What happened to the ones who dropped out? Outcome in eating disorder patients who complete or prematurely terminate treatment.

INTRODUCTION: There is a lack of knowledge about the outcome of eating disorder patients who terminate treatment prematurely. The present study followed-up eating disorder patients who had previously dropped out of treatment and examined clinical status 36 months after intake. METHOD: Dropouts (n = 30) were compared with treatment completers (n = 52) on diagnostic status, clinical symptoms, psychosocial adjustment and treatment satisfaction at follow-up. Patterns of change from intake to follow-up within groups, as well as between groups, were explored. RESULTS: No significant differences were found between groups at follow-up, except for more treatment dissatisfaction reported among dropouts. When patterns of change were examined between groups, patients who completed treatment were found to have made significantly greater changes (less eating disorder symptoms, less psychological problems and more positive self-image) compared to dropouts. DISCUSSION: Although no significant differences in outcome were found between dropouts and completers, greater clinical improvement was found among those who completed treatment. The dropouts examined in this study did well despite premature termination of treatment. Clinical and research implications are discussed.

Anorexic self-control and bulimic self-hate: differential outcome prediction from initial self-image.

OBJECTIVE: The study investigated initial self-image (structural analysis of social behavior) and its relation to 36-month outcome, among patients with anorexia nervosa and bulimia nervosa. Hypotheses were that degree of different aspects of self-image would predict outcome in the groups. METHOD: Participants were 52 patients with anorexia and 91 with bulimia from a longitudinal naturalistic database, and outcome measures included eating disorder and psychiatric symptoms and a general outcome index. Stepwise regression was used to investigate which self-image variables were related to outcome, and multiple regression contrasted the groups directly on each obtained predictor. RESULTS: Consistent with hypotheses, in bulimia degree of self-hate/self-love moderately predicted outcome, whereas self-control-related variables powerfully predicted outcome in anorexia. DISCUSSION: It is important to focus on self-image in the treatment of both diagnostic groups, but especially in anorexia nervosa, where control-submission interactions between patient and therapist should be handled with care.

Persistent effects of subliminal stimulation: sex differences and the effectiveness of debriefing.

Persistent and non-trivial effects of unconscious stimuli have been reported (Sohlberg & Birgegard, 2003). This raises the ethical question of whether informing participants about such stimuli effectively returns them to a normal state. Two experiments (sex-mixed, N = 70 and 118) tested two kinds of debriefing to participants following subliminal (tachistoscopic) attachment-related or control stimulation. Measures were the Beck Depression Inventory, Structural Analysis of Social Behavior, and Retrospective Attachment. Results showed persistent effects. Simple debriefing about the stimulus was effective in preventing these, while more elaborate debriefing also describing the effects and mechanisms for them was less effective. Persistent effects were also strongly related to participant sex, but debriefing effects were similar in men and women with regard to the purpose of debriefing. The findings have implications for ethical recommendations for subliminal research, and suggest that this unexplored area requires more attention.

Self-image and treatment drop-out in eating disorders.

INTRODUCTION: Drop-out from treatment is a serious problem in eating disorders which remains poorly understood. The present study investigated whether self-image and interpersonal theory could help to explain why eating disorder patients drop out of treatment. METHOD: Intake data on eating disorder patients who terminated treatment prematurely (N=54) were compared with patients who had completed treatment (N=54) and those who were still in treatment after 12 months (N=54). Self-image was assessed using the structural analysis of social behaviour (SASB), and comparisons were made on demographic and clinical variables. RESULTS: Patients who dropped out had initially presented with less negative self-image and fewer psychological problems compared with remainers. Low levels of SASB self-blame discriminated drop-outs from completers and remainers and significantly predicted treatment drop-out. DISCUSSION: Drop-out in eating disorders appears to be a complex phenomenon, not necessarily as pathological as often assumed. There may be important differences in the treatment goals of drop-outs and therapists; patients who drop out may be choosing to disengage at a time when symptom improvement creates space for closer examination of interpersonal issues.

Negative self-image and outcome in eating disorders: results at 3-year follow-up.

