Christopher Thornton

Obsessive compulsive comorbidity in the dieting disorders

OBJECTIVE This study investigated the comorbidity of obsessive compulsive disorder and obsessive compulsive personality disorder with the dieting disorders. A comorbid sample was examined in order to test the hypothesis that obsessive compulsive symptoms and personality are premorbid in these patients. METHOD Sixty-eight inpatients (35 with anorexia nervosa and 33 with bulimia nervosa) were assessed for DSM-III-R Axis 1 and Axis 11 obsessive compulsive psychopathology using the Composite International Diagnostic Interview (CIDI) and the Personality Disorders Inventory (PDE), respectively. RESULTS Twenty-one percent of the group met criteria for a diagnosis of obsessive compulsive disorder. Thirty-seven percent of anorexia nervosa patients were comorbid for obsessive compulsive disorder compared to only 3% of bulimia nervosa patients. In most, the obsessive compulsive disorder had predated the dieting disorder. Nineteen percent of patients were found to have premorbid obsessive compulsive personality disorder. DISCUSSION This study supports the assumption of obsessive compulsive comorbidity within the dieting disorders and provides empirical support that this obsessionality is a premorbid characteristic.

Measuring self‐esteem in dieting disordered patients: The validity of the Rosenberg and Coopersmith contrasted

OBJECTIVE In order to ascertain the most appropriate measure of self-esteem for dieting disordered patients, this study contrasted the construct and convergent validities of two widely used measures. In addition, dieting disordered subgroups were compared on levels of self-esteem. METHOD One hundred and seventeen male and female patients diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified completed the Rosenberg Self-Esteem Scale (SES), the Coopersmith Self-Esteem Inventory (SEI), and measures of dieting disorder pathology and depression. RESULTS No significant differences among the three dieting disorder subgroups were found. In determining convergent validity, regression analyses indicated that the SES was a significant predictor of dieting disorder psychopathology whereas the SEI was not. Of the two self-esteem measures, only the SES showed evidence of convergent validity. DISCUSSION The results suggest that the SES has sounder construct and convergent validity than the SEI. Hence, the SES may be more appropriate for use with dieting disordered populations.

Dissociation, abuse and the eating disorders: evidence from an Australian population

Objective: Anumber of European and Northern American studies have investigated a possible association between dissociative phenomena, eating disorders, child sexual abuse and self-mutilation. However, there has been little confirmation from other countries and cultures, and the Australian experience of these interrelationships has not previously been studied. Method: Dissociative symptomatology and self-reported history of abusive experiences, physical and sexual, were retrospectively studied in a sample of Australian eating disordered patients using a self-report measure, the Dissociation Questionnaire (DIS-Q). Results: As hypothesised, dissociative symptoms were particularly frequent in those who reported child and adult sexual abuse and in those who self-mutilated. A correlation between multiple forms of abuse and higher dissociation scores was only partially upheld. Conclusions: Interrelationships between victimisation and dissociation are discussed within the context of current knowledge in the field, and brief suggestions for therapeutic strategies are offered.

Does the Composite International Diagnostic Interview underdiagnose the eating disorders

OBJECTIVE A study was undertaken to assess the procedural validity of the Composite International Diagnostic Interview (CIDI) for the diagnosis of eating disorders. METHOD The CIDI was administered to 44 patients consecutively admitted to an eating disorders unit. CIDI-generated diagnoses were compared with clinical diagnoses documented in patient files. Discrepancies between diagnoses were examined in detail. RESULTS A significant level of disagreement was apparent, particularly for anorexia nervosa patients. A large number of patients with symptoms requiring inpatient treatment did not reach criteria using CIDIs diagnostic algorithm. CONCLUSION Considerable difficulties remain in the use of standardized assessments, such as the CIDI, to diagnose eating disorders. While presenting features of the illness, for example, ego syntonic nature of the illness, secrecy, and denial, may be part of the reason, the questions used by the CIDI appear to be in need of some refinement.

Experiences of physical and sexual abuse in Australian general practice attenders and an eating disordered population

Objective: To determine the reported rates of child physical and sexual abuse experienced by hospitalised eating disordered patients compared to a control group of women attending general practitioners. Method: A retrospective survey using the self-report Finkelhor Sexual Life Events Inventory and clinical reports. Results: Nearly one-half of eating disordered patients reported a history of child sexual abuse and one-quarter reported child physical abuse. These rates were significantly higher than those reported by the control group. Conclusions: Direct questioning regarding trauma histories is warranted when assessing patients with eating disorders and attention to such issues should be incorporated into the total management plan.

Medical management of eating disorders: a practical handbook for health care professionals

Part I. The Medical Perspective: 1. Definitions and epidemiology 2. The behavioural disorders 3. History, examination and investigations 4. Medical manifestations by system 5. The clinicians response to common physical complaints Part II. Treatment: 6. Principles of treatment 7. Medical and nutritional therapy Part III. Special Issues: 8. Specific patient populations 9. Prepubertal child and the younger adolescent Part IV. The Psychiatric and Psychological Perspective: 10. Physical disease and mental illness: pathology and psychopathology 11. Psychopathology and the mental status examination 12. Psychopathology and phenomenology 13. Specific psychological therapies Part V. Areas of Special Interest: 14. The role of the general practitioner 15. Nursing patients with anorexia nervosa 16. The role of the dietitian 17. Information for family and friends Bibliography Index.

The Treatment of Perfectionism within the Eating Disorders: A Pilot Study

The aim of this pilot study was to investigate the impact of the direct treatment of perfectionism on the outcome of perfectionism and eating disorder pathology. Sixty-one participants, attending day hospital treatment, participated in a randomised controlled study, in which treatment as usual (TAU) was compared with TAU combined with a clinician-lead cognitive behavioural treatment for perfectionism (TAU+P). Linear mixed model analysis revealed no significant interaction effects but significant main effects for time on variables measuring eating pathology and perfectionism. Outcomes supported the effectiveness of overall treatment but suggested that adding direct treatment of perfectionism did not enhance treatment. The results are discussed in relation to the existing literature on the treatment of perfectionism.

Selective eating in a 9-year-old boy: family therapy as a first-line treatment

Whilst empirical studies continue to demonstrate the efficacy of family-based therapy in the treatment of adolescent anorexia nervosa, less comprehensive evidence exists in guiding the treatment of pre-adolescent eating disorders, which are typically characterised by a greater variety of symptom presentation. We present the case of a pre-adolescent male who met criteria for selective eating who was treated into full remission with eating-disorder-focused family therapy. This family-based intervention deviated significantly from recently manualised family-based therapy interventions, and we suggest continued exploration of family therapy techniques in the treatment of pre-adolescent eating disorders.

Anorexia nervosa in the family: a sibling's perspective

Purpose: There is growing evidence that siblings have a role to play in the recovery from adolescent anorexia nervosa (AN), yet we know very little about the effect that AN has on them and what they do to cope. This study aims to investigate the impact of AN on adolescent siblings. Method: Semi-structured interviews were conducted with 20 adolescent siblings of young people being treated for AN, and analysed using thematic analysis. Results: The results indicate that the effects of AