Symptoms of emotional disorders and sociodemographic factors as moderators of dropout in psychological treatment: A meta-review

ObjectiveDropout from psychological treatment is an important problem that substantially limits treatment effectiveness. A better understanding of this phenomenon, could help to minimize it. Therefore, we performed a systematic review of meta-analyses (MA) on dropout from psychological treatments to (1) determine the estimated overall dropout rate (DR) and (2) to examine potential predictors of dropout, including clinical symptoms (anxiety and depression) and sociodemographic factors.MethodA literature search of the PubMed PsycINFO, Embase, Scopus and Google Scholar databases was conducted. We identified 196 MAs on dropout from psychological treatment carried out primarily in adult patients or mixed samples (adults and children) between 1990 and 2022. Of these, 12 met all inclusion criteria. Two forest plots were created to visualize the DR and the relationship between DR and the disorder.ResultsThe DR ranged from 15.9% to 46.8% and was significantly moderated by symptoms of emotional disorders. The highest DR were observed in younger, unmarried patients, and those with lower educational and income levels.ConclusionsDR in patients undergoing psychological treatment is highly heterogeneous, but higher in individuals presenting symptoms of anxiety and/or depression, especially the latter. Given that high DR undermine the effectiveness of psychological interventions, it is clear that greater efforts are needed to reduce dropout, particularly among individuals with symptoms of emotional disorders.     

MMPI-2 in the inpatient assessment of women with eating disorders

The MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) reveals similar patterns across all Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) eating-disorder diagnoses. In this study, 550 women with eating disorders completed the MMPI-2. The 3 highest mean elevations for all eating-disorder diagnostic groups occurred on the same scales in the same order: 2, 7, and 3. The modal code for all groups was 2-7/7-2. However, multivariate analyses using the 16 validity and clinical scales, as well as the 27 content and supplementary scales, indicated that the MMPI-2 also distinguishes among eating disorders, especially in that patients with restricting anorexia report less psychopathology than other groups. These results are compared with the results of past eating-disorder research that used the older MMPI (Hathaway & McKinley, 1983).     

MMPI-A in the inpatient assessment of adolescents with eating disorders.

The MMPI-A (Butcher et al., 1992), like the older MMPI (Hathaway & McKinley, 1983), distinguishes between anorexia and bulimia. In this study, 245 adolescent girls diagnosed with anorexia, bulimia, or eating disorder not otherwise specified completed the MMPI-A. Multivariate analyses revealed significant differences between anorexia and bulimia on the MMPI-A's validity, clinical, content, and supplementary scales, particularly suggesting multiple impulse control problems among bulimic patients. However, profiles were also more homogeneous across eating disorder groups than in studies using the older MMPI, with high points involving some combination of Scales 1, 2, 3, and 0 for two thirds of the patients in this study. Implications are considered for understanding the common and differential psychopathology of eating disorders.     

Childhood abuse as a possible locus for early intervention into problems of violence and psychopathology

Reviewed research on abuse in childhood. Physical abuse, sexual abuse, psychological abuse, as well as children witnessing parents abuse each other, were all found to be associated with later problems with violence and psychopathology. No causal conclusions could be drawn because of the correlational nature of the research. Also, research into possible interventions was reviewed. At least somewhat effective interventions for stopping abuse once it begins are available for all of the types of abuse. However, there are no data on the effects of these interventions on long-term problems of violence or psychopathology. It is recommended that psychopathologists and therapists collaborate in long-term studies which utilize intervention as a tool for experimentally investigating the relationships between childhood abuse and later problems of violence or psychopathology.     

Childhood emotional abuse and attachment processes in the dyadic adjustment of dating couples

In an effort to improve understanding of the mechanisms that link early maltreatment to later outcomes, this study investigated the mediation effects of adult attachment processes on the association between childhood emotional abuse and later romantic relationships among heterosexual couples. College students and their dating partners (N = 310; 155 couples) completed the Childhood Trauma Questionnaire, Experiences in Close Relationship Scale, and Dyadic Adjustment Scale. Using the Actor–Partner Interdependence Model (Kenny, Kashy, & Cook, 2006), multilevel modeling results indicated that memories of childhood emotional abuse reported by both students and their partners were significantly associated with attachment strategies, as well as romantic relationship quality. Findings supported hypothesized mediation effects of attachment anxiety and avoidance.     

