohort of women living with a restrictive eating disorder.

METHODS

Patients were asked to fill in a general data collection form aiming to investigate their current conditions and to attend the outpatient unit for a 10-year follow-up clinical and laboratory evaluation.

RESULTS

Forty-four patients completed the follow-up general data collection form and 20 agreed to attend the outpatient unit for the 10 year-follow-up evaluation. In total, 52% of patients were single, 55% had achieved a university degree, and 55% had steady employment. After 10 years, there was a clear improvement in biochemical markers, but cholesterol levels were still slightly high. The prevalence of osteopenia in the whole sample was 70% when measured on the lumbar column and 20% on the total body, while osteoporosis was found in 10% of patients and only on the lumbar column.

CONCLUSION

According to the collected data, women with a history of restrictive eating disorders appear to re-adapt well to social life by obtaining the level of their unaffected peers in terms of education and employment.

The Relation Between Eating Disorders and Voice Disorders

OBJECTIVE

The purpose of this study is to determine the relation between specific eating disorder diagnoses/purging behaviors and voice disorders.

METHOD

One hundred-nine participants with eating disorders completed a survey inquiring about eating disorder symptoms, purging behaviors, and voice disorder symptoms. Participants also completed the Eating Disorders Examination Questionnaire, Voice Handicap Index, and the Reflux Symptom Index.

RESULTS

The prevalence of voice disorders among the group with eating disorders was 21.88%. Of those with both eating disorders and voice disorders, anorexia nervosa appeared to be more prevalent in this group than bulimia nervosa. In addition, purging behaviors of exercise presented with a higher prevalence of voice problems than vomiting.

CONCLUSION

Individuals with eating disorders seem to be at a higher risk for voice disorders than the general population. Anorexia nervosa and exercise as a purging method were identified as the highest risk factors for voice disorders.

The predictive value of the early maladaptive schemas in social situations in anorexia nervosa

BACKGROUND

Patients with anorexia nervosa (AN) show an impairment in the recognition and expression of emotions, as well as an increased sensitivity to being socially excluded, and rigid maladaptive schemas. The Cyberball paradigm is a virtual ball-toss game that can simulate social exclusion and inclusion. Our aim is to evaluate how cognitive schemas can influence the perception and the evaluation of the experiences of social inclusion/exclusion.

METHODS

Thirty-two AN patients and 34 healthy controls completed a psychological evaluation and were randomly assigned to exclusion or overinclusion paradigm of the Cyberball task.

RESULTS

Patients with AN showed a significantly higher level of maladaptive schemas as well as higher sensitivity to being ostracized by peers in comparison with healthy controls. Regression analyses identified specific significant relation between being ostracized and dependence/incompetence, negativity/pessimism, and self-sacrifice.

DISCUSSION

Our findings provide evidence that patients with AN may be ineffective in expressing their mood in exclusive and overinclusive social situations. Specific cognitive/temperamental schemas might play a role in the way people communicate their feelings, and they could be considered targets for psychotherapy interventions to improve social interpretation and emotional recognition/communication.

Moving beyond self-report data collection in the natural environment: A review of the past and future directions for ambulatory assessment in eating disorders

OBJECTIVE

In recent years, ecological momentary assessment (EMA) has been used to repeatedly assess eating disorder (ED) symptoms in naturalistic settings, which has allowed for increased understanding of temporal processes that potentiate ED behaviors. However, there remain notable limitations of self-report EMA, and with the rapid proliferation of technology there are ever-increasing possibilities to improve ambulatory assessment methods to further the understanding and treatment of EDs. Therefore, the purpose of this review was to (a) systematically review the studies in EDs that have utilized ambulatory assessment methods other than self-report, and (b) provide directions for future research and clinical applications.

METHOD

A systematic literature search of electronic databases was conducted, and data regarding study characteristics and methodological quality were extracted.

RESULTS

The search identified 17 studies that used ambulatory assessment methods to gather objective data, and focused primarily on autonomic functioning, physical activity, and cognitive processes in ED and control groups.

DISCUSSION

Together the literature demonstrates the promise of using a range of ecologically valid ambulatory assessment approaches in EDs, though there remains limited research that has utilized methods other than self-report (e.g., wearable sensors), particularly in recent years. Going forward, there are several technology-enhanced momentary assessment methods that have potential to improve the understanding and treatment of EDs.

From Ecological Momentary Assessment (EMA) to Ecological Momentary Intervention (EMI): Past and Future Directions for Ambulatory Assessment and Interventions in Eating Disorders

PURPOSE OF REVIEW

Ambulatory assessment methods, including ecological momentary assessment (EMA), have often been used in eating disorders (EDs) to assess the type, frequency, and temporal sequencing of ED symptoms occurring in naturalistic environments. Relatedly, growing research in EDs has explored the utility of ecological momentary interventions (EMIs) to target ED symptoms. The aims of the present review were to (1) synthesize recent literature pertaining to ambulatory assessment/EMA and EMI in EDs, and (2) identify relevant limitations and future directions in these domains.

RECENT FINDINGS

With respect to ambulatory assessment and EMA, there has been substantial growth in the expansion of constructs assessed with EMA, the exploration of state- vs. trait-level processes, integration of objective and passive assessment approaches, and consideration of methodological issues. The EMI literature in EDs also continues to grow, though most of the recent research focuses on mobile health (mHealth) technologies with relatively minimal EMI components that adapt to momentary contextual information. Despite these encouraging advances, there remain several promising areas of ambulatory assessment research and clinical applications in EDs going forward. These include integration of passive data collection, use of EMA in treatment evaluation and design, evaluation of dynamic system processes, inclusion of diverse samples, and development and evaluation of adaptive, tailored EMIs such as just-in-time adaptive interventions. While much remains to be learned in each of these domains, the continual growth in mobile technology has potential to facilitate and refine our understanding of the nature of ED psychopathology and ultimately improve intervention approaches.