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Reilly EE, Gorrell S, Johnson C, Duffy A, Blalock DV, Mehler P, Johnson M, Le Grange D, Rienecke RD. Characterising use of recovery record among a large, transdiagnostic sample of adults with eating disorders across higher levels of care. Euro Eating Disorders Rev 2024; 32:404-416. [PMID: 37997259 PMCID: PMC10994750 DOI: 10.1002/erv.3053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Smartphone applications (i.e., apps) designed to target mental health symptoms have received increasing public and empirical attention, including in eating disorder|eating disorders (EDs) treatment. While some data have begun to characterise app users in non-controlled settings, there is limited information on use of apps in higher levels of care (e.g., partial hospitalisation or residential treatment programs) for EDs. METHOD This study aimed to explore metrics of use while in treatment for a commonly used ED-focused mobile app (Recovery Record) among individuals enroled in intensive outpatient, partial hospitalisation, residential, or inpatient treatments (N = 2042). RESULTS Results indicated that older individuals and participants with binge eating disorder demonstrated more frequent app engagement compared to younger participants and other ED diagnoses, respectively. Individuals entering at intensive outpatient and partial hospitalisation levels of care, as well as those with routine discharges engaged more frequently with RR compared to individuals entering in inpatient or residential treatment, and those with non-routine discharges. CONCLUSIONS Our data provide initial descriptions of how RR may be used within higher levels of care for adults with EDs. Further work is needed to establish the benefit of these apps in clinical settings for EDs over and above standard treatment, better characterise for whom these apps provide benefit, and identify how best to tailor the experience to promote engagement across the full spectrum of ED patients.
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Affiliation(s)
- Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Craig Johnson
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Philip Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Acute Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Madelyn Johnson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago (Emeritus), Chicago, Illinois, USA
| | - Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
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Gorrell S, Sanzari CM, Ziegenhardt PS, Spell J, Johnson MG, Whitlow B, Saigal M. Preventing eating pathology among elite adolescent ballet dancers: a pilot trial of the Athlete Body Project. Eat Disord 2024:1-20. [PMID: 38572849 DOI: 10.1080/10640266.2024.2337525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Adolescent ballet dancers are commonly recognized as aesthetic athletes who are at higher risk for body dissatisfaction, disordered eating, and eating disorders. Although athletic participation can generally protect against negative mental and physical health outcomes, idealization of a body ideal specific to ballet can confer unique vulnerability for eating pathology. Despite this known vulnerability, rigorous efforts to prevent eating pathology among young dancers are lacking. Previously, we reported on a trial of the Female Athlete Body Project adapted for professional female ballet dancers. The current study tested a subsequent adaptation, the Athlete Body Project (ABP), tailored for younger dancers, including a version for boys. This non-randomized, uncontrolled pilot trial tested ABP among boys and girls in two elite ballet schools (N = 23), formatted in-person and via video-conferencing. Program delivery met benchmarks for feasibility and acceptability across gender and delivery formats, and dancers provided positive qualitative feedback. Overall results suggest the potential of ABP in intervening on pre-post eating pathology and body appreciation, and significantly decreasing drive for muscularity among young ballet dancers. Taken together, this pilot work addresses a gap in the field and advances the needed development of eating disorder prevention programming for young, high-risk aesthetic athletes.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | | | - Philippa S Ziegenhardt
- The Australian Ballet School, Melbourne, VIC, Australia
- Private Practice, Mecklenburg-West Pomerania, Germany
| | - Josh Spell
- Private Practice, Seattle, Washington, USA
| | - Madelyn G Johnson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- University at Albany, State University of New York, Albany, New York, USA
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Garber AK, Cheng J, Accurso EC, Buckelew SM, Downey AE, Le Grange D, Gorrell S, Kapphahn CJ, Kreiter A, Moscicki AB, Golden NH. Short-term outcomes of the study of refeeding to optimize inpatient gains for patients with atypical anorexia nervosa. Int J Eat Disord 2024; 57:859-868. [PMID: 38179719 DOI: 10.1002/eat.24115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE The StRONG trial demonstrated the safety and efficacy of higher calorie refeeding (HCR) in hospitalized adolescents and young adults with malnutrition secondary to restrictive eating disorders. Here we compare refeeding outcomes in patients with atypical anorexia nervosa (atypical AN) versus anorexia nervosa (AN) and examine the impact of caloric dose. METHOD Patients were enrolled upon admission and randomized to meal-based HCR, beginning 2000 kcal/day and advancing 200 kcal/day, or lower calorie refeeding (LCR), beginning 1400 kcal/day and advancing 200 kcal every other day. Atypical AN was defined as %median BMI (mBMI) > 85. Independent t-tests compared groups; multivariable linear and logistic regressions examined caloric dose (kcal/kg body weight). RESULTS Among n = 111, mean ± SD age was 16.5 ± 2.5 yrs; 43% had atypical AN. Compared to AN, atypical AN had slower heart rate restoration (8.7 ± 4.0 days vs. 6.5 ± 3.9 days, p = .008, Cohen's d = -.56), less weight gain (3.1 ± 5.9%mBMI vs. 5.4 ± 2.9%mBMI, p < .001, Cohen's d = .51) and greater hypomagnesemia (29% vs. 11%, p = .03, OR = 3.29). These suboptimal outcomes were predicted by insufficient caloric dose (32.4 ± 6.9 kcal/kg in atypical AN vs. 43.4 ± 9.8 kcal/kg in AN, p < .001, Cohen's d = 1.27). For every 10 kcal/kg increase, heart rate was restored 1.7 days (1.0, 2.5) faster (p < .001), weight gain was 1.6%mBMI (.8, 2.4) greater (p < .001), and hypomagnesemia odds were 70% (12, 128) lower (p = .02). DISCUSSION Although HCR is more efficacious than LCR for refeeding in AN, it contributes to underfeeding in atypical AN by providing an insufficient caloric dose relative to the greater body weight in this diagnostic group. PUBLIC SIGNIFICANCE The StRONG trial previously demonstrated the efficacy and safety of higher calorie refeeding in patients with malnutrition due to restrictive eating disorders. Here we show that higher calorie refeeding contributes to underfeeding in patients with atypical anorexia nervosa, including poor weight gain and longer time to restore medical stability. These findings indicate these patients need more calories to support nutritional rehabilitation in hospital.
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Affiliation(s)
- Andrea K Garber
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
| | - Jing Cheng
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Sara M Buckelew
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
| | - Amanda E Downey
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago (Emeritus), Chicago, Illinois, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Cynthia J Kapphahn
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, California, USA
| | - Anna Kreiter
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, California, USA
| | - Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, California, USA
| | - Neville H Golden
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA
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Gorrell S, Shott ME, Pryor T, Frank GKW. Neural Response to Expecting a Caloric Sweet Taste Stimulus Predicts Body Mass Index Longitudinally Among Young Adult Women With Anorexia Nervosa. Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 9:298-304. [PMID: 37506848 PMCID: PMC10811282 DOI: 10.1016/j.bpsc.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/28/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is an often-chronic illness, and we lack biomarkers to predict long-term outcome. Recent neuroimaging studies using caloric taste stimuli suggest that paradigms that have tested conditioned neural responses to expectation or salient stimulus receipt may underpin behaviors. However, whether activation of those neural circuits can predict long-term outcome has not been studied. METHODS We followed women treated for AN (n = 35, mean age [SD] = 23 [7] years) and tested whether functional imaging brain response during a taste conditioning paradigm could predict posttreatment body mass index (BMI). We anticipated greater neural activity relative to caloric stimulus expectation and that dopamine-related receipt conditions would predict lower posttreatment BMI, indicating fear-associated arousal. RESULTS Follow-up occurred at mean (SD) = 1648 (1216) days after imaging. Stimulus expectation in orbitofrontal and striatal regions and BMI and BMI change at follow-up were negatively correlated, and these correlations remained significant for the right superior orbitofrontal cortex and BMI change after multiple comparison correction (r = -0.484, p = .003). This relationship remained significant after including time between brain scanning and follow-up in the model. Reward prediction error response did not predict long-term BMI. CONCLUSIONS The orbitofrontal cortex is involved in learning and conditioning, and these data implicate this region in learned caloric stimulus expectation and long-term prediction of weight outcomes in AN. Thus, conditioned elevated brain response to the anticipation of receiving a caloric stimulus may drive food avoidance, suggesting that breaking such associations is central for long-term recovery from AN.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Megan E Shott
- Department of Psychiatry, University of California, San Diego, San Diego, California
| | | | - Guido K W Frank
- Department of Psychiatry, University of California, San Diego, San Diego, California.
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Lampe EW, Schaumberg K, Kolar D, Coniglio K, Cooper M, Chapa DAN, Gorrell S. Working out measurement overlap in the assessment of maladaptive exercise. Int J Eat Disord 2024; 57:558-567. [PMID: 38221645 PMCID: PMC10947899 DOI: 10.1002/eat.24127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Although exercise is generally considered healthy, many individuals engage in maladaptive exercise (e.g., compulsive in nature). Several definitions of maladaptive exercise exist, leading to multiple, varied assessment tools; assuming homogeneity across these assessments contributes to low consensus in etiological models. METHOD We used a Jaccard Index to quantify content overlap among 15 commonly-used self-report instruments measuring maladaptive exercise, with 31 features identified across 224 items. RESULTS The most common features were exercise to control weight/shape and to avoid negative affect (both included in 9/15 instruments), or compensate for calories consumed (8/15 instruments). Overlap among instruments was low (.206) and no features were common across all instruments. CONCLUSIONS Findings generally support theoretical models of exercise in eating pathology. However, instruments most commonly used to assess maladaptive exercise measure heterogenous content. Careful consideration should be taken when comparing findings derived from differing instruments, when synthesizing literature on maladaptive exercise, and when selecting instruments to measure specific maladaptive exercise features. PUBLIC SIGNIFICANCE Many, varied, tools exist for the assessment of maladaptive exercise (e.g., compulsive or compensatory) in the context of eating disorders. Assuming homogeneity across tools contributes to low consensus in the field. We used a Jaccard Index to quantify content overlap among 15 self-report instruments measuring maladaptive exercise. The most commonly used instruments measure heterogenous content. Careful consideration should be taken when synthesizing literature and selecting instruments to use in research.
