Mood Intolerance Research Articles

Acceptance and Commitment Therapy as a Conceptual Treatment Model for Obsessive-Compulsive Personality Disorder

Acceptance and commitment therapy (ACT) has demonstrated efficacy in thousands of clinical trials for eating disorders, depression, anxiety, personality disorders, and more. However, ACT has not established efficacy as a treatment for obsessive compulsive personality disorder (OCPD) in a clinical trial. The prevalence of OCPD is one of the highest among personality disorders, yet there is a dearth of research regarding empirically supported treatments and the disorder in general. Aspects of OCPD, including perfectionism, mood intolerance, experiential avoidance, and impaired psychosocial functioning, make it particularly suitable for research involving ACT, which aims to increase psychological flexibility. The purpose of this paper is to elucidate a conceptual model for the treatment of OCPD using ACT. Specific strategies and techniques will be discussed. Future research avenues include exploring ACT as a viable treatment for OCPD, as well as the constructs of experiential avoidance and psychological flexibility related to OCPD functioning.

Understanding eating disorder symptoms in adolescents: testing a cognitive-behavioural model of eating disorders in a community sample

ABSTRACT Clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties are associated with eating disorder symptoms in clinical samples. The aim of the current study was to test a model including clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties to understand eating disorder symptoms in an adolescent community sample. Adolescents (N = 446, M age = 16.25 years, SD = 1.64; 74.2% female) completed measures of clinical perfectionism, self-esteem, mood intolerance, interpersonal difficulties, and eating disorder symptoms. Path analysis indicated clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties were all directly associated with symptoms of eating disorders, and that clinical perfectionism was indirectly associated with eating disorders through self-esteem, mood intolerance, and interpersonal difficulties. The results indicate the cognitive-behavioural model of eating disorders can be applied to adolescents in the community with symptoms of eating disorders. Directional causality between constructs should be established to understand whether increased clinical perfectionism, and reduced self-esteem, mood intolerance, and interpersonal difficulties are vulnerabilities to the development and maintenance of eating disorders.

General and body-related self-conscious emotions predict facets of restrictive eating in undergraduate women

It is well understood that mood intolerance is a predictor of eating disorder (ED) symptoms. However, it is unclear whether intolerance of specific emotional experiences predicts ED symptoms. The current study used an ecological momentary assessment design to assess associations between the intensity and intolerance of general and body-related self-conscious emotions and facets of restrictive eating. Participants were 151 female undergraduate students (Mage = 18.99, SD = 1.30 years) who completed six surveys per day for 10 consecutive days. Participants reported on the intensity and intolerance of general and body-related shame, guilt, envy, and embarrassment and cognitive restraint (thoughts about restrictive eating) and behavioral restriction (act of restrictive eating) facets of restrictive eating. Data were analyzed using multilevel modeling. Based on the between-person findings, participants higher on intensity and intolerance of general and body-related self-conscious emotions experienced higher levels of cognitive restraint and behavioral restriction relative to individuals with lower levels of the emotion intensity and intolerance predictors on average. Based on the within-person findings, experiencing a higher intolerance of body-related self-conscious emotions compared to one's average was particularly important when examining behavioral restriction. Experiencing a higher intolerance of body-related envy was able to predict increased behavioral restriction at the time of the next report. These findings may inform tailored treatment targets for mood intolerance and restrictive eating.

Is personality the key in cognitive‐behavioural therapy for eating disorders? A review

The efficacy of individual cognitive-behavioural therapy (CBT) for eating disorders can be assessed by investigating the potential predictors, mediators and moderators of treatment. The present review focused on personality since its crucial role has been emphasized both by research and practice. Sixteen studies were collected, and data were extracted through a highly operationalized coding system. Overall, personality disorders were the most investigated construct; however, their influence was somewhat contradictory. A more cogent result occurred for borderline personality disorder (BPD) when considered as a moderator (not a predictor nor a mediator). Patients with a more disturbed borderline personality benefited to a greater extent from treatments including booster modules on affects, interpersonal relationships and mood intolerance, rather than symptoms exclusively. Nine additional personality dimensions, beyond BPD, were investigated sparsely, and results regarding them were barely indicative in this review. However, some of these dimensions (e.g., affective lability and stimulus-seeking behaviours) could be traced back to BPD, thereby strengthening evidence of the role of borderline disorder as a moderator. Although research on the relationship between personality and eating disorders needs to be increased and methodologically improved, personality, taken as a whole, emerged as a promising variable for enhancing the efficacy of CBT.

