Abstracts in English

F R Quale: A Behaviour Contracting Approach to Weight Control. Saand J Behav Ther, 4, 117-124, 1975. A weight control program employing behaviour modification techniques is presented. In the first phase the clients were trained to use different techniques to achieve weight loss. A weight control contract, specifying a penalty for weight gain or lack of weight loss, was established. In the second phase, the goal was maintenance of weight loss during the following year. The success rate reported was 62 % in Phase I and 91 % in Phase II.C Botella & L Wadelius: Behavioural and Traditional Treatment of Obesity. SaandJ Behav Ther, 4, 125-136, 1975. After a summarized background to the overweight problem the literature on behavioural treatment of obesity is reviewed. An experimental comparison between behavioural treatment of obesity and traditional medical treatment is reported. Both treatment groups lost weight significantly. At the one-year follow-up, only the behaviourally treated group had maintained a significant weight loss, although less than immediately after the end of treatment.

H Fries: Anorectic Behaviour: Nosological Aspects and Introduction of a Behaviour Scale. Saand J Behav Ther, 4, 137-148, 1975. The anorectic behaviour is typical for patients with primary or "true" anorexia nervosa. It may also be of a more unspecific character, as in mitigated forms of anorexia nervosa or "pseudo-anorectic" conditions. A valid and easily applicable anorectic behaviour scale is introduced, which seems well suitable for diagnostic purpose and routine evaluation of therapeutic effects.T Aim & L-G Kall: Anorexia Nervosa and Behaviour Therapy. Saand J Behav Ther, 4, 159–163, 1975. The historical development of the treatment of anorexia nervosa is reviewed. Experimental evaluations of active components in therapy, by means of single—subject designs are discussed. Some concluding remarks are given pointing at the importance of including the patient's natural environment in the treatment.M Lindquist & K G Gotestam: Self—Control over Eating. Saand J Behav Ther, 4, 159–163,. 1975. The effect of environmental planning and self—administration of consequences was studied in an A-B-C design in the treatment of a client with incorrect eating habits. The combination of the techniques proved to be effective for this problem.     

Psychometric features related to the acute phase and final outcome of anorexia nervosa

The MMPI responses of a poor and good final outcome group from a follow-up study of anorexia nervosa were compared with responses of a group of anorexic patients in the acute phase. The poor outcome group produced elevated scores in the psychopathological range except on scales 4, 5 and 9. No elevations occurred in the good outcome group and the MMPI thus discriminated significantly between different kinds of final outcome of anorexia nervosa. The profile of the patients in the acute phase at time of testing was not significantly different from the poor outcome group profile. In order to improve the predictive validity of the MMPI related to anorexia nervosa, the paper points to possible directions for further research.     

Cross‐Cultural Examination of the Tripartite Model in Adults

Abstract

Operant conditioning was applied to a total of 32 female anorexia nervosa patients in order to restore their normal weight. A comparative study was carried out on two groups of 16 patients each, who were treated with two different therapeutic procedures. The group having informational feedback, more flexible contacts with their family and a special psychomotor program (Group B), achieved a greater rate of weight gain compared to the other group (Group A), with an average of 1.75 versus 1.30 per week. The differences in weight evolution and problems during treatment are discussed. The fact that the study only is a short-term one concerning a limited aspect of the treatment of anorexia nervosa, and also the need for further follow-up research is strongly emphasized.     

Guided self-help for disordered eating: A randomised control trial

Treatment guidelines recommend evidence-based guided self-help (GSH) as the first stage of treatment for bulimia nervosa and binge eating disorder. The current randomised control trial evaluated a cognitive behavioural therapy-based GSH pack, ‘Working to Overcome Eating Difficulties,’ delivered by trained mental health professionals in 6 sessions over 3 months. It was congruent with the transdiagnostic approach and so was intended as suitable for all disordered eating, except severe anorexia nervosa. Eighty one clients were randomly allocated to either a GSH or waiting list condition. Eating disorder psychopathology (EDE-Q), key behavioural features and global distress (CORE) were measured at pre- and post-intervention, and 3- and 6-month follow-up. Results showed significant improvements in eating disorder psychopathology, laxative abuse, exercise behaviours, and global distress, with the GSH condition being superior to the waiting list on all outcomes. Treatment gains were maintained at 3 and 6 months. This study adds to the evidence supporting GSH for disordered eating, including EDNOS. However, further work is needed to establish the factors that contribute to observed therapeutic improvements and determine for whom GSH is most suitable.     

