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Krug I, Fung S, Liu S, Treasure J, Huang C, Felmingham K, Fuller-Tyszkiewicz M, McConchie O. The impact of oxytocin on emotion recognition and trust: Does disordered eating moderate these relationships? PLoS One 2024; 19:e0303824. [PMID: 38820421 DOI: 10.1371/journal.pone.0303824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/01/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVES The current study aimed to investigate the impact of oxytocin on emotion recognition, trust, body image, affect, and anxiety and whether eating disorder (ED) symptoms moderated any of these relationships. METHOD Participants (n = 149) were female university students, who were randomly allocated to receive in a double-blind nature, a single dose of oxytocin intranasal spray (n = 76) or a placebo (saline) intranasal spray (n = 73). Participants were asked to complete an experimental measure of emotion recognition and an investor task aimed to assess trust. RESULTS The oxytocin group exhibited better overall performance on the emotion recognition task (especially with recognising positive emotions), and a decline in state positive affect than the control group at post-intervention. However, these effects were not moderated by ED symptom severity, nor were effects found for state anxiety, negative affect, body image and recognising negative emotions in the emotion recognition task. CONCLUSION The current findings contribute to the growing literature on oxytocin, emotion recognition and positive affect and suggest that ED pathology does not moderate these relationships. Future research would benefit from examining the efficacy of an oxytocin intervention using a within-subjects, cross-over design, in those with sub-clinical and clinical EDs, as well as healthy controls.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Fung
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Shanshan Liu
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry and Neuroscience, Section of Eating Disorders, London, United Kingdom
| | - Chia Huang
- Eating Disorders Program, The Melbourne Clinic, Richmond, Victoria, Australia
| | - Kim Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
| | - Olivia McConchie
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Chu TH, Xiao F. Applying Stages of Change Model to Examine Online Peer Communication on Binge Eating. HEALTH COMMUNICATION 2023; 38:3012-3021. [PMID: 36214317 DOI: 10.1080/10410236.2022.2129640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Despite the distress and disruption associated with eating disorder (ED), people struggling with EDs are often ambivalent about their eating issues and unmotivated for recovery. Rather than seek professional help, these people tend to turn to online ED groups for information and support. Using the stages of change model, this study investigates the characteristics of online peer communication around binging vis-à-vis participants' motivation and readiness for behavioral change. Our results illustrate how individuals with binging issues in different motivational stages discuss their problematic eating online and provides insights into their ambivalence toward treatment and relapses into binging. This study further clarifies how people with binging issues feel trapped in a cycle of dieting-binging, which is observed to be undergirded by unresolved weight-related issues, and how they cope with the stressful relationship between eating and body weight through their postings on social media. These findings suggest that healthcare providers should promote healthier methods of addressing the weight gain from binge eating and provide support tailored to individuals' motivational stage in breaking the dieting-binging cycle.
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Affiliation(s)
- Tsz Hang Chu
- Department of Media and Communication, City University of Hong Kong
| | - Fan Xiao
- School of Communication, Hong Kong Baptist University
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Eka Prasetya TA, Kusuma Wardani RW. Systematic review of social media addiction among health workers during the pandemic Covid-19. Heliyon 2023; 9:e16784. [PMID: 37274718 PMCID: PMC10225338 DOI: 10.1016/j.heliyon.2023.e16784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023] Open
Abstract
The risk of social media (SM) addiction exponentially increases when social media is utilized during office hours for health workers. This study aims to explore the various factors that influence SM addiction in healthcare workers and to identify the potential social media addiction associated with it. The design used in this research is a systematic review with text mining methods and PRISMA (Preferred Reporting Items for Systematic Reviews & Meta-Analyses). The databases used in this study are PubMed, ProQuest, science direct, Elsevier, and Sage journals for data collection. The used keywords were associated factors, influencing factors, social media, addiction, healthcare workers, outbreak, pandemic, and COVID-19. The inclusion criteria were quantitative research, international studies, published in 2020-2022, published in Q1-Q3 journals, and open access studies and the exclusion criteria were not systematic review studies. Publications without English language and abstracts only also will be excluded. Advanced search is selected by using topics with strings "associated factors", and "influencing factors" and strings "outbreak", "pandemic", and "COVID-19". Furthermore, data extraction is carried out using text mining by the R programming to present the characteristics of publications and identify the descriptive result, such as term quantity, term replication, and Hierarchical cluster analysis. Descriptive analysis is used to present the percentage and frequency of data characteristics. Text mining begins with data preparation, namely importing text and string operations. The dataset and tokenization are created after importing the text. The most answered terms extracted from the analysis were combined into terms that will be the focus of a further investigation. A considerable part of healthcare professionals experienced Internet addiction, according to a study on the incidence and risk factors of Internet addiction among healthcare workers. Mental health not only affects physical health but also has effects on social and professional functioning in addition to being connected to personal health. Among health professionals, higher Internet and social media use was substantially linked to both anxiety and depression, as well as overall psychological health and increased substance use.
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John V, Jacob M. Binge eating after a religious fast: Acute gastric dilation causing perforation - a case report. Trop Doct 2023; 53:125-127. [PMID: 36423252 DOI: 10.1177/00494755221140947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute gastric dilation after binge eating may lead to ischaemic necrosis and perforation of the gastric wall. Though rarely seen owing to the rich blood supply of the stomach, its sequelae may be avoided by prompt decompression of the dilated stomach. We present such a case heretofore rarely reported from India.
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Affiliation(s)
- Viju John
- Consultant Surgeons, 81611Herbertpur Christian Hospital, Dehradun, Uttarakhand, India
| | - Mariya Jacob
- Consultant Surgeons, 81611Herbertpur Christian Hospital, Dehradun, Uttarakhand, India
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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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6
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Coopey E, Johnson G. Exploring the experience of young people receiving treatment for an eating disorder: family therapy for anorexia nervosa and multi-family therapy in an inpatient setting. J Eat Disord 2022; 10:101. [PMID: 35831883 PMCID: PMC9277598 DOI: 10.1186/s40337-022-00609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research indicates that family therapy for anorexia nervosa (FT-AN) and multi-family therapy (MFT) are effective treatments for adolescents experiencing anorexia nervosa (AN). However, less is known about young people's experiences of these two treatments, as there is limited qualitative research, and to date no qualitative research within an inpatient setting. It is argued that the lack of such insight limits the development of services for young people experiencing AN. METHOD Five young people were recruited to the study from a specialist inpatient unit who were receiving treatment on the AN pathway which included both FT-AN and MFT. Semi structured interviews were undertaken and analysed using Interpretative Phenomenological Analysis. RESULTS Four superordinate themes and ten subthemes were developed from the data. The four superordinate themes were: 'Process of Understanding', 'Reviving Connection', 'Emerging from the Eating Disorder and 'Development of I'. CONCLUSIONS There appeared to be two overarching concepts: the role of the individual and the role of others, that helpfully framed the results. The superordinate themes: 'Emerging from the Eating Disorder' and 'Development of I' focused on the development of the individual. Conversely, the superordinate themes: 'The Process of Understanding' and 'Reviving Connection' were centred on the relationships existing within the family system. The results could help inform future service developments regarding inpatient provision and service design. The most widely used and recognised treatment for anorexia nervosa in young people is family therapy for anorexia nervosa (FT-AN). An alternative treatment is multi-family therapy (MFT). Both treatments are deemed to be effective and usually happen in the community. However, some hospitals provide these treatments while the young people are in-patients. There is no research exploring young people's experiences of these two treatments while in an in-patient unit. Young people who had received both FT-AN and MFT in an inpatient setting were asked to share their experiences of these two treatments. Their stories were analysed by a researcher. The analysis identified four themes: 'Process of Understanding', 'Reviving Connection', 'Emerging from the Eating Disorder and 'Development of I'. The results highlighted that the young people appeared to place more value on the role of others and perhaps others changing enabled them to change. The research highlighted the benefit in others' understanding and therefore how improving societal understanding more broadly would be helpful. The young people reflected that both they and their parents benefited from FT-AN and MFT in an in-patient setting and it is proposed that this could help inform future service developments regarding inpatient provision.
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Affiliation(s)
- Emily Coopey
- Centre for Applied Psychology, School of Psychology, University of Birmingham, Birmingham, UK. .,Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK.
| | - George Johnson
- Centre for Applied Psychology, School of Psychology, University of Birmingham, Birmingham, UK
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Al-Musharaf S, Rogoza R, Mhanna M, Soufia M, Obeid S, Hallit S. Factors of body dissatisfaction among lebanese adolescents: the indirect effect of self-esteem between mental health and body dissatisfaction. BMC Pediatr 2022; 22:302. [PMID: 35606738 PMCID: PMC9125344 DOI: 10.1186/s12887-022-03373-4] [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: 02/25/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Body dissatisfaction (BD) rates are alarmingly high, especially among adolescents, thus. Having a better understanding of correlates associated with BD seems to be an important issue in this developmental context. Furthermore, as adolescence is an essential time in the development of self-perception and self-esteem the current study assesses factors associated with BD among Lebanese adolescents and evaluates the indirect effect of self-esteem between depression/anxiety/stress and BD. Methods This is a cross-sectional study among 555 Lebanese adolescents, ages 15–18, who completed an online survey incorporating BD, socioeconomic status, weight and height, physical activity index, Rosenberg Self Esteem Scale, Beirut Distress Scale, Hamilton Anxiety Rating Scale, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index and Global Physical Activity Questionnaire. Results The results of a stepwise linear regression, taking the body dissatisfaction score as the dependent variable, showed that higher BMI (B = 0.47), feeling pressured by media/TV to lose weight (Beta = 2.80), higher depression (Beta = 0.39), exercising to lose weight (Beta = 1.84) and following a diet to lose weight (Beta = 1.58) were significantly associated with more body dissatisfaction, whereas higher self-esteem (Beta=-0.11) and more psychological distress (Beta=-0.21) were significantly associated with less body dissatisfaction. Self-esteem played an indirect role in the associations between anxiety and body dissatisfaction and stress and body dissatisfaction. Conclusions BD is common among young Lebanese adolescents. Treating adolescents with low self-esteem and psychological issues is crucial in preventing anticipated BD and future eating disorders.
