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Anorexia nervosa [keywords]
- Mortality following hospital discharge with a diagnosis of eating disorder: National record linkage study, England, 2001-2009. [JOURNAL ARTICLE]
- Int J Eat Disord 2014 Mar 5.
To calculate mortality of people with eating disorders (ED) in England, relative to that of people of the same age and sex, between 2001 and 2009. We were specifically interested in mortality amongst adolescents and young adults (15-24 years), and older adults (25-44 years).We analyzed a NHS Hospital Episode Statistics (HES) dataset for all England, linked to death registrations, to calculate age- and sex-specific discharge rates for people with a diagnosis of ED and their subsequent mortality by one year after discharge.The standardized mortality ratio (SMR) for adolescents and young adults with a diagnosis of ED was 7.8 (95% confidence interval: 4.4-11.2). This compares with an SMR for people of the same age with schizophrenia of 10.2 (8.3-12.2), with bipolar disorder of 3.6 (1.1-6.1, and with depression of 4.5 (3.6-5.3). Of the ED, the SMR for anorexia nervosa (AN) in people aged 15-24 was 11.5 (6.0-17.0), for bulimia nervosa (BN) was 4.1 (0-8.7), and eating disorders not otherwise specified (ED NOS) was 1.4 (0-4.0). For older adults aged 25-44 years, the SMR for ED was 10.7 (7.7-13.6). Specifically, for AN was 14.0 (9.2-18.8), for BN was 7.7 (3.5-11.9), and ED NOS was 4.7 (1.4-8.0), for schizophrenia was 7.3 (6.6-7.9), for bipolar disorder was 4.3 (3.5-5.1) and for depression was 4.9 (4.6-5.3). No deaths were recorded below 15 years of age.This study confirms the high SMR associated with ED, notably with anorexia and bulimia. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014).
- "Doing the Impossible": The Process of Recovery From Chronic Anorexia Nervosa. [JOURNAL ARTICLE]
- Qual Health Res 2014 Mar 4.
In this study, we aimed to explore the process of recovery over time from the perspective of those who had fully recovered from chronic anorexia nervosa (AN), using stringent recovery criteria. Eight women, assessed as fully recovered from chronic AN, told their story of the process of recovery. Data were analyzed using the qualitative method, narrative inquiry. Recovery was identified as a long and complex process that spanned four phases: from being unable or unready to change, to experiencing a tipping point where motivation increased and changed in quality, allowing the women to take action against the AN and finally allowing them to reflect and rehabilitate. Results provide a framework for understanding this complex process. Findings suggest that full recovery from chronic AN is possible and emphasize the importance of hope, motivation, self-efficacy, and support from others in the recovery process.
- Correction: Resistance to treatment and change in anorexia nervosa: a clinical overview. [JOURNAL ARTICLE]
- BMC Psychiatry 2014 Mar 4; 14(1):62.
Due to an error in the publication process, this article was published with an incorrect title. The correct title of the article is 'Resistance to treatment and change in anorexia nervosa: a clinical overview'. Readers should be aware that this article may still be indexed under its previous, incorrect title 'Resistance to treatment in eating disorders: a critical challenge'. BioMed Central apologize to the authors and readers for the error and any inconvenience caused.
- Process Evaluation of the Maudsley Model for Treatment of Adults with Anorexia Nervosa Trial. Part II: Patient Experiences of Two Psychological Therapies for Treatment of Anorexia Nervosa. [Journal Article]
- Eur Eat Disord Rev 2014 Mar; 22(2):131-9.
This study is the second part of a process evaluation, embedded in the MOSAIC study, a large randomised controlled trial comparing two different psychological therapies, the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) and Specialist Supportive Clinical Management (SSCM). The study adopted a qualitative approach to examine patient experiences of the two treatments.Seventeen semi-structured interviews were conducted with Anorexia Nervosa and Eating Disorder Not Otherwise Specified-Anorexia Nervosa type patients, and transcripts were analysed thematically.Patient responses yielded five main themes: positive and helpful aspects, beneficial outcomes, less helpful aspects, possible improvements to the treatments, and the therapeutic and external environment. The findings show clear differences and some overlaps between patients' views on MANTRA and SSCM.Both therapies were experienced by patients as credible and largely helpful, albeit in different ways. These results are in agreement with those of therapists' views on these treatments. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
- Memory versus perception of body size in patients with anorexia nervosa and healthy controls. [Journal Article]
- Eur Eat Disord Rev 2014 Mar; 22(2):109-15.
The objective of this study was to compare body size estimation based on memory versus perception, in patients with anorexia nervosa (AN) and healthy controls, adjusting for possible confounders. Seventy-one women (AN: 37, controls: 35), aged 14-29 years, were assessed with a computerized body size estimation morphing program. Information was gathered on depression, anxiety, time since last meal, weight and height. Results showed that patients overestimated their body size significantly more than controls, both in the memory and perception condition. Further, patients overestimated their body size significantly more when estimation was based on perception than memory. When controlling for anxiety, the difference between patients and controls no longer reached significance. None of the other confounders contributed significantly to the model. The results suggest that anxiety plays a role in overestimation of body size in AN. This finding might inform treatment, suggesting that more focus should be aimed at the underlying anxiety. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
- Fostering self-endorsed motivation to change in patients with an eating disorder: The role of perceived autonomy support and psychological need satisfaction. [JOURNAL ARTICLE]
- Int J Eat Disord 2014 Mar 3.
