Eating and Weight Disorders-studies on Anorexia Bulimia and Obesity, Sep 1, 2004
Binge eating disorder (BED) has been hypothesized to be associated with poor outcome in gastric b... more Binge eating disorder (BED) has been hypothesized to be associated with poor outcome in gastric bypass surgery (GBP). However, past studies have yielded inconsistent results regarding BED and surgical outcome, which may be due to the variety of measures used to assess BED. The present study examines the utility of two commonly used BED diagnostic tools: the Structured Clinical Interview (SCID) and the Questionnaire of Eating and Weight Patterns-Revised (QEWP-R). Subjects were 168 adult patients evaluated for GBP. BED was assessed using the SCID and the 27% of the sample received a diagnosis of BED using the QEWP-R, compared with 14% using the SCID. Agreement using Cohen's kappa was 0.37. Compared to sub-non-concordant diagnoses of BED, subjects with concordant diagnoses scored on a measure of self-esteem. Although both diagnostic tools use the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria, each yielded different results. Further studies are needed to determine the most accurate method of assessing BED in this population.
Family therapy is increasingly recommended as the treatment of choice for eating disorders among ... more Family therapy is increasingly recommended as the treatment of choice for eating disorders among adolescents. The shift from blaming parents for causing an ED to seeing them as a necessary part of the recovery process was set in motion by Salvador Minuchin and colleagues, and then reinforced and expanded on by researchers at the Maudsley Hospital in London, UK, and in the United States and Australia. Data supporting the efficacy of family therapy for adolescent anorexia nervosa has been solidified, while family-based approaches in the treatment of adolescents with bulimia nervosa show promise. Further research is needed to replicate the findings of existing studies and to further clarify the utility of parental involvement in the treatment of older adolescents, or transition age youth, with anorexia nervosa and bulimia nervosa.
International Journal of Eating Disorders, Sep 23, 2022
ObjectiveThe purpose of this study was to compare symptom severity of eating disorders (EDs), dep... more ObjectiveThe purpose of this study was to compare symptom severity of eating disorders (EDs), depression and anxiety at admission and discharge for transgender and nonbinary (TNB) individuals and cisgender adult individuals receiving treatment for EDs at higher levels of care (HLOC), adding to the limited research in this area.MethodParticipants were 25 TNB individuals and 376 cisgender individuals admitted to a HLOC ED treatment facility. Participants completed the Eating Disorder Examination Questionnaire (EDE‐Q), Patient Health Questionnaire‐9, and Beck Anxiety Inventory at admission and discharge.ResultsTNB individuals showed significant improvements on EDE‐Q global scores between admission and discharge (Cohen's d = 1.27), and showed similar improvements on the EDE‐Q over the course of treatment (Cohen's d = 0.06) when compared to cisgender individuals. TNB individuals had more severe depression at admission (Cohen's d = 0.61). Although depression improved over the course of treatment for both groups, TNB individuals showed less improvement (Cohen's d = 0.59). Suicidality was higher for TNB individuals on admission and discharge and did not improve significantly over the course of treatment (Cohen's d = 0.38).DiscussionThis study provides preliminary evidence that TNB and cisgender individuals show similar improvement in ED symptoms during HLOC treatment. However, TNB individuals have more severe depression and less improvement in depression compared to cisgender individuals, without improvement in suicidality. TNB individuals may benefit from care targeting depression and suicidality during ED treatment.Public Significance StatementTNB individuals have increased risk of EDs. Little research addresses how TNB individuals respond to ED treatment, which was traditionally created for cisgender individuals. We present one of the first studies examining ED treatment outcomes for TNB adults. TNB individuals showed improved ED symptoms with treatment, but less improvement in depression and their suicidality remained elevated. This suggests the need for targeted treatment.
