DSM-5 unspecified feeding and eating disorders in adolescents: What do they look like and are they clinically significant?

This is the peer reviewed version of the following article: Wade, T. D. and O'Shea, A. (2015), DSM-5 unspecified feeding and eating disorders in adolescents: What do they look like and are they clinically significant?. International Journal of Eating Disorders, 48: 367–374. , which has been published in final form at DOI:10.1002/eat.22303. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy.Objective: The recent DSM-5 categorization of eating disorders introduces a new category of eating disorders, Unspecified Feeding and Eating Disorders (UFED), where symptoms do not meet criteria for any other diagnostic category, but cause clinically significant distress or impairment. The aim of the current study was to explore what disorders in UFED might look like in an adolescent population. Method: We examined a large cohort of adolescent female twins (N=699) who were assessed on three occasions and who did not meet a DSM-5 eating disorder diagnosis but who reported threshold levels of either fasting and/or driven exercise (N=33; 4.7%). This group of girls was compared to girls who reported no eating disorder over the three waves, and girls who met a diagnosis of either anorexia nervosa (AN) or atypical AN. Results: The UFED group was characterized as being in the overweight range while striving to lose weight, and placing a high degree of importance on weight and shape in their self-evaluation. This group was indistinguishable from the two eating disorder groups on measures of global eating disorder severity, and demonstrated significantly elevated impairment and distress compared to the no eating disorder group commensurate with the eating disorder groups. Discussion: Further research of this group is necessary to ensure that these individuals are not overlooked, and that treatment options are appropriate and available. Key words: DSM-5, impairment, adolescents, UFE

The role of perfectionism in body dissatisfaction

Body dissatisfaction is a robust risk factor for disordered eating and is thought to be especially problematic in the presence of high levels of perfectionism. The aim of the current study was to investigate what types of perfectionism were associated with body dissatisfaction. Participants were 1083 women aged 28 to 40 years, with a mean age of 35 years (SD=2.11). Self-reports on perfectionism (using the Frost Multidimensional Perfectionism Scale), weight, height, desired weight, and current and ideal figural stimuli were analysed for the current study. Two measures of body dissatisfaction were utilised: discrepancy between the current and desired weight, and discrepancy between the current and ideal figural stimuli. Results: Linear regressions controlling for current body mass index (BMI)/current silhouette examined the relationship between desired BMI/silhouette and simultaneous entry of the 6 sub-scales of the perfectionism measure. A lower desired BMI was associated with higher levels of Concern over Mistakes and Organisation, and a smaller ideal silhouette was associated with higher levels of Concern over Mistakes and Doubt about Actions and Organisation. Conclusions: These findings confirm the pertinence of different dimensions of perfectionism to body dissatisfaction, and suggest avenues to explore in terms of universal prevention work.Grant 160009 from the National Health and Medical Research Council (NHMRC) supported this work. The authors would like to thank the twins for their participation in this research, and Ms Jacqueline Bergin for coordinating the data collection. Administrative support for data collection was received from the Australian Twin Registry that is supported by an Enabling Grant (ID 310667) from the NHMRC administered by the University of Melbourne. Publication costs of this research were supported by the National Eating Disorders Collaboration

Examination of the Sociocultural Attitudes Towards Appearance Questionnaire-3 in a mixed-gender young-adolescent sample

Author version made available in accordance with publisher copyright policy.Thin-ideal (or media) internalization is an important eating disorder risk factor that has become a central target of many prevention programs. However, evidence for its valid assessment in young, mixed-gender, adolescent samples is limited, and the current study is the first published to explore the psychometric properties of the 30-item Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3: Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004) in a non-adult community sample. Two samples of Grade 8 students (M age = 13.68 years, SD = .39), totalling 680 girls (N =332) and boys (N =348) completed the SATAQ-3 and other measures, whereas a smaller sample (N = 123) of Grade 10 females (M age = 15.01 years, SD = .41) served as a comparison group for supplementary analyses. Principal component analyses (PCA) with data from Sample One (N=201) revealed four factors with eigenvalues >1.0, similar to the original authors structure but where some cross-loading occurred between the Pressures and Internalization – General scales. Confirmatory factor analyses (CFA) were conducted with data from Sample Two (N=479) on the factor solution found in the PCA. The model did not fit well, leading to further revisions based on removal of cross-loading items and CFA modification indices, resulting in a 19-item, 4 factor solution with acceptable fit. Examinations of validity and reliability were generally acceptable. The overall findings suggest an abbreviated version of the SATAQ-3 might be more appropriate than the original version with young-adolescent, mixed gender audiences. Further examinations of the psychometric properties of the SATAQ-3 with this demographic are indicated

Depression as a moderator of benefit from Media Smart: a school-based eating disorder prevention program

© 2013. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Objective: To investigate if baseline depression moderated response to Media Smart, an 8-lesson school-based program previously found to achieve a long-term risk reduction effect in young adolescents. Method: 540 Grade 8 students (M age = 13.62 years, SD = .37) from 4 schools participated with 11 classes receiving the Media Smart program (126 girls; 107 boys) and 13 comparison classes receiving their normal lessons (147 girls; 160 boys). Shape and weight concern, media internalization, body dissatisfaction, dieting, ineffectiveness, and perceived pressure were the outcome variables. Results: Moderation was indicated by significant interaction effects for group (Media Smart; Control) X moderator (high depression; low depression) X time (post-program; 6-month follow-up; 2.5-year follow-up), with baseline entered as a covariate. Such effects were found for shape and weight concern, media internalization, body dissatisfaction, ineffectiveness and perceived pressure. Post-hoc testing found high depression Media Smart participants scored significantly lower than their control counterparts at post-program on shape and weight concern, media internalization and dieting, whereas low depression Media Smart participants scored significantly lower on shape and weight concern at 2.5-year follow-up. Discussion: Media Smart achieved a reduction in eating disorder risk factors for high-depression participants and a reduced rate of growth in risk factor scores for low-depression participants