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Affiliation(s)
- Sara Al-Musharaf
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Radoslaw Rogoza
- Cardinal Stefan Wyszyński University, Warsaw, Poland.,Social Innovation Chair, University of Lleida, Lleida, Spain
| | - Mariam Mhanna
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Psychology Department, College of Humanities, Effat University, 21478, Jeddah, Saudi Arabia. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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8
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He Z, Yang W. Impulsiveness as potential moderators of the relation between social media dependence and eating disorders risk. BMC Psychol 2022; 10:120. [PMID: 35527270 PMCID: PMC9080113 DOI: 10.1186/s40359-022-00830-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Social media dependence (SMD) and eating disorders (ED) risk are often thought to be inextricably linked. Because social media dependence often precedes an ED, predicts poor outcome, and persists even after recovery from an ED, it is important to examine whether certain factors have the ability to potentially attenuate or intensify SMD's effect on eating disorders. METHODS In the current study, we examined one possible moderating factor: impulsiveness. 767 undergraduates (mean age = 18.78 years, SD = 1.20) in Shaanxi province of China, completed anonymous questionnaires regarding social media dependence, eating disorders, impulsiveness. RESULTS Revealed that non-planned impulsiveness (NPI) moderated the relation between SMD and ED risk. Individuals who were low in SMD and who reported low levels of NPI reported much lower levels of ED risk than those with low SMD and high NPI. However, Individuals who were high in SMD and who reported low levels of NPI reported much higher levels of ED risk than those with high SMD and high NPI. Contrary to our hypotheses, Motor impulsiveness and cognitive impulsiveness did not emerge as moderators of the relation between SMD and ED risk. CONCLUSIONS Results provide growing support that factors that interact with SMD can lessen or aggravate SMD's effect on ED risk. These findings can be beneficial to our understanding of how and when social media dependence impacts undergraduates' eating disorders risk.
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Affiliation(s)
- Zhonghua He
- School of Journalism and New Media, Xi'an Jiaotong University, No. 28, Xianning West Road, Xi'an, 710049, Shaanxi, People's Republic of China.
| | - Weili Yang
- School of Public Health, Shaanxi University of Chinese Medicine, Xi'an, People's Republic of China
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Papini NM, Jung M, Cook A, Lopez NV, Ptomey LT, Herrmann SD, Kang M. Psychometric properties of the 26-item eating attitudes test (EAT-26): an application of rasch analysis. J Eat Disord 2022; 10:62. [PMID: 35509106 PMCID: PMC9069796 DOI: 10.1186/s40337-022-00580-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The 26-item Eating Attitudes Test (EAT-26) is a commonly used tool to assess eating disorder risk. The purpose of this study was to examine the psychometric properties of the EAT-26 with a combined sample: (1) of adults with overweight and obesity enrolled in a behavioral weight loss program and (2) general adult sample (n = 469; age = 36.17 ± 17.83 years; female = 72.5%; white = 66.3%; obese BMI category = 58%). METHODS Rasch modeling was used to assess model-data fit, create an item-person map to evaluate relative distribution items and persons, item difficulty, and person's eating disorder (ED) risk level of the EAT-26. Differential item functioning (DIF) and rating scale functioning of the EAT-26 were also evaluated using Rasch analysis. RESULTS A total of 7 misfit items were removed from the final analysis due to unacceptable Infit and Outfit mean square residual values. The item-person map showed that the items were biased toward participants with moderate to high levels of ED risk and did not cover those who had low risk for having an ED (< - 1 logits). The DIF analyses results showed that none of the items functioned differently across sex, but 5 items were flagged based on obesity status. The six-category Likert-type rating scale did not function well indicating a different response format may be needed. CONCLUSION Several concerns were identified with the psychometric evaluation of the EAT-26 that may question its utility in assessing ED risk in individuals at low risk for ED, within samples of people who have overweight and obesity seeking weight loss treatment. The 26-item Eating Attitudes Test is a self-rated measure of eating attitudes that measures symptoms and concerns of eating disorders (ED). Very little is known about how this instrument performs differently based on individual factors like body mass index (BMI) and sex (male/female). We used an advanced measurement theory (i.e., Rasch analysis) to determine if the EAT-26 is an adequate measure to detect disordered eating in men and women of different BMIs. Results indicated that the EAT-26 was biased toward participants with moderate to high levels of disordered eating risk and did not adequately detect individuals at low risk for disordered eating. The EAT-26 did not function differently based on sex (male/female). However, five questions did function differently based on obesity status (those without obesity/ those with obesity). Finally, we observed the six-category rating scale did not function appropriately and that a new response format may be warranted. In sum, there were several issues (e.g., poor rating scale and different item functioning) with the EAT-26 and future work should develop screening tools that detect low risk of disordered eating as well as function well in adults with overweight and obesity.
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Affiliation(s)
- Natalie M Papini
- Department of Health Sciences, Northern Arizona University, 1100 S. Beaver St., Flagstaff, AZ, 86001, USA.
| | - Myungjin Jung
- Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, MS, USA
| | - Amanda Cook
- Volunteer Behavioral Health Care System, Murfreesboro, TN, USA
| | - Nanette V Lopez
- Department of Health Sciences, Northern Arizona University, 1100 S. Beaver St., Flagstaff, AZ, 86001, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Minsoo Kang
- Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, MS, USA
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Kennedy HL, Dinkler L, Kennedy MA, Bulik CM, Jordan J. How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (ARFID). J Eat Disord 2022; 10:53. [PMID: 35428338 PMCID: PMC9013144 DOI: 10.1186/s40337-022-00578-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/08/2022] [Indexed: 12/29/2022] Open
Abstract
Avoidant/restrictive food intake disorder (ARFID) was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Unlike anorexia nervosa, ARFID is characterised by avoidant or restricted food intake that is not driven by weight or body shape-related concerns. As with other eating disorders, it is expected that ARFID will have a significant genetic risk component; however, sufficiently large-scale genetic investigations are yet to be performed in this group of patients. This narrative review considers the current literature on the diagnosis, presentation, and course of ARFID, including evidence for different presentations, and identifies fundamental questions about how ARFID might fit into the fluid landscape of other eating and mental disorders. In the absence of large ARFID GWAS, we consider genetic research on related conditions to point to possible features or mechanisms relevant to future ARFID investigations, and discuss the theoretical and clinical implications an ARFID GWAS. An argument for a collaborative approach to recruit ARFID participants for genome-wide association study is presented, as understanding the underlying genomic architecture of ARFID will be a key step in clarifying the biological mechanisms involved, and the development of interventions and treatments for this serious, and often debilitating disorder.
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Affiliation(s)
- Hannah L Kennedy
- Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand
| | - Lisa Dinkler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden.,Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, 411 19, Gothenburg, Sweden
| | - Martin A Kennedy
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, 27599-7160, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
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Aouad P, Bryant E, Maloney D, Marks P, Le A, Russell H, Hay P, Miskovic-Wheatley J, Touyz S, Maguire S. Informing the development of Australia's National Eating Disorders Research and Translation Strategy: a rapid review methodology. J Eat Disord 2022; 10:31. [PMID: 35246250 PMCID: PMC8895520 DOI: 10.1186/s40337-022-00556-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are highly complex mental illnesses associated with significant medical complications. There are currently knowledge gaps in research relating to the epidemiology, aetiology, treatment, burden, and outcomes of eating disorders. To clearly identify and begin addressing the major deficits in the scientific, medical, and clinical understanding of these mental illnesses, the Australian Government Department of Health in 2019 funded the InsideOut Institute (IOI) to develop the Australian Eating Disorder Research and Translation Strategy, the primary aim of which was to identify priorities and targets for building research capacity and outputs. A series of rapid reviews (RR) were conducted to map the current state of knowledge, identify evidence gaps, and inform development of the national research strategy. Published peer-reviewed literature on DSM-5 listed EDs, across eight knowledge domains was reviewed: (1) population, prevalence, disease burden, Quality of Life in Western developed countries; (2) risk factors; (3) co-occurring conditions and medical complications; (4) screening and diagnosis; (5) prevention and early intervention; (6) psychotherapies and relapse prevention; (7) models of care; (8) pharmacotherapies, alternative and adjunctive therapies; and (9) outcomes (including mortality). While RRs are systematic in nature, they are distinct from systematic reviews in their aim to gather evidence in a timely manner to support decision-making on urgent or high-priority health concerns at the national level. RESULTS Three medical science databases were searched as the primary source of literature for the RRs: Science Direct, PubMed and OVID (Medline). The search was completed on 31st May 2021 (spanning January 2009-May 2021). At writing, a total of 1,320 articles met eligibility criteria and were included in the final review. CONCLUSIONS For each RR, the evidence has been organised to review the knowledge area and identify gaps for further research and investment. The series of RRs (published separately within the current series) are designed to support the development of research and translation practice in the field of EDs. They highlight areas for investment and investigation, and provide researchers, service planners and providers, and research funders rapid access to quality current evidence, which has been synthesised and organised to assist decision-making.
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Affiliation(s)
- Phillip Aouad
- Inside Out Institute, University of Sydney & Sydney Local Health District, Sydney, NSW, Australia.
- Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Emma Bryant
- Inside Out Institute, University of Sydney & Sydney Local Health District, Sydney, NSW, Australia
| | - Danielle Maloney
- Inside Out Institute, University of Sydney & Sydney Local Health District, Sydney, NSW, Australia
- Sydney Local Health District, New South Wales Health, Sydney, NSW, Australia
| | - Peta Marks
- Inside Out Institute, University of Sydney & Sydney Local Health District, Sydney, NSW, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Haley Russell
- Inside Out Institute, University of Sydney & Sydney Local Health District, Sydney, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Jane Miskovic-Wheatley
- Inside Out Institute, University of Sydney & Sydney Local Health District, Sydney, NSW, Australia
| | - Stephen Touyz
- Inside Out Institute, University of Sydney & Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- Inside Out Institute, University of Sydney & Sydney Local Health District, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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12
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Qian J, Wu Y, Liu F, Zhu Y, Jin H, Zhang H, Wan Y, Li C, Yu D. An update on the prevalence of eating disorders in the general population: a systematic review and meta-analysis. Eat Weight Disord 2022; 27:415-428. [PMID: 33834377 PMCID: PMC8933366 DOI: 10.1007/s40519-021-01162-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/01/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To update the prevalence of eating disorders in the general population before 2021 and to analyze the distribution characteristics at different times and in different regions and sexes, as well as the diagnostic criteria. METHODS Based on the method from a previous report by the authors, studies were identified from the following databases: PubMed/Medline, PsycINFO, ISI Web of Knowledge, Ovid and the 4 most important Chinese databases. Articles in English and Chinese before 2021 were retrieved. The data retrieved at this time were pooled with the data from a previous report for analyses. RESULTS Thirty-three studies were identified, which included 18 studies supplemented in this retrieval. The pooled lifetime and 12-month prevalence of eating disorders were 0.91% (95% CI, 0.48-1.71) and 0.43% (95% CI, 0.18-0.78), respectively. The pooled lifetime and 12-month prevalence of the subgroup EDs (any), which covers all types of eating disorders, were 1.69% and 0.72%, respectively. The lifetime prevalence of AN, BN and BED was 0.16% (95% CI, 0.06-0.31), 0.63% (95% CI, 0.33-1.02) and 1.53% (95% CI, 1.00-2.17), respectively. The lifetime prevalence of EDs in Western countries was 1.89%, and was high at 2.58% in females. Prevalence studies using DSM-5 criteria were scarce. CONCLUSIONS The prevalence of eating disorders might be underestimated thus far. Not all types of EDs were included in a majority of epidemiological surveys, and the prevalence rates of the new types of EDs were significantly higher. Eating disorders were especially common in Western countries and in females. New diagnostic criteria should be used to comprehensively assess all types of eating disorders. LEVEL OF EVIDENCE 1, systematic review and meta-analysis.
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Affiliation(s)
- Jie Qian
- Shanghai Yangpu District Central Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying Wu
- Shanghai Tianyou Hospital, Shanghai, China
| | - Fanxiao Liu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yikang Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua Jin
- Shanghai Yangpu District Central Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongmei Zhang
- Shanghai Yangpu District Mental Health Center, Shanghai, China
| | - Yumei Wan
- Shandong Mental Health Center, Jinan, China
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dehua Yu
- Shanghai Yangpu District Central Hospital, Tongji University School of Medicine, Shanghai, China.
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13
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Mutiso VN, Ndetei DM, N Muia E, K Alietsi R, Onsinyo L, Kameti F, Masake M, Musyimi C, Mamah D. The prevalance of binge eating disorder and associated psychiatric and substance use disorders in a student population in Kenya - towards a public health approach. BMC Psychiatry 2022; 22:122. [PMID: 35172765 PMCID: PMC8848944 DOI: 10.1186/s12888-022-03761-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/15/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Kenya in particular and Africa in general lack data on Binge Eating Disorder (BED). The overarching objective of this study is to fill that gap. Kenyans may not be aware that BED exists when a "very good" appetite is considered a sign of good health, especially if food is available either at home, in fast food shops or when communally eating together, a very common cultural practice. On the other hand where there is relatively insufficient food, it is not expected that one could be having a problem of eating too much. METHOD We administered the following tools and measurements to 9742 participants (high school, college and university students): 1) Researcher designed socio-demographic and economic indicator questionnaire; 2) An instrument documenting DSM-IV diagnostic criteria for BED and its various symptoms; 3) An instrument to determine DSM-IV psychiatric disorders and substance abuse;4) An instrument measuring high risk for psychosis ,affectivity and stress; 5) A WHO designed instrument measuring the severity of substance abuse for specific substances. We used descriptive and inferential analysis to determine the prevalence and association of the different variables. Independent predictors of BED were generated from a generalized linear model (p<0.05). RESULTS We found a prevalence of 3.2% of BED and a wide range of prevalence for BED and BED related symptoms (8.1% to 19%). The least prevalent was "To prevent weight gain from eating binge did you force yourself to vomit, or used laxatives?". The most common was "Did you often go on eating binges (eating a very large amount of food very quickly over a short period of time)." Major depression, obsessive compulsive disorder, panic disorder, agoraphobia, generalized anxiety disorder ,a positive stress screen and drug abuse were independent predictors of BED (p<0.05). CONCLUSION Our findings on the prevalence of BED and significant associations with various psychiatric disorders and substance use disorders are similar to those obtained in High Income Countries (HIC) using similar large-scale samples in non-clinical populations. Our findings suggest the need fora public health approach to enhance awareness of BED and to promote health-seeking behaviour towards management of BED.
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Affiliation(s)
- Victoria N. Mutiso
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - David M. Ndetei
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya ,grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Esther N Muia
- grid.493101.e0000 0004 4660 9348Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Rita K Alietsi
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Lydia Onsinyo
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Frida Kameti
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Monicah Masake
- grid.493101.e0000 0004 4660 9348Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Christine Musyimi
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Daniel Mamah
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University Medical School, St. Louis, Missouri USA
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14
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Flamarique I, Vidal B, Plana MT, Andrés-Perpiñá S, Gárriz M, Sánchez P, Pajuelo C, Mont L, Castro-Fornieles J. Long-term cardiac assessment in a sample of adolescent-onset anorexia nervosa. J Eat Disord 2022; 10:12. [PMID: 35101147 PMCID: PMC8802465 DOI: 10.1186/s40337-022-00533-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND High mortality rates have been reported in patients with anorexia nervosa, mainly due to cardiovascular alterations. The purpose of the present study was to assess cardiac structural and functional abnormalities some 20 years after initial treatment in a sample of adolescent-onset anorexia nervosa (A-AN) and to compare them with matched healthy controls (HC). METHODS A sample of 29 women diagnosed and treated for AN during adolescence (A-AN) were assessed more than 20 years later. A complete cardiac evaluation was carried out including an electrocardiogram (ECG) and a standard 2D echocardiography. Thirty matched HC were also assessed. RESULTS In the A-AN group, four subjects had a body mass index lower than 18.5 and met full DSM 5 criteria for AN at follow-up (Low-Weight group). They were compared with the rest of the sample (n = 25) who had normalized their weight (Normal-Weight group), though some still showed some eating disorder symptoms. Both groups were compared with the HC group. Subjects in the Low-Weight group presented statistically significant decreases in the left ventricular end-diastolic and left atrium dimensions and left ventricular mass in comparison with the Normal-Weight group and the HC. No other differences in cardiac parameters were found between groups. CONCLUSIONS Echocardiographic and ECG parameters of adults who had presented A-AN twenty years earlier and currently maintained normal weight were similar to those of HC who had never been treated or diagnosed with AN. Adult subjects with A-AN who still had low weight in the long term present certain cardiac abnormalities similar to those seen in short-lasting disease. More studies are needed to confirm these results in a larger sample.
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Affiliation(s)
- I Flamarique
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Clinic Institute of Neurosciences, Hospital Clínic Universitari de Barcelona, IDIBAPS, CIBERSAM, C/Villarroel, 170, 08036, Barcelona, Spain.
| | - B Vidal
- Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Instituto de Salud Carlos III (CB16/11/00354), CIBERCV, Madrid, Spain
| | - M T Plana
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Clinic Institute of Neurosciences, Hospital Clínic Universitari de Barcelona, IDIBAPS, CIBERSAM, C/Villarroel, 170, 08036, Barcelona, Spain
| | - S Andrés-Perpiñá
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Clinic Institute of Neurosciences, Hospital Clínic Universitari de Barcelona, IDIBAPS, CIBERSAM, C/Villarroel, 170, 08036, Barcelona, Spain
| | - M Gárriz
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar de Barcelona, Llull, 410, 08019, Barcelona, Spain
| | - P Sánchez
- Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Instituto de Salud Carlos III (CB16/11/00354), CIBERCV, Madrid, Spain
| | - C Pajuelo
- Department of Cardiology, Hospital Plató, Barcelona, Spain
| | - L Mont
- Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Instituto de Salud Carlos III (CB16/11/00354), CIBERCV, Madrid, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - J Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Clinic Institute of Neurosciences, Hospital Clínic Universitari de Barcelona, IDIBAPS, CIBERSAM, C/Villarroel, 170, 08036, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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15
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Miskovic-Wheatley J, Koreshe E, Kim M, Simeone R, Maguire S. The impact of the COVID-19 pandemic and associated public health response on people with eating disorder symptomatology: an Australian study. J Eat Disord 2022; 10:9. [PMID: 35039076 PMCID: PMC8762631 DOI: 10.1186/s40337-021-00527-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE People with lived experience of eating disorders (ED) may be particularly vulnerable to the COVID-19 pandemic and associated public health response due to exasperating situations such as social isolation, presence of other mental and physical health conditions, disruptions to treatment, etc. This study investigates the association of the pandemic with ED symptomatology to consider impact and identify risk factors for clinical consideration. METHODS Participants with self-reported ED diagnosis and/or symptomatology over 16 years were invited to complete an online survey during the first months of the pandemic in Australia. Questions included history of ED, occurrence of co-occurring mental health conditions, change in ED symptoms since the start of the pandemic, and validated measures of ED illness, state mental health and loneliness. RESULTS Of 1723 participants (mode age 24.9 years, 91.6% identifying as female, EDE-Q Global Score x = 4.08, SD = 1.18, 79.0% reporting co-occurring mental health condition, predominantly obsessive-compulsive disorder and/or anxiety), 88.0% reported an increase in body image concerns, 74.1% in food restriction, 66.2% binge eating and 46.8% driven exercise during the pandemic. Increased ED symptomatology was associated with poorer state mental health (i.e., depression, anxiety, and stress) and loneliness across the ED symptom profile. Most participants were negatively impacted by various aspects of the public health response, more so for those with more acute ED illness as measured by the Eating Disorder Examination Questionnaire (EDE-Q). CONCLUSIONS Associated with the COVID-19 pandemic is a mental health crisis, particularly for those with a lived experience of an eating disorder. With 40.5% of participants not having sought formal diagnostic assessment and less than half in treatment, this study provides evidence for the detrimental impact of the pandemic on people with a lived experience of an eating disorder, especially for those not yet supported by the health care system.
