Structural models of psychotherapy groups and their effect on inpatients with borderline personality disorders: Patients' perceptions

This research compares the way in which various group structural models affect self-understanding, interpersonal relationships and catharsis in hospitalized patients with borderline personality disorders. Each of the models is characterized by a different combination of group focus and leadership style. Three psychotherapy groups were chosen as paradigms: the dynamic psychotherapy group; the therapeutic games group, and psychodrama group. Sixty three inpatients with borderline personality disorders participated in the study. The one-way ANOVA yielded significant differences between the group models. Results of the post-hoc t-test showed that the dynamic and the games groups were perceived by the patients as more beneficial than psychodrama.     

A Review of Eating Disorders in Athletes

SUMMARY

The current review aims to evaluate the literature on eating disorders and athletes with the purpose of making recommendations for sport psychologists and other relevant personnel on how to proceed in identifying, managing, and preventing eating disorders in school settings. Whereas the intention of this review is to make recommendations for secondary educational settings, research on other populations such as collegiate and young adult athletes was also reviewed where helpful or where information on adolescent athletes was not available. Recommendations for prevention and intervention include ongoing education of athletes and coaches regarding nutrition, body composition, and performance, using appropriate screening to detect eating disorders, and use of a sport management team to aid in athlete recovery.     

Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples

In order to examine the concurrent and criterion validity of the questionnaire version of the Eating Disorders Examination (EDE-Q), self-report and interview formats were administered to a community sample of women aged 18-45 (n = 208). Correlations between EDE-Q and EDE subscales ranged from 0.68 for Eating Concern to 0.78 for Shape Concern. Scores on the EDE-Q were significantly higher than those of the EDE for all subscales, with the mean difference ranging from 0.25 for Restraint to 0.85 for Shape Concern. Frequency of both objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) was significantly correlated between measures. Chance-corrected agreement between EDE-Q and EDE ratings of the presence of OBEs was fair, while that for SBEs was poor. Receiver operating characteristic (ROC) analysis, based on a sample of 13 cases, indicated that a score of 2.3 on the global scale of the EDE-Q in conjunction with the occurrence of any OBEs and/or use of exercise as a means of weight control, yielded optimal validity coefficients (sensitivity = 0.83, specificity = 0.96, positive predictive value = 0.56). A stepwise discriminant function analysis yielded eight EDE-Q items which best distinguished cases from non-cases, including frequency of OBEs, use of exercise as a means of weight control, use of self-induced vomiting, use of laxatives and guilt about eating. The EDE-Q has good concurrent validity and acceptable criterion validity. The measure appears well-suited to use in prospective epidemiological studies.     

Team weigh-ins and self-weighing: Relations to body-related perceptions and disordered eating in collegiate male athletes

ObjectivesIn this study we examined the relation of team weigh-ins and self-weighing frequency on collegiate male athletes' internalization of body ideals, social pressures about weight/body, body satisfaction, dietary intent, negative affect, drive for muscularity, and bulimic symptomatology.Design and methodsWe used a cross-sectional survey design, and collected data electronically from 738 male intercollegiate athletes in the U.S.ResultsAthletes who self-weighed 7 + times per week reported the most pressure to lose weight and be lean and muscular, engaged in muscle-building behaviors most frequently, dieted most often, and had the highest level of bulimic symptomatology. Further, athletes on teams that conducted mandatory weigh-ins (vs. not) engaged in more muscularity behaviors and dietary restriction.ConclusionWeighing, but in particularly that conducted voluntarily, may contribute to an overconcern with appearance, body size/shape, and weight, which in turn can lead to a variety of behaviors related to eating and body change.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

The effectiveness of enhanced cognitive behavioural therapy for eating disorders: an open trial

