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.     

Brain activation patterns in major depressive disorder and work stress-related long-term sick leave among Swedish females

Deficits in executive functioning and working memory associated with frontal lobe dysfunction are prominent in depression and work-related long-term sick leave (LTSL). This study used functional magnetic resonance imaging (fMRI) to investigate potential differences in brain activation patterns in these conditions. In addition, the function of the hypothalamic-pituitary-adrenal (HPA) axis was examined and compared between groups. Since there is a clear overrepresentation of women in these diagnostic groups, and to ensure a more homogenous sample population, only women were included. To examine the neural correlates of relevant cognitive processes in patients on sick leave >90 days due to work-related LTSL, recently diagnosed patients with major depression Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV criteria, untreated), and healthy controls (n?=?10, each group), a 2-back working memory task and a visual long-term memory task were administered during fMRI scanning. HPA axis functioning was investigated using a diurnal curve of saliva cortisol and a dexamethasone suppression test. Task performance was comparable among the three groups. Multivariate image analysis revealed that both memory tasks engaged a similar brain network in all three groups, including the prefrontal and parietal cortex. During the 2-back task, LTSL patients had significant frontal hypoactivation compared to controls and patients with depression. Saliva cortisol measurements showed a flattening of the diurnal rythmicity in LTSL patients compared to patients with depression and healthy contols. Taken together, these findings indicate that work stress-related LTSL and major depression are dissociable in terms of frontal activation and diurnal cortisol rhythmicity.     

An index of prenatal steroid exposure predicts adult face perception skills

Face perception skills are fundamental to social cognition, yet they vary markedly across individuals. This diversity has stimulated controversy over the relative contributions of genetic factors, prenatal environment, and postnatal experience to face perception. Recent twin studies have found that face perception is heritable, highlighting the potential for substantial prenatal determination of these skills. In contrast, previous work on potential influences of the prenatal hormonal environment on social cognition have found no association between 2D:4D, a marker for prenatal androgen exposure, and processing of facial emotional expressions, apparently precluding a major role for prenatal hormones in governing face perception. We propose that substantial predictive relationships between 2D:4D and face perception may have been masked in previous work because the task employed required both face perception and processing of others?? emotions, the latter component being greatly influenced by circulating hormones in adults. To assess prenatal hormone influences on face perception without requiring emotion processing, we related 2D:4D to the face inversion effect (FIE), a measure of the recruitment of specialist face processes to visual perception. The magnitude of the resulting predictive relationship (r = .52) compared surprisingly well with that found between identical twins?? face perception (rs = .27?C.61), suggesting that mechanisms of 2D:4D may account for a substantial proportion of perinatal influences on face processing. Furthermore, we employed 2D:4D as a common scale to map individual differences in the FIE onto prenatal testosterone:estrogen ratios, assayed by Lutchmaya, Baron-Cohen, Raggatt, Knickmeyer, and Manning (Early Human Development 77:23?C28, 2004). The substantial overlap between the two data sets further implicates prenatal steroids in adult face perception skills.     

Latent class analysis of eating disorders: relationship to mortality

The current diagnostic nomenclature for eating disorders has shortcomings. Empirical attempts to identify a new nomenclature have found numerous latent structures, but validation of this work has been largely cross-sectional, and nothing is known yet about the relationship of derived latent classes to mortality. This study examined latent diagnostic structure in 1,885 participants seeking outpatient eating disorder treatment over an 18-year period. Eating disorder symptoms were used as indicators, and the main validator was mortality as assessed using computerized linkage to the National Death Index. Six latent classes were derived; three of the six had significantly elevated standardized mortality ratios. It appeared that the latent class structure yielded better delineation of mortality risk than the existing classifications in the Diagnostic and Statistical Manual of Mental Disorders. These results provide support for an alternative, empirically derived diagnostic structure.     

EARLY RESPONSE DISTRIBUTION AND OUTCOMES OF RESPONSE-RESTRICTION ANALYSES

We examined whether the results of a response‐restriction analysis (RRA) could be predicted on the basis of response distribution in early sessions, when these sessions indicated interaction with multiple items. Four preschool‐aged children participated. For 3 of the 4 participants, the results from sessions conducted prior to restriction of the first item corresponded closely with results of the full RRA.     