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Affiliation(s)
- Jane Miskovic-Wheatley
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia.
| | - Eyza Koreshe
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia
| | | | - Rachel Simeone
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Charles Perkins Centre, Camperdown, NSW, 2006, Australia
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Chen DR, Sun G, Levin B. Gender-specific responses to multifaceted factors associated with disordered eating among adolescents of 7th to 9th grade. J Eat Disord 2022; 10:5. [PMID: 35012675 PMCID: PMC8751146 DOI: 10.1186/s40337-021-00524-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of disordered eating is increasing among adolescents in Asia. The prevalence and predictors of disordered eating in boys have often gone unrecognized. This study examined gender-specific responses to multifaceted factors associated with disordered eating, including personal, behavioral, family, and school-related characteristics. METHODS After excluding responses with incomplete information, a sample of 729 adolescents (48.97% boys) between the ages of 13 and 16 were surveyed through convenience sampling from 37 classrooms in three junior high schools in New Taipei City of Taiwan were analyzed. The Eating Attitudes Test-26 questionnaire was used to identify disordered eating. RESULTS No difference in the prevalence of disordered eating between the genders was found. Adolescent girls exhibit a preoccupation with fatness and a desire to be thinner, whereas boys are more likely to engage in extreme dieting behaviors such as vomiting, keeping the stomach empty, and avoiding sweets. Girls engaging in disordered eating reported relatively high levels of interpersonal stress involving family member weight-teasing, low peer acceptance, and high peer pressure to control weight. High intensity of regular exercise was found in girls with disordered eating. The perception of body weight is a more critical factor of engaging in disordered eating for boys than girls. Adolescents with immigrant parents were associated with disordered eating among both genders. CONCLUSIONS Changing gender-specific weight-related norms in schools and families is essential to reduce the prevalence of disordered eating, particularly among girls. Future studies using representative samples to confirm this study's findings are warranted.
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Affiliation(s)
- Duan-Rung Chen
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan.
| | - Grace Sun
- University of Southern California, Los Angeles, CA, USA
| | - Brianna Levin
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
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17
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Anderson KE, Desai SG, Zalaznik R, Zielinski N, Loeb KL. From research to practice: a model for clinical implementation of evidence-based outpatient interventions for eating disorders. J Eat Disord 2021; 9:150. [PMID: 34772462 PMCID: PMC8586828 DOI: 10.1186/s40337-021-00491-9] [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: 03/17/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A question frequently raised in the field is whether evidence-based interventions have adequate translational capacity for delivery in real-world settings where patients are presumed to be more complex, clinicians less specialized, and multidisciplinary teams less coordinated. The dual purpose of this article is to (a) outline a model for implementing evidence-driven, outpatient treatments for eating disorders in a non-academic clinical setting, and (b) report indicators of feasibility and quality of care. MAIN BODY Since our inception (2015), we have completed nearly 1000 phone intakes, with first-quarter 2021 data suggesting an increase in the context of COVID-19. Our caseload for the practice currently consists of approximately 200 active patients ranging from 6 to 66 years of age. While the center serves a transdiagnostic and trans-developmental eating disorder population, modal concerns for which we receive inquiries are Anorexia Nervosa and Avoidant Restrictive Food Intake Disorder, with the most common age range for prospective patients spanning childhood through late adolescence/emerging adulthood; correspondingly, the modal intervention employed is Family-based treatment. Our team for each case consists, at a minimum, of a primary internal therapist and a physician external to the center. SHORT CONCLUSION We will describe our processes of recruiting, training and coordinating team members, of ensuring ongoing fidelity to evidence-based interventions, and of training the next generation of clinicians. Future research will focus on a formal assessment of patient outcomes, with comparison to benchmark outcomes from randomized controlled trials.
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Affiliation(s)
- Kristen E Anderson
- Chicago Center for Evidence Based Treatment, 25 E Washington Street, Suite 1015, Chicago, IL, 60602, USA.
| | - Sara G Desai
- Chicago Center for Evidence Based Treatment, 25 E Washington Street, Suite 1015, Chicago, IL, 60602, USA
| | - Rodie Zalaznik
- Chicago Center for Evidence Based Treatment, 25 E Washington Street, Suite 1015, Chicago, IL, 60602, USA
| | - Natalia Zielinski
- Chicago Center for Evidence Based Treatment, 25 E Washington Street, Suite 1015, Chicago, IL, 60602, USA
| | - Katharine L Loeb
- Chicago Center for Evidence Based Treatment, 25 E Washington Street, Suite 1015, Chicago, IL, 60602, USA
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Marek RJ, Anderson JL. Measurement of Eating Pathology Using the Minnesota Multiphasic Personality Inventory-3 (MMPI-3). J Pers Assess 2021; 104:674-679. [PMID: 34678090 DOI: 10.1080/00223891.2021.1991361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Eating disorders are prevalent among college student populations. Although previous iterations of the instrument did not include specific measurement of eating pathology, the Minnesota multiphasic personality inventory-3 (MMPI-3) now includes a specific scale (i.e., Eating Concerns [EAT]) to assess problematic eating behaviors. The current study examined the MMPI-3 assessment of eating pathology among 249 undergraduate women. A pattern emerged where symptoms of internalizing psychopathology on the MMPI-3 were generally associated with symptoms of eating disorder. However, the newly included EAT scale demonstrated the strongest associations with most areas of eating dysfunction. Further, hierarchical regression analyses suggested that the EAT scale added substantial incremental predictive utility (up to 23%) over other MMPI-3 scales combined in assessing eating pathology. Classification accuracy statistics yielded high sensitivity and specificity coefficients when predicting eating disorder risk at an EAT scale score cutoff of 75 T or higher. These findings support the use of the MMPI-3 in assessing eating pathology in college women, although its performance with men and with women not of college age remains to be studied.
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Barakat S, Touyz S, Maloney D, Russell J, Hay P, Cunich M, Lymer S, Kim M, Madden S, Miskovic-Wheatley J, Maguire S. Supported online cognitive behavioural therapy for bulimia nervosa: a study protocol of a randomised controlled trial. J Eat Disord 2021; 9:126. [PMID: 34649625 PMCID: PMC8515319 DOI: 10.1186/s40337-021-00482-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite the availability of effective treatments for bulimia nervosa (BN), a number of barriers to accessibility exist. Examples include access to trained clinicians, the expense of treatment, geographical limitations, and personal limitations such as stigma regarding help seeking. Self-help interventions, delivered via a digital platform, have the potential to overcome treatment gaps by providing patients with standardised, evidence-based treatments that are easily accessible, cost-effective, and require minimal clinician support. Equally, it is important to examine the shortcomings of digital interventions when compared to traditional to face-to-face delivery (e.g., high dropout rates) in order to maximise the therapeutic effectiveness of online, self-help interventions. METHODS A three-arm, multisite randomised controlled trial will be conducted in Australia examining the effectiveness and cost-effectiveness of a newly developed online self-help intervention, Binge Eating eTherapy (BEeT), in a sample of patients with full or sub-threshold BN. The BEeT program consists of 10, multimedia sessions delivering the core components of cognitive behaviour therapy. Eligible participants will be randomised to one of three groups: independent completion of BEeT as a purely self-help program, completion of BEeT alongside clinician support (in the form of weekly telemedicine sessions), or waitlist control. Assessments will take place at baseline, weekly, post-intervention, and three-month follow up. The primary outcome is frequency of objective binge episodes. Secondary outcomes include frequency of other core eating disorder behavioural symptoms and beliefs, psychological distress, and quality of life. Statistical analyses will examine treatment effectiveness, feasibility, acceptability and cost effectiveness. DISCUSSION There is limited capacity within the mental health workforce in Australia to meet the demand of people seeking treatment for eating disorders. This imbalance has only worsened following outbreak of the COVID-19 pandemic. Further research is required into innovative digital modes of treatment delivery with the capacity to service mental health needs in an accessible and affordable manner. Self-help programs may also appeal to individuals who are more reluctant to engage in traditional face-to-face treatment formats. This study will provide rigorous evidence on how to diversify treatment options for individuals with BN, ensuring more people with the illness can access evidence-based treatment. The study has been registered with the Australia New Zealand Clinical Trials Registry (ANZCTR Registration Number: ACTRN12619000123145p). Registered 22 January 2019, https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619000123145 .
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia.
- School of Psychology, The University of Sydney, Sydney, Australia.
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia
| | - Janice Russell
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia
- Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Campbelltown, Australia
| | - Michelle Cunich
- Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District Camperdown, Camperdown, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, Australia
| | - Sharyn Lymer
- Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney, Australia
| | - Marcellinus Kim
- Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sloane Madden
- Department of Psychological Medicine, Children's Hospital at Westmead, Sydney, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia
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Knatz Peck S, Towne T, Wierenga CE, Hill L, Eisler I, Brown T, Han E, Miller M, Perry T, Kaye W. Temperament-based treatment for young adults with eating disorders: acceptability and initial efficacy of an intensive, multi-family, parent-involved treatment. J Eat Disord 2021; 9:110. [PMID: 34496951 PMCID: PMC8424819 DOI: 10.1186/s40337-021-00465-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Adult eating disorder treatments are hampered by lack of access and limited efficacy. This open-trial study evaluated the acceptability and preliminary efficacy of a novel intervention for adults with eating disorders delivered to young adults and parent-supports in an intensive, multi-family format (Young Adult Temperament-Based Treatment with Supports; YA-TBT-S). METHODS 38 YA-TBT-S participants (m age = 19.58; SD 2.13) with anorexia nervosa (AN)-spectrum disorders, bulimia nervosa (BN)-spectrum disorders, and avoidant/restrictive food intake disorder (ARFID) completed self-report assessments at admission, discharge, and 12-month follow-up. Assessments measured program satisfaction, eating disorder psychopathology and impairment, body mass index (BMI), and trait anxiety. Outcomes were analyzed using linear mixed effects models to examine changes in outcome variables over time. RESULTS Treatment was rated as highly satisfactory. 53.33% were in partial or full remission at 12-month follow-up. 56% of participants received other treatment within the 12-month follow-up period, suggesting that YA-TBT-S may be an adjunctive treatment. Participants reported reductions in ED symptomatology (AN and BN), increases in BMI (AN and ARFID), and reductions in clinical impairment (AN and ARFID) at 12-month follow-up. CONCLUSIONS YA-TBT-S is a feasible and acceptable adjunctive treatment for young adults with a broad range of ED diagnoses and may be a method for involving parents in ED treatment in ways that are acceptable to both parents and YA. Further evaluation of efficacy is needed in larger samples, and to compare YA-TBT-S to other ED treatment approaches. Plain English summary Eating disorders are costly and dangerous psychiatric disorders that affect millions of individuals each year. Despite their risks and societal costs, currently available treatments are limited. This study examined the acceptability and efficacy of Young Adult, Temperament-Based Treatment with Supports (YA-TBT-S), a new treatment program for adults with eating disorders. YA-TBT-S was rated highly, and a significant portion of participants improved based on ratings collected 12 months after program participation. Those with anorexia nervosa (AN) and bulimia nervosa (BN) showed significant reductions in eating disorder pathology, and those with AN and avoidant/restrictive food intake disorder (ARFID) showed increases in BMI over time.
