Interpersonal problems across restrictive and binge-purge samples: Data from a community-based eating disorders clinic

Contemporary models of eating disorders suggest that interpersonal problems contribute to the maintenance of eating disorders. This study examined whether baseline interpersonal problems differed across eating disorder diagnoses and across eating disorder subtypes (“restrictors” vs. “binge-purge” patients) in a large clinical sample. Patients with a primary eating disorder diagnosis (N = 406) completed measures of interpersonal problems, eating disorder symptoms, and mood prior to treatment at a specialist eating disorder clinic. Across the sample, more severe eating disorder psychopathology was associated with significantly greater difficulty socializing. Anorexia Nervosa (AN) / restrictor patients reported significantly greater difficulty socializing than Bulimia Nervosa (BN) / binge-purge patients. AN patients reported significantly greater difficulty on a measure of competitiveness/assertiveness compared to BN and Eating Disorder Not Otherwise Specified patients. All findings were significant after controlling for comorbid depression and anxiety symptoms. Interpersonal problems appear to be unique risk factors for eating disorders. Specific interpersonal mechanisms include difficulties socializing and being assertive, which were most pronounced in AN patients. These findings provide potential avenues for enhancing interventions, such as adjunctive assertiveness training for AN

Therapeutic alliance in Enhanced Cognitive Behavioural Therapy for bulimia nervosa: Probably necessary but definitely insufficient

The present paper assessed therapeutic alliance over the course of Enhanced Cognitive Behavioural Therapy (CBT-E) in a community-based sample of 112 patients with a diagnosis of bulimia nervosa (BN) or atypical BN. Temporal assessment of alliance was conducted at three time points (the start, middle and end of treatment) and the relationship between alliance and treatment retention and outcome was explored. Results indicated that the alliance between patient and therapist was strong at all stages of CBT-E, and even improved in the early stages of treatment when behaviour change was initiated (weekly in-session weighing, establishing regular eating, and ceasing binge-eating and compensatory behaviours).The present study found no evidence that alliance was related to treatment retention or outcomes, or that symptom severity or problematic interpersonal styles interacted with alliance to influence outcomes. Alliance was also unrelated to baseline emotional or interpersonal difficulties. The study provides no evidence that alliance has clinical utility for the prediction of treatment retention or outcome in CBT-Efor BN, even for individuals with severe symptoms or problematic interpersonal styles. Early symptom change was the best predictor of outcome in CBT-E. Further research is needed to determine whether these results are generalizable to patients with anorexia nervosa

Severe and enduring anorexia nervosa? Illness severity and duration are unrelated to outcomes from enhanced cognitive behaviour therapy

Objective: The present study aimed to examine whether Anorexia Nervosa (AN) illness severity or duration is associated with retention or treatment response in outpatient, enhanced cognitive–behavioral therapy (CBT-E). Method: Patients with a confirmed AN diagnosis (N = 134) completed measures of eating disorder symptoms and quality of life, and had their BMI objectively measured before, during, and after treatment. We evaluated whether illness severity or duration predicted treatment outcomes, using longitudinal regression models. Results: Greater levels of illness severity and duration were not associated with poorer treatment outcomes. Conclusions: Patients with more severe or long-standing AN illness did just as well in CBT-E as any other patient starting treatment. Therefore, classifying individuals as “severe and enduring” appears to lack clinical utility in CBT-E. Clinicians should continue to administer evidence-supported treatments such as CBT-E for patients with AN, regardless of duration or severity of AN illness. (PsycINFO Database Record (c) 2018 APA, all rights reserved

The development and validation of a measure of eating disorder-specific interpersonal problems: The Interpersonal Relationships in Eating Disorders (IR-ED) scale

Clinical reports suggest that interpersonal problems are associated with the onset and maintenance of eating pathology, but existing measures of such problems have limited links to eating pathology. Therefore, the aim of this study was to develop an eating-specific measure of interpersonal problems. The new measure, the Interpersonal Relationships in Eating Disorders scale (IR-ED), was administered to a large community sample, a nonclinical replication sample, and a clinical group of eating disorder patients. In Study 1, the psychometric properties of the IR-ED were established, and they were tested using confirmatory analyses in Study 2. Study 3 determined the validity of the test score interpretations in a clinical sample. The final 15-item version of the IR-ED demonstrated 3 distinct factors with reliability of test scores—Food-Related Isolation; Avoidance of Body Evaluation; and Food-Related Interpersonal Tension. Study 2 demonstrated that the IR-ED comprises a common Interpersonal Problems factor and a specific group factor—Avoidance of Body Evaluation. Study 3 showed that the clinical group had higher IR-ED scores than a nonclinical group. Across the studies, Avoidance of Body Evaluation was the strongest correlate of eating pathology in this group. The IR-ED has strong psychometric properties and its test scores appear to be more valid than those of a generic measure of interpersonal problems. Avoidance of Body Evaluation is the strongest facet of such interpersonal problems, and has meaningful links to models of eating psychopathology

