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1.
Nutrients ; 13(7)2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34371967

RESUMO

Interventions that address binge eating and food insecurity are needed. Engaging people with lived experience to understand their needs and preferences could yield important design considerations for such interventions. In this study, people with food insecurity, recurrent binge eating, and obesity completed an interview-based needs assessment to learn facilitators and barriers that they perceive would impact their engagement with a digital intervention for managing binge eating and weight. Twenty adults completed semi-structured interviews. Responses were analyzed using thematic analysis. Three themes emerged. Participants shared considerations that impact their ability to access the intervention (e.g., cost of intervention, cost of technology, accessibility across devices), ability to complete intervention recommendations (e.g., affordable healthy meals, education to help stretch groceries, food vouchers, rides to grocery stores, personalized to budget), and preferred intervention features for education, self-monitoring, personalization, support, and motivation/rewards. Engaging people with lived experiences via user-centered design methods revealed important design considerations for a digital intervention to meet this population's needs. Future research is needed to test whether a digital intervention that incorporates these recommendations is engaging and effective for people with binge eating and food insecurity. Findings may have relevance to designing digital interventions for other health problems as well.


Assuntos
Bulimia/psicologia , Bulimia/terapia , Insegurança Alimentar , Obesidade/psicologia , Obesidade/terapia , Design Centrado no Usuário , Adulto , Idoso , Custos e Análise de Custo , Dieta Saudável , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Masculino , Refeições , Pessoa de Meia-Idade , Motivação , Determinação de Necessidades de Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos
2.
Eat Behav ; 42: 101541, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34332312

RESUMO

The Clinical Impairment Assessment (CIA) is a widely used self-report measure of the psychosocial impairment associated with eating-disorder symptoms. Past studies recommended a global CIA score of 16 to identify clinically significant impairment associated with a probable eating disorder (ED). However, to date, research on the properties of the CIA has been conducted in majority-women samples. Preliminary research on gender differences in CIA scores suggested men with EDs report less impairment on the CIA relative to women with EDs. Thus, the purpose of this study was to test if a different impairment threshold is needed to identify cases of men with EDs. We hypothesized that a lower CIA threshold, relative to that identified in majority-women samples, would most accurately identify men with EDs. Participants (N = 162) were men from our university-based and general community-based ED participant registry who completed the CIA and Eating Disorder Diagnostic Scale. Both precision-recall and receiver operating characteristic curves assessed what CIA global score threshold most accurately identified men with EDs. Both analytic approaches indicated that a CIA global score of 13 best predicted ED case-status in men. Consistent with past research, men with a clinically significant ED appear to report lower impairment on the CIA. Results have implications for screening and assessing for substantial ED-related impairment in men. Additionally, past research using the CIA to identify men with EDs may have under-identified men with clinically significant symptoms.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Feminino , Humanos , Masculino , Psicometria , Autorrelato , Inquéritos e Questionários , Universidades
3.
Int J Eat Disord ; 54(6): 1063-1067, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34013611

RESUMO

Gastrointestinal (GI) problems are common in individuals with eating disorders (EDs) and associated with distress, impairment, and increased healthcare utilization. GI symptoms may be exacerbated by meals and other interventions central to ED recovery thereby contributing to negative clinical outcomes. Informed by models emphasizing the role of the brain-gut axis in the expression of GI symptoms, this article describes a program of research to adapt "brain-gut psychotherapies" for EDs. First, the role of the brain-gut axis in GI symptoms is described, and evidence-based brain-gut psychotherapies are reviewed, with an emphasis on cognitive behavioral therapy for GI disorders and gut-directed hypnotherapy. Next, future directions for research in EDs to (a) understand the impact of GI symptoms on illness course and outcome; (b) clarify target engagement; (c) evaluate brain-gut psychotherapies; and (d) optimize intervention reach and delivery are described. We present a conceptual model that emphasizes GI-specific anxiety and altered gut physiology as targets of brain-gut psychotherapies in EDs, and discuss several issues that need to be addressed in designing clinical trials to test these interventions. We also describe how engagement with multidisciplinary stakeholders and use of digital tools could speed translation from the laboratory to clinical settings.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos da Alimentação e da Ingestão de Alimentos , Gastroenteropatias , Encéfalo , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Gastroenteropatias/etiologia , Gastroenteropatias/terapia , Humanos , Psicoterapia
4.
JMIR Form Res ; 5(5): e23809, 2021 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-33970114

RESUMO

BACKGROUND: Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. OBJECTIVE: This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. METHODS: A total of 22 adults (7/22, 32% non-Hispanic White; 8/22, 36% male) with self-reported obesity and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. RESULTS: Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82% (18/22) struggled with implementation, and 23% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82% (18/22) indicated the strategy was helpful, and 86% (19/22) planned to continue use. One-week average within-subject changes in weight (-2.2 [SD -5.0] pounds) and binge eating (-1.6 [SD -1.8] episodes) indicated small clinical improvement. CONCLUSIONS: Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions.

5.
Int J Eat Disord ; 54(7): 1213-1223, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33885180

RESUMO

OBJECTIVE: This study tested the association between food insecurity and eating disorder (ED) pathology, including probable ED diagnosis, among two cohorts of university students before and during the beginning of the COVID-19 pandemic. METHOD: Students (n = 579) from a large Midwestern American university completed self-report questionnaires assessing frequency of ED behaviors, ED-related impairment, and individual food insecurity as measured by the Eating Disorder Diagnostic Scale 5, Clinical Impairment Assessment, and Radimer/Cornell, respectively. Chi-square tests and MANOVA with post-hoc corrections were conducted to compare demographic characteristics, ED pathology, and probable ED diagnosis prevalence between students with and without individual food insecurity. RESULTS: Partially supporting hypotheses, MANOVA indicated significantly greater frequency of objective binge eating, compensatory fasting, and ED-related impairment for students with food insecurity compared with individuals without food insecurity. Chi-squared tests showed higher prevalence of ED diagnoses among individuals with food insecurity compared with those without food security (47.6 vs. 31.1%, respectively, p < .01, NNT = 6.06), specifically bulimia nervosa and other specified feeding and eating disorder. There were no differences in food insecurity before or during the beginning of the COVID-19 pandemic. DISCUSSION: Consistent with prior literature, food insecurity was associated with elevated ED psychopathology in this sample. Findings emphasize the importance of proper ED screening for college students vulnerable to food insecurity and EDs.


Assuntos
COVID-19/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Insegurança Alimentar , Pandemias , Estudantes/psicologia , Adolescente , Adulto , Estudos de Coortes , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Feminino , Humanos , Masculino , Meio-Oeste dos Estados Unidos/epidemiologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades , Adulto Jovem
6.
J Am Psychiatr Nurses Assoc ; 27(3): 231-239, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31291805

RESUMO

BACKGROUND: Efforts to examine alternative classifications (e.g., personality) of anorexia nervosa (AN) using empirical techniques are crucial to elucidate diverse symptom presentations, personality traits, and psychiatric comorbidities. AIMS: The purpose of this study was to use an empirical approach (mixture modeling) to test an alternative classification of AN as categorical, dimensional, or hybrid categorical-dimensional construct based on the co-occurrence of personality psychopathology and eating disorder clinical presentation. METHODS: Patients with AN (N = 194) completed interviews and questionnaires at treatment admission and 3-month follow-up. Mixture modeling was used to test whether indicators best classified AN as categorical, dimensional, or hybrid. RESULTS: A four-latent class, one-latent dimension mixture model that was variant across groups provided the best fit to the data. Results suggest that all classes were characterized by low self-esteem and self-harming and suicidality tendencies. Individuals assigned to Latent Class 2 (LC2; n = 21) had a greater tendency toward being impulsive and easily angered and having difficulties controlling anger compared with those in LC1 (n = 84) and LC3 (n = 66). Moreover, individuals assigned to LC1 and LC3 were more likely to have a poor outcome from intensive treatment compared with those in LC4 (n = 21). Findings indicate that the dimensional aspect within each class measured frequency of specific eating disorder behaviors but did not predict treatment outcomes. CONCLUSIONS: These results emphasize the complexity of AN and the importance of considering how facets of clinical presentation beyond eating disorder behaviors may have different treatment and prognostic implications.