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Affiliation(s)
- Elizabeth W. Lampe
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, United States
| | | | - David Kolar
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Kathryn Coniglio
- Department of Psychology, Rutgers University, Rutgers NJ, United States
| | - Marita Cooper
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia PA, United States
| | - Danielle A. N. Chapa
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, United States
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco CA, United States
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Conn K, Huang K, Gorrell S, Foldi CJ. A transdiagnostic and translational framework for delineating the neuronal mechanisms of compulsive exercise in anorexia nervosa. Int J Eat Disord 2024. [PMID: 38174745 DOI: 10.1002/eat.24130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE The development of novel treatments for anorexia nervosa (AN) requires a detailed understanding of the biological underpinnings of specific, commonly occurring symptoms, including compulsive exercise. There is considerable bio-behavioral overlap between AN and obsessive-compulsive disorder (OCD), therefore it is plausible that similar mechanisms underlie compulsive behavior in both populations. While the association between these conditions is widely acknowledged, defining the shared mechanisms for compulsive behavior in AN and OCD requires a novel approach. METHODS We present an argument that a better understanding of the neurobiological mechanisms that underpin compulsive exercise in AN can be achieved in two critical ways. First, by applying a framework of the neuronal control of OCD to exercise behavior in AN, and second, by taking better advantage of the activity-based anorexia (ABA) rodent model to directly test this framework in the context of feeding pathology. RESULTS A cross-disciplinary approach that spans preclinical, neuroimaging, and clinical research as well as compulsive neurocircuitry and behavior can advance our understanding of when, why, and how compulsive exercise develops in the context of AN and provide targets for novel treatment strategies. DISCUSSION In this article, we (i) link the expression of compulsive behavior in AN and OCD via a transition between goal-directed and habitual behavior, (ii) present disrupted cortico-striatal circuitry as a key substrate for the development of compulsive behavior in both conditions, and (iii) highlight the utility of the ABA rodent model to better understand the mechanisms of compulsive behavior relevant to AN. PUBLIC SIGNIFICANCE Individuals with AN who exercise compulsively are at risk of worse health outcomes and have poorer responses to standard treatments. However, when, why, and how compulsive exercise develops in AN remains inadequately understood. Identifying whether the neural circuitry underlying compulsive behavior in OCD also controls hyperactivity in the activity-based anorexia model will aid in the development of novel eating disorder treatment strategies for this high-risk population.
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Affiliation(s)
- K Conn
- Department of Physiology, Monash University, Clayton, Australia
- Monash Biomedicine Discovery Institute, Clayton, Australia
| | - K Huang
- Department of Physiology, Monash University, Clayton, Australia
- Monash Biomedicine Discovery Institute, Clayton, Australia
| | - S Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - C J Foldi
- Department of Physiology, Monash University, Clayton, Australia
- Monash Biomedicine Discovery Institute, Clayton, Australia
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Gorrell S, Vendlinski SS, Thompson AS, Downey AE, Kramer R, Hail L, Clifton S, Forsberg S, Reilly EE, Saunders E, Buckelew SM, Le Grange D. Modification of an inpatient medical management protocol for pediatric Avoidant/Restrictive Food Intake Disorder: improving the standard of care. J Eat Disord 2023; 11:165. [PMID: 37737186 PMCID: PMC10514937 DOI: 10.1186/s40337-023-00895-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/16/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND No guidelines currently exist that represent a standardization of care for Avoidant/Restrictive Food Intake Disorder (ARFID) on an inpatient service. Unique features of this diagnosis (e.g., sensory sensitivity contributing to involuntary emesis) suggest that established protocols that were developed for anorexia nervosa might be less effective for adolescents with ARFID. To inform improved inpatient medical stabilization and care for these patients, we first provide an overview of clinical characteristics for patients with ARFID who presented to a pediatric hospital for inpatient eating disorder care. We use these descriptives to outline the rationale for, and executions of, modifications to an inpatient protocol designed to flexibly meet the needs of this clinical population. METHODS Chart review with descriptive statistics were conducted for patients who had received an ARFID diagnosis from March 2019 to March 2023 (N = 32, aged 9-23). We then present a case series (n = 3) of adolescents who either transitioned to a novel adjusted protocol from an original standard of care on the inpatient service, or who received only the standard protocol. RESULTS The sample was aged M(SD) = 15.6 (3.3) years, 53% male, and a majority (69%) presented with the ARFID presentation specific to fear of negative consequences. On average, patients had deviated from their growth curve for just over two years and presented with mean 76% of their estimated body weight. Of those requiring nasogastric tube insertion during admission (n = 8, 25%), average duration of tube placement was 15 days. From within this sample, case series data suggest that the adjusted protocol will continue to have a positive impact on care trajectory among adolescents admitted for ARFID including improved weight gain, reduction of emesis, and improved food intake. CONCLUSIONS Findings demonstrate the likely need to tailor established medical inpatient protocols for those with ARFID given different symptom presentation and maintenance factors compared to patients with anorexia nervosa. Further research is warranted to explore the longer-term impact of protocol changes and to inform standardization of care for this high priority clinical population across care sites.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, USA.
| | - Siena S Vendlinski
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Arianna S Thompson
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Amanda E Downey
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Rachel Kramer
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, USA
| | - Lisa Hail
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, USA
| | - Sharon Clifton
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, USA
| | - Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, USA
| | - Elizabeth Saunders
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Sara M Buckelew
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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Gorrell S, Downey AE, Saunders E, Accurso EC, Buckalew S, Kreiter A, Grange DL, Garber AK. Parental self-efficacy: Longitudinal impact on clinical outcomes across levels of care in adolescent anorexia nervosa. Int J Eat Disord 2023; 56:1764-1771. [PMID: 37272755 PMCID: PMC10524863 DOI: 10.1002/eat.24007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Parental self-efficacy in the domain of weight restoration for adolescents with restrictive eating disorders is central to success in family-based interventions. We sought to characterize this parental self-efficacy during a brief hospitalization for medical stabilization and follow-up among patients with anorexia nervosa (AN) or atypical AN (AAN) enrolled in the StRONG clinical trial to understand the potential impact of inpatient treatment on caregiver empowerment. METHODS Patients were enrolled upon hospital admission and refed per protocol. We examined correlates of the Parents Versus Anorexia (PVA) scale, a measure of parental self-efficacy in the domain of weight restoration, at admission, discharge, 10-days, 1-month, and 3-months post-discharge. Multi-level models evaluated associations among PVA scores and change in %median BMI and Eating Disorder Examination-Questionnaire (EDE-Q) global scores over 3-months post-discharge. RESULTS Parents of N = 67 adolescents and young adults M(SD) age 15.79 (2.20) years and 85.00 (11.86) %median BMI participated. PVA scores did not change significantly during hospitalization (p = .053), which lasted on average 10.7 ± 4.5 days. PVA scores increased post-discharge (p = .009), with significant increase between discharge and 1-month post-discharge (p = .045). PVA scores were not associated with subsequent clinical outcomes. Rather, a main effect of time significantly predicted higher %median BMI and improved EDE-Q scores (p < .001). DISCUSSION The finding that parental self-efficacy did not deteriorate during the inpatient stay is promising given the medical necessity of hospitalization to ensure short-term safety in some cases and the importance of parental self-efficacy to support long-term recovery. PUBLIC SIGNIFICANCE Family-based treatment is the recommended treatment for young people with AN and AAN, serious psychiatric illnesses that may require inpatient medical stabilization. Prior evidence suggests that parental self-efficacy in the outpatient setting is a key component of treatment success. The current study suggests that parental self-efficacy and longer-term treatment outcomes are not undermined by a brief inpatient hospitalization.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Amanda E. Downey
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth Saunders
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sara Buckalew
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA (Emeritus)
| | - Andrea K. Garber
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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Kramer R, Radin R, Forsberg S, Garber AK, Reilly EE, Hail L, Huryk KM, Keyser J, Bruett LD, Le Grange D, Gorrell S, Accurso EC. An exploration of the association between premorbid weight status on patient and caregiver factors at pre and post-treatment among youth with anorexia nervosa/atypical anorexia nervosa. Eat Behav 2023; 50:101786. [PMID: 37542754 PMCID: PMC10481430 DOI: 10.1016/j.eatbeh.2023.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/03/2023] [Accepted: 07/21/2023] [Indexed: 08/07/2023]
Abstract
Patients with atypical anorexia nervosa (AAN) or anorexia nervosa (AN) with premorbid history of higher weight (PHW; median BMI ≥ 85th %ile) may report greater eating disorder (ED) pathology, anxiety, and depression, than patients with premorbid history of lower weight (PLW; mBMI <85th %ile). Less is known about caregiver attitudes or treatment outcome related to premorbid weight history. The current study examined associations between premorbid weight history and patient/caregiver factors at presentation, during treatment, and end of treatment among adolescents (N = 138) diagnosed with AN/AAN and their caregivers who received interdisciplinary ED treatment. The sample comprised adolescents with PHW (n = 58, 40.6 %) or PLW (n = 82, 59.4 %). Adolescents with PHW did not differ with regard to patient- or caregiver-reported ED symptoms, comorbid psychopathology, rates of treatment completion, and attainment of estimated body weight compared to PLW (ps > .05). Adolescents with PHW (vs. PLW) were more likely to be diagnosed with AAN (67.9 %, p < .001), identify as cisgender male (p < .001) and to have lost more weight prior to presentation (p < .001). Perceived caregiver burden was lower among adolescents with PHW vs. PLW (p < .001). Further research should expand on this preliminary study exploring associations between premorbid weight history on patient and caregiver factors at treatment presentation and conclusion to enhance the efficacy of evidence-based treatment across the weight-spectrum.
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Affiliation(s)
- Rachel Kramer
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Rachel Radin
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Andrea K Garber
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa Hail
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kathryn M Huryk
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica Keyser
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lindsey D Bruett
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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Gorrell S, Grange DL. How best to support parents of children with an eating disorder: A commentary on Wilksch (2023). Int J Eat Disord 2023; 56:1286-1288. [PMID: 37184424 PMCID: PMC10759187 DOI: 10.1002/eat.23992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
Wilksch (2023) uses survey data to characterize the perspective of caregivers of children who have undergone treatment for an eating disorder. With this framework, the author presents an evocative view of both the challenges these parents experience in acquiring needed specialty treatment, as well as the negative impact that the caregiving role may have on their own well-being. Altogether, this Forum underscores the unquestionable importance of not overlooking the practical and emotional needs of caregivers of youth with eating disorders, and presents a compelling call to action for our field to better support parents who navigate treatment for these challenging illnesses.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA (Emeritus)
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11
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Lampe EW, Gorrell S, Smith K, Payne-Reichert AM, Juarascio AS, Manasse SM. Divergent trajectories of positive affect following maladaptive and non-maladaptive exercise among individuals with binge-spectrum eating disorders. Int J Eat Disord 2023; 56:1001-1010. [PMID: 36719039 PMCID: PMC10286557 DOI: 10.1002/eat.23901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Individuals with eating disorders (EDs) often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating) which maintains eating pathology. Maladaptive exercise has been theorized to help individuals with EDs regulate emotions by enhancing positive affect (PA) and reducing negative affect (NA) associated with binge episodes and poor body image. However, no research has considered the presence of non-maladaptive exercise or evaluated this theory in binge-spectrum EDs. METHODS This study evaluated affective trajectories pre- and post-exercise and examined exercise type (maladaptive or non-maladaptive) as a moderator. We recruited adults with binge-spectrum EDs (N = 107; n = 84 endorsed exercise) to complete a 7- to 14-day ecological momentary assessment protocol assessing NA (anxiety, guilt, and sadness), PA (excitement and cheerfulness), and exercise. RESULTS There was a significant quadratic trajectory of PA pre-exercise, suggesting that the upward trajectory of PA leveled out as it moved closer to an exercise episode. Exercise type significantly moderated the cubic trajectory of PA post-exercise, such that the upward trajectory of PA accelerated in the hours following non-maladaptive exercise episodes while the downward trajectory of PA accelerated in the hours following maladaptive exercise episodes. No trajectories of NA demonstrated significant effects. CONCLUSIONS Pre-exercise trajectories of PA may reflect positive expectancies around exercise. Post-exercise trajectories of PA suggest that non-maladaptive exercise promotes increased PA. Future research should evaluate when, and for whom, exercise serves to regulate affect and examine other momentary risk factors of exercise in EDs. PUBLIC SIGNIFICANCE Individuals with EDs often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating). Maladaptive exercise has been theorized to help individuals with EDs regulate emotions. This study evaluated affective trajectories pre- and post-exercise and examined whether exercise type (maladaptive or non-maladaptive) changed these trajectories. Pre-exercise trajectories of PA may reflect positive expectancies around exercise. Post-exercise trajectories of PA suggest that non-maladaptive exercise promotes increased PA.
