(Dis-)solving the Weight Problem in Binge-Eating Disorder: Systemic Insights From Three Treatment Contexts With Weight Stability, Weight Loss, and Weight Acceptance.

Binge-eating disorder (BED) is a severe eating disorder strongly associated with obesity. Treatments struggle to provide safe and effective ways of addressing weight in a BED context. This study explored a two-phased treatment for BED developed at a major out-patient eating disorder service in Denmark. The study used interviews and participant observations to gain insight into experiences and processes related to weight and body issues in three treatment contexts that addressed weight stability, weight acceptance, and weight loss. Using systems theory, the study proposed a relational weight problem that embeds feelings of non-acceptance due to weight, a merge of weight and identity, and an internalized body- and weight-critical gaze of others. Contrary to critical claims that weight acceptance discourages people with obesity from engaging in weight loss efforts, this study suggests that acceptance and a disentanglement of weight and identity are prerequisites for weight loss for this group.

Eating disorder severity and functional impairment: moderating effects of illness duration in a clinical sample.

PURPOSE: The aim was to examine duration of illness and body mass index as possible moderators of the relationship between eating disorder severity and functional impairment, as well as psychological distress as a possible mediator of this relationship. METHODS: The study included 159 patients diagnosed with bulimia nervosa, binge eating disorder or eating disorder not otherwise specified. Regression analysis was applied to assess the effect of the hypothesized moderators and mediators. Eating disorder severity was measured with the Eating Disorder Examination Questionnaire, functional impairment was measured with the Sheehan Disability Scale, and psychological distress was measured with the Symptom Check List-90-R. Duration of illness and body mass index were assessed clinically. RESULTS: Duration of illness significantly moderated the relationship between eating disorder severity and functional impairment; the relationship was strongest for patients with a shorter duration of illness. Psychological distress partly mediated the relationship between eating disorder severity and functional impairment. Duration of illness significantly moderated the relationship between psychological distress and functional impairment; the strongest relationship was seen for patients with a shorter duration of illness. Body mass index was not a significant moderator of the relationship between ED severity and functional impairment. CONCLUSIONS: Overall, this study established a link between ED severity, psychological distress and functional impairment indicating that both eating disorder severity and psychological distress are more strongly related to impaired role functioning for patients with more recent onset of an eating disorder. More research in the complex relationship between ED severity and functional impairment is needed.

Feedback in group psychotherapy for eating disorders: A randomized clinical trial.

OBJECTIVE: To investigate the effect of client feedback in group psychotherapy on attendance and treatment outcome for patients with eating disorders. METHOD: We conducted a randomized clinical trial with central randomization stratified for diagnosis and treatment type according to a computer-generated allocation sequence concealed to the investigators. One-hundred and 59 adult participants, diagnosed with bulimia nervosa, binge eating disorder, or eating disorder not otherwise specified according to DSM-IV, were included. Eighty participants were allocated to the experimental group, and 79 participants to the control group. Both groups received 20-25 weekly group psychotherapy sessions. In the experimental group, participants gave and received feedback about therapy progress and alliance, measured before and after each session using the Outcome Rating Scale and the Group Session Rating Scale. The primary outcome was rate of attendance to treatment sessions; the secondary outcome was severity of eating disorder symptoms measured with the Eating Disorder Examination interview. Exploratory outcomes were psychological distress measured with the Symptom Checklist-90-R and the Outcome Rating Scale, social functioning measured with the Sheehan Disability Scale, and episodes of self-harm and suicide measured with a modified version of the Self-Harm Inventory. RESULTS: Feedback compared with control did not affect the rate of attendance (0.59 vs. 0.58; p = .96), the severity of symptoms (2.03 vs. 2.02; p = .46), or any of the exploratory outcomes (p values from 0.06 to 0.67). CONCLUSIONS: Feedback neither increased attendance nor improved outcomes for outpatients in group psychotherapy for eating disorders. The results are discussed from different perspectives. (PsycINFO Database Record

Feedback versus no feedback in improving patient outcome in group psychotherapy for eating disorders (F-EAT): protocol for a randomized clinical trial.