Eating disordered adolescent males

The purpose of this study was to describe a sample of 40 eating disordered adolescent males in order to complete a series of follow-up studies on adolescent females who were seen for evaluation and treatment at Boston Children's Hospital Outpatient Eating Disorders Clinic between 1981 and 1991. The sample was drawn from all males seen at the clinic (between 1981 and 1995) who were eligible for inclusion because of a diagnosis of anorexia nervosa, bulimia nervosa, or eating disorder-not otherwise specified. Data were collected via retrospective chart review and three self-administered quantitative scales. Although the response rate to the mailed follow-up questionnaires was low, comparisons with the three studies on females were consistent with those of other investigations, suggesting that the course and outcome of these illnesses are remarkably similar for males and females. The findings support the idea that clinicians, coaches, peers, and family members should encourage young men to share concerns about body image and weight at an earlier, less severe juncture, with assurance that these issues are common to both sexes.     

Understanding the relationships between body esteem,risk for anorexia nervosa,and domain-dependent decision-making impulsivity in a college sample

Impulsivity has been suggested to interact with low body esteem to elevate risk for anorexia nervosa. Discounting tasks are unique tools for examining impulsivity. Female college students (N = 139) at varying levels of body esteem and risk for anorexia nervosa responded to discounting scenarios depicting opportunities to lose/gain weight and to worsen/improve complexion. Multiple regression analyses were used to examine the relationships between impulsivity and risk for anorexia nervosa and body esteem in four disorder-relevant decision-making contexts. Results indicated that lower decision-making impulsivity predicted lower body esteem levels when the outcome of the task was framed as an opportunity to lose weight. It is suggested that greater self-control regarding weight-loss in women with low body esteem may be problematic, placing them at higher risk for eating- and weight-related problems. Results reiterate the need for continued attention to fostering healthy body esteem and weight-control patterns in women on college campuses.     

Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa

This study examined the relationship between therapeutic alliance and primary symptom change (weight gain) during CBT for anorexia nervosa. The aims were threefold: (1) to establish the strength of the therapeutic alliance across the treatment, (2) to determine whether early therapeutic alliance is associated with the completion of CBT for this client group, and (3) to determine the direction of the relationship between therapeutic alliance and weight gain. Adult outpatients (N = 65) with a diagnosis of anorexia nervosa (or atypical anorexia nervosa) completed a measure of alliance at session six and at the end of treatment. Weight was recorded at the start of treatment, session six and at the end of treatment. The strength of the alliance was consistently high in the sample. However, early therapeutic alliance was not associated with either the likelihood of completing treatment or subsequent weight gain. In contrast, both early and later weight gain were associated with the strength of subsequent alliance. These findings indicate that it might be advisable to focus on techniques to drive weight gain rather than rely on the therapeutic alliance to bring about therapeutic change.     

Developing a model of the treatment for eating disorder: Using neuroscience research to examine the how rather than the what of change

Treatments for eating disorders, in particular for people with anorexia nervosa, have often been adaptations of therapies designed for other conditions. Indeed, there is a move advocating the use of a transdiagnostic treatment approach in which general module based treatments are mixed together as needed rather than using a specific anorexia nervosa targeted strategy. The outcome of treatment is relatively poor, especially for those who for some reason do not have the benefit of an expert form of early intervention for anorexia nervosa. Technological advances in the neurosciences and genetics have radically altered how eating disorders and in particular anorexia nervosa have been conceptualised. In this paper we describe evidence that suggests that key aspects of the social information processing network both the cognitive and affective elements may be anomalous in people with anorexia nervosa. This has implications for models of treatment which can be tailored more directly to these causal and or maintaining factors. We describe the Maudsley method of working with adults with anorexia nervosa which has integrated these elements. This treatment approach includes working with the individual to develop a more flexible and holistic cognitive style with greater emotional intelligence. This is supplemented with work with the families to interrupt interactions that either accommodate to or aggravate the symptoms. Thus we are now in the position to understand and work to change how people with anorexia nervosa think and behave rather than focusing on what people think and say they do. Our prediction is that treatments that focus more directly on aetiology such as the intrapersonal and interpersonal maintaining factors will improve outcome.     