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Affiliation(s)
- Stephanie Knatz Peck
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA.
| | - Terra Towne
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Christina E Wierenga
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Laura Hill
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Ivan Eisler
- King's College London, London, UK.,Maudsley Centre for Child Adolescent Eating Disorders, London, UK
| | - Tiffany Brown
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Emily Han
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - McKenzie Miller
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Taylor Perry
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Walter Kaye
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
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Imani M, Jalali A, Salari N, Abbasi P. Effect of instrumental music on anxiety and depression among hemodialysis patients: A randomized controlled trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:305. [PMID: 34667805 PMCID: PMC8459877 DOI: 10.4103/jehp.jehp_1472_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Hemodialysis patients suffer from mental disorders such as anxiety and depression. One of the known nonpharmacological methods to eliminate these disorders is music therapy. The present study aimed to investigate the effect of instrumental music on state depression and anxiety in hemodialysis patients. MATERIALS AND METHODS This study was a clinical trial. The population was hemodialysis patients in Hamedan in 2017 and 50 patients were selected and randomly divided into experimental and control groups. The duration each time of the instrumental music intervention for the experimental group was 3 weeks, 3 times a week for 20 min. Data were measured by beck depression inventory and SpeilBerger State-Trait Anxiety Inventory-Y1 before the intervention and immediately after the last intervention and analyzed using Yates correction, Chi-square test, Mann-Whitney U-test, independent t-test, and Wilcoxon test. RESULTS No significant difference between the intervention and control groups was observed before the study in terms of demographic variables (P > 0.05). In the intervention group, the mean and standard deviation of the depression score before the intervention was 8.99 ± 23.68 and after the intervention reached 7.54 ± 14.88, which shows that the variable was significant (P = 0.001); however, no significant difference was observed in the control group. In the intervention group, the mean of state anxiety before the intervention was 10.05 ± 53.76 and after the intervention reached 9.76 ± 42.48, which was statistically significant (P = 0.004), while no significant difference was observed in the control group. CONCLUSION The results indicate the positive effect of instrumental music on reducing anxiety and depression in hemodialysis patients. It is recommended that this therapy be used as a nursing method to reduce state anxiety and depression in hemodialysis patients.
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Affiliation(s)
- Mohammad Imani
- Department of Nursing, Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalali
- Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Biostatistics, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parvin Abbasi
- Department of Nursing, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Accurso EC, Mu KJ, Landsverk J, Guydish J. Adaptation to family-based treatment for Medicaid-insured youth with anorexia nervosa in publicly-funded settings: Protocol for a mixed methods implementation scale-out pilot study. J Eat Disord 2021; 9:99. [PMID: 34389052 PMCID: PMC8360814 DOI: 10.1186/s40337-021-00454-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Family-based treatment (FBT) for anorexia nervosa is an evidence-based treatment, but its effectiveness is untested among socioeconomically disadvantaged and racially diverse youth. Adapting FBT may facilitate "scale-out" for Medicaid-insured youth served in publicly-funded settings and potentially improve outcomes for more diverse populations. METHODS This mixed methods effectiveness-implementation Hybrid Type 3 pilot study protocol included a planning period in collaboration with the San Francisco Department of Public Health, culminating in a two-day in-person FBT training for 25 therapists in the county, followed by the opportunity to engage in one year of weekly supervision. The training incorporated FBT adaptations intended to improve fit for low-income families within community-based settings. Treatment appropriateness and acceptability will be measured immediately post-training. Following the training, cases referred for FBT will only be assigned to the trained clinicians who voluntarily opted into long-term group supervision. Clinicians treating at least one FBT case during the supervision period will report on implementation, adaptations, and patient weight gain. Finally, semi-structured interviews with clinician participants will be conducted, focused on implementation challenges and facilitators, local treatment adaptations, and overall satisfaction with FBT. DISCUSSION Learning about clinician adaptations will advance knowledge about treatment of eating disorders in publicly-funded community clinics, which serve a racially/ethnically and socioeconomically diverse group of youth. This project is designed to accelerate FBT implementation in publicly-funded mental health systems, and inform service improvements for underserved youth with eating disorders.
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Affiliation(s)
- Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
| | - Karen J Mu
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,San Francisco Department of Public, Health Behavioral Health Services, San Francisco, CA, USA
| | | | - Joseph Guydish
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Hambleton A, Le Grange D, Miskovic-Wheatley J, Touyz S, Cunich M, Maguire S. Translating evidence-based treatment for digital health delivery: a protocol for family-based treatment for anorexia nervosa using telemedicine. J Eat Disord 2020; 8:50. [PMID: 33052259 PMCID: PMC7544521 DOI: 10.1186/s40337-020-00328-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Family-based treatment (FBT) is an efficacious outpatient intervention for young people diagnosed with Anorexia Nervosa (AN). To date, treatment to protocol has relied on standard face-to-face delivery. Face-to-face therapy is subject to geographic, temporal and human factors, rendering it particularly susceptible to inequities and disruption. This has resulted in poorer service provision for rural and regional families, and recently a significant challenge to providing face-to-face services during the COVID-19 global pandemic. The present study examines whether FBT for AN can be successfully translated to a digital delivery platform to address these access issues. METHOD Forty young people aged 12 to 18 years who meet DSM-5 diagnostic criteria for AN, and live in a rural or regional setting, will along with their family be recruited to the study. Trained therapists will provide 18 sessions of FBT over 9 months via telemedicine to the home of the young person and their family. The analysis will examine treatment effectiveness, feasibility, acceptability, and cost-effectiveness. DISCUSSION The study addresses the treatment needs of families not able to attend face-to-face clinical services for evidence-based treatment for eating disorders. This might be due to several barriers, including a lack of local services or long travel distances to services. There has been a recent and unprecedented demand for telemedicine to facilitate the continuity of care during COVID-19 despite geographical circumstances. If delivering treatment in this modality is clinically and economically effective and feasible, it will facilitate access to potentially lifesaving, evidence-based treatments for families formerly unable to access such care and provide evidence for the continuity of services when and where face-to-face treatment is not feasible.
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Affiliation(s)
- A. Hambleton
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - D. Le Grange
- UCSF Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, San Francisco, California USA
| | - J. Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - S. Touyz
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - M. Cunich
- The Boden Collaboration for Obesity, Nutrition & Eating Disorders, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW Australia
| | - S. Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, St Leonards, Australia
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Lindstedt K, Forss E, Elwin M, Kjellin L, Gustafsson SA. Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: treatment interventions and patient satisfaction. Child Adolesc Psychiatry Ment Health 2020; 14:16. [PMID: 32391079 PMCID: PMC7196214 DOI: 10.1186/s13034-020-00323-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 04/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite major research efforts, current recommendations of treatment interventions for adolescents with anorexia nervosa are scarce, and the importance of patient satisfaction for treatment outcome is yet to be established. The overall aim of the present study was to examine treatment interventions and patient satisfaction in a naturalistic sample of adolescents with anorexia nervosa or subthreshold anorexia nervosa and possible associations to outcome defined as being in remission or not at treatment follow-up. METHODS Participants were identified through the Swedish national quality register for eating disorder treatment (SwEat). The samples consisted of 1899 patients who were follow-up registered 1 year after entering treatment and 474 patients who had completed a 1-year patient satisfaction questionnaire. A two-step cluster analysis was used for identifying subgroups of patients who received certain combinations and various amounts of treatment forms. RESULTS Patients who received mainly family-based treatment and/or inpatient care were most likely to achieve remission at 1-year follow-up, compared to patients in the other clusters. They were also younger, in general. Individual therapy was the most common treatment form, and was most appreciated among the adolescents. At 1-year follow-up, many patients reported improvements in eating habits, but far fewer reported improvements regarding cognitive symptoms. Overall, the patients rated the therapist relationship in a rather positive way, but they gave quite low ratings to statements associated with their own participation in treatment. CONCLUSIONS The results indicate that young adolescents who receive mainly family-based treatment and/or inpatient care respond more rapidly to treatment compared to older adolescents who receive mainly individual therapy or mixed treatment interventions. At 1-year follow-up, the adolescents reported improvements in behavioral symptoms and seemed quite satisfied with the therapist relationship.
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Affiliation(s)
- Katarina Lindstedt
- grid.15895.300000 0001 0738 8966University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Emma Forss
- grid.15895.300000 0001 0738 8966Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marie Elwin
- grid.15895.300000 0001 0738 8966University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lars Kjellin
- grid.15895.300000 0001 0738 8966University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sanna Aila Gustafsson
- grid.15895.300000 0001 0738 8966University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Abstract
Eating disorders (EDs) are a group of prevalent psychiatric illnesses with an onset in early to late adolescence-a time of significant neural development, physical and psychologic growth, and self-exploration. The etiology and neurobiology of EDs are not well understood, but EDs are recognized as brain-based illnesses with serious acute and long-term consequences if undertreated or ignored. Two EDs, anorexia nervosa (AN) and bulimia nervosa (BN), have historically been the primary EDs of focus. The DSM-5 updated diagnostic criteria for these disorders added two more: binge-eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). EDs severely impact males as well as females across the weight spectrum. Comorbidity is high; mortality rates for AN and BN are the highest in psychiatric conditions and higher than many medical conditions. Several treatment options are available to treat an ED ranging from inpatient hospitalization to outpatient services and different psychotherapy options. This chapter reviews the diagnostic criteria, clinical presentation, and treatment for these disorders. Where available, sex differences and developmental considerations will be noted. For all EDs, early recognition and swift treatment are necessary to avoid a chronic course.