7.
Psychol Assess ; 32(10): 943-955, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32718162

RESUMO

Proper assessment and diagnosis of eating disorders (EDs) are critical to determine to whom prevention and treatment efforts should be targeted, the extent to which treatment is working, and when an individual has recovered. Although existing ED diagnostic interviews have numerous strengths, they also have certain limitations, including poor internal consistency, low discriminant validity, and poor factor-structure replicability. The purpose of the current study was to address problems of past ED diagnostic interviews through the creation of a new clinician-rated interview-the Eating Pathology Symptoms Inventory-Clinician-Rated Version (EPSI-CRV). The EPSI-CRV was designed to measure dimensional constructs assessed in the self-report version of the EPSI and generate current Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) diagnoses. Participants were community-recruited adults with a DSM-5 ED (N = 257). Participants completed self-report and interview-based measures of eating, mood, and anxiety disorders and self-report measures of psychiatric impairment. The EPSI-CRV demonstrated evidence for interrater reliability, convergent and discriminant validity, and a good-fitting factor structure. EPSI-CRV dimensions showed concurrent validity for distinguishing among ED diagnoses. Baseline EPSI-CRV dimensions significantly predicted psychiatric impairment at baseline but not at 1-year follow-up. Although some scales had lower internal consistency than ideal, internal consistency values were similar to those of other established diagnostic measures. The EPSI-CRV appears to represent a promising new interview that can be used across a variety of clinical and research settings. Interested readers can access the EPSI-CRV and relevant training materials here: https://kuscholarworks.ku.edu/handle/1808/29616. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Entrevista Psicológica/normas , Escalas de Graduação Psiquiátrica/normas , Psicometria/normas , Adulto , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , Autorrelato
8.
Int J Eat Disord ; 53(8): 1315-1317, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32496572

RESUMO

Severe and enduring anorexia nervosa (SE-AN) is well known to clinicians who treat eating disorders, especially in adults, yet an empirically validated definition of SE-AN is lacking. Current approaches to delineating SE-AN rely on expert opinion, and there is little consensus regarding the criteria that distinguish SE-AN from other clinical presentations or the thresholds that define the boundaries of severity and enduringness. Empirical classification techniques and clinical staging frameworks that incorporate biomarkers offer intriguing alternatives to expert consensus in refining the definition of SE-AN. Empirical approaches, such as latent class analysis and taxometric analysis, have contributed to advances in eating disorders classification, including support for distinctions between eating disorder classes. Likewise, clinical staging models are being applied to other psychiatric disorders and offer a framework for incorporating biological indices of illness progression, such as neurocognitive changes, into a definition of SE-AN. Though some of these methods (e.g., biomarkers) are a long way from being realized, the need for an evidence-based approach to classifying SE-AN is clear. Without it, the challenges outlined by Wonderlich et al. (International Journal of Eating Disorders, 2020) will be difficult to resolve, and the burden of SE-AN on patients, their loved ones, and the healthcare system will continue.


