•Suicidality in eating disorders (ED) is linked to low interoceptive awareness (IA).•Low body trust predicted the presence of suicidal ideation in an ED sample.•No dimensions of IA were associated ...with severity of suicidal ideation.
Previous research has demonstrated that both suicidal ideation (SI) and eating disorders (EDs) are associated with poor interoceptive awareness (IA). Suicidality research has demonstrated that the IA dimension of lower body trust is associated with SI, suicide plans, and suicide attempts. Similarly, in ED samples, recent research supports that low body trust has been the most robust dimension of IA associated with eating pathology. However, to date, research is lacking in how dimensions of IA may be associated with SI in an ED sample, above and beyond the impact of eating pathology on SI. Thus, in a clinical ED sample, the present study sought to determine which IA dimensions predict the presence and severity of SI, above and beyond ED symptoms. Participants (N = 102) completed a clinical interview assessing SI and self-report assessments including the Multidimensional Assessment of Interoceptive Awareness (MAIA). Results demonstrated that patients with current SI reported greater ED psychopathology, lower MAIA Attention Regulation, MAIA Self-Regulation, and MAIA Trusting scores compared to patients without SI. Higher ED psychopathology and lower MAIA Attention Regulation, Self-Regulation, and Trusting subscale scores were all significantly associated with the presence of SI. However, only low MAIA Trusting scores predicted the presence of SI, above and beyond covariates (age, depression, and eating pathology). No MAIA subscales were correlated with the severity of SI. Consistent with previous research, results suggest low MAIA Trusting scores may be associated with SI in ED samples and highlight the need for future research on mechanisms of these associations.
Barriers limit access to eating disorder treatment. Evidence-based treatment delivered using telemedicine could expand access. This study determined the effectiveness of enhanced Family-Based ...Treatment (FBT+) delivered using telemedicine for children and adolescents with eating disorders. Participants had a confirmed eating disorder diagnosis, lived in states where treatment was available, and lived with a family member willing to participate. Virtual FBT+ was administered by a five-person team including a therapist, dietitian, medical provider, peer mentor, and family mentor for up to 12 months. Measures were recorded at baseline and varying frequencies throughout treatment. Weight was self-reported. Eating disorder symptoms were assessed with the Eating Disorder Examination-Questionnaire Short Form (EDE-QS) and depression and anxiety were measured using the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7). Caregiver burden and self-efficacy were measured using the Burden Assessment Scale, and Parent Versus Eating Disorder scale. The majority of patients (N = 210; 6 to 24 years old mean 16 · 1 years) were cisgender female (83%) White, (71%), required weight restoration (78%), and had anorexia nervosa, restricting type (63%). After 16 weeks, patients on weight restoration gained on average 11 · 3 9 · 86, 12 · 8 pounds and the average change in EDE-QS score was −6 · 31 −8 · 67, −4 · 10 points. Similar reductions were seen for depression (−2 · 62 −4 · 24, −1 · 04), anxiety (−1 · 44 −1 · 12, 0 · 78), and caregiver burden (−4 · 41 2 · 45, 6 · 31). Caregiver self-efficacy increased by 4 · 56 3 · 53, 5 · 61 points. Patients and caregivers reported satisfaction with treatment. Virtual FBT+ for eating disorders can transcend geographical and psychosocial treatment barriers, expanding access to evidence-based eating disorder treatment.
Objective
Weight restoration or weight gain is a common goal in eating disorder treatment. However, approaches to determine expected body weight (EBW) vary. A standardized approach based on normative ...data for a patient's age and gender uses weight associated with median BMI (mBMI). An individualized approach predicts EBW based on a patient's individual growth trajectory. Little research has examined differences in these approaches.
Method
Weight and clinical data were collected from patients ages 6–20 enrolled in virtual eating disorder treatment. EBW associated with mBMI was compared with EBW using the individualized approach. Linear mixed effects models examined differences in weight, eating disorder symptoms, depression, and anxiety, and whether EBW approach varied by patient characteristics.
Results
Patients (N = 609) were on average age 15.6 (2.29), 85% were cisgender female, and predominantly diagnosed with anorexia nervosa (83.1%). The individualized approach led to significantly higher EBW on average (mean difference = 8.4 lbs SE: .75; p < .001) compared to mBMI; 70% of patients had a higher EBW using the individualized approach. Notably, EBW varied based on gender and diagnosis and it took longer on average to achieve individualized EBW. Time was the strongest predictor of changes in psychosocial outcomes and there were no significant differences by EBW approach.
Discussion
Results from this study indicate that an individualized approach led to significantly higher EBWs compared with using mBMI. As underestimation of EBW may lead to higher risk of relapse, eating disorder professionals should consider using an individualized approach for setting EBW.
Public Significance
For eating disorder patients who need to gain weight, accurately estimating target body weight for eating disorder treatment is critical to recovery and preventing relapse. An individualized, patient‐centered approach to estimating target body weight more accurately estimated target body weight than the standardized, median body mass index approach. Using an individualized approach to treatment may improve a patient's likelihood of full recovery.