An examination of the transdiagnostic cognitive-behavioural model of eating disorders in adolescents

ObjectiveThe validity of the transdiagnostic cognitive-behavioural model of eating disorders has been examined in adults, however there is limited examination in adolescents with eating disorders. The present study examined the direct and indirect relationships between eating disorder symptoms and the four maintaining processes: perfectionism, low core self-esteem, mood intolerance, and interpersonal difficulties. MethodUsing a correlational cross-sectional design, adolescents with eating disorders (N = 270; anorexia nervosa [restricting; 35.9%]; anorexia nervosa [binge purge; 8.1%]; bulimia nervosa [9.3%]; atypical anorexia nervosa [27.4%]; bulimia nervosa [of low frequency and/or limited duration; 3%]; purging [1.1%]; and unspecified feeding or eating disorders [15.2%]) completed measures of perfectionism, self-esteem, mood intolerance, interpersonal difficulties, and eating disorder symptoms as part of the intake assessment to an eating disorders program. ResultsPath analysis revealed that low self-esteem and mood intolerance were directly associated with eating disorder symptoms. Perfectionism was indirectly associated with eating disorder symptoms through self-esteem and mood intolerance. DiscussionThe findings provide partial support for the transdiagnostic model of eating disorders in an adolescent clinical sample. In particular, core low self-esteem and mood intolerance were found to be pertinent in adolescents with eating disorders. A limitation of the current study was the use of cross-sectional data. Future research should examine the transdiagnostic model with the use of longitudinal data. Furthermore, future research is required to examine potential differences in the way the maintaining mechanisms operate between adolescents and adults with eating disorders and the implications for treatment.

Predictors and moderators of outcomes and readmission for adolescent inpatients with anorexia nervosa: A pilot study

ObjectiveThis pilot study investigated predictors, moderators, and mediators of outcome and readmission in adolescents receiving specialist inpatient treatment for anorexia nervosa.MethodAdolescents (n = 40) aged between 14 and 17 years (mean = 15.42) were assessed at admission and discharge from a specialist inpatient programme and again at three‐month follow‐up on the following outcome variables: eating disorder pathology, quality of life (QOL), and body mass index (BMI) centile. Readmissions to hospital were recorded over the three months post‐discharge period. Potential predictors were drawn from theoretical models.ResultsReadmission during the three‐month follow‐up period was less likely for first presentations. Higher baseline purging, concern over mistakes, perfectionism, ineffectiveness, and mood intolerance were associated with higher levels of eating disorder pathology and poorer QOL over all points of follow‐up. Driven exercise moderated weight outcomes such that higher levels of baseline exercise resulted in a lower BMI centile at follow‐up. Greater weight gain during treatment predicted higher BMI centile at follow‐up, and increased perfectionism during treatment predicted a greater likelihood of being readmitted within three months of discharge.ConclusionsWeight gain during inpatient treatment should be encouraged to improve later weight outcomes. Focusing on the prevention of growth in perfectionism may be useful in improving psychological outcomes as will prioritising the elimination of purging and improved emotional regulation and self‐efficacy. Efforts should be made to reduce driven exercise to promote better weight‐related outcomes.

Evaluation of the DSM-5 Severity Specifier for Bulimia Nervosa in Treatment-Seeking Youth.

