Predictors for relapse and chronicity in eating disorders: A review of follow-up studies

Abstract: Eating disorders have been known to be intractable. Yet, their long-term consequences have received relatively little attention in the literature. In this paper, the outcome and follow-up studies of anorexia nervosa and bulimia are reviewed and the current knowledge of the predictors and correlates of relapse and chronicity in each disorder is summarized. Based on the problems and limitations of the extant studies, suggestions for future research are offered, especially from a developmental perspective, to understand better the mechanisms underlying long-term prognosis and relapse.     

Public and private self-consciousness as specific psychopathological features

Public self-consciousness (PUBSC) and private self-consciousness (PRISC) represent aspects of dispositional self-directed attention. The aim of the present study was to investigate whether four clinical groups, namely patients with a diagnosis of social phobia, panic disorder, obsessive–compulsive disorder or bulimia nervosa, and normal controls differentiated on the basis of their PUBSC and PRISC scores. Results indicated that both PUBSC and PRISC are extremely elevated in patients with social phobia. Patients with panic disorder and patients with obsessive–compulsive disorder score somewhere between social phobics and normal controls on PUBSC and PRISC scales. Bulimics had significantly higher PUBSC values than both controls and patients with panic disorder, but had lower values than social phobics. Compared to normal controls, bulimics showed no elevated PRISC scores. In addition, contrary to the other groups, PUBSC and PRISC seem to be unrelated in bulimics. Thus, PUBSC and PRISC appear to be specific psychopathological features for German females when comparing groups with different mental disorders and normal controls.     

Sensitivity for Treatment Effects of the Screen for Child Anxiety Related Emotional Disorders

The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a relatively new self-report questionnaire that measures DSM-defined anxiety disorders symptoms in children. The present study examined the treatment sensitivity of the SCARED. Eleven anxiety-disordered children aged 10 to 13 years received cognitive-behavioral treatment, an intervention that is generally known to be effective. Children completed the SCARED on three occasions: (1) 3 months before treatment (i.e., baseline), (2) at pretreatment, and (3) at posttreatment. Before and after treatment, scores on traditional childhood anxiety measures (i.e., State-Trait Anxiety Inventory for Children, Revised Children's Manifest Anxiety Scale, and Fear Survey Schedule for Children) were also obtained. Results showed that children's SCARED scores remained relatively stable from baseline to pretreatment. However, from pre- to post-treatment, significant decreases were evident for the SCARED and for all traditional measures. These results suggest that the SCARED reliably taps treatment effects and, thus, provide further support for its utility as a self-report index of childhood anxiety in clinical and research settings.     

A comparison of peer verbal responding directed toward adolescents with behavioral disorders and nonhandicapped peers

One of the primary intents of inclusion is the maximization of interaction between persons with and without disabilities. The purpose of this study was to analyze the verbal responding that peers directed toward adolescents with behavioral disorders and, to this effect, several comparisons were made: verbal responding of peers directed toward adolescents with behavioral disorders was compared to verbal responding of peers directed toward regular class adolescents; verbal responding of peers directed toward the same adolescents with behavioral disorders was compared across their self-contained and integrated settings; and verbal responding of peers directed toward adolescents with behavioral disorders in integrated settings was compared to verbal responding of peers directed toward regular class adolescents. Data, collected in real time using portable microcomputers, focused on positive, negative, and neutral social responding and positive, negative, and neutral academic responding. All verbal responding of peers directed toward 14 adolescents with behavioral disorders and 14 regular class peers was recorded. Data were analyzed by group and setting, as well as by social or academic content. Results of the study support inclusion, with high levels of peer responding directed toward adolescents with behavioral disorders in integrated classrooms. Almost all peer responding was positive or neutral in content. Results were discussed as they related to placement of students, social skills training, and previous research.     

Walter Bradford Cannon: Pioneer of stress research

Walter Bradford Cannon, M.D., made a significant contribution to psychology and medicine with the discovery of the stress response around 1915, setting the cornerstone for psychosomatic medicine. This brief, introductory article etches out the nature of his contribution and sets the stage for Dr. Bradford Cannon to reflect on his father's important professional contributions and personal life in the following article.     

BRAIN, SYMBOL, & EXPERIENCE: A PSYCHIATRIC AND THEOLOGICAL DIALOGUE

Abstract. Brain, Symbol & Experience attempts to solidify the authors' work in the fields of neurophenomenology and consciousness. The interdisciplinary nature of the work dictates less than extensive discussions of individual academic topics, but it does facilitate the identification of mutual points of interest for future pluralistic dialogues. This paper explores the implications of Laughlin, McManus, and d'Aquili for the neurosciences, psycho-pathology, psychotherapy, contemporary literature, theology, and faith development theory. Suggestions for specific interdisciplinary conversations are offered.     