Vitamin D is implicated in vascular health in CKD. This study compared placebo, calcifediol, and calcitriol treatment with changes in vascular stiffness, BP, proteinuria, mineral metabolism ...parameters, C-reactive protein, and fibroblast growth factor 23 in patients with stable CKD.
We conducted a double-blind, randomized controlled trial in out-patient CKD clinics in Vancouver, Canada, from February of 2011 to August of 2014, enrolling 119 patients with an eGFR of 15-45 ml/min per 1.73 m
. Change in pulse wave velocity (PWV) was measured after 6 months of treatment with a fixed dose of oral calcifediol (5000 IU 25-hydroxyvitamin D
), calcitriol (0.5
g 1,25-dihydroxyvitamin D
), or placebo, thrice weekly.
Eighty-seven participants were evaluated. Mean age was 66 years, 71% were men, 40% were diabetic, and mean baseline PWV was 11.5 m/s (SD=3.9 m/s). After 6 months, the PWV decreased in the calcifediol group (mean change, -1.1; 95% confidence interval 95% CI, -2.2 to 0.1 m/s), remained unchanged in the calcitriol group (mean change, 0.2; 95% CI, -0.9 to 1.4 m/s), and increased in the placebo group (mean change, 1.1; 95% CI, -0.1 to 2.2 m/s). The overall
value for between-arm changes was 0.03. Absolute PWV change was significantly different between groups (
=0.04): the combined vitamin D treatment group saw decreased PWV (mean change, -0.4; 95% CI, -1.2 to 0.4 m/s) whereas the placebo group saw increased PWV (mean change, +1.1; 95% CI, -0.1 to 2.2 m/s). The treatment group demonstrated significantly decreased serum parathyroid hormone (mean difference, -0.5; 95% CI, -0.7 to -0.3 lnpg/ml;
<0.001) and increased calcium (mean difference, 0.4; 95% CI, -0.1 to 0.7 mg/dl;
=0.02). In observational analysis, participants in the highest 25-hydroxyvitamin D tertile at trial end had significant decreases in PWV (mean change, -1.0; 95% CI, -2.0 to 0.0 m/s) compared with the middle and lowest tertiles (
<0.01). Side effects were minor and rare.
Six months of supplemental vitamin D analogs at fixed doses may achieve a reduction of PWV in patients with advanced CKD. Because the treatment effect was attenuated when baseline PWV was included as a covariate, these findings should be replicated in larger populations and further studied.
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
Individuals with eating disorders (EDs) often have difficulty tolerating uncomfortable body sensations. As such, anxiety sensitivity specific to gastrointestinal (GI) sensations, has ...relevance for EDs. However, to date, no validated measures of this construct exist in EDs. Thus, the present study sought to validate the visceral sensitivity index (VSI), a 15‐item measure originally validated in an irritable bowel syndrome sample, in an ED sample and explore associations with ED symptoms.
Method
Two hundred and sixty‐six adolescents (n = 116) and adults (n = 150) in an ED partial hospital program completed the VSI and related measures at admission. Confirmatory factor analysis examined the factor structure of the VSI and hierarchical regression analyses explored associations between the VSI and ED symptoms.
Results
The original version of the VSI had adequate model fit. An alternative 13‐item model removing specific items with poor fit and less theoretical relevance to EDs also demonstrated good fit. The 15‐item and 13‐item VSI had strong internal consistency (α = .93–.94), and correlation results supported the convergent and divergent validity of both versions. Higher visceral sensitivity was associated with elevated body dissatisfaction, cognitive restraint, purging, restricting, and excessive exercise (p‐values <.05), beyond length of illness, body mass index, and trait anxiety.
Discussion
Results support the relevance of GI‐specific anxiety in EDs and suggest that the original 15‐item VSI and modified 13‐item VSI have strong psychometric properties in an ED sample. Given comparable model fit and psychometric properties, both versions of the VSI may be used for future ED research.