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Affiliation(s)
- Elizabeth W. Lampe
- Department of Psychology, Drexel University, Philadelphia, PA, United States
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, United States
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kathryn Smith
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar St, #2200 Los Angeles, CA 90033
| | - Adam M. Payne-Reichert
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, United States
| | - Adrienne S. Juarascio
- Department of Psychology, Drexel University, Philadelphia, PA, United States
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, United States
| | - Stephanie M. Manasse
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, United States
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Abstract
PURPOSE OF REVIEW With the current review, we provide a brief summary of recent literature that tests clinically observable characteristics at baseline that may impact treatment response, across eating disorder diagnoses. We then provide a critical discussion regarding how researchers may shift their approach to this research to improve treatment implications and generalizability of these findings. RECENT FINDINGS Recent work has broadly replicated prior findings suggesting a negative impact of lower weight status, poor emotion regulation, and early-life trauma on eating disorder treatment outcomes. Findings are more mixed for the relative contributions of illness duration, psychiatric comorbidity, and baseline symptom severity. Recent studies have begun to explore more specific domains of previously tested predictors (e.g., specific comorbidities) as well as previously neglected identity-related and systemic factors. However, recent research continues to use similar sampling techniques and approaches to analysis used in prior work. We propose that resolving remaining questions and illuminating predictors of treatment outcome in eating disorders requires a new approach to research sampling and study design. Suggested changes that can be applied within a traditional clinical trial framework may yield new insights with relevance across transdiagnostic eating disorder presentations.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18Th St, CA, 94143, San Francisco, USA.
| | - Lisa Hail
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18Th St, CA, 94143, San Francisco, USA
| | - Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18Th St, CA, 94143, San Francisco, USA
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13
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Gorrell S, Cohen S, Schaumberg K, Anderson LM, Reilly EE. Open Science in eating disorders: Using current evidence to inspire a plan for increasing the transparency of our research. Int J Eat Disord 2023; 56:925-932. [PMID: 36609851 PMCID: PMC10159898 DOI: 10.1002/eat.23893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE There is increasing consensus that open science practices improve the transparency and quality of clinical science. However, several barriers impede the implementation of these practices at the individual, institutional, and field levels; understanding and addressing these barriers is critical to promoting targeted efforts in increasing effective uptake of open science. METHODS Within this research forum, we drew from publicly available online information sources to identify initial characterizations of researchers engaged in several types of open science practices in the field of eating disorders. We use these observations to discuss potential barriers and recommendations for next steps in the promotion of these practices. RESULTS Data from online open science repositories suggest that individuals using these publishing approaches with pre-prints and articles with eating-disorder-relevant content are predominantly non-male gender identifying, early to mid-career stage, and are more likely to be European-, United States-, or Canada-based. DISCUSSION We outline recommendations for tangible ways that the eating disorder field can support broad, increased uptake of open science practices, including supporting initiatives to increase knowledge and correct misconceptions; and prioritizing the development and accessibility of open science resources. PUBLIC SIGNIFICANCE STATEMENT The use of open science practices has the potential to increase the transparency and quality of clinical science. This Forum uses publicly sourced online data to characterize researchers engaged in open science practices in the field of eating disorders. These observations provide an important framework from which to discuss potential barriers to open science and recommendations for next steps in the promotion of these practices.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Shira Cohen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Lisa Marie Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Erin E. Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
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14
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Egbert AH, Gorrell S, Smith KE, Goldschmidt AB, Hughes EK, Sawyer SM, Yeo M, Lock J, Le Grange D. When eating disorder attitudes and cognitions persist after weight restoration: An exploratory examination of non-cognitive responders to family-based treatment for adolescent anorexia nervosa. Eur Eat Disord Rev 2023; 31:425-432. [PMID: 36715459 PMCID: PMC10116695 DOI: 10.1002/erv.2968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/18/2022] [Accepted: 01/07/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Family-based treatment (FBT) is a well-established intervention for adolescent anorexia nervosa (AN). Although FBT is efficacious in promoting weight gain and improvements in psychological symptoms, for some adolescents, cognitive/attitudinal recovery lags behind weight gain. This study conducted an exploratory post hoc analysis of outcomes of adolescents who achieved weight gain by the end of FBT but continued to experience elevated psychological symptoms post-treatment. METHODS Data were drawn from two randomised controlled trials (RCTs) testing two forms of FBT (conjoint/whole family and parent-focussed). Descriptive statistics and generalised estimating equations were used to examine differences in treatment outcomes between non-cognitive responders (NCRs) (those who regained weight but continued to experience psychological symptoms) and full responders (FRs) (those who achieved both weight and cognitive restoration by the end of treatment) (n = 80; 83.7% female, Agemean [SD] = 14.66 [1.73]). RESULTS By 12 months post-treatment, there were no differences in weight between NCRs and FRs. However, NCRs had a slower trajectory of weight gain than FRs and continued to have elevated levels of psychological symptoms throughout the follow-up period. CONCLUSIONS A subset of adolescents appear to continue to experience clinically significant levels of eating pathology up to 12 months after FBT even when weight restoration is achieved.
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Affiliation(s)
- Amy H Egbert
- Department of Psychological Sciences, The University of Connecticut, Storrs, Connecticut, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Andrea B Goldschmidt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elizabeth K Hughes
- Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michelle Yeo
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience (Emeritus), The University of Chicago, Chicago, Illinois, USA
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15
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Gorrell S, Hughes EK, Patton GC, Sawyer SM, Le Grange D, Kerr JA. Weight status and weight-control exercise in adolescents: A longitudinal population-based study. Eat Behav 2023; 49:101725. [PMID: 37075647 PMCID: PMC10760941 DOI: 10.1016/j.eatbeh.2023.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Exercise is a transdiagnostic clinical feature of eating disorders, but consensus is lacking as to what constitutes, and gives rise to, excessive exercise motivated by weight control. Using a longitudinal cohort study, we aimed to describe population-level prevalence rates of varying levels of weight-control exercise and examine gender and weight status (overweight or obesity; OVOB) as cross-sectional determinants of weight-control exercise in 14-15-year-old adolescents. We then evaluated the association of OVOB at 10-11 years with weight-control exercise at 14-15 years. METHODS The sample comprised 6329 adolescents from the Longitudinal Study of Australian Children (LSAC). Weight and height were measured in early adolescence (aged 10-11) and in mid-adolescence (aged 14-15). Participants reported weight-control exercise using the Branched Eating Disorders Test at 14-15 years. RESULTS In mid-adolescence, the estimated population prevalence for any weight-control exercise was 49 % (55 % in females). For girls, moderate levels of exercise were most prevalent, and low levels for boys. For all levels except for the very lowest, boys with (vs. without) OVOB history (10-11 years) had about twice the odds of endorsing every level of weight-control exercise. Patterns among girls were similar, though lower in magnitude (∼1.5 times). CONCLUSIONS For both girls and boys, across most exercise levels, rates of weight-control exercise were greatest for those with OVOB; for the highest exercise level, effects were strongest for boys with OVOB. To accurately identify at-risk adolescents, our results provide preliminary support for a fluid definition of excessive weight-control exercise, dependent on gender and weight status.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Elizabeth K Hughes
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - George C Patton
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Centre for Adolescent Health & Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Centre for Adolescent Health & Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Jessica A Kerr
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Department of Psychological Medicine, University of Otago Christchurch, New Zealand
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16
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Sanzari CM, Gorrell S, Anderson LM, Reilly EE, Niemiec MA, Orloff NC, Anderson DA, Hormes JM. The impact of social media use on body image and disordered eating behaviors: Content matters more than duration of exposure. Eat Behav 2023; 49:101722. [PMID: 37060807 PMCID: PMC10363994 DOI: 10.1016/j.eatbeh.2023.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/31/2023] [Accepted: 03/29/2023] [Indexed: 04/17/2023]
Abstract
Social media use is rapidly expanding in terms of frequency, duration, and the diversity of platforms available. Given evidence for associations between social media use, body image disturbances, and disordered eating it is important to identify potentially harmful aspects of social media use that could serve as intervention targets. This study surveyed two demographically diverse undergraduate student cohorts in 2015 and 2022 to compare patterns in social media use, body image, and disordered eating behaviors between samples, including as a function of the COVID-19 pandemic, and to test the hypothesized moderating role of specific content consumed in the association between social media use and maladaptive outcomes. Participants in 2022 reported greater body image disturbances, more frequent vomiting and laxative use, and more time spent on a greater number of social media accounts, with significantly greater use of image-based platforms such as Snapchat, TikTok, and YouTube. Moderated regression analyses suggest that type of content consumed, but not the amount of time spent on social media or diversity of platforms utilized, is associated with body image disturbances and disordered eating behaviors after controlling for gender and body mass index. Specifically, exposure to weight loss content was associated with lower body appreciation, greater fears of negative appearance evaluation, and more frequent binge eating. Contrary to initial hypotheses, exposure to body positivity/neutrality content did not have protective effects. Findings suggest that interventions targeting negative consequences of social media use should focus on addressing content consumed, rather than time spent on social media platforms.
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Affiliation(s)
- Christina M Sanzari
- Department of Psychology, University at Albany, State University of New York, USA.