International Journal of Eating Disorders, May 29, 2023
ObjectiveTo examine the psychometric properties of the Parent Eating Disorder Examination Questio... more ObjectiveTo examine the psychometric properties of the Parent Eating Disorder Examination Questionnaire (PEDE‐Q), developed to improve eating disorder (ED) assessment among youth by including parents as informants.MethodsA multi‐site, transdiagnostic sample of 355 adolescents with EDs completed the Eating Disorder Examination Questionnaire (EDE‐Q) and their parents completed the PEDE‐Q.ResultsThe internal consistencies of the PEDE‐Q subscales were on par with established EDE‐Q ranges (.73 to .90), both when examined using the original four‐factor EDE‐Q subscales and the seven‐item, three‐factor subscales of the brief EDE‐Q. Statistically significant medium‐ to large‐sized correlations and poor to moderate levels of agreement were found between the corresponding EDE‐Q and PEDE‐Q subscales. Receiver‐operator characteristic (ROC) curves showed that the PEDE‐Q had a statistically significant area under the curve (AUC) to maximize sensitivity and specificity in diagnosing full‐syndrome AN, whereas the EDE‐Q did not. Based on chi‐square analyses, the PEDE‐Q identified a statistically significantly greater number of AN cases than the EDE‐Q. The EDE‐Q yielded a BN diagnosis more frequently than the PEDE‐Q, although this difference was not statistically significant.DiscussionResults suggest that the PEDE‐Q has good psychometric properties and provides incremental information that can aid in the assessment and diagnosis of adolescents with EDs, particularly those with AN.Public significanceThere exist complex challenges to identifying clinically significant eating disorders among youth. The PEDE‐Q is a questionnaire measure that improves eating disorder assessment among children and adolescents by asking parents to report on the symptoms and behaviors they have observed in their child and that youth may not fully disclose. The PEDE‐Q can aid in the diagnosis of adolescents with eating disorders, particularly those with anorexia nervosa.
ObjectiveInvoluntary treatment for anorexia nervosa (AN) is sometimes necessary and lifesaving bu... more ObjectiveInvoluntary treatment for anorexia nervosa (AN) is sometimes necessary and lifesaving but can be experienced negatively by some individuals. The purpose of this qualitative study was to better understand participants' perceptions about their experience with involuntary treatment for AN.MethodThirty adult participants, who had been treated involuntarily for AN in the past, completed self‐report measures and qualitative interviews. Interview transcripts were coded using thematic analysis.ResultsThree themes were identified: (1) mixed perceptions about involuntary treatment, (2) the impact of involuntary treatment on external factors, including relationships, education, and employment, and (3) lessons learned from the experience. Participants who endorsed a positive shift in perspective regarding the need for involuntary treatment also reported favorable changes in their eating disorder recovery, whereas individuals whose perspective about their involuntary treatment remai...
Background Most studies reporting treatment outcomes for eating disorders at higher levels of car... more Background Most studies reporting treatment outcomes for eating disorders at higher levels of care focus on anorexia nervosa and bulimia nervosa. No studies have been published with a singular focus on examining treatment outcomes for adults receiving residential programming specifically designed for the treatment of binge eating spectrum disorders (BESD), including binge eating disorder and bulimia nervosa. Objective The purpose of this paper is to outline the protocol of a prospective study examining treatment outcomes at discharge and 3-month, 6-month, and 12-month postdischarge follow-up, for a sample of consecutive admissions to a residential program specifically for patients with BESD. Methods One hundred consecutive admissions to a binge eating treatment program were enrolled in the prospective single-arm trial between January 2019 and February 2020. Data were collected at admission, discharge, and 3, 6, and 12 months postdischarge, with admission, discharge, and 12-month fol...