Changes in genetic and environmental influences on disordered eating between early and late adolescence: a longitudinal twin study

Author version under embargo for a period of 6 months from the date of publication, made available in accordance with the publisher's policy.Background: We investigated the genetic and environmental contributions to disordered eating (DE) between early and late adolescence in order to determine whether different sources of heritability and environmental risk contributed to these peak times of emergence of eating disorders. Methods: Adolescent female twins from the Australian Twin Registry were interviewed over the telephone with the Eating Disorder Examination (EDE). Data were collected at 12-15 and 16-19 years (Wave 1: N=699, 351 pairs; Wave 3: N=499, 247 pairs). Assessments also involved self-report measures related to negative life events and weight-related peer teasing. Results: Unstandardised estimates from the bivariate Cholesky decomposition model showed both genetic influences and non-shared environmental influences increased over adolescence, but shared environmental influences decreased. While non-shared environmental sources active at ages 12-15 continued to contribute at 16-19 years, new sources of both additive genetic and non-shared environmental risk were introduced at ages 16-19. Weight-related peer teasing in early-mid adolescence predicted increases of DE in later adolescence, while negative life events did not. Conclusions: Two-thirds of the heritable influence contributing to DE in late adolescence was unique to this age group. During late adolescence independent sources of genetic risk, as well as environmental influences are likely to be related in part to peer teasing, appear key antecedents in growth of DE. Key words: Global EDE, adolescents, twins, genetic, environmental, longitudina

An investigation of temperament endophenotype candidates for early emergence of the core cognitive component of eating disorders

This study was designed to investigate potential temperament endophenotypes for clinically significant importance of shape and weight. Seven temperament risk factors for eating disorders and the Eating Disorder Examination were assessed in 699 female twins aged 12–15 years. Each variable was evaluated against the following endophenotype criteria : associated with illness in the general population ; found in non-affected family members at a higher rate than in the general population ; and, heritable. All seven variables were significantly associated with clinically significant importance of shape and weight, while thin-ideal internalization, ineffectiveness, body dissatisfaction and sensitivity to punishment were found at significantly elevated levels in non-affected twins, when controlling for sister’s temperament score. These four variables had genetic correlations with importance of shape and weight, ranging from 0.48 to 0.95. Future research should evaluate the stability of the identified endophenotypes and their utility for predicting significant growth in importance of shape and weight, and also whether different endophenotypes emerge when the importance of weight and shape reaches its peak in adolescents, around 15 to 16 years of age

Developing a protocol to address co-occurring mental health conditions in the treatment of eating disorders

OBJECTIVE: While co-occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy. METHOD: The literature on managing mental health conditions that co-occur with eating disorders is outlined and reviewed. RESULTS: In the absence of clear evidence to inform managing co-occurring mental health conditions, we advocate for use of an iterative, session-by-session measurement to guide practice and research. We identify three data-driven treatment approaches (focus solely on the eating disorder; multiple sequential interventions either before or after the eating disorder is addressed; integrated interventions), and the indications for their use. Where a co-occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four-step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol. DISCUSSION: Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co-occurring mental health condition is a comorbid symptom or condition; (2) the place of biological treatments within these guidelines; (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co-occurring conditions; (4) optimal approaches to involving consumer input into identifying the most relevant co-occurring conditions; (5) detailed specification on how to determine which adjuncts to add. PUBLIC SIGNIFICANCE: Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence-based techniques. This paper outlines data-driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested

Evaluating the efficacy of a self-guided Web-based CBT intervention for reducing cancer-distress: a randomised controlled trial.

The author manuscript is made available following 12 months embargo from date of publication (Aug 7 2015) in accordance with publisher copyright policy. “The final publication is available at Springer via http://dx.doi.org/10.1007/s00520-015-2867-6."Purpose This study evaluated the efficacy of a self-guided Web-based cognitive behaviour therapy (CBT) intervention compared to an attention control in improving cancer-related distress, health-related quality of life (HRQOL), and maladaptive coping, among people recently diagnosed with cancer. Methods Sixty individuals with cancer diagnosed in the previous 6 months and receiving treatment with curative intent were randomised to receive either the 6-week intervention Cancer Coping Online (CCO: n = 30) or the 6-week Web-based attention control (n = 30). Outcome measures, including cancer distress (the Posttraumatic Stress Scale—Self-Report), general distress (Depression Anxiety Stress Scale), quality of life (EORTC QLQ-C30), and coping (mini-MAC), were administered at baseline, immediately post-intervention, and at 3 and 6 months post-intervention. Results Significant main effects for time were found for cancer distress, global QOL, physical function, role function, social function, and anxious preoccupation. Post hoc between-group comparisons showed CCO participants had statistically significantly higher physical functioning compared to controls at 3 months of follow-up (d = −0.52, p = 0.02). Furthermore, compared to controls, post hoc comparisons found moderate between-group effect sizes favouring CCO post-intervention for cancer distress (d = 0.43) and anxious preoccupation (d = 0.38), and at 6 months of follow-up for global QOL (d = −0.43). Conclusions These results provide preliminary support for the potential efficacy of a self-guided Web-based CBT programme in improving aspects of HRQOL, cancer-related distress, and anxious preoccupation after cancer diagnosis. This paper provides justification for, and will help inform the development of, subsequent larger multi-site studies