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, USA
| | - Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Drew A Anderson
- Department of Psychology, University at Albany, State University of New York, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, State University of New York, USA
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17
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Rienecke RD, Gorrell S, Johnson M, Duffy A, Mehler PS, Le Grange D. Expressed emotion and treatment outcome in higher levels of care for eating disorders. Int J Eat Disord 2023; 56:628-636. [PMID: 36584076 PMCID: PMC9992295 DOI: 10.1002/eat.23890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Expressed emotion (EE) among caregivers toward the affected offspring is a negative prognostic indicator for adolescent patients with eating disorders (EDs) in outpatient treatment. Less research has examined its impact on adolescents in higher levels of care (HLOC). The current study examined differences in caregiver EE according to the subtype of anorexia nervosa (AN) (restricting [AN-R] versus binge/purge [AN-BP]), and level of care (LOC). We also examined the main effects of baseline caregiver EE (emotional overinvolvement [EOI] or criticism), AN subtype, and their interaction on eating pathology and depression at discharge. METHOD Adolescent patients (N = 203) receiving treatment at HLOCs completed measures of ED pathology (Eating Disorder Examination-Questionnaire) and depression (Patient Health Questionnaire-9) at baseline and discharge, and one caregiver of each patient completed a measure of EE (Family Questionnaire) at baseline. RESULTS No differences in caregiver EE were found between patients with AN-R versus AN-BP, or relative to LOC. Caregiver EE did not predict outcome for ED symptoms or depression at discharge. DISCUSSION The impact of high caregiver EE may be less substantial at HLOCs than outpatient care given that caregivers are less involved in treatment at HLOCs. Future research is needed to determine if high caregiver EOI leads to poor treatment outcome for adolescents as it does for adults, or whether it is an appropriate expression of care for patients who are ill enough to require HLOC treatment. PUBLIC SIGNIFICANCE STATEMENT High caregiver EE was not found to predict treatment outcome for adolescents with eating disorders in higher levels of care (HLOCs), possibly due to the limited involvement of caregivers in HLOCs. However, patients step down to outpatient treatment, where high caregiver EE can have a significant negative impact on outcome. HLOCs should incorporate efforts to reduce high caregiver EE in anticipation of step-down to outpatient treatment.
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Affiliation(s)
- Renee D. Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Madelyn Johnson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Philip S. Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
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18
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Datta N, Hagan K, Bohon C, Stern M, Kim B, Matheson BE, Gorrell S, Le Grange D, Lock JD. Predictors of family-based treatment for adolescent eating disorders: Do family or diagnostic factors matter? Int J Eat Disord 2023; 56:384-393. [PMID: 36454189 PMCID: PMC9898138 DOI: 10.1002/eat.23867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Misconceptions around which patients will and will not benefit from family-based treatment (FBT) for adolescent eating disorders (EDs) limit referrals and access to this treatment modality. The present study explored whether common demographic and clinical factors that may prevent referral to FBT predict treatment outcomes in adolescent anorexia nervosa (AN) and bulimia nervosa (BN). METHOD The following predictors of treatment outcomes were assessed: baseline family and diagnostic factors (socioeconomic status, comorbidity, illness duration, parent feelings of self-efficacy, family status, prior treatment, sex and prior hospitalizations) in a combined sample of adolescents receiving FBT compared to those randomized to other treatment conditions, across six clinical trials in the United States and Canada (total n = 724, ages 12-18, 90% female across both diagnoses). AN and BN samples were examined separately. RESULTS Any prior ED treatment emerged as the only predictor of outcome in AN and BN, such that having no prior treatment predicted better outcomes in FBT for AN, and in both FBT and other treatment modalities for BN. No other sociodemographic or clinical variables predicted outcomes for AN or BN in FBT or in other evidence-based treatment modalities. CONCLUSIONS The findings of this exploratory analysis suggest that commonly assumed factors do not predict outcome in FBT. Specifically socioeconomic and demographic factors or clinical variability in families seeking treatment do not predict treatment outcomes in FBT, or other evidence-based treatment modalities, with the exception of prior treatment. Providers should consider referring to FBT even when these factors are present. PUBLIC SIGNIFICANCE This manuscript reports that commonly assumed family, sociodemographic and diagnostic factors do not predict outcome in FBT or other evidence-based treatment modalities, with the exception of prior treatment. This data may be helpful for providers when considering referrals to FBT in the context of variability in these variables.
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Affiliation(s)
- Nandini Datta
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford CA, 94305
| | - Kelsey Hagan
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford CA, 94305
- Equip Health, Inc., Carlsbad, CA
| | - May Stern
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford CA, 94305
| | - Bohye Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford CA, 94305
| | - Brittany E. Matheson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford CA, 94305
| | - Sasha Gorrell
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Daniel Le Grange
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL (Emeritus)
| | - James D. Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford CA, 94305
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19
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Hagan KE, Matheson BE, Datta N, L’Insalata AM, Onipede ZA, Gorrell S, Mondal S, Bohon CM, Grange DL, Lock JD. Understanding outcomes in family-based treatment for adolescent anorexia nervosa: a network approach. Psychol Med 2023; 53:396-407. [PMID: 33952357 PMCID: PMC8820974 DOI: 10.1017/s0033291721001604] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes. METHODS Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT (N = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their child's recovery from AN were identified in a subset of participants (n = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms). RESULTS The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission. CONCLUSIONS Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.
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Affiliation(s)
- Kelsey E. Hagan
- Stanford University School of Medicine, Division, Stanford, CA, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Nandini Datta
- Stanford University School of Medicine, Division, Stanford, CA, USA
| | | | | | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences and UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Sangeeta Mondal
- Stanford University School of Medicine, Division, Stanford, CA, USA
| | - Cara M. Bohon
- Stanford University School of Medicine, Division, Stanford, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences and UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - James D. Lock
- Stanford University School of Medicine, Division, Stanford, CA, USA
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Gorrell S, Le Grange D, Blalock DV, Hutchinson V, Johnson M, Duffy A, Mehler PS, Johnson C, Manwaring J, McClanahan S, Rienecke RD. Care utilization in eating disorders: for whom are multiple episodes of care more likely? Eat Weight Disord 2022; 27:3543-3551. [PMID: 36260274 PMCID: PMC9851811 DOI: 10.1007/s40519-022-01491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The current study aimed to determine baseline clinical features among adults receiving varied levels of care for transdiagnostic eating disorders (N = 5206, 89.9% female, mean age 29 years old) that may be associated with increased care utilization. METHODS We used negative binomial regression models to evaluate associations among eating disorder diagnoses, other psychiatric features (e.g., lifetime history of comorbid disorders), and the number of episodes of care for treatment of the eating disorder. RESULTS Having a diagnosis of binge eating disorder (p < .001) or avoidant restrictive food intake disorder (p = .04) were associated with lower odds of readmissions. A lifetime diagnosis of major depressive disorder (p < .001) or self-injury (p < .001) was each associated with significantly higher odds of readmissions. CONCLUSIONS Care utilization may differ according to eating disorder diagnosis, with a likelihood of increased readmission for those with a history of mood disorder or self-injury. Identification of individuals with greater vulnerability for eating disorder care utilization holds potential in aiding treatment and discharge planning, and development. LEVEL OF EVIDENCE Level III: evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, USA.
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Madelyn Johnson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Seattle, USA
| | - Philip S Mehler
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Seattle, USA
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Denver, CO, USA
| | - Craig Johnson
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Seattle, USA
| | - Jamie Manwaring
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Seattle, USA
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA
| | - Susan McClanahan
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Seattle, USA
| | - Renee D Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
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21
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Gorrell S, Rienecke RD, Duffy A, Huston E, Mehler PS, Johnson C, Manwaring J, McClanahan S, Blalock DV, Le Grange D. Understanding non-routine discharge: Factors that are associated with premature termination from higher levels of care in adults with anorexia nervosa. Eat Disord 2022; 30:686-699. [PMID: 35175902 PMCID: PMC9869711 DOI: 10.1080/10640266.2021.2011648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study sought to replicate and extend associations between clinical and demographic features at admission and types of premature treatment termination for adults diagnosed with anorexia nervosa (AN) in higher-level-of-care settings. Secondary data analyses examined a study population comprised of adults with AN (N = 565) who were admitted to one of two United States eating disorder treatment centers (April 2015-April 2020) for intensive outpatient, partial hospitalization, residential, or inpatient services. There were no significant differences in the type of non-routine discharge according to level of care. At admission, those with lower BMI were more likely to discharge against medical advice, and those with lower cognitive restraint and elevated binge eating were more likely to discharge against medical advice or by staff-initiated request, respectively. Discharge by parent/patient request was more likely among those who were older or who reported lower baseline desire for muscularity. Overall older age, elevated binge eating, and lower weight, desire for muscularity, and cognitive restraint may be associated with less tolerance/acceptability for AN treatment. Increased understanding of how to better support patients who admit to higher levels of care with these clinical features will contribute to better odds of completion of a full course of treatment.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Emma Huston
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychology and Counseling, Palo Alto University, PGSP - Stanford PsyD Consortium, Palo Alto, California, USA
| | - Philip S Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Acute Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Craig Johnson
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Jamie Manwaring
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Susan McClanahan
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago (Emeritus), Chicago, Illinois, USA
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22
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Reilly EE, Gorrell S, Brosof L, Lock J, Le Grange D. Characterizing changes in obsessive-compulsive symptoms over the course of treatment for adolescent bulimia nervosa. Int J Eat Disord 2022; 55:1342-1351. [PMID: 35861249 PMCID: PMC9869712 DOI: 10.1002/eat.23782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Data suggest that obsessive-compulsive (OC) symptoms are commonly observed in adolescents with eating disorders and predict poorer treatment response. Further, emerging data among adults suggest that changes in OC symptoms relate to changes in eating disorder symptoms across treatment. Given evidence that early invention decreases risk for protracted illness, evaluating processes that may relate to treatment response will be useful in increasing the effectiveness of existing interventions. Therefore, the current investigation explored changes in general and eating disorder-specific OC symptoms throughout family-based treatment (FBT) and cognitive behavioral therapy (CBT) for bulimia nervosa (BN), as well as associations among these changes and eating disorder outcomes at follow-up. METHOD Participants (N = 110) received 18 sessions of FBT or CBT and completed measurements of general and eating disorder-specific OC symptoms at baseline, end-of-treatment, and 6- and 12-month follow-up. RESULTS Multilevel models indicated that across both treatments, there was no change in general OC symptoms, whereas all eating disorder-related OC symptoms decreased over treatment and follow-up. Exploratory analyses indicated that lower severity in discharge eating-disorder-specific OC symptoms contributed to lower eating pathology at follow-up. DISCUSSION Together, findings support the efficacy of both FBT and CBT in helping to reduce eating disorder-specific OC symptoms and suggest that adjunctive intervention may be required for ameliorating general OC symptoms in this population. PUBLIC SIGNIFICANCE BN is associated with significant increases in mortality and societal cost, and there is a pressing need for innovations within available treatments for young people with this disorder. In the current study, we explore the extent to which existing evidence-based treatments for adolescent BN are effective in targeting obsessive-compulsive symptoms, a known predictor of treatment response and common co-morbidity in this population.
