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Disorders Association (disorders + association)
Selected AbstractsThe diagnosis of eating disorders in adults with learning disabilities: Conceptualisation and implications for clinical practiceEUROPEAN EATING DISORDERS REVIEW, Issue 5 2010Ceri J. Jones Abstract Objective The literature suggests that less attention has been afforded to eating disorders (EDs) in adults with learning disabilities (LDs) than in adults of normal intellect. This review aimed to examine the methods, prevalence and implications of an ED diagnosis in adults with LDs. Method Key texts, journals and online databases were searched for literature examining disordered eating in adults with LDs. Results A review of the extant literature revealed that a range of dysfunctional eating behaviours have been classified as ,eating disorders' and highlighted a lack of clarity about the distinction between feeding and EDs. A small body of research suggests that some individuals with LDs show the emotional and cognitive characteristics of typical EDs. Discussion The lack of consensus about conceptualisation, assessment, diagnosis and treatment of EDs in individuals with LDs needs to be addressed in order to aid awareness and enhance clinical approaches for this population. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [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] Quality assurance of specialised treatment of eating disorders using large-scale internet-based collection systems: Methods, results and lessons learned from designing the Stepwise databaseEUROPEAN EATING DISORDERS REVIEW, Issue 4 2010Andreas Birgegård Abstract Computer-based quality assurance of specialist eating disorder (ED) care is a possible way of meeting demands for evaluating the real-life effectiveness of treatment, in a large-scale, cost-effective and highly structured way. The Internet-based Stepwise system combines clinical utility for patients and practitioners, and provides research-quality naturalistic data. Stepwise was designed to capture relevant variables concerning EDs and general psychiatric status, and the database can be used for both clinical and research purposes. The system comprises semi-structured diagnostic interviews, clinical ratings and self-ratings, automated follow-up schedules, as well as administrative functions to facilitate registration compliance. As of June 2009, the system is in use at 20 treatment units and comprises 2776 patients. Diagnostic distribution (including subcategories of eating disorder not otherwise specified) and clinical characteristics are presented, as well as data on registration compliance. Obstacles and keys to successful implementation of the Stepwise system are discussed, including possible gains and on-going challenges inherent in large-scale, Internet-based quality assurance. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Anorexia nervosa: Towards an integrative neuroscience modelEUROPEAN EATING DISORDERS REVIEW, Issue 3 2010A. Hatch Abstract We reviewed the evidence for emotion-related disturbances in anorexia nervosa (AN) from behavioural, cognitive, biological and genetic domains of study. These domains were brought together within the framework of an integrative neuroscience model that emphasizes the role of emotion and feeling and their regulation, in brain organization. PsychInfo and Medline searches were performed to identify published peer-reviewed papers on AN within each domain. This review revealed evidence for ,Emotion', ,Thinking and Feeling' and ,Self-regulation' disturbances in AN that span non-conscious to conscious processes. An integrative neuroscience framework was then applied to develop a model of AN, from which hypotheses for empirical investigation are generated. We propose that AN reflects a core disturbance in emotion at the earliest time stage of information processing with subsequent effects on the later stages of thinking, feeling and self-regulation. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Towards an ecology of eating disorders: Creating sustainability through the integration of scientific research and clinical practiceEUROPEAN EATING DISORDERS REVIEW, Issue 1 2010David Clinton The field of eating disorders is currently at a crossroads and faces important challenges of sustainability. These challenges include problems with the current diagnostic classification of eating disorders and the divide between scientific research and clinical practice. If not addressed, there is a danger that the field will fail to evolve adaptively, risking increased stagnation and reduced relevance. To meet these challenges, researchers and clinicians must work toward a more holistic ecology of eating disorders based on the interaction of theory, research and practice. The present paper proposes six steps towards increased sustainability based on developing clinically relevant diagnosis, using systematic quality assurance, expanding the scope of treatment research and the definition of evidence, promoting therapist development, as well as stimulating diversity and discourse. If we rise to the occasion and face these challenges, then we will be better equipped to meet the evolving needs of clinicians, researchers, and most importantly patients. