Affect consciousness and eating disorders. Short term stability and subgroup characteristics

The aim of the study was to analyse differences in observer rated affect consciousness (AC) between subgroups of patients diagnosed with eating disorders (N = 44; 30 with anorexia nervosa and 14 with bulimia nervosa), and a non‐clinical group (N = 40). Another aim was to study the short‐term stability of AC over 10–11 weeks of treatment and its relation to self‐reported eating pathology and general psychopathology. A moderate short‐term stability of AC was found but the levels were not correlated with eating pathology or psychopathology. No differences between the two diagnostic categories were found, but the eating disorder group as whole had significantly lower AC compared with a non‐eating disorder reference group. AC seems to be a moderately stable ability that differentiates patients diagnosed with eating disorders from a non‐clinical population. However, AC is not related to symptoms of eating disorder or general psychiatric symptoms in this group of patients. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Self‐Disgust within Eating Disordered Groups: Associations with Anxiety,Disgust Sensitivity and Sensory Processing

This study aimed to assess the relationship between self‐disgust and sensory processing within eating psychopathology. Five hundred and ninety‐one women with a self‐reported diagnosis of anorexia nervosa, bulimia nervosa or who had no previous history of an eating disorder completed a battery of online questionnaires measuring disgust, emotion and sensory variables. Those with an eating disorder reported significantly higher rates of self‐disgust than those with no history of disordered eating. In groups of women with self‐reported bulimia, self‐disgust was associated with sensation avoidance and sensation seeking. Within the group with anorexia nervosa, self‐disgust was associated with low registration and sensation seeking. This report is the first to examine the expression of the emotion self‐disgust within eating psychopathology and examine associations of this factor with sensory processing. The emotion self‐disgust needs to be further examined to understand its possible role in the onset and maintenance of disordered eating. Copyright © 2017 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.     

Self‐Discrepancy and Eating Disorder Symptoms Across Eating Disorder Diagnostic Groups

This study examined self‐discrepancy, a construct of theoretical relevance to eating disorder (ED) psychopathology, across different types of EDs. Individuals with anorexia nervosa (AN; n = 112), bulimia nervosa (BN; n = 72), and binge eating disorder (BED; n = 199) completed semi‐structured interviews assessing specific types of self‐discrepancies. Results revealed that actual:ideal (A:I) discrepancy was positively associated with AN, actual:ought (A:O) discrepancy was positively associated with BN and BED, and self‐discrepancies did not differentiate BN from BED. Across diagnoses, A:O discrepancy was positively associated with severity of purging, binge eating, and global ED psychopathology. Further, there were significant interactions between diagnosis and A:O discrepancy for global ED psychopathology and between diagnosis and A:I discrepancy for binge eating and driven exercise. These results support the importance of self‐discrepancy as a potential causal and maintenance variable in EDs that differentiates among different types of EDs and symptom severity. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

Purging Disorder: A Comparison to Established Eating Disorders with Purging Behaviour

This study is part of the larger Christina Barz Study, and it compared consecutively admitted patients with purging disorder (PurD; N = 225) with consecutively admitted patients with anorexia nervosa binge eating/purging subtype (AN‐bp; N = 503) and bulimia nervosa purging subtype (BN‐p; N = 756). Participants answered self‐rating questionnaires on admission, at the end of inpatient treatment, and in a 5‐year follow‐up. Patients with PurD reported lower severity of general psychopathology than patients with AN‐bp and lower severity of eating disorder symptoms than patients with AN‐bp and BN‐p on admission. Eating disorder symptoms of patients with PurD improved less during the course than of the comparison groups. Diagnostic perseverance was stronger in the PurD group than for patients with AN‐bp; mortality was higher than for patients with BN‐p. Predictors for better outcome differed for the groups. Our results provide new data about the long‐term course of patients with PurD and indicate clinical relevance of the disorder. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Food Addiction in a Spanish Sample of Eating Disorders: DSM‐5 Diagnostic Subtype Differentiation and Validation Data