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Affiliation(s)
- Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Leigh Brosof
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois (Emeritus), USA
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23
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Gorrell S, Byrne CE, Trojanowski PJ, Fischer S, Le Grange D. A scoping review of non-specific predictors, moderators, and mediators of family-based treatment for adolescent anorexia and bulimia nervosa: a summary of the current research findings. Eat Weight Disord 2022; 27:1971-1990. [PMID: 35092554 PMCID: PMC9872820 DOI: 10.1007/s40519-022-01367-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/13/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE This scoping review presents an up-to-date synthesis of the current evidence base for non-specific predictors, moderators, and mediators of family-based treatment (FBT) for adolescent anorexia and bulimia nervosa. METHODS We identify ways in which end-of-treatment outcomes have been shown to differ based upon baseline clinical features and person-specific factors and explore psychological mechanisms that may explain differences in treatment response. We draw from this evidence base to outline recommendations for clinical practice, as well as directions for future clinical eating disorder research. RESULTS Noted findings from review include that early response in weight gain and parental criticism may be particularly influential in treatment for anorexia nervosa. Further, for adolescents with either anorexia or bulimia nervosa, eating-related obsessionality may be a key intervention target to improve outcomes. CONCLUSION In addition to highlighting a need for attention to specific patient- and caregiver-level factors that impact treatment response, recommendations for research and clinical practice include testing whether certain targeted treatments (e.g., exposure-based approaches) may be suitable within the context of FBT for eating disorders. LEVEL OF EVIDENCE Level I: Evidence obtained from: at least one properly designed randomized controlled trials; experimental studies.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | | | | | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, IL, USA
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24
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Bruett LD, Forsberg S, Accurso EC, Gorrell S, Hail L, Keyser J, Le Grange D, Huryk KM. Development of evidence-informed bridge programming to support an increased need for eating disorder services during the COVID-19 pandemic. J Eat Disord 2022; 10:71. [PMID: 35596216 PMCID: PMC9120343 DOI: 10.1186/s40337-022-00590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
Over the course of the COVID-19 pandemic, rates of eating disorders have increased, further straining systems of care that were already overburdened. The current paper describes novel interventions, largely informed by Family-Based Treatment (FBT), that were implemented by a tertiary specialist adolescent eating disorders service. In response to the pandemic, programming was designed to bridge access to care while waiting for availability of evidence-based therapy. The Brief Psychology Consultation Clinic provides several sessions to patients and families, focused on psychoeducation and problem-solving informed by FBT and other evidence-based therapies. Two groups, the FBT Caregiver Workshop Series and FBT Caregiver Support Group, provide psychoeducation and support for caregivers of youth with eating disorders. Perceived strengths and benefits of these services, as well as barriers to implementation and future research directions are discussed.
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Affiliation(s)
- Lindsey D Bruett
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA.
| | - Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Lisa Hail
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Jessica Keyser
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Kathryn M Huryk
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
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25
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Gorrell S, Shott ME, Frank GK. Associations between aerobic exercise and dopamine-related reward-processing: Informing a model of human exercise engagement. Biol Psychol 2022; 171:108350. [PMID: 35561818 PMCID: PMC9869713 DOI: 10.1016/j.biopsycho.2022.108350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/22/2022] [Accepted: 05/06/2022] [Indexed: 01/26/2023]
Abstract
Endurance or aerobic exercise has many physical and mental health benefits, but less is known about the specific impact that cardiovascular activity may have on dopamine-associated brain circuits involved in reward processing and mood regulation in humans. Understanding such effects will help to explain individual differences in both exercise uptake and maintenance. This study evaluated neural response to a classical taste-conditioning reward prediction error task with the use of functional magnetic resonance imaging, along with data on self-reported aerobic exercise among healthy young adult females (N = 111). Results indicated positive associations between reported aerobic exercise and regional brain response that remained significant after multiple comparison correction for the right medial orbital frontal cortex response to unexpected sucrose receipt (r = 0.315, p = .0008). The medial orbitofrontal cortex is implicated in reward and outcome value computation and the results suggest that aerobic exercise may strengthen this circuitry, or reciprocally, higher orbitofrontal cortical activity may reinforce exercise behavior. The findings aid in developing a model of how exercise engagement can modify reward-circuit function and could be used therapeutically in conditions associated with altered brain salience response.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Megan E. Shott
- Department of Psychiatry, University of California, San Diego, CA
| | - Guido K.W. Frank
- Department of Psychiatry, University of California, San Diego, CA
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26
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Gorrell S, Reilly EE, Brosof L, Le Grange D. Use of Telehealth in the Management of Adolescent Eating Disorders: Patient Perspectives and Future Directions Suggested from the COVID-19 Pandemic. Adolesc Health Med Ther 2022; 13:45-53. [PMID: 35401019 PMCID: PMC8992734 DOI: 10.2147/ahmt.s334977] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/26/2022] [Indexed: 01/13/2023] Open
Abstract
Efforts to increase accessibility of eating disorder (ED) treatment via telemedicine have been ongoing for the past decades. However, there has been a recent surge in research focused on remote delivery of interventions since the onset of the novel coronavirus pandemic (COVID-19) in 2020, the related lockdowns, and an exponential increase in ED symptoms in youth secondary to the pandemic worldwide. In the current review, we provide a focused summary of existing literature regarding telehealth for the treatment of EDs in adolescents using a frame of past, present, and future work. Specifically, we begin with a brief overview of research in remote delivery for EDs in youth prior to 2020. Then, we detail more recent studies in this domain, with a focus on research conducted during the COVID-19 pandemic. We close by outlining limitations of the existing data and future steps necessary to expand the rigor and impact of this work. Overall, there are considerable limitations associated with research conducted during the pandemic, but an increase in the acceptability of remote delivery methods and interest in hybrid care appears to be feasible, and likely to be lasting. Future work must replicate more recent research in non-pandemic contexts and prioritize evaluation of factors that will aid in matching patients to the most efficient and effective modalities of care moving forward.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychology, Hofstra University, Hempstead, NY, USA
| | - Leigh Brosof
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago (Emeritus), Chicago, IL, USA
- Correspondence: Daniel Le Grange, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA, Email
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27
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Gorrell S, Hughes EK, Sawyer SM, Roberts SR, Nagata JM, Yeo M, Lock J, Le Grange D. Gender-based clinical differences in evidence-based treatment for adolescent anorexia nervosa: analysis of aggregated randomized controlled trials. Eat Weight Disord 2022; 27:1123-1130. [PMID: 34170489 PMCID: PMC8796313 DOI: 10.1007/s40519-021-01257-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Boys represent a small proportion of samples in randomized clinical trials (RCT) investigating evidence-based treatment for adolescents with anorexia nervosa (AN). Consequently, knowledge of potential gender differences in clinical characteristics and treatment response in adolescents is considerably limited. METHODS Secondary analyses of aggregated data from two RCTs were used to characterize baseline and end-of-treatment clinical features in male and female adolescents with AN (n = 228, 10.53% male). Mixed analyses of variance were used to investigate potential gender differences in treatment response relative to weight outcomes (% median BMI) and eating disorder cognitions (Eating Disorder Examination Global scores; EDE). RESULTS There were no significant gender differences in prior inpatient care, illness duration, psychiatric comorbidity, or psychotropic medication use at baseline. Nor were there significant gender differences in binge eating, purging, or driven exercise at baseline or end-of-treatment. Girls reported elevated weight and shape concern compared to boys at baseline but overall reduction in EDE Global scores over the course of treatment did not differ according to gender. Boys gained more relative weight during treatment than girls, but this difference was statistically non-significant. CONCLUSION Overall findings do not suggest significant differences in treatment outcome relative to weight or ED cognitions, by gender. Current evidence suggests that, with the exception of shape and weight concerns, boys present with cognitive and behavioral symptoms as severe as their female counterparts which underscores the need for increased accuracy in assessment of these disorders in boys and young men. LEVEL OF EVIDENCE Level 1, secondary data analysis of randomized controlled trials.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Elizabeth K Hughes
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, Australia
| | - Susan M Sawyer
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Savannah R Roberts
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Michele Yeo
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Australia
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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28
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Gorrell S. The Role of Dopamine in Contributing to Vulnerable and Resilient Phenotypes in a Mouse Model of Anorexia Nervosa. Biol Psychiatry 2021; 90:e69-e71. [PMID: 34794638 PMCID: PMC8810290 DOI: 10.1016/j.biopsych.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California.
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29
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Abstract
Ergogenic supplements to improve athletic performance are commonly used among college athletes, but little is known about their association with eating disorder symptoms. The objective of this study was to examine associations between ergogenic supplement use and disordered eating attitudes and behaviors among university students, and to compare differences by sex. Undergraduate students from 10 top-ranked National College Athletics Association (NCAA) Division I colleges completed an online survey on supplement use, athletic activities, and eating attitudes and behaviors. Among 1633 university students, males (38.9%) reported higher rates of current supplement use than females (15.2%) (p < .001). In linear regression models adjusting for athletic status and body mass index, current supplement use was associated with higher Eating Disorders Examination-Questionnaire (EDE-Q) Global, Shape Concern, and Restraint scores in both males and females. Supplement use was associated with driven/compelled exercise (OR 2.00, 95% CI 1.33-2.99) in males and diuretic (OR 6.39, 95% CI 2.02-20.22) and diet pill use (OR 3.07, 95% CI 1.79-5.27) in females. Results suggest ergogenic supplement use is common in undergraduates and associated with disordered eating attitudes and behaviors. Clinicians should screen for disordered eating behaviors particularly in young adults who use ergogenic supplements.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Rebecka Peebles
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine B Hill
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Jennifer L Carlson
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
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30
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Rienecke RD, Gorrell S, Blalock DV, Smith K, Lock J, Le Grange D. Expressed emotion and long-term outcome among adolescents with anorexia nervosa. Int J Eat Disord 2021; 54:2019-2024. [PMID: 34553396 PMCID: PMC8810289 DOI: 10.1002/eat.23613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of the current study is to examine expressed emotion (EE) and long-term treatment outcome among adolescents participating in a randomized controlled trial (RCT) for treatment of anorexia nervosa (AN). It was hypothesized that patients with high EE parents at baseline would show more severe symptoms at end-of-treatment, 12-month follow-up, and 4-year follow-up than patients from low EE families. METHOD Secondary data analysis was conducted of original RCT data from a two-site eating disorder treatment trial conducted in the United States. Participants were 121 adolescents with AN who completed measures of EE, eating disorder psychopathology, depression, and self-esteem. RESULTS Generalized estimating equations showed that participants who were in the Low EE group achieved a more accelerated drop in depression scores in the context of treatment (first 12 months) than participants in the High EE group. No other significant Group × Time interactions were found. DISCUSSION Findings suggest that high parental EE at baseline does not indicate that adolescent patients with AN will fare poorly 4 years later.
