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.     

Subtypes of Personality and ‘Locus of Control’ in Bariatric Patients and their Effect on Weight Loss,Eating Disorder and Depressive Symptoms,and Quality of Life

The present study subdivided personality types in a bariatric sample and investigated their impact on weight loss and psychopathology 6 and 12 months after surgery. One hundred thirty participants answered questionnaires on personality (NEO‐FFI), ‘locus of control’ (IPC), depression severity (BDI‐II), eating disorder psychopathology (EDE‐Q), and health‐related quality of life (HRQoL; SF‐12). K‐means cluster analyses were used to identify subtypes. Two subtypes emerged: an ‘emotionally dysregulated/undercontrolled’ cluster defined by high neuroticism and external orientation and a ‘resilient/high functioning’ cluster with the reverse pattern. Prior to surgery, the first subtype reported more eating disorder and depressive symptoms and less HRQoL. Differences persisted regarding depression and mental HRQoL until 12 months after surgery, except in the areas weight loss and eating disorders. Personality seems to influence the improvement or maintenance of psychiatric symptoms after bariatric surgery. Future research could elucidate whether adapted treatment programmes could have an influence on the improvement of procedure outcomes. 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.     

The role of general family environment and sexual and physical abuse in the origins of eating disorders

This paper reviews the role of childhood family functioning and of sexual and physical abuse in eating disorders. Bearing in mind the huge methodological differences across studies the following tentative conclusions can be reached: there is evidence of more family pathology in eating disorder families than in normal control families. Those with bulimic disorders seem to have poorer family functioning than restrictors. Different eating disorder subgroups show less or comparable levels of family pathology compared to psychiatric or other medical controls depending on the comparison group. In bulimia nervosa high levels of family disturbance seem to be associated with greater severity and chronicity of bulimic symptomatology. There is some suggestion that family functioning may have more of an effect on Axis II than on Axis I disorders. Rates of sexual abuse appear to be higher in bulimia nervosa than in normal controls. Depending on which psychiatric control groups are chosen, eating disorder patients may have similar, higher or lower rates of contact sexual abuse. The majority of studies fails to find differences between eating disorder subtypes in terms of rates of sexual abuse. The evidence on whether there is any link between abuse characteristics and the severity of eating disorder is inconclusive. On balance, childhood sexual abuse does not seem to be a specific risk factor for eating disorders. Physical abuse is more common in bulimic than in restricting disorders and usually occurs in the context of a disturbed family environment. The clinical implications of these findings are discussed. Future research in the area of family factors or childhood trauma in eating disorders needs to get away from mere ‘head counts’ and needs to focus more strongly on the mediators between abuse and neglect and the development of eating disorders and also on the relative importance of family factors compared with other aetiological factors. © 1997 John Wiley & Sons, Ltd and Eating Disorders Association.     

Eating psychopathology in young non‐clinical adults: a pilot study of the impact of parental personality

This pilot study aims to determine the effect of parental personality factors on their grown‐up children's eating attitudes. Thirty sets of non‐clinical participants (mother, father, young adult child) completed standardized measures of narcissism, borderline personality disorder characteristics and eating pathology. Data were analysed using correlations. There were specific associations between parental personality pathology and their child's eating attitudes in young adulthood, but only in relation to fathers' levels of maladaptive narcissism. The ‘martyred’ form of narcissism in fathers was linked to bulimic attitudes in their children, while their ‘controlling’ narcissism was linked with restrictive eating attitudes. These results add to the growing body of research demonstrating paternal influences on the development of eating attitudes. Potential clinical implications for family and individual therapy are also discussed. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Personality Subtypes in Female Pre‐Bariatric Obese Patients: Do They Differ in Eating Disorder Symptoms,Psychological Complaints and Coping Behaviour?

