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Bulimia Nervosa (bulimia + nervosa)
Selected AbstractsA case series evaluation of a modified version of interpersonal psychotherapy (IPT) for the treatment of bulimic eating disorders: A pilot studyEUROPEAN EATING DISORDERS REVIEW, Issue 4 2009Jon Arcelus Abstract Objective To determine the therapeutic outcome of a modified form of (IPT-BNm) amongst patients with Bulimia Nervosa (BN) and Eating Disorders Not Otherwise Specified (EDNOS). Method Following initial assessment, 59 patients with diagnoses of BN or EDNOS entered treatment in the form of 16 sessions of IPT-BNm. At initial assessment, patients completed measures of general psychopathology (SCL-90), Self esteem (RSE), eating psychopathology (EDE-Q), interpersonal functioning (Inventory of Interpersonal Functioning; IIP-32) and depression (BDI). At the middle and end of treatment, EDE-Q, IIP-32 and BDI measures were repeated. Results By the middle of therapy, patients had made significant improvements in terms of their eating disordered cognitions and behaviours (including reductions in EDE-Q scores, bingeing and self-induced vomiting), interpersonal functioning and levels of depression. Conclusions IPT-BNm is an effective treatment for patients with Bulimic Eating Disorders and appears to work quickly, as there were significant reductions in eating disorders symptoms within the first eight sessions of treatment. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Eating disorders in females with type 1 diabetes: an update of a meta-analysisEUROPEAN EATING DISORDERS REVIEW, Issue 4 2002Søren Nielsen Abstract Objective: Firstly to provide a quantitative summary of existing studies on the occurrence of eating disorders (ED) in females with type 1 diabetes (IDDM), with the focus on retinopathy and insulin misuse for the different eating disorders. Secondly to disseminate knowledge about useful statistical tools. Research Design and Methods: Data were extracted from the relevant case,control and follow-up studies. Odds ratios (OR) and risk differences (RD) were the main effect sizes analysed. Analyses were based on ,exact' methods as many studies are sparse. Data and findings are presented in sufficient detail for re-analysis. Results: An hypothesis of an increase in Anorexia Nervosa (AN) in IDDM is not supported by existing evidence. Bulimia Nervosa is increased (OR,=,2.9 (95%CI: 1.03 to 8.4); pOR,=,0.04) in IDDM. Both ED-NOS and subthreshold ED is increased (OR ,2; pOR,<,0.001) in females with IDDM. Co-existing ED in IDDM increases the overall common OR for retinopathy to 4.8 (95%CI: 3.0 to 7.8); pOR,<,0.00001, and the overall mean RD is 33% (95%CI: 25% to 42%); pRD,<,0.001. Insulin misuse (IM) is increased when ED co-exists with IDDM: OR 12.6 (95%CI: 7.8 to 21.1); pOR,<,0.00001, and mean RD is 40% (95%CI: 29% to 50%); pRD,<,0.001. Conclusions: ED-NOS and subthreshold ED seem to be the quantitatively most important EDs in type 1 diabetic females. Mismanagement of diabetes in the form of IM is frequent in eating disordered IDDM probands. Early occurrence of retinopathy and other complications is an increased risk in concurrent cases, as is premature death. The implications of Binge Eating Disorder (BED) and overweight needs to be elucidated for both type 1 and type 2 diabetes. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Should bulimia nervosa be subtyped by historyof anorexia nervosa?INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue S3 2007A longitudinal validation Abstract Objective: To determine whether a past diagnosis of anorexia nervosa (AN) predicts longitudinal course and outcome among women with bulimia nervosa (BN). Method: A subset (n = 176) of participants in the Longitudinal Study of Anorexia and Bulimia Nervosa who met DSM-IV criteria for BN either at study intake (n = 144) or during follow-up (n = 32; 4 had restricting AN at intake, 28 had binge/purge AN at intake) were included in this report. Over a median of 9 years, weekly eating disorder symptom data were collected from participants using the Longitudinal Interview Follow-up Examination, Eating Disorders Version. Results: While there were no between-group differences in likelihood of partial recovery, women with BN who had a history of AN were more likely to have a protracted illness, relapsing into AN during follow-up, compared to those with no AN history who were more likely to move from partial to full recovery. Conclusion: Lifetime AN is an important prognostic indicator among women with BN and these longitudinal data would support the subtyping of BN on the basis of AN history. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [source] A Multidimensional Meta-Analysis of Psychotherapy for Bulimia NervosaCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2003Heather Thompson-Brenner We report a multidimensional meta-analysis of psychotherapy trials for bulimia nervosa published between 1980 and 2000, including multiple variables in addition to effect size such as inclusion and exclusion, recovery, and sustained recovery rates. The data point to four conclusions. First, psychotherapy leads to large improvements from baseline. Approximately 40% of patients who complete treatment recover completely, although 60% maintain clinically significant posttreatment symptoms. Second, individual therapy shows substantially better effects than group therapy for the therapies tested. Third, additional approaches or treatment parameters (e.g., number of sessions) need to be tested for the substantial number of patients who enter treatment and do not recover. Finally, the utility of meta-analyses can be augmented by including a wider range of outcome metrics, such as recovery rates and posttreatment symptom levels. [source] Long-term follow-up of adolescent onset anorexia nervosa in northern SwedenEUROPEAN EATING DISORDERS REVIEW, Issue 2 2005Karin Nilsson Abstract Objective This study examines the long-term outcome of adolescent onset anorexia nervosa, 8 and 16 years after first admission to child and adolescent psychiatric (CAP) treatment in northern Sweden. Method Two follow-ups (1991 and 1999) were made of 68 women who were first admitted to CAP between 1980 and 1985. The follow-ups included interviews and self-report inventories. Eating disorders and GAF were evaluated according to DSM-III-R. Results Recovery increased from 46 (68%) to 58 (85%). EDNOS (eating disorder not otherwise specified) decreased from 16 (24%) to seven (10%). The numbers for anorexia nervosa (AN) were the same, two (3%) in both follow-ups. Bulimia nervosa (BN) decreased from four (6%) in the first follow-up to one (1.5%) in the second follow-up. The mortality rate was one (1%). Self-evaluation of mental health indicated that 15% had problems with depression, anxiety or compulsive symptoms. Somatic problems and paediatric inpatient care during the first treatment period could predict long-term outcome. Most former patients had a satisfactory family and work situation. Conclusion Recovery from eating disorders continued during the follow-ups. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] The changing profile of eating disorders at a tertiary psychiatric clinic in Hong Kong (1987,2007)INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2010Sing Lee MBBS Abstract Objective: To examine the clinical profile of Chinese eating disorder patients at a tertiary psychiatric clinic in Hong Kong from 1987 to 2007. Method: Data on 195 consecutive patients were retrieved from a standardized intake interview by an eating disorder specialist. Patients seen between 1987,1997 (n = 67) and 1998,2007 (n = 128) and fat-phobic (n = 76) and nonfat-phobic (n = 39) anorexic patients were compared. Results: Patients were predominantly single (91.8%), female (99.0%), in their early-20s and suffered from anorexia (n = 115; 59.0%) or bulimia (n = 78; 40.0%) nervosa. The number of patients increased twofold across the two periods. Bulimia nervosa became more common while anorexia nervosa exhibited an increasingly fat-phobic pattern. Nonfat-phobic anorexic patients exhibited significantly lower premorbid body weight, less body dissatisfaction, less weight control behavior, and lower EAT-26 scores than fat-phobic anorexic patients. Discussion: The clinical profile of eating disorders in Hong Kong has increasingly conformed to that of Western countries. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [source] Japanese version of the Body Attitude Test: Its reliability and validityPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2003Akiko Kashima Abstract The Body Attitude Test (BAT) was developed by Probst et al. (1995) for female patients with eating disorders (ED). This test measures the subjective body experience and attitudes toward one's body. The present authors have developed the Japanese version of the BAT and the purpose of the present paper was to investigate its reliability and validity in control (CON, n = 599) and ED patients (n = 46). The ED patients consisted of 21 anorexia nervosa, restricting type (AN-R) patients and 25 bulimia nervosa (BN) patients. Internal consistency was determined with Cronbach's , coefficient in CON. Factor analysis was conducted on BAT ratings given by CON. Factor analysis indicated that BAT was composed of two factors. These were body dissatisfaction (factor 1) and lack of familiarity with one's body (factor 2). A comparison was made among AN-R, BN, and CON. Bulimia nervosa had a significantly higher score than the other two groups. The BAT scores of ED patients correlated significantly with the Self -rating Depression Scale, and State,Trait Anxiety Inventory. These results show that ED patients have negative feelings toward their own body, similar to the findings in the original report. On factor analysis, however, it was not possible to distinguish between negative appreciation of body size and general body dissatisfaction as described in the original report. The authors also examine influences on this difference from a cross-cultural view point. [source] Emotional processing in eating disorders: specific impairment or general distress related deficiency?DEPRESSION AND ANXIETY, Issue 6 2006Eva Gilboa-Schechtman Ph.D. Abstract The literature on eating disorders emphasizes the relationship between alexithymia and anorexia