A framework for conceptualising early intervention for eating disorders

OBJECTIVE: This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders. METHOD AND RESULTS: Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence-based approaches to early intervention for eating disorders and progress is being made in scaling these. CONCLUSIONS: We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics

The transition into adoptive parenthood: adoption as a process of continued unsafe uncertainty when family scripts collide

Our prospective study investigated couples’ expectations of adoptive parenthood and explored how these changed with their actual experience of parenthood. Six heterosexual couples were interviewed just before placement began and six months after the children had arrived. Interpretative Phenomenological Analysis (IPA) was used to analyse both sets of interview data. Expectations of adoptive parenthood mostly transformed smoothly into adoption experience for couples but challenges were experienced when family scripts collided and a continued feeling of unsafe uncertainty then prevailed within these newly formed family systems. Family script collision seemed a particular problem for couples adopting sibling pairs. To further professional practice in working with families over the transition to adoptive parenting we suggest that professionals keep in mind a framework that includes: Internal and external world influences on family members, Intergenerational issues, Family scripts, and the Structural challenges of adoption (IIFS)

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: A multi-centre study

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses

‘Wellness’ lifts us above the Food Chaos’: a narrative exploration of the experiences and conceptualisations of Orthorexia Nervosa through online social media forums

The increasing prevalence of eating disorders has motivated a burgeoning of research from narrative methods to illuminate the cultural and social aspects of disordered eating habits. A seemingly new eating disorder, Orthorexia Nervosa, has gained visibility through the internet sphere and popular media, though scholarly attention has been scarce. This study develops qualitative understandings of the fixation with ‘clean eating’ through narrative inquiry by employing an internet ethnographic approach. Data were analysed using a thematic narrative analysis, focusing on parallels and divergences across narratives presented online. This article presents 30 male and female voices, illustrating how these individuals understand their eating habits through narratives of pursuit, resistance and recovery, which are largely motivated by the desire for physical, emotional and social change. Crucially, this study illuminates a range of cultural elements enabling eating disorders in response to the transmission of cultural values online set within the broader context and processes of reflexive-modernisation

Stomaching uncertainty: Relationships among intolerance of uncertainty, eating disorder pathology, and comorbid emotional symptoms

Intolerance of uncertainty (IU) is proposed to be a transdiagnostic vulnerability factor for various emotional disorders. There is robust evidence for the role of IU in anxiety and depressive disorders, but a paucity of evidence in eating disorders (ED). This study evaluated the factorial validity, internal consistency, and convergent validity of the Intolerance of Uncertainty Scale-Short Form (IUS-12; Carleton, Norton, & Asmundson, 2007), and examined whether IU is associated with ED pathology and comorbid emotional symptoms, in a clinical sample with EDs (N = 134). A unitary factor solution provided the best fit. The IUS-12 showed excellent internal consistency, and good convergent validity. IU had an indirect effect on dietary restraint, purging, and emotional symptoms via overvaluation of eating, weight, and shape. The indirect effect was not significant for bingeing. Findings provide partial support for the notion that IU is a vulnerability factor for ED pathology and support the notion that IU is a transdiagnostic vulnerability factor for emotional symptoms. Limitations, research implications, and future directions for research are discussed

Avoidance of affect in the eating disorders

The Distress Tolerance Scale (DTS) (Corstorphine, Mountford, Tomlinson, Waller, & Meyer, 2007) measures the tendency to use cognitive and behavioural strategies to manage the experience of positive and negative affect. This paper aimed to explore the factor structure of the DTS, particularly in relation to avoidance of affect. Participants were 227 female university students (non-clinical sample) and 257 clients seeking treatment for an eating disorder (clinical sample). Confirmatory factor analysis was used to test two previously proposed factor structures of the DTS in the non-clinical sample. Both of these models were found to be a poor fit to the data. Subsequently, nine items measuring avoidance of affect were analysed using exploratory factor analysis in the non-clinical sample. Three factors of avoidance of affect were identified (Behavioural Avoidance of Positive Affect, Behavioural Avoidance of Negative Affect, and Cognitive Avoidance of Affect). Confirmatory factor analysis supported this avoidance of affect model in the clinical sample. Significant correlations were observed between avoidance of affect subscales and eating psychopathology in both samples. Results suggest that the avoidance of positive emotion may be an important factor in eating disorders. It is recommended that future studies broaden their investigation of the role of emotion in eating disorders to include both negative and positive emotion