Adult Eating Disorders Research Articles

Eating disorders in adult women: biopsychosocial, developmental, and clinical considerations

Research and clinical practice indicate that increasing numbers of adult women are suffering from both clinical and subclinical eating disorders and are now seeking treatment. The unique needs and experiences of this population bear examination through the lens of female adult development. The rapid increase in eating disorders, the ongoing gender disparity, and the complex realities of female biology suggest that this evaluation will be best informed by a biopsychosocial perspective. Developmental transitions including marriage, divorce, pregnancies, parenting, menopause, and the ageing process all create risk in an era that promotes weight loss, thinness, and a youthful appearance as the ultimate signs of success for women. Globalisation has contributed to the emergence of eating disorders in diverse countries and cultures. Consequently, all primary mental health and medical providers must understand the risk factors, signs, and symptoms of adult eating disorders, as well as the effect of environmental ...

The effects of improving service efficiency in a specialist inpatient eating disorder treatment program

The Hollywood Clinic is a private adult eating disorder inpatient service in Western Australia with ten specialised beds. It was identified that this service had a long length of stay, which was shown to limit access to care and made the program less cost-effective. Not only are there sizable financial savings in reduced length of stay but indirect “costs” to patients may include missed school and work, impoverished relationships and decreased quality of life. Conversely, early discharge resulting from pressure on length of stay may negatively impact treatment outcomes and recovery trajectories. Our objective then, was to optimise patients' length of stay. We introduced a range of initiatives to improve program efficiency. These included earlier increases in oral intake prescription, higher energy content of menus, closer monitoring of weight restoration, stream-lining our protocol and utilising our day patient program on discharge. These initiatives resulted in a reduction in the average length of stay from 52 days to 35 days. Concomitantly, there has been no reduction in treatment gains during shorter admissions. Furthermore, there is currently no waiting list for admission to our inpatient eating disorder program, giving us increased capacity to treat more patients in need of the service.

Position Paper of the Society for Adolescent Health and Medicine: Medical Management of Restrictive Eating Disorders in Adolescents and Young Adults

The medical provider plays an important role in the management of adolescents and young adults with restrictive eating disorders including anorexia nervosa. This position paper clarifies the role of the medical provider in diagnosing and treating eating disorders, proposes an evidence-based method for determining degree of malnutrition, and advocates for standardization of terminology and consistency in the use of terms referring to ideal, expected, or median body weight. The need for medical monitoring at each level of care is underscored.

An audit of patients with severe malnutrition secondary to eating disorders in Western Australia - a legacy of underinvestment in comprehensive care of youths and adults with eating disorders?

From February 2012 until January 2014 an acute medical ward at a 600 bed tertiary hospital in Western Australia conducted an internal audit of youth and adult inpatient separations for patients admitted with complications of severe eating disorders. This cohort exhibited levels of severe malnutrition on par with or more severe than those managed in a specialist service in another state of comparable size, (the average BMI on admission was 12.4 range 9.8-15.8; n=12) and may reflect the fact that Western Australia is one of only two states / territories in Australia that does not have a publicly funded specialist adult inpatient eating disorders program. Proposals for development of a state wide comprehensive specialist eating disorders service for youths and adults in Western Australia must take into account a potential legacy of decades of under investment in this area of health care, and potential barriers to optimising nutritional recovery within the confines of an activity based funding framework. This abstract was presented in the Service Initiatives stream of the 2014 ANZAED Conference.

Implementation of a day hospital treatment programme based on CBT-E for severe eating disorders in adults: an open trial

More intense forms of enhanced cognitive-behaviour therapy (CBT-E) may be necessary for patients who do not benefit from outpatient CBT-E. A novel application of the transdiagnostic approach for eating disorders (ED) was implemented. A mixed sample of 62 patients, 13 anorexia nervosa (AN) (21%); 29 bulimia nervosa (BN) (47%) and 20 eating disorders not otherwise specified (EDNOS) (32%) were admitted to a CBT-E day treatment. Forty-seven patients (75.8%) completed the treatment as defined by completing two-thirds of treatment and the discharge assessment. A total of 31.9% (15/47) achieved recovery as defined by post-treatment body mass index (BMI) ≥ 18.5 and global Eating Disorder Examination Questionnaire (EDE-Q) +1 SD above community mean. An increase of 1.2 BMI units (15.8–17.0, p < .02) was observed for very underweight patients (BMI < 17.5). Patients with BN showed significantly greater improvement than AN or EDNOS for ED symptomology, state anxiety and self-esteem. Findings demonstrated high treatmen...

