青少年饮食失调：同伴的表现形式及作用机制

饮食失调在青少年群体中非常普遍, 同伴被认为是一种重要的影响因素。梳理其作用机制, 对青少年饮食失调的预防和干预有重要意义。研究表明, 同伴对青少年饮食失调具有消极影响, 主要表现为感知到的同伴行为、实际的同伴行为、身体不满意的中介作用、以及同伴质量的影响。研究者从直接、间接的角度就同伴对青少年饮食失调的作用机制及影响进行了阐释。未来的研究应深化研究内容, 如增加关于同伴影响的长期效应、同伴属性划分、影响路径作用大小以及同伴与饮食失调的其它社会影响因素间的交互作用等方面的研究。     

Effectiveness of Dialectical Behavior Therapy for Treating Eating Disorders

This study evaluated the effectiveness of dialectical behavior therapy (DBT) for treating eating disorder episodes and co‐occurring depression symptoms among individuals diagnosed with eating disorders. Separate meta‐analytic procedures for between‐groups and single‐group studies were conducted and yielded large effect sizes, indicating that DBT may be efficacious for decreasing disordered episodes among women diagnosed with eating disorders; medium to large effect sizes were noted for treating depression symptoms. Implications for evidence‐supported practice and study limitations are discussed.     

Characteristics of Dieting and Nondieting Adolescents in a Psychiatric Inpatient Setting

  The clinical and psychosocial characteristics of 239 dieting and nondieting adolescents (61% female; mean age=15.3) recruited from an inpatient psychiatric setting were examined. Dieting adolescents were compared to nondieting adolescents on exercise frequency, weight control behaviors, risky behaviors, psychiatric comorbidity and distress, eating disorder symptomatology, smoking, coping, and family factors. While dieters did not statistically differ from nondieters on scores of body mass index, dieting youth reported greater levels of self-reported distress, poorer coping, greater eating disorder symptomatology, and were more likely to engage in extreme weight control behaviors. In addition, dieting was associated with higher rates of major depression (58% vs 34%) and eating disorders (14% vs 1%). Among adolescent smokers, dieters endorsed smoking as a weight control behavior. Engaging in risky behaviors or familial factors did not differentiate dieters from nondieters. Given the number of negative correlates associated with dieting in adolescents, identifying dieting and weight control behaviors in clinical settings may prove to be an effective strategy in the development of prevention and intervention efforts for youth.     

Suicidal Ideation and Eating Disorder Symptoms in Adolescents: The Role of Interoceptive Deficits

Eating disorder symptoms and suicidal ideation are relatively common, and often begin to emerge in adolescence. Interoceptive deficits, or the inability to perceive and accurately identify the physiological condition of the body, is an established risk factor for both eating disorders and suicidal thoughts and behaviors. Despite this, longitudinal research examining the temporal dynamics between these variables is scarce, especially within adolescent samples. Using a three-wave longitudinal design, the present study tested bidirectional relationships between interoceptive deficits, eating disorder symptoms, and suicidal ideation to examine whether interoceptive deficits predicted eating disorder symptoms and suicidal ideation over the course of a year among a sample of adolescents. Participants were 436 community adolescents recruited from local middle- and high-schools. Data were collected at baseline, 6-month follow-up, and 12-month follow-up. Study measures assessed current suicidal ideation, eating disorder symptom severity, and interoceptive deficits. Autoregressive cross-lagged modeling was conducted in MPlus. We found baseline eating disorder symptoms significantly predicted suicidal ideation at 6-month follow-up when controlling for baseline suicidal ideation. Baseline interoceptive deficits significantly predicted eating disorder symptoms 6-months later, while 6-month follow-up interoceptive deficits significantly predicted 12-month follow-up suicidal ideation. Our findings highlight the need for early and regular assessment of suicidal ideation and eating disorder symptoms in adolescents. Given that interoceptive deficits was a shared risk factor for both conditions within this sample, these results underscore the need for targeted interventions aimed at improving interoception.     

