Caregiver burden and family functioning in different neurological diseases

Aim of this study is to examine caregiver burden and family functioning in different neurological conditions. Forty-two primary caregivers of patients with Amyotrophic Lateral Sclerosis (ALS), Alzheimer’s Disease and other dementia (AD), Parkinson’s Disease (PD), Acquired Brain Injuries (ABI) and Multiple Sclerosis (MS) were administered scales for the evaluation of caregiver burden (CBI) and family functioning (FACES IV). Caregiver burden was overall high, with caregivers of patients with ALS and ABI having exceeded the CBI cut-off score for possible burn-out. The average scores of caregivers of patients with AD or other dementia and PD were close to the cut-off score, whereas those of caregivers of patients with MS were significantly lower than the others. Family cohesion, family satisfaction and the quality of family communication were associated with reduced levels of caregiver burden, whereas disengagement was associated with a higher burden. The data from the present study confirm that caregiver burden is a relevant issue in the context of neurological diseases, especially for those causing higher degrees of impairment. Significant correlations with family functioning emerged as well, highlighting the importance of studying and treating caregiver burden within the context of family relations.     

Do eating disorder voice characteristics predict treatment outcomes in anorexia nervosa? A pilot study

Individuals with anorexia nervosa often describe experiencing an internal “voice” of their disorder, which previous research has associated with multiple dimensions of eating pathology. This pilot study examined whether eating disorder measures use invoice characteristics at the outset of outpatient therapy predicted changes in disordered eating over the course of treatment. Participants were 14 individuals meeting ICD-10 criteria for anorexia nervosa. Participants completed measures relating to the severity of disordered eating and voice-related characteristics (perceived voice power and metacognitive appraisals about its nature) at the start and end of therapy. Results indicated that the perceived power of the eating disorder was reduced over the course of outpatient therapy, although its other characteristics remained stable. Greater levels of voice power, omnipotence and benevolence at the outset of therapy were related to greater improvements in eating attitudes. No voice-related characteristics were associated with changes in weight. These findings suggest that voice-related appraisals do not obstruct the effectiveness of outpatient therapies for anorexia nervosa. Further studies are needed to ratify these preliminary findings.     

Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention

Third-wave behavioural interventions are increasingly popular for treating and preventing mental health conditions. Recently, researchers have begun testing whether these interventions can effectively targeting eating disorder risk factors (disordered eating, body image concerns). This meta-analysis examined whether third-wave behavioural interventions (acceptance and commitment therapy; dialectical behaviour therapy; mindfulness-based interventions; compassion-focused therapy) show potential for being effective eating disorder prevention programs, by testing their effects on eating disorder risk factors in samples without an eating disorder. Twenty-four studies (13 randomized trials) were included. Most studies delivered selective prevention programs (i.e. participants who reported elevated risk factor). Third-wave interventions led to significant pre–post (g = 0.59; 95% CI = 0.43, 0.75) and follow-up (g = 0.83; 95% CI = 0.38, 1.28) improvements in disordered eating, and significant pre–post improvements in body image (g = 0.35; 95% CI = 0.13, 0.56). DBT-based interventions were associated with the largest effects. Third-wave interventions were also significantly more efficacious than wait-lists (g = 0.39; 95% CI = 0.09, 0.69) in reducing disordered eating, but did not differ to other interventions (g = 0.25; 95% CI = –0.06, 0.57). Preliminary evidence suggests that third-wave interventions may have a beneficial effect in ameliorating eating disorder risk.     

Women’s regulation styles for eating behaviors and outcomes: The mediating role of approach and avoidance food planning

The purpose of this article was to examine the role played by different orientations in planning for eating behaviors as mediators of the relationship between regulation styles and eating behaviors. In Study 1, a new scale was developed to assess approach food planning and avoidance food planning. Results from confirmatory analyses (N = 241) supported the two-factor structure of the scale. In Study 2 (N = 202), in agreement with past research on the effects of autonomous and controlled motivation for the regulation of eating behaviors, we found that approach food planning partially mediated the effects of autonomous regulation for eating behaviors on healthy eating behaviors, while avoidance food planning partially mediated the effects of controlled regulation for eating behaviors on dysfunctional eating behaviors. Implications of these results for self-determination theory and for promoting healthy eating behaviors are discussed.