Temperamental differences between adolescents and young adults with or without an eating disorder

ObjectiveThere is an increasing interest into the role of temperament, and more specifically the traits Sensitivity to Punishment (SP) and Sensitivity to Reward (SR), in the occurrence of eating disorder (ED) symptoms. However, the results on this topic are inconsistent, different instruments are used to measure SP and SR and there is a lack of research on adolescents and young adults, although they form a group at risk to develop an ED. Therefore, the present objective was to study personality profiles co-occurring with specific EDs in adolescents and young adults. MethodThe present study examined the levels of SP and SR for different ED-diagnoses, namely Anorexia Nervosa of the Restricting type (AN-R; n=41), Anorexia Nervosa of the Binge/Purge type (AN-B/P; n=20) and Bulimia Nervosa (BN; n=30), and compared these with a Healthy Control group (HC; n=292). SP and SR were measured by three different temperament questionnaires in order to rule out instrument-specific findings. Only female participants between the age of 14 and 25 years were included. ResultsSP was transdiagnostically increased compared to HCs, whereas SR was lower in AN-R patients compared to BN patients. These results were independent of the questionnaire being used. DiscussionFurther research is necessary to explain how these traits may influence specific ED-symptoms.

A controlled study of personality traits in female adolescents with eating disorders

BackgroundAmong adults, personality traits have been implicated in the development and maintenance of eating disorders (EDs); whether these findings extend to youth is unknown. The aim of this study was to investigate personality traits of adolescents with EDs.MethodsA case‐control approach was performed by comparing a clinical group of female adolescents with EDs (n = 23) to a control group of adolescents in the general community (n = 26) on personality traits of inhibited, self‐demeaning, and borderline tendency. Controls were frequency‐matched to cases on age and sex, were drawn from a similar geographic catchment area, and observed in the same year as clinical cases.ResultsThe clinical group demonstrated significantly higher scores on self‐demeaning (F(1,47) = 41.39, p < .001, η2 = .075), borderline (F(1,47) = 24.50, p < .001, η2 = .093), and inhibited (F(1,47) = 13.33, p = .001, η2 = .014) personality styles. Adjustment for affective symptomatology diminished the strength of these relationships, but personality pathology still demarcated the group with clinical EDs.ConclusionsThe well‐established link between personality pathology and EDs in adults generalised to adolescents.

Evaluation of an adult inpatient eating disorders unit

Whilst most treatment for eating disorders occurs in an outpatient setting, inpatient treatment and care can play an important role if a patient is medically unstable, or is not responding to outpatient or day program treatments. With limited research conducted to date, the effectiveness of inpatient care and the role it plays in promoting recovery remain incompletely elucidated.

Patient characteristics from a Melbourne based adult eating disorders inpatient unit

This study aims to inform clinicians and researchers about the characteristics of patients admitted to the Eating Disorders Inpatient Unit, NorthWestern Mental Health, Royal Melbourne Hospital across a 4 year period. It is anticipated that this information can provide insights into the potential base rates for particular inpatient diagnosis, chronicity of illness, duration of admissions and planned versus unplanned discharges. Data was collected retrospectively via a hospital file audit of admissions to the unit between the years 2009 and 2012. Across the 4 year period there were a total of 193 admissions to the unit and just over a third of patients (35%) were placed on an involuntary treatment order. On admission, the average eating disorder duration was 5.4 years and eating disorder diagnosis comprised; anorexia nervosa-restricting type (65.8%), anoirexia nervosa–binge purge type (6.8%), bulimia Nervosa (3.2%), eating disoirdfer noit otherwise specified (18.9%) and no eating disorder diagnosis (4.7%). The average duration of admission was 36 days and the majority of discharges were planned (88.4%) compared to unplanned (11.6%). Given the chronicity of illness, these findings emphasise the importance of intensive follow-up given the relatively short inpatient stay which may include outreach services, frequent individual/group outpatient appointments and utilising day patient programs as a step down following discharge.