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Nilsen JV, Hage TW, Rø Ø, Halvorsen I, Oddli HW. External support and personal agency - young persons' reports on recovery after family-based inpatient treatment for anorexia nervosa: a qualitative descriptive study. J Eat Disord 2020; 8:18. [PMID: 32391150 PMCID: PMC7197126 DOI: 10.1186/s40337-020-00293-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/31/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Recommended treatment for adolescent anorexia nervosa (AN) is usually family-based and an overarching treatment aim is to empower the parents to manage the difficult meals and aid their child toward recovery. While family-based treatment prioritize collaborating with the parents, understanding the young persons' views on recovery is also important. Understanding the young person's views and ideas is relevant as this may facilitate the therapeutic alliance and thus aid the therapeutic process. The purpose of the present study was to investigate the reflections of young persons with a lived experience of anorexia nervosa, and what factors they consider important for the recovery process. All participants had been provided with a family-based inpatient treatment program, a program inspired by the core features of outpatient family-based treatment. METHODS Participants (n = 37) presented with an extensive treatment history, including outpatient and inpatient treatment for AN. Interview transcripts were analyzed by applying a predominantly inductive thematic approach to generate themes across participants. RESULTS The qualitative analysis generated a thematic structure entailing three levels. The superordinate theme, "Recovery is a long and winding journey: recognizing the need for support and highlighting the need for action", captured three main themes, "Realizing you have a problem", "Being involved in important relationships", and "Giving treatment a real chance". CONCLUSIONS Our results demonstrated that although young persons with a lived experience of anorexia nervosa recognized the importance of support from others, they placed a distinctive emphasis on self-responsibility and determination. We recommend clinicians working within the recommended family-based treatment frameworks be curious about young patient's subjective perspectives of the recovery process, as connecting with their views can potentially strengthen therapeutic relationships and facilitate change. PLAIN ENGLISH SUMMARY Recommended treatment for adolescent anorexia nervosa is usually family-based. These recommendations are supported by decades of research. In family-based treatment the overarching aim is to empower the young person's parents to manage and take charge of the difficult situation caused by the eating disorder. As recommended family-based treatments usually prioritize collaborating with the parents, it is important to be curious on the adolescents own views of what is regarded as important for the recovery process. The present study offers insights into factors considered important to the recovery process by young persons with lived experience of AN. Although voicing the importance of enlisting support from families, friends, and loved ones, the young participants distinctly emphasized their own responsibility, motivation and self-determination as critical factors for recovery. Inspired by our findings, we recommend that clinicians address the young patient's own preferred ideas for recovery during treatment.
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Affiliation(s)
- Jan-Vegard Nilsen
- 1Department of Psychology, University of Oslo, Oslo, Norway.,2Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Trine Wiig Hage
- 2Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- 2Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Inger Halvorsen
- 2Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Grammer AC, Fitzsimmons-Craft EE, Laing O, Pietro BD, Wilfley DE. Eating Disorders on College Campuses in the United States: Current Insight on Screening, Prevention, and Treatment. CURRENT PSYCHOPHARMACOLOGY 2020; 9:91-102. [PMID: 32905358 PMCID: PMC7470246 DOI: 10.2174/2211556009999200416153022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eating disorders are prevalent on college campuses and pose significant risks to student health, well-being, and academic performance. However, few students receive access to evidence-based prevention and treatment. OBJECTIVE The present review synthesizes the recent literature on ED screening, prevention, and treatment approaches on college campuses in the United States. We provide an overview of ED screening efforts on college campuses, including relevant screening tools, summarize the extant literature on prevention programming, as well psychological and pharmacological treatment approaches, and outline limitations of current programming and provide future directions for research. CONCLUSION Recent advances in ED screening, prevention, and treatment efforts highlight the importance of early detection and intervention. Innovative approaches to screening and dissemination of evidence-based prevention and treatment programs on college campuses are warranted. Implications for future research are discussed.
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Affiliation(s)
- Anne C Grammer
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Olivia Laing
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Bianca De Pietro
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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Casasnovas AF, Huryk KM, Levinson D, Markowitz S, Friedman S, Stice E, Loeb KL. Cognitive dissonance-based eating disorder prevention: pilot study of a cultural adaptation for the Orthodox Jewish community. Eat Disord 2019; 29:1-13. [PMID: 31354097 DOI: 10.1080/10640266.2019.1644797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Body Project (BP) is a cognitive dissonance-based eating disorders (ED) prevention program that targets thin-ideal internalization and reduces ED risk factors and onset for higher-risk adolescent/young adult females. Although the more insular Orthodox Jewish communities reduce exposure to mainstream secular media, they are not immune to thin-ideal internalization and EDs. The present uncontrolled study evaluated the preliminary effects of a cultural adaptation of the BP for Orthodox Jewish girls. The modified manual improved fit with ultra-Orthodox Jewish norms, practices, and values. Eighty-nine 11th-graders in a private, all-female religious high school participated. ED risk factors and symptoms were assessed at baseline, end of 4-week intervention, and 6-month follow-up. Multi-level modeling showed that body dissatisfaction and negative affect significantly decreased across time. Findings demonstrate potential for the BP to be adapted for and implemented in cultural and religious communities wherein interactions with societal influences on thin-ideal internalization differ from dominant culture.
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Affiliation(s)
- Arielle F Casasnovas
- a School of Psychology, Fairleigh Dickinson University , Teaneck , New Jersey , USA
| | - Kathryn M Huryk
- a School of Psychology, Fairleigh Dickinson University , Teaneck , New Jersey , USA
| | - Devorah Levinson
- b Relief Resources, Eating Disorder Division , Lakewood , NJ , USA
| | | | | | - Eric Stice
- e Oregon Research Institute , Eugene , OR , USA
| | - Katharine L Loeb
- a School of Psychology, Fairleigh Dickinson University , Teaneck , New Jersey , USA
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Reyes-Rodríguez ML, Watson HJ, Barrio C, Baucom DH, Silva Y, Luna-Reyes KL, Bulik CM. Family involvement in eating disorder treatment among Latinas. Eat Disord 2019; 27:205-229. [PMID: 31084429 PMCID: PMC6542266 DOI: 10.1080/10640266.2019.1586219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Latinos are less likely to seek health care for eating disorders and more likely to drop out of treatment than members of other ethnic groups, highlighting existing challenges to engagement in traditional mental health care. This study explored the role of family in the treatment of adult Latinas with eating disorders through content analysis of family sessions adjunctive to cognitive behavioral therapy. This study yielded insight into the experiences of 10 Latinas with eating disorders (M age = 39.90 years) and 10 relatives (M age = 39.50) from the Promoviendo una Alimentación Saludable trial who were randomly selected to receive six family enhancement sessions. Data from 53 sessions were analyzed using a qualitative content analysis approach. Family intervention might serve as a valuable adjunct to conventional treatment by positively influencing social, family, and emotional support for Latinas with eating disorders.
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Affiliation(s)
| | - Hunna J Watson
- a Department of Psychiatry , University of North Carolina , Chapel Hill , NC , USA.,b School of Paediatrics and Child Health , University of Western Australia , Perth , Australia.,c School of Psychology and Speech Pathology , Curtin University , Perth , Australia
| | - Concepción Barrio
- d Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Donald H Baucom
- e Department of Psychology , University of North Carolina , Chapel Hill , NC , USA
| | - Yormeri Silva
- a Department of Psychiatry , University of North Carolina , Chapel Hill , NC , USA
| | - Kiara L Luna-Reyes
- f Department of Psychology , University of North Carolina , Greensboro , NC , USA
| | - Cynthia M Bulik
- a Department of Psychiatry , University of North Carolina , Chapel Hill , NC , USA.,g Department of Nutrition , University of North Carolina , Chapel Hill , NC , USA.,h Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , NC , Sweden
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Aradas J, Sales D, Rhodes P, Conti J. "As long as they eat"? Therapist experiences, dilemmas and identity negotiations of Maudsley and family-based therapy for anorexia nervosa. J Eat Disord 2019; 7:26. [PMID: 31388424 PMCID: PMC6670233 DOI: 10.1186/s40337-019-0255-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/25/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Maudsley Family Therapy and its manualised version Family-Based Therapy for Anorexia Nervosa (FBT-AN) have accrued the most significant research evidence-base for the treatment of adolescent Anorexia Nervosa (AN). A tradition of seeking augmentations for this treatment has also been established to enhance efficacy. There exists, however, a gap in the uptake of this form of manualised treatment into the "real world" of clinicians who work with adolescent AN. AIMS This research study investigated the key experiences and identity negotiations of a group of nine Australian clinicians who were interested in contributing to research into ways that Maudsley and FBT-AN might be improved. METHODS Nine clinicians, who at the time of the interview practised or had previously practised, FBT-AN participated in a semi-structured interview. A critical discursive analysis of interview transcripts generated a thematic map of these therapists' experiences and identity negotiations in their practice of FBT-AN. RESULTS These therapists experienced the structure of FBT-AN as both a secure map for therapy, yet also constraining at times, in their work with adolescents and their families. Additionally, their professional identities were both invested and troubled by the identity position of themselves as evidence-based practitioners, particularly where evidence-based practice (EBP) meant strict fidelity to the manual and restrained them from tailoring a broader range of therapeutic interventions to an individual adolescent and their family. Within their narratives, these therapists refashioned alternative identity positions around what it meant to be an evidence-based practitioner through listening to and drawing on their clinical expertise of what works in therapeutic practice with an individual adolescent and their family. CONCLUSIONS These therapists narratives highlight the power of the dominant discourse of EBP that works to privilege the research evidence over other forms of evidence that include clinician expertise and client preferences. The dilemmas faced by these therapists questioned not only the strict application of FBT-AN for adolescent AN across diverse therapeutic contexts, but also the effects of supervisory practices that paralleled this strict fidelity to the model. Further research is needed into therapeutic interventions and supervisory practices that give greater scope for clinicians to draw on their expertise in the flexible tailoring of treatments to the unique needs and preferences of the individual adolescent and their family.
