Primary Care Provider Familiarity with Binge Eating Disorder and Implications for Obesity Management: A Preliminary Survey

Current guidelines for the evaluation and treatment of obesity recommend referring individuals with binge eating disorder (BED) to a mental health professional. However, it is unclear how familiar primary care providers are with BED. The purpose of this study was to assess providers' familiarity with BED diagnosis and treatment. Providers in two primary care clinics completed a questionnaire, which assessed perceived familiarity with BED and demonstrated familiarity with BED diagnosis and treatment. Results indicated that 61% of respondents demonstrated familiarity with the essential symptoms of BED, and 80% reported familiarity with the diagnosis of BED. However, 35% of respondents who perceived themselves as familiar with BED did not demonstrate familiarity with the most basic symptoms. These results demonstrate that while many providers in primary care are familiar with BED, steps to improve provider familiarity with the disorder and provide appropriate mechanisms to address BED are warranted.     

Assessment and Diagnosis of Eating Disorders: A Guide for Professional Counselors

Despite the prevalence of and risk associated with disordered eating, there are few guidelines for counselors on how to conduct an eating disorder assessment. Given the importance of the clinical interview, the purpose of this article is to provide recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment.     

Development and validation of the Eating Disorders Screen for Athletes (EDSA): A brief screening tool for male and female athletes

ObjectivesTo develop and validate the Eating Disorders Screen for Athletes (EDSA), a brief eating disorders screening tool for use in both male and female athletes. Methods: Data from Division I athletes at a Midwestern university (N = 434) were used to conduct exploratory factor analysis (EFA) by gender. Data from athletes competing at various levels at universities across the United States (N = 862) were then used to conduct confirmatory factor analysis (CFA) and receiver operator characteristic (ROC) curve analysis by gender. Athletes from a range of lean and non-lean sports were included. Gender-specific empirically derived cut-offs on the Eating Disorder Examination-Questionnaire were used to classify high eating disorder risk for ROC curve analysis. Measurement invariance by gender, level of competition, and sport type was also examined. Results: A six-item, one-factor structure for the EDSA was supported by EFA and CFA in both genders, and internal consistency was good for both male (α = 0.80) and female athletes (α = 0.86). ROC curve analyses indicated that the EDSA was highly accurate in predicting eating disorder risk status and identified a score of 3.33 as the optimal cut-off for both male (sensitivity = 0.96, specificity = .80) and female athletes (sensitivity = 0.96, specificity = .64). Results also supported strong measurement invariance for the EDSA by gender, level of competition (Division I versus club), and sport type (lean versus non-lean). Conclusions: The EDSA shows promise as a brief screening tool to identify male and female athletes at risk for eating disorders.     

Domestic violence against women: Understanding social processes and women's experiences

The prevalence of domestic abuse against women has been estimated as high as one in four. The risk is particularly high for women who are younger, economically dependent, unemployed and with children. Research about the factors that maintain situations of abuse has generally focused separately on the coping strategies of women, barriers to leaving the relationship and the perpetrators' means of abuse. In this study we used a community psychology perspective to seek a broader understanding of what maintains situations of abuse, in order to suggest interventions in a rural County in the North of England. Twelve women who had experienced domestic abuse and had used voluntary sector services agreed to be interviewed about their experiences and the resources and strategies available to them. Using grounded theory we generated four themes: (1) Commonalities and contradictions in the experience of abuse; (2) living with abuse; (3) the response of systems reinforced or challenged the abuse and (4) dealing with abuse beyond the relationship. These findings illustrate how situations of domestic abuse can be prolonged by limited options available to victims for support and protection, and a lack of active public acknowledgement that domestic abuse is unacceptable. Copyright © 2009 John Wiley & Sons, Ltd.     

Modified Comprehensive Behavioral Intervention for Tics: Treating Children With Tic Disorders,Co-Occurring ADHD,and Psychosocial Impairment

Our objective was to evaluate the feasibility and acceptability, and preliminary efficacy of a modified comprehensive behavioral intervention for tics (MCBIT) therapy for youth with chronic tic disorders (CTDs), co-occurring attention-deficit hyperactivity disorder (ADHD), and associated psychosocial impairment. Seventeen youth ages 10–17 with CTD and co-occurring ADHD were randomly assigned to the MCBIT group (n = 9) or to a control group where they received traditional comprehensive behavioral intervention for tics (CBIT) therapy (n = 8). Both groups received ten 55-minute weekly treatment sessions, and two 55-minute biweekly relapse prevention sessions. Sixteen of the 17 participants completed the study, and acceptability ratings in both treatment groups were high with no significant differences in expectation of improvement. The MCBIT and CBIT groups in combination showed significant improvement in tic severity, ADHD symptom severity, and tic-related impairment. Group differences were not significant. The results indicate that MCBIT treatment is feasible and acceptable for youth with CTD and ADHD, and is similarly well tolerated relative to traditional CBIT. Results were not sufficiently superior to recommend MCBIT over CBIT for this population. However, given the demonstrated benefit of behavioral treatments that target co-occurring conditions concurrently, continuing to examine novel behavioral approaches that can target tics and related conditions simultaneously and successfully is recommended.     