Assuntos
Anorexia Nervosa , Transtornos da Alimentação e da Ingestão de Alimentos , Adulto , Humanos
9.
West J Nurs Res ; 42(12): 1068-1077, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32266857

RESUMO

Despite growing recognition of the importance of workforce diversity in health care, limited research has explored diversity among eating disorder (ED) professionals globally. This multi-methods study examined diversity across demographic and professional variables. Participants were recruited from ED and discipline-specific professional organizations. Participants' (n = 512) mean age was 41.1 years (SD = 12.5); 89.6% (n=459) of participants identified as women, 84.1% (n = 419) as heterosexual/straight, and 73.0% (n = 365) as White. Mean years working in EDs was 10.7 years (SD = 9.2). Qualitative analysis revealed three themes resulting in a theoretical framework to address barriers to increasing diversity. Perceived barriers were the following: "stigma, bias, stereotypes, myths"; "field of eating disorders pipeline"; and "homogeneity of the existing field." Findings suggest limited workforce diversity within and across nations. The theoretical model suggests a need for focused attention to the educational pipeline, workforce homogeneity, and false assumptions about EDs, and it should be tested to evaluate its utility within the EDs field.

10.
Int J Eat Disord ; 53(4): 611-617, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32112592

RESUMO

OBJECTIVE: User-centered design can improve engagement with and the potential efficacy of behavioral interventions, but is underutilized in health care. This work demonstrates how design methodologies can inform the design of a mobile behavioral intervention for binge eating and obesity. METHOD: A needs assessment was conducted with end-users (N = 22 adults with obesity and recurrent binge eating [≥12 episodes in 3 months] who were interested in losing weight and addressing binge eating), which included assessing participants' past/current and future willingness to engage with 20 treatment targets for managing binge eating and weight. Targets focused on improving dietary intake, increasing physical activity, and reducing overvaluation of weight and/or shape, unhealthy weight control practices, and negative affect. RESULTS: Participants' past and current use of targets varied. For all targets except those addressing unhealthy weight control practices, on average, participants had increasing levels of willingness to try targets. Among participants not currently using a target, at least some were willing to use every target again. DISCUSSION: Findings inform ways to personalize how users begin treatment. Furthermore, this study exemplifies how user-centered design can inform ways to ensure that digital interventions are designed to meet end-users' needs to improve engagement and clinical impact.


Assuntos
Terapia Comportamental/métodos , Transtorno da Compulsão Alimentar/terapia , Adulto , Feminino , Humanos , Masculino
11.
Int J Eat Disord ; 52(10): 1095-1107, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31313370

