Eating Disorder Research Articles
Below, please find summaries and links for eating disorder research articles we think you might find helpful.
1) Agras, W. S., Lock, J., Brandt, H., Bryson, S. W., Dodge, E., Halmi, K. A., et al. (2014). Comparison of 2 Family Therapies for Adolescent Anorexia Nervosa. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2014.1025
IMPORTANCE Anorexia nervosa (AN) is a serious disorder with high rates of morbidity and mortality. Family-based treatment (FBT) is an evidence-based therapy for adolescent AN, but less than half of those who receive this approach recover. Hence, it is important to identify other approaches to prevent the development of the chronic form of AN for which there is no known evidence-based treatment.
OBJECTIVE To compare FBT with systemic family therapy (SyFT) for the treatment of adolescent-onset AN.
DESIGN, SETTING, AND PARTICIPANTS Research in Anorexia Nervosa (RIAN) is a 2-group (FBT and SyFT) randomized trial conducted between September 2005 and April 2012. Interviewers were blinded to the treatment condition. A total of 564 adolescents receiving care at 6 outpatient clinics experienced in the treatment of AN were screened. Of these, 262 adolescents did not meet the inclusion criteria and 138 declined to participate; hence, 164 adolescents (aged 12-18 years) of both sexes meeting the criteria for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, AN (except for amenorrhea) were enrolled. Three participants were withdrawn from FBT and 7 were withdrawn from SyFT after serious adverse events occurred.
INTERVENTIONS Two manualized family therapies with 16 one-hour sessions during 9 months. Family-based therapy focuses on the facilitation of weight gain, whereas SyFT addresses general family processes.
MAIN OUTCOMES AND MEASURES The primary outcomes were percentage of ideal body weight (IBW) and remission (95% of IBW). The a priori hypothesis was that FBT would result in faster weight gain early in treatment and at the end of treatment (EOT).
RESULTS Therewerenostatisticallysignificantdifferencesbetweentreatmentgroupsforthe primary outcome, for eating disorder symptoms or comorbid psychiatric disorders at the EOT or follow-up. Remission rates included FBT, 33.1% at the EOT and 40.7% at follow-up and SyFT, 25.3% and 39.0%, respectively. Family-based therapy led to significantly faster weight gain early in treatment, significantly fewer days in the hospital, and lower treatment costs per patient in remission at the EOT (FBT, $8963; SyFT, $18 005). An exploratory moderator analysis found that SyFT led to greater weight gain than did FBT for participants with more severe obsessive-compulsive symptoms.
CONCLUSIONS AND RELEVANCE The findings of this study suggest that FBT is the preferred treatment for adolescent AN because it is not significantly different from SyFT and leads to similar outcomes at a lower cost than SyFT. Adolescents with more severe obsessive- compulsive symptoms may receive more benefits with SyFT.
TRIAL REGISTRATION clinicaltrials.gov.IdentifierNCT00610753
2) Chen, E. Y., Segal, K., Weissman, J., Zeffiro, T. A., Gallop, R., Linehan, M. M., et al. (2014). Adapting dialectical behavior therapy for outpatient adult anorexia nervosa-A pilot study. International Journal of Eating Disorders, n/a–n/a. doi:10.1002/eat.22360
Objective: Anorexia Nervosa (AN) is associated with excessive self-control. This iterative case series describes the augmentation of Dialectical Behavior Therapy (DBT) for outpatient adult AN with skills addressing emotional and behavioral overcontrol. An overly controlled style is theorized to develop from the transaction between an individual with heightened threat sensitivity and reduced reward sensitivity, interacting with an environment reinforcing overcontrol and punishing imperfection.
Method: Case Series 1 utilized standard DBT, resulting in retention of 5/6 patients and a body mass index (BMI) effect size increase of d 5 20.5 from pre- to post-treatment. Case series 2, using standard DBT augmented with
skills addressing overcontrol, resulted in retention of 8/9 patients with an effect size increase in BMI at post- treatment that was maintained at 6- and 12-months follow-up (d 5 21.12, d 5 20.87, and d 5 21.12).
Discussion: Findings suggest that skills training targeting rigidity and increasing openness and social connectedness war- rant further study of this model and treatment for AN.