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 longitudinal study addressed the role of an autonomy-supportive environment and psychological need satisfaction in fostering self-endorsed motivation for change and subsequent weight gain.Female inpatients (n = 84) with mainly anorexia nervosa and bulimia nervosa filled out questionnaires 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 satisfaction, and their reasons for undertaking 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.At the start of treatment, perceived parental autonomy support related positively to self-endorsed motivation through psychological need satisfaction. 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 motivation related to relative increases in BMI throughout treatment in a subgroup of patients with anorexia nervosa.These results point to the importance of an autonomy-supportive context for facilitating self-endorsed motivation. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014).
- Emotion regulation difficulties in anorexia nervosa before and after inpatient weight restoration. [JOURNAL ARTICLE]
- Int J Eat Disord 2014 Mar 3.
This study examined: (1) changes in emotion regulation difficulties in underweight inpatients with anorexia nervosa (AN) following weight restoration, (2) differences in emotion regulation between AN subtypes at acute and weight-restored stages of illness.Repeated measure analyses of variance examined changes in scores on the Difficulties in Emotion Regulation Scale (DERS; Gratz and Roemer, J Psychopathol Behav Assess, 26, 41-54, 2004) and other clinical variables in a group of inpatients with AN from hospital admission (N = 65) to weight restoration (N = 51). Correlations between BMI and DERS scores at both time points were examined. Emotion regulation difficulties were compared between individuals with AN, restricting type (AN-R) and AN, binge/purge type (AN-BP) at both time points using multivariate analysis of covariance.All clinical variables, except for the DERS, significantly improved with weight restoration (p < .001). There were no associations between BMI and DERS prior to or after weight restoration and AN subtypes did not significantly differ in emotion regulation difficulties.Unlike other clinical variables, emotion regulation difficulties in AN did not improve with weight restoration. In addition, both subtypes of AN appear to have similar difficulties with emotion regulation. The treatment of AN might be enhanced by focusing on improving emotion regulation abilities. © 2014 Wiley Periodicals, Inc. Int J Eat Disord 2014.
- A Systematic Review of the Effects of Experimental Fasting on Cognition. [REVIEW]
- Appetite 2014 Feb 27.
Numerous investigations have been conducted on the impact of short-term fasting on cognition in healthy individuals. Some studies have suggested that fasting is associated with executive function deficits, however findings have been inconsistent. The lack of consensus regarding the impact of short-term fasting in healthy controls has impeded investigation of the impact of starvation or malnutrition in clinical groups, such as anorexia nervosa (AN). One method of disentangling these effects is to examine acute episodes of starvation experimentally. The present review systematically investigated the impact of short-term fasting on cognition. Studies investigating attentional bias to food-related stimuli were excluded so as to focus on general cognition. Ten articles were included in the review. The combined results are equivocal: several studies report no observable differences as a result of fasting and others show specific deficits on tasks designed to test psychomotor speed, executive function, and mental rotation. This inconsistent profile of fasting in healthy individuals demonstrates the complexity of the role of short-term fasting in cognition; the variety of tasks used, composition of the sample, and type and duration of fasting across studies may also have contributed to the inconsistent profile. Additional focused studies on neuropsychological profiles of healthy individuals are warranted in order to better develop an understanding of the role of hunger in cognition.
- Knowledge and practice of eating disorders among a group of adolescent dental patients. [Journal Article]
- J Clin Pediatr Dent 2013; 38(1):39-43.
The objectives are to ascertain how much is known about the eating disorders of bulimia and anorexia nervosa in a group of female adolescents, to determine if they had practiced behaviors consistent with these eating disorders, and to determine if there was a disconnect with actual and perceived healthy weight status.126 research subjects completed a survey instrument. Embedded in the eighteen question survey were the five "SCOFF" questions, to determine if an eating disorder may exist. The BMI percentile was obtained for all participants.18.3% of the research sample may have an eating disorder as predicted by the SCOFF questions. Of those with a suspected eating disorder, only 38% could correctly identify the best description of bulimia nervosa and 50% for anorexia nervosa. The BMI percentiles were higher in the group suspected of having an eating disorderYoung adolescent females are at risk for eating disorders. Educational interventions should be directed at this young age group. If the at-risk individuals knew more about the consequences of these disorders, they may be less likely to practice the behaviors.
- Risk Factors and Antecedent Life Events in the Development of Anorexia Nervosa: A Portuguese Case-Control Study. [JOURNAL ARTICLE]
- Eur Eat Disord Rev 2014 Feb 27.
The aetiology of anorexia nervosa (AN) is considered to be multifactorial. This study aims to identify potential risk factors for AN and whether these factors are specific to AN or precede the development of psychiatric disorders in general and to identify specific life events in the 12 months immediately preceding the onset of eating disorder (ED) symptoms.A case-control design was used to compare a group of women who meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for AN (N = 86) with healthy controls (N = 86) and with a group of controls with other psychiatric disorders (N = 68), each group matched to the AN patients by age and parental socioeconomic status bands. Risk factors were assessed by interviewing each person with the Oxford Risk Factor Interview.Women with AN reported significantly higher rates of perfectionism, negative attitudes toward parents' shape and weight, significant concern about feeling fat and a family history of AN or bulimia nervosa. Critical comments about weight, shape or eating was the most notable event in the year preceding AN onset.Perfectionism and a family history of ED emerged as the most convergent findings in the development of AN, along with being critical toward parents' shape and weight, and feeling fat. Critical comments about appearance and eating seem to be an important precipitating factor in AN onset. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.