Attachment insecurity predicts eating disorder symptoms and treatment outcomes in a clinical sample of women.

We examined the extent to which attachment insecurity was related to eating disorder (ED) symptoms, and predictive of treatment outcomes. Women diagnosed with anorexia nervosa (AN) restricting subtype (ANR), AN binge purge subtype (ANB), or bulimia nervosa (BN) completed an attachment scale pretreatment, and ED symptom scales pretreatment (N = 243) and post-treatment (N = 157). A comparison sample of 126 non-ED women completed attachment scales on 1 occasion. Those with EDs had significantly higher attachment insecurity than non-ED. ANB was associated with higher attachment avoidance compared with ANR and BN, and higher attachment anxiety compared with BN. Higher attachment anxiety was significantly related to greater ED symptom severity and poorer treatment outcome across all EDs even after controlling for ED diagnosis. Attachment dimensions substantially contribute to our understanding of ED symptoms and treatment outcome. Addressing attachment insecurity when treating those with EDs may improve treatment outcomes.

Personality dimensions among women with an eating disorder: towards reconceptualizing DSM.

OBJECTIVE: To evaluate the incremental validity of a dimensional assessment of personality, after controlling for diagnostic category, in accounting for meaningful variation in eating disorder attitudes and behaviours and in current affective distress among a clinical sample of eating disordered women. METHODS: 244 treatment seeking eating disordered women and 116 non-eating disordered women were assessed with the NEO five factor inventory (NEO-FFI), and with measures of eating disorder attitudes and of affective distress using a cross sectional design. RESULTS: As predicted, differences were found between eating disordered and non-eating disordered women on several NEO-FFI scales, which provided a context for subsequent analyses. NEO-FFI scales accounted for meaningful variation in eating disordered attitudes and behaviours as well as in levels of current affective distress over and above DSM-IV diagnostic category. CONCLUSION: A flexible approach to diagnosis, which includes personality dimensions along with a description of eating disorder symptoms, may result in a more inclusive and useful diagnostic scheme for treating women with eating disorders.

Three-level multilevel growth models for nested change data: a guide for group treatment researchers.

Researchers have known for years about the negative impact on Type I error rates caused by dependencies in hierarchically nested and longitudinal data. Despite this, group treatment researchers do not consistently use methods such as multilevel models (MLMs) to assess dependence and appropriately analyse their nested data. The goals of this study are to review some of the study design issues with regard to hierarchically nested and longitudinal data, discuss MLMs for assessing and handling dependence in data, and present a guide for developing a three-level growth MLM that is appropriate for group treatment data, design, and research questions. The authors present an example from group treatment research to illustrate these issues and methods.

Psychometric properties of the eating disorders inventory-2 among women seeking treatment for binge eating disorder.

Psychometric properties of the Eating Disorders Inventory-2 (EDI-2) when used for women with Binge Eating Disorder (BED) are assessed. The EDI-2 was administered to 144 outpatients seeking treatment for BED and 152 outpatients seeking treatment for Bulimia Nervosa (BN). Most EDI-2 scales had acceptable internal consistence for both the BED and BN samples. EDI-2 scales demonstrated adequate stability within a subsample of those with BED who were retested. Confirmatory factor analyses revealed a hypothesized second-order two-factor structure for the original EDI scales for the BED group but not for those with BN. When the provisional EDI-2 scales were included, a two-factor structure was not supported for any group. Some scales differentiated the BED from the BN sample, and the second-order factors correlated with measures of similar constructs. The original EDI scales can be used reliably for those with BED.

Attachment dimensions and group climate growth in a sample of women seeking treatment for eating disorders.

Adult attachment and group process research are emerging areas of research for treating eating disorders. In this study, we examined several aspects of group processes: the weekly growth of group therapy climate, the relationship between group climate growth and outcomes, and the impact of the group on individual experiences of group climate. Further, we assessed the relationship between adult attachment dimensions and these group processes. Women (n = 264) diagnosed with an eating disorder completed attachment scales pre-treatment, eating disorder symptom scales pre- and post-treatment, and group climate scales weekly during treatment. Treatment consisted of a specialized eating disorders group-based day hospital program with rolling admissions. Engaged group climate increased and Avoidance group climate decreased across weeks of treatment. Engaged group climate growth was associated with improved eating disorder symptoms post-treatment. Higher attachment avoidance at pre-treatment was related to lower Engaged group climate at week 1, and was related to a greater impact of the group on the individual's experience of group engagement. Clinicians might improve group processes and outcomes by tailoring interventions to individuals' attachment avoidance when treating women for eating disorders.

Psychometric properties of self-monitoring of eating disorder urges among treatment seeking women: ecological momentary assessment using a daily diary method.

OBJECTIVES: The psychometric properties of an ecological momentary assessment (EMA) method used to evaluate eating disorder (ED) urges were examined. METHODS: Participants, 139 women who sought treatment for an ED, completed a daily diary measuring ED urges after each meal for a three week period at the start of treatment, and a measure of ED attitudes and behaviors pre- and post-treatment. RESULTS: The construct validity of this method was indicated by a two factor solution representing binge eating urges and ED compensatory behavior urges, and by significant differences between ED diagnostic groups on ED urge type. Correlations of ED urges early in therapy with outcomes provided evidence for predictive validity. Correlations at pre-treatment between ED urges and ED attitudes and behaviors supported criterion validity. EMA of ED urges showed good retest stability. CONCLUSIONS: EMA of ED urges is a valid and reliable approach that is associated with ED symptom severity, and predictive of treatment outcome.