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Atypical antipsychotics and anorexia nervosa: A reviewEUROPEAN EATING DISORDERS REVIEW, Issue 1 2010Rebecca F. McKnight Abstract Background There is currently mixed opinion regarding the value of using atypical antipsychotics to treat anorexia nervosa (AN). Aims To evaluate the literature on the use of atypical antipsychotics in AN. Method A review of all studies and clinical guidelines published before September 2009 involving use of an atypical antipsychotic in patients with AN. Analysis is by narrative synthesis. Results Forty-three publications or study protocols were found, including four randomized-controlled trials, five open-label trials and 26 case reports. The most studied drugs were olanzapine, quetiapine and risperidone. Atypical antipsychotics appear safe and there is some evidence of positive effects on depression, anxiety and core eating disordered psychopathology in patients with anorexia nervosa. Currently there is insufficient evidence to confirm atypical antipsychotics enhance weight gain in this setting. Conclusions Further high quality evidence is needed in this area in order to provide practical guidance to clinicians. However, the main challenge is to persuade adequate numbers of AN patients to participate in research trials. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association. [source] A systematic review of impulsivity in eating disordersEUROPEAN EATING DISORDERS REVIEW, Issue 6 2009Samantha E. Waxman Abstract The purpose of this paper is to conduct a systematic review of the current literature that examines impulsivity in individuals with eating disorders (ED). Studies were obtained from Embase, Pubmed and Psycinfo, and were included if they assessed impulsivity in individuals over 18 years of age with an ED diagnosis and published in the last 10 years. The methodological quality of the studies was rated. Twelve studies were included in this review, with methodological quality varying across studies. Findings suggest that impulsivity is best assessed multi-modally, with a combination of self-report, behavioural and physiological measures. In general, impulsivity was found to differentiate individuals with EDs from controls, as well as across diagnostic subtypes. The current findings have important clinical implications for our understanding and treatment of both impulsivity and eating disorders. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 6 2009M. I. Berman Abstract The aim of the present study was to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) for treatment of anorexia nervosa (AN) using a case series methodology among participants with a history of prior treatment for AN. Three participants enrolled; all completed the study. All participants had a history of 1,20 years of intensive eating disorder treatment prior to enrollment. Participants were seen for 17,19 twice-weekly sessions of manualized ACT. Symptoms were assessed at baseline, post-treatment and 1-year follow-up. All participants experienced clinically significant improvement on at least some measures; no participants worsened or lost weight even at 1-year follow-up. Simulation modelling analysis (SMA) revealed for some participants an increase in weight gain and a decrease in eating disorder symptoms during the treatment phase as compared to a baseline assessment phase. These data, although preliminary, suggest that ACT could be a promising treatment for subthreshold or clinical cases of AN, even with chronic participants or those with medical complications. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] User satisfaction with services in a randomised controlled trial of adolescent anorexia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 5 2009Peter Roots Abstract Background User satisfaction is a neglected outcome in adolescent anorexia nervosa especially since the relative effectiveness of different treatments is unclear. It may also affect clinical outcome. Aims To assess young person's and parents' satisfaction with CAMHS outpatient, specialist outpatient and inpatient treatment received in a large randomised controlled trial. Method Quantitative and qualitative analysis of questionnaire data from 215 young people and their parents followed by focus groups to further explore emerging themes. Results High levels of satisfaction were reported, more amongst parents than young people and with specialist services. Both young people and carers strongly valued clinical relationships that involved being listened to and understood. They valued the expertise of specialist rather than generic CAMHS services. There were polarised views on the influence of other young people in inpatient units. Parents in particular valued support for themselves, both from professionals and other parents and felt this, and sibling support was lacking. Conclusions All comprehensive CAMH services are able to provide the good generic psychotherapeutic skills that parents and young people value so highly. However, generic CAMHS struggle to provide the demanded level of expertise and more specialised individual and family therapeutic interventions. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Appraisal of caregiving burden, expressed emotion and psychological distress in families of people with eating disorders: A systematic reviewEUROPEAN EATING DISORDERS REVIEW, Issue 5 2009Maria Jose Zabala Abstract The purpose of this review is to appraise the literature regarding psychological distress, burden and expressed emotion (EE) in caregivers of people with eating disorders (EDs). Electronic databases were searched up until October 2008. Selected studies contained carers of people with ED and employed one measure of burden, EE or psychological distress. Twenty studies were identified measuring psychological distress burden and EE. Most of the studies examined these features in families of anorexic patients. The majority of the studies found high levels of psychological distress, burden and EE in this population. Only few studies included a control group. Carers of people with ED presented high levels of psychological distress and burden. ED carers tend to have levels of EE resembling that found in families of