The impact of a four‐month day treatment programme on alexithymia in eating disorders

High prevalence rates of alexithymia have been reported in eating‐disordered patients. The aim of this study was first to investigate whether a 4‐month day hospital treatment leads to a decrease in alexithymia in eating‐disordered patients and second to see whether alexithymia predicts short‐term outcome in this population. The Toronto Alexithymia Scale (TAS) and the Eating Disorder Inventory (EDI) were given to 47 patients with anorexia nervosa (n = 18), bulimia nervosa (n = 25) and eating disorders not otherwise specified (n = 4) respectively at the beginning and at the end of a 4‐month treatment programme. Comparison of pre‐ and post‐treatment scores showed significant declines in the EDI as well as in the TAS. However, baseline scores for alexithymia did not predict post‐treatment outcome. We conclude that even highly alexithymic patients benefit from psychological treatment which encourages understanding and expressions of emotion and also leads to significant reduction in eating disorder‐related symptoms. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.     

Personality disorders in patients in a day‐treatment programme for eating disorders

The present study examined the prevalence of DSM‐III‐R personality disorders (PDs) and levels of depressive symptoms in patients in a day‐hospital programme for eating disorders. Sixty‐five patients diagnosed with anorexia nervosa and bulimia nervosa were administered the Personality Diagnostic Questionnaire Revised (PDQ‐R), the Eating Disorder Inventory (EDI) and the Beck Depression Inventory (BDI). In total, 49.2 per cent of all patients had at least one PD diagnosis. No significant difference was found between patients with bulimia nervosa and anorexia nervosa. Eating Disorder patients with at least one PD had higher scores on the BDI and three EDI subscales compared to patients without a PD. In general, the prevalence of Personality Disorders in the present sample tended to be closer to results quoted by studies with eating‐disordered outpatients rather than inpatients. Axis I disorders may affect personality state measures. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.     

Effectiveness of day hospital treatment for anorexia nervosa and bulimia nervosa

The aim of this observational study was to examine the short‐term effectiveness of a structured, largely manualised day hospital treatment, as well as the stability of short‐term effects in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Eighty‐three patients, 47 with AN and 36 with BN, were assessed at pre‐treatment, at the end of the day hospital treatment and at follow‐up approximately one year after post‐treatment. Outcome measures were body mass index (BMI), disturbed eating attitudes and behaviours assessed by the Eating Disorder Inventory (EDI), frequency of bingeing and purging, and general psychopathology assessed by the Symptom Checklist‐90 (SCL‐90). At the end of the day hospital treatment, significant improvements could be found on all outcome variables (frequency of binge eating/vomiting/laxative abuse, BMI and core EDI‐subscales ‘drive for thinness’/‘bulimia’/‘body dissatisfaction’). Effect sizes were generally large (.74 > d < 2.44). The effects were maintained or improved until follow‐up (18 months). At follow‐up, 40.2% of AN patients and 40.4% of BN patients could be classified as remitted. General psychopathological impairment was also significantly reduced at post‐treatment and maintained until follow‐up. The results demonstrate both the short‐term effectiveness and long‐term stability of day hospital treatment in a large sample of patients with anorexia and BN. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.     

Eating disorders and concurrent psychopathology: a reconceptualisation of clinical need through Rasch analysis

Therapies for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS) take as their focus, perhaps of necessity, the eating disorder symptomatology. However, there is increasing evidence of comorbidity of psychopathological mechanisms (e.g. perfectionism, depression) with eating disorders which, left untreated, may diminish any therapeutic effects. Thus identifying the extent of comorbidity in an eating disorder population and assessing the relationship between psychopathological mechanisms and the eating disorder is important. Rasch analysis was applied to the findings from questionnaires (EDI‐2; SCL90‐R) completed by 105 female patients referred to an eating disorder unit. General psychopathology was found to be more indicative of ‘caseness’ than eating disorder psychopathology. In particular, interpersonal sensitivity, depression and mild interpersonal aspects of psychoticism emerged as important factors across eating disorders. The comorbidity of psychopathological mechanisms needs to be given consideration in the successful treatment of eating disorders. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

Motivation to change in adolescents with bulimia nervosa mediates clinical change after treatment