The aim of this study was to examine the effectiveness of Enhanced Cognitive Behaviour Therapy (CBT-E) for eating disorders in an open trial for adults with the full range of eating disorders found in the community. The only previously published trial of CBT-E for eating disorders was a randomised controlled trial (RCT) conducted in the U.K. for patients with a BMI ≥ 17.5. The current study represents the first published trial of CBT-E to include patients with a BMI < 17.5. The study involved 125 patients referred to a public outpatient clinic in Perth, Western Australia. Patients attended, on average, 20–40 individual sessions with a clinical psychologist. Of those who entered the trial, 53% completed treatment. Longer waiting time for treatment was significantly associated with drop out. By the end of treatment full remission (cessation of all key eating disorder behaviours, BMI ≥ 18.5 kg/m², not meeting DSM-IV criteria for an eating disorder) or partial remission (meeting at least 2 these criteria) was achieved by two thirds of the patients who completed treatment and 40% of the total sample. The results compared favourably to those reported in the previous RCT of CBT-E, with one exception being the higher drop-out rate in the current study. Overall, the findings indicated that CBT-E results in significant improvements, in both eating and more general psychopathology, in patients with all eating disorders attending an outpatient clinic.     

Community perceptions of mental disorders: a Greek perspective

The present cross‐sectional study examines the perceptions of residents of a rural community in Greece pertaining to the interpretation, explanation, treatment and prognosis of various psychological problems. In all, 100 community residents took part. A series of vignettes in combination with both qualitative and quantitative data collection procedures was employed. The findings indicate a variation in the endorsement of interpretations and causal attributions as a function of the type of symptomatology presented. The overt psychotic cases of schizophrenia were more likely to be understood within a genetic explanatory framework while the less overt symptoms of mental disorders were perceived as being indicative of emotional problems triggered by personality and social environmental factors. A preference for psychological methods of treatment was expressed. Copyright © 2006 John Wiley & Sons, Ltd.     

Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study

Objective

Use classification tree analysis with lagged predictors to determine empirically derived cut-points for identifying adolescent girls at risk for future onset of threshold, subthreshold, and partial eating disorders and test for interactions between risk factors that may implicate qualitatively distinct risk pathways.

Method

Data were drawn from a prospective study of 496 adolescent girls who completed diagnostic interviews and surveys annually for 8 years.

Results

Body dissatisfaction emerged as the most potent predictor; adolescent girls in the upper 24% of body dissatisfaction showed a 4.0-fold increased incidence of eating disorder onset (24% vs. 6%). Among participants in the high body dissatisfaction branch, those in the upper 32% of depressive symptoms showed a 2.9-fold increased incidence of onset (43% vs. 15%). Among participants in the low body dissatisfaction branch, those in the upper 12% of dieting showed a 3.6-fold increased incidence onset (18% vs. 5%).

Conclusion

This three-way interaction suggests a body dissatisfaction pathway to eating disorder onset that is amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies. It may be possible to increase the effectiveness of prevention programs by targeting each of these qualitatively distinct risk groups, rather than only individuals with a single risk factor.     

The effect of inpatient cognitive-behavioral therapy for eating disorders on temperament and character

Personality traits seem to have an important role in the development, clinical expression, course, and treatment response in eating disorders (EDs). We investigated the effects of an inpatient cognitive-behavioral treatment (CBT) on the measures of temperament and character (Temperament and Character Inventory (TCI)) in 149 consecutive patients with EDs. Baseline assessment included anthropometry, the Eating Disorder Examination (EDE), the Beck Depression Inventory (BDI), and the TCI. Treatment was based on the transdiagnostic cognitive behavior theory and treatment of ED, adapted for an inpatient setting. Treatment effects were tested by paired ANOVA, adjusted for covariates. No effects were found on Novelty Seeking, Reward Dependence, and Cooperativeness. Harm Avoidance (F=18.17, p<0.001), Persistence (F=7.71, p=0.006), Self-Directedness (F=27.55, p<0.001), and Self Transcendence (F=16.38, p<0.001) significantly changed after treatment. Changes in TCI scores were wholly dependent on the changes in BDI and EDE, and independent of ED diagnosis and behavior and of BMI changes. We conclude that in ED, a few scales of both temperament and character are significantly modified by CBT, in relation to changes in psychopathology and depression, independently of nutrition. These results are relevant for future studies based on TCI.     

Finding Home: A Qualitative Approach to Understanding Adolescent Mothers’ Housing Instability

Many low‐income Latina adolescent mothers face instability in their housing circumstances, which has implications for their long‐term prospects and that of their children. This study used longitudinal, ethnographic data from Welfare, Children, and Families: A Three‐City Study to explore experiences of low‐income, Latina adolescent mothers (N = 15) with unstable housing who primarily rely on their families or the families of their significant others for housing support. Results of analysis employing grounded theory and narrative approaches suggested two types of instability: “Horizontal moves” between family homes and “vertical moves” between family homes and independent living. Although family support often was fundamental in allowing for participants’ pursuit of independent housing (i.e., vertical moves), it also was associated with greater residential mobility (i.e., horizontal moves), most often in the context of intrafamilial conflict and family instability. These results are discussed with respect to inconsistencies in policies to address this vulnerable population.     

Mothers’ Dreams,Children Realities: The Case of Uprooted Families from South Lebanon

In this exploratory qualitative study, 15 mothers and 18 adolescents who, as family members of the South Lebanon Army, were uprooted from that country and now living in Israel, were interviewed separately. The mothers described their image of the adaptive adult, which stressed the positive values of loyalty to the family, orientation toward the group, respect, and acceptance of hierarchy and guided their child‐rearing goals and socialization. The children shared similar attitudes about the importance of family loyalty and orientation toward the group, but differed from their mothers with regard to the issues of respect and obedience. We discussed the notion of “liminality,” to further our understanding of the families in transition and suggest how it applies to the uprooted members of South Lebanon army. We suggest that different time orientations and contextual factors influence the participating mothers’ image of the adaptive adult and the degree to which their children accept it. Implications for research and interventions are also explored.     

Pilot Study of a Program to Increase Mothers’ Understanding of Dads

The present study evaluated the effects of mothers' participation in an 8‐week coparenting intervention program, Understanding Dad^?, on mothers' awareness and attitudes regarding how their relationships with fathers influence paternal involvement with children, knowledge of healthy pro‐relationship skills, and relationship self‐efficacy. Thirty‐four mothers were recruited from four sites to participate in a study that used a pretest/posttest one‐group design. Over the course of this 8‐week program, mothers demonstrated moderate to large gains in each of the outcome measures, after controlling for mothers' educational level. Moreover, there was one significant within‐subjects interaction effect for time × location. That is, mothers made significantly greater gains in pro‐relationship knowledge in one of the intervention sites. Implications for future research are discussed.     

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。     

Eating disorders in the course of life: A qualitative approach to vital change

Eating disorders (EDs) have become one of the biggest mental-health problems in the last decades, especially among youth and women. The present study aims to analyse the suitability of Prochaska and DiClemente’s Transtheoretical Model of Change when applied to the living experiences of people diagnosed with ED and their carers. For this purpose, we applied a narrative biographic approach to the ways in which people face their problems and vital development in the ED domain. Through the narrative analysis of these autobiographies, we aimed to study the patients’ own notions of ‘change’, ‘problem’ and ‘vital trajectory’. We focused on five autobiographic interviews of persons diagnosed as ED (four women and a man). The analysis yields three discourses which organize and give sense to our participants’ vital transitions: a discourse of functional adaptation to events and experiences; one that pays attention to random events and people entering your life; and one that has the personal initiative and agency of an individual agent at its core. It also illuminates particular ways of understanding determination, contemplation and pre-contemplation. These ways of understanding change are shown to extend the possible ways of thinking about people’s lives and ED patients’ perspectives.     

The use of virtual reality in the study, assessment, and treatment of body image in eating disorders and nonclinical samples: a review of the literature

This article reviews research into the use of virtual reality in the study, assessment, and treatment of body image disturbances in eating disorders and nonclinical samples. During the last decade, virtual reality has emerged as a technology that is especially suitable not only for the assessment of body image disturbances but also for its treatment. Indeed, several virtual environment-based software systems have been developed for this purpose. Furthermore, virtual reality seems to be a good alternative to guided imagery and in vivo exposure, and is therefore very useful for studies that require exposure to life-like situations but which are difficult to conduct in the real world. Nevertheless, review highlights the lack of published controlled studies and the presence of methodological drawbacks that should be considered in future studies. This article also discusses the implications of the results obtained and proposes directions for future research.     

Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity

Conceptually, eating disorder recovery should include physical, behavioral, and psychological components, but such a comprehensive approach has not been consistently employed. Guided by theory and recent recovery research, we identified a “fully recovered” group (n = 20) based on physical (body mass index), behavioral (absence of eating disorder behaviors), and psychological (Eating Disorder Examination-Questionnaire) indices, and compared them with groups of partially recovered (n = 15), active eating disorder (n = 53), and healthy controls (n = 67). The fully recovered group was indistinguishable from controls on all eating disorder-related measures used, while the partially recovered group was less disordered than the active eating disorder group on some measures, but not on body image. Regarding psychosocial functioning, both the fully and partially recovered groups had psychosocial functioning similar to the controls, but there was a pattern of more of the partially recovered group reporting eating disorder aspects interfering with functioning. Regarding other psychopathology, the fully recovered group was no more likely than the controls to experience current Axis I pathology, but they did have elevated rates of current anxiety disorder. Results suggest that a stringent definition of recovery from an eating disorder is meaningful. Clinical implications and future directions regarding defining eating disorder recovery are discussed.     

Mothers’ attuned responses to infant affect expressivity promote earlier achievement of language milestones

To investigate infants’ affective expressivity and maternal attuned responsiveness to infant expressivity in relation to early language achievement, 77 dyads were visited in their homes at 9 and 13 months, and mothers were interviewed about their children’s language between 9 and 21 months. Maternal responses that were attuned to infant affect, by selectively matching either the gradient features or the valence of infants’ affective expressions, were more predictive of children’s language achievement than maternal nonmatching responses; and maternal matching responses at 9 months were more predictive of children’s language achievements than maternal responses at 13 months. Moreover, maternal matching responses at 9 months predicted second-year language achievements over and above infant affect expressivity at 9 and 13 months, and over and above maternal matching responses at 13 months. Infants’ affective expressivity per se was not predictive.     

Enhancing dissemination in selective eating disorders prevention: An investigation of voluntary participation among female university students

Maximising dissemination of efficacious psychological interventions is an important undertaking, particularly in prevention work where the target population may not be seeking help. Consequently, the current study investigated voluntary participation in a selective eating disorder prevention programme by examining predictors of, and evaluating a motivational enhancement approach to, increased participation. Female students studying first-year psychology (N = 124, M_age = 19.30, SD = 1.55) completed baseline measures, were randomised to a motivational or control condition, then presented with a flyer for an eating disorders prevention trial and assessed regarding potential participation. Results showed that interest and likelihood of participation were low overall and lack of time the most commonly endorsed reason. Participants high on weight concerns were more likely to cite the group format of the intervention as a deterrent. A greater belief in the helpfulness of body image programmes and higher personal ineffectiveness were significant predictors of interest in participation. There was no significant difference between those who did and did not undergo the motivational enhancement with respect to interest and likelihood of participation. These findings suggest important avenues for consideration when designing eating disorder prevention efforts relying on voluntary participation, and highlight the importance of evaluating programmes cross-culturally.     

Prevention of anxiety disorders: A model for intervention

Anxiety disorders are among the most prevalent of all psychological disorders and are potentially amenable to early intervention and prevention. In this article, we review the various costs associated with anxiety disorders that make early prevention a valuable endeavor. Also, we considered extant data regarding risk factors for anxiety disorders, as knowledge of risk factors permits the targeting of a select group of the population considered to be most likely to develop anxiety disorders. Existing efficacy research on prevention for anxiety disorders is promising, but an overarching model to guide further research and development is lacking. We propose such models to guide high-risk sample selection including the content and format of prevention efforts.