Although the concept of ‘food addiction’ (FA) has raised growing interest because of evidence for similarities between substance dependence and excessive food intake, there is a lack of studies that explore this construct among the wide spectrum of eating disorders (EDs). Besides providing validation scores of a Spanish version of the Yale FA Scale (YFAS‐S), this study examined the prevalence of ‘FA’ among ED subtypes compared with healthy‐eating controls (HCs) and the association between ‘FA’ scores, eating symptomatology and general psychopathology. A sample of 125 adult women with ED, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders 5 criteria, and 82 healthy‐eating women participated in the study. All participants were assessed with the YFAS‐S, the ED Inventory‐2 and the Symptom Checklist‐Revised. Results showed that the internal structure of the one‐dimensional solution for the YFAS‐S was very good (α = 0.95). The YFAS‐S has a good discriminative capacity to differentiate between ED and controls (specificity = 97.6% and sensitivity (Se) = 72.8%; area under receiver operating characteristic curve = 0.90) and a good Se to screen for specific ED subtypes. YFAS‐S scores were associated with higher levels of negative affect and depression, higher general psychopathology, more severe eating pathology and greater body mass index. When comparing the prevalence of ‘FA’ between ED subtypes, the lowest prevalence of ‘FA’, measured with the YFAS‐S, was for the anorexia nervosa (AN) restrictive subtype with 50%, and the highest was for the AN binge–purging subtype (85.7%), followed by bulimia nervosa (81.5%) and binge eating disorder (76.9%). In conclusion, higher YFAS‐S scores are associated with bingeing ED‐subtype patients and with more eating severity and psychopathology. Although the ‘FA’ construct is able to differentiate between ED and HC, it needs to be further explored. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Predictors of improved eating behaviour following body image therapy: A pilot study

Cognitive processes seem to play a vital role in eating disorders and body image. The current study, therefore, examines the impact and change of dysfunctional cognitions during a body image group therapy, which included 41 patients with an eating disorder. Dysfunctional cognitions were assessed with the ‘Eating Disorder Cognition Questionnaire’ both before and after treatment. Eating disorder psychopathology was also assessed. Results indicate a significant reduction of dysfunctional cognitions relating to ‘body and self‐esteem’, ‘dietary restraint’, ‘eating and loss of control’, as well as ‘internalisation and social comparison’. Furthermore, the changes in dysfunctional cognitions were associated with a reduction in eating disorder psychopathology. Body image therapy is a worthy complementation to standardised eating disorder treatment programmes as it reduces negative eating related thoughts and changes attitudes towards the body. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Detecting Eating Psychopathology in Female Athletes by Asking About Exercise: Use of the Compulsive Exercise Test

The present study assessed the suitability of the Compulsive Exercise Test (athlete version; CET‐A) for identifying female athletes with clinically significant features related to or comparable with eating psychopathology. Three hundred and sixty‐one female athletes (including 12 with a clinically diagnosed eating disorder) completed the Eating Disorders Examination Questionnaire and the CET‐A. Receiver operating curve analysis was employed to identify a cut‐off value on the CET‐A, which could indicate clinically significant features related to or comparable with eating psychopathology among female athletes. The analysis demonstrated that a CET‐A score of 10 successfully discriminated female athletes with a current eating disorder. The results suggest that the CET‐A may be a suitable tool for detecting eating psychopathology in female athletes. Additional longitudinal research is needed to evaluate the predictive value of the CET‐A. Copyright © 2017 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.     

Predictors of Outcome for Cognitive Behaviour Therapy in Binge Eating Disorder

The aim of this naturalistic study was to identify pretreatment predictors of response to cognitive behaviour therapy in treatment‐seeking patients with binge eating disorder (BED; N = 304). Furthermore, we examined end‐of‐treatment factors that predict treatment outcome 6 months later (N = 190). We assessed eating disorder psychopathology, general psychopathology, personality characteristics and demographic variables using self‐report questionnaires. Treatment outcome was measured using the bulimia subscale of the Eating Disorder Inventory 1. Predictors were determined using hierarchical linear regression analyses. Several variables significantly predicted outcome, four of which were found to be both baseline predictors of treatment outcome and end‐of‐treatment predictors of follow‐up: Higher levels of drive for thinness, higher levels of interoceptive awareness, lower levels of binge eating pathology and, in women, lower levels of body dissatisfaction predicted better outcome in the short and longer term. Based on these results, several suggestions are made to improve treatment outcome for BED patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Mother–Daughter Coping and Disordered Eating