Eating-related problems among 13-15 year old Swedish adolescents: Frequency and stability over a one-year period

Viborg, N., Wångby‐Lundh, M., Lundh, L.‐G. & Johnsson P. (2012). Eating‐related problems among 13‐15 year old Swedish adolescents: Frequency and stability over a one‐year period. Scandinavian Journal of Psychology 53, 401–406. The frequency of eating‐related problems in young adolescents, and their stability over a one‐year period, was studied by the RiBED‐8 (Risk Behaviours related to Eating Disorders, 8 items) in a community sample of 13–15 year old adolescents who took part in a prospective study with a 2‐wave longitudinal design. The RiBED‐8 was found to have good reliability and construct validity among the girls, although it did not show equally convincing psychometric properties among boys. With a cut‐off of at least three critical answers on the RiBED‐8, 28.5–31.0% of the girls were seen as risk cases for the development of eating disorder. Of those girls who were risk cases at Time 1, a majority (68.8%) remained so at Time 2; of those girls who were not risk cases at Time 1, 16.1% became risk cases at Time 2. It is suggested that the RiBED‐8 is a brief, easily administered instrument that may be potentially useful in screening for eating‐related problems among girls.     

Description of an Intensive Dialectical Behavior Therapy Program for Multidiagnostic Clients With Eating Disorders

The authors describe an intensive outpatient dialectical behavior therapy (DBT) program for multidiagnostic clients with eating disorders who had not responded adequately to standard, empirically supported treatments for eating disorders. The program integrates DBT with empirically supported cognitive behavior therapy approaches that are well established for the treatment of eating disorders. Attention is given to inclusion and exclusion criteria, how the program differs from standard treatments for eating disorders, and the application of specific DBT treatment components for multidiagnostic clients with eating disorders.     

Mindfulness and Acceptance in the Treatment of Disordered Eating

Mindfulness and acceptance-based approaches to the treatment of clinical problems are accruing substantial empirical support. This article examines the application of these approaches to disordered eating. Theoretical bases for the importance of mindfulness and acceptance in the treatment of eating problems are reviewed, and interventions for eating problems that incorporate mindfulness and acceptance skills are briefly described. Empirical data are presented from a pilot study of mindfulness-based cognitive therapy adapted for treatment of binge eating.     

Bridging the Gap Between Hospital and Community-Based Mental Health Services

Depression and anxiety affect a person’s ability to move from hospital to community and engage in valued occupations. The purpose of this study was to understand the effectiveness of an occupational therapist-led transitional service for people with mood and anxiety disorders. Using a mixed-method design consisting of retrospective pre-post analysis of outcome measures and qualitative analysis of interviews with key stakeholders, statistically and clinically significant improvements were seen in depression and anxiety symptoms as well as occupational engagement after completion of the service. This study highlights the unique contributions of occupational therapist-led programing in mental health recovery.     

Thematic review of family therapy journals 2009

In this article the contents of the principal English‐language family therapy journals published in 2009 are reviewed under these headings: narrative therapy, child‐focused problems, adult‐focused problems, substance abuse across the lifespan, illness across the lifespan, family violence, couples, diversity, developments in systemic practice, training and research.     

Is there evidence for the use of art therapy in treatment of psychosomatic disorders,eating disorders and crisis? A comparative study of two different systems for evaluation

A comparative study of two different systems for evaluation. Scandinavian Journal of Psychology 53, 47-53. As with any type of treatment the requirement for evidence based practice (EBP) has also affected art therapy (AT) when used as an intervention. This review evaluates the available evidence for using AT for psychosomatic disorders, eating disorders and crisis. The search in Cochrane, Best Practice, AMED, CINAHL, PION, PsycINFO and PubMed from 1987 until now resulted in a huge number of articles but only 32 articles met our criteria for evaluations. The articles were assessed with two evaluation systems, the GRADE system used by the Swedish Council on Health Technology Assessment (SBU) and the US Preventive Services Task Force (USPSTF/Task Force). When comparing the results we found that the GRADE evaluation system rejected the quality in 84% of the 32 studies and the USPSTF/Task Force 41% of these studies. An evidence base for AT was found only according to the criteria of USPSTF/Task Force. Hence, the evidence concept is not explicit, which means that effective treatments run a risk of not being implemented in health care. We suggest a broader view of what constitutes evidence in order to make it possible to include different types of research designs and methods.     