ObjectiveSmartphone applications (i.e., apps) designed to target mental health symptoms have rece... more ObjectiveSmartphone applications (i.e., apps) designed to target mental health symptoms have received increasing public and empirical attention, including in eating disorder|eating disorders (EDs) treatment. While some data have begun to characterise app users in non‐controlled settings, there is limited information on use of apps in higher levels of care (e.g., partial hospitalisation or residential treatment programs) for EDs.MethodThis study aimed to explore metrics of use while in treatment for a commonly used ED‐focused mobile app (Recovery Record) among individuals enroled in intensive outpatient, partial hospitalisation, residential, or inpatient treatments (N = 2042).ResultsResults indicated that older individuals and participants with binge eating disorder demonstrated more frequent app engagement compared to younger participants and other ED diagnoses, respectively. Individuals entering at intensive outpatient and partial hospitalisation levels of care, as well as those wi...
OBJECTIVE This study aimed to assess how baseline motivation to recover impacts eating disorder (... more OBJECTIVE This study aimed to assess how baseline motivation to recover impacts eating disorder (ED) and comorbid symptoms at end-of-treatment (EOT) for adolescents and adults in inpatient/residential treatment. METHOD Two hundred and three adolescent (M = 15.90) and 395 adult (M = 25.45) patients with a Diagnostic Statistical Manual, 5th edition ED diagnosis completed the Decisional Balance Scale (DBS) at baseline, and psychosocial measures (ED symptoms, anxiety, depression, obsessive-compulsive disorder symptoms), and %body mass index (kg/m2 ; BMI) or median %BMI (for adolescents) at baseline and EOT. RESULTS The DBS Avoidance Coping and Burdens subscales at baseline were significantly lower for adolescents than adults (p < 0.001), whereas the DBS Benefits subscale at baseline did not significantly differ between subsamples (p = 0.06). Motivation to recover via DBS subscales was a more reliable predictor of EOT outcomes for both ED and comorbid psychopathology in adults (significant predictor in 19 of 54 total analyses, and 4 significant associations post-Bonferroni correction) than adolescents (significant predictor in 5 of 54 total analyses, and 1 significant association post-Bonferroni correction). CONCLUSIONS Baseline motivation to recover may be an important predictor of outcome for adult patients in inpatient/residential treatment but does not appear associated with outcomes for adolescent patients.
Eating and Weight Disorders-studies on Anorexia Bulimia and Obesity, Sep 1, 2004
Binge eating disorder (BED) has been hypothesized to be associated with poor outcome in gastric b... more Binge eating disorder (BED) has been hypothesized to be associated with poor outcome in gastric bypass surgery (GBP). However, past studies have yielded inconsistent results regarding BED and surgical outcome, which may be due to the variety of measures used to assess BED. The present study examines the utility of two commonly used BED diagnostic tools: the Structured Clinical Interview (SCID) and the Questionnaire of Eating and Weight Patterns-Revised (QEWP-R). Subjects were 168 adult patients evaluated for GBP. BED was assessed using the SCID and the 27% of the sample received a diagnosis of BED using the QEWP-R, compared with 14% using the SCID. Agreement using Cohen&#39;s kappa was 0.37. Compared to sub-non-concordant diagnoses of BED, subjects with concordant diagnoses scored on a measure of self-esteem. Although both diagnostic tools use the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria, each yielded different results. Further studies are needed to determine the most accurate method of assessing BED in this population.
Family therapy is increasingly recommended as the treatment of choice for eating disorders among ... more Family therapy is increasingly recommended as the treatment of choice for eating disorders among adolescents. The shift from blaming parents for causing an ED to seeing them as a necessary part of the recovery process was set in motion by Salvador Minuchin and colleagues, and then reinforced and expanded on by researchers at the Maudsley Hospital in London, UK, and in the United States and Australia. Data supporting the efficacy of family therapy for adolescent anorexia nervosa has been solidified, while family-based approaches in the treatment of adolescents with bulimia nervosa show promise. Further research is needed to replicate the findings of existing studies and to further clarify the utility of parental involvement in the treatment of older adolescents, or transition age youth, with anorexia nervosa and bulimia nervosa.