Several studies have related motivation to change and treatment response in adult patients with bulimia nervosa but there are no longitudinal studies analysing this relationship in adolescents. The objective was to determine whether motivation to change is related to clinical improvement after treatment in adolescent patients with bulimia nervosa. The Bulimia Nervosa Stages of Change Questionnaire, the Eating Disorders Inventory (EDI‐2) and the Beck Depression Inventory (BDI) were administered at the beginning of treatment to 40 adolescent patients with bulimia nervosa (DSM‐IV) (mean age = 16.2 years). Thirty‐one patients were re‐assessed after 6 months of treatment. The majority of clinical and psychological variables improved significantly at the second evaluation. There were significant correlations between initial motivation to change and improvement in number of binges and the EDI‐2 scales of Bulimia and Interoceptive Awareness. In the stepwise multiple linear regression analysis, which included initial motivation to change and other potential confounding variables such as age, BDI, duration of disorder and body mass index, only motivation to change was selected as a predictor of improvement in number of binges (standardized β coefficient = 0.45; p = 0.012) and of decrease on the Bulimia scale (standardized β coefficient = 0.43; p = 0.029). Regarding improvement in Interoceptive Awareness, only the BDI score was selected as an independent predictor (β coefficient = 0.58; p = 0.002). In conclusion, in adolescent patients receiving treatment for bulimia nervosa, improvement in bulimic symptomatology seems to be especially related to initial motivation to change. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Symptoms of obsessive-compulsive disorder in hospitalized eating disorder patients: A study using the maudsley obsessional-compulsive inventory (MOCI)

Thirty-one consecutive admissions with either anorexia or bulimia nervosa (DSM III R) were examined by the Maudsley Obsessional-Compulsive Inventory (MOCI). Nutritional status was documented by Body Mass Index (BMI), eating disorder psychopathology by the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI) and depression by the Beck Depression Inventory (Beck). MOCI scores were significantly higher than normative values, conflicting with previous reports using the same instrument, but supporting earlier studies which had employed the Leyton Obsessional Inventory (LOI). The MOCI score correlated with three subscales in the EDI, but none of the other measures. There were no significant differences in MOCI scores between anorexia and bulimia nervosa patients, or between patients with restricting or purging presentations. As the MOCI is a measure of obsessive-compulsive symtomatology, distinct both from those features of eating disorders which may resemble obsessional symptoms and from obsessional personality traits, the findings suggest a positive association of eating disorders with obsessivecompulsive disorder (OCD).     

The prevalence and psychological correlates of anorexia nervosa,bulimia nervosa and binge eating among 15‐year‐old students: a controlled epidemiological study

The present study reports on the prevalence of adolescent anorexia nervosa, bulimia nervosa and binge eating disorders. Also, the hypothesis by Slade (1982) suggesting ‘perfectionism’ and ‘general dissatisfaction’ as setting conditions for eating disorders was tested. A total of 678 15‐year‐old adolescents were screened, and those who scored above 10 on the ‘drive for thinness’ subscale on the Eating Disorder Inventory (EDI) were interviewed for suspected eating disorders. A gender‐ and age‐matched control group of low scores were also clinically interviewed. The interviewers were blind to whether individuals were suspected of having eating disorders or not. The Setting Conditions for Anorexia Nervosa Scale (SCANS) was used to test the setting condition hypothesis. Other variables included were the EDI subscales ‘Bulimia’ and ‘Body dissatisfaction’. Weight was calculated using the Body Mass Index. For the total material, we found 1.0 per cent with a binge eating disorder, 0.7 per cent with bulimia nervosa, 0.3 per cent with a bulimic subtype of anorexia nervosa and 0.7 per cent with subclinical bulimia nervosa. All subjects were girls. In addition, 3.5 per cent were considered ‘at risk’, of whom we identified 22 girls (3.2 per cent) and two boys (0.3 per cent). High scores on ‘perfectionism’ were unrelated to the presence of eating disorders. Controlling for ‘body dissatisfaction’, ‘general dissatisfaction’, on the other hand, was related to eating disorders and an ‘at‐risk’ condition. The prevalence figures in this age cohort equal those for older age groups. The weak support to the setting condition hypothesis may point to an inadequate instrument and not necessarily to a theoretically blind alley. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.     