Assessing the specific psychopathology of binge eating disorder patients: Interview or self-report?

Research addressing the assessment of binge eating and associated eating disorder psychopathology has steadily increased in recent years. Few studies have examined the relationship between the various assessment methods. This study compared an investigator-based interview, the Eating Disorder Examination (EDE), with a self-report version of that interview, the EDE-Q. Fifty-two individuals (six men and 46 women) with binge eating disorder (BED) completed both instruments. Modest-to-good agreement and significant correlations (P < 0.0001) were found between the two methods on all four subscales assessing specific eating disorder psychopathology (i.e., Restraint, Eating Concern, Weight Concern, and Shape Concern subscales). However, higher levels of disturbance were consistently reported on the EDE-Q than the EDE interview. The two methods were not significantly or reliably related to one another when assessing binge eating. This may be due in part to the difficulty inherent in identifying binges in subjects with BED. Examination of individual item scores suggest that it might be possible to improve the performance of the EDE-Q by clarifying the definitions of certain complex features, although this should not be at the expense of compromising the practical utility of its self-report format.     

Eating Disorder Symptom and Fear Change Trajectories During Imaginal Exposure Therapy: A Slope Network Analysis

Eating disorders (EDs) are characterized by fears related to food, body image, and social evaluation. Exposure-based interventions hold promise for targeting a range of ED fears and reducing ED psychopathology. We investigated change mechanisms and optimal fear targets in imaginal exposure therapy for EDs using a novel approach to network analysis. Individuals with an ED (N = 143) completed up to four online imaginal exposure sessions. Participants reported ED symptoms and fears at pretreatment, posttreatment, and 6-month follow-up. We constructed networks of symptoms (Model 1), fears (Model 2), and combined symptoms and fears (Model 3). Change trajectory networks from the slopes of symptoms/fears across timepoints were estimated to identify how change in specific ED symptoms/fears related to change in other ED symptoms/fears. The most central changing symptoms and fears were feeling fat, fear of weight gain, guilt about one’s weight/shape, and feared concerns about consequences of eating. In Model 3, change in ED fears bridged to change in desire to lose weight, desiring a flat stomach, following food rules, concern about eating with others, and guilt. As slope networks present averages of symptom/fear change slopes over the course of imaginal exposure therapy, further studies are needed to examine causal relationships between symptom changes and heterogeneity of change trajectories. Fears of weight gain and consequences of eating may be optimal targets for ED exposure therapy, as changes in these fears were associated with maximal change in ED pathology. Slope networks may elucidate change mechanisms for EDs and other psychiatric illnesses.     

Diagnosing,Conceptualizing, and Treating Eating Disorders Not Otherwise Specified: A Comprehensive Practice Model

This article presents research and evidence‐based practices for identifying, understanding, diagnosing, conceptualizing, and providing a continuum of treatment for the most commonly experienced types of eating‐related counseling concerns—namely, eating disorders not otherwise specified—among the population most likely to present these types of needs: adolescent girls and young adult and adult women.     

Eating Disorders—The Regulation of Positive as well as Negative Emotion Experience

Disordered eating behaviors are often conceptualized as maladaptive emotion regulation strategies. The present study investigated links between emotional experience, schematic belief systems, and psychological themes associated with eating disorders. In contrast to the majority of studies, which focus on just one or two emotions and use nonclinical samples, this study compared the full range of emotional experience in women with eating disorders to a control group. Measures used include the Differential Emotional Scale-IV, Youngs Early Maladaptive Schema Questionnaire, and Eating Disorder Inventory-2. The study provides the first empirical evidence that women diagnosed with eating disorders report experiencing pleasant as well as unpleasant emotions more frequently than do controls. A surprising finding was that pleasant emotions (joy, interest, surprise) correlated with eating disorder themes (EDI-2 subscales) more consistently than unpleasant emotions in the eating disorder group, while the reverse was true of the control group. Also of note, eating-disordered women reported significantly less anger and similar levels of fear vs. controls. While eating-disordered women scored more highly than do controls on all maladaptive schema (suggesting high levels of distress in women with eating disorders), the pattern of correlations between schema and emotion experience was distinctly different for each group and counterintuitive for the eating disorder group. In particular, pleasant emotion was highly correlated with maladaptive schema in the eating-disordered group but not in the control group. These marked group differences in the pattern of relationships between emotion experience, eating disorder themes, and belief systems suggest that it is not valid to draw conclusions about eating disorders from research that employs only nonclinical samples. The authors discuss these findings, and suggest that women with eating disorders are proficient at using disordered eating behaviors to manipulate their experience of both positive and negative emotional states, and that this dynamic should be recognized as an important maintenance factor.     