Background Adult eating disorder treatments are hampered by lack of access and limited efficacy. This open-trial study evaluated the acceptability and preliminary efficacy of a novel intervention for ...adults with eating disorders delivered to young adults and parent-supports in an intensive, multi-family format (Young Adult Temperament-Based Treatment with Supports; YA-TBT-S). Methods 38 YA-TBT-S participants (m age = 19.58; SD 2.13) with anorexia nervosa (AN)-spectrum disorders, bulimia nervosa (BN)-spectrum disorders, and avoidant/restrictive food intake disorder (ARFID) completed self-report assessments at admission, discharge, and 12-month follow-up. Assessments measured program satisfaction, eating disorder psychopathology and impairment, body mass index (BMI), and trait anxiety. Outcomes were analyzed using linear mixed effects models to examine changes in outcome variables over time. Results Treatment was rated as highly satisfactory. 53.33% were in partial or full remission at 12-month follow-up. 56% of participants received other treatment within the 12-month follow-up period, suggesting that YA-TBT-S may be an adjunctive treatment. Participants reported reductions in ED symptomatology (AN and BN), increases in BMI (AN and ARFID), and reductions in clinical impairment (AN and ARFID) at 12-month follow-up. Conclusions YA-TBT-S is a feasible and acceptable adjunctive treatment for young adults with a broad range of ED diagnoses and may be a method for involving parents in ED treatment in ways that are acceptable to both parents and YA. Further evaluation of efficacy is needed in larger samples, and to compare YA-TBT-S to other ED treatment approaches. Plain English summary Eating disorders are costly and dangerous psychiatric disorders that affect millions of individuals each year. Despite their risks and societal costs, currently available treatments are limited. This study examined the acceptability and efficacy of Young Adult, Temperament-Based Treatment with Supports (YA-TBT-S), a new treatment program for adults with eating disorders. YA-TBT-S was rated highly, and a significant portion of participants improved based on ratings collected 12 months after program participation. Those with anorexia nervosa (AN) and bulimia nervosa (BN) showed significant reductions in eating disorder pathology, and those with AN and avoidant/restrictive food intake disorder (ARFID) showed increases in BMI over time. Keywords: Eating disorders, Psychological treatment, Treatment, Young adults, Anorexia nervosa, Bulimia nervosa, Avoidant restrictive food intake disorder, Family-based treatment
Purpose
Research and clinical experience suggest that individuals with anorexia nervosa (AN) have deficits in gastric interoception, which has been hypothesized to maintain restrictive eating. ...Behavioral water load tasks (WLTs) have the capability to noninvasively assess gastric interoception; however, to date, no studies have examined WLTs in AN. Thus, the present proof-of-concept pilot study explored the preliminary validity of a WLT in individuals with AN.
Methods
Participants were
n
= 10 individuals with AN and
n
= 10 matched-control women (CW). Participants completed self-report questionnaires before and after a WLT, in which participants were asked to drink water until “completely full”.
Results
Participants with AN drank significantly less water than CW (AN = 240(109.14) milliliters (ml), CW = 398.00(149.21) ml,
p
= 0.02, Cohen’s
d
= 1.21), but reported greater increases in negative affect pre- to-post-WLT (
p
= 0.04, partial eta
2
= 0.21). Correlations between WLT performance and interoceptive sensibility in AN and CW participants supported the convergent validity of the WLT.
Conclusion
Preliminary results support the potential utility of the WLT as a behavioral measure of gastric interoception in patients with AN. Future research should examine how response to the WLT changes over the course of intervention and how results are related to treatment outcome.
Level of evidence
Level IV: Evidence obtained from multiple time series analysis such as case studies. (NB: Dramatic results in uncontrolled trials might also be regarded as this type of evidence).
Introduction
Emotional processes play a role in both suicide risk and eating disorders (EDs), which are often comorbid. However, limited research has explored how emotional processes relate to ...suicide risk in EDs and the prognostic value of suicide risk for ED treatment. Thus, the current study examined associations between emotion dysregulation and reactivity with suicide risk in patients with EDs, and determined if suicide risk predicts ED treatment outcomes.
Methods
Participants (n = 201) were adults in an ED partial hospitalization program who completed measures at admission, 1‐month post‐admission, and discharge.
Results
When controlling for depressive symptoms, limited access to adaptive emotion regulation strategies, difficulties engaging in goal‐oriented behaviors, and engaging in impulsive behavior when experiencing negative emotions (i.e., emotion dysregulation) were associated with suicide attempt frequency. Depressive symptoms were associated with suicide risk severity, while emotion dysregulation and reactivity were not. Importantly, patients with elevated suicide risk at admission improved comparably to other risk categories across treatment, despite presenting with greater ED symptoms at admission.
Conclusion
Emotion dysregulation and depression are salient factors when examining suicide risk in patients with EDs. Suicide risk and attempt history may not negatively impact ED treatment outcomes when using emotion‐focused treatment.
There is a critical need to identify processes that may influence outcome in existing treatments for eating disorders (EDs). Intolerance of uncertainty (IU), which refers to excessive distress ...regarding uncertain situations, is a well-established feature of anxiety disorders. Emerging work suggests that IU decreases over the course of cognitive-behavioral treatments and may relate to better treatment outcomes. As some literature has suggested IU may functionally maintain ED symptoms, testing whether changes in IU over treatment relate to outcome may result in the identification of novel treatment targets. This study aimed to build upon past work documenting links between IU and ED symptoms by exploring changes in IU over treatment and links between early change in IU (1-month) and discharge symptoms. Participants (N = 274) receiving partial hospitalization treatment completed the Eating Pathology Symptoms Inventory and Intolerance of Uncertainty Scale at admission, 1-month post-admission, and discharge. Results suggested that IU significantly reduced from admission to discharge and that reductions in IU scores from admission to 1-month related to cognitive restraint, dietary restriction, and body image at discharge. However, this pattern did not hold for exercise, binge eating, or purging. Altogether, these results replicate past work supporting IU as a common feature across ED diagnoses and provide initial data suggesting that targeting IU early in treatment may enhance treatment outcomes.
•Intolerance of uncertainty (IU) appears to be elevated in eating disorders (EDs).•Participants with EDs completed measures of IU and ED symptoms throughout treatment.•IU significantly decreased from intake to discharge.•Early IU change related to lower discharge dietary restriction, restraint, and body image.•IU change did not relate to exercise, binge eating, or purging at discharge.
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