Discomfort with space and motion: A possible marker of vestibular dysfunction assessed by the situational characteristics questionnaire

Space and motion discomfort (SMD) refers to the situational specificity of symptoms occurring in some patients with vestibular dysfunction, such as those with balance disorders and some with panic disorder. SMD occurs in situations characterized by inadequate visual or kinesthetic information for normal spatial orientation. We report the results of two studies of the construct validity of the Situational Characteristics Questionnaire (SitQ), which has two subscales, both of which measure SMD: the SMD-I and SMD-II. In Study 1, the SitQ was administered to members of a self-help group for balance disorders, a psychiatric sample consisting of patients with panic disorder, nonpanic anxiety disorders, depression, and a sample of normals. SMD levels were the highest in the self-help balance group, next to the highest in the panic groups, and lowest in the remaining groups. In Study 2, the SitQ was administered to otolaryngological patients with vestibular dysfunction and to patients with hearing loss. SMD levels were higher in the vestibular patients. Data on internal consistency, test-retest reliability, and convergent and discriminant validity are presented. The SitQ, particularly the SMD-II, is recommended for quantifying space and motion discomfort in patients with anxiety and/or balance disorders.Study 1 was funded by MH 40757. Study 2 was funded by a grant from the Upjohn Company and MH 19816.     

Binge Eating,Purging, and Restriction Symptoms: Increasing Accuracy of Prediction Using Machine Learning

Eating disorders are severe mental illnesses characterized by the hallmark behaviors of binge eating, restriction, and purging. These disordered eating behaviors carry extreme impairment and medical complications, regardless of eating disorder diagnosis. Despite the importance of these disordered behaviors to every eating disorder diagnosis, our current models are not able to accurately predict behavior occurrence. The current study utilized machine learning to develop longitudinal predictive models of binge eating, purging, and restriction in an eating disorder sample (N = 60) using real-time intensive longitudinal data. Participants completed four daily assessments of eating disorder symptoms and emotions for 25 days on a smartphone (total data points per participant = 100). Using data, we were able to compute highly accurate prediction models for binge eating, restriction, and purging (.76–.96 accuracy). The ability to accurately predict the occurrence of binge eating, restriction, and purging has crucial implications for the development of preventative interventions for the eating disorders. Machine learning models may be able to accurately predict onset of problematic psychiatric behaviors leading to preventative interventions designed to disrupt engagement in such behaviors.     

Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders

Despite striking empirical support, exposure-based treatments for anxiety disorders are underutilized. This is partially due to clinicians’ concerns that patients may reject exposure or experience severe side effects, particularly in intensive forms of exposure. We examined acceptance and side effects of two randomly assigned variants of prediction error-based exposure treatment differing in temporal density (1 vs. 3 sessions/week) in 681 patients with panic disorder, agoraphobia, social anxiety disorder, and multiple specific phobias. Treatment acceptance included treatment satisfaction and credibility, engagement (i.e., homework completion), and tolerability (i.e., side effects, dropout, and perceived treatment burden). Side effects were measured with the Inventory for the Balanced Assessment of Negative Effects of Psychotherapy (INEP). We found treatment satisfaction, credibility, and engagement to be equally high in both variants of exposure-based treatment, despite higher treatment burden (β = 0.25) and stronger side effects (β = 0.15) in intensified treatment. 94.1% of patients reported positive effects in the INEP. 42.2% reported side effects, with treatment stigma (16.6%), low mood (14.8%) and the experience to depend on the therapist (10.9%) being the most frequently reported. The mean intensity of side effects was low. We conclude that prediction error-based exposure treatment is well accepted by patients with different anxiety disorders and that patients also tolerate temporally intensified treatment, despite higher perceived treatment burden and stronger side effects. Clinicians should be aware of the most frequent side effects to take appropriate countermeasures. In sum, temporal intensification appears to be an acceptable strategy to achieve faster symptom reduction, given patients’ well-informed consent.     

Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Comorbid Substance Abuse and Mental Health Disorders

Comorbid substance use disorders (SUDs) and mental health disorders are a pervasive problem among post-9/11 veterans and service members. Treatment of SUD and comorbid disorders has historically occurred separately and sequentially, and when treated concurrently has been primarily done in a weekly outpatient setting, which has high rates of dropout. The current study describes an integrated 2-week intensive outpatient treatment (IOP) using cognitive-behavioral therapy, including prolonged exposure for posttraumatic stress disorder (PTSD), unified protocol for anxiety and mood disorders, and relapse prevention for SUD. Forty-two patients completed the comorbid treatment program. Results indicated that self-reported substance use, PTSD, and depression symptoms significantly decreased following treatment, while satisfaction with participation in social roles increased. These preliminary effectiveness data indicate that comorbid SUD and mental health disorders can be effectively treated in a 2-week intensive outpatient program.