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Affiliation(s)
- Renee D. Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Center, Chicago, Illinois, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Dan V. Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kathryn Smith
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
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31
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Schaumberg K, Peters D, Ahrenholtz R, Crombie KM, Zhang R, Gorrell S. Registered report: A pilot investigation of acute exercise response among girls and young women with and without eating disorders. Int J Eat Disord 2021; 54:2057-2065. [PMID: 34323294 PMCID: PMC8595629 DOI: 10.1002/eat.23587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Driven exercise (DEx) is a serious and common feature of eating disorders (EDs), but current understanding of factors that give rise to and maintain DEx is limited. DEx may be reinforced through its effects on the threat reduction and reward systems. The current protocol is designed to evaluate acute psychobiological response to exercise among female participants (age 16-22) with and without EDs. METHOD Twenty medically-stable participants with restrictive-spectrum EDs and 20 healthy control (HC) participants will complete study screening and three task visits which will include two 30-minute bouts of aerobic exercise. RESULTS We aim to validate and demonstrate feasibility of two tasks capturing exercise response in this sample. Further, we will estimate the degree to which a bout of exercise impacts state body image, affect, and circulating concentrations of biological markers among participants, and we will examine whether the impact of exercise on psychological outcomes may differ across ED and HC groups. DISCUSSION Completion of this project will contribute to the conceptualization of DEx and how individuals' acute biological and affective responses to exercise contribute to risk for and maintenance of DEx.
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Affiliation(s)
- Katherine Schaumberg
- University of Wisconsin - Madison, Department of Psychiatry, 6001 Research Park Boulevard, Madison, Wisconsin, United States of America, 53719-1176
| | - Danielle Peters
- University of Wisconsin - Madison, Department of Psychiatry, 6001 Research Park Boulevard, Madison, Wisconsin, United States of America, 53719-1176
| | - Rachel Ahrenholtz
- University of Wisconsin - Madison, Department of Psychiatry, 6001 Research Park Boulevard, Madison, Wisconsin, United States of America, 53719-1176
| | - Kevin M. Crombie
- University of Wisconsin - Madison, Department of Psychiatry, 6001 Research Park Boulevard, Madison, Wisconsin, United States of America, 53719-1176
| | - Ruisu Zhang
- University of Wisconsin - Madison, Department of Psychiatry, 6001 Research Park Boulevard, Madison, Wisconsin, United States of America, 53719-1176
| | - Sasha Gorrell
- University of California - San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Avenue, San Francisco, California, United States of America, 94143
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Forsberg S, Gorrell S, Accurso EC, Trainor C, Garber A, Buckelew S, Le Grange D. Family-based treatment for pediatric eating disorders: Evidence and guidance for delivering integrated interdisciplinary care. Child Health Care 2021; 52:7-22. [PMID: 36619528 PMCID: PMC9817879 DOI: 10.1080/02739615.2021.1984240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Eating disorders (EDs) are complex psychiatric diagnoses requiring specialized care. Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa and is also efficacious for other EDs. This study describes practice changes due to the implementation of an integrated interdisciplinary FBT-aligned treatment program for EDs at a large tertiary care hospital in the United States. We examined the feasibility and acceptability of implementation, barriers to implementation, and impact on providers' roles over a one-year period. Practice changes came with shifts in roles, and were largely experienced as acceptable with good suitability. Barriers identified may inform future interdisciplinary implementation efforts.
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Affiliation(s)
- Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Claire Trainor
- Department of Psychology, Drexel University, Philadelphia,
PA, USA
- Center for Weight Eating and Lifestyle Science (WELL
Center), Drexel University, Philadelphia, PA, USA
| | - Andrea Garber
- Department of Pediatrics, Division of Adolescent Medicine,
University of California, San Francisco, San Francisco, CA, USA
| | - Sara Buckelew
- Department of Pediatrics, Division of Adolescent Medicine,
University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
- Department of Psychiatry & Behavioral Neuroscience, The
University of Chicago, Chicago, IL, USA (Emeritus)
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33
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Gorrell S, Flatt RE, Bulik CM, Le Grange D. Psychosocial etiology of maladaptive exercise and its role in eating disorders: A systematic review. Int J Eat Disord 2021; 54:1358-1376. [PMID: 33942917 PMCID: PMC8811798 DOI: 10.1002/eat.23524] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Although maladaptive exercise (ME) is widely recognized as a clinical feature in transdiagnostic eating disorders, less is known about psychosocial factors that give rise to and perpetuate this behavior. This systematic review aimed to examine the empirical status of this association. METHOD We reviewed 46 full text articles examining longitudinal associations between psychosocial variables and ME. RESULTS Eighteen studies met full inclusion criteria. Based on our qualitative synthesis, evidence suggests reasonably consistent associations between early concern with weight and shape, and negative affect on later development of ME. DISCUSSION Inconsistent and insufficient assessment of ME across a majority of studies underscores caution in interpretation of results, but guides important discussion for future clinical and research efforts.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Rachael E. Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cynthia M. Bulik
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
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34
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Walker DC, Gorrell S, Hildebrandt T, Anderson DA. Consequences of Repeated Critical Versus Neutral Body Checking in Women With High Shape or Weight Concern. Behav Ther 2021; 52:830-846. [PMID: 34134824 PMCID: PMC8827350 DOI: 10.1016/j.beth.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
Body checking is a repeated behavior conducted in an attempt to gain information about one's shape, weight, size, or body composition. Body checking is associated with negative behavioral, emotional, and cognitive outcomes and may maintain body dissatisfaction and eating disorders. The precise function and consequences of body checking remain less well understood. Specifically, immediate and delayed impacts of repeated critical body checking (CBC) have not been determined. The current study randomly assigned 142 young women with high shape/weight concern to daily 10-min CBC, neutral body checking (NBC), or a non-body critical checking (NBCC) comparison condition, examining their immediate and delayed (one-week follow-up) effects on body satisfaction, self-esteem, and negative affect. Multilevel modeling and follow-up planned comparisons found that compared to NBCC, CBC participants' body satisfaction and self-esteem immediately decreased, but negative affect improved from baseline to follow-up. Compared to CBC, NBC participants' self-esteem and negative affect improved immediately, and their self-esteem improved over time compared to NBCC. Over time, all participants' state body satisfaction improved, regardless of condition. Our findings suggest a 10-min CBC session may function differently than typical (harmful) in vivo body checking. However, reasons for this difference are unclear. Additional research is needed to distinguish (harmful) in vivo body checking from CBC procedures such as this and other mirror exposure interventions. Research is needed to examine the effects of varying CBC duration and instructions during body exposure to further clarify mechanisms of change during body exposures.
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Mond J, Gorrell S. "Excessive exercise" in eating disorders research: problems of definition and perspective. Eat Weight Disord 2021; 26:1017-1020. [PMID: 33389704 PMCID: PMC8068596 DOI: 10.1007/s40519-020-01075-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia.,School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
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36
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Reilly EE, Bohrer B, Sullivan D, Essayli JH, Farrell NR, Brown TA, Gorrell S, Anderson LM, Cooper M, C Schreyer C, Olesnycky O, Peros O, Schaumberg K. Registered report: Initial development and validation of the eating disorders safety behavior scale. Int J Eat Disord 2021; 54:660-667. [PMID: 33638564 PMCID: PMC8044048 DOI: 10.1002/eat.23479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/07/2022]
Abstract
Anxiety and eating disorders (EDs) often co-occur, prompting calls to explore anxiety-related maintenance processes in ED samples. Safety behaviors, which function to prevent a feared outcome from occurring or to reduce anxiety associated with a feared stimulus, are observed across anxiety disorders and, along with overt avoidance behaviors, are an important target in treatment. Data suggest that individuals with EDs also engage in safety behaviors. However, no existing assessments provide a comprehensive measure of eating-disorder-specific overt avoidance and safety behaviors. The goal of this Stage 1 Registered Report is to develop a comprehensive self-report measure of ED-specific safety behaviors. In Study 1, we will recruit 50 women with EDs to complete the scale and provide feedback on the response scale. Feedback from these participants will be used to refine the measure. In Study 2, we will evaluate the psychometric properties of the measure in a large sample of women with EDs (n dependent on the size of measurement) and a community sample without current or a history of ED symptoms. We will explore the measure factor structure, known-groups validity by comparing scores from women with EDs to healthy controls, internal consistency, and convergent and divergent validity with other psychological instruments.