Locus of control,psychopathology, and weight gain in Juvenile anorexia nervosa

Based on a hypothesized disturbance in personal control and efficacy in anorexia nervosa, locus of control score infernale adolescents with anorexia nervosa was compared to scores obtained from depressed and conduct disorder controls, and to adolescent female standardization norms. Results indicated that (a) as a group, anorectics were significantly more internal than each of the controls; (b) anorectics scoring in a more external direction showed greater denial of illness, fear of weight change, impulse dyscontrol, rigidity of self-imposed controls, use of purgatives and diuretics, and body-image distortion; and (c) more internal anorectics evidenced more rapid weight gain during treatment. Findings were discussed in terms of the psychopathology of anorexia nervosa and the empirical literature relating locus of control to personality functioning and symptom alleviation.     

The Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ-3): reliability and normative comparisons of eating disordered patients

The Sociocultural Attitudes Toward Appearance Questionnaire-3 (SATAQ-3) is a measure of one’s endorsement of societal appearance ideals. The measure has received extensive evaluation in normative samples, but only minimal evaluation in clinical groups. In this study, 440 patients with eating disorders completed the SATAQ-3. Internal consistencies were excellent for the four SATAQ-3 subscales. Groups did not differ by diagnosis on the Information subscale, however, individuals with bulimia nervosa scored higher than individuals with both subtypes of anorexia nervosa (restricting and binge eating/purging) on levels of Internalization-General and Internalization-Athlete. The findings provide informative normative data, along with preliminary results indicative of the potentially greater role of media messages and images in the formation and/or maintenance of bulimia nervosa than anorexia nervosa.     

Establishing appropriate symptomatic control groups for the eating disorders

Two symptomatic control groups for the eating disorders were defined using high and low scores on the Dietary Restraint and Disinhibition scales of the Three Factor Eating Questionnaire. Clinical subjects diagnosed with anorexia and bulimia nervosa were compared with these symptomatic control groups using measures of body weight, bulimic symptoms, and anorexic symptoms. In comparison to the high-Restraint/low-Disinhibition group, anorexic subjects scored higher on measures of eating disorder symptoms but not on Restraint and Disinhibition. The high-Restraint/high-Disinhibition group differed from bulimia nervosa subjects on measures of eating disorder symptoms but did not differ on Restraint and Disinhibition. The results suggested that a control group defined by high Restraint and low Disinhibition formed an appropriate control group for anorexia nervosa. For bulimia nervosa, the most appropriate control group was defined by high Restraint and high Disinhibition.     

The Continuum Versus Categorical Debate on Eating Disorders: Implications for Counselors

The authors summarize a study by D. A. Williamson et al. (2002) in which clinical groups with anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, and binge eating disorder were contrasted with nonclinical groups of participants (i.e., obese and normal weight). The eating disorder groups were qualitatively different. Also, bulimia nervosa, purging and nonpurging types, may fall on a continuum of pathology with the binge‐eating, purging type of anorexia. Anorexia nervosa, restricting type, may be distinct from bulimia nervosa, purging and nonpurging types, and the binge‐eating, purging type of anorexia.     

Perceived acceptability of anorexia and bulimia in women with and without eating disorder symptoms

Perceptions of the acceptability of eating‐disordered behaviour were examined in young adult women with (n = 44) and without (n = 268) eating disorder symptoms. All participants viewed vignettes of anorexia nervosa (AN) and bulimia nervosa (BN) and responded to the same series of questions—addressing different possible ways in which the conditions described might be seen to be acceptable—in relation to each vignette. Participants with eating disorder symptoms perceived eating‐disordered behaviour to be more acceptable than asymptomatic participants, and this was the case for both AN and BN vignettes and for a range of different items. Differences on items tapping the perception that it ‘might not be too bad’ to have an eating disorder and that an eating disorder is ‘nothing to be concerned about’ were particularly pronounced. The findings could not be accounted for by between‐group differences in body weight. The findings indicate the ambivalence towards eating‐disordered behaviour that exists among a subgroup of young women in the community and the clear association between such ambivalence and actual eating disorder symptoms. The perceived acceptability of eating‐disordered behaviour may need to be addressed in prevention and early‐intervention programs for eating disorders.     