Mortality in eating disorders: A follow-up study of adult eating disorder patients treated in tertiary care, 1995–2010

Elevated mortality risk in anorexia nervosa has been established, but less is known about the outcomes of bulimia nervosa and binge eating disorder. In this follow-up study we determined mortality in adults (N=2450, 95% women) admitted to the eating disorder clinic of the Helsinki University Central Hospital in the period 1995–2010. Most of the patients (80.7%) were outpatients. For each patient four controls were selected and matched for age, sex and place of residence. The matching was taken into account by modelling end-point events using Cox's proportional hazard model. The hazard ratio (HR) for all-cause mortality was 6.51 (95% CI 3.46–12.26) in broad anorexia nervosa (AN), 2.97 (95% CI 1.90–4.65) in broad bulimia nervosa (BN), and 1.77 (95% CI 0.60–5.27) in binge eating disorder (BED). Mortality risk in broad AN was highest during the first years after admission but declined thereafter, while in broad BN the mortality risk started to rise two years after the first admission. The HR for suicide was elevated both in broad AN (HR 5.07; 95% CI 1.37–18.84) and in broad BN (HR 6.07; 95% CI 2.47–14.89). Results show that eating disorders are associated with increased mortality risk even when specialised treatment is available.

Internet-based interventions for eating disorders in adults: a systematic review

BackgroundThis systematic review evaluates the efficacy of internet-based interventions for the treatment of different eating disorders in adults.MethodA search for peer reviewed journal articles detailing Randomised Control Trials (RCT) and Controlled Trials (CT) addressing participants with eating disorders aged at least 16 was completed in the electronic databases Web of Science, PsycInfo and PubMed. The quality of the included articles was assessed, results were reviewed and effect sizes and corresponding confidence intervals were calculated.ResultsEight studies, including a total of N = 609 participants, fulfilled the selection criteria and were included. The majority of treatments applied in these studies were based on CBT principles. Six studies described guided self-help interventions that showed significant symptom reduction in terms of primary and secondary outcomes regarding eating behaviour and abstinence rates. These studies produced significant medium to high effect sizes both within and between the groups after utilisation of guided self-help programs or a self-help book backed up with supportive e-mails. The two remaining studies utilised a specific writing task or e-mail therapy that did not follow a structured treatment program. Here, no significant effects could be found. Treatment dropout rates ranged from 9% to 47.2%. Furthermore, reductions in other symptoms, for example depression and anxiety, and an increase in quality of life were found by four studies.ConclusionsOverall, the results support the value of internet-based interventions that use guided self-help to tackle eating disorders, but further research is needed due to the heterogeneity of the studies.

Childhood Abuse and Eating Psychopathology: The Mediating Role of Core Beliefs

This study aimed to investigate the mediating role of early maladaptive schemas (core beliefs) in the relationship between childhood abuse and eating psychopathology. Three self-report questionnaires assessing experiences of childhood abuse, eating psychopathology, and levels of maladaptive schemas were administered to 118 female university students. Emotional abuse predicted drive for thinness, whereas sexual abuse predicted symptoms of bulimia nervosa (BN). Mistrust and abuse beliefs were found to fully mediate relationships between childhood abuse and drive for thinness and bulimia scales. Abandonment beliefs were also shown to be partial mediators of the relationship between sexual abuse and symptoms of BN. In a sample of nonclinical women, beliefs pertaining to abandonment and mistrust or abuse appeared to be important in the explanation of the relationship between recollections of childhood abuse and adult eating disorder symptoms.

Diagnostic Issues of Binge Eating in Eating Disorders

Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for eating disorders (EDs) are problematic and due to be revised. One area of debate concerns binge eating. We investigated the impact of four aspects of binge eating (binge size, loss of control, frequency of objective and subjective binge eating) assessed by questionnaire and interview in adult ED patients on concurrent and follow-up symptoms. Data came from two independent naturalistic Swedish ED databases (N = 2354, with 12-month follow-up; and N = 597, with 36-month follow-up). We found fair concurrent validity of criteria assessed using questionnaire, but poor concurrent validity for interview assessment, and no prognostic validity regardless of assessment method. The findings give support to some planned DSM-5 revisions, but challenge the assumption of binge eating as a useful diagnostic criterion, as well as having implications for measurement.