A new severity specifier for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (e.g., laxative misuse, self-induced vomiting, fasting, diuretic misuse, and excessive exercise), has been added to the most recent (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a means of addressing variability and heterogeneity in the severity of the disorder. While existing research provides support for the DSM-5 severity specifier for BN in adult patients, evidence for its validity and clinical utility in youth is currently lacking. To address this gap, data from 272 treatment-seeking adolescents with DSM-5 BN (94.2% female, M age = 15.3years, SD 1.7) were analysed to examine whether these patients, sub-grouped based on the DSM-5 severity definitions, would show meaningful differences in a broad range of clinical variables and demographic and physical characteristics. Analyses revealed that participants categorized with mild, moderate, severe, and extreme severity of BN significantly differed from each other in 15 variables regarding eating disorder pathological features and putative maintenance factors (i.e., core low self-esteem, perfectionism, social appearance anxiety, body surveillance, and mood intolerance), health-related quality of life and comorbid psychiatric (i.e., affective and anxiety) disorders (large effect sizes). Between-group differences in demographics, body mass index, or age-of-BN onset were not observed. Collectively, our findings provide support for the utility of the frequency of inappropriate weight compensatory behaviours as a severity indicator for BN and suggest that age-at-onset of BN is probably more disorder- than severity-dependent. Implications for future research are outlined.

Enhanced cognitive behavioral therapy for eating disorders adapted for a group setting.

This randomized control trial is an evaluation of the effectiveness of enhanced cognitive behavioral treatment (CBT-E) for eating disorders adapted for a group setting. The study aimed to examine the effects of group CBT-E on eating disorder psychopathology and additional maintaining pathology. A transdiagnostic sample of individuals with eating disorders with a BMI ≥ 18 kg/m2 (N = 40) were randomized to an immediate-start or delayed-start condition so as to compare therapeutic effects of group CBT-E with a waitlist control. Global Eating Disorder Examination Questionnaire (EDE-Q) scores, BMI, and measures of Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were measured across the 8-week control period, throughout the group treatment and at 3-months post-treatment. Over 70% of those who entered the trial completed treatment. The first eight weeks of group CBT-E were more effective at reducing Global EDE-Q scores than no treatment (waitlist control). By post-treatment, good outcome (a Global EDE-Q within 1 SD of Australian community norms plus BMI ≥ 18.5) was achieved by 67.9% of treatment completers and 66.7% of the total sample. Symptom abstinence within the previous month was reported by 14.3% of treatment completers and 10.3% of the total sample. Significant reductions in Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were also observed. This study demonstrated that a group version of CBT-E can be effective at reducing eating disorder psychopathology in a transdiagnostic sample of individuals with eating disorders. Group CBT-E could provide a means of increasing availability of evidence-based treatment for eating disorders.

Cognitive-behavioral and attachment interventions in the transdiagnostic treatment of bulimia nervosa and binge eating disorder

Background The transdiagnostic model of eating disorders provides an evidence-based cognitive-behavioral treatment approach, emphasizing the maintaining factors of low selfesteem, perfectionism, mood intolerance and interpersonal difficulties. Although attachment quality is associated with these factors, there is no treatment model focusing on both attachment-related and cognitive-behavioral maintaining factors of the symptoms. Aims The aim was to construct and test a multilevel treatment model, which integrates attachment interventions into the transdiagnostic treatment of eating disorders. Methods Relevant aspects of attachment functioning were joined together with the four cognitive-behavioral maintaining factors of the symptoms, and attachment interventions were incorporated into an extended transdiagnostic treatment of a bulimia nervosa and a binge eating disorder patient. Results Attachment domains could be integrated into the transdiagnostic model of eating disorders at both the case conceptualization and treatment level. The improvement of attachment functioning was related to treatment outcomes at a one month follow-up. Conclusions When attachment dysfunctions contribute to precipitating or maintaining mechanisms of eating disorder symptoms a multilevel treatment targeting both the relevant aspects of attachment and cognitive-behavioral functioning can be suggested. Randomized controlled studies with different intervention groups are required to confirm the result of these case studies.

Validity and clinical utility of the DSM-5 severity specifier for bulimia nervosa: results from a multisite sample of patients who received evidence-based treatment.

