A longitudinal study of perfectionism and orthorexia in exercisers

Research suggests that trait perfectionism and perfectionistic self-presentation are related to orthorexia – a pathological obsession with correct nutrition. However, no studies have examined these relationships over time or compared the influence of the two aspects of perfectionism on orthorexia. In the present study we sought to address these two issues. Gym members who engaged in high degrees of exercise were recruited via social media platforms. They completed an online questionnaire that included the Multidimensional Perfectionism Scale-Short Form, Perfectionistic Self-Presentation Scale, and the Eating Habits Questionnaire on two occasions: 177 participants (Mean age = 31.6 years) initially completed the questionnaire and 82 completed the questionnaire six weeks later. A series of multiple regression analyses revealed that (i) trait perfectionism predicted an increase in orthorexia symptomatology over time with socially prescribed perfectionism and other-oriented perfectionism unique predictors of orthorexia, (ii) perfectionistic self-presentation predicted orthorexia over time with nondisplay of imperfection a unique predictor of orthorexia, and (iii) when considered alongside each other, only trait dimensions of perfectionism were unique predictors of orthorexia. The present study provides further evidence that perfectionism is related to orthorexia. In addition, the study also provides preliminary evidence that more engrained trait aspects of perfectionism are more predictive of intensifying orthorexia over time than the self-presentational aspects of perfectionism

Evaluating integrative services in edge-of-care work

Children living on ‘the edge-of-care’ are typically known to local safeguarding authorities and are considered likely to face risks to their safety. Many are subject to a child protection plan and/or involved in ‘pre-proceedings’ processes. A growing number of their parents face (un)diagnosed mental health difficulties as well as economic and social precarity. This article draws on a mixed methods evaluation of a pilot service in the East of England offering a therapeutically led attachment-based intervention for families. The service cross-cuts health and social care, allowing psychologists and psychotherapists to work alongside social workers and other practitioners. The evaluation examined psychological and safeguarding outcomes and explored practitioner perspectives. A key outcome was that 85.4% of families were enabled to remain, or reunite with their child, compared with an estimated 50% of ‘edge-of-care’ cases nationally. This supports the need for similarly oriented interventions that could help lower the incidence of child removals

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Self-Compassion and Orthorexia : Moving away from self-criticism and excessive food control.

KEY POINTS Eating disorders, including orthorexia, are linked to low levels of self-compassion. Self-compassion involves learning to be kind to ourselves and moving away from self-criticism. Self-compassion can be cultivated within ourselves to help us let go of restrictive eating

Trait Perfectionism and Orthorexia in Exercisers: The Mediating Role of Perfectionistic Self-Presentation

Purpose: Research suggests that trait perfectionism can predict orthorexia – a pathological obsession with correct nutrition. However, no studies have examined the role of perfectionistic self-presentation in whether a desire to present oneself perfectly is an explanation for previously observed relationships. The present study therefore examined whether perfectionistic self-presentation mediates relations between trait perfectionism and orthorexia. Methods: A sample of 177 gym members (Mean age = 31.6 years) were recruited via social media platforms. Participants completed an online questionnaire that included the Multidimensional Perfectionism Scale-Short Form, Perfectionistic Self-Presentation Scale, and the Eating Habits Questionnaire on two occasions (separated by 6-weeks). Results: Using cross-sectional mediation analyses, perfectionistic self-promotion and nondisplay of imperfection mediated relations between self-oriented perfectionism and orthorexia, perfectionistic self-promotion mediated relations between other-oriented perfectionism and orthorexia, and perfectionistic self-promotion and nondisplay of imperfection mediated relations between socially prescribed perfectionism and orthorexia. Using longitudinal mediation analyses, nondisplay of imperfection mediated relations between self-oriented perfectionism and orthorexia and socially prescribed perfectionism and orthorexia over time. Conclusion: The study provides evidence that nondisplay of imperfection and perfectionistic self-promotion are important in regards to predicting orthorexia and may mediate the trait perfectionism-orthorexia relationship

Why Perfectionism May Lead to Disordered Eating

Pressure to have a perfect image give rise to poor well-being, body dissatisfaction, and disordered eating. Some personality traits, such as perfectionism, also contribute to disordered eating. Because their standards cannot be met, perfectionists are susceptible to disordered eating in an attempt to to counteract their perceived flaws

Norfolk Parent-Infant Mental Health Attachment Project (PRIMAP): working towards integration in attachment, mental health and social care

The Norfolk Parent-Infant Mental Health Attachment Project (PIMHAP) addresses the needs of 'at risk' families in keeping with previous innovations within the area of parent-infant mental health both in the United Kingdom and internationally. This account highlights the need for 'transformational change' at individual, family and structural levels. From the initial point of referral PIMHAP works to achieve integration across agencies through formulating an appropriate package of support with input from psychotherapy, psychiatry, social care and local children's centres. This multidisciplinary cooperation allows a key feature of the project: the offer of assessment and treatment of both adult mental health difficulties and parent-infant attachment. Observations suggest that the further cases are down the 'legal route', with associated truncated time scales, the less possible it is to work therapeutically. It is not possible to identify a case that is fully representative of the work since families and needs are complex and varied