Objective
The objective of this study is to compare treatment trajectories in anorexia nervosa (AN) and atypical AN.
Method
Adolescents and adults with AN (n = 319) or atypical AN (n = 67) in a ...partial hospitalization program (PHP) completed diagnostic interviews and self‐report questionnaires measuring eating disorder (ED), depression, and anxiety symptoms throughout treatment.
Results
Premorbid weight loss did not differ between diagnoses. Individuals with atypical AN had more comorbid diagnoses, but groups did not differ on specific diagnoses. ED psychopathology and comorbid symptoms of depression/anxiety did not differ at admission between groups nor did rate of change in ED psychopathology and comorbid symptoms of depression/anxiety from admission to 1‐month. From admission to discharge, individuals with atypical AN had a faster reduction in ED psychopathology and comorbid symptoms of depression and anxiety (ps < 0.05; rs = 0.01–0.32); however, there were no group differences in ED psychopathology or depression symptoms at discharge (ps>.50; ds = .01–.30). Individuals with atypical AN had lower anxiety at discharge compared to individuals with AN (p = 0.05; d = .4). Length of stay did not differ between groups (p = 0.11; d = .21).
Discussion
Groups had similar ED treatment trajectories, suggesting more similarities than differences. PHP may also be effective for AAN.
Public Significance
This study supports previous research that individuals with AN and atypical AN have more similarities than differences. Results from this study indicate that individuals with AN and atypical AN have similar treatment outcomes for both ED psychopathology and depressive symptoms; however, individuals with atypical AN have lower anxiety symptoms at discharge compared to individuals with AN. AN and atypical AN also have more symptom similarity at admission and throughout treatment, which challenges their current designation as distinct disorders.
Objective
Despite the increased risk for eating disorders (EDs) among sexual minority (SM) individuals, no ED treatments exist specifically for this population. SM stress and appearance‐based ...pressures may initiate and/or maintain ED symptoms in SM individuals; thus, incorporating strategies to reduce SM stressors into existing treatments may help address SM individuals' increased ED risk. This mixed‐methods study evaluated the feasibility, acceptability, and preliminary efficacy of Promoting Resilience to Improve Disordered Eating (PRIDE)—a novel ED treatment for SM individuals.
Methods
N = 14 SM individuals with an ED diagnosis received 14 weekly sessions integrating Enhanced Cognitive Behavioral Therapy for EDs (CBT‐E) with techniques and principles of SM‐affirmative CBT developed to address SM stressors. Participants completed qualitative interviews and assessments of ED symptoms and SM stress reactions at baseline (pretreatment), posttreatment, and 1‐month follow‐up.
Results
Supporting feasibility, 12 of the 14 (85.7%) enrolled participants completed treatment, and qualitative and quantitative data supported PRIDE's acceptability (quantitative rating = 3.73/4). By 1‐month follow‐up, 75% of the sample was fully remitted from an ED diagnosis. Preliminary efficacy results suggested large and significant improvements in ED symptoms, clinical impairment, and body dissatisfaction, significant medium‐large improvements in internalized stigma and nonsignificant small‐medium effects of sexual orientation concealment.
Discussion
Initial results support the feasibility, acceptability, and initial efficacy of PRIDE, an ED treatment developed to address SM stressors. Future research should evaluate PRIDE in a larger sample, compare it to an active control condition, and explore whether reductions in SM stress reactions explain reductions in ED symptoms.
Public Significance
This study evaluated a treatment for SM individuals with EDs that integrated empirically supported ED treatment with SM‐affirmative treatment in a case series. Results support that this treatment was well‐accepted by participants and was associated with improvements in ED symptoms and minority stress outcomes.
The Role of Disgust in Eating Disorders Anderson, Lisa M.; Berg, Hannah; Brown, Tiffany A. ...
Current psycchiatry reports/Current psychiatry reports,
01/2021, Letnik:
23, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Purpose of Review
In current review, we evaluate the current literature examining the role of disgust in eating disorders (EDs), and provide a theoretical model designed to inform the study and ...treatment of disgust-based symptoms in EDs.
Recent Findings
Findings from this review suggest that aberrant disgust-conditioning processes represent promising but understudied mechanisms that may contribute to the risk and maintenance of core eating disorder (ED) psychopathology. In addition, preliminary evidence supports the use of interventions designed to target aversive disgust cues and disrupt maladaptive disgust-based conditioning that may maintain eating pathology. However, experimental studies designed to elucidate the role of disgust and aversive learning processes remain limited.
Summary
Disgust is a promising risk and maintenance factor in EDs. Future systematic investigation is needed to examine disgust-based processes at a mechanistic level in order to better understand the links between disgust, avoidance behaviors, and EDs. Further investigation of the mechanistic role of disgust in EDs is warranted.
The ICD‐11 has a new diagnostic system for personality disorder, which includes five optional trait specifiers to characterize the diagnosed pathology. The current study evaluated the internal ...structure and construct validity of the Personality Assessment Questionnaire for ICD‐11 (PAQ‐11) personality trait domains in a US population‐representative community sample. An exploratory factor analysis revealed the support for a four‐factor model underlying the 17 PAQ‐11 items, reflecting four of the five ICD‐11 trait domains (Negative Affectivity, Detachment, Disinhibition and Anankastia). Moreover, correlation analyses revealed that the PAQ‐11 domain scale scores were associated, as expected, with their counterparts from two other ICD‐11 trait domain measures, as well as with traditional personality disorder scores. More broadly, the results raised questions about the structural integrity of the Dissociality domain scale, and the discriminant validity of the Disinhibition and Anankastia scales. The overall conclusion was nevertheless promising with respect to the PAQ‐11 serving as a brief screening measure for the ICD‐11 trait domains.