A new "severity specifier" for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (IWCBs), was added to the DSM-5 as a means of documenting heterogeneity and variability in the severity of the disorder. Yet, evidence for its validity in clinical populations, including prognostic significance for treatment outcome, is currently lacking. Existing data from 281 treatment-seeking patients with DSM-5 BN, who received the best available treatment for their disorder (manual-based cognitive behavioural therapy; CBT) in an outpatient setting, were re-analysed to examine whether these patients subgrouped based on the DSM-5 severity levels would show meaningful and consistent differences on (a) a range of clinical variables assessed at pre-treatment and (b) post-treatment abstinence from IWCBs. Results highlight that the mild, moderate, severe, and extreme severity groups were statistically distinguishable on 22 variables assessed at pre-treatment regarding eating disorder pathological features, maintenance factors of BN, associated (current) and lifetime psychopathology, social maladjustment and illness-specific functional impairment, and abstinence outcome. Mood intolerance, a maintenance factor of BN but external to eating disorder pathological features (typically addressed within CBT), emerged as the primary clinical variable distinguishing the severity groups showing a differential treatment response. Overall, the findings speak to the concurrent and predictive validity of the new DSM-5 severity criterion for BN and are important because a common benchmark informing patients, clinicians, and researchers about severity of the disorder and allowing severity fluctuation and patient's progress to be tracked does not exist so far. Implications for future research are outlined.

The relationship between proposed maintaining mechanisms of the transdiagnostic model of eating disorders and eating disorder symptom severity in a community sample

The transdiagnostic theory of eating disorders proposes that clinical perfectionism, core low self-esteem, interpersonal problems and mood intolerance can maintain eating disorder psychopathology in some individuals. The current study aimed to explore eating disorder symptom severity as a function of these maintaining mechanisms in a community sample. Participants completed questionnaires online and were classified according to whether they met criteria for zero, one, or two or more mechanisms. A greater number of maintaining mechanisms was found to be significantly associated with higher global eating disorder examination questionnaire (EDE-Q) scores, and a higher prevalence of binge eating, purging and driven exercise. Moreover, participants with 2 or more maintaining mechanisms had more severe eating disorder symptoms than participants with 1, who in turn had more severe symptoms than participants with no maintaining mechanisms. Regression models evaluated the role of each maintaining mechanism in predicting different aspects of eating disorder pathology. Self-esteem, perfectionism and mood intolerance all predicted unique variance in global EDE-Q scores. There were differences in the maintaining mechanisms that predicted binge eating, purging and driven exercise. These results provide support for the transdiagnostic model of eating disorders and have implications for detecting and treating eating disorders in community samples. This abstract was presented in the Peter Beumont Young Investigator award finalist stream of the 2014 ANZAED Conference.

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study.

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40-50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses.

Comprehensive examination of the trans-diagnostic cognitive behavioral model of eating disorders in males

The Trans-diagnostic Model (TM) of eating pathology describes how one or more of four hypothesized mechanisms (i.e., mood intolerance, core low self-esteem, clinical perfectionism and interpersonal difficulties) may interrelate with each other and with the core psychopathology of eating disorders (i.e., over-evaluation of weight and shape) to maintain the disordered behaviors. Although a cognitive behavioral treatment based on the TM has shown to be effective in treating eating disorders, the model itself has undergone only limited testing. This is the first study to both elaborate and test the validity of the TM in a large sample (N=605) of undergraduate men. Body mass index was controlled within structural equation modeling analyses. Although not all expected associations for the maintenance variables were significant, overall the validity of the model was supported. Concern about shape and weight directly led to exercise behaviors. There was a direct path from binge eating to exercise and other forms of compensatory behaviors (i.e., purging); but no significant path from restriction to binge eating. Of the maintaining factors, mood intolerance was the only maintaining variable directly linked to men's eating disorder symptoms. The other three maintaining factors of the TM indirectly impacted restriction through concerns about shape and weight, whereas only interpersonal difficulties predicted low self-esteem and binge eating. Potential implications for understanding and targeting eating disturbances in men are discussed.