Being a mother with anorexia: A phenomenological study of seeking and receiving professional support for white heterosexual women in the UK

Mothers are currently under-represented in the literature on anorexia, including research on treatment, with most research focussed on female adolescents. This raises questions about how adult women and particularly those who are mothers, experience eating disorder treatment. This study provides a phenomenological exploration of lived experiences of seeking and receiving professional help and interactions with health professionals for six white heterosexual mothers who experienced anorexia while raising their children. Four themes are reported that capture the women's diverse experiences of seeking and receiving support for anorexia: (1) conflict between mothering and seeking help; (2) experiences of feeling blamed, poorly treated or misunderstood by health professionals; (3) positive experiences of seeking and receiving support; and (4) the importance of ongoing support. The women's experiences suggest that healthcare professionals should adopt a more holistic approach that acknowledges the subjective reality of the client (including their mother status) when working with mothers experiencing anorexia.     

A systematic review and narrative synthesis of occupational therapy-led interventions for individuals with anxiety and stress-related disorders

Anxiety and stress-related disorders are highly prevalent and impede participation in life activities. Occupational therapists work extensively with people diagnosed with these disorders but the effectiveness of their interventions is unclear. A systematic search strategy identified 19 papers describing 13 studies. Studies varied in methodology, intervention type, and theory base. The results show the potential for lifestyle approaches, occupational science-based programs, and skill-building to improve mental health. The variety of interventions and methodologies of many studies means that the effectiveness of occupational therapy interventions for this population is not yet determined. High-quality research is required to replicate interventions with emerging potential for effectiveness.     

The self and eating disorders

In our review, we focus on self-related constructs in the context of eating disorders with four aims. First, we examine a variety of self-related constructs that have been theoretically and empirically linked to the development and course of eating disorders. In addition to the more well-researched constructs of self-esteem and self-efficacy, we also report on findings related to selflessness, contingent self-worth, self-objectification, ego-syntonicity, self-concept clarity, self-compassion, social comparison, self-oriented perfectionism/self-criticism, and narcissism. Second, we discuss self-related constructs that may be especially relevant to comorbidities common among those with eating disorders. Third, we review intervention and prevention programs where self-related constructs play a prominent role. Lastly, we share future research directions regarding self-related constructs and eating disorders that we believe will advance a deeper understanding of the role of the self in the eating disorders.     

Thematic Analysis of the Intersection of Spirituality and Eating Disorder Symptoms

The authors interviewed 12 female participants about the intersection of their spiritual beliefs and eating disorder symptoms. Three main themes emerged from the data: (a) spiritual beliefs as helpful, (b) choice not to ask for spiritual help, and (c) guilt.     

Confirmatory factor analysis of eating disorder symptoms in college women

Recent studies have found that the eating disorders can best be conceptualized as multidimensional. Four factors have consistently emerged from factor analytic studies of eating disorder symptoms: dietary restraint, bulimic behaviors, neurotic personality characteristics, and body image/body dysphoria. Confirmatory factor analysis was utilized to determine if this four-factor structure of eating disorder symptoms would be found in a sample of college women. Principal components analysis extracted four factors which were supported with a confirmatory factor analysis procedure. These four factors were negative affect and body dysphoria, bulimic behaviors, restrictive eating, and body image. The negative affect and body dysphoria factor was positively correlated with the other factors (i.e., bulimic behaviors, restrictive eating, and body image). This factor structure was similar to the factor structure found in samples of patients with bulimia and anorexia nervosa, except that the factors were more highly intercorrelated in the nonclinical sample. Results suggest that the measures of eating disorder symptoms used in this investigation are measuring the same multidimensional constructs in clinical and nonclinical subjects.This paper is partially based upon the master's thesis of the first author.