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Affiliation(s)
- Jessica Aradas
- 1University of Western Sydney, Locked Bag 1797, Penrith, 2751 Australia
| | - Diana Sales
- 1University of Western Sydney, Locked Bag 1797, Penrith, 2751 Australia
| | | | - Janet Conti
- 1University of Western Sydney, Locked Bag 1797, Penrith, 2751 Australia
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Dimitropoulos G, Landers AL, Freeman VE, Novick J, Cullen O, Engelberg M, Steinegger C, Le Grange D. Family-based treatment for transition age youth: parental self-efficacy and caregiver accommodation. J Eat Disord 2018; 6:13. [PMID: 29928504 PMCID: PMC5989339 DOI: 10.1186/s40337-018-0196-0] [Citation(s) in RCA: 2] [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: 12/03/2017] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family-Based Treatment (FBT) is the first line of care in paediatric treatment while adult programs focus on individualized models of care. Transition age youth (TAY) with Anorexia Nervosa (AN) are in a unique life stage and between systems of care. As such, they and their caregivers may benefit from specialized, developmentally tailored models of treatment. METHODS The primary purpose of this study was to assess if parental self-efficacy and caregiver accommodation changed in caregivers during the course of FBT-TAY for AN. The secondary aim was to determine if changes in parental self-efficacy and caregiver accommodation contributed to improvements in eating disorder behaviour and weight restoration in the transition age youth with AN. Twenty-six participants (ages 16-22) and 39 caregivers were recruited. Caregivers completed the Parents versus Anorexia Scale and Accommodation and Enabling Scale for Eating Disorders at baseline, end-of-treatment (EOT), and 3 months follow-up. RESULTS Unbalanced repeated measures designs for parental self-efficacy and caregiver accommodation towards illness behaviours were conducted using generalized estimation equations. Parental self-efficacy increased from baseline to EOT, although not significantly (p = .398). Parental self-efficacy significantly increased from baseline to 3 months post-treatment (p = .002). Caregiver accommodation towards the illness significantly decreased from baseline to EOT (p = 0.0001), but not from baseline to 3 months post-treatment (p = 1.000). Stepwise ordinary least squares regression estimates of eating disorder behaviour and weight restoration did not show that changes in parental-self efficacy and caregiver accommodation predict eating disorder behaviour or weight restoration at EOT or 3 months post-treatment. CONCLUSIONS Our findings demonstrate, albeit preliminary at this stage, that FBT-TAY promotes positive increases in parental self-efficacy and assists caregivers in decreasing their accommodation to illness behaviours for transition age youth with AN. However, changes in the parental factors did not influence changes in eating and weight in the transition age youth.
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Affiliation(s)
- Gina Dimitropoulos
- 1Faculty of Social Work, Matheson Centre for Mental Health Research, University of Calgary, 4212-2800 University Way N.W., Calgary, Alberta Canada.,8Hotchkiss Brain Institute, University of Calgary, 4212-2800 University Way N.W., Calgary, Alberta Canada
| | - Ashley L Landers
- 2Department of Human Development and Family Science, Virginia Polytechnic Institute and State University, Falls Church, VA USA
| | - Victoria E Freeman
- 3University Health Network, Toronto General Hospital, Toronto, Ontario Canada
| | - Jason Novick
- 4Department of Sociology, Mount Royal University, Calgary, Alberta Canada
| | - Olivia Cullen
- 1Faculty of Social Work, Matheson Centre for Mental Health Research, University of Calgary, 4212-2800 University Way N.W., Calgary, Alberta Canada
| | - Marla Engelberg
- 5Adolescent Eating Disorder Program, North York General Hospital, Toronto, Ontario Canada
| | - Cathleen Steinegger
- 6Division of Adolescent Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario Canada
| | - Daniel Le Grange
- 7Department of Psychiatry, University of California, San Francisco, CA USA
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Dimitropoulos G, Landers AL, Freeman V, Novick J, Garber A, Le Grange D. Open Trial of Family-Based Treatment of Anorexia Nervosa for Transition Age Youth. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2018; 27:50-61. [PMID: 29375633 PMCID: PMC5777691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This pilot study conducted an open trial of a manualized adaptation to Family-Based Treatment for Transition Age Youth (FBT-TAY) for Anorexia Nervosa (AN). The aims were: (1) determine the acceptability of FBT for TAY; and, (2) establish preliminary effect sizes for the impact of FBT-TAY on eating disorder behaviour and weight restoration. METHOD Twenty-six participants across two paediatric and one adult hospital site were recruited to participate. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q) at the start of treatment, the end-of-treatment, and three-month follow-up. RESULTS FBT-TAY is an acceptable and feasible treatment to all study therapists as evidenced by their fidelity to the model. FBT-TAY is a feasible and acceptable intervention to transition age youth, given only 27.27% chose treatment as usual over FBT-TAY. Participants presented significant improvement at end-of-treatment and three-months post-treatment (p < .001; ES = 0.34) from baseline on the EDE-Q Global Score. Participants also achieved and maintained weight restoration at the end-of-treatment and three-months post-treatment when compared to baseline (p < .0001, ES = 0.54). CONCLUSIONS FBT-TAY, the first manualized AN treatment for TAY, demonstrated feasibility and acceptability with therapists and participants as well as improvement for participants in EDE-Q global score and weight. Given the current dearth of effective treatments for TAY with AN, FBT-TAY is a promising adaptation of FBT. A larger clinical trial with a 12-month follow-up is recommended.
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Affiliation(s)
| | | | - Victoria Freeman
- Eating Disorders Program, Toronto General Hospital, Toronto, Ontario
| | - Jason Novick
- Department of Sociology, University of Calgary, Calgary, Alberta
| | - Andrea Garber
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, California, USA
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Hage TW, Rø Ø, Moen A. "Do you see what I mean?" staff collaboration in eating disorder units during mealtimes. BMC Nurs 2017; 16:40. [PMID: 28736503 PMCID: PMC5520364 DOI: 10.1186/s12912-017-0233-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 06/29/2017] [Indexed: 12/02/2022] Open
Abstract
Background Eating disorders are psychiatric illnesses with potentially life-threatening consequences. Inpatient treatment is typically required for the most severely ill patients, who are often emaciated or significantly malnourished. A core therapeutic objective is to normalize eating patterns and facilitate weight gain. These goals guide the efforts of milieu therapeutic staff working with this patient group, who support renourishment through the positive manipulation of a structured environment, as well via relational aspects. However, there is a lack of empirical research exploring inpatient staff members’ perspectives concerning various aspects of this work. This article explore staff’s teamwork during mealtimes on inpatient eating disorder units. Specifically, we investigated the collaborative strategies employed to support core therapeutic goals of meal completion and normalized eating behavior, while concurrently maintaining a supportive, friendly atmosphere during mealtimes. Methods This was a exploratory qualitative study. Data was collected through 20 semi-structured in-depth interviews with staff members working on a specialized eating disorder unit. The interviews were performed after the conduction of meal time support. Cultural historical activity theory was used as the key theoretical tool for analysis. Results The analysis revealed three main themes: 1) strategic seating arrangements mediates division of labor, 2) the use of verbal and nonverbal communication as collaborative tools, and 3) the importance of experience as a collaborative resource. Conclusions The present study found that mealtime collaborative strategies on inpatient EDUs were mainly of non-verbal nature, with level of experience as an important premise for staff collaboration. Greater awareness about how collegial collaboration is practiced may help staff members to learn routines and regulate scripts for mealtime practices.
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Affiliation(s)
- Trine Wiig Hage
- Institute for Health and Society, University of Oslo, Oslo, Norway.,Oslo University Hospital, Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo, Norway
| | - Øyvind Rø
- Oslo University Hospital, Regional Department of Eating Disorders, Division of Mental Health and Addiction, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Moen
- Institute for Health and Society, University of Oslo, Oslo, Norway
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Hay P, Mitchison D, Collado AEL, González-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. J Eat Disord 2017; 5:21. [PMID: 28680630 PMCID: PMC5494787 DOI: 10.1186/s40337-017-0149-z] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/24/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Little is known about the epidemiology and health related quality of life (HRQoL) of the new DSM-5 diagnoses, Binge Eating Disorder (BED) and Avoidant/Restrictive Food Intake Disorder (ARFID) in the Australian population. We aimed to investigate the prevalance and burden of these disorders. METHODS We conducted two sequential population-based surveys including individuals aged over 15 years who were interviewed in 2014 (n = 2732) and 2015 (n =3005). Demographic information and diagnostic features of DSM-5 eating disorders were asked including the occurrence of regular (at least weekly over the past 3 months) objective binge eating with levels of distress, extreme dietary restriction/fasting for weight/shape control, purging behaviors, overvaluation of shape and/or weight, and the presence of an avoidant/restrictive food intake without overvaluation of shape and/or weight. In 2014 functional impact or role performance was measured with the 'days out of role' question and in 2015, Health Related Quality of Life (HRQoL) was assessed with the Short Form -12 item questionnaire (SF-12v1). RESULTS The 2014 and 2015 3-month prevalence of eating disorders were: anorexia nervosa-broad 0.4% (95% CI 0.2-0.7) and 0.5% (0.3-0.9); bulimia nervosa 1.1% (0.7-1.5) and 1.2% (0.9-1.7); ARFID 0.3% (0.1-0.5) and 0.3% (0.2-0.6). The 2015 3-month prevalence rates were: BED-broad 1.5% (1.1-2.0); Other Specified Feeding or Eating Disorder (OSFED) 3.2 (2.6-3.9); and Unspecified Feeding or Eating Disorder (UFED) 10.4% (0.9-11.5). Most people with OSFED had atypical anorexia nervosa and majority with UFED were characterised by having recurrent binge eating without marked distress. Eating disorders were represented throughout sociodemographic groups and those with bulimia nervosa and BED-broad had mean weight (BMI, kg/m2) in the obese range. Mental HRQoL was poor in all eating disorder groups but particularly poor for those with BED-broad and ARFID. Individuals with bulimia nervosa, BED-broad and OSFED-Purging Disorder also had poor physical HRQoL. ARFID and bulimia nervosa groups had lower role performance than those without an eating disorder. CONCLUSIONS Whilst full spectrum eating disorders, including ARFID, were less common than OSFED or UFED, they were associated with poor mental HRQoL and significant functional impairment. The present study supports the movement of eating disorders in to broader socio demographic groups including men, socio-economic disadvantaged groups and those with obesity.