Cognitive‐behavioural,fluoxetine and combined treatment for bulimia nervosa: short‐ and long‐term results

This study examined the short‐ and long‐term effectiveness of cognitive‐behavioural group treatment (CBT), pharmacological treatment with fluoxetine and combined treatment in patients with DSM‐III‐R bulimia nervosa. Fifty‐three patients were randomly assigned to the three conditions. Outcome measures were frequency of bingeing and purging, attitudes toward weight and shape, depression and self‐concept. Patients were followed for 1 year post‐treatment. Thirty‐five patients completed treatment. Drop‐out rates were 42 per cent for CBT, 25 per cent for the fluoxetine and 33 per cent for the combined condition. All treatments led to significant improvements in eating disorder symptoms and in other psychological disturbances between pre‐ and post‐treatment, which could be maintained at 1‐year follow‐up. Abstinence rates for completers were highest for CBT at both post‐treatment and follow‐up. The short‐ and long‐term results of this study do not favour the combined treatment in comparison to CBT alone. Cultural differences in health systems as well as in the acceptance of treatments offered in a treatment trial are discussed. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.     

Premature termination of treatment in an inpatient eating disorder programme

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.     

Symptom severity and treatment course of bulimic patients with and without a borderline personality disorder

There are contradictory results concerning the frequency of borderline personality disorder (BPD) in bulimic patients and its impact on eating pathology and treatment outcome. We evaluated 240 patients with bulimia nervosa using EDI‐2, SIAB and SCL‐90‐R. Only a minority of patients had a BPD (13.8%). There were no differences in binging or purging behaviour between patients with and without BPD, but borderline patients had significantly more feelings of ineffectiveness and more disturbances in interoceptive awareness. Bulimic patients with BPD showed significantly more general psychopathology. Although, BPD patients started with higher levels of pathology, there were similar reductions of symptoms over the course of treatment in both groups. Psychotherapy in bulimic patients with a BPD has to focus not only on eating pathology but also on aspects that are caused by the severe personality disturbance. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

EDI results of Japanese and German women and possible sociocultural explanations

The goal of this study was to compare data for women with bulimia nervosa and for a healthy control group both in Japan and Germany. These data were obtained using the Eating Disorder Inventory (EDI‐2). In Germany, EDI‐2 data and BMI values were collected from 102 nurses in training, 57 female medical students, and 29 patients with bulimia nervosa. In Japan, data were gathered from 243 female ‘short college’ students and 20 patients with bulimia nervosa. The Japanese non‐clinical control group showed significantly higher values on nearly all EDI scales than the German control group. They had a markedly higher drive for thinness, though their BMI values were lower. When the German and the Japanese bulimia nervosa patients were compared, the Japanese patients also showed higher values than their German counterparts on three EDI scales, but these differences were negligible. It is suggested that sociocultural factors in Japan, in particular a significant dependency on social norms, may contribute to the high EDI values. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

A brief questionnaire to assess readiness to change in adolescents with eating disorders: its applications to group therapy

There has been little attention paid to the motivation of adolescents entering treatment for an eating disorder. The present study investigates a questionnaire designed to assess readiness to change based on Prochaska and DiClemente's model. The Motivational Stages of Change for Adolescents Recovering from an Eating Disorder (MSCARED) was examined with 34 adolescent girls attending one of six eating disorder treatment groups. The assessment prior to, and at the termination of the groups, included the MSCARED; Children's Depression Inventory (CDI); Perceived Body Image Scale (PBIS); Eating Disorders Inventory (EDI‐2—pre‐only); and, the Group Evaluation Form (post‐only). The MSCARED proved to be easy for youth to complete, reliable, and demonstrated concurrent and predictive validity. While the group was beneficial to girls at each stage of change, greater gains were reported by those who started at a more advanced stage. The clinical and research implications of measuring motivation to change are discussed. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.     