Keywords: anorexia nervosa; dialectical behavior therapy; adult; outpatient; case series
3) Edge, P. J., & Gold, M. S. (2014). Potential Role of Addiction Pharmacotherapy in Problematic Eating Behavior. Current Addiction Reports. doi:10.1007/s40429-014-0010-2
Obesity is pandemic worldwide, and hyperphagia remains extremely difficult for physicians to treat. Currently, appetite suppression continues to be the focus of antiobesity drugs, and these drugs are clearly unsuccessful in the long term. Although the food addiction concept remains controversial, this hypothesis provides a matrix in which to examine disordered eating behaviors and their similarities to addiction. This article looks at food addiction as the high end of an eating disorder continuum, with anorexia nervosa as the low end. Similarities with drug addiction provide an avenue leading to new and potentially more successful treatments.
4) Geller, J., & Srikameswaran, S. (2014). What effective therapies have in common. Advances in Eating Disorders, 1–7. doi:10.1080/21662630.2014.895394
In light of current debates about best practices in the eating disorders, at the 2013 International Conference for Eating Disorders, each speaker from the treatment plenary was asked to answer three questions: (i) How does the therapy in your trial engage and motivate patients? (ii) How does the therapy help patients develop skills and alternate ways of coping? and (iii) What are the boundaries and therapeutic expectations of the therapy? The treatments that were included in the plenary included Enhanced Cognitive Behaviour Therapy, the Maudsley Anorexia Nervosa Treatment for Adults, Specialist Supportive Clinical Management, Integrative Cognitive Affective Therapy and Internet-based therapies. Interestingly, there were far more similarities than differences across the treatment modalities. Practices that were common to all of the therapies included the use of a collaborative framework, the importance of psycho- education, emotion regulation, examining relationships, identifying higher values and the use of behavioural experiments. The discussion also raised interesting points to consider regarding treatment non-responders such as flexibility vs. firmness of therapeutic boundaries and behavioural expectations. This paper recognises and celebrates the established common ingredients of effective treatments, while challenging us to ask more complex research questions.
5) van der Kaap-Deeder, J., Vansteenkiste, M., Soenens, B., Verstuyf, J., Boone, L., & Smets, J. (2014). Fostering self-endorsed motivation to change in patients with an eating disorder: The role of perceived autonomy support and psychological need satisfaction. International Journal of Eating Disorders, n/a–n/a. doi:10.1002/eat.22266
Objective: Although several studies have established the beneficial effects of self-endorsed forms of motivation for lasting therapeutic change, the way patients with an eating disorder can be encouraged to volitionally pursue change has received less attention. On the basis of Self-Determination Theory, this longi- tudinal study addressed the role of an autonomy-supportive environment and psychological need satisfaction in foster- ing self-endorsed motivation for change and subsequent weight gain.
Method: Female inpatients (n 5 84) with mainly anorexia nervosa and bulimia nervosa filled out question- naires at the onset of, during, and at the end of treatment regarding their perceived autonomy support from parents, staff members, and fellow patients, their psychological need sat- isfaction, and their reasons for under- taking change. Furthermore, the body mass index (BMI) of the patients at the onset and end of treatment was assessed by the staff. Path analyses were used to investigate the relations between these constructs.
Results: At the start of treatment, per- ceived parental autonomy support related positively to self-endorsed motiva- tion through psychological need satisfac- tion. Perceived staff and fellow patients autonomy support related to changes in self-endorsed motivation over the course of treatment through fostering change in psychological need satisfaction. Finally, relative increases in self-endorsed motiva- tion related to relative increases in BMI throughout treatment in a subgroup of patients with anorexia nervosa.
Discussion: These results point to the importance of an autonomy-supportive context for facilitating self-endorsed moti- vation. VC 2014 Wiley Periodicals, Inc.