RESUMO

OBJECTIVE: Technology-enabled services frequently have limited reach and suboptimal engagement when implemented in real-world settings. One reason for these implementation failures is that technology-enabled services are not designed for the users and contexts in which they will be implemented. User-centered design is an approach to designing technologies and services that is grounded in information from the stakeholders who will be using or impacted by them, and the contexts for implementation. The purpose of this article is to present user-centered design methods that can be applied to technology-enabled services for eating disorders. METHOD: We provide an overview of the user-centered design process, which is iterative and involves stakeholders throughout. One model is presented that depicts six phases of a user-centered design process: investigate, ideate, prototype, evaluate, refine and develop, and validate. RESULTS: We then review how user-centered design approaches can be applied to designing technology-enabled services for patients with eating disorders, and we integrate a hypothetical case example that demonstrates the application of these techniques to designing a technology-enabled service for binge eating. Most of the user-centered design techniques can be implemented relatively quickly, allowing us to rapidly learn what stakeholders want and to identify problems before devoting time and resources to developing and delivering technologies and services. DISCUSSION: Through this work, we show how designing services that fit into the patterns and routines that stakeholders already are doing can ensure that services are relevant to stakeholders and meet their needs, potentially improving engagement and clinical impact. RESUMEN: Los servicios habilitados tecnológicamente frecuentemente tienen un alcance limitado y un involucramiento subóptimo cuando son implementados en escenarios del mundo real. Una razón para estas fallas de implementación es que los servicios habilitados tecnológicamente no están diseñados para los usuarios y contextos en los que serán implementados. El diseño centrado en el usuario es un abordaje para diseñar tecnologías y servicios que está basado en información de las partes interesadas que estarán haciendo uso o impactados por ellos, y los contextos para implementación. El propósito de este estudio es presentar métodos de diseños centrados en el usuario que pueden ser aplicados a servicios habilitados tecnológicamente para trastornos de la conducta alimentaria. Ofrecemos una visión general del proceso de diseño centrado en el usuario, que es iterative e involucra a las partes interesadas a lo largo de todo el proceso. Hemos presentado un modelo que describe seis fases de un proceso de diseño centrado en el usuario: investigar, idear, crear prototipos, evaluar, refinar y desarrollar, y validar. Luego revisamos cómo estos abordajes de diseño centrado en el usuario pueden ser aplicados para diseñar servicios habilitados tecnológicamente para pacientes con trastornos de la conducta alimentaria, e integramos un ejemplo de caso hipotético que demuestra la aplicación de estas técnicas para diseñar un servicio habilitado tecnológicamente para comer en atracones. Muchas de las técnicas de diseño centrado en el usuario pueden ser implementadas relativamente rápido, lo que nos permite aprender rápidamente lo que las partes interesadas quieren e identificar los problemas antes de dedicarles tiempo y recursos al desarrollo y entrega de tecnologías y servicios. A través de este trabajo, mostramos cómo el diseño de servicios que se ajustan a los patrones y rutinas que las partes interesadas ya están haciendo puede garantizar que los servicios sean relevantes para los interesados y que satisfagan sus necesidades, lo que podría mejorar la participación y el impacto clínico.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Tecnologia/métodos , Humanos
12.
J Health Psychol ; 24(7): 941-952, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-28810399

RESUMO

Comparing individuals of varying weight statuses on their identification and regulation of emotions may increase our understanding of mechanisms that drive excess weight gain and highlight more precise weight regulation targets. In Study I ( N = 1333), adults with obesity had reduced self-reported attention to and repair of emotions compared to adults with overweight or normal weight. In Study II ( N = 85), adults with obesity had deficits in assessor-administrated tasks of strategic emotional intelligence (i.e. understanding and using emotional information for self-management). Problems identifying and regulating emotions could impact emotion regulation processes that lead to problematic behaviors associated with eating and weight gain.


Assuntos
Inteligência Emocional/fisiologia , Regulação Emocional/fisiologia , Emoções/fisiologia , Sobrepeso/psicologia , Adolescente , Adulto , Atenção , Conscientização , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Testes Psicológicos , Autorrelato , Ganho de Peso , Adulto Jovem
13.
Suicide Life Threat Behav ; 49(2): 520-528, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29578246

RESUMO

Anorexia nervosa (AN) is an eating disorder characterized by severe food restriction resulting in low body weight and an intense fear of gaining weight. This disorder has one of the highest suicide rates of any psychiatric illness; however, few studies have investigated prospective predictors of suicide ideation (SI) in this population. Quality-of-life impairment may be particularly relevant for understanding suicide risk in AN, given associations with SI in other psychiatric disorders and associations with chronicity and severity in AN. This study explored associations between eating disorder-related impairment and SI in individuals with AN (n = 113) who completed assessments at treatment discharge and 3, 6, and 12 months after discharge. Greater psychological impairment predicted future occurrence of SI controlling for age, depression, history of SI, and eating disorder variables. Associations were specific to psychological impairment as other domains of impairment did not predict SI over time. Findings highlight the potential importance of targeting interpersonal-psychological consequences of AN to decrease future suicide risk.