BACKGROUND: Continuous feedback on patient improvement and the therapeutic alliance may reduce the number of dropouts and increase patient outcome. There are, however, only three published randomized trials on the effect of feedback on the treatment of eating disorders, showing inconclusive results, and there are no randomized trials on the effect of feedback in group therapy. Accordingly the current randomized clinical trial, initiated in September 2012 at the outpatient clinic for eating disorders at Stolpegaard Psychotherapy Centre, aims to investigate the impact of continuous feedback on attendance and outcome in group psychotherapy. METHODS/DESIGN: The hypothesis is that continuous feedback to both patient and therapist on treatment progress and alliance will increase attendance and treatment outcome. The trial is set up using a randomized design with a minimum of 128 patients allocated to either an experimental or control group at a ratio of 1:1. The experimental group will receive standard treatment (systemic and narrative group psychotherapy) with feedback intervention, whereas the control group will receive standard treatment only. The participants are diagnosed with bulimia nervosa, binge eating disorder, or an eating disorder not otherwise specified, according to the DSM-IV. In the experimental group feedback to the participants, based on the Outcome Rating Scale (ORS) and the Group Session Rating Scale (GSRS), is actively added to standard treatment. The ORS assesses areas of life functioning known to change as a result of therapeutic intervention. The GSRS assesses key dimensions of effective therapeutic relationships. In the control group, the patients fill out the Outcome Rating Scale only, and feedback is not provided.The primary outcome is the rate of attendance to treatment sessions. The secondary outcome is the severity of eating disorder symptoms. Exploratory outcomes are the level of psychological and social functioning, and suicide or self-harm. This is measured with the ORS, Symptom Check List, WHO-Five Wellbeing Index, Sheehan Disability Scale and a modified version of the Self-Harm Inventory. DISCUSSION: If the results will confirm the hypothesis, this trial will support feedback as a way to improve group treatment attendance for outpatients with eating disorders. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01693237.

[Comparison between risk behaviour for eating disorders and SF-36 and perceived stress among 16-29-year old Danish women]. / Sammenhaenge mellem risikoadfaerd for spiseforstyrrelser og Short Form-36 samt selvoplevet stress blandt 16-29-årige danske kvinder.

INTRODUCTION: To improve the early identification of eating disorders the study tested whether women with risk behaviour for eating disorders have lower health-related life quality and more perceived stress than women without risk behaviour. MATERIAL AND METHODS: The study was a representative cross sectional survey of 16-29-year old women and was part of the Danish Health Interview Survey 2005. After the personal interviews, 487 returned the questionnaires, with a response rate of 53.3%. Participants responded to RiBED-8, a screening instrument for identification of risk behaviour for eating disorders and also to SF-36 and Perceived Stress Scale (PSS). RESULTS: Women with risk behaviour for eating disorders have a lower score on all subscales of SF-36 than women without risk behaviour. The differences are significant for the subscales for mental health, vitality, social function and general health. They also have a higher mean score on PSS than women without risk behaviour. CONCLUSION: Women with risk behaviour for eating disorders have lower mental health-related life quality than women without risk behaviour. They also experience daily life as more unpredictable, stressful and difficult.

[Mental and physical health and risk behaviour related to eating disorders among 16-29-year-old women]. / Psykisk og fysisk helbred og risikoadfaerd for spiseforstyrrelser hos kvinder på 16-29 år.

INTRODUCTION: Possibilities for early identification of eating disorders among 16-29-year-old women are investigated regarding physical and mental health-related determinants. MATERIAL AND METHODS: The study was a representative cross-sectional survey of 16-29-year-old women, and was part of the Danish Health Interview Survey 2005. The response rate was 53.3%. Participants responded to RiBED-8, a screening instrument for identification of risk behaviour for eating disorders. Relative Risk (RR) for the development of risk behaviour was shown for each variable to identify the effect on prevalence of risk behaviour for eating disorders. Analyses showed no effect of non-response on prevalence of risk behaviour for eating disorders. RESULTS: 19% of 16-29-year-old women had risk behaviour for eating disorders. Women had a higher RR for developing risk behaviour if they had had sick leave from work, complained of nervousness, anxiety and depression in the last 2-4 weeks, or had had suicidal thoughts within the last year. Furthermore, overweight and a desire to lose weight and intense physical activity were factors connected with risk behaviour. CONCLUSION: Young women with risk behaviour for eating disorders may be identified since they often present themselves in general practice with mental problems, overweight and a wish to lose weight.

Obesity and prevalence of risk behaviour for eating disorders among young Danish women.

AIMS: Danish women aged 16-29 from two nationwide, representative, cross-sectional interview/questionnaire surveys from 2000 and 2005 are analyzed for trends in prevalence of risk behaviour for developing eating disorders and associations to BMI and age. METHODS: Participants completed the Danish Health Interview Survey and an 8-item screen, RiBED-8, for risk behaviour for eating disorders. To analyze how the prevalence of risk behaviour depends on age, BMI, and year of survey, logistic regression analyses were applied. On acceptance of no interaction, the effect of each variable was tested and described using odds ratios with 95% confidence intervals. RESULTS: Women aged 16-19 or with a BMI of>25 had the greatest chance of reporting risk behaviour for eating disorders. However, many women in their 20s also had risk behaviour. Prevalence of risk behaviour for eating disorders did not change from 2000 to 2005. CONCLUSIONS: The shared risk factors for obesity and eating disorders require further investigation for development of collaborative prevention and treatment strategies that should also be directed towards young women in their 20s as well as young teenagers.