Changes in defensiveness and in affective distress following inpatient treatment of eating disorders: Rorschach comprehensive system and self-report measures

Conceptualizing eating disorders (EDs) as forming a coping mechanism against facing psychic pain, in this study, we examined the contribution of weight stabilization and ED behaviors to psychological outcomes of affective distress, defensiveness, and contact with inner/external reality among 2 subgroups of adolescent inpatients with (a) "restricting type" anorexia (AN-R) and (b) bingeing/purging type EDs (B/P). We administered Rorschach Comprehensive System (CS; Exner, 2003) and self-report measures at acute admission and on discharge. Data indicated that in both subgroups, stabilization of weight and disordered eating behaviors was accompanied by reduced explicit (self-reported) affective distress, yet by elevated implicit affective distress (D, SumShd). Subgroups' different Rorschach change trends indicated different dynamic processes in defensive style and contact with inner/external reality.     

Sociological factors in the development of eating disorders.

In recent years, anorexia and bulimia nervosa, whether combined into a single clinical picture or considered as distinct syndromes, have reached epidemic proportions among adolescents. Professionals in the educational and physical and mental health care fields need to be aware of the influence of social pressures on teenagers' perceptions of body image and appearance. This article reviews the sociocultural, socioeconomic, and sex-related factors which contribute to the development of eating disorders. It is recommended that professionals help adolescents resist societal pressure to conform to unrealistic standards of appearance, and provide guidance on nutrition, realistic body ideals, and achievement of self-esteem, self-efficacy, interpersonal relations and coping skills.     

Childhood physical and emotional abuse by a parent: transference effects in adult interpersonal relations

Extending research on transference and the relational self (Andersen & Chen, 2002), female undergraduates with or without a history of physical and emotional abuse by a loved parent participated in an experiment manipulating parental resemblance and threat-relevant interpersonal context in a new person. Transference elicited differences not evident in the control condition between abused and nonabused participants' responses, with greater rejection expectancy, mistrust, dislike, and emotional indifference reported by abused participants. Immediate implicit affect was more positive in transference than in the control condition regardless of abuse history. Yet, abused participants in transference also reported increased dysphoria that was markedly attenuated when interpersonal threat was primed, and no such pattern occurred among nonabused participants. Evidence that interpersonally guarded and affectively complex responses are triggered in transference among previously abused individuals suggests that this social-cognitive process may underlie long-term interpersonal difficulties associated with parental abuse.     

进食障碍影响因素的探讨

神经性厌食症和神经性贪食症是主要的进食障碍症状。进食障碍的影响因素有社会文化因素（例如媒体和同伴的影响）、家庭因素（如困惑和冲突）、消极情绪、低自尊水平和对自身的不满及认知和生物方面的因素等。     

Towards effective treatment of eating disorders: nothing is as practical as a good theory

There is much room for improvement in the treatment of eating disorders, anorexia nervosa in particular. It is argued that for more effective treatment a radical change in thinking and doing is needed. First, the wide-spread multicausal model of eating disorders must be abandoned and replaced by (a) fundamental strategic research into the most parsimonious explanation of eating disorders and (b) interventions solely directed on the specific maintaining mechanisms. Second, evidence-based working is needed in mental health care. In daily practice, two of three psychotherapists do not treat their eating disordered patients with the best treatment available, i.e. cognitive behaviour therapy. The Dutch Ministry of Health, Welfare and Sport tried to improve the care for eating disorder patients by the nomination of several specialist hospital units. These units are, however, not selected for their treatment quality or the use of evidence-based treatment protocols. It is argued that this ministerial operation will not increase the supply of effective treatment. The Minister obviously should have done two other things to improve the amount and quality of treatment supply for eating disorders: First, she better could invest in a broad array of workshops, training and supervision programs in cognitive behaviour therapy for all psychotherapists working with eating disorders. Second, since nothing is so practical as a good theory, the facilitation of research into parsimonious models of the relevant mechanisms as well as the experimental tests of interventions on these mechanisms would have been a promising move to effective treatment.     

