Patterns of expressed emotion in adolescent eating disorders

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135121/1/jcpp12594.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135121/2/jcpp12594_am.pd

Early weight gain predicts treatment response in adolescents with anorexia nervosa enrolled in a family‐based partial hospitalization program

ObjectiveImproved treatment outcome in family‐based treatment (FBT) for anorexia nervosa (AN) is predicted by weight gain occurring early in the course of treatment (i.e., about 4 lbs by week 4). Although prior work suggests that early weight gain in higher levels of care (e.g., partial hospitalization programs [PHP]) predicts weight restoration at discharge, no study has examined the specific rate of gain within FBT‐informed PHP programs that best predicts treatment response.MethodThis study examined rate of weight gain in pounds and percent expected body weight (EBW) that predicts positive outcome in 70 patients (M age = 15.49 years, SD = 2.56) with AN who were enrolled in a family‐based PHP.ResultsReceiver operator characteristic analyses demonstrated that changes in %EBW during weeks 2–5 were more useful than changes in weight in predicting positive outcome. Gaining at least 8.9 pounds or over 8% of EBW in the first 4 weeks of treatment significantly predicted positive outcome.DiscussionFindings suggest that positive outcome in an FBT‐informed PHP is predicted by rapid weight gain in the initial weeks of treatment. Research is needed to identify specific family and patient characteristics that facilitate weight gain and to develop corresponding interventions to improve outcome.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154930/1/eat23248_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154930/2/eat23248.pd

The posited effect of positive affect in anorexia nervosa: Advocating for a forgotten piece of a puzzling disease

Anorexia nervosa (AN) is a complex and life‐threatening eating disorder. Current models of AN onset and maintenance have largely focused on the role of negative affect, while fewer models have described the role of positive affect (PA). Given that these theoretical models have informed current treatment approaches, and that treatment remains minimally effective for adults with AN, we advocate that targeting PA is one avenue for advancing maintenance models and by extension, treatment. We specifically propose that AN may arise and be chronically and pervasively maintained as a function of dysregulated PA in response to weight loss and weight loss behaviors (e.g., restriction, excessive exercise), to a degree that is not accounted for in existing models of AN. We present evidence from multiple domains, including biological, behavioral, and self‐report, supporting the hypothesis that PA dysregulation in AN contributes to the maintenance of the disorder. We conclude with several specific avenues for treatment development research as well as a call for future work elucidating the biological correlates of PA.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151291/1/eat23147.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151291/2/eat23147_am.pd

Health-related quality of life among adolescents with eating disorders

Objective Health-related quality of life (HRQoL) is an emerging area of research in eating disorders (EDs) that has not been examined in adolescents in detail. The aim of the current study is to investigate HRQoL in an adolescent ED sample, examining the impact of ED symptoms on HRQoL. Methods Sixty-seven treatment-seeking adolescents (57 females) with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) completed self-report measures of HRQoL and ED symptoms. Results Participants reported poorer HRQoL in mental health domains than in physical health domains. Disordered attitudes, binge eating, and compensatory behaviors were associated with poorer mental health HRQoL, and body dissatisfaction was associated with poorer physical health HRQoL. Conclusion The current study assessed HRQoL among adolescents with EDs, finding several consistencies with the literature on adults with EDs. Future research should compare adolescents and adults with EDs on HRQoL

Empirical investigation of different factor structures for the eating disorder examination–questionnaire in adult women with anorexia nervosa

The Eating Disorder Examination–Questionnaire (EDE-Q) is a widely used self-report measure of eating pathology. Despite widespread use, investigations of its factor structure have proved inconclusive and rarely supported the “original” interpretation. The current study evaluates several proposed factor solutions of the EDE-Q using latent variable analysis in a sample of adult women with anorexia nervosa (AN). A total of 804 patients from a specialist treatment center in the United States participated in the study. Confirmatory factor analysis was conducted on 22 EDE-Q items assessing attitudinal features of eating pathology. Findings suggested that three full-item versions (none of which was the “original” interpretation) fit the data adequately, with a brief, seven-item version showing excellent fit. The study is one of the first to examine this within a sample of women with AN and provides an empirical foundation for how best to use the EDE-Q among clinical and research participants with AN. Findings suggest that the “original” factor structure lacks structural validity in women with AN. Its use should generally be discouraged, and future work on screening and treatment outcomes might consider the EDE-Q7

Augmentative Approaches in Family‐Based Treatment for Adolescents with Restrictive Eating Disorders: A Systematic Review

ObjectiveTo systematically review the literature reporting outcomes of augmentative family‐based treatment (FBT) interventions for adolescents with restrictive eating disorders (EDs).MethodArticles were identified through a systematic search of five electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Database).ResultsThirty articles were included, reporting on FBT augmentations featuring adjunctive treatment components, modified treatment structure and/or content with adherence to FBT principles, and adaptations allowing FBT delivery in different settings. All reported significant improvements in weight and/or ED symptoms at end‐of‐treatment, although few compared augmentative and standard FBT interventions and good quality follow‐up data was generally lacking.ConclusionsThere is early evidence for the effectiveness of augmentative FBT‐based approaches in facilitating weight and/or ED symptom improvements for adolescents with restrictive EDs. There remains a lack of robust evidence demonstrating superior effects of such approaches over standard FBT, and further controlled studies are required to expand on the current evidence. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142429/1/erv2577.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142429/2/erv2577_am.pd