nervosa on the one hand, and between bulimia nervosa and affect dysregulation on the other. In our study, two questions are addressed: (1) Are there different patterns of emotional processing deficiencies in anorexia and bulimia? and (2) Is there a unique contribution of eating disorders to emotional processing deficiencies? Participants were women with anorexia nervosa (ANs, n=20), bulimia nervosa (BNs, n=20), and normal controls (NCs, n=20). Three hypotheses were examined: (1) Women with eating disorders will exhibit lower emotional awareness and more deficient emotional regulation than will NCs (emotional deficiency); (2) ANs will be less emotionally aware than BNs, whereas BNs will be less capable of effective emotional regulation than ANs (disorder specificity); and (3) emotional distress will mediate the relationships between emotional processing and eating disorders (emotional distress mediation). Results supported the emotional deficiency and distress mediation hypotheses, and partially supported the disorder specificity hypothesis. The need to move beyond alexithymia in understanding the pattern of emotional processing deficiencies in eating disorders is discussed. Depression and Anxiety 23:331,339, 2006. © 2006 Wiley-Liss, Inc. [source] Indicators of pretreatment suicidal ideation in adults with major depressive disorderACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010D. W. Morris Morris DW, Trivedi MH, Husain MM, Fava M, Budhwar N, Wisniewski SR, Miyahara S, Gollan JK, Davis LL, Daly EJ, Rush AJ. Indicators of pretreatment suicidal ideation in adults with major depressive disorder. Objective:, In order to evaluate the presence of treatment emergent suicidal ideation (SI), it becomes necessary to identify those patients with SI at the onset of treatment. The purpose of this report is to identify sociodemographic and clinical features that are associated with SI in major depressive disorder (MDD) patients prior to treatment with a selective serotonin reuptake inhibitor. Method:, This multisite study enrolled 265 out-patients with non-psychotic MDD. Sociodemographic and clinical features of participants with and without SI were compared post hoc. Results:, Social phobia, bulimia nervosa, number of past depressive episodes, and race were independently associated with SI by one or more SI measure. Conclusion:, Concurrent social phobia and bulimia nervosa may be potential risk factors for SI in patients with non-psychotic MDD. Additionally, patients with more than one past depressive episode may also be at increased risk of SI. [source] Self-help treatments for disorders of recurrent binge eating: a systematic reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2006S. C. Stefano Objective:, To evaluate self-help interventions for patients with binge eating disorder (BED) and bulimia nervosa (BN), tested in randomized controlled trials, and compared with waiting list or any other type of control group. Methods:, A systematic review including quality appraisal was conducted of randomized controlled trials, using self-help techniques in patients with BED and/or BN. Six databases were searched during the period between January 1994 and June 2004. Results:, A total of 2686 articles were identified, 1701 abstracts were evaluated in detail and, nine studies fulfilled the inclusion criteria for this review. All studies indicated that patients treated with active interventions had a reduced number of binge eating episodes at end of treatment. Conclusion:, The results support self-help interventions but shall be interpreted with caution. Because of the small number of studies using self-help techniques for BED and BN, further larger randomized, multi-center controlled studies that apply standardized inclusion criteria, evaluation instruments and self-help materials, are needed. [source] Change processes in residential cognitive therapy for bulimia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 5 2010Asle Hoffart Abstract The purpose of the study was to examine the relationships of process variables derived from the cognitive model of bulimia nervosa (BN) and weekly outcome. The participants were 39 patients with BN or subthreshold bulimia consecutively admitted to an inpatient treatment program for bulimia. Theory-derived process and outcome variables were measured repeatedly during the course of therapy with a gap of a week between each measurement. The data were analysed with time series methods (ARIMA). Weekly variations in the process variables: self-efficacy about resisting binge eating, dysfunctional beliefs, negative affect and positive affect influenced variations in subsequent outcome, whereas weekly outcome did not influence subsequent process. These results are consistent with the cognitive model of BN and suggest that self-efficacy, dysfunctional beliefs, negative affect and positive affect are potential targets for treatment that need further investigation. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Meta-analysis on drugs in people with eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 4 2009Ana Calero-Elvira Abstract Objective The aim of this study was to examine whether drug use (DU) is higher in people with eating disorders (EDs) compared to a healthy control group and to perform a meta-analysis on the literature related to DU in people with EDs. Method We searched electronic databases (Medline, PsycINFO, Web of Science and CINAHL) and reviewed studies published from 1994 to August, 2007, in English, German or Spanish. A total of 16 papers fulfilled the inclusion criteria and were included. Results The general meta-analysis revealed a negligible albeit significant effect size (0.119, p,<,.05). Risk was found to be higher in bulimia nervosa (BN, ,,=,0.462, p,=,,<,.001), smaller in binge eating disorder (,,=,0.14, p,<,.05) and non-significant in anorexia nervosa (AN, ,,=,,.167, p,=,.070). Conclusions The differential risk observed in patients with BN might be related to differences in temperament or might be the result of reward sensitization. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Cognitive-behavioural therapy for individuals with bulimia nervosa and a co-occurring substance use disorderEUROPEAN EATING DISORDERS REVIEW, Issue 2 2009Robyn Sysko Abstract A significant percentage of individuals with bulimia nervosa (BN) also can be diagnosed with a co-occurring substance use disorder (SUD). Although studies have addressed the frequency of overlap between the disorders, etiology and shared personality traits, limited research is available about the treatment of these comorbid patients. Adapting cognitive-behaviour therapy (CBT) to serve as an integrated treatment for patients with both BN and a SUD is a viable option, as studies of CBT suggest that this form of treatment is efficacious for both disorders independently. The shared strategies in CBT for BN and SUDs facilitate the development of a combined treatment for individuals with both disorders with the addition of modules designed to address some common features of these disorders, such as motivation, difficulty with interpersonal relationships, reward sensitivity and impulsivity. Future research should begin to evaluate the efficacy of an integrated CBT in treating individuals with BN and a SUD. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Are Anorexia nervosa and bulimia nervosa separate disorders?EUROPEAN EATING DISORDERS REVIEW, Issue 1 2009Challenging the, transdiagnostic' theory of eating disorders Abstract Background Anorexia nervosa (AN) and bulimia nervosa (BN) are classified as separate and distinct clinical disorders. Recently, there has been support for a transdiagnostic theory of eating disorders, which would reclassify them as one disorder. Objective To determine whether AN and BN are a single disorder with one cause or separate disorders with different causes. Method Hill's Criteria of Causation were used to test the hypothesis that AN and BN are one disorder with a single cause. Hill's Criteria of Causation demand that the minimal conditions are needed to establish a causal relationship between two items which include all of the following: strength of association, consistency, temporality, biological gradient, plausibility, coherence, experimental evidence and analogy. Results The hypothesis that AN and BN have a single cause did not meet all of Hill's Criteria of Causation. Strength of association, plausibility, analogy and some experimental evidence were met, but not consistency, specificity, temporality, biological gradient, coherence and most experimental evidence. Conclusions The hypothesis that AN and BN are a single disorder with a common cause is not supported by Hill's Criteria of Causation. This argues against the notion of a transdiagnostic theory of eating disorders. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Personality traits and self-injurious behaviour in patients with eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 4 2008Jennie Ahrén-Moonga Abstract The interest in different aspects of personality and the neuropsychological basis for behaviour in eating disorder patients has increased over the last decade. The present study aims at exploring personality traits, self-injurious behaviour (SIB) and suicide attempts in a group of severely ill eating disorder patients. Patients with eating disorders (N,=,38) and age-matched controls (N,=,67) were examined concerning self-reported personality traits by means of the Karolinska scales of personality (KSP). Psychosocial history and SIB was collected from medical records. Depression was rated by means of the Beck Depression Inventory (BDI). Results indicated significantly higher anxiety-related and detachment traits in both anorexia nervosa (AN) and bulimia nervosa (BN) patients and higher hostility in BN patients than controls. No specific personality traits could be defined as typical for self-injurious or suicidal behaviour. The AN group was lower than the BN group on scales measuring impulsivity, guilt and anxiety. Furthermore, presence of SIB and suicide attempts was more frequent among the BN patients. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Getting better byte by byte: a pilot randomised controlled trial of email therapy for bulimia nervosa and binge eating disorder,EUROPEAN EATING DISORDERS REVIEW, Issue 2 2008Paul Robinson Abstract One hundred and ten people in an university population responded to emailed eating disorder questionnaires. Ninty-seven fulfilling criteria for eating disorders (bulimia nervosa (BN), binge eating disorder (BED), EDNOS) were randomised to therapist administered email bulimia therapy (eBT), unsupported Self directed writing (SDW) or Waiting list control (WLC). Measures were repeated at 3 months. Diagnosis, Beck depression inventory (BDI) and Bulimia investigatory test (BITE) scores were recorded. Follow-up rate was 63% and results must be interpreted cautiously. However significantly fewer participants who had received eBT or SDW fulfilled criteria for eating disorders at follow up compared to WLC. There was no significant difference between eBT and SDW in the analysis of variance (ANOVA), although in separate analyses, eBT was significantly superior to WLC (p,<,0.02) and the difference for SDW approached significance (p,=,0.06). BDI and BITE scores showed no significant change. For eBT participants there was a significant positive correlation between words written and improvement in BITE severity score. BN, BED and EDNOS can be treated via email. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Personality disorders in 545 patients with eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 2 2008*Article first published online: 5 DEC 200, Kristine Godt Abstract Objective Previous research on the prevalence of personality disorders in patients with eating disorders varies greatly in findings, but a general understanding seem to exist that personality disorders are rather common among eating-disordered patients. The present investigation is aimed at establishing the prevalence of DSM III-R or DSM IV personality disorders in a large population seeking treatment for eating disorders. Method Five hundred and forty-five patients with DSM IV- eating disorders have been evaluated using the structured clinical interview for DSM III-R or IV-Axis II and the eating disorder examination. Results The 29.5% of the population have one or more personality disorders according to DSM III-R or DSM IV criteria. Personality disorders, and specifically borderline personality disorder, are significantly more common in patients with bulimia nervosa. Discussion The proportion of eating-disordered patients with co-morbid personality disorder may not be as large as often found in studies. This challenges the understanding of a strong overall connection between the two groups of disorder; however, the connection seems to exist in subsets of eating disorder samples. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] The needs of carers of patients with anorexia and bulimia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 1 2008Holmer Graap Abstract Objective This study aims to assess the degree of distress and the need for support of carers of patients with anorexia and bulimia nervosa (BN). Methods Thirty-two carers filled out the General Health Questionnaire (GHQ-12) and the Burden Inventory (BI). In addition, they were interviewed with a semi-structured research interview, the Carers' Needs Assessment (CNA), to assess relevant problem areas as well as the needs for helpful interventions. Patients were interviewed with the Eating Disorder Examination (EDE) to assess the severity of the eating disorder. All patients met criteria for anorexia (n,=,16) or BN (n,=,16) according to DSM-IV criteria. Results The mean duration of illness was 5.6 years. The mean age of the carers was 41 years. Most of the carers were mothers or partners. In the CNA we found high numbers of problems as well as high numbers of needed interventions. The most frequently mentioned problem area was ,disappointment caused by the chronic course of the illness, concerns about the patient's future' and the most frequently reported need for support was ,counselling and support by a professional'. In three problem areas carers of persons suffering from anorexia nervosa (AN) reported significantly higher scores than carers of persons suffering from BN. Conclusions Our results suggest that carers themselves have high levels of needs which are usually not addressed in clinical practice. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Eating disorder not otherwise specified in an inpatient unit: the impact of altering the DSM-IV criteria for anorexia and bulimia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 5 2007Riccardo Dalle Grave Abstract Objective To evaluate (1) the Eating Disorder Not Otherwise Specified (EDNOS) prevalence in an eating disorder inpatient unit; (2) the impact of altering the diagnostic criteria for anorexia nervosa and bulimia nervosa on the prevalence of EDNOS. Method One hundred and eighty six eating disorder patients consecutively hospitalised were included in the study. The prevalence of anorexia nervosa, bulimia nervosa and EDNOS was evaluated with the Eating Disorder Examination (EDE). The EDNOS prevalence was recalculated after the alteration of three diagnostic criteria for anorexia nervosa and one for bulimia nervosa. Results Seventy eight patients (41.9%) met the diagnostic criteria for anorexia nervosa, 33 (17.8%) for bulimia nervosa and 75 (40.3%) for EDNOS. The alteration of the DSM-IV diagnostic criteria reduced the prevalence of EDNOS to 28 cases (15%). Conclusion EDNOS is a very frequent diagnostic category in an inpatient setting. Altering the diagnostic criteria for anorexia nervosa and bulimia nervosa reduced significantly the prevalence of EDNOS. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] The co-morbidity of eating disorders and anxiety disorders: a reviewEUROPEAN EATING DISORDERS REVIEW, Issue 4 2007Jessica M. Swinbourne Abstract Objective To critically review the literature examining the co-morbidity between eating disorders and anxiety disorders. Method A review of the literature on the co-morbidity between anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified and the anxiety disorders of OCD, PTSD, social anxiety, GAD, panic and agoraphobia. Results Of the empirical studies undertaken, it is clear that anxiety disorders are significantly more frequent in subjects with eating disorders than the general community. Researchers have shown that often anxiety disorders pre-date eating disorders, leading to a suggestion that early onset anxiety may predispose individuals to developing an eating disorder. To date however, the research presents strikingly inconsistent findings, thus complicating our understanding of eating disorder and anxiety co-morbidity. Furthermore, despite indications that eating disorder prevalence amongst individuals presenting for anxiety treatment may be high, there is a distinct lack of research in this area. Discussion This review critically examines the available research to date on the co-morbidity of eating disorders and anxiety disorders. Some of the methodological limitations of previous research are presented, in order to highlight the issues which warrant further scientific investigation in this area. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Premature termination of treatment in an inpatient eating disorder programmeEUROPEAN EATING DISORDERS REVIEW, Issue 4 2007Philip C. Masson Abstract This retrospective study was conducted to explore rates, timing and predictors of two forms of premature termination of treatment (PTT) in an inpatient eating disorders programme: patient dropout (DO) and administrative discharge (AD). A chart review was conducted to obtain demographic, Eating Disorder Inventory-2 (EDI-2), and Resident Assessment Instrument-Mental Health (RAI-MH) data for 186 patients being treated for bulimia nervosa (BN), anorexia nervosa (AN), or eating disorder not otherwise specified (EDNOS). Overall, of the 37.6% of patients who terminated treatment prematurely, 22.1% of patients dropped out, and 15.5% of patients were administratively discharged. Time at which discharge occurred was found to be associated with the type of premature termination. The presence of DSM-IV Axis-I comorbidity was found to be the only factor associated with an increased risk of being administratively discharged. No factors were predictive of patients dropping out of treatment. The findings support the notion that AD and patient DO are different events that may have different factors influencing their rates and timing. Implications for future research and programme planning are discussed. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] A Dutch day treatment program for anorexia and bulimia nervosa in comparison with internationally described programsEUROPEAN EATING DISORDERS REVIEW, Issue 2 2007M. W. Lammers Abstract A Dutch day treatment program for patients with anorexia and bulimia nervosa is described and compared to intensive day treatment programs for patients with eating disorders outlined in international literature. The 5-day program is described in terms of its general characteristics, intended outcome and specific treatment interventions. Along these parameters it is compared to the programs found in a systematic literature search of day hospitalization programs for eating disorders. Global inspection shows a lot of similarities between all the programs. Looking more closely, also many important differences exist (concerning, e.g. treatment duration, intensity of treatment, theoretical orientation, goals of treatment and weight gain regime). Because of the differences, it is hard to compare outcome data between centres. Besides, on many of these dimensions, the literature does not yet tell us unambiguously what is best for our patients. Therefore, it is necessary to keep the dialogue between treatment centres going. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Eating disorders and attachment: the effects of hidden family processes on eating disorders,EUROPEAN EATING DISORDERS REVIEW, Issue 2 2007Francoise Ringer Abstract Aim This study examined pattern of attachment in cohort of women with an eating disorder to determine what types of self-protective strategies they used, and further whether there was a specific relationship between strategy and diagnosis. Method The participants were 62 young women with an eating disorder (19 with anorexia nervosa, 26 with bulimia nervosa and 17 with bulimic anorexia). Attachment was assessed using the Adult attachment interview (AAI), classified using Crittenden's Dynamic-Maturational Method. Results The results indicated that all women with an eating disorder were anxiously attached. About half used an extreme coercive Type C strategy while most of the others combined coercion with an extreme dismissing Type A strategy. The content of the AAIs suggested lack of resolution of trauma or loss among the mothers and also of hidden family conflict between the parents. This in turn elicited extreme strategies for generating parent,child contingency from the daughters. Conclusions Central in almost all cases was the women's confusion regarding how parental behaviour was tied causally to their own behaviour. Questions are raised regarding the focus of treatment. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Assessing motivation to change in bulimia nervosa: the bulimia nervosa stages of change questionnaireEUROPEAN EATING DISORDERS REVIEW, Issue 1 2007Esteve Martinez Abstract Objective To assess motivation to change in adolescent patients with bulimia nervosa through the Bulimia Nervosa Stages of Change Questionnaire (BNSOCQ), an instrument adapted from the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) already validated in anorexic patients. Method Subjects were 30 bulimia nervosa patients (mean age,=,16.3 years) who were receiving treatment at an eating disorders unit. The evaluation instruments were: the BNSOCQ, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI). The BNSOCQ was re-administered 1 week later to evaluate test-retest reliability. Results The BNSOCQ demonstrated good internal consistency (Cronbach's alpha,=,0.94) and one week test-retest reliability (Pearson's r,=,0.93). Negative significant correlations were found between the BNSOCQ and several EDI-2 scales (Pearson's r between ,0.51 and ,0.84) and the BDI (r,=,,0.74). Conclusion The study provides initial support for the reliability and validity of the BNSOCQ as a self-report instrument for assessing motivation to change in adolescents with bulimia nervosa. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] An exploratory investigation of the experiences of partners living with people who have bulimia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 6 2006Katherine Huke Abstract Objective This study aimed to explore partners' experiences of living as a couple with someone with bulimia nervosa. Method Transcripts of eight exploratory interviews with partners were analysed using Interpretative Phenomenological Analysis. Results Five superordinate themes emerged: (1) Living with the secrecy and deception; (2) Struggling to understand and find reasons; (3) Discovering your powerlessness; (4) ,It's like growing to live with it'; (5) Experiencing strengths and strains in the relationship. Discussion Living with someone with bulimia presents many challenges for partners. They struggle to understand what is happening, can find the secrecy difficult to live with, and are often left feeling powerless. However, partners also look to find ways of accepting and living with the bulimia. It is suggested that partners could be offered opportunities to access support, and that their perspectives could be a useful resource for therapeutic interventions. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Different changes of body-images in patients with anorexia or bulimia nervosa during inpatient psychosomatic treatmentEUROPEAN EATING DISORDERS REVIEW, Issue 2 2006Dieter Benninghoven Abstract Background Changes of perceptual body size distortion and body dissatisfaction during inpatient psychosomatic treatment were assessed. Differences between patients with anorexia and bulimia nervosa were compared. Methods Forty-one female patients with anorexia and 37 with bulimia nervosa were examined at beginning and end of an inpatient psychosomatic treatment. Body images were assessed by the somatomorph matrix and by the Eating Disorder Inventory (EDI-2). Results Both groups showed a distorted body size perception at the beginning of treatment. This decreased with the bulimia patients, with anorexia patients it largely remained in spite of a successful increase in weight. With bulimia patients body satisfaction improved, whereas it hardly changed with anorexia patients. Conclusion Bulimia patients were able to positively modify their body images. Treatment might have enabled patients with anorexia to maintain their level of body satisfaction and to tolerate a bigger perceived body image while they significantly gained weight. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Cognitive-behavioural therapy for adolescents with bulimia nervosa,EUROPEAN EATING DISORDERS REVIEW, Issue 1 2006G. Terence Wilson Abstract Psychological and pharmacological treatments for bulimia nervosa (BN) have been studied extensively in adults, but there are no published controlled treatment studies of adolescents with BN. One option for treating adolescents with BN is to adapt cognitive-behavioural therapy (CBT) for younger individuals. The rationale for developing CBT for adolescents with BN is three-fold: the efficacy of CBT for adult patients with BN, the efficacy of CBT in treating adolescents with other clinical disorders, and the conceptual fit between CBT and adolescent eating disorders. CBT should be tailored to the treatment of adolescents, with particular focus on domains of development, including: motivation, cognitive processing, interpersonal functioning, and family involvement. A recently described new version of CBT for BN (Fairburn, Cooper, & Shafran, 2003) is well-suited for adapting manual-based CBT from adults to adolescents. Future research should evaluate the efficacy of CBT for the treatment of adolescents with BN and related eating disorders. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Effect of self-monitoring on binge eating: treatment response or ,binge drift'?EUROPEAN EATING DISORDERS REVIEW, Issue 1 2006Tom Hildebrandt Abstract The current study aimed to determine if subjective bulimic episodes (SBEs) and objective bulimic episodes (OBEs) have different reactive effects to self-monitoring. Fourteen women with bulimia nervosa (57%) or binge eating disorder (43%) were diagnosed using the Eating Disorder Examination (EDE; version 12.0). During the 7-days post-interview, participants filled out daily self-monitoring records indicating the food consumed and any episodes of loss of control over eating. These records were reviewed and coded for OBEs and SBEs using the EDE coding scheme. Paired samples t -tests indicated that participants' average number of daily OBEs significantly decreased from baseline to the period of self-monitoring (t,=,2.41, p,<,0.05, Cohen's d,=,0.90), whereas there was a significant increase from baseline to self-monitoring in their average number of SBEs (t,=,,2.41, p,<,0.05, Cohen's d,=,0.86). Of the 12 participants who showed a decrease in OBEs, 75% showed a concurrent increase in SBEs. The data suggest that the reactivity of OBEs to minimal or brief interventions may in part be due to binge drift, or the reduction of OBEs at the expense of increasing SBEs. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Integrated psychodynamic therapy for bulimia nervosa and binge eating disorder: theory, practice and preliminary findingsEUROPEAN EATING DISORDERS REVIEW, Issue 6 2005Susan Murphy Abstract While there is a substantial evidence base for the use of more recently developed therapeutic approaches, there is very little evidence that psychodynamically based treatments are effective in treating bulimia nervosa or binge-eating disorder. Clinicians have suggested that such an approach should be supplemented with behavioural foci and that it should be time-limited. This paper outlines an integrative approach to the outpatient treatment of these eating disorders, where psychodynamic principles and practice are used in tandem with behavioural strategies, and presents preliminary data on behavioural changes among patients who undertake this programme. A case series design was used, employing this approach with a selected group of 21 female patients. Data are presented on failure to complete the programme, as well as changes in body mass index and frequency of bingeing and vomiting. All of the 21 patients completed the programme, though 5 were lost to the study by the last follow-up point. Those who completed the programme had a stable body mass index, but showed clinically and statistically significant reductions in bulimic symptoms. These preliminary findings indicate that the bulimic disorders can be treated effectively using a psychodynamic approach that is integrated with behavioural techniques and that has time limits. While further research is needed to support this conclusion, it appears to be important to use a more integrative psychodynamic approach than is commonly used. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Care provision for patients with eating disorders in Europe: what patients get what treatment where?EUROPEAN EATING DISORDERS REVIEW, Issue 3 2005Matthias Richard Abstract In this paper, we report on the similarities and differences between patients with eating disorders and the services provided to them across 80 centres participating in a European collaboration (COST Action B6). Differences in patient characteristics as well as differences in treatment regimen, especially length of treatment, are described. The relationship between patient characteristics, treatment setting and length of treatment is investigated by multilevel analysis. The findings show a rich diversity in service conditions and traditions across European countries. Patients with anorexia nervosa are mostly treated in inpatient settings, patients with bulimia nervosa are treated mostly as outpatients,with the exception of German-speaking countries. Day-patient settings were generally rare. Clinical characteristics of the patients,e.g. severity of symptoms or illness duration,contributed only little to the differences in treatment length (within as well as between centres), whereas organizational factors explained the largest proportion of between centre variability. The findings are discussed from a service research perspective. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] | ||||||||||||||||