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Affiliation(s)
- Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, NSW Australia
| | | | - David Alejandro González-Chica
- Discipline of General Practice, Adelaide Medical School, NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, The University of Adelaide, Adelaide, SA Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, The University of Adelaide, Adelaide, SA Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW 2006 Australia
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Peckmezian T, Hay P. A systematic review and narrative synthesis of interventions for uncomplicated obesity: weight loss, well-being and impact on eating disorders. J Eat Disord 2017; 5:15. [PMID: 28469914 PMCID: PMC5410702 DOI: 10.1186/s40337-017-0143-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/22/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Most weight loss research focuses on weight as the primary outcome, often to the exclusion of other physiological or psychological measures. This study aims to provide a holistic evaluation of the effects from weight loss interventions for individuals with obesity by examining the physiological, psychological and eating disorders outcomes from these interventions. METHODS Databases Medline, PsycInfo and Cochrane Library (2011-2016) were searched for randomised controlled trials and systematic reviews of obesity treatments (dietary, exercise, behavioural, psychological, pharmacological or surgical). Data extracted included study features, risk of bias, study outcomes, and an assessment of treatment impacts on physical, psychological or eating disorder outcomes. RESULTS From 3628 novel records, 134 studies met all inclusion criteria and were evaluated in this review. Lifestyle interventions had the strongest evidence base as a first-line approach, with escalation to pharmacotherapy and bariatric surgery in more severe or complicated cases. Quality of life was the most common psychological outcome measure, and improved in all cases where it was assessed, across all intervention types. Behavioural, psychological and lifestyle interventions for weight loss led to improvements in cognitive restraint, control over eating and binge eating, while bariatric surgery led to improvements in eating behaviour and body image that were not sustained over the long-term. DISCUSSION Numerous treatment strategies have been trialled to assist people to lose weight and many of these are effective over the short-term. Quality of life, and to a lesser degree depression, anxiety and psychosocial function, often improve alongside weight loss. Weight loss is also associated with improvements in eating disorder psychopathology and related measures, although overall, eating disorder outcomes are rarely assessed. Further research and between-sector collaboration is required to address the significant overlap in risk factors, diagnoses and treatment outcomes between obesity and eating disorders.
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Affiliation(s)
| | - Phillipa Hay
- Foundation Chair of Mental Health and Centre for Health Research, School of Medicine, Western Sydney University, Parramatta, Australia
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Chen EY, Weissman JA, Zeffiro TA, Yiu A, Eneva KT, Arlt JM, Swantek MJ. Family-Based Therapy for Young Adults with Anorexia Nervosa Restores Weight. Int J Eat Disord 2016; 49:701-7. [PMID: 27037965 PMCID: PMC7350506 DOI: 10.1002/eat.22513] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We examined the preliminary acceptability and efficacy of family-based therapy (FBT) for weight restoration in young adults (FBTY) with Anorexia Nervosa (AN). METHOD Twenty-two primarily female participants ranging from age 18 to 26, with AN or atypical AN (ICD-10) and their support adults were enrolled in a 6-month open trial of FBTY. Participants were assessed at baseline, after treatment, and at six and 12 month follow-up visits. The primary outcome was BMI and secondary outcomes included eating disorder psychopathology, current eating disorder obsessions, and compulsions, number of other Axis I disorders and global assessment of functioning. RESULTS Although FBTY was rated as suitable by participants and their support adults, during FBTY, 9/22 participants dropped out and 3/22 dropped out at follow-up assessments. Despite being offered 18-20 sessions over six months, a mean of 12 FBTY sessions (SD = 6) were attended. After FBTY, 15 of the intent-to-treat sample of 22 were no longer underweight (BMIs ≥ 19 kg/m(2) ) and 12 months after treatment, 13/22 were no longer underweight. The magnitude of the BMI increase during FBTY (Hedges g = 1.20, 95th percentile CI = 0.55-1.85) was comparable to findings for adolescent FBT for AN. Secondary outcomes also improved. DISCUSSION FBTY for young adults with AN and atypical AN, which involves support adults participants have chosen, results in weight restoration that is sustained up to a year after treatment. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:701-707).
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Affiliation(s)
- Eunice Y. Chen
- Temple Eating Disorders Program, Department of Psychology, Temple University, Philadelphia, Pennsylvania,Correspondence to: E. Chen,
| | | | | | - Angelina Yiu
- Temple Eating Disorders Program, Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Kalina T. Eneva
- Temple Eating Disorders Program, Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Jean M. Arlt
- Temple Eating Disorders Program, Department of Psychology, Temple University, Philadelphia, Pennsylvania
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Mack I, Cuntz U, Grämer C, Niedermaier S, Pohl C, Schwiertz A, Zimmermann K, Zipfel S, Enck P, Penders J. Weight gain in anorexia nervosa does not ameliorate the faecal microbiota, branched chain fatty acid profiles, and gastrointestinal complaints. Sci Rep 2016; 6:26752. [PMID: 27229737 PMCID: PMC4882621 DOI: 10.1038/srep26752] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/09/2016] [Indexed: 02/07/2023] Open
Abstract
The gut microbiota not only influences host metabolism but can also affect brain function and behaviour through the microbiota-gut-brain axis. To explore the potential role of the intestinal microbiota in anorexia nervosa (AN), we comprehensively investigated the faecal microbiota and short-chain fatty acids in these patients before (n = 55) and after weight gain (n = 44) in comparison to normal-weight participants (NW, n = 55) along with dietary intake and gastrointestinal complaints. We show profound microbial perturbations in AN patients as compared to NW participants, with higher levels of mucin-degraders and members of Clostridium clusters I, XI and XVIII and reduced levels of the butyrate-producing Roseburia spp. Branched-chain fatty acid concentrations, being markers for protein fermentation, were elevated. Distinct perturbations in microbial community compositions were observed for individual restrictive and binge/purging AN-subtypes. Upon weight gain, microbial richness increased, however perturbations in intestinal microbiota and short chain fatty acid profiles in addition to several gastrointestinal symptoms did not recover. These insights provide new leads to modulate the intestinal microbiota in order to improve the outcomes of the standard therapy.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Ulrich Cuntz
- Klinik Roseneck, Center for Behavioral Medicine, Prien, Germany
| | - Claudia Grämer
- Klinik Roseneck, Center for Behavioral Medicine, Prien, Germany
| | | | - Charlotte Pohl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | | | | | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - John Penders
- Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Medical Microbiology, Maastricht, The Netherlands
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Kells M, Schubert-Bob P, Nagle K, Hitchko L, O'Neil K, Forbes P, McCabe M. Meal Supervision During Medical Hospitalization for Eating Disorders. Clin Nurs Res 2016; 26:525-537. [PMID: 26964805 DOI: 10.1177/1054773816637598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The focus of medical hospitalization for restrictive eating disorders is weight gain; however, no guidelines exist on how to achieve successful and safe weight gain. Meal supervision may be a supportive intervention to aid in meal completion and weight gain. The aim of this study was to examine the effect of standardized meal supervision on weight gain, length of stay, vital signs, electrolytes, and use of liquid caloric supplementation in hospitalized adolescents and young adults with restrictive eating disorders. A chart review compared patients who received meal supervision from admission through discharge to an earlier cohort who received meal supervision as needed. There were no differences in weight, electrolytes, or vital signs between the two cohorts. Length of stay for those who received meal supervision from admission was 3 days shorter than earlier cohort. Nursing supervised meals beginning at admission may shorten length of stay and decrease health care costs.
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Affiliation(s)
| | | | | | | | - Kathleen O'Neil
- 1 Boston Children's Hospital, MA, USA.,2 Mid-Pacific Institute, Honolulu, HI, USA
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Brownlow RS, Maguire S, O'Dell A, Dias-da-Costa C, Touyz S, Russell J. Evaluation of an online training program in eating disorders for health professionals in Australia. J Eat Disord 2015; 3:37. [PMID: 26550477 PMCID: PMC4636783 DOI: 10.1186/s40337-015-0078-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/02/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early detection and treatment of eating disorders is instrumental in positive health outcomes for this serious public health concern. As such, workforce development in screening, diagnosis and early treatment of eating disorders is needed. Research has demonstrated both high rates of failure to accurately diagnose and treat cases early and low levels of perceived access to training in eating disorders by health professionals-representing an urgent need for clinician training in this area. However, significant barriers to the access of evidence-based training programs exist, including availability, cost and time, particularly when large geographic distances are involved. Online learning presents a solution to workforce challenges, as it can be delivered anywhere, at a fraction of the cost of traditional training, timing is user controlled, and a growing body of research is demonstrating it as effective as face-to-face training. The Centre for Eating and Dieting Disorders in Australia has developed an Online Training Program In Eating Disorders, to educate health professionals in the nature, identification, assessment and management of eating disorders. The aim of the current study was to evaluate the ability of this online learning course to improve clinician levels of knowledge, skill and confidence to treat eating disorders. As well as its effect on stigmatised beliefs about eating disorders known to effect treatment delivery. METHODS One-hundred-eighty-seven health professionals participated in the program. A pre training questionnaire and a post training evaluation examined participants' levels of knowledge, skill and confidence to treat eating disorders, as well attitudes and beliefs about people with eating disorders. RESULTS Significant improvements in knowledge, skill, and confidence to treat eating disorders was found between pre and post program assessment in health professionals who completed the course, along with a significant decrease in stigmatised beliefs about eating disorders. DISCUSSION The results of this study demonstrated that the online training program was an effective tool in increasing health professionals' level of knowledge, skill and confidence to treat people with eating disorders. The results also demonstrated that online training reduced health professionals' personal bias towards people with eating disorders. Limitations of this study include the use of self-report measures rather than observation of the health professional in clinical practice. As a result, it is not possible to make determinations regarding the translation of these results to clinical settings. CONCLUSIONS The findings of this study suggest that online training programs may present an innovative solution to the considerable workforce development challenges faced by clinicians needing training in eating disorders.
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Affiliation(s)
| | | | - Adrienne O'Dell
- The Centre for Eating and Dieting Disorders, Sydney, NSW Australia
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