Premature termination: A clinical study

Ten patients who terminated prematurely from 10 different therapy groups were interviewed using a semistructured interview protocol. Half the subjects were patients in private therapy groups; the other half were patients in clinic therapy groups. Among the issues inquired about were subjects' initial attitudes about group treatment; the nature of the preparation process; subjects' experience of the group therapist, other group members, and the group process; their reasons for leaving their groups; and the nature of the termination process. The findings reported focus on patients' perceptions of therapists' motives; the importance of establishing appropriate treatment goals; the handling of negative feelings about the group and/or the group therapist; the issue of narcissistic injury; the experience of the balance between giving and receiving; the difficulties caused by unresolved conflicts within groups; and the problems posed by inadequate preparation for the group experience. Guidelines for practices aimed at minimizing premature terminations are offered.     

A longitudinal transactional risk model for early eating disorder onset

The presence of binge eating behavior in early middle school predicts future diagnoses and health difficulties. We showed that this early binge eating behavior can be predicted by risk factors assessed in elementary school. We tested the acquired preparedness model of risk, which involves transactions among personality, psychosocial learning, and binge eating. In a sample of 1,906 children assessed in the spring of fifth grade (the last year of elementary school), the fall of sixth grade, and the spring of sixth grade, we found that fifth grade negative urgency (the personality tendency to act rashly when distressed) predicted subsequent increases in the expectancy that eating helps alleviate negative affect, which in turn predicted subsequent increases in binge eating behavior. This transactional risk process appeared to continue to occur at later time points. Negative urgency in the fall of sixth grade was predicted by fifth grade pubertal onset, binge eating behavior, and expectancies. In turn, it predicted increases in high-risk eating expectancies by the spring of sixth grade, and thus heightened risk.     

Adolescent eating disorder: bulimia

Bulimia, an eating disorder, recently has emerged as a major mental health problem, especially among adolescent females. The bulimic experiences periods of compulsive binge eating followed by purges to rid the body of unwanted calories. Binges are triggered by intense emotional experiences, such as loneliness, anger, rejection, or stress. Associated features of bulimia are secretiveness, depression, drug abuse, preoccupation with body image and sexual attractiveness, and an awareness that the behavior is abnormal. The physical side effects include dental problems, inflamed esophagus, EEG abnormalities, abdominal or urinary disturbances, and changes in blood sugar level. Cognitive disturbances related to binging and purging are perfectionistic, egocentric, and distorted thinking, misconceptions about nutritional requirements, unreasonable goals and expectations, and disturbed affect. Bulimics resist treatment; however, such methods as cognitive, group, family, behavior, and drug therapy, and hospitalization appear promising.     

False memories in individuals at risk for developing an eating disorder

In the present study, the authors used the Roediger and McDermott paradigm (H. L. Roediger & K. B. McDermott, 1995) to examine the creation of false memories in individuals at risk for developing an eating disorder. Thirty-three controls and 34 individuals at risk for eating disorders studied 6 word lists taken from the paradigm. Three lists were food related (bread, fruit, sweet), and 3 were not food related (king, doctor, black). Both groups produced false memories (i.e., recalled or recollected words that were not presented in the lists), and controls actually produced more false memories than the at-risk individuals produced in the recall of the food-related items. Groups did not differ in their recall of items not related to food.     

Early attachment quality moderates eating disorder risk among adolescent girls

Objective: There is growing evidence that children’s early relational environment has lasting implications for physical and mental health. In this paper, we test whether attachment insecurity in early childhood is associated with increased responsivity to risk factors for eating disorders (EDs; e.g. pubertal weight gain, maternal negative affect) during adolescence.

Design: Hypotheses were tested with longitudinal data from 447 girls (final mean age?=?15.1?years) over a 12-year period. Tests of direct effects, moderation and moderated mediation were conducted using nested structural equation models and bootstrapped estimates of direct and indirect effects.

Results: Early attachment quality was not directly associated with disordered eating attitudes and behaviours (DEABs), but did moderate relations between adolescent ED risk factors and DEABs. Specifically, among girls with an insecure attachment history, higher BMI at age 15 directly predicted more DEABs, while maternal negative affect and pubertal weight gain indirectly predicted DEABs via greater preoccupation with parental relationships. These same direct and indirect paths did not emerge among adolescent girls with a secure attachment history.

Conclusion: Results delineate one way early attachment quality may contribute to EDs among some adolescent girls, and support recent efforts to incorporate relational components into obesity and ED prevention programmes.     