This study explores whether the coping style of teenage girls with and without an eating disorder is similar to that of their mothers' (biological and adoptive), and whether teens with disordered eating utilize more maladaptive coping compared with those without. Eating disorder was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria, and the Coping Inventory for Stressful Situations was administered to distinguish the coping style of the participants. Our findings suggest that daughters coped very similarly to their mothers in either group. Contrary to previous studies, our sample of teenage girls with eating disorders as well as their mothers utilized less frequently the avoidance–distraction coping compared with the girls without eating disorders and their mothers. These findings reinforce the importance for family involvement and for simultaneous focus on intrapersonal and interpersonal maintenance factors during eating disorder treatment. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Quality of life,course and predictors of outcomes in community women with EDNOS and common eating disorders

We investigated the 2‐year course and putative predictors of outcome of 87 young community women with common eating disorders (n = 59, 68% with Eating Disorder not Otherwise Specified) following a health literacy (informational) intervention. Participants were recruited in 3‐phases: community survey, interview and then invitation to a longitudinal study. The health literacy intervention was provided randomly to half participants at baseline and half at 1 year. Eating disorder symptoms and mental health related quality of life (MHQoL), general psychological function, help‐seeking, and defence style were assessed at baseline, and after 2 years by questionnaire. Multiple linear regression analyses were used to identify features predictive of eating disorder symptom levels and MHQoL. Eating disorder psychopathology remained high and MHQoL remained poor. In the multivariate models, a higher baseline level of immature defence style significantly predicted higher levels of eating disorder symptoms, poorer MHQoL and more disability as measured by ‘days out of role’. In addition, higher educational attainment, baseline general psychological disturbance, lower BMI and having main work outside the home were associated with poorer MHQoL. Women with common eating disorders followed to 2 years continued to be highly symptomatic and have poor quality of life. Psychological features important to outcome included an immature coping style and higher general psychological distress. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

All better? How former anorexia nervosa patients define recovery and engaged in treatment

The purpose of this study was to explore how individuals with anorexia nervosa (AN) engage in treatment and define recovery. A mixed methods design was used to triangulate the experience of 20 women with a history of AN. Interview data were analysed thematically to explore frequency of emergent themes and current eating disorder psychopathology was assessed using standardized self‐report measures. Participants' mean age was 29.35 (SD = 12.11). Participants' scores were indicative of persistent psychopathology. Those with more involvement in treatment choice had better motivation to change and normalized eating. Participants' definition of recovery mapped on well to current research conceptualizations, though a substantial proportion of the group expressed some ambivalence around the concept. Results are interpreted in the context of self‐determination theory of motivation and suggest that patients should be involved collaboratively in the formulation of shared goals and concepts of recovery in treatment settings. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Replication of a Modified Factor Structure for the Eating Disorder Examination‐Questionnaire: Extension to Clinical Eating Disorder and Non‐clinical Samples in Portugal

Psychometric investigations of the Eating Disorder Examination‐Questionnaire (EDE‐Q) have generally not supported the original scale structure. The present study tested an alternative brief factor structure in two large Portuguese samples: (1) a non‐clinical sample of N = 4117 female students and (2) a treatment‐seeking sample of N = 609 patients diagnosed with eating disorders. Confirmatory factor analysis revealed a poor fit for the original EDE‐Q structure in both the non‐clinical and the clinical samples but revealed a good fit for the alternative 7‐item 3‐factor structure (dietary restraint, shape/weight overvaluation and body dissatisfaction). Factor loadings were invariant across samples and across the different specific eating disorder diagnoses in the clinical sample. These confirmatory factor analysis findings, which replicate findings from studies with diverse predominately overweight/obese samples, supported a modified 7‐item, 3‐factor structure for the EDE‐Q. The reliable findings across different non‐clinical and clinical eating disorder groups provide confidence regarding the potential utility of this brief version. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Spanish Validation of the Accommodation and Enabling Scale for Eating Disorders Among Carers: A Pilot Study