The role of body image and self‐perception in anorexia nervosa: the neuroimaging perspective

Anorexia nervosa is a severe psychiatric illness characterized by intense fear of gaining weight, relentless pursuit of thinness, deep concerns about food and a pervasive disturbance of body image. Functional magnetic resonance imaging tries to shed light on the neurobiological underpinnings of anorexia nervosa. This review aims to evaluate the empirical neuroimaging literature about self‐perception in anorexia nervosa. This narrative review summarizes a number of task‐based and resting‐state functional magnetic resonance imaging studies in anorexia nervosa about body image and self‐perception. The articles listed in references were searched using electronic databases (PubMed and Google Scholar) from 1990 to February 2016 using specific key words. All studies were reviewed with regard to their quality and eligibility for the review. Differences in brain activity were observed using body image perception and body size estimation tasks showing significant modifications in activity of specific brain areas (extrastriate body area, fusiform body area, inferior parietal lobule). Recent studies highlighted the role of emotions and self‐perception in anorexia nervosa and their neural substrate involving resting‐state networks and particularly frontal and posterior midline cortical structures within default mode network and insula. These findings open new horizons to understand the neural substrate of anorexia nervosa.     

Nature against nurture: calcification in the right thalamus in a young man with anorexia nervosa and obsessive-compulsive personality disorder

This report describes the case of a young man with a large calcification in the right thalamus that was first diagnosed at 9 years of age. Case history reveals specific eating rituals and other obsessive-compulsive personality traits during the patient's childhood and adolescence, fulfilling diagnostic criteria of obsessive-compulsive personality disorder. After a critical life event the patient develops anorexia nervosa. We suggest that our case and further literature provide evidence for an involvement of specific thalamic structures, such as the dorsomedial nucleus, in the development of anorexia nervosa. Furthermore, the treatment of the patient by a combined psychotherapeutic and pharmacotherapeutic approach is described. We focus on the beneficial effect of the atypical antipsychotic olanzapine, which can induce weight gain by an increase of leptin levels.     

Thoughts about eating, weight and shape in anorexia nervosa and bulimia nervosa.

Concurrent verbalisation and a self-report questionnaire were used to investigate self-statements in patients with anorexia nervosa, patients with bulimia nervosa, two groups of dieters and non-dieting controls. Thoughts were collected while subjects performed three behavioural tasks, looking at themselves in a full-length mirror, weighing themselves and eating a chocolate covered mint. Both groups of patients had more negative thoughts related to eating, weight and shape than those in the three control groups. In addition, patients with anorexia nervosa showed a greater concern with eating while patients with bulimia nervosa showed a greater concern with weight and appearance. Differences were found between the patients and non-dieting controls using both methods but the self-report questionnaire was less sensitive than concurrent verbalisation to differences between the patients and dieters. Implications of the findings for cognitive-behavioural treatments of the two disorders are discussed.     

Demythologizing the attitudes of family caretakers about “mental illness”

This paper introduces the Boundary-Control Model. The model provides an account of the emergence, maintenance, and treatment of anorexia nervosa, with particular emphasis on the role of boundaries and control. The model delineates four basic emotional needs, which shape the adolescent's sense of self-worth. It assumes that when those needs are damaged, anxiety is induced and anorexia emerges as a defense mechanism. Treatment involves stripping away the adolescent's false sense of power by creating a crisis and provoking the hidden anxieties. The development and maintenance of anorexia nervosa, as well as its treatment, will be discussed in light of the proposed model.     

Relations among premorbid weight,referral weight,and psychological test scores for patients with anorexia nervosa

The purpose of this study was to test the hypothesis that, in anorexia nervosa, patients with a low premorbid weight are associated with a low weight at referral and that premorbid weight, referral weight, and weight loss are associated with mood states. The changes of Body Mass Index from premorbid to referral, the duration of illness, and the psychological scores on the Profile of Mood States and the Cornell Medical Index-Health Questionnaire were examined in 49 anorexia nervous patients. Body Mass Index at referral of patients with lower premorbid Body Mass Index was significantly lower than that of patients with higher premorbid level. For patients with a larger relative decrease, scores on depressive mood were lower. These findings suggested that in anorexia nervosa patients, lower premorbid Body Mass Index was associated with lower Body Mass Index at referral, and that the patients with higher relative decrease in Body Mass Index might be satisfied with their weight loss.