Inpatient Cognitive Behaviour Therapy for Anorexia Nervosa: A Randomized Controlled Trial

Background: The aim of this study was to compare the immediate and longer-term effects of two cognitive behaviour therapy programmes for hospitalized patients with anorexia nervosa, one focused exclusively on the patients' eating disorder features and the other focused also on mood intolerance, clinical perfectionism, core low self-esteem or interpersonal difficulties. Both programmes were derived from enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Methods: Eighty consecutive patients with severe anorexia nervosa were randomized to the two inpatient CBT-E programmes, both of which involved 20 weeks of treatment (13 weeks as an inpatient and 7 as a day patient). The patients were then followed up over 12 months. The assessments were made blind to treatment condition. Results: Eighty-one percent of the eligible patients accepted inpatient CBT-E, of whom 90% completed the 20 weeks of treatment. The patients in both programmes showed significant improvements in weight, eating disorder and general psychopathology. Deterioration after discharge did occur but it was not marked and it was restricted to the first 6 months. There were no statistically significant differences between the effects of the two programmes. Conclusions: These findings suggest that both versions of inpatient CBT-E are well accepted by these severely ill patients and might be a viable and promising treatment for severe anorexia nervosa. There appears to be no benefit from using the more complex form of the treatment.

Psychosomatic syndromes and anorexia nervosa

BackgroundIn spite of the role of some psychosomatic factors as alexithymia, mood intolerance, and somatization in both pathogenesis and maintenance of anorexia nervosa (AN), few studies have investigated the prevalence of psychosomatic syndromes in AN. The aim of this study was to use the Diagnostic Criteria for Psychosomatic Research (DCPR) to assess psychosomatic syndromes in AN and to evaluate if psychosomatic syndromes could identify subgroups of AN patients.Methods108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP) were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory–2, and Temperament and Character Inventory. Data were submitted to cluster analysis.ResultsIllness denial (63%) and alexithymia (54.6%) resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%), somatization group (26%), and severe psychosomatic group (25%). The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome.ConclusionsThese results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments.

2199 – An evaluation of the enhanced cognitive-behavioural model and its constructs as moderators of the core psychopathology of eating pathology-bulimic symptomatology relationship

Introduction The original cognitive-behavioural model of bulimia nervosa (CBT-BN) proposes that specific dysfunctional cognitions and behavioural factors maintain BN, and has provided the basis for the widely used cognitive-behavioural therapy (CBT) of BN. However, Fairburn et al. (2003) noted that among treatment completers with BN, only 40% achieved full remission of the bulimic symptomatology. The enhanced CBT-BN model (CBT-E) proposed by the authors describes how four additional factors (i.e., clinical perfectionism, low self esteem, mood intolerance and interpersonal difficulties) interact with the core psychopathology of BN (i.e., over-evaluation of eating, weight, and shape and their control) to maintain the disorder. Aims The goal of this study was to examine (a) the validity of the CBT-E model and (b) whether each of the four hypothesized maintenance factors intensifies the core psychopathology-bulimic symptomatology relationship in a clinical sample. Methods Data were analysed from 362 adults seeking treatment for BN (n = 167) or atypical BN (n =195) at four Italian specialized care centres, using latent variable structural equation modeling approach. Results Both the measurement and the structural model were good fits for the data. All four hypothesized factors exacerbated the core psychopathology-bulimic symptomatology relationship. Core psychopathology explained approximately 47.7% of the variance of bulimic symptomatology. The inclusion of the direct effects and interaction terms increased the explained variance of bulimic symptomatology to 64%. Conclusions Overall, results supported the validity of the CBT-E model and highlighted the importance of assessment and treatment of the four maintenance processes included in the CBT-E model.

An Evaluation of the Transdiagnostic Cognitive‐behavioural Model of Eating Disorders

To determine if the relationships between additional maintaining factors and core eating disorder maintaining mechanisms outlined in the cognitive-behavioural model of eating disorders are transdiagnostic. Patients (n = 1451) diagnosed with anorexia nervosa, bulimia nervosa (BN) or eating disorder not otherwise specified completed the Eating Disorder Examination Questionnaire, Eating Disorder Inventory-2 and Personality Assessment Inventory prior to entering treatment. Multi-group structural equation modelling results suggested that low self-esteem, overevaluation of weight and shape, and mood intolerance processes were transdiagnostic. However, some differences between diagnostic groups were observed. Dietary restraint was only positively associated with binge eating in BN, interpersonal difficulties were only associated with dietary restraint in eating disorder not otherwise specified and perfectionism was not associated with core eating disorder maintaining mechanisms in BN. A mixture of transdiagnostic and disorder-specific processes was implicated in the maintenance of eating disorders, although longitudinal research is needed to validate results.

