IVF-induced pregnancy and early motherhood among women with a history of severe eating disorders

BackgroundThere is a higher prevalence of eating disorders among women seeking in vitro fertilization (IVF). Women with a history of eating disorders may be particularly vulnerable to eating disorder relapse during IVF, pregnancy, and early motherhood. The experience of these women during this process has hardly been studied scientifically, despite its high clinical relevance. The overall aim of this study is to describe how women with a history of eating disorders experience the process of becoming a mother through IVF, pregnancy, and the postpartum period.MethodsWe recruited women with a history of severe anorexia nervosa who had undergone IVF (n = 7) at public family health centers in Norway. Semi-openly, the participants were interviewed extensively first during pregnancy, and then 6 months after birth. The 14 narratives were analyzed using interpretative phenomenological analyses (IPA). All participants were required to complete the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE), during both pregnancy and postpartum.ResultsAll participants experienced a relapse of an eating disorder during IVF. They perceived IVF, pregnancy, and early motherhood to be overwhelming, confusing, a source of severe loss of control, and a source of body alienation. There were four core phenomena that were reported that were strikingly similar across all participants: “anxiousness and fear,” “shame and guilt,” “sexual maladjustment,” and “non-disclosure of eating problems.” These phenomena persisted continuously throughout IVF, pregnancy, and motherhood.ConclusionWomen with a history of severe eating disorders are highly susceptible to relapse when undergoing IVF, pregnancy, and early motherhood. The process of IVF is experienced as extremely demanding and provoking. There is evidence that eating problems, purging, over-exercising, anxiousness and fear, shame and guilt, sexual maladjustment, and non-disclosure of eating problems continue throughout IVF, pregnancy, and the early years of motherhood. Therefore, it is necessary for healthcare workers providing services to women undergoing IVF to be attentive and intervene when they suspect a history of eating disorders

Bodies out of control: Relapse and worsening of eating disorders in pregnancy

Background: Being pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how women with a history of eating disorder experience being pregnant. Method: We interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE). Results: On becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the “chaotic” “rigid” “perfect” “worried” “shameful” “motherhood fearing” and “the mother with lost identity” Perceived triggers of worsening or relapse were: “loss of control” “unpredictability” “competition” “change of appearance” “shame and nausea” and “loss of identity.” Conclusion: Pregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention.Bodies out of control: Relapse and worsening of eating disorders in pregnancypublishedVersio

Changes in the sense of agency : Implications for the psychotherapy of bulimia nervosa- A case study

A sense of agency is a transtheoretical concept that increases our understanding of important processes in psychotherapy. Agency can be described in terms of how strongly the person believes that she can have an impact on her problematic experiences and behaviors. In this case study, a patient's sense of agency in relation to symptoms of bulimia nervosa was assessed during 3 years of psychotherapy. Five distinct phases of agency in relation to eating disorder symptoms were identified: A false sense of agency or no agency at all, a weak sense of agency, a nascent sense of agency, a wavering sense of agency, and a strong sense of agency. A better understanding of patient agency can facilitate adapting approaches and methods best suited for the patient's capacity for change throughout treatment.Peer reviewe

The NOURISHED randomised controlled trial comparing mentalization based treatment for eating disorder (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of Borderline Personality Disorder (BPD)

BACKGROUND: In this multi-centre RCT we compared modified Mentalization Based Therapy (MBT-ED) to Specialist Supportive Clinical Management (SSCM-ED) in patients with Eating disorders (ED) and Borderline Personality Disorder symptoms (BPD). This group of patients presents complex challenges to clinical services and a treatment which addresses their multiple problems has the potential to improve outcome. MBT has been shown to be effective in improving outcome in patients with BPD, but its use has not been reported in ED. METHODS: 68 eligible participants were randomised to MBT-ED or SSCM-ED. The primary outcome measure was the Global Score on the Eating Disorders Examination. Secondary outcomes included measures of BPD symptoms (the ZAN-BPD), general psychiatric state, quality of life and service utilization. Participants were assessed at baseline and 6, 12 and 18 months after randomization. Analysis was performed using linear mixed models. RESULTS: Only 15 participants (22%) completed the 18 month follow-up. Early drop-out occurred significantly more in the SSCM-ED group. Dropout did not vary with treatment model later in therapy and was sometimes attributed to participants moving away. There was higher drop-out amongst smokers and those with higher neuroticism scores. 47.1% of participants in the MBT-ED arm and 37.1% in the SSCM-ED arm attended at least 50% of therapy sessions offered. Amongst those remaining in the trial, at 12 and 18-months MBT-ED was associated with a greater reduction in Shape Concern and Weight Concern in the Eating Disorders Examination compared to SSCM-ED. At 6, 12 and 18 months there was a decline of ED and BPD symptoms in both groups combined. Ten participants were reported as having had adverse events during the trial, mostly self harm, and there was one death, attributed as “unexplained” by the coroner. CONCLUSIONS: The high drop-out rate made interpretation of the results difficult. Greater involvement of research staff in clinical management might have improved compliance with both therapy and research assessment. MBT-ED may have had an impact on core body image psychopathology

