Seasonal and subtype differences in body mass index at admission in inpatients with anorexia nervosa

Objective In the general population, body weight is—on average—higher in the winter than in the summer. In patients with anorexia nervosa (AN), however, the opposite pattern has been reported. Yet, only a handful of studies exist to date that suffer from small sample sizes and inconsistent results. Therefore, the current study examined seasonal effects on body weight in a large sample of patients with AN to dissolve previous inconsistencies. Method Clinical records of N = 606 inpatients (95.4% female) who received AN treatment at the Schoen Clinic Roseneck (Prien am Chiemsee, Germany) between 2014 and 2019 were analyzed. Results Patients with restrictive type AN had lower body mass index at admission in the winter than in the summer. This difference was not found for patients with binge/purge type AN and patients with atypical AN. Discussion Individuals with restrictive type AN show seasonal variations in body weight that are opposite to seasonal variations in body weight in individuals without AN. These seasonal effects are specific to the restrictive subtype and cannot be found for the binge/purge or atypical subtypes. Future studies that replicate this effect in other cultures or latitudes and that examine the mediating mechanisms are needed

Therapist-guidedsmartphone-based aftercare for inpatients with severeanorexianervosa (SMART-AN): Study protocol of a randomized controlled trial

Objective: Inpatient treatment for patients with anorexia nervosa (AN) is recommended in extreme or severe cases after failure of outpatient treatment and is highly effective. However, a number of patients show symptom increase and relapse after discharge. The aim of this study is to evaluate the efficacy of a therapist-guided smartphone-based aftercare intervention for inpatients with AN to support symptom stabilization. Method A total of 186 female patients with a DSM-5 diagnosis of AN (307.1) will be randomized either to receive a 16-week smartphone-based aftercare intervention with therapist feedback as add-on to treatment as usual (TAU) or TAU alone. Data will be assessed at discharge (= baseline, T0), after 16 weeks (= end of the aftercare intervention, T1) and after 10 months (= 6-month follow-up, T2). Primary outcome will be overall eating disorder symptomatology (Eating Disorder Examination Global score). Secondary outcome measures will include body mass index, depression, motivation to change, self-efficacy, patient satisfaction with and adherence to the smartphone-based aftercare intervention as well as rehospitalization rate. Discussion: This study will be the first randomized controlled trial to examine a therapist-guided smartphone-based aftercare intervention for inpatients with AN. Results may reveal whether and to which extent this novel intervention can support symptom stabilization after inpatient treatment

Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes

Background: Previous studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients' treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology. Methods: A total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change. Results: 20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors. Conclusions: Despite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients

The Potential of Technology-Based Psychological Interventions for Anorexia and Bulimia Nervosa: A Systematic Review and Recommendations for Future Research

Background: Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer-and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. Objective: The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN),for both prevention and treatment, and also for carers of eating disorder patients. Methods: A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Results: Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. Conclusions: TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed

The Potential of Technology-Based Psychological Interventions for Anorexia and Bulimia Nervosa: A Systematic Review and Recommendations for Future Research

Background: Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer-and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. Objective: The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN),for both prevention and treatment, and also for carers of eating disorder patients. Methods: A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Results: Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. Conclusions: TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed

Self-reported quantity, compulsiveness and motives of exercise in patients with eating disorders and healthy controls: differences and similarities

Background: Compulsive exercise (CE) is a frequent symptom in patients with eating disorders (EDs). It includes, in addition to quantitatively excessive exercise behaviour, a driven aspect and specific motives of exercise. CE is generally associated with worse therapy outcomes. The aims of the study were to compare self-reported quantity of exercise, compulsiveness of exercise as well as motives for exercise between patients with anorexia nervosa (AN), bulimia nervosa (BN) and healthy controls (HC). Additionally, we wanted to explore predictors of compulsive exercise (CE) in each group. Methods: We investigated 335 female participants (n = 226 inpatients, n = 109 HC) and assessed self-reported quantity of exercise, compulsiveness of exercise (Compulsive Exercise Test), motives for exercise (Exercise Motivations Inventory-2), ED symptoms (Eating Disorder Inventory-2), obsessive-compulsiveness (Obsessive-Compulsive Inventory-Revised), general psychopathology (Brief Symptom Inventory-18) and depression (Beck Depression Inventory-2). Results: Both patients with AN and BN exercised significantly more hours per week and showed significantly higher CE than HC;no differences were found between patients with AN and BN. Patients with EDs and HC also partly varied in motives for exercise. Specific motives were enjoyment, challenge, recognition and weight management in patients with EDs in contrast to ill-health avoidance and affiliation in HC. Patients with AN and BN only differed in regard to exercise for appearance reasons in which patients with BN scored higher. The most relevant predictor of CE across groups was exercise for weight and shape reasons. Conclusions: Exercise behaviours and motives differ between patients with EDs and HC. CE was pronounced in both patients with AN and BN. Therefore, future research should focus not only on CE in patients with AN, but also on CE in patients with BN. Similarities in CE in patients with AN and BN support a transdiagnostic approach during the development of interventions specifically targeting CE in patients with EDs

Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder - a process-outcome study