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.     

High self-reported rates of neglect and emotional abuse, by persons with binge eating disorder and night eating syndrome

This study compared rates of self-reported childhood maltreatment in three groups diagnosed using semi-structured interviews: binge eating disorder (BED; n=176), night eating syndrome (NES, n=57), and overweight/obese comparison (OC, n=38). We used the Childhood Trauma Questionnaire (CTQ) to assess childhood maltreatment and the Beck Depression Inventory-II to assess depression levels. Reports of maltreatment were common in patients with BED (82%), NES (79%), and OC (71%). The BED group reported significantly more forms of maltreatment above clinical cut-points (2.4) than the OC (1.4) group but not the NES (1.8) group. The BED and NES groups reported more emotional abuse than the OC group. A higher proportion of the BED group reported emotional neglect and a higher proportion of the NES group reported physical neglect. Depression levels, which were higher in BED and NES than OC, were associated with higher levels of physical and emotional abuse and neglect. In conclusion, reported rates of physical and sexual abuse differed little across groups, whereas reports of neglect and emotional abuse were higher in the BED and NES groups than in the OC group and were associated with elevated depression levels.     

Graduate students' social and emotional functioning relative to characteristics of eating disorders

The authors explored gender-based patterns of relations between social and emotional functioning and the behaviors empirically supported as being highly potent for eating disorders: drive to be thin and body dissatisfaction. Graduate students between 20 and 25 years of age served as participants. Correlation analyses revealed that for women, personal adjustment and internalizing behaviors had significant relations to drive for thinness and body dissatisfaction. Using hierarchical regression analysis, the authors found that self-esteem contributed to the most variation in the prediction of both outcome variables. A differing pattern emerged for men as drive for muscularity and hyperactivity were most strongly predictive of drive for thinness, but not body dissatisfaction. The authors discuss implications relative to T. L. Tylka and L. M. Subich's (2004) model.     

Self-induced vomiting in eating disorders: Associated features and treatment outcome

Self-induced vomiting is adopted by people with a variety of eating disorders (ED) to control body shape and weight. We tested the prevalence, the associated features and the role on treatment outcome of self-induced vomiting in 152 ED patients consecutively admitted to an inpatient cognitive-behavioral treatment (CBT), based on the transdiagnostic CBT for ED. The Eating Disorder Examination, together with the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Temperament and Character Inventory were recorded at entry and at end of treatment. Self-induced vomiting was reported in 35.5% of cases, and 21.1% had multiple purging with vomiting. Individuals with vomiting and those with multiple purging had significantly higher BMI and a higher frequency of bulimic episodes, but individuals with multiple purging were also characterized by higher levels of depression, longer ED duration, more severe ED psychopathology and lower self-directness. Individuals with vomiting had higher eating concern and novelty seeking compared with those without purging behaviors. However, the three groups had similar dropout rates and outcomes in response to inpatient CBT, in keeping with the transdiagnostic theory of EDs.     

Food, mood, and attitude: reducing risk for eating disorders in college women.

Food, Mood, and Attitude (FMA) is a CD-ROM prevention program developed to decrease risk for eating disorders in college women. Female 1st-year students (N = 240) were randomly assigned to the intervention (FMA) or control group. Equal numbers of students at risk and of low risk for developing an eating disorder were assigned to each condition. Participants in the FMA condition improved on all measures relative to controls. Significant 3-way interactions (Time x Condition x Risk Status) were found on measures of internalization of sociocultural attitudes about thinness, shape concerns, and weight concerns, indicating that at-risk participants in the intervention group improved to a greater extent than did low-risk participants. At follow-up, significantly fewer women in the FMA group reported overeating and excessive exercise relative to controls.