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.     

The metaphor police: A case study of the role of metaphor in explanation

While many scholars have pointed to the role of metaphor in explanation, relatively little experimental research has examined whether and how metaphors are used and understood in everyday explanatory discourse. Across 3 experiments, we investigated the nature and function of metaphor in explanation by drawing on a real-world example where the terms guardian and warrior were used to metaphorically explain the role of police officers. We found, first, that the associations participants brought to mind for these concepts differed depending on whether they had previously answered questions about law enforcement (e.g., associations for warrior emphasized aggression and violence rather than strength and bravery when participants had previously answered questions about policing). Second, people were almost evenly split in their judgment of which metaphor was more appropriate to explain the role of law enforcement; this preference was highly predictive of beliefs related to policing and the criminal justice system. Third, and most important, using these metaphors to explain the job of policing causally influenced attitudes toward law enforcement in a metaphor-congruent manner (i.e., exposure to the guardian metaphor led to more positive attitudes), a finding that could not be accounted for by basic lexical priming. These studies complement existing work that has identified metaphor as a mechanism for representing abstract concepts, but also highlight the communicative and explanatory, rather than representational, functions of metaphor by showing that metaphors can encapsulate and convey an array of structured attitudes and beliefs.     

The cost effectiveness of cognitive behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

Objective

A number of effective treatments for bulimia nervosa have been developed, but they are infrequently used, in part due to problems with dissemination. The goal of this study was to examine the cost effectiveness of telemedicine delivery of cognitive behavioral therapy for bulimia nervosa.

Method

A randomized controlled trial of face-to-face versus telemedicine cognitive behavioral therapy for bulimia nervosa. One hundred twenty eight women with DSM-IV bulimia nervosa or eating disorder, not otherwise specified subsyndromal variants of bulimia nervosa were randomized to 20 sessions of treatment over 16 weeks. A cost effectiveness analysis from a societal perspective was conducted.

Results

The total cost per recovered (abstinent) subject was $9324.68 for face-to-face CBT, and $7300.40 for telemedicine CBT. The cost differential was accounted for largely by therapist travel costs. Sensitivity analyses examining therapy session costs, gasoline costs and telemedicine connection costs yielded fundamentally similar results.

Discussion

In this study, CBT delivered face-to-face and via telemedicine were similarly effective, and telemedicine delivery cost substantially less. These findings underscore the potential applicability of telemedicine approaches to eating disorder treatment and psychiatric treatment in general.     

Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa

Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.     

Maternal correlates of 2‐year‐old American Indian children's social‐emotional development in a Northern Plains tribe

The developmental experiences of very young American Indian children today are not well documented in the current literature. The present study sought to explore the social‐emotional development of American Indian toddlers living on a Northern Plains reservation, as a function of maternal variables. Mothers completed self‐report questionnaires about their experiences and their children's development. Observer ratings of children's development also were conducted. Maternal stress, substance use/abuse, perceptions of stress in the mother–child relationship, social support, and American Indian cultural identity were significantly related to children's social‐emotional development. This study is the first to explore these relationships in a Northern Plains American Indian sample of young children and their mothers. Results suggest possible points of intervention for improving the developmental outcomes of very young American Indian children.     

The Electronically Activated Recorder (EAR): A device for sampling naturalistic daily activities and conversations

A recording device called the Electronically Activated Recorder (EAR) is described. The EAR tape-records for 30 sec once every 12 min for 2–4 days. It is lightweight and portable, and it can be worn comfortably by participants in their natural environment. The acoustic data samples provide a nonobtrusive record of the language used and settings entered by the participant. Preliminary psychometric findings suggest that the EAR data accurately reflect individuals’ natural social, linguistic, and psychological lives. The data presented in this article were collected with a first-generation EAR system based on analog tape recording technology, but a second generation digital EAR is now available.     

Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms

Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant different intervention approaches. In this study, a latent profile analysis was conducted using data from adults with AN (n?=?118). Frost Multidimensional Perfectionism Scale (Frost et al. Cognitive Therapy and Research, 14(5), 449–46, 1990) subscales were used to identify subgroups differing according to endorsed perfectionism features (e.g., adaptive and maladaptive perfectionism). Generalized linear models were used to compare subgroups on eating disorder and affective symptoms measured through questionnaire and ecological momentary assessment. Four subgroups were identified: (a) Low Perfectionism; (b) High Adaptive and Maladaptive Perfectionism; (c) Moderate Maladaptive Perfectionism; and (d) High Maladaptive Perfectionism. Subgroups differed on overall eating disorder symptoms (p?<?.001), purging (p?=?.005), restrictive eating (p?<?.001), and body checking (p?<?.001) frequency, depressive (p?<?.001) and anxiety (p?<?.001) symptoms, and negative (p?=?.001) and positive (p?<?.001) affect. The Low Perfectionism group displayed the most adaptive scores and the Moderate and High Maladaptive Perfectionism groups demonstrated the most elevated clinical symptoms. The High Adaptive and Maladaptive Perfectionism group demonstrated low affective disturbances, but elevated eating disorder symptoms. Results support the clinical significance of subtyping according to perfectionism dimensions in AN. Research is needed to determine if perfectionism subtyping can enhance individualized treatment targeting in AN.