Experiencing mindfulness meditation—a client narrative perspective

The study was based on the non-participant involvement of the researcher in four six-to-eight weeks' mindfulness meditation training courses led by chartered psychologists. The participants suffered from stress/sleeplessness, depression or agoraphobia in the presented cases. They were selected on the basis of recommendations by the psychologist who was the course instructor, who described them as positive and suitable. The participants wrote diaries on a weekly basis, and they were interviewed at the beginning, middle and end of the course. An in-depth analysis of three individual cases will be presented in the form of narratives constructed from their own words. The narratives demonstrate the unique and embodied changes of the individual participant's experiences during the training course. The purpose was to illustrate richly what happens and how changes happen during these weeks of learning and practicing mindfulness meditation. It is not the intention to give evidence about the effectiveness of mindfulness meditation in general, but to present the whats and hows of cases where mindfulness meditation appears to improve quality of life, health and well-being

Effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified: study protocol of a randomized controlled trial

Background: Disordered eating behavior and body dissatisfaction affect a large proportion of the Dutch population and account for severe psychological, physical and social morbidity. Yet, the threshold for seeking professional care is still high. In the Netherlands, only 7.5% of patients with bulimia nervosa and 33% of patients with anorexia nervosa are treated within the mental health care system. Easily accessible and low-threshold interventions, therefore, are needed urgently. The internet has great potential to offer such interventions. The aim of this study is to determine whether a web-based treatment program for patients with eating disorders can improve eating disorder psychopathology among female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified. Methods/design: This randomized controlled trial will compare the outcomes of an experimental treatment group to a waiting list control group. In the web-based treatment program, participants will communicate personally and asynchronously with their therapists exclusively via the internet. The first part of the program will focus on analyzing eating attitudes and behaviors. In the second part of the program participants will learn how to change their attitudes and behaviors. Participants assigned to the waiting list control group will receive no-reply email messages once every two weeks during the waiting period of 15 weeks, after which they can start the program. The primary outcome measure is an improvement in eating disorder psychopathology as determined by the Eating Disorder Examination Questionnaire. Secondary outcomes include improvements in body image, physical and mental health, body weight, self-esteem, quality of life, and social contacts. In addition, the participants’ motivation for treatment and their acceptability of the program and the therapeutic alliance will be measured. The study will follow the recommendations in the CONSORT statement relating to designing and reporting on RCTs. Discussion: This study protocol presents the design of a RCT for evaluating the effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified

Psychiatry in the flesh. Embodiment of troubled lives. Studies of anorexia nervosa and eating disorders.

Body and mind – new perspectives on eating disorders In this doctoral dissertation the author focuses on models of understanding of how body and mind might interact in eating disorders, with particular emphasis on anorexia nervosa. The thesis ”Psychiatry in the flesh. Embodiment of troubled lives. Studies of anorexia nervosa and eating disorders” is based on six scientific articles which all have been published in referee-based psychiatric journals. Three of these scientific papers describe how people with anorexia nervosa embody their emotions. Such bodily concretization of emotional life is described as a central psychopathological trait, and in this dissertation is termed “impaired mentalising competence”. Such an approach represents a new intellectual framework for the understanding of such disorders. The dissertation also presents an outline for mentalisation-based treatment as a new therapeutic approach to anorexia nervosa. A fourth paper describes how different forms of shame affects are central to the psychopathology of persons qualifying for the diagnosis anorexia nervosa. A fifth paper investigates and discusses how clients in child care institutions report about self esteem, body dissatisfaction and eating disorder symptoms, with particular emphasis on boys’ experiences. Based on data the article concludes with the necessity of increased focus on male experiences about body and food in general, and more specifically on boys in risk populations. A sixth and last paper presents an explorative study where female patients with severe anorexia were given a time-limited program for Adapted Physical Activity (APA). The aim of the study was to investigate how social interactions in activities could move negative attention from the objectified anorectic body to a more profound and subjective experience of one’s own body. The concluding proposal is that APA may represent a therapeutic access to anorexia, as a supplement to psychotherapy