In the pre‐bariatric psychological assessment of 102 morbidly obese women, two personality subtypes emerged: a resilient/high functioning subtype with a ‘normal’ personality profile and an emotional dysregulated/undercontrolled subtype, characterized by high neuroticism and low extraversion/conscientiousness. Emotional dysregulated/undercontrolled patients showed more concerns about eating/weight/shape, more binge eating driven by emotions and external triggers, more psychological complaints (such as depression and anxiety) and more avoidance and depressive coping reactions than resilient/high functioning patients. Further research should clarify whether these clearly different psychological profiles are related to different outcomes (weight loss or well‐being) of bariatric surgery. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Psychiatric comorbidity and the persistence of drug use disorders in the United States

Aims DSM‐IV drug use disorders, a major public health problem, are highly comorbid with other psychiatric disorders, but little is known about the role of this comorbidity when studied prospectively in the general population. Our aims were to determine the role of comorbid psychopathology in the 3‐year persistence of drug use disorders. Design and setting Secondary data analysis using waves 1 (2001–02) and 2 (2005–05) of the National Epidemiologic Survey on Alcohol and Related Conditions. Participants Respondents with current DSM‐IV drug use disorder at wave 1 who participated in wave 2 (n = 613). Measurements Alcohol Use Disorders and Associated Disabilities Interview Schedule IV (AUDADIS‐IV) obtained DSM‐IV Axis I and II diagnoses. Persistent drug use disorder was defined as meeting full criteria for any drug use disorder between waves 1 and 2. Findings Drug use disorders persisted in 30.9% of respondents. No Axis I disorders predicted persistence. Antisocial [odds ratio (OR) = 2.75; 95% confidence interval (CI): 1.27–5.99], borderline (OR = 1.91; 95% CI: 1.06–3.45) and schizotypal (OR = 2.77; 95% CI: 1.42–5.39) personality disorders were significant predictors of persistent drug use disorders, controlling for demographics, psychiatric comorbidity, family history, treatment and number of drug use disorders. Deceitfulness and lack of remorse were the strongest antisocial criteria predictors of drug use disorder persistence, identity disturbance and self‐damaging impulsivity were the strongest borderline criteria predictors, and ideas of reference and social anxiety were the strongest schizotypal criteria predictors. Conclusions Antisocial, borderline and schizotypal personality disorders are specific predictors of drug use disorder persistence over a 3‐year period.     

Personality traits and self‐injurious behaviour in patients with eating disorders

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.     

Does Enhanced Cognitive Behaviour Therapy for Eating Disorders Improve Quality of Life?

Quality of life (QOL) is the degree of enjoyment and satisfaction experienced in life, and embraces emotional well‐being, physical health, economic and living circumstances, and work satisfaction. QOL recovery with eating disorder treatment has received sparse attention, and until now, no study has investigated QOL recovery with enhanced cognitive behaviour therapy (CBT‐E). Patients (n = 196) admitted to a specialist eating disorders outpatient programme and receiving CBT‐E completed measures of QOL, eating disorder psychopathology, depression, anxiety and self‐esteem, before and after treatment. QOL at intake was compared with community norms, and QOL below the norm was predicted from sociodemographic and clinical correlates with logistic regression. Baseline QOL below the norm was associated with depression and anxiety Axis I comorbidity, and severity of depressive symptoms. Predictors of post‐treatment QOL were baseline QOL and level of depressive symptoms and self‐esteem at post‐treatment. CBT‐E was associated with gains in QOL over the course of treatment, in addition to eating disorder symptom relief. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Affective disorders and anxiety disorders predict the risk of drug harmful use and dependence