西方家庭影响进食障碍的研究述评

家庭是进食障碍发展过程中一个重要的影响因素。已有众多西方学者采用各种方法对进食障碍和家庭之间的关系进行了研究。从时间发展脉络来看, Minuchin等学者首先对此进行了经典临床研究; 随后有众多量化研究出现, 对此可以依据不同的测量水平、研究变量和被试视角进行梳理; 近些年, 有学者采用质化研究方法重新对此进行探讨。进食障碍家庭研究的发展趋势表现出：重视本土化研究、对家庭做多水平的探讨、兼顾家庭结构和家庭变化过程。     

Subtyping children and adolescents with loss of control eating by negative affect and dietary restraint

OBJECTIVE: Research suggests that subtyping adults with binge eating disorders by dietary restraint and negative affect predicts comorbid psychopathology, binge eating severity, and treatment outcome. Little research has explored the validity and clinical utility of subtyping youth along these dimensions. METHOD: Children (aged 8-18 years) reporting loss of control eating (n=159) were characterized based upon measures of dietary restraint and negative affect using cluster analysis, and then compared regarding disordered eating attitudes and behaviors, and parent-reported behavior problems. RESULTS: Robust subtypes characterized by dietary restraint (n=114; 71.7%) and dietary restraint/high negative affect (n=45; 28.3%) emerged. Compared to the former group, the dietary restraint/high negative affect subtype evidenced increased shape and weight concerns, more frequent binge eating episodes, and higher rates of parent-reported problems (all ps<0.05). CONCLUSION: Similar to findings from the adult literature, the presence of negative affect may mark a more severe variant of loss of control eating in youth. Future research should explore the impact of dietary restraint/negative affect subtypes on psychiatric functioning, body weight, and treatment outcome.     

Effects of Helper and Recipient Sex on the Experience and Outcomes of Comforting Messages: An Experimental Investigation

The purpose of this experimental study was to examine whether and in what ways the sex of the helper and the recipient moderate the effects of comforting messages in face-to-face interactions. A total of 216 participants disclosed an emotionally upsetting event to a confederate trained to display different levels of nonverbal immediacy and verbal person centeredness. Men and women responded very similarly to comforting messages that exhibited different levels of verbal person centeredness and nonverbal immediacy, and this response similarity was not moderated by the sex of the helper. Both men and women were most comforted by messages that exhibited high levels of person centeredness and nonverbal immediacy, and they were least comforted by messages that exhibited low levels of these qualities. Moreover, both sexes viewed highly person-centered and immediate messages as exhibiting the highest comforting quality, and, with one minor exception, both sexes viewed helpers who used these messages as the most competent.     

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.     

BODY, MOTHER, MIND: ANOREXIA, FEMININITY AND THE INTRUSIVE OBJECT

This paper takes as its starting point the preponderance of female to male patients who suffer from anorexia. The author suggests that there may be something specific about certain experiences of femaleness which predispose towards anxieties of intrusion. Two contemporary theories of the aetiology of anorexia are outlined. Both of these suggest that the problem has its origins in intrusion or invasion of different sorts. The author suggests that many women who suffer from anorexia have an intrusive object instated in their minds, which may not necessarily be the result of actual intrusions in external reality. In the final part of the paper, the author examines the intrusiveness of anorexic patients in the transference and suggests that such patients very often harbour profound phantasies of intruding between the parents, with a wish to regain their special place with mother, untroubled by the presence of father. It is further suggested that the psychopathology underlying certain cases of anorexia leads to a failure in symbolisation. This failure in turn complicates the clinical picture, making such patients particularly difficult to think with about their difficulties.     

Attachment Style and Family Functioning as Discriminating Factors in Eating Disorders

This study sought to examine the extent to which family environment and attachment styles are concurrently related to eating disorders. The Adult Attachment Scale and the Family Environment Scale were administered to 25 anorexic and 33 bulimic female patients at intake in an eating disorder clinic, and 37 age-matched female controls. Eating disorder patients were found to be less secure, more avoidant, and more anxious than controls. The families of eating disorder patients were found to be less cohesive, expressive, and encouraging of personal growth than were controls. Low encouragement of personal growth and uncertain attachment styles may be manifestations of family difficulties in supporting the child during the process of separation individuation, and exploration of the outside world.