Changes in eating disorder characteristics over the years

Since 1980, the diagnostic criteria of patients with eating disorders (ED) have changed over the years. Are these changes also expressed in the clinical features of the ED patients? A cross‐sectional sample was drawn consisting of 100 consecutive female patients' files diagnosed with anorexia nervosa (AN) and bulimia nervosa (BN) and bulimia nervosa and admitted at an inpatient unit from the first of January 1990, 2000, and 2010, respectively. Several reliable and well‐validated questionnaires (Eating Disorder Inventory, Body Attitude Test, Symptom Checklist, and the Beck Depression Inventory) were administered and scores were compared. The ratio AN/BN remained the same (65/35). No differences were found between the three cohorts except for depression, which increased over the years. This pattern is the same for the subsamples of anorexia nervosa and bulimia nervosa. Specific characteristics of eating disorder pathology did not change across time.     

An evaluation of the Oxford Adult Eating Disorders Service between 1994 and 2002

This paper examines the outcomes of 631 patients who were assessed at the Oxford Adult Eating Disorders Service between May 1994 and December 2002. After treatment, significant improvements were reported across the total sample for body mass index (BMI), the Beck Depression Inventory, the Beck Anxiety Inventory and the Robson Self Concept Questionnaire. Significant improvements were also reported for all measures of the Eating Disorder Questionnaire (EDE) and for all measures of the Eating Disorder Inventory (EDI) except for perfectionism. Patients with anorexia nervosa showed improvements in both BMI and associated psychopathology. Patients with bulimia nervosa showed a reduction in the number of self‐induced vomiting occasions and the number of objective binges and improvements in the associated psychopathology. Further research is required to identify factors associated with improvements in symptomatology. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Validating the eating disorder inventory (EDI‐2) in two danish samples: A comparison between female eating disorder patients and females from the general population

The Eating Disorder Inventory, Version 2 (EDI‐2) is a questionnaire used clinically and in research all over the world. EDI‐2 is cross‐culturally valid, yet normative values may depend on culture. Norms and reliability of the Danish version have to date been lacking, and will be presented in this article, comparing patients (N = 575) and controls (N = 881). Also, internal reliability of scales is tested for both groups. Differences between norms of the Danish and the North American version of EDI were small but significant for all scales except asceticism (eating disorder patients) and ineffectiveness, interpersonal distrust and maturity fears (normal controls). For both groups the internal consistency was >0.70 for all subscales except asceticism. Although differences across the eating disorder diagnostic groups were dubious, the EDI‐2 is useful to screen for eating problems in the general population as well as to rate progress and outcome among eating disorder patients. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

Getting better byte by byte: a pilot randomised controlled trial of email therapy for bulimia nervosa and binge eating disorder

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.     

Clinical and socio‐demographic characteristics of university students referred to an eating disorders service

This study describes the socio‐demographic characteristics and eating disorders symptomatology of university students assessed by a specialised NHS eating disorders service in the UK over a 4‐year period. Information was gathered on past treatment history, source of referral, details of university and course of study, whether the patient was still open to the service or discharged, and if the patient had dropped out of contact from services. The study also describes the diagnosis of the assessed patients as well as the results of the Eating Disorders Inventory (EDI), Rosenberg Self‐Esteem Scale (RSES) and Revised Symptom Check List 90 (SCL‐90‐R) questionnaires. The study shows that the university students attending an eating disorder service often suffer from severe conditions, which are generally well‐established before they start their university studies. The study discuses the implication of those results in service delivery and future service development. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.     

To Go or Not to Go: A Proof of Concept Study Testing Food‐Specific Inhibition Training for Women with Eating and Weight Disorders

Inefficient food‐specific inhibitory control is a potential mechanism that underlies binge eating in bulimia nervosa and binge eating disorder. Go/no‐go training tools have been developed to increase inhibitory control over eating impulses. Using a within‐subjects design, this study examined whether one session of food‐specific go/no‐go training, versus general inhibitory control training, modifies eating behaviour. The primary outcome measure was food consumption on a taste test following each training session. Women with bulimia nervosa and binge eating disorder had small non‐significant reductions in high‐calorie food consumption on the taste test following the food‐specific compared with the general training. There were no effects on eating disorder symptomatic behaviour (i.e. binge eating/purging) in the 24 h post‐training. The training task was found to be acceptable by the clinical groups. More research is needed with larger sample sizes to determine the effectiveness of this training approach for clinical populations. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome

This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory‐2 (EDI‐2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m². Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI‐2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI‐2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non‐responders. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.