International Journal of Eating Disorders, Sep 23, 2022
ObjectiveThe purpose of this study was to compare symptom severity of eating disorders (EDs), dep... more ObjectiveThe purpose of this study was to compare symptom severity of eating disorders (EDs), depression and anxiety at admission and discharge for transgender and nonbinary (TNB) individuals and cisgender adult individuals receiving treatment for EDs at higher levels of care (HLOC), adding to the limited research in this area.MethodParticipants were 25 TNB individuals and 376 cisgender individuals admitted to a HLOC ED treatment facility. Participants completed the Eating Disorder Examination Questionnaire (EDE‐Q), Patient Health Questionnaire‐9, and Beck Anxiety Inventory at admission and discharge.ResultsTNB individuals showed significant improvements on EDE‐Q global scores between admission and discharge (Cohen's d = 1.27), and showed similar improvements on the EDE‐Q over the course of treatment (Cohen's d = 0.06) when compared to cisgender individuals. TNB individuals had more severe depression at admission (Cohen's d = 0.61). Although depression improved over the course of treatment for both groups, TNB individuals showed less improvement (Cohen's d = 0.59). Suicidality was higher for TNB individuals on admission and discharge and did not improve significantly over the course of treatment (Cohen's d = 0.38).DiscussionThis study provides preliminary evidence that TNB and cisgender individuals show similar improvement in ED symptoms during HLOC treatment. However, TNB individuals have more severe depression and less improvement in depression compared to cisgender individuals, without improvement in suicidality. TNB individuals may benefit from care targeting depression and suicidality during ED treatment.Public Significance StatementTNB individuals have increased risk of EDs. Little research addresses how TNB individuals respond to ED treatment, which was traditionally created for cisgender individuals. We present one of the first studies examining ED treatment outcomes for TNB adults. TNB individuals showed improved ED symptoms with treatment, but less improvement in depression and their suicidality remained elevated. This suggests the need for targeted treatment.
International Journal of Eating Disorders, May 29, 2023
ObjectiveTo examine the psychometric properties of the Parent Eating Disorder Examination Questio... more ObjectiveTo examine the psychometric properties of the Parent Eating Disorder Examination Questionnaire (PEDE‐Q), developed to improve eating disorder (ED) assessment among youth by including parents as informants.MethodsA multi‐site, transdiagnostic sample of 355 adolescents with EDs completed the Eating Disorder Examination Questionnaire (EDE‐Q) and their parents completed the PEDE‐Q.ResultsThe internal consistencies of the PEDE‐Q subscales were on par with established EDE‐Q ranges (.73 to .90), both when examined using the original four‐factor EDE‐Q subscales and the seven‐item, three‐factor subscales of the brief EDE‐Q. Statistically significant medium‐ to large‐sized correlations and poor to moderate levels of agreement were found between the corresponding EDE‐Q and PEDE‐Q subscales. Receiver‐operator characteristic (ROC) curves showed that the PEDE‐Q had a statistically significant area under the curve (AUC) to maximize sensitivity and specificity in diagnosing full‐syndrome AN, whereas the EDE‐Q did not. Based on chi‐square analyses, the PEDE‐Q identified a statistically significantly greater number of AN cases than the EDE‐Q. The EDE‐Q yielded a BN diagnosis more frequently than the PEDE‐Q, although this difference was not statistically significant.DiscussionResults suggest that the PEDE‐Q has good psychometric properties and provides incremental information that can aid in the assessment and diagnosis of adolescents with EDs, particularly those with AN.Public significanceThere exist complex challenges to identifying clinically significant eating disorders among youth. The PEDE‐Q is a questionnaire measure that improves eating disorder assessment among children and adolescents by asking parents to report on the symptoms and behaviors they have observed in their child and that youth may not fully disclose. The PEDE‐Q can aid in the diagnosis of adolescents with eating disorders, particularly those with anorexia nervosa.
