Illness pathways between eating disorder and post‐traumatic stress disorder symptoms: Understanding comorbidity with network analysis

Eating disorders (EDs) and post‐traumatic stress disorder (PTSD) are highly comorbid. However, specific mechanisms by which PTSD‐ED comorbidity is maintained are unknown. The current study constructed two PTSD‐ED comorbidity networks (25 EDs and 17 PTSD symptoms) in two samples: a clinical (N = 158 individuals with an ED diagnosis) and a nonclinical sample (N = 300 college students). Glasso networks were constructed to identify (1) pathways between disorders (bridge symptoms) and (2) core symptoms. Three illness pathways emerged: between binge eating and irritability, between desire for a flat stomach and disturbing dreams, and between concentration problems and weight and shape‐related concentration problems. Our findings suggest that pathways between binge eating and irritability, body dissatisfaction and trauma reminders, and concentration difficulties may be the mechanisms by which comorbidity is maintained. Interventions disrupting these pathways and targeting core and bridge symptoms may be more efficient than traditional treatment approaches.     

Addressing complex ethical issues in the treatment of children and adolescents with eating disorders: application of a framework for ethical decision‐making

Ethically problematic situations frequently arise in the care of children and adolescents with eating disorders. The younger person with anorexia nervosa can often deteriorate quickly, therefore the child who is in denial with respect to the seriousness of her condition and/or markedly ambivalent regarding renourishment is at grave risk. Involuntary treatment is likely to be a consideration during such a medical crisis. In this paper we outline an ethical decision‐making framework that can assist the clinician in engaging the young patient and her family well in advance of a crisis, so that decisions can be made at a time when recourse to establishing incompetency or enforcing involuntary treatment are unnecessary. We have adopted a narrative approach in our application of the decision‐making framework, and safety is emphasized as the central concept underlying the application of this model. Finally, a number of recommendations are made regarding application of the ethical decision‐making framework with younger persons. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association.     

Treatment for eating disorders from a patient satisfaction perspective: a Norwegian replication of a British study

The purpose of this study was to replicate a British survey on patient satisfaction with treatment for eating disorders, factors associated with satisfaction and the consumer's suggestions on how to improve the quality of health care services. A questionnaire was completed by 321 members of the Norwegian organizations for eating disorder patients. The British results were replicated as subjects were highly satisfied with outpatient individual and group psychotherapy, and to a less extent with family therapy. Also, a similar delay of 5–6 years from the first subject recognition of eating disorder symptoms to the time of seeking help was found. However, we found a relation between treatment delay and treatment satisfaction. Inpatient treatment was more favourably experienced in the UK than in Norway. Subjects who experienced therapists as competent on eating disorders reported higher treatment satisfaction. The results imply a critical view on the issue of early detection, a more selective use of family therapy, the need for more competence on eating disorders among clinicians, and a closer cooperation between professionals and the services provided by the patient organizations. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.     

Patient satisfaction with treatment in eating disorders: cause for complacency or concern?

The present study explored treatment satisfaction among eating disorder patients participating in a Swedish multicentre study (N = 469) who had been followed up 36 months after initial assessment. Satisfaction was measured using a questionnaire focusing on initial reception at the treatment unit, suitability of treatment, ability of staff to listen and understand, confidence in the unit and agreement on treatment goals. After 36 months, 38% of patients were ‘highly satisfied’ with treatment, while 39% were ‘satisfied’ and 23% were ‘unsatisfied’. Satisfaction was predicted by treatment interventions focusing on support and increased control of eating problems. Although unsatisfied patients were characterized by significantly higher levels of eating disorder psychopathology and psychiatric symptoms as well as more negative interpersonal profiles at follow‐up, these patients had been virtually indistinguishable from the other groups at initial assessment, with a few notable exceptions. Unsatisfied patients had previously been less prepared to change their eating habits, had higher levels of conflict with their fathers, had a lesser degree of present weight acceptance and tended to expect less from treatment interventions focusing on control of eating problems. It is concluded that, although we may be successful in engaging and satisfying patients who are predisposed to therapeutic strategies focusing on support and control of eating problems, we may be less successful with those who have a greater number of interpersonal problems and who are not as focused on their symptoms of disordered eating. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.     