depressed patients, rather than schizophrenic patients. There is some evidence (particularly for EE) that these factors can impact the outcome of ED. Copyright © 2009 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] A 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] The effect of attentional training on body dissatisfaction and dietary restrictionEUROPEAN EATING DISORDERS REVIEW, Issue 3 2009Evelyn Smith Abstract The aim of the present study is to investigate the effect of attentional training towards shape, weight and food related information on body dissatisfaction and dietary restriction. A total of 98 female participants were trained to attend to negative shape/weight words, positive shape/weight words, negative (high calorie) food words, positive (low calorie) food words or neutral words. Subsequently, a body image challenge was presented and participants' body dissatisfaction and dietary restriction were measured. Results indicated that negative shape/weight attentional biases exacerbated body dissatisfaction and a bias towards negative food words intensified dietary restriction. The study provides evidence for specificity in the effects of attentional biases and supports the notion that attentional training may be a useful component in interventions to improve body image and reduce dieting. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Let eating disorder patients decide: Providing choice may reduce early drop-out from inpatient treatmentEUROPEAN EATING DISORDERS REVIEW, Issue 3 2009Walter Vandereycken Abstract Premature drop-out from treatment is a highly prevalent phenomenon among eating disorder (ED) patients. In a specialized inpatient treatment unit a major change was made in the admission strategy in 2001, giving a maximum of personal choice to the patients. A quasi-experimental research was carried out comparing 87 patients treated till 2000 (,old' strategy) with 87 patients treated from 2001 on (,new' strategy). The results indicate that the provision of choice at the beginning of treatment significantly reduced drop-out during the first weeks of inpatient treatment. No differences between both strategies on later drop-out and weight change (in anorexia nervosa patients) during inpatient treatment were found. The results are discussed in the light of the importance placed on dynamics of personal choice, autonomy and volition within the framework of the self-determination theory (SDT). 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] Binge eating disorder pharmacotherapy clinical trails,who is left out?EUROPEAN EATING DISORDERS REVIEW, Issue 2 2009Anna I. Guerdjikova Abstract Objective This report examined the characteristics of subjects interested in binge eating disorder (BED) pharmacotherapy trails who were ineligible for participation. Methods Data on 2685 potential subjects interested in participating in five different placebo-controlled monotherapy trails of BED were analysed. Results Of the 2685 potential subjects, 1230 (45.8%) were ineligible because they did not meet entry criteria, 586 (21.8%) were eligible for participation, 531 (19.8%) were not interested in the study and 338 (12.6%) were not contacted. Among the 1230 ineligible candidates, 525 (42.7%) were taking exclusionary psychotropic medication, 305 (24.8%) did not meet specified BED criteria, 157 (12.7%) were out of the required age (n,=,83) or weight (n,=,74) range, 212 (17.2%) had prohibited medical (n,=,78) or psychiatric (n,=,134) disorders and 31 (2.5%) were participating in weight loss programmes. Discussion Given the complexity of BED, future pharmacotherapy studies should examine a broader range of subjects, including subjects with subthreshold forms of BED, those with comorbid disorders and elderly subjects. Copyright © 2008 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] Pros and cons of using the mental health act for severe eating Disorders in AdolescentsEUROPEAN EATING DISORDERS REVIEW, Issue 1 2009Agnes Ayton Abstract Background In England and Wales the compulsory treatment of young people with severe eating disorders is controversial. There is a concern that such treatment may impair patient autonomy and negatively influence the outcome. In this study, based in a specialist hospital, we compared patients treated under parental consent with those detained under the Mental Health Act: their characteristics and outcome up to 12 months after discharge. Results 34 patients were informal (treated under parental consent) (age: 16.2,±,1.3 years) and 16 were treated under Section 3 of the Mental Health Act (age: 16.2,±,1) in a 3-year period. Detained patients had an earlier age of onset (12.2,±,5 vs. 14.3,±,1.8) and more previous hospitalisation. On admission, their psychosocial functioning (Children's Global Assessment Scale (C-GAS): 13.6,±,2 vs. 26.9,±,9; Health of the Nation Outcome Scale for Children and Adolescents (HONOSCA): 41.7,±,5 vs. 31.9,±,5) were worse than voluntary patients', they had a higher level of co-morbid depression (BDI: 38.1,±,15.6 vs. 26.6,±,12.4) and a higher rate of suicidal behaviour. All physical and psychosocial measures improved substantially and clinically significantly by discharge and there was no statistically significant difference at this stage between the two patient groups. Two informal patients died within a year after discharge (6.3%), but there were no deaths amongst the detained patients. Comments In contrast with previous findings in adults, the outcome for detained patients was similar to that for informal patients, despite the former having more severe presentation on admission. There was no evidence of higher mortality in the detained group. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Treatment emergent mania responding to valproate in a Chinese female adolescent population with eating disorders: A case seriesEUROPEAN EATING DISORDERS REVIEW, Issue 6 2008Phern Chern Tor Abstract Eating disorders are commonly associated with depressive symptoms. In an adolescent and binge eating population fluoxetine is commonly used to treat co-morbid depression associated with eating disorders. In some patients this may precipitate treatment emergent mania (TEM). Risk factors in the adolescent population include being older, female, having a longer duration of illness, more previous mood episodes, a higher prevalence of subclinical hypothyroidism, early-onset anxiety and recent exposure to a mood-elevating agent. Diagnosis and management of these co-morbid conditions is challenging due to the overlapping symptomatology and the adverse effects of both conditions complicating pharmacological management. This is illustrated with three cases in a Chinese female adolescent population that experienced TEM while on fluoxetine and responded to valproate. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Cross-cultural differences in the macronutrient intakes of women with anorexia nervosa in Australia and SingaporeEUROPEAN EATING DISORDERS REVIEW, Issue 6 2008Nerissa Li-Wey Soh Abstract Aim To compare the macronutrient intakes of women with and without anorexia nervosa (AN) across cultures. Method Participants were women with AN (n,=,39) and without AN (n,=,89) of North European and East Asian backgrounds recruited in Australia and Singapore. Energy and the percentage energy contributed by protein (%protein), fat (%fat) and carbohydrate (%CHO) were assessed from participant's diet histories and analysed in terms of cultural group, acculturation, socio-economic status (SES) and education level. Results AN status was associated with lower energy and higher %CHO. Greater %protein was associated with greater acculturation to Western culture and lower SES, but not AN. Greater %fat was associated with lower SES and lower acculturation in women with AN, but with higher acculturation in controls. Greater %CHO was also associated with higher SES. Conclusion The findings may represent Western diets' higher protein and fat contents, ,Western' knowledge of weight-loss diets, and affordability of low fat foods. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [source] The inpatient management of physical activity in young people with anorexia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 5 2008Sarah Davies Abstract This study investigates the management of physical activity in young inpatients with anorexia nervosa. Through telephone interviews and postal surveys inpatient units across the UK were asked about written documents regarding physical activity management, how they viewed healthy exercise, how they assessed physical fitness to engage in activity, the management approaches taken, provision of education and support around this issue and range of activities provided. Results indicated that a variety of approaches were taken, with little consensus between units, although the majority of approaches did involve some form of restriction, frequently determined by weight criteria. There were few substantial written documents to guide practice and a range of interpretations of healthy exercise. The findings are discussed and suggestions made for research to explore this area further and to inform the development of effective interventions. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Group motivational enhancement therapy as an adjunct to inpatient treatment for eating disorders: a preliminary study,EUROPEAN EATING DISORDERS REVIEW, Issue 4 2008Helen Y. Dean Abstract Difficulties in fostering eating disorder (ED) patients' motivations to overcome their illness are widely considered to be a major hurdle in the course of successful treatment. However, no previous study has assessed the use of interventions specifically designed to target poor motivation amongst patients with illnesses that are severe enough to warrant hospitalisation. Objective A brief Motivational Enhancement Therapy (MET) group programme for inpatient ED sufferers was developed and evaluated. Method Forty two consecutive inpatients were sequentially allocated to treatment groups. Twenty three inpatients completed a four session MET group programme in addition to routine hospital care. A control group of 19 participants completed treatment as usual (TAU). Results Despite an absence of significant differences between the MET and the TAU groups on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer term motivation and engagement, and to promote treatment continuation. Conclusion The results tentatively suggest that MET could be valuable for the treatment of inpatient eating disorder patients and further research is warranted. Copyright © 2007 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] Primary prevention of eating disorders: characteristics of effective programmes and how to bring them to broader disseminationEUROPEAN EATING DISORDERS REVIEW, Issue 3 2008Uwe Berger Abstract Objective Based upon the observation of advances in the primary prevention of eating disorders (ED), it is summarized that school-based programmes, focusing on risk factors for females with interactive elements, dissonance induction and booster sessions yield significant effects even under strong methodological conditions. However, beyond the presented research findings it remains often unclear, if and how programmes can be brought to a broader dissemination within a community, region or country. Method Introducing the programme PriMa (German school-based programme for the primary prevention of anorexia nervosa (AN) for girls up to the age of 12), we describe the process of programme