1,721,564 research outputs found
Introduction to Family, Peers, and Carers
No full textSocial factors play a central role in eating disorders and can contribute to the predisposition, maintenance, or recovery from an eating disorder (Schmidt & Treasure, 2006; Treasure et al., 2020). In this part there are a collection of chapters that examine the role of social factors across the life course. These range from the individual through to the global perspective
Stress hormones and eating disorders
No full textAims: The aim of this paper is to emphasize the role of stress processes in the aetiology of eating disorders. Methods: We have examined the literature for evidence that people with eating disorders might exhibit markers of stress and show signs of the “maltreated ecophenotype”. Results: Early adversity is more common among people with binge eating behaviours. The secondary effects of malnutrition, which are mostly marked in anorexia nervosa, may be an added stressor that could also contribute to the stress related phenotype. People with eating disorders have anomalies in brain structure, reward and punishment sensitivity, and the balance between HPA and SMA function. These may be potential targets for treatment
Every mistake is a treasure: Lessons learned from the TRIANGLE trial for anorexia nervosa
No full textBackground Despite several decades of treatment research for anorexia nervosa (AN), many of the same questions remain: how to boost enrollment, engage participants, prevent attrition, and meet the needs of a diverse patient population within the rigorous framework of a randomized controlled trial (RCT).Methods In this research forum, we highlight some of the challenges and opportunities observed over the course of TRIANGLE, the largest RCT for severe AN treatment in the UK to date. We discuss strategies for addressing common challenges and avoiding common pitfalls and propose solutions to future researchers seeking to conduct treatment research in AN.Results Our experience underscores the value of involving people with lived experience at every stage of intervention research. We offer additional recommendations for treatment researchers, including, (1) early qualitative research to identify patient barriers and obstacles, (2) clear, systematic collaboration with clinical sites for patient recruitment and passive data collection, (3) careful consideration of assessment metrics, including repeated measurement of quality of life, (4) adopting a flexible, patient-centered approach to clinical trial research, and (5) considering the unique needs and obstacles that might impact carer participation in research and their ability to provide support to their loved ones.Discussion We hope that these lessons learned will prove fruitful for the next generation of researchers embarking on treatment research for AN.Public Significance Using the TRIANGLE trial as an illustrative case study, we highlight the value of lived experience and codesign for developing and testing interventions for AN. We offer several lessons learned over the course of the trial, pertaining to trial enrollment, retention and engagement, measurement of outcomes, and research adaptations for real-world settings, and hope that these recommendations facilitate future treatment research for AN
Outcomes for adults with anorexia nervosa who do not respond early to outpatient treatment
No full textObjective: To better understand those patients with anorexia nervosa who do not show early response to treatment and are likely to have poorer outcome. Method: From an existing data set of 187 patients with anorexia nervosa across 22 eating disorder outpatient services in the United Kingdom, participants who had started treatment and had at least one body mass index (BMI) observation in the first 6 weeks of treatment were eligible for these secondary analyses (N = 65), a latent class analysis of BMI change over the first 6 weeks of treatment. Fifty-six patients showed no early change in BMI. We used logistic regression to examine predictors of good outcome in the 40 participants who had 12-month follow-up data. Predictors included global EDE-Q, negative affect (Depression, Anxiety, and Stress Scales) and functional impairment (Work and Social Adjustment Scale). Results: Good outcome was achieved by 23% of patients and remission by 15%. Good outcome was predicted by less functional impairment at baseline. Discussion: Further work that can identify sub-groups of patients with anorexia nervosa who do not achieve good outcome after treatment will inform the development of targeted engagement approaches. © 2021 Wiley Periodicals LLC
Reactivity to interpersonal stress in patients with eating disorders: A systematic review and meta-analysis of studies using an experimental paradigm
No full textReactivity to interpersonal stress in patients with eating disorders: A systematic review and meta-analysis of studies using an experimental paradigm. NEUROSCI BIOBEHAV REV XXX-XXX, 2018.- Social difficulties have been implicated in the development and maintenance of eating disorder symptoms. The aim of this work was to conduct a systematic review and meta-analysis of experimental studies testing patientsö reactivity to interpersonal stress, compared to healthy controls. Thirty-four studies were included. Meta-analyses were conducted on 16 studies and on following outcomes: attention bias and interference to threatening faces, cortisol, heart rate and negative affect before and after exposure to interpersonal stress. Patients showed heightened attention bias and interference to threatening faces. Lower heart rate after exposure to interpersonal stress and greater negative affect before and after interpersonal stress were observed in the clinical group compared to controls. Surprisingly, only a small minority of studies included measures of abnormal eating behaviour and attitudes. This seems a missed opportunity for testing the causal and maintaining role that abnormalities in interpersonal stress response play in eating disorders. Nonetheless, findings corroborate the hypothesis that patients' response to interpersonal stress differs from that of healthy controls
Genetic and Environmental Aspects of Eating Disorders
No full textIn this chapter, we review the evidence for the relevance of family factors in the aetiology of eating disorder. The focus is on evidence compiled in recent systematic reviews and/or from well-powered community and clinically based studies. Both genetic and environmental factors within families impact on the risk of developing an eating disorder. Large international studies have led to greater understanding of the genetic underpinnings of anorexia nervosa. Similar studies for the binge spectrum disorders are now in progress. Eating disorders (particularly those within the binge spectrum disorders) are associated with a genetic profile shared with many other psychiatric disorders. However, a unique aspect of the genetic risk for eating disorders is the association with the anthropometric and metabolic genetic profile. Interestingly, this somatic profile shows contrasts across the range of eating disorders. Environmental factors within the family context also moderate the risk of developing an eating disorder. These range from generically stressful events and specific stresses related to weight stigma or “fat talk” to influences within the food environment. Critical developmental stages such as puberty or transitions increase the risk of an eating disorder, possibly through interactions with the genetic and family environment. Prevention programs which target some of the specific environmental risk factors have been developed and may be of value for those with a high familial risk
The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence
Full text linkThe implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02336841
A proof-of-concept study for the use of a computerised avatar to embody the eating disorder voice in anorexia nervosa
Full text linkPurpose This study assessed (1) the experience of the eating disorder voice in people with anorexia nervosa or in remission, and (2) the feasibility of creating and interacting with a computerised representation (i.e., avatar) of this voice. Methods Twenty-one individuals with anorexia nervosa and 18 individuals who were in remission participated in the study. They reported on the characteristics of their eating disorder voice and created a personalised avatar (a visual and auditory representation of the eating disorder voice), using a computerised software. Participants assessed closeness of match between the voice and the avatar, perceived distress and acceptability of re-exposure to the avatar. Results Patients felt less powerful than their eating disorder voice and unable to disregard the voice's commands. The experience of the voice was associated with negative, as well as some positive emotions, reflecting the prototypical ambivalence towards the illness. Individuals in remission had an opposite pattern of responses. They attributed only negative emotions to the voice, felt more powerful than the voice, and able to disregard its commands. Overall participants reported that there was a good match between the voice and the sound of the avatar. Patients expressed willingness to repeat exposure to the avatar. Conclusion Individuals with anorexia can create personalised digital avatars representing the eating disorder voice and are willing to engage therapeutically with the avatar. The next step is to test the feasibility of repeated exposure to the avatar to address the power and distress associated with the eating disorder voice
Interpersonal reactivity in eating disorders: A systematic review and meta-analysis of literature studies
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