Work demands, social support, and job satisfaction in eating disorder inpatient settings: A qualitative study

In this qualitative study, we aimed to investigate work demands experienced by health-care workers in an adult eating disorder inpatient service. We also aimed to investigate the use of social support and job satisfaction in this setting. Twelve health-care workers from an eating disorder inpatient ward, including nurses, health-care support workers, and occupational therapists, participated in semistructured interviews. Interviews were transcribed verbatim and analysed using thematic analysis. A number of work demands were discussed relating to therapeutic care, physical care, and organizational demands. Most participants discussed social support at work as being highly valuable, formally and informally, whereas external support was viewed as less important. Despite the challenges of caring for patients with eating disorders, the majority of participants reported good patient-related job satisfaction, but poor job satisfaction in relation to organizational factors. Eating disorder inpatient care is complex and demanding, necessitating effective teamwork, communication, and support systems among health-care workers. Interventions should be developed to target barriers to care, including time constraints, administrative workload, and insufficient allocation of staff.

Cognitive-behavioral therapy for binge eating disorder in adolescents: study protocol for a randomized controlled trial.

BackgroundBinge eating disorder is a prevalent adolescent disorder, associated with increased eating disorder and general psychopathology as well as an increased risk for overweight and obesity. As opposed to binge eating disorder in adults, there is a lack of validated psychological treatments for this condition in adolescents. The goal of this research project is therefore to determine the efficacy of age-adapted cognitive-behavioral therapy in adolescents with binge eating disorder – the gold standard treatment for adults with binge eating disorder.Methods/designIn a single-center efficacy trial, 60 12- to 20-year-old adolescents meeting diagnostic criteria of binge eating disorder (full-syndrome or subthreshold) according to the Diagnostic and Statistical Manual of Mental Disorders 4th or 5th Edition, will be centrally randomized to 4 months of cognitive-behavioral therapy (n = 30) or a waiting-list control condition (n = 30). Using an observer-blind design, patients are assessed at baseline, mid-treatment, post-treatment, and at 6- and 12-month follow-ups after the end of treatment. In 20 individual outpatient sessions, cognitive-behavioral therapy for adolescents focuses on eating behavior, body image, and stress; parents receive psychoeducation on these topics. Primary endpoint is the number of episodes with binge eating over the previous 28 days at post-treatment using a state-of-the art clinical interview. Secondary outcome measures address the specific eating disorder psychopathology, general psychopathology, mental comorbidity, self-esteem, quality of life, and body weight.DiscussionThis trial will allow us to determine the short- and long-term efficacy of cognitive-behavioral therapy in adolescent binge eating disorder, to determine cost-effectiveness, and to identify predictors of treatment outcome. Evidence will be gathered regarding whether this treatment will help to prevent excessive weight gain. If efficacy can be demonstrated, the results from this trial will enhance availability of evidence-based treatment of adolescent binge eating disorder.Trial registrationGerman Clinical Trials Register: DRKS00000542

Challenges in Making the Transition Between Pediatric and Adult Eating Disorder Programs: A Qualitative Study From the Perspective of Service Providers

There is scant research regarding the transition from pediatric to adult eating disorder programs. This study aims to increase understanding of the factors that impede or facilitate successful service transition for individuals with anorexia nervosa moving from pediatric to adult eating disorder programs. Participants included service providers representing pediatric and adult eating disorder programs, in addition to community treatment providers in a large city. The following themes were identified: a) readiness, not age, should determine service transition; and b) implementation of interventions for facilitating transition from pediatric to adult eating disorder programs including appropriate medical follow-up. These findings delineate various factors that may help facilitate or interrupt a seamless and coordinated transition from pediatric to adult eating disorder programs.

