How do males recover from eating disorders? An interview study.

OBJECTIVES: The aim of the current study is to investigate what males experience as helpful in their recovery process from eating disorders (ED). METHODS: Qualitative in-depth interviews within a phenomenological approach, and using content analysis to excavate overarching text themes. SETTING: Norway and Sweden. PARTICIPANTS: Included were 15 males with an age range from 19 to 52 years. Duration of illness varied between 3 and 25 years of experience with anorexia nervosa (n=10), bulimia nervosa (n=4) or ED not otherwise specified (n=1). RESULTS: The content analysis revealed four main categories, that is, 'the need for a change', 'a commitment to leave the eating disorder behind', 'interpersonal changes' and 'searching for a life without an eating disorder'. These categories comprise features like motivation to change, gaining structure in eating situations, a re-learning of personal and interpersonal skills as well as accepting losses and starting a reorientation of identity and meaning. We noted a rather goal-oriented approach to help seeking and a variation in how the males engaged their social network in resolving the challenges associated with the recovery process. Still, the overall nature of the recovery process highly accords with what has been reported for women. DISCUSSION: A clinical implication from our findings is that symptom relief is important to facilitate good circles of improvement, but that the nature of the recovery process would require a wider perspective in treatment. Clinicians may also be informed about challenges related to an instrumental approach to help seeking reported in this study.

Eating disorders and anabolic androgenic steroids in males--similarities and differences in self-image and psychiatric symptoms.

BACKGROUND: Body dissatisfaction is common among both females and males. Dissatisfaction with the body is a risk factor both for onset of eating disorders and for abuse of anabolic androgenic steroids (AAS). Few studies have however investigated if there are other similarities in respect to self-image or psychiatric symptoms between clinical samples of eating disordered males and males in treatment for negative effects of AAS use. AIM: The aim of this study was to compare two clinical samples, one of males with ED and one of males who used AAS, regarding self-image and psychiatric symptoms. METHODS: This study compared males with eating disorders (n = 13) and males who recently stopped AAS use (n = 29) on self-image and psychiatric symptoms, using The Structural Analysis of Social Behavior self-questionnaire and a shortened version of The Symptom Check List. RESULTS: The eating disorder group reported significantly lower scores for Self-emancipation and Active self-love and higher scores for Self-blame and Self-hate. Both groups reported serious psychiatric symptoms. The common denominator between groups was serious psychiatric symptomatology rather than negative self-image. CONCLUSIONS: The negative self-image profile, especially self-hate, found among males with Eating Disorders may indicate that the studied groups differ in aetiology of the underlying problems. The serious psychiatric symptoms in both groups call staff to pay attention to any thoughts of suicide due to severe depressive symptoms where by specialized psychiatric treatment may be needed.

Male experiences of life after recovery from an eating disorder.

The aim of this study was to describe how former male patients perceive life after recovery from an eating disorder. A qualitative method with a phenomenographic approach was used to identify ways of experiencing recovery. Two descriptive categories were developed: body acceptance and self-worth. Six conceptions describe how recovered patients now relate in a balanced way to exercise and food, using strategies to avoid relapse. With a sense of self-acceptance and autonomy, they now appreciate their social life. Some perceive recovery as coping with remaining impulses to diet or exercise. Others experience themselves as totally free from the eating disorder.

Laterality, hand control and scholastic performance: a British birth cohort study.

OBJECTIVES: To use simple measures of laterality and hand control that can identify a greater risk of poorer scholastic ability, potentially signalling suboptimal hemispheric lateralisation. DESIGN: Analysis of material from a birth cohort study. SETTING: Members of the National Child Development Study, a British birth cohort study following people born in 1958. PARTICIPANTS: 10 612 children who undertook tests at age 11 years. PRIMARY OUTCOME MEASURES: Teacher-administered tests of non-verbal general ability, verbal general ability, reading comprehension and mathematics. RESULTS: Linear regression produced associations (and 95% CIs) with tests of verbal general ability, non-verbal general ability, reading comprehension and mathematics scores for the lowest third (compared with highest) of a left-hand control test involving picking up matches of -1.21 (-1.73 to -0.68; p<0.001), -0.72 (-1.14 to -0.29; p=0.001), -0.70 (-1.06 to -0.35; p<0.001) and -1.32 (-1.90 to -0.73; p<0.001). Among those in the lowest third of the right-hand control test score, mixed-handedness compared with right-handedness was associated with poorer scholastic performance, with regression coefficients (and 95% CIs; p values) of 1.90 (-3.01 to -0.80; p=0.001), -1.25 (-2.15 to -0.35; p=0.007), -1.28 (2.04 to -0.53; p=0.001) and -1.33 (-2.53 to -0.13; p=0.030). The estimates are for a point change in the scholastic test scores, after adjustment for sex, left-hand motor function and social class. Statistically significant associations with mixed-handedness were only observed for the lowest third of right-hand motor function. CONCLUSIONS: Measures involving poorer left-hand motor function may represent useful markers of reduced cognitive function possibly reflecting suboptimal hemispheric lateralisation. Crude measures of laterality such as reported non-right-handedness may be more useful for research when combined with measures of motor function.

The impact of different outcome measures on estimates of remission in a 3-year follow-up of eating disorders.

OBJECTIVE: To examine the impact of using different outcome measures on estimates of remission rates in eating disorders (ED). METHOD: Adult ED patients (n = 334) included in a naturalistic, longitudinal project were assessed 3 years after intake. Remission was operationally defined using six different measures of outcome. Pairwise analyses of agreement between outcome measures were also calculated. RESULTS: Remission rates for the entire group varied considerably from 24.3 to 77.8% depending on how remission was defined and who made the assessment (experts or patients). Outcome measures performed differently depending on diagnosis, and agreement between measures varied from none to very good. CONCLUSION: The impact of different definitions of outcome on remission estimates is considerable. There is a need to validate different estimates of remission by examining them in relation to multiple domains of outcome over time and by critically examining their relative merits both empirically and clinically.

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.

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.

Mortality among mentally disordered offenders: a community based follow-up study.

BACKGROUND: Follow-up information about outcome for hospitalized mentally disordered offenders (MDO) is necessary for evaluation and improvement in quality of forensic psychiatric care. AIM: A study was undertaken to estimate the standard mortality rate (SMR) of a population based sample of people sentenced to forensic psychiatric care. METHOD: All MDOs in Orebro County, Sweden, discharged from a forensic psychiatric treatment unit between 1992 and 1999 were identified (n = 46). The variables were gender, age, offence, diagnosis and duration of admission. Case linkage was made with the National Cause-of-Death register. Median follow-up time was 53 months (0-93). RESULTS: The sample yielded a significantly elevated SMR 13.4 (95% CI 4.35-31.3) times higher than that in the general population, mostly due to suicide. CONCLUSIONS: The cohort size is small but representative, and it provides data from an additional country for the growing international pool confirming the high risk of premature, generally self-inflicted death among MDOs. Resettlement and rehabilitation services for them may need to take as much account of mortality risk as that of re-offending.