Effectiveness of peer-led dissonance-based eating disorder prevention groups: Results from two randomized pilot trials

ObjectiveThe present preliminary trials tested whether undergraduate peer leaders can effectively deliver a dissonance-based eating disorder prevention program, which could facilitate broad dissemination of this efficacious intervention.MethodIn Study 1, female undergraduates (N = 171) were randomized to peer-led groups, clinician-led groups, or an educational brochure control condition. In Study 2, which improved a design limitation of Study 1 by using completely parallel outcome measures across conditions, female undergraduates (N = 148) were randomized to either immediate peer-led groups or a waitlist control condition.ResultsIn Study 1, participants in peer- and clinician-led groups showed significantly greater pre–post reductions in risk factors and eating disorder symptoms than controls (M d = .64 and .98 respectively), though clinician- versus peer-led groups had higher attendance and competence ratings, and produced stronger effects at posttest (M d = .32) and at 1-year follow-up (M d = .26). In Study 2, participants in peer-led groups showed greater pre–post reductions in all outcomes than waitlist controls (M d = .75).ConclusionsResults provide novel evidence that dissonance-based eating disorder prevention groups led by undergraduate peers are feasible and produce greater reductions in eating disorder risk factors and symptoms than minimal-intervention control conditions, but indicate that effects are smaller for peer- versus clinician-led groups.     

Processing fat-related information in individuals at risk for developing an eating disorder

The authors examined the effect that being at risk for developing an eating disorder has on the lexical processing of words related to fat and words not related to fat. Individuals (n = 17) at risk for developing an eating disorder were compared with controls (n = 31) using a lexical decision task in which fat-related words (e.g., large), unrelated words (e.g., fair), neutral words (e.g., post), and pseudowords (e.g., flirp) were given. The results revealed an expected Group x Stimuli interaction for reaction times indicating that at-risk individuals were significantly faster at processing fat-related words than words unrelated to fat. The authors discuss these results within the context of how fat-related stimuli are processed in at-risk individuals and how models of information processing can aid in the interpretation and understanding of eating disorders.     

Adolescent eating disorder: anorexia nervosa

Anorexia nervosa is an eating disorder observed with increasing frequency, especially among adolescent females. No consensus exists concerning the causes of the disorder. Social, psychosexual, family system, biological theories, and the regression hypothesis have been advanced to explain the phenomenon. The major characteristics are 25% loss of body weight, use of various means to lose weight, weight phobia, preoccupation with food, body image disturbances, as well as numerous associated medical conditions: bradycardia, hypotension, dehydration, hypothermia, electrolyte abnormalities, amenorrhea, metabolic changes, and abdominal distress. Anorexic adolescents resist treatment and may die if not cured. The following therapeutic modalities have been effective: hospitalization, and cognitive, behavioral, and family therapy. Some of the typical family patterns, early characteristics, social adjustment problems, and society's contribution to the disorder are presented.     

Avoidance coping style and the risk of developing an eating disorder in adolescents

The first aim of this study was to analyse the relationship between coping styles and strategies in Spanish adolescents of both genders, with high and low eating disorder risk. Secondly, this study aims to examine the relation of coping styles and coping strategies with eating disorder risk. The sample comprised 2142 adolescents (1.130 girls and 1.012 boys), mean age 13,96 years (SD= 1.34). They completed the Adolescent Coping Scale (ACS) and the Eating Attitude Test (EAT-40). The results showed high use of intropunitive avoidance coping in both female and male adolescents with high EAT-40 scores. The regression analysis indicated that, in both girls and boys, the intropunitive avoidance and the tension reduction coping strategy explained a high percentage of variance of eating disorder risk. The results of this study have implications for the prevention of these behaviours in adolescents, because people with a high risk of developing an eating disorder present a maladaptive coping style before the onset of the eating disorder.     

Night-time eating in men and women with binge eating disorder

This study examined the frequency of night-time eating (NE) and its correlates in men and women with binge eating disorder (BED). Two-hundred and seven consecutively evaluated adults (45 men and 162 women) with BED were assessed with semi-structured interviews and a battery of behavioral and psychological measures. Overall, 28% (N = 58) of the participants reported NE. A significantly higher proportion of men (42%) than women (24%) reported NE. Overall, participants who reported NE had a significantly higher body mass index, but otherwise differed little from those who did not report NE. Men and women without NE differed little on behavioral and psychological measures, whereas women with NE had significantly higher levels of eating-, weight-, and shape-concerns than men with NE.     

Personality disorder cognitions in the eating disorders

The eating disorders are frequently found to be comorbid with Axis II cluster B and C personality disorders. It is important to identify the personality-level cognitions that typify these disorders. This study of a clinical group examines the personality disorder cognitions in the eating disorders. The cognitions that were most relevant to the eating disorder pathology were those relating to avoidant and obsessive-compulsive personality disorder. Other personality disorder cognitions were associated with comorbid psychopathology in largely clinically meaningful ways. These findings extend our understanding of the comorbidity of eating disorders and personality pathology, suggesting that some cases need to be assessed and formulated with such cognitions in mind. Treatment strategies are required that address both the eating and the personality pathology, while considering the impact of these cognitions on the therapeutic relationship.     