Assuntos
Anorexia Nervosa/psicologia , Depressão/psicologia , Saúde Mental , Qualidade de Vida/psicologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Comportamento Autodestrutivo/psicologia , Adulto Jovem
14.
Int J Eat Disord ; 51(11): 1252-1260, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30265751

RESUMO

OBJECTIVE: Research evidence supports the clinical significance of subjective feelings of loss of control over eating; however, limited attention has been given to how this construct is assessed. Two measures have been developed in recent years (i.e., Eating Loss of Control Scale [ELOC] and Loss of Control over Eating Scale [LOCES]), but further validation in clinical and non-clinical samples is needed. METHOD: The current study evaluated the psychometric properties, including factor structure, criterion validity, and measurement invariance of the ELOC and LOCES across two groups: (a) a clinical sample of individuals with eating disorders (n = 106) and (b) a non-clinical sample of college students (n = 321). RESULTS: Confirmatory factor analyses indicated that the 16-item version of the ELOC and 7-item brief version of the LOCES provided good fit to the data in both samples. These measures were highly correlated (r = .83-.87) and associated with binge-eating and related psychopathology. The ELOC demonstrated partial invariance between men and women and between the clinical and non-clinical samples. The LOCES-brief demonstrated full invariance between men and women and partial invariance between the clinical and non-clinical samples. DISCUSSION: Findings suggest that the 16-item ELOC and 7-item LOCES are reliable measures of severity of loss of control eating in clinical and non-clinical samples. Given the brevity of the LOCES-brief and evidence for measurement invariance across sex, it is recommended over the ELOC in heterogeneous samples. Future research is needed to confirm the validity of these measures across individuals with and without eating disorders.


Assuntos
Transtorno da Compulsão Alimentar/psicologia , Psicometria/métodos , Autorrelato/normas , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
15.
Int J Eat Disord ; 51(8): 870-878, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29734468

RESUMO

BACKGROUND: Desired weight is an indicator of illness severity in youth with anorexia nervosa (AN), but its impact on eating disorder symptoms over time and in adults is unknown. This study examined longitudinal associations between two desired weight constructs (desired weight percentage, weight difference percentage) and eating disorder severity and body mass index (BMI) in patients aged 16-62 years old with AN presenting for inpatient or day hospital treatment. METHOD: Participants (N = 160) completed the Eating Disorder Examination and measures of height and weight at treatment admission, discharge, and 3, 6, and 12 months post-discharge. Desired weight percentage was calculated as [desired BMI(desired weight in kg/height in meters2 )/healthy BMI] × 100. weight difference percentage was calculated as [(actual weight-desired weight)/actual weight] × 100. RESULTS: At admission, participants were approximately 78.6% of a healthy BMI and desired to be 81% of a healthy BMI. During the year following treatment, participants were 89% of a healthy BMI, but wanted to be 86% of a healthy BMI. Individuals with lower desired weight percentage (wanting to be a lower percentage of a healthy BMI) or higher weight difference percentage (wanting to lose a larger percentage of weight) at treatment admission endorsed greater eating disorder severity across time. Additionally, individuals with higher desired weight percentage or weight difference percentage had higher BMIs at intake, and greater increases in BMI over time. DISCUSSION: Results highlight that desired weight constructs represent correlates of illness severity in AN and may inform an individual's likely weight trajectory during and after treatment.


Assuntos
Anorexia Nervosa/terapia , Peso Corporal/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Adolescente , Adulto , Anorexia Nervosa/patologia , Transtornos da Alimentação e da Ingestão de Alimentos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
J Abnorm Child Psychol ; 46(3): 625-638, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28646354