Aim To investigate whether affective disorders, anxiety disorders and alcohol use disorders may increase the risk of subsequently developing drug (non‐alcohol‐related) dependence and/or drug (non‐alcohol‐related) harmful use. Setting and design A retrospective cohort study based on nationally representative household survey data collected from the 2007 National Survey of Mental Health and Wellbeing (MHW). Measurement The MHW survey applied the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (WMH‐CIDI 3.0) to collect information on ICD‐10 mental disorder diagnoses. Ages at first onset for mental disorders and harmful drug use were used to reconstruct the cohort according to definition of exposure, time at risk and outcome. Participants A total of 8841 Australian adults aged 18–85 years who were included in the 2007 MHW survey. Findings Participants with affective disorders and anxiety disorders were at higher risk of drug harmful use and drug dependence, and the effects did not vary by the length of time respondents had been exposed to mental disorders. Conclusion It is uncertain whether experience of affective disorders and anxiety disorders, possibly prior to the disorder being identified by the individual or a health worker, may lead to self‐medication with psychoactive substances or whether common genetic factors linking mental disorder and drug use disorders are the underlying cause. Symptoms of mental health disorders should alert health‐care providers to the possibility of drug use disorder comorbidity and the need for early intervention, especially among young males.     

Comorbidity Between Lifetime Eating Problems and Mood and Anxiety Disorders: Results from the Canadian Community Health Survey of Mental Health and Well‐being

This study was to examine profiles of eating problems (EPs), mood and anxiety disorders and their comorbidities; explore risk patterns for these disorders; and document differences in health service utilization in a national population. Data were from the Canadian Community Health Survey of Mental Health and Well‐being. The lifetime prevalence of EPs was 1.70% among Canadians, compared with 13.25% for mood disorder, 11.27% for anxiety disorder and 20.16% for any mood or anxiety disorder. Almost half of those with EPs also suffered with mood or anxiety disorders. A similar pattern in depressive symptoms was found among individuals with major depression and EPs, but individuals with EPs reported fewer symptoms. Factors associated with the comorbidity of EPs and mood and anxiety disorders were identified. Individuals with EPs reported more unmet needs. Patients with EPs should be concomitantly investigated for mood and anxiety disorders, as similar interventions may be effective for both. Copyright © 2015 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.     

Emotion regulation and disordered eating behaviour in youths: Two daily-diary studies

Objective

Disordered eating cognitions and behaviours in childhood and adolescence have been identified as precursors for the development of eating disorders. Another important contributor to eating disorder risk is maladaptive emotion regulation. However, while the regulation of negative affect has been the focus of much research, the literature on the role of positive emotion regulation in eating pathology is extremely limited. The present study extends previous research by examining the regulation of both positive and negative affect in disordered eating using two waves of a daily diary design.

Method

Every evening for 21 days, 139 youths (8–15 years) reported their use of rumination, dampening, and disordered eating cognitions and behaviours. 1 year later, during the onset of the COVID-19 pandemic, 115 of these youths were followed-up.

Results

As predicted, higher levels of rumination and dampening were found to be associated with a higher frequency of weight concerns and restrictive eating on person-level (both Waves) and day-level (Wave 2). Further, a higher frequency of rumination at Wave 1 predicted increases in the frequency of restrictive eating 1 year later.

Conclusions

Our findings underline the importance of examining regulation of both positive and negative emotion in order to understand eating disorder risk.     

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.     

Psychiatric Comorbidity Reduces Quality of Life in Chronic Methadone Maintained Patients

Despite the efficacy of methadone maintenance treatment (MMT), opioid dependence still involves severe impairment offunctioning and low quality of life. This study examines the influence of the psychiatric comorbidity of MMT patients on their quality of life. A total of 193 middle‐aged patients in long‐term MMT were assessed for current and lifetime Axis I psychiatric disorders, substance use disorders, and personality disorders using the MINI, the CIDI‐SAM, and the SIDP‐IV. Quality of life (Qol) was assessed using the EQ‐5D. Psychiatric comorbidity was documented in 78% of the patients. Mood disorders (60%) and anxiety disorders (46%) were the most common diagnoses. Additional substance use disorders were diagnosed in 70% of the MMT patients. While a probable personality disorder was documented for 65% of the patients, 66 of these patients actually showed an antisocial personality disorder. Qol was severely diminished to a level comparable to that for patients with chronic psychiatric and/or somatic disorders. Multivariate analyses showed the occurrence of comorbid psychiatric disorders to explain about 32% of the variance in Qol. The quality of life for MMT patients is generally low. The present results showed a high rate of psychiatric comorbidity for this patient group with mood disorders, additional substance use disorders, and personality disorders occurring in particular. Such comorbid psychopathology substantially affects quality of life. The negative influence of comorbid psychopathology on quality of life is an important reason to provide additional mental health services for MMT patients.     