Moderators and predictors of response to eating disorder risk factor reduction programs in collegiate female athletes

ObjectiveThe primary aim of this paper was to investigate moderators and predictors of response to two programs designed to reduce eating disorder risk factors in collegiate female athletes. This study served as an ancillary study to a parent trial that investigated the feasibility of an athlete modified cognitive dissonance-based program (AM-DBP) and an athlete modified healthy weight intervention program (AM-HWI).Design157 female collegiate athletes were randomized to either the AM-DBP or the AM-HWI program. Participants completed surveys at baseline, post-intervention, 6 weeks, and 1 year.MethodsAfter classifying sports as either lean or non-lean, we investigated if sport type acted as a moderator of program response to AM-DBP and AM-HWI using ANOVAs. Next, we examined whether baseline thin-ideal internalization, weight concern, shape concern, bulimic pathology, dietary restraint, and negative affect acted as predictors of changes in bulimic pathology using linear regression models.ResultsAthletes in non-lean sports who received AM-DBP showed more improvement in negative affect versus non-lean sport athletes in AM-HWI. Higher baseline scores of bulimic pathology predicted greater response in bulimic pathology to both programs at 6-weeks. In contrast, athletes with higher dietary restraint and negative affect baseline scores showed decreased response to both interventions at 6-weeks. Finally, athletes with higher baseline shape concern showed a decreased response to the AM-HWI intervention at the post intervention time point.ConclusionResults from the present study indicate that lean/non-lean sport may not play a strong role in determining response to efficacious programs. Further, factors such as pre-existing bulimic pathology, dietary restraint, negative affect, and shape concern may affect general response to intervention versus specific responses to specific interventions.     

Mediators in the dissonance eating disorder prevention program

Previous research has supported thin-ideal internalization as a partial mediator of the effects of the dissonance eating disorder prevention program. The current study replicated previous findings and examined an additional mediator, body dissatisfaction, hypothesized to account for partial intervention effects. As a secondary goal, we developed a more rigorous and accurate test of mediation that accounted for the temporal, causal interplay between mediator and outcome, and controlled for “reverse mediation”. Results from a sample of 71 high-risk females (M age = 19.8, SD = 1.3) who participated in a four-week dissonance intervention supported thin-ideal internalization as a partial mediator of the effects of the dissonance intervention on bulimic symptoms, even after controlling for body dissatisfaction as a second mediator. Furthermore, results supported body dissatisfaction as a partial mediator for bulimic symptoms after controlling for thin-ideal internalization. Significant “reverse mediation” effects suggested the reciprocal influence of some risk factors for bulimia nervosa and bulimic symptoms. These results contribute to our understanding of the mediators in the dissonance intervention, which can help refine eating disorder prevention programs.     

Being a therapist in eating disorder treatment trials: constraints and creativity

This paper gives a brief overview of the sequence and content of the eating disorder treatment trials at the Maudsley Hospital in London, and describes the experience of the author working as a research therapist on these trials. It considers the different ways research constraints affected the therapist, how she learnt to make creative use of what appeared to be therapeutic restrictions, and how having her clinical freedom curtailed taught her to be more flexible and showed her new ways of understanding her patients.     

Interpersonal sensitivity, eating disorder symptoms, and eating/ thinness expectancies

This study examined social-emotional and cognitive factors in relation to eating disorder symptoms in 84 female undergraduates. Sensitivity to criticism and rejection-sensitivity related to each other and to appearance-related sensitivity. Although both interpersonal and appearance sensitivity related to a drive for thinness, appearance sensitivity had the stronger relationship. Interpersonal sensitivity was significantly correlated with expectancies that dieting and thinness lead to overgeneralized self-improvement, but not with eating expectancies. After controlling for body mass index, interpersonal sensitivity, and appearance sensitivity, dieting/thinness expectancies were related to drive for thinness, and expectancies that eating helps to manage negative affect were related to symptoms of bulimia. Findings are discussed in terms of the potential role that interpersonal sensitivity and eating-related expectancies may play in the development and maintenance of eating disorders, as well as intervention approaches. Portion of this paper were presented at the 72^nd Annual Meeting of the Midwestern Psychological Association, Chicago, IL, May 2000.     

Interpersonal sensitivity,eating disorder symptoms,and eating/ thinness expectancies

This study examined social-emotional and cognitive factors in relation to eating disorder symptoms in 84 female undergraduates. Sensitivity to criticism and rejection-sensitivity related to each other and to appearance-related sensitivity. Although both interpersonal and appearance sensitivity related to a drive for thinness, appearance sensitivity had the stronger relationship. Interpersonal sensitivity was significantly correlated with expectancies that dieting and thinness lead to overgeneralized self-improvement, but not with eating expectancies. After controlling for body mass index, interpersonal sensitivity, and appearance sensitivity, dieting/thinness expectancies were related to drive for thinness, and expectancies that eating helps to manage negative affect were related to symptoms of bulimia. Findings are discussed in terms of the potential role that interpersonal sensitivity and eating-related expectancies may play in the development and maintenance of eating disorders, as well as intervention approaches. Portion of this paper were presented at the 72^nd Annual Meeting of the Midwestern Psychological Association, Chicago, IL, May 2000.