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Affiliation(s)
- Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Brittany Bohrer
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Daniel Sullivan
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Jamal H Essayli
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Saint Paul, Minnesota, USA
| | - Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Olenka Olesnycky
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Olivia Peros
- Department of Psychology, Hofstra University, Hempstead, New York, USA
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Gorrell S, Le Grange D, Blalock DV, Mehler PS, Johnson C, Manwaring J, Duffy A, Huston E, McClanahan S, Rienecke RD. Gender identity, race/ethnicity and eating pathology in a treatment-seeking community sample. J Behav Cogn Ther 2021; 31:77-89. [PMID: 36703863 PMCID: PMC9876537 DOI: 10.1016/j.jbct.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Despite the wide-reaching impact of eating disorders (EDs), less is known about eating pathology among individuals across racial/ethnic groups whose gender identity differs from the binary categorization. Examining ED pathology both across binary and minority-gender groups, and relative to racial/ethnic identification is necessary to inform screening and culturally-sensitive intervention efforts. This study investigated patterns of ED symptomology among youth and adults (N = 13658) who telephoned treatment centers in the United States when seeking clinical support for ED symptoms. Analyses examined data from participants who completed a semi-structured clinical interview. Results indicated that Anorexia nervosa was the most common diagnosis in each gender category and for a majority of race/ethnic groups; Black individuals had elevated rates of binge eating disorder. Compared to females, males were less likely to endorse all ED symptoms (ps < .001); gender minority status was also associated with decreased report of a majority of ED symptoms. Asian and Black individuals were less likely than Whites to endorse most ED symptoms. When compared to Whites, Hispanic/Latinx and Bi/Multi-racial participants did not demonstrate significant differences in presentation across a majority of ED symptoms. Overall findings suggest individuals with female gender and White race may seek treatment from an ED treatment facility with greater frequency than other demographic groups. Noted exceptions include Hispanic/Latinx and Bi/Multi-racial individuals, for whom ED pathology may be represented comparably to Whites. While findings confirm traditional patterns in gender and racial/ethnic representation in EDs, current study findings also underscore that EDs are not culture bound.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA (Emeritus)
| | - Dan V. Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Philip S. Mehler
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA,ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA,University of Colorado School of Medicine, Denver, CO, USA
| | - Craig Johnson
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA
| | - Jamie Manwaring
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA
| | - Emma Huston
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Renee D. Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
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38
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Gorrell S, Nagata JM, Hill KB, Carlson JL, Shain AF, Wilson J, Alix Timko C, Hardy KK, Lock J, Peebles R. Eating behavior and reasons for exercise among competitive collegiate male athletes. Eat Weight Disord 2021; 26:75-83. [PMID: 31782028 PMCID: PMC7253316 DOI: 10.1007/s40519-019-00819-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Research concerning eating disorders among adolescent and young adult male athletes is limited compared with female counterparts, but increasing evidence indicates that they may be at unique risk for unhealthy exercise and eating behavior. The current study aimed to characterize unhealthy exercise and eating behavior according to competitive athlete status, as well as per sport type. METHOD Collegiate male athletes (N = 611), each affiliated with one of the 10 National College Athletics Association (NCAA) Division I schools in the United States, completed an online survey, reporting on eating and extreme weight control behaviors, and reasons for exercise. RESULTS Competitive athletes endorsed increased driven exercise and exercising when sick. Baseball players, cyclists, and wrestlers emerged as the sports with the most players reporting elevated Eating Disorder Examination-Questionnaire scores in a clinical range, and basketball players reported the highest rates of binge eating. overall, baseball players, cyclists, rowers, and wrestlers appeared to demonstrate the greatest vulnerability for unhealthy eating and exercise behavior. CONCLUSION Findings revealed differences between competitive and non-competitive male athletes. Among competitive athletes, results identified unique risk for unhealthy eating and exercise behavior across a variety of sport categories and support continued examination of these attitudes and behaviors in a nuanced manner. LEVEL II Evidence obtained from well-designed controlled trials without randomization.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | | | | | | | - Jenny Wilson
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristina K Hardy
- Departments of Psychiatry & Behavioral Science and Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Rebecka Peebles
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Abstract
As aesthetic athletes, professional dancers have increased vulnerability for eating disorders (EDs), with three times higher risk than non-dancers. Among ballet dancers, generalized risk for EDs associated with internalization of western cultural female beauty ideals is compounded by idealization of a ballet-specific body ideal, a combination that confers unique vulnerability for eating pathology. Empirical support has been established for an athlete-specific intervention promoting body acceptance and reduced eating pathology among general populations of young-adult women and female collegiate athletes; the current study adapted this intervention for pilot implementation among professional ballet dancers. Participants from two elite ballet companies (N = 19) were randomized to a control and intervention condition. All participants self-reported eating pathology and related variables pre- and post-intervention, and at six-week follow-up. Post-intervention, participants receiving the intervention demonstrated reductions in body dissatisfaction, p = .005, r = -.63, dietary restraint, p = .008, r = -.59, and eating pathology, p = .007, r = -.60, as compared to control group counterparts; significant differences were retained at follow-up. Results provide preliminary evidence that this intervention has the potential to provide a feasible and acceptable means of ED prevention in female professional ballet dancers. Barriers to feasibility are identified and discussed.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychology, University at Albany, State University of New York , Albany, NY, USA.,Department of Psychiatry, University of California , San Francisco, CA, USA
| | | | - James F Boswell
- Department of Psychology, University at Albany, State University of New York , Albany, NY, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, State University of New York , Albany, NY, USA
| | - Drew A Anderson
- Department of Psychology, University at Albany, State University of New York , Albany, NY, USA
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40
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Kolar DR, Gorrell S. A call to experimentally study acute affect-regulation mechanisms specific to driven exercise in eating disorders. Int J Eat Disord 2020; 54:10.1002/eat.23427. [PMID: 33289120 PMCID: PMC8166956 DOI: 10.1002/eat.23427] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022]
Abstract
Driven exercise (i.e., feeling compelled to exercise to control one's weight or shape, to obtain other positive consequences of exercising, or to avoid other negative consequences of not exercising) is a common phenomenon in individuals with eating disorders (EDs), typically associated with negative clinical outcomes. Current theoretical models of driven exercise highlight the short-term affect-regulating outcome of acute driven exercise, which is implicated to maintain this symptom either by positive or negative reinforcement. However, few studies have actually investigated cognitive, affective, and psychobiological mechanisms related to acute driven exercise. In particular, experimental studies that directly test mechanisms leading to the short-term affective improvement after acute driven exercise are scarce. In this article, we therefore propose potential cognitive, affective, and psychobiological mechanisms that could explain the affect-regulating function of driven exercise in individuals with EDs. In addition, we suggest examples of experimental studies that could directly test these mechanisms in individuals with EDs, as recent studies have demonstrated the safety of supervised exercise in EDs research. Our aim of stimulating research on the underlying causes and maintenance factors of driven exercise in EDs has the potential to critically inform treatment development for this high-risk population.
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Affiliation(s)
- David R. Kolar
- Department of Child and Adolescent Psychiatry, University Medicine of Johannes Gutenberg-University, Mainz, Germany
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
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41
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Scharmer C, Martinez K, Gorrell S, Reilly EE, Donahue JM, Anderson DA. Eating disorder pathology and compulsive exercise during the COVID-19 public health emergency: Examining risk associated with COVID-19 anxiety and intolerance of uncertainty. Int J Eat Disord 2020; 53:2049-2054. [PMID: 33098579 PMCID: PMC8817895 DOI: 10.1002/eat.23395] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE COVID-19 has led to disruptions in daily living and increased uncertainty about physical, financial, social, and psychological consequences, which may contribute to anxiety, eating disorder (ED) pathology, and compulsive exercise. Individual factors, such as intolerance of uncertainty, may impact risk for ED pathology and CE in response to COVID-19 anxiety. The current study examined associations between COVID-19 anxiety, trait intolerance of uncertainty, and COVID-19 intolerance of uncertainty and ED pathology and compulsive exercise. METHOD Undergraduate participants (N = 295) completed a series of online questionnaires between March and April of 2020. RESULTS COVID-19 anxiety and intolerance of uncertainty were associated with ED pathology, but not compulsive exercise. Additionally, both trait and COVID-19 intolerance of uncertainty moderated associations between COVID-19 anxiety and compulsive exercise and ED pathology. COVID-19 anxiety was more strongly related to compulsive exercise and ED pathology for individuals with lower intolerance of uncertainty. DISCUSSION COVID-19 anxiety may increase risk for ED pathology and may be specifically important in determining risk for ED pathology and compulsive exercise among individuals with lower intolerance of uncertainty. These results contribute to a growing body of research aimed at understanding the mental health consequences of the COVID-19 and suggest that individual factors (e.g., anxiety and intolerance of uncertainty) are important in determining risk for ED pathology and compulsive exercise in the context of the pandemic.
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Affiliation(s)
- Christina Scharmer
- Department of Psychology, University at Albany, State University of New York, Albany, New York
| | - Kimberly Martinez
- Department of Psychology, University at Albany, State University of New York, Albany, New York
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California
| | - Erin E. Reilly
- Department of Psychology, Hofstra University, Hempstead, New York
| | - Joseph M. Donahue
- Department of Psychology, University at Albany, State University of New York, Albany, New York
| | - Drew A. Anderson
- Department of Psychology, University at Albany, State University of New York, Albany, New York
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42
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Schaumberg K, Reilly EE, Gorrell S, Levinson CA, Farrell NR, Brown TA, Smith KM, Schaefer LM, Essayli JH, Haynos AF, Anderson LM. Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clin Psychol Rev 2020; 83:101952. [PMID: 33221621 DOI: 10.1016/j.cpr.2020.101952] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
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Affiliation(s)
| | | | - Sasha Gorrell
- University of California, San Francisco, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | | | - Tiffany A Brown
- University of California, San Diego, United States of America
| | - Kathryn M Smith
- Sanford Health, United States of America; University of Southern California, United States of America
| | | | | | - Ann F Haynos
- University of Minnesota, United States of America
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43
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Nagata JM, Ganson KT, Gorrell S, Mitchison D, Murray SB. Association Between Legal Performance-Enhancing Substances and Use of Anabolic-Androgenic Steroids in Young Adults. JAMA Pediatr 2020; 174:992-993. [PMID: 32421175 PMCID: PMC7235901 DOI: 10.1001/jamapediatrics.2020.0883] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This cohort study uses data from the National Longitudinal Study of Adolescent to Adult Health database to describe the association between anabolic-androgenic steroid use and legal performance-enhancing substances in young adults.