Safety Behaviours in Eating Disorders: Factor Structure and Clinical Validation of the Brief Safety Behaviours Scale

This study examined the utility of a transdiagnostic measure of safety behaviours [Brief Safety Behaviours Scale (BSBS)] in eating disorders. Prior to treatment, a group of 102 women with eating disorders completed the BSBS and well‐validated measures of eating pathology, anxiety and intolerance of uncertainty. The BSBS had three factors, suggesting that avoidant, checking and social safety behaviours are distinct constructs in the eating disorders. This three‐scale scoring system showed greater clinical precision in correlations with eating pathology than the original two‐scale version. The pattern of safety behaviours in the eating disorders is more specific than had previously been shown in other clinical samples. While it is important to consider eating‐related safety behaviours in the eating disorders (e.g. restriction, body checking), it is also necessary to consider the role of generic safety behaviours when assessing, formulating and treating eating disorders. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

Sensation seeking: a personality trait characteristic of adolescent girls and young women with eating disorders?

The aim of the following study was to evaluate the role of sensation seeking in eating disorders (anorexia and bulimia), taking into account the subtypes (purging versus nonpurging) and the concept of binge‐eating disorder. The study involved 141 adolescent girls and young women, aged 14 to 25 years who lived in the French speaking part of Switzerland (79 clinical subjects with eating disorders according to DSM‐IV criteria, and 62 control subjects without eating disorders from the general population). All the subjects completed the Sensation Seeking Scale (SSS, Zuckerman, 1971). The results show that subjects with bulimic behaviours characterized by recurrent episodes of binge‐eating, whatever their exact diagnosis and subtype, do not significantly differ from one another on the Sensation Seeking Scale. They all had higher scores than the control group especially on the ‘Thrill and Adventure Seeking’ dimension. In contrast, restricting anorexics had lower scores on the Sensation Seeking Scale than the control group, especially on the ‘Experience Seeking’ dimension. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.     

Transactions between early binge eating and personality predict transdiagnostic risk

Psychiatric comorbidities are prevalent in youth eating disorders. In a sample of 1,906 youth from the United States (49.2% female), followed from elementary school into high school, we found support for a model to help explain this comorbidity. Endorsement of binge eating in fifth grade (elementary school) predicted increases in negative urgency, negative affect, and lack of planning in seventh grade (middle school). In turn, seventh grade negative urgency predicted increases in 10th grade (high school) externalizing dysfunction (binge eating, alcohol use problems, and smoking) and internalizing dysfunction (depressive symptoms). Seventh grade negative affect predicted increases in 10th grade binge eating and depressive symptoms. Seventh grade lack of planning predicted increases only in 10th grade externalizing behaviours. Early engagement in binge eating may elevate risk for multiple forms of dysfunction, at least in part due to its prediction of high‐risk personality change in middle school.     

Processing of five types of ‘threat’ information in anorexic and bulimic women

This study investigated further the ‘escape’ hypothesis of bulimia and compared the processing of ‘threat’ information in control, anorexic and bulimic women. Using a novel information‐processing task, five types of non‐eating ‘threat’ (autonomy, sociotropy, discomfort anxiety, ego threat from others and ego threat from self) were addressed. The women did not differ in response time taken to identify ‘threat’ information, although there was support for the ‘escape’ hypothesis of bulimia. Specific non‐eating ‘threat’ information appeared relevant to both anorexia and bulimia nervosa, suggesting the potential value of addressing general threat schemata in clinical practice. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.