Support for a Transdiagnostic Motivational Model of Self-Damaging Behaviors: Comparing the Salience of Motives for Binge Drinking,Disordered Eating,and Nonsuicidal Self-Injury

Integrating across motivational models suggests that different self-damaging behaviors (SDBs) are enacted for similar reasons. However, it remains unclear whether some motives are more relevant to certain SDBs than others. To answer this question, the present study compared the salience of 8 potentially shared motives across 3 exemplar SDBs, selected to represent different points along the internalizing and externalizing spectra: binge drinking, disordered eating (binge eating, purging, fasting), and nonsuicidal self-injury (NSSI). Seven hundred and four first-year university students (73% female, M_age = 17.97) completed monthly surveys assessing their engagement in and motives for SDBs. Motives were conceptualized as either interpersonal (bonding with others, conforming with others, communicating strength, communicating distress, reducing demands) or intrapersonal (reducing negative emotions, enhancing positive emotions, punishing oneself). Multilevel models compared endorsement of each motive across SDBs. Results revealed that SDBs were motivated by similar goals, albeit to different degrees. Although some exceptions emerged, interpersonal motives were most salient to binge drinking, followed by disordered eating, and then NSSI. In contrast, intrapersonal motives were most salient to NSSI, followed by disordered eating, and then binge drinking. Motivational differences were also found within disordered eating. For example, punishing oneself was more relevant to purging and fasting than binge eating, whereas relieving negative emotions was more relevant to binge eating and purging than fasting. Similar to dimensional models that position SDBs on internalizing or externalizing spectra, the salience of motives for binge drinking and NSSI may fall on distinct spectra (i.e., interpersonal and intrapersonal, respectively), with motives for disordered eating exhibiting elements consistent with both spectra. This study supports a common motivational framework for investigating and potentially treating a variety of topographically distinct SDBs.     

Community,Affect, and Family Relations: A Cross-Cultural Study of Spiritual Resiliency in Eight Old Women

ABSTRACT

Paying attention to emotionally resilient persons is long overdue, particularly resilient old persons. Because seniors frequently cite religious faith as a primary source of strength during difficult losses and transitions, we asked how old women might be empowered by their spirituality to transcend significant losses and traumatic family events. Using triangulated methods, a feminist perspective and symbolic interactionism, we conducted focus groups and eight in-depth interviews with women over 65 in the United States and Germany. Themes of community, affect, and relationality occurred repeatedly in the narratives, revealing both unique and universal aspects of the women's spiritualities and confirming the centrality of religion as a neglected factor in family studies research.     

An investigation into the possibility of an innovative treatment for weight‐related hyperphagia: Towards a more effective combination of physiological and psychological treatment for clinically obese patients who binge‐eat,category DSM IV EDNOS (Eating Disorders Not Otherwise Specified)

This paper describes Phase One of a five‐phase doctoral research inquiry into hyperphagia (eating beyond requirement) as experienced in Binge Eating Disorder (BED). It is a response to the need for a treatment plan which combines the opportunity to explore psychological reasons for overeating, as well as to understand physiological reasons for uncontrollable cravings. Three participants, recruited through local gyms, received twelve sessions of integrative counselling combining cognitive behavioural therapy and physiological information with a person‐centred approach and psychodynamic theory to help participants discover for themselves the emotional causes of their overeating. The results informed Phase Two in which a small group addressed the same issues. The outcome of both phases will be used to design a treatment programme (Phase Three) for a larger group as a pilot study (Phase Four), all phases being part of an action research project which will be evaluated in Phase Five. The study is aimed at promoting a better understanding on the part of health professionals and counsellors of the need for sufferers of BED to address emotional causes of overeating and providing such treatment in primary care. Participants in Phase One self‐reported a steady decrease in Body Mass Index (BMI) during an interval of one year and achieved an awareness of the way in which their complex relationship with food was underpinned by emotionally painful and avoidant relationships with others.     

A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.     

Enhancing parental reflective functioning: A special tribute to the life and work of Nancy E. Suchman,PhD

Nancy E. Suchman's contributions to the fields of infant mental health, maternal reflective functioning, and attachment-based intervention will have long-lasting impacts. In particular, through the development and dissemination of her intervention program, Mothering from the Inside Out (MIO), she innovated a way of working with mothers with substance use disorders that represented a paradigm shift within the field of addiction. In this introduction to the special issue, written to honor her life and work, we review Nancy's background and briefly describe her academic accomplishments. The special issue contains nine qualitative and quantitative research reports written by Nancy's colleagues and their collaborators. All nine papers pertain to the theme of understanding, measuring, and promoting parents’ capacity for reflective functioning. Four provide findings that advance our understanding of parental reflective functioning. The other five highlight insights from continuing evaluations of MIO, including new adaptations of the model. To introduce the special issue, we provide an overview of the scope of the work done within these projects. Finally, the special issue concludes with two commentaries contributed by Linda Mayes and Arietta Slade, leading scholars within the field who were also Nancy's close colleagues. Both provide insight into Nancy's impact on the field.