Objective
Some individuals meet the criteria for atypical anorexia nervosa and another eating disorder simultaneously. The current study evaluated whether allowing a diagnosis of atypical anorexia ...nervosa to supersede a diagnosis of bulimia nervosa (BN) or binge‐eating disorder (BED) provided additional information on psychological functioning.
Methods
Archival data from 650 university students (87.7% female, 69.4% white) who met Eating Disorder Diagnostic Survey for DSM‐5 eating disorder criteria and completed questionnaires assessing quality of life, eating disorder‐related impairment, and/or eating pathology at a single time point. Separate regression models used diagnostic category to predict quality of life and impairment. Two diagnostic schemes were used: the DSM‐5 diagnostic scheme and an alternative scheme where atypical anorexia nervosa superseded all diagnoses except anorexia nervosa. Model fit was compared using the Davidson–Mackinnon J test. Analyses were pre‐registered (https://osf.io/2ejcd).
Results
Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided better fit to the data for eating disorder‐related impairment (p = .02; n = 271), but not physical, psychological, or social quality of life (p's ≥ .33; n = 306). Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided a better fit in cross‐sectional models predicting purging (p = .02; n = 638), but not body dissatisfaction, binge eating, restricting, or excessive exercise (p's ≥ .08; n's = 633–647).
Discussion
The current data support retaining the DSM‐5 diagnostic scheme. More longitudinal work is needed to understand the predictive validity of the atypical anorexia nervosa diagnosis.
Public Significance
The current study examined how changes to the diagnostic categories for eating disorders may change how diagnoses are associated with quality of life and impairment. Overall, findings suggest that the diagnostic hierarchy should be maintained.
Objective
Previous research examining family functioning in eating disorder (ED) treatment has focused primarily on outpatient settings. However, few studies have examined this aspect in partial ...hospitalization programs. To address this gap, this study examined family functioning over the course of an ED partial hospitalization program (PHP) in adolescent females (M(SD) age = 15.66 (1.50)).
Method
Participants (n = 105) completed the Family Assessment Device and Eating Disorder Examination Questionnaire at treatment admission, 1‐month post‐admission, and discharge.
Results
Results from repeated measures analysis of variance indicated adolescents perceived an improvement in family functioning regarding Communication, Affective Responsiveness, and Behavioral Control through 1‐year follow‐up (p values < .05). Neither family functioning at admission nor change in family functioning in the first month correlated with any outcomes (weight, ED symptoms, and remission).
Discussion
Results support that family functioning does not contribute to ED severity, and that treatment can improve adolescent perception of family functioning. Given the importance of involving the family in ED treatment, identifying mediators of treatment outcomes is critical to improve treatment efficacy.
Public Significance
Adolescents in a partial hospital program (PHP) for eating disorders (EDs) perceived improvements in their family communication, behavior, and ability to process appropriate emotions from admission to 1‐year post‐treatment, although these aspects did not significantly predict treatment outcomes. The findings provide helpful information for future research on adolescents with EDs in higher levels of care and underscore the importance of exploring mechanisms of family‐based treatment in PHP.
Despite high levels of muscularity concerns among sexual-minority men, most of the existing literature on the drive for muscularity and muscle dysmorphia focuses on heterosexual men and has mainly ...been conducted in Western and English-speaking regions. The present study aimed to evaluate the psychometric properties of the Drive for Muscularity Scale (DMS) and the Muscle Dysmorphic Disorder Inventory (MDDI) in Brazilian cisgender gay and bisexual adult men who were 18-50 years old. We evaluated the factor structure of both measures using a two-step, split-sample exploratory (EFA;
= 704) and confirmatory (CFA;
= 705) factor-analytic approach, which supported the original three-factor structure of the MDDI and resulted in a reduced two-factor solution with 13 items for the DMS. Convergent validity was supported through associations of the DMS and the MDDI with eating disorder symptoms, body-ideal internalization, self-objectification beliefs and behaviors, and body appreciation measures. Additionally, we found good internal consistency, and test-retest reliability of both measures. Results support the validity and reliability of the DMS and the MDDI in Brazilian cisgender gay and bisexual adult men and will support future studies exploring these constructs in Brazilian sexual-minority men.
Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy ...(DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (MSD = 309.58144.59 days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.
•Emotion dysregulation plays an important role in eating disorder psychopathology•Patients with bulimia nervosa improved on emotion regulation through follow-up•Anorexia, binge-purge patients did not maintain improvements through follow-up•Anorexia, restricting patients had fewer emotion regulation improvements over time
Objective
Previous research supports the relevance of early symptom change in eating disorder (ED) treatment; however, few studies have distinguished early weight change from early change in ED ...psychopathology, particularly in higher levels of care. Thus, the present study examined whether early change in weight and ED psychopathology predicted outcome for adolescents with anorexia nervosa (AN) in a partial hospitalization program.
Method
Adolescents with AN (n = 99) completed assessments at admission, 1‐month after treatment admission, discharge, and 6‐month follow‐up.
Results
Higher admission percent expected body weight (%EBW), greater early change in %EBW, longer duration of treatment, shorter length of illness, and earlier age of onset predicted greater change in %EBW at discharge, but not follow‐up. Greater ED psychopathology at admission and greater early change in ED psychopathology predicted later change in ED symptoms at discharge, but not follow‐up. Neither early change in %EBW nor ED psychopathology predicted likelihood of remission at discharge and follow‐up.
Discussion
Results support the importance of early change in predicting later change in the same ED outcome variables and suggest that early change in both %EBW and ED psychopathology in adolescents may be an important area for future research.
PDF