ObjectiveInvoluntary treatment for anorexia nervosa (AN) is sometimes necessary and lifesaving bu... more ObjectiveInvoluntary treatment for anorexia nervosa (AN) is sometimes necessary and lifesaving but can be experienced negatively by some individuals. The purpose of this qualitative study was to better understand participants' perceptions about their experience with involuntary treatment for AN.MethodThirty adult participants, who had been treated involuntarily for AN in the past, completed self‐report measures and qualitative interviews. Interview transcripts were coded using thematic analysis.ResultsThree themes were identified: (1) mixed perceptions about involuntary treatment, (2) the impact of involuntary treatment on external factors, including relationships, education, and employment, and (3) lessons learned from the experience. Participants who endorsed a positive shift in perspective regarding the need for involuntary treatment also reported favorable changes in their eating disorder recovery, whereas individuals whose perspective about their involuntary treatment remai...
Background Most studies reporting treatment outcomes for eating disorders at higher levels of car... more Background Most studies reporting treatment outcomes for eating disorders at higher levels of care focus on anorexia nervosa and bulimia nervosa. No studies have been published with a singular focus on examining treatment outcomes for adults receiving residential programming specifically designed for the treatment of binge eating spectrum disorders (BESD), including binge eating disorder and bulimia nervosa. Objective The purpose of this paper is to outline the protocol of a prospective study examining treatment outcomes at discharge and 3-month, 6-month, and 12-month postdischarge follow-up, for a sample of consecutive admissions to a residential program specifically for patients with BESD. Methods One hundred consecutive admissions to a binge eating treatment program were enrolled in the prospective single-arm trial between January 2019 and February 2020. Data were collected at admission, discharge, and 3, 6, and 12 months postdischarge, with admission, discharge, and 12-month fol...
ObjectiveSmartphone applications (i.e., apps) designed to target mental health symptoms have rece... more ObjectiveSmartphone applications (i.e., apps) designed to target mental health symptoms have received increasing public and empirical attention, including in eating disorder|eating disorders (EDs) treatment. While some data have begun to characterise app users in non‐controlled settings, there is limited information on use of apps in higher levels of care (e.g., partial hospitalisation or residential treatment programs) for EDs.MethodThis study aimed to explore metrics of use while in treatment for a commonly used ED‐focused mobile app (Recovery Record) among individuals enroled in intensive outpatient, partial hospitalisation, residential, or inpatient treatments (N = 2042).ResultsResults indicated that older individuals and participants with binge eating disorder demonstrated more frequent app engagement compared to younger participants and other ED diagnoses, respectively. Individuals entering at intensive outpatient and partial hospitalisation levels of care, as well as those wi...
OBJECTIVE This study aimed to assess how baseline motivation to recover impacts eating disorder (... more OBJECTIVE This study aimed to assess how baseline motivation to recover impacts eating disorder (ED) and comorbid symptoms at end-of-treatment (EOT) for adolescents and adults in inpatient/residential treatment. METHOD Two hundred and three adolescent (M = 15.90) and 395 adult (M = 25.45) patients with a Diagnostic Statistical Manual, 5th edition ED diagnosis completed the Decisional Balance Scale (DBS) at baseline, and psychosocial measures (ED symptoms, anxiety, depression, obsessive-compulsive disorder symptoms), and %body mass index (kg/m2 ; BMI) or median %BMI (for adolescents) at baseline and EOT. RESULTS The DBS Avoidance Coping and Burdens subscales at baseline were significantly lower for adolescents than adults (p < 0.001), whereas the DBS Benefits subscale at baseline did not significantly differ between subsamples (p = 0.06). Motivation to recover via DBS subscales was a more reliable predictor of EOT outcomes for both ED and comorbid psychopathology in adults (significant predictor in 19 of 54 total analyses, and 4 significant associations post-Bonferroni correction) than adolescents (significant predictor in 5 of 54 total analyses, and 1 significant association post-Bonferroni correction). CONCLUSIONS Baseline motivation to recover may be an important predictor of outcome for adult patients in inpatient/residential treatment but does not appear associated with outcomes for adolescent patients.
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