A computer simulation of the argument from disagreement

In this paper we shed new light on the Argument from Disagreement by putting it to test in a computer simulation. According to this argument widespread and persistent disagreement on ethical issues indicates that our moral opinions are not influenced by any moral facts, either because no such facts exist or because they are epistemically inaccessible or inefficacious for some other reason. Our simulation shows that if our moral opinions were influenced at least a little bit by moral facts, we would quickly have reached consensus, even if our moral opinions were affected by factors such as false authorities, external political shifts, and random processes. Therefore, since no such consensus has been reached, the simulation gives us increased reason to take seriously the Argument from Disagreement. Our conclusion is however not conclusive; the simulation also indicates what assumptions one has to make in order to reject the Argument from Disagreement. The simulation algorithm we use builds on the work of Hegselmann and Krause (J Artif Soc Social Simul 5(3); 2002, J Artif Soc Social Simul 9(3), 2006).     

Is the Continuity of Externalizing Psychopathology the Same in Adolescents and Middle–Aged Adults? A Test of the Externalizing Spectrum’s Developmental Coherence

Externalizing psychopathology (EXT) is a framework for understanding diagnostic comorbidity and etiology of antisocial and substance-use behaviors. EXT indicates continuity in adulthood but the structure of adolescent EXT is less clear. This report examines whether adolescent EXT is trait-like, as has been found with adults, or categorical. We use tests of measurement invariance to determine how diagnostic indicators of EXT differ in adolescents compared to adults. The EXT measures employed were DSM-IIIR diagnoses of adult antisocial behavior, conduct disorder, and alcohol, marijuana, and drug dependence. Latent trait, latent class, and hybrid models were fit to two separate data sets: 2,769 seventeen-year-old adolescents and 2,619 adults from the Minnesota Twin Family Study. The best model in both samples was a single-trait LT model. Parameters from the adolescent and adult models were equivalent for all disorders except alcohol dependence. It appears that EXT in adolescence can be accurately represented by a single-trait model, and the measurement properties of EXT are similar during these time periods with the exception of alcohol dependence.     

Development and validation of a revised measure of codependency

This study assessed the factor structure, internal consistency, and concurrent validity of a revised instrument, the Composite Codependency Scale (CCS), a 19‐item measure designed to assess codependent traits. Exploratory factor analysis of the CCS, using data from 301 adults from the general population and 49 attending members of Codependents Anonymous (CoDA), yielded three factors: self‐sacrifice, interpersonal control, and emotional suppression. The scale and its subscales exhibited good internal consistency. Consistent with the tenets of the codependency model, higher codependency scores were significantly associated with higher levels of depression, anxiety, stress, and familial dysfunction and lower levels of narcissistic tendencies, self‐esteem, and emotional expressivity. Furthermore, the revised measure effectively discriminated members of CoDA from those in the general population.     

Revisiting the suitability of antisaccade performance as an endophenotype in schizophrenia

Poor performance on the antisaccade task has been proposed as a candidate endophenotype in schizophrenia. Caveats to this proposal, however, include inconsistent findings in first-degree relatives of individuals with schizophrenia, and substantial heterogeneity in individuals with the disorder. In this study, we examined antisaccade performance in patients and relatives, and sought to establish whether antisaccade measures could differentiate between two patients clusters identified in the Western Australian Family Study of Schizophrenia with either pervasive cognitive deficits (CD) or cognitively spared (CS). Ninety-three patients (CD = 47, CS = 46), 99 relatives and 62 healthy controls carried out a standard antisaccade task. Results showed: (i) significantly greater error rate, and prolonged latencies to correct responses and self-correction saccades in patients compared with controls; (ii) high error rates in relatives of poorly performing patients; (iii) longer latencies of self-correction saccades in relatives compared to controls; and (iv) higher error rate and longer latencies of self-correction saccades in the CD subgroup compared with CS. Unaffected relatives as a group were unimpaired in error rate as compared to healthy controls. These findings suggest that the antisaccade error rate and latency of self-correction saccades are useful measures in specific applications of genetic research in schizophrenia, without fully meeting endophenotype co-familiality requirements.