Literature suggests that families may accommodate patients' symptoms in attempts to alleviate family conflict and stress. These accommodating and enabling behaviours may have a negative impact on carers and those they care for. There are no self‐report questionnaires validated in Spanish to measure accommodation among relatives of patients with an eating disorder. The aim of this study was to examine the psychometric properties of the Spanish version of the Accommodation and Enabling Scale for Eating Disorders (AESED‐S) among relatives of eating disorder patients. A cross‐sectional study of 90 relatives was carried out to explore the factor structure, reliability and validity of the AESED‐S. The internal consistency of the Spanish version of the AESED subscales was good, ranging from .89 to .81. The correlation of the five subscales with conceptually related measures (negative caregiving experience and distress) supports the convergent validity of this instrument in this sample. Results indicated that the Spanish version of the AESED provides a reliable and valid tool for assessing family accommodation in the context of having a relative with an eating disorder. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Exploring Types of Family Environments in Youth with Eating Disorders

While many studies have explored the relationship between different eating disorder diagnoses and the familial social environment, current evidence does not support associations between distinct family interaction patterns (e.g. high enmeshment) and particular diagnoses (e.g. anorexia nervosa). The current study seeks to move beyond the current literature to explore whether empirically derived subtypes of family environment are associated with clinical features within a transdiagnostic sample of youth seeking treatment for eating disorders (n = 123). Latent class modelling of the Family Environment Scale identified three classes (i.e. different Family Environment Scale profiles): (1) Control‐Oriented; (2) System Maintenance‐Oriented; and (3) Conflict‐Oriented. Data are presented to characterize the classes (e.g. age, gender, rates of different eating disorders, severity of eating disorder pathology and rates of comorbid disorders). These preliminary results suggest that family interaction types may help personalize treatment for eating disorders and encourage future research to guide such efforts. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Day treatment group programme for eating disorders: reasons for drop‐out

This study was designed to identify clinical variables and personality factors that could predict the completion or non‐completion of a day treatment group programme for patients with eating disorders. Patients (n = 125) were subdivided into those who had completed a 4‐month day treatment programme (n = 106) and those who had dropped out (n = 19). All the patients had been assessed with regard to eating psychopathology, general psychopathology and personality features at the beginning of the programme. At presentation, 50.4 per cent fulfilled DSM‐IV criteria for anorexia nervosa, 39.2 per cent for bulimia nervosa and 10.4 per cent for an eating disorder not otherwise specified. Non‐completion of therapy was associated with more severe bulimic symptoms, high levels of aggression and extraversion and low levels of inhibitedness. Assessment of these characteristics could be used to improve the therapy programme and to help those patients at increased risk of dropping out. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.     

Risk Factors for Eating Disorder Psychopathology within the Treatment Seeking Transgender Population: The Role of Cross‐Sex Hormone Treatment

Many transgender people experience high levels of body dissatisfaction, which is one of the numerous factors known to increase vulnerability to eating disorder symptoms in the cisgender (non‐trans) population. Cross‐sex hormones can alleviate body dissatisfaction so might also alleviate eating disorder symptoms. This study aimed to explore risk factors for eating disorder symptoms in transgender people and the role of cross‐sex hormones. Individuals assessed at a national transgender health service were invited to participate (N = 563). Transgender people not on cross‐sex hormones reported higher levels of eating disorder psychopathology than people who were. High body dissatisfaction, perfectionism, anxiety symptoms, and low self‐esteem were risk factors for eating psychopathology, but, after controlling for these, significant differences in eating psychopathology between people who were and were not on cross‐sex hormones disappeared. Cross‐sex hormones may alleviate eating disorder psychopathology. Given the high prevalence of transgender identities, clinicians at eating disorder services should assess for gender identity issues. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.