Parental dieting impacts inpatient treatment outcomes for adolescents with restrictive eating disorders

Objective

Parental feeding practices and disordered eating are potential risk factors for the development of disordered eating in children and adolescents. This study measured the relationship between parental dieting behaviours and inpatient treatment outcomes for adolescents with restrictive eating disorders (EDs).

Method

Parents of adolescents with restrictive EDs (N = 45) admitted to a specialty integrated inpatient-partial hospital meal-based ED treatment programme completed questionnaires assessing parental eating and exercise behaviours. Adolescent clinical data, including percentage median body mass index (%mBMI) at admission and discharge and rate of weight gain, were abstracted from the electronic medical record.

Results

Adolescents whose parents reported dieting had a slower rate of weight gain (3.47 lbs./week) compared to participants whose parents were not dieting (4.54 lbs./week; p = 0.017). Additionally, participants whose parents reported dieting had a lower %mBMI at programme discharge (M = 93.56) than participants whose parents did not report dieting (M = 95.99; p = 0.033).

Conclusion

Parental dieting behaviours may impact an adolescent's response to inpatient ED treatment. Findings suggest a need to assess parental dieting behaviour, and when appropriate, provide additional psychoeducation regarding the potential risks of weight or shape-focussed dialogue and the benefits of modelling adaptive meal behaviours.     

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.     

Classification of eating disturbance in children and adolescents: Proposed changes for the DSM‐V

Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self‐report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

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.     

Perceptions about quality of life in a school-based population of adolescents with menorrhagia: implications for adolescents with bleeding disorders

Summary.  This study examined the effect of menorrhagia on the quality of life (QOL) of adolescents. We used data from a survey of 45 adolescents. Using the Pictorial Blood Assessment Chart (PBAC) and a PBAC score of ≥100 we identified adolescents likely to have menorrhagia. Our statistical analysis indicated that menorrhagia adversely affects the QOL of adolescents. In this article we discuss the implications of our study and future research avenues.     

Different outcomes,psychopathological features,and comorbidities in patients with eating disorders reporting childhood abuse: A 3‐year follow‐up study

The aim of this study was to evaluate the role of childhood adversities in long‐term outcomes in eating disorders (EDs). One hundred thirty‐three eating disorder patients were studied by means of the Structured Clinical Interview for DSM‐IV and psychometric tests, at baseline, at the end of individual cognitive behavioural therapy, and at 3‐year follow‐up. As compared with the other patients, those reporting childhood abuse (overall: 24.8%; physical abuse: 20.3%; sexual abuse: 13.6%) showed higher impulsivity, psychiatric comorbidity, lower full recovery at follow‐up (12.1% vs. 31%), and higher diagnostic crossover (39.4% vs. 13.0%). The different rates of recovery were mostly due to a higher persistence of depression in abused patients (77.8% vs. 26.7%). Patients with both abuse and neglect had a higher probability of dropout. Eating disorder patients with childhood abuse represent a group of persons with more complex psychopathological features and a worse long‐term outcome, thus requiring specific treatment strategies.     

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.     

Body Image Self‐evaluation Colouring Lens: comparing the ornamental and instrumental views of adolescent girls with eating disorders

A new visual measure of body image, the Body Image Self‐evaluation Colouring Lens (BISCL), was used to examine how 22 girls with diagnosed eating disorders evaluated their bodies. Results revealed that the percent of negative body evaluation was significantly higher when girls evaluated their body form as compared to their body function. Girls expressed new insights when comparing their relatively positive evaluation of their body functioning to their generally negative view of their body appearance. They expressed dissatisfaction with body parts that did not conform to their current cultural ideals. The BISCL was correlated in a predictable manner with standardized measures of body dissatisfaction. The promising applications of the BISCL as a clinical and research tool are discussed. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.