6) Schaefer, J. T., & Magnuson, A. B. (2014). A Review of Interventions that Promote Eating by Internal Cues. Journal of the Academy of Nutrition and Dietetics, 114(5), 734–760. doi:10.1016/j.jand.2013.12.024
Traditional diet programs that encourage individuals to consciously restrict their dietary intake have not only been ineffective in terms of weight outcomes, but have also been counterproductive, promoting psychological distress and unhealthy eating behaviors. Nondiet approaches shift the focus away from weight outcomes to the improvement of health outcomes and psychological well-being. One such approach, intuitive eating, promotes dietary intake based on internal cues of hunger and fullness, body acceptance, and making behavior choices based on health as well as enjoyment. Several studies have implemented such ideas into intervention programs. The purpose of our review was to examine the physical and psychological effects of these programs. Twenty interventions were identified. Overall, studies had positive results, demonstrating improvements in eating habits, lifestyle, and body image as measured by dietary restraint, restrictive dieting, physical activity, body satisfaction, and drive for thinness. Participants also experienced improved psychological health as measured by depression, ineffectiveness, anxiety, self-esteem, negative affect, and quality of life. Several improvements were sustained through follow-up periods as long as 2 years. Completion rates were as high as 92% in nondieting groups. In addition, improvements in eating behaviors and maintaining a nondiet approach, increased self-esteem, and decreased body dissatis- faction were sustained long-term. Overall, studies that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress. Results from our review favor the promotion of programs that emphasize a nonrestrictive pattern of eating, body acceptance, and health rather than weight loss.
J Acad Nutr Diet. 2014;114:734-760.
7) Turner, H., Tatham, M., Lant, M., & Mountford, V. A. (2014). Clinicians' concerns about delivering cognitive-behavioural therapy for eating disorders. Behaviour Research and …. doi:10.1016/j.brat.2014.04.003
Despite research supporting the effectiveness of evidence-based interventions in the treatment of eating disorders, those interventions are under-utilised in routine clinical practice, possibly due to clinicians’ concerns about delivering the relevant techniques. This study examined what elements of therapy cli- nicians worry about when delivering cognitive-behavioural therapy (CBT) for the eating disorders, and what clinician variables are associated with such concerns. The participants were 113 clinicians who used individual CBT with eating disorder patients. They completed a novel measure of concerns about delivering elements of CBT, as well as demographic characteristics and a standardised measure of intolerance of uncertainty. Clinicians worried most about body image work and ending treatment, but least about delivering psychoeducation. Their concerns fell into four distinct factors. Older, more expe- rienced clinicians worried less about delivering the CBT techniques, but those with greater levels of prospective and inhibitory anxiety worried more about specific factors in the CBT techniques. Clinicians’ capacity to tolerate uncertainty might impair their delivery of evidence-based CBT, and merits consid- eration as a target in training and supervision of CBT clinicians.
8) de Vos, J., Houtzager, L., Katsaragaki, G., van de Berg, E., Cuijpers, P., & Dekker, J. (2014). Meta analysis on the efficacy of pharmacotherapy versus placebo on anorexia nervosa, 1–14. doi:10.1186/s40337-014-0027-x
Background: Anorexia Nervosa (AN) has a devastating impact on the psychological and physical well being of affected individuals. There is an extensive body of literature on interventions in AN, however more studies are needed to establish which form of pharmacotherapy is effective. The few meta-analyses that have been done are based on one type of medication only. This article is the first to present data on three different, most commonly used, forms of pharmacotherapy. The primary objective of this meta-analysis was to create an overview and to determine the efficacy of three forms of pharmacotherapy (antidepressants, antipsychotics, hormonal therapy) compared to treatment with placebo in patients with AN.
Method: A systematic literature search was performed to identify all randomized controlled intervention trials investigating the effectiveness of pharmacotherapy for AN within the following databases: PubMed, PsycINFO, Embase and Cochrane Library. In addition, 32 relevant reviews and meta-analyses were screened for additional intervention studies. A meta-analysis was performed on a total of 18 included studies (N = 869). Efficacy was measured in terms of weight gain or weight restoration.
Results: The pooled effect sizes indicating the difference between antidepressants and placebo, and between antipsychotics and placebo on weight were not significant. Because of the small sample size no meta regression and subgroup analyses could be conducted. The pooled effect size indicating the difference between hormonal therapy and the placebo condition on weight (all weight measures) at post-treatment was 0.42 (95% CI: 0.11 ~ 0.73), which was significant. For hormonal therapy heterogeneity was high (I2 = 64.70). No evidence for publication bias was found. Meta-regression analyses of the weeks of medication treatment (slope = −0.008) yielded a significant effect (p = 0.04).
Conclusions: In this study we found that hormonal therapy has a significantly larger effect on weight compared to placebo in the treatment of AN. However for these analyses heterogeneity was high, which means that these results have to be regarded with caution. We found that anti-depressants and antipsychotics had no significant effect on weight compared to placebo in the treatment of AN, although the power to detect significant effects was too low.