RESUMO

Epidemiological research suggests racial differences in the presentation of eating disorder symptoms. However, no studies have examined associations between race and eating disorder symptom trajectories across youth and adolescence, which is necessary to inform culturally sensitive prevention programs. The purpose of the current study was to examine the trajectories of eating disorder symptoms from childhood to young adulthood and to examine whether race was associated with trajectory group membership. Data were drawn from 2,305 Black and White girls who participated in a community-based longitudinal cohort study (Pittsburgh Girls Study) examining the development of psychopathology. The child and adult versions of the Eating Attitudes Test assessed self-reported eating disorder symptoms at six time points between ages 9 and 21 years. Growth mixture modeling was used to examine developmental trajectories of dieting, bulimia/food preoccupation, and total eating disorder symptom scores. Given potential confounds with race and disordered eating, financial strain (i.e., receiving public assistance) and weight were included as covariates. Four to six distinct developmental patterns were found across eating disorder symptoms, including none, increasing, decreasing, or increasing-decreasing trajectories. Black girls had a greater likelihood of being in the decreasing trajectories for dieting, bulimia/food preoccupation, and total eating disorder symptom scores. White girls were more likely to follow increasing trajectories of dieting and total eating disorder symptom scores compared to Black girls. These results highlight the importance of examining the influence of racial background on eating disorder symptoms and the potential need for differences in the timing and focus of prevention interventions in these groups.


Assuntos
Afro-Americanos/etnologia , Grupo com Ancestrais do Continente Europeu/etnologia , Transtornos da Alimentação e da Ingestão de Alimentos/etnologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Desenvolvimento Humano , Adolescente , Adulto , Criança , Feminino , Humanos , Estudos Longitudinais , Adulto Jovem
17.
J Adolesc Health ; 62(1): 107-113, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29054735

RESUMO

PURPOSE: Neuroimaging studies suggest that altered brain responses to food-related cues in reward-sensitive regions characterize individuals who experience binge-eating episodes. However, the absence of longitudinal data limits the understanding of whether reward-system alterations increase vulnerability to binge eating, as theorized in models of the development of this behavior. METHODS: Adolescent girls (N = 122) completed a functional magnetic resonance imaging monetary reward task at age 16 years as part of an ongoing longitudinal study. Self-report of binge eating was assessed using the Eating Attitudes Test at ages 16 and 18 years. Regression analyses examined concurrent and longitudinal associations between the blood-oxygenation-level-dependent response to anticipating and winning monetary rewards and the severity of binge eating while controlling for age 16 depressive symptoms and socioeconomic status. RESULTS: Greater ventromedial prefrontal cortex and caudate responses to winning money were correlated with greater severity of binge eating concurrently but not prospectively. CONCLUSIONS: This study is the first to examine longitudinal associations between reward responding and binge eating in community-based, mostly low-socioeconomic status adolescent girls. Ventromedial prefrontal cortex response to reward outcome-possibly reflecting an enhanced subjective reward value-appears to be a state marker of binge-eating severity rather than a predictor of future severity.


Assuntos
Transtorno da Compulsão Alimentar/fisiopatologia , Sinais (Psicologia) , Recompensa , Adolescente , Encéfalo/fisiopatologia , Depressão , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética , Córtex Pré-Frontal/fisiopatologia , Escalas de Graduação Psiquiátrica
18.
Int J Eat Disord ; 50(8): 963-969, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28429386

RESUMO

OBJECTIVE: Individuals with eating disorders (ED), particularly anorexia nervosa (AN), and bulimia nervosa (BN), often wish to reduce their body weight in pursuit of a thin ideal, but no study has examined the relation between desired weight and ED pathology in a clinical population of youth. Given the potential impact of desired weight on normalization of eating patterns and weight restoration, we examined the relation between desired weight and ED pathology in youth with AN or BN. METHODS: Participants were 340 youth presenting to an outpatient ED clinical research program. Height and weight were measured, and youth completed the Eating Disorder Examination. Desired weight was operationalized as "desired weight percentage" (calculated as a percentage of expected body weight [EBW]) and "weight difference percentage" (actual weight minus desired weight, divided by actual weight and multiplied by 100). RESULTS: Youth with AN desired to be a lower percentage of their EBW than youth with BN (p < .001). However, youth with AN, on average, wanted to gain 5.28% of their body weight and youth with BN wanted to lose 13.60% (p < .001). Desired weight percentage and weight difference percentage were associated with greater ED psychopathology, controlling for ED diagnosis, age, and sex (ps < .001). DISCUSSION: Desired weight is associated with elevated ED psychopathology. Weight goals may shift as individuals progress through treatment; if they do not, then desired weight may be an important indicator of a lack of psychological progress.