Background: Cognitive models of obsessive-compulsive disorder suggest that changes in obsessive beliefs are a key mechanism of treatments for obsessive-compulsive disorder. Thus, in the present process-outcome study, we tested whether changes in obsessive beliefs during a primarily cognitive behavioral inpatient treatment predicted treatment outcome and whether these changes mediated symptom changes over the course of treatment. Methods: Seventy-one consecutively admitted inpatients with obsessive-compulsive disorder were assessed with the Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire at treatment intake, after six weeks of treatment and at discharge, and with the Beck-Depression-Inventory-II at intake and discharge. Results: Changes in obsessive beliefs during the first six weeks of treatment predicted obsessive-compulsive symptoms at discharge when controlling for obsessive-compulsive and depressive symptoms at intake in a hierarchical regression analysis. Multilevel mediation analyses showed that reductions in obsessive beliefs partially mediated improvements in obsessive-compulsive symptoms over time. Conclusions: Our findings indicate that decreasing obsessive beliefs in inpatient cognitive behavioral therapy for obsessive-compulsive disorder might be a promising treatment approach

A Comparison of Schemas, Schema Modes and Childhood Traumas in Obsessive-Compulsive Disorder, Chronic Pain Disorder and Eating Disorders

BACKGROUND In this study, we investigated early maladaptive schemas (EMS), schema modes and childhood traumas in patients suffering from obsessive-compulsive disorder (OCD) in contrast to patients with other Axis I disorders. Based on cognitive theories on OCD, our main research question was whether schemas belonging to the domain of 'impaired autonomy and performance' are more prevalent in OCD than in both eating disorders (ED) and chronic pain disorder (CPD). SAMPLING AND METHODS EMS, schema modes and traumatic childhood experiences were measured in 60 patients with OCD, 41 with ED, 40 with CPD and 142 healthy controls. To analyze differences between the groups, MANCOVAs were conducted followed by deviation contrasts. Depression level, age and gender were considered as possible covariates. RESULTS OCD patients scored higher on 4 EMS, 2 of which belong to the domain 'impaired autonomy and performance'. ED patients had higher scores in the EMS 'emotional inhibition' and CPD patients on the Childhood Trauma Questionnaire subscale 'physical neglect'. CONCLUSIONS These results suggest that there might be typical schema patterns associated with OCD and ED. We can also conclude that a higher prevalence of traumatic experiences does not necessarily coincide with more EMS and schema modes

Funktionalitäten von Essstörungen - Ergebnisse einer Analyse im stationären Setting

Introduction: Symptoms of mental disorders can serve different functions. The affected person frequently does not perceive the symptomatology as solely aversive;thus, the attitude towards therapy can be ambivalent. This survey aimed at identifying intrapsychic and interpersonal functions of eating disorders (EDs). Method: Functions of EDs were analyzed for 37 in-patients with anorexia nervosa (AN) or bulimia nervosa (BN), using a pilot questionnaire that consisted of an open introductory and concluding question each and an assessment of 18 defined functions. Qualitative content analysis was applied to classify the free-text answers. Frequency distributions were calculated, and mean values for AN and BN were compared. Results: Intrapsychic functions were more frequently ascribed to EDs than interpersonal functions. The most prominent functions were emotion regulation, gaining safety and control, and establishing content and structure. The introductory question returned establishing closeness and a feeling of security as the most frequently mentioned interpersonal functions;the answers to the concluding question suggest that EDs serve as a cry for help. The only significant difference between patients with AN and BN with regard to the functions of EDs was ED as a cry for help. Conclusions: A multitude of functions of EDs were registered. Intrapsychic functions, and particularly emotion regulation, are highly relevant. The results highlight the importance of specifically targeting functions in disorder-specific psychotherapy

Orthorexic tendencies moderate the relationship between semi-vegetarianism and depressive symptoms

PURPOSE Vegetarianism and semi-vegetarianism (i.e., overly vegetarian diet with rare consumption of meat) have been repeatedly linked with depression. As the nature of this association is unclear, we explored whether orthorexic (i.e., pathologically healthful eating) tendencies and ecological/ethical motives to follow a vegetarian diet may moderate the relationship between (semi-)vegetarian diets and depressive symptoms. METHODS Five-hundred eleven adults (63.4% females; 71.2% omnivores, 19.2% semi-vegetarians, 9.6% vegetarians) completed the Patient Health Questionnaire (PHQ-9) questionnaire-measuring depressive symptoms-and the Düsseldorf Orthorexia Scale (DOS)-measuring orthorexic tendencies. Based on respective questions, participants were categorized as omnivores, semi-vegetarians, and vegetarians (including vegans) and were asked to indicate whether they chose their diet based on ecological/ethical motives. Moderation analyses were carried out with PROCESS. RESULTS Adjusted for age, sex, and body mass index, there was a statistically significant interaction effect between diet (omnivore vs. semi-vegetarianism vs. vegetarianism) and DOS scores when predicting PHQ depression scores. At low or medium DOS scores, diets did not differ in PHQ depression scores (all > 0.05). At high DOS scores, however, semi-vegetarians had higher PHQ depression scores than both omnivores (p = 0.002) and vegetarians (p < 0.001). The interaction between diet and ecological/ethical eating motives when predicting PHQ depression scores was not statistically significant (p = 0.41). CONCLUSION Semi-vegetarians with strong orthorexic tendencies show more depressive symptoms than omnivores and vegetarians. The complex nature of the relationship between vegetarianism and depression requires further investigation. LEVEL OF EVIDENCE III, case-control analytic studies