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Affiliation(s)
- Jason M. Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
| | - Kyle T. Ganson
- School of Social Work, Simmons University, Boston, Massachusetts
| | - Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia,Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Stuart B. Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles
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Gorrell S, Lebow J, Kinasz K, Mitchell JE, Goldschmidt AB, Le Grange D, Accurso EC. Psychotropic medication use in treatment-seeking youth with eating disorders. Eur Eat Disord Rev 2020; 28:739-749. [PMID: 32926514 DOI: 10.1002/erv.2788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/07/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Psychotropic medication use in youth with eating disorders (EDs) is poorly understood despite high co-occurrence of psychiatric disorders. This study examined characteristics associated with medication use in treatment-seeking youth with EDs. METHOD Youth up to age 18 reported on medication use when presenting to an academic medical center outpatient ED service in the United States. Data presented were collected between 1998-2015. RESULTS The sample (N = 604) was predominantly female (90.6%) with a mean age of 15.3 years (SD = 2.3). Approximately one-third (30%, n = 173) were taking psychotropic medications (40%, n = 70, were taking multiple medications). Antidepressant use was most common (26%, n = 152), followed by atypical antipsychotics (8%, n = 43). Adjusting for co-occurring psychiatric disorders, non-Hispanic Whites who had received prior treatment (psychotherapy, hospitalization) were significantly more likely to be using medication. Longer illness duration and prior treatment were associated with greater antidepressant use. For atypical antipsychotics, prior hospitalization was associated with greater use. CONCLUSIONS Findings confirm moderate psychotropic medication use among young patients with EDs despite a lack of clarity regarding optimally effective pharmacologic interventions in this population. Pharmacological trials examining the efficacy of medications for young patients with EDs are warranted to inform future prescribing practice.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Jocelyn Lebow
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn Kinasz
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - James E Mitchell
- Sanford Biobehavioral Research Institute, Fargo, North Dakota, USA.,School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota, USA
| | - Andrea B Goldschmidt
- Weight Control and Diabetes Research Center, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, California, USA.,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Erin C Accurso
- Department of Psychiatry, University of California, San Francisco, California, USA
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Abstract
Driven exercise (i.e., the tendency to exercise in excess to influence weight/shape or regulate emotion) is difficult to manage in the context of anorexia nervosa, and is associated with poorer treatment outcomes, and psychological and medical severity. Driven exercise is observed in a considerable number of those diagnosed with anorexia nervosa; however, to date, this hallmark symptom remains poorly understood. Dopamine signaling is implicated in motivating and maintaining appetitive behavior among patients with eating disorders; but, much less is known about the role of dopamine signaling specific to the symptom of driven exercise. An improved understanding of this biobehavioral mechanism may inform the etiology of driven exercise in anorexia nervosa, with the potential to impact future research and treatment efforts. This review describes the role that dopamine serves in maintaining symptoms in the context of anorexia nervosa, and synthesizes current relevant evidence on exercise in AN and related dopaminergic activity. Throughout, theoretical implications are discussed, along with critical directions for future research.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Anne G.E. Collins
- Department of Psychology and Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA (Emeritus)
| | - Tony T. Yang
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
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Gorrell S, Matheson BE, Lock J, Le Grange D. Remission in adolescents with bulimia nervosa: Empirical evaluation of current conceptual models. Eur Eat Disord Rev 2020; 28:445-453. [PMID: 32130757 DOI: 10.1002/erv.2729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/31/2020] [Accepted: 02/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The few randomized clinical trials (RCTs) investigating adolescent treatment for bulimia nervosa (BN) suggest variability in both rates of, and criteria for remission. The current study examined reactivity in remission rates, relative to various conceptualizations of remission in a single RCT data set. METHOD A data set of adolescents with BN who participated in an RCT (N = 110) was used to evaluate remission models based upon behavioral symptoms (e.g., binge eating), psychological symptoms (Eating Disorder Examination [EDE] scores), and combinations of these criteria. RESULTS At end-of-treatment (EOT), a remission model defined by behavioral symptom abstinence plus meaningful reduction in EDE global scores yielded comparable remission rates to a model defined by behavioral abstinence alone (i.e., 29% remitted). Participants with higher EOT EDE global scores were less likely to be abstinent from behavioral symptoms at 6- and 12-month follow-up (ps < .001). DISCUSSION Reduction in psychological symptoms with behavioral abstinence did not inform remission status at EOT, over and above behavioral symptom change alone. However, psychological symptom improvement by EOT may predict positive prognosis in posttreatment assessment. Results underscore the necessity of including psychological symptom improvement, as well as consistency across research and practice, in defining remission in adolescent BN.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Brittany E Matheson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
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47
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Trainor C, Gorrell S, Hughes EK, Sawyer SM, Burton C, Le Grange D. Family-based treatment for adolescent anorexia nervosa: What happens to rates of comorbid diagnoses? Eur Eat Disord Rev 2020; 28:351-357. [PMID: 31995262 DOI: 10.1002/erv.2725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/26/2019] [Accepted: 01/11/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Rates of psychiatric comorbidity are elevated in adolescents with anorexia nervosa, but little is known about how psychiatric comorbidity changes following family-based treatment (FBT). METHODS Adolescents with anorexia nervosa (N = 107) enrolled in a randomized controlled trial comparing two forms of FBT completed the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline and end of treatment. Analyses tested whether baseline comorbid diagnoses predicted the presence of comorbid diagnoses at end of treatment and if baseline eating disorder psychopathology impacted this association. RESULTS Rates of comorbid diagnoses decreased from 54% at baseline to 26% at end of treatment. Logistic regression analyses indicated that individuals with multiple comorbid diagnoses at baseline were more likely to meet criteria for a comorbid condition at end of treatment (b = 2.00, p < .05). Individuals with reported psychotropic medication use were less likely to meet criteria for a comorbid condition at end of treatment (b = -1.63, p = .04). Diagnostic rates for major depressive disorder, generalized anxiety disorder, and panic disorder/agoraphobia decreased following FBT. CONCLUSIONS Findings suggest that FBT for adolescent anorexia nervosa may aid in the resolution of some co-occurring psychiatric diagnoses. Continued research is needed to understand factors contributing to comorbid symptom improvement throughout treatment.
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Affiliation(s)
- Claire Trainor
- Department of Psychiatry, University of California, San Francisco, CA
| | - Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, CA
| | - Elizabeth K Hughes
- The University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Susan M Sawyer
- The University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Claire Burton
- The University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, CA.,Department of Paediatrics, The University of Chicago, Chicago, IL
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48
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Gorrell S, Scharmer C, Kinasz K, Anderson D. Compulsive exercise and weight suppression: Associations with eating pathology in distance runners. Eat Behav 2020; 36:101358. [PMID: 31887559 PMCID: PMC7927975 DOI: 10.1016/j.eatbeh.2019.101358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 01/18/2023]
Abstract
Some athletes, particularly those who participate in activities that emphasize leanness such as competitive running, are at greater risk for eating disorder (ED) pathology. Compulsive exercise (CE) is linked with ED pathology among female athletes, with evidence that CE for weight control is most strongly correlated with ED thoughts and behaviors. Weight suppression (WS), the discrepancy between highest adult weight and current weight, is also linked with ED symptoms. Taken together, runners with greater WS may be more likely to engage in CE to influence their weight or shape and may subsequently report other associated ED symptoms. As such, the current study investigated associations between CE and ED pathology in a mixed-gender sample of adult distance runners (N = 277, 51% female), and tested the impact of WS on this association. Results indicated that females reported greater CE and ED pathology, whereas males reported greater WS. A significant interaction effect for CE x WS, (p < .05) indicated that the relation between CE and ED scores was stronger among male runners who reported higher WS. In contrast, WS did not impact the association between CE and ED pathology for female runners. Results from the current study have important implications for the assessment and treatment of ED in athletes, specifically runners, and suggest that WS is an important factor to consider when working with male athletes.
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Affiliation(s)
- Sasha Gorrell
- University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY 12222, USA.
| | - Christina Scharmer
- University at Albany, State University of New York, Albany, New York, 1400 Washington Avenue, Albany, NY, 12222 USA
| | - Kate Kinasz
- University of California, San Francisco, San Francisco, California 401 Parnassus Avenue, San Francisco, CA, 94143 USA
| | - Drew Anderson
- University at Albany, State University of New York, Albany, New York, 1400 Washington Avenue, Albany, NY, 12222 USA
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49
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Matheson BE, Gorrell S, Bohon C, Agras WS, Le Grange D, Lock J. Investigating Early Response to Treatment in a Multi-Site Study for Adolescent Bulimia Nervosa. Front Psychiatry 2020; 11:92. [PMID: 32184746 PMCID: PMC7058584 DOI: 10.3389/fpsyt.2020.00092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/04/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This secondary data analysis seeks to replicate and extend findings that early response to treatment in adolescent bulimia nervosa (BN) predicts outcome, resulting in earlier identification of patients who might need a different treatment approach. METHODS Participants were 71 adolescents (M ± SD: 15.69 ± 1.55 years; 93% female; 75% non-Hispanic) with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnosis of BN or partial BN enrolled in a two-site treatment study. Participants were randomized to cognitive behavioral therapy for adolescents (CBT-A), family-based treatment for BN (FBT-BN), or supportive psychotherapy (SPT). The Eating Disorder Examination was administered at baseline, end-of-treatment (EOT), 6-month, and 12-month follow-up. Binge eating and purge symptoms were self-reported at each session. Outcome was defined as abstinence of binge eating and compensatory behaviors (self-induced vomiting, laxative use, diet pills, diuretics, compensatory exercise, fasting) in the 28 days prior to assessment. Receiver operating characteristic (ROC) analyses were utilized to assess the viability of predicting treatment outcomes based on reduction of symptoms within the first 10 sessions of treatment. RESULTS ROC analyses suggest that reduction in purging at session 2 (AUC =.799, p < .001) and binge eating at session 4 (AUC =.750, p < .01) were independently related to abstinence of symptoms at EOT, regardless of treatment type. Symptom reduction later in treatment predicted outcome at follow-up, as change in binge eating at session 8 and purging at session 9 were the strongest predictors of abstinence at 6-month follow-up (AUCs =.726-.763, ps < .01). Change in binge eating, but not purging behaviors, was significantly related to abstinence at 12-month follow-up (AUC =.766, p < .01). Only slight differences emerged based on treatment group, such that reductions in symptoms most predictive of abstinence at EOT occurred one session sooner in FBT-BN than SPT. CONCLUSION Reductions in binge eating and purge symptoms early in adolescent BN treatment suggest better outcome, regardless of treatment modality. Additional research with larger samples is needed to better understand which treatments, if any, contribute to earlier change in BN symptoms and/or likelihood of improved patient response.
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Affiliation(s)
- Brittany E Matheson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Sasha Gorrell
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - W Stewart Agras
- Department of Psychiatry and Behavioral Sciences, Emeritus, Stanford University School of Medicine, Stanford, CA, United States
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Neuroscience, Emeritus, The University of Chicago, Chicago, IL, United States
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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50
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Scharmer C, Gorrell S, Schaumberg K, Anderson D. Compulsive exercise or exercise dependence? Clarifying conceptualizations of exercise in the context of eating disorder pathology. J Clin Sport Psychol 2020; 46:101586. [PMID: 34093941 PMCID: PMC8174529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Maladaptive exercise relates to eating disorder (ED) pathology and impairment in clinical and non-clinical populations. At present, two different conceptualizations of maladaptive exercise are often studied in relation to ED pathology: compulsive exercise and exercise dependence. Compulsive exercise functions to avoid negative affect (e.g., guilt and anxiety) associated with not exercising, whereas exercise dependence is associated with tolerance to exercise benefits and avoidance of exercise withdrawal. At present, clinicians and researchers struggle to determine the most appropriate term for describing problematic exercise in individuals with ED pathology. This study aimed to directly compare these conceptualizations of maladaptive exercise in relation to severity of ED pathology. DESIGN This study examined cross-sectional data. METHOD Undergraduate participants (N =235, 78% female) with elevated ED pathology completed the Eating Disorder Examination Questionnaire (EDE-Q), Compulsive Exercise Test (CET), and Exercise Dependence Scale (EDS). Multiple linear regression analyses evaluated associations between EDE-Q and CET and EDS scores and dominance analysis determined which qualities of exercise were uniquely associated with EDE-Q scores. RESULTS Results suggest that compulsive qualities of exercise, including exercise to control shape and weight and to avoid negative affect are more strongly associated with severity of ED pathology than qualities of exercise dependence. CONCLUSIONS Clinicians and researchers working with ED populations can benefit from prioritizing assessments that capture compulsive qualities of exercise. Additionally, these results suggest that interventions that effectively target other compulsive behaviors (e.g., exposure and response prevention) may be promising treatment options for problematic exercise in the context of EDs.
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Affiliation(s)
- Christina Scharmer
- University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
| | - Sasha Gorrell
- University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | | | - Drew Anderson
- University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
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