Assuntos
Peso Corporal/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Adolescente , Criança , Transtornos da Alimentação e da Ingestão de Alimentos/patologia , Feminino , Humanos , Masculino
19.
Compr Psychiatry ; 75: 62-67, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28324677

RESUMO

OBJECTIVE: Clinical studies suggest comorbidity between eating disorders and aggressive behaviors. This study examined the pattern of comorbidity between intermittent explosive disorder (IED) and eating disorders (ED). METHODS: Data were analyzed from both the adult and adolescent samples of the National Comorbidity Survey-Replication (n = 19,430) and a clinical research sample (n = 1,642). RESULTS: Lifetime prevalence of Any ED was elevated in IED vs. non-IED for both the community and clinical research samples. Though anorexia nervosa displayed no relationship with IED in either sample, bulimia nervosa was associated with IED in the community sample and binge eating disorder was associated with IED in both the community and clinical research samples. Onset of IED preceded onset of Any ED in at least 70% of comorbid IED/ED cases in both community and clinical research samples. Associations of IED with Any ED and bulimia nervosa in the community sample, and associations of IED with binge eating disorder in the clinical research sample, remained significant after controlling for other psychiatric disorders. CONCLUSIONS: Individuals with IED are more likely to report lifetime prevalence of ED, particularly bulimic spectrum disorders. This finding, and the observation that the onset of IED occurs prior to the onset of ED in the majority of individuals, suggests that longitudinal studies are needed to clarify this relationship and determine whether IED is a risk factor for the development of ED. Early identification of individuals with IED or impulsive aggression may provide clinically useful information to determine most effective treatment interventions.


Assuntos
Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Agressão , Comorbidade , Transtornos Disruptivos, de Controle do Impulso e da Conduta/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
20.
J Consult Clin Psychol ; 85(3): 228-237, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28221058

RESUMO

Bulimia nervosa can be reliably classified into subtypes based on dimensions of dietary restraint and negative affect. Community and clinical studies have shown that dietary-negative affect subtypes have greater test-retest reliability and concurrent and predictive validity compared to subtypes based on the Diagnostic and Statistical Manual of Mental Disorders (DSM). Although dietary-negative affect subtypes have shown utility for characterizing eating disorders that involve binge eating, this framework may have broader implications for understanding restrictive eating disorders. OBJECTIVE: The purpose of this study was to test the concurrent and predictive validity of dietary-negative affect subtypes among patients with anorexia nervosa (AN; N = 194). METHOD: Latent profile analysis was used to identify subtypes of AN based on dimensions of dietary restraint and negative affect. Chi-square and multivariate analysis of variance were used to characterize baseline differences between identified subtypes. Structural equation modeling was used to test whether dietary-negative affect subtypes would outperform DSM categories in predicting clinically relevant outcomes. RESULTS: Results supported a 2-profile model that replicated dietary-negative affect subtypes: Latent Profile 1 (n = 68) had clinically elevated scores on restraint only; Latent Profile 2 (n = 126) had elevated scores on both restraint and negative affect. Validation analyses showed that membership in the dietary-negative affect profile was associated with greater lifetime psychiatric comorbidity and psychosocial impairment compared to the dietary class. Dietary-negative affect subtypes only outperformed DSM categories in predicting quality-of-life impairment at 1-year follow-up. CONCLUSIONS: Findings highlight the clinical utility of subtyping AN based on dietary restraint and negative affect for informing future treatment-matching or personalized medicine strategies. (PsycINFO Database Record


Assuntos
Afeto , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/psicologia , Dieta/psicologia , Adulto , Feminino , Humanos , Masculino , Prognóstico , Reprodutibilidade dos Testes
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