INTRODUCTION: Negative self-image has been hypothesised to be of aetiological significance in eating disorders; however, its relationship to outcome remains unclear. The present study examined the relationship between self-image and follow-up status in a heterogeneous sample of eating disorder patients (N=246). METHODS: Patients were assessed at intake and after 36 months. Self-image was measured using SASB, and a general outcome measure was calculated comprising eating disorder symptoms, occupational status, interpersonal relationships and general psychopathology. RESULTS: SASB self-hate was the most important variable for predicting poor outcome, followed by occupational status, interpersonal relationships, eating disorder symptoms, SASB self-emancipation and general psychiatric symptoms. Together these variables predicted 23% of the variance in outcome. DISCUSSION: High levels of self-hate may increase the risk of poor outcome in eating disorders by adversely affecting interpersonal relationships and making it difficult for patients to engage in treatment.

Shame: mechanisms of activation and consequences for social perception, self-image, and general negative emotion.

In two experiments we explored Tomkins's (1963) concept of shame, comparing conscious versus unconscious shame activation. In line with Tomkins' theory, an impeded positive feedback sequence, consciously or unconsciously perceived, elicited more shame than continuously negative feedback. This was, however, true only for participants with an initially low degree of internalized shame. Participants with a high degree of internalized shame unexpectedly displayed shame following the positive feedback intended to elicit positive emotion. Whether this has implications for Tomkins's theory or rather for methodological issues is discussed. Exploring consequences of shame for social perception and self-image, we found reversed results depending on level of consciousness. Effects were consistently greater for women, although at marginal significance levels. Results partly support Tomkins's notion of shame, but imply that his theory might need modification in terms of the role played by consciousness and, possibly, by individual differences such as sex and shame proneness.

Extracting a maximum of useful information from statistical research data.

The practice of statistical inference in psychological research is critically reviewed. Particular emphasis is put on the fast pace of change from the sole reliance on null hypothesis significance testing (NHST) to the inclusion of effect size estimates, confidence intervals, and an interest in the Bayesian approach. We conclude that these developments are helpful for psychologists seeking to extract a maximum of useful information from statistical research data, and that seven decades of criticism against NHST is finally having an effect.

Interpersonal profiles in eating disorders: ratings of SASB self-image.

INTRODUCTION: Although evidence suggests that interpersonal psychotherapy may be an efficacious treatment for eating disorders, there is surprisingly little systematic knowledge about the interpersonal world of these patients. METHOD: SASB self-image ratings were used to explore interpersonal profiles in a large heterogeneous sample of eating disorders (N = 830), matched normal controls (N = 105) and a small group of controls with subclinical depression (N = 26). RESULTS: Eating disorder patients clearly presented with significantly more negative interpersonal profiles compared to controls. Within the eating disorder group, anorexics were characterized by high self-control, self-blame and self-attack. Patients with binge eating disorder expressed the least negative self-image, and were significantly more self-affirming than bulimics and less self-controlling than patients with atypical eating disorders. CONCLUSIONS: Eating disorder patients may have distinct interpersonal profiles that increase the risk of negative therapeutic reaction. Better knowledge of interpersonal processes in eating disorders may help to improve both diagnostic assessment and treatment.

Persistent complex subliminal activation effects: first experimental observations.

A strong recent focus on unconscious processes has increased interest in subliminal stimulation and other experimental activation technologies. Five experiments using male and female university students (N = 365) were carried out to compare 5-ms exposures of "mommy and I" stimuli with 5-ms control stimulation. Measures of self-mother similarity and other variables taken 7-14 days after exposure were more strongly correlated among experimental participants. Such complex, persistent effects may follow when powerfully activating stimuli administered under wholly unconscious conditions provokes schematic processing of social information and behavioral confirmation. These scientifically exciting and ethically problematic findings imply a need for further reduction of the role accorded to conscious volition and control in psychology.

Memories of mother, complementarity and shame: predicting response to subliminal stimulation with "Mommy and I are one".

A poorly understood finding with potentially wide-ranging implications is that subliminal stimulation with "Mommy and I are one" affects behavior. In this study (n= 62), "Mommy and I are one" lowered implicit mood (p= 0.0015) in comparison with a neutral stimulus ("People are walking"). The effect was most pronounced in shame-prone participants with less positive memories of their mother, and low self-mother complementarity (interaction p= 0.0044). Effects of a potentially shame-inducing stimulus ("I am completely isolated") were not significant (ps > 0.11). The results concerning less positive memories of mother replicate previous findings. We suggest that activation of unconscious associative networks explains the data. Though more research is needed, the cognitive content of these networks may involve representations of self-with-mother; for some, the affective content could involve shame.