evaluation (including 1.006 girls from 42 schools in Thuringia, Germany, who participated in a controlled study using a pre-post-design and a 3 months follow-up), programme implementation and development of follow-up programmes, including an intervention for boys and flanking secondary preventive actions (such as a telephone hotline). Results Using standardized measures, the girls in the intervention group of PriMa reported significant improvements in body self esteem, figure dissatisfaction, knowledge and eating attitudes. The teachers, who conducted the programme, felt well qualified and were evaluated significantly positive by their students. Based upon the PriMa evaluation, we established a comprehensive health promotion programme at 60 Thuringian schools within the last 3 years, which could function as a model of a fruitful cooperation between a governmental institution (Thuringian Ministry of Culture) and a research institution (University Hospital Jena). Conclusions Existing programmes have the potential for effective prevention of ED. To confirm these effects under ,real world conditions' within a given community will still be a great challenge that often requires methodological and organizational concessions and compromises. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Depressive tendencies and lower levels of self-sacrifice in mothers, and selflessness in their anorexic daughters,EUROPEAN EATING DISORDERS REVIEW, Issue 3 2008Eytan Bachar Abstract (1) To compare levels of selflessness (the tendency to ignore one's own needs and serve others') and asceticism of parents and daughters, in anorexic and control families. (2) To investigate the relationship between parents' depression and daughters' selflessness. Twenty-eight anorexic daughters and their 28 mothers and 23 fathers were compared to 29 control daughters and their 29 mothers and 28 fathers, participants were administered the Beck Depression Inventory, the Selflessness Scale, the asceticism scale of the Eating Disorder Inventory and the Structured Clinical Interview for DSM-IV. Anorexics' mothers showed significantly lower levels of selflessness and asceticism compared to control mothers; anorexic daughters showed significantly higher levels of selflessness and asceticism compared to control daughters. Depressive tendencies in anorexics' mothers were associated positively and significantly with their daughters' selflessness. The results support the clinical literature that depicts the anorexic daughters' readiness to sacrifice themselves for the family's needs. Clinical implications are drawn. Copyright © 2007 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] Metacognition in patients with anorexia nervosa, dieting and non-dieting women: a preliminary studyEUROPEAN EATING DISORDERS REVIEW, Issue 1 2008Rachel A. Woolrich Abstract Objective To explore metacognition in women with anorexia nervosa (AN), dieting and non-dieting women. Method A cross-sectional study between groups design compared women with AN (n,=,15), normal dieters (n,=,17) and non-dieters (n,=,18). A semi-structured interview was used to explore presence and content of explicit metacognitions and use of metacognitive control strategies. Results Explicit metacognitions and metacognitive control strategies were present in all three groups of women. There were group differences in amount and function of metacognitive activity and trends in the qualitative data suggested participants with AN believed that their thoughts were abnormal and uncontrollable. They used six metacognitive strategies more than control groups and were less successful at using thought re-appraisal and attending to body and others. Half of participants with AN reported using these strategies to deliberately make themselves feel worse. Discussion It is suggested that metacognitive activity may play a role in the maintenance of AN, particularly in reinforcing negative self-evaluations. 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] Are two informants better than one?EUROPEAN EATING DISORDERS REVIEW, Issue 6 2007Parent, child agreement on the eating styles of children who are overweight Abstract Aim It is currently unknown to what extent the view of a child with overweight on its' own eating behaviour converges with parental perception regarding this behaviour and how parent,child agreement is influenced by overweight status and age. Method Youngsters (N,=,498; range 7,15 years; 37% boys) referred for weight treatment to an outpatient University centre filled in the Dutch Eating Behaviour Questionnaire,child version (DEBQ-child version; Van Strien & Braet, unpublished work), prior to treatment, while their parents reported on their child's eating behaviour by completing the DEBQ-parent version (Braet & Van Strien, 1997). Results Parents scored significantly higher when reporting on the emotional eating and external eating behaviour of their child, while they scored lower for restrained eating (all p,<,0.001). Comparisons between the subscales of the DEBQ-parent version and the DEBQ-child version revealed significant positive correlations of r,=,0.45 for emotional eating, r,=,0.35 for external eating and r,=,0.36 for restrained eating (all p,<,0.01); convergence is lowest for the age group younger than 10 (p,<,0.05). Both versions of the DEBQ displayed low correlations with the degree of overweight of the child. Discussion Parents and children displayed moderate to good agreement with regard to emotional eating, external eating and restrained eating. However when only one perspective can be assessed, possible biases must be taken into account. In that case, the use of appropriate age-specific norms is indicated. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] | ||||||||||