An Investigation of the Transdiagnostic Model of Eating Disorders in the Context of Muscle Dysmorphia

Muscle dysmorphia is a psychiatric disorder that has been conceptually linked to eating disorders, although its precise nosology remains unclear. To further investigate this notion, the present study examined the applicability of the transdiagnostic model of eating disorders to muscle dysmorphia. One hundred and nineteen male undergraduate students completed self-report measures of multidimensional perfectionism, mood intolerance, self-esteem, interpersonal problems, and muscle dysmorphia symptomatology. Self-oriented perfectionism, socially prescribed perfectionism, mood intolerance, and low self-esteem significantly predicted muscle dysmorphia symptomatology, whereas other-oriented perfectionism and interpersonal problems did not demonstrate significant predictive value when accounting for the other transdiagnostic constructs. The transdiagnostic model of eating disorders may potentially be applied to enhance our understanding of the maintenance of muscle dysmorphic features in addition to eating disorder symptomatology.

Evaluation of a new measure of mood intolerance, the Tolerance of Mood States Scale (TOMS): Psychometric properties and associations with eating disorder symptoms

ObjectiveThis research aimed to (i) validate a new measure of mood intolerance, the Tolerance of Mood States (TOMS) scale, and (ii) to examine associations between TOMS scores and eating pathology. MethodsThe original TOMS was developed and evaluated using the data from 258 adult participants. The measure consisted of two separate scales, initially with a total of 64 items, with this reduced to 34 items through exploratory factor analyses. The 34-item TOMS was administered to a new sample of adult participants recruited from a university setting (N=227), along with the Distress Tolerance Scale (DTS-C; Corstorphine, Mountford, Tomlinson, Waller, & Meyer, 2007) and other measures of psychological distress and eating disorder symptoms. The reliability and validity of the 34-item TOMS scales were examined through confirmatory factor analysis, inspection of alpha coefficients, and inspection of correlations between TOMS scores and those on other relevant measures. Associations between TOMS scores and eating disorder symptoms were considered using continuous and categorical analyses. ResultsAnalyses provided support for the reliability and validity of the scale two of the TOMS. This scale consists of 11 items on two subscales, and assesses the tendency to engage in maladaptive behaviours when confronted with intense moods. Scores on this scale were significantly higher amongst participants who reported binge eating and purging than amongst participants who did not, and they correlated significantly with a global index of eating disorder symptoms. The 11-item scale was retained as the final version of the TOMS. ConclusionsPreliminary support is provided for the validity of a new measure of mood intolerance, the TOMS. Scores on the TOMS subscales were significantly associated with eating disorder symptoms in this non-clinical sample.

Increased wait-list time predicts dropout from outpatient enhanced cognitive behaviour therapy (CBT-E) for eating disorders

Between 30 and 70% of patients with eating disorders drop out from outpatient treatment. However, research has been unable to identify factors that consistently predict dropout from eating disorder treatment. Most studies have exclusively investigated the role that individual patient characteristics play in dropout and have ignored more process-based factors such as expectations about treatment, the therapeutic alliance, or time spent on a treatment waiting list. This study aimed to investigate the roles of both individual patient characteristics and process-based factors in dropout from outpatient treatment for eating disorders. The study involved data collected from consecutive eating disorder referrals to the only public specialist eating disorder service for youth and adults in Perth, Western Australia. The standard treatment provided at this service is Enhanced Cognitive Behaviour Therapy on an individual basis. The study involved 189 patients referred to the service between 2005 and 2010. Forty five percent of this sample dropped out of treatment. Results showed that, in this sample, two individual factors, lowest reported weight and the tendency to avoid affect, and one process-based factor, time spent on the wait list for treatment, were significant predictors of dropout. These findings are valuable because a process-based factor, such as wait-list time, may be easier to address and modify than a patient’s weight history or the trait of mood intolerance. Increased resources for eating disorder services may reduce waiting list times which would help to reduce dropout and maximize treatment outcomes.