Functions of disordered eating behaviors: a qualitative analysis of the lived experience and clinician perspectives.

BACKGROUND: One method to improve treatment outcomes for individuals with eating disorders (EDs) may be understanding and targeting individuals' motives for engaging in DE behaviors-or the functions of DE behaviors. The goal of this study was to investigate and categorize the various functions of DE behaviors from the perspectives of adults who engage in DE behaviors and clinicians who treat EDs. METHODS: Individuals who engage in DE behaviors (n = 16) and clinicians who treat EDs (n = 14) were interviewed, and a thematic analysis was conducted to determine key functions of DE behaviors. RESULTS: Four main functions of DE behaviors were identified by the authors: (1) alleviating shape, weight, and eating concerns; (2) regulating emotions; (3) regulating one's self-concept; and (4) regulating interpersonal relationships/communicating with others. CONCLUSIONS: Differences in participant responses, particularly regarding the relevance of alleviating shape and weight concerns as an DE behavior function, highlight the importance of individualized conceptualizations of DE behavior functions for any given client.

There are many reasons why individuals engage in disordered eating (DE) behaviors, and gathering information on these functions of one's DE behaviors might help clinicians decide which treatments to administer to individual clients. This study identified and organized numerous functions of DE behaviors based on perspectives of both adults who engage in DE behaviors and clinicians who treat EDs. These functions can be largely grouped into four categories: (1) reducing concerns about one's shape, weight, and/or eating habits; (2) managing one's emotions; (3) managing one's beliefs about themselves as a person; and (4) managing relationships with others or communicating with others. Using treatments that address these reasons for one's DE behaviors may be beneficial for clients.

Change in emotion regulation during the course of treatment predicts binge abstinence in guided self-help dialectical behavior therapy for binge eating disorder.

BACKGROUND: Dialectical behavior therapy (DBT), which appears to be an effective treatment for binge eating disorder (BED), focuses on teaching emotion regulation skills. However, the role of improved emotion regulation in predicting treatment outcome in BED is uncertain. METHODS: This secondary analysis explored whether change in self-reported emotion regulation (as measured by the Difficulties in Emotion Regulation Scale) during treatment was associated with abstinence from binge eating at post-treatment and 4-, 5-, and 6-month follow-up in individuals who received a guided self-help adaptation of DBT for BED. Participants were 60 community-based men and women with BED who received a self-help manual and six 20-minute support phone calls. RESULTS: Greater improvement in self-reported emotion regulation between pre- and post-treatment predicted abstinence from binge eating at post-treatment, 4-, 5-, and 6-month follow-up. However, some follow-up results were no longer significant when imputed data was excluded, suggesting that the effect of emotion regulation on binge abstinence may be strongest at 4-month follow-up but decline across a longer duration of follow-up. CONCLUSIONS: This study provides preliminary support for the theoretical role played by improved emotion regulation in achieving binge eating abstinence. If this finding is replicated with larger samples, further research should identify specific techniques to help more individuals to effectively regulate their emotions over a longer duration.

A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder.

This study examined the efficacy of guided self-help based on dialectical behaviour therapy (DBTgsh) for binge eating disorder (BED). Individuals (88.3% female; mean 42.8 years) were randomized to DBTgsh (n=30) or wait-list (WL; n=30). DBTgsh participants received an orientation, DBT manual, and six 20-min support calls over 13 weeks. All participants were assessed pre- and post-treatment using interview and self-report; also, DBTgsh participants were re-assessed six months post-treatment. At treatment end, DBTgsh participants reported significantly fewer past-month binge eating episodes than WL participants (6.0 versus 14.4) and significantly greater rates of abstinence from binge eating (40.0% versus 3.3%). At six-month follow-up, DBTgsh participants reported significantly improved quality of life and reduced ED psychopathology compared to baseline scores. In addition, most improvements in the DBTgsh group were maintained, although binge eating abstinence rates decreased to 30%. These preliminary positive findings indicate that DBTgsh may offer an effective, low-intensity treatment option for BED.

How does overeaters anonymous help its members? A qualitative analysis.

Overeaters Anonymous (OA) is a 12-step, self-help group for individuals who perceive themselves to have problems with compulsive overeating. Despite the popularity of OA and the frequent use of addictions-based treatments for eating disorders, little is known about how OA is helpful. The purpose of this qualitative study was to explore members' experiences with and perceptions of OA. We conducted three focus groups with self-selected members of OA (N = 20). We present three primary themes that emerged from the analysis of the focus groups' discussions, which emphasize why individuals entered OA, OA's 'tools', and how individuals perceived OA to 'work'. Overall, although participants agreed OA was helpful to them, there was no consensus regarding how OA 'works'.

Clinicians' perspectives on the premature termination of treatment in patients with eating disorders.

In-depth interviews concerning the premature termination of treatment (PTT) were conducted with seven clinicians in an inpatient eating disorders program. Motivation to be in the program and work on recovery, and the ability to establish a trusting relationship with staff were thought to be important factors in completing treatment. Patients who are asked to leave the treatment program, termed "administrative discharge" (AD), were believed by clinicians to differ from patients who dropped out of treatment in terms of having more reasons to stay in the program. While AD was described as a stressful process, particularly when there was disagreement among team members, it was considered necessary in order to maintain a recovery-centered community milieu. These findings, their implications and suggestions for future research are discussed.

Premature termination of treatment in an inpatient eating disorder programme.

This retrospective study was conducted to explore rates, timing and predictors of two forms of premature termination of treatment (PTT) in an inpatient eating disorders programme: patient dropout (DO) and administrative discharge (AD). A chart review was conducted to obtain demographic, Eating Disorder Inventory-2 (EDI-2), and Resident Assessment Instrument-Mental Health (RAI-MH) data for 186 patients being treated for bulimia nervosa (BN), anorexia nervosa (AN), or eating disorder not otherwise specified (EDNOS). Overall, of the 37.6% of patients who terminated treatment prematurely, 22.1% of patients dropped out, and 15.5% of patients were administratively discharged. Time at which discharge occurred was found to be associated with the type of premature termination. The presence of DSM-IV Axis-I comorbidity was found to be the only factor associated with an increased risk of being administratively discharged. No factors were predictive of patients dropping out of treatment. The findings support the notion that AD and patient DO are different events that may have different factors influencing their rates and timing. Implications for future research and programme planning are discussed.