Navigating the transition from pediatric to adult eating disorder programs: Perspectives of service providers

This study aims to conduct qualitative research on the perspectives of service providers regarding the transition process from pediatric to adult specialized eating disorder tertiary care programs. Two focus groups with a diverse group of clinicians in pediatric and adult eating disorder programs and five qualitative interviews with clinicians in the community were conducted. Three themes were identified as challenges during the transition process: (1) illness related factors (ambivalence and denial); (2) the interruption of normative adolescent developmental processes by the illness; and, (3) the impact of decreased parental involvement in the adult compared to pediatric eating disorder programs. These themes were compared with empirical evidence on other chronic mental or physical health concerns for the purpose of identifying ways to facilitate a more successful service transition for young adults with anorexia nervosa. Future research and clinical implications are delineated.

Portuguese validation of the children's eating attitudes test

BACKGROUND: The Eating Attitudes Test (EAT) is the most widely used instrument for evaluating eating disorders in adults and adolescents in a variety of cultures and samples. OBJECTIVE: The aim of this study was to analyse the psychometric properties of the Portuguese version of the Children's Eating Attitudes Test (ChEAT). METHOD: Nine hundred and fifty-six Portuguese secondary students (565 girls and 391 boys) answered the ChEAT. The test-retest reliability was obtained with data from 206 participants from the total sample who re-answered the questionnaire after 4-6 weeks. Psychometric analyses were carried out for the total sample and separately for girls and boys. RESULTS: Internal consistency and test-retest reliability were satisfactory. Principal components factorial analysis yielded four factors in the total sample, accounting for 42.35% of the total variance. Factor structure was similar in the total sample and in both genders. Factors were labelled: F1 Fear of Getting Fat, F2 Restrictive and Purgative Behaviours, F3 Food Preoccupation and F4 Social Pressure to Eat. The concurrent validity, explored using the Contour Drawing Figure Rating Scale (CDRS) was high. DISCUSSION: The Portuguese version of the ChEAT is a valid and useful instrument for the evaluation of abnormal eating attitudes and behaviours among Portuguese adolescents.

Psychopharmacological Interventions for Adolescents with Eating Disorders

The purpose of this article is to review evidence-based pharmacological treatments for eating disorders with a special focus on the adolescent population. Eating disorders commonly present in adolescence, yet little published data are available to guide the adolescent psychiatrist. The use of medications in the context of evidence-based psychotherapeutic interventions and co-morbid psychiatric conditions will be discussed. Defined will be the unique role of the adolescent psychiatrist in orchestrating treatment by a multidisciplinary team, determining the appropriate level of care, monitoring safety, and evaluating treatment response. Risks and benefits of the use of pharmacological interventions in individuals who are malnourished or engaging in eating disordered behaviors, such as purging or laxative abuse, will be delineated along with proposed monitoring. Each potentially affected organ system will be addressed. Sequentially described is the existing evidence for use of medications for anorexia nervosa, bulimia nervosa, and binge eating disorder in adults and, where available, adolescents. Atypical antipsychotics, particularly olanzapine, have shown promise for adults with anorexia nervosa. However, in a recent trial of adolescents, no benefit for olanzapine over placebo was found. Several antidepressants have been shown to be effective treatments for bulimia nervosa, and fluoxetine has the FDA approval for treatment of this disorder in adults. Although fluoxetine has been deemed safe and effective in an open trial of adolescent patients, controlled studies in this population are lacking. Special considerations for the use of these medications in adolescents are discussed.

The impact of different outcome measures on estimates of remission in a 3‐year follow‐up of eating disorders

To examine the impact of using different outcome measures on estimates of remission rates in eating disorders (ED). Adult ED patients (n = 334) included in a naturalistic, longitudinal project were assessed 3 years after intake. Remission was operationally defined using six different measures of outcome. Pairwise analyses of agreement between outcome measures were also calculated. Remission rates for the entire group varied considerably from 24.3 to 77.8% depending on how remission was defined and who made the assessment (experts or patients). Outcome measures performed differently depending on diagnosis, and agreement between measures varied from none to very good. The impact of different definitions of outcome on remission estimates is considerable. There is a need to validate different estimates of remission by examining them in relation to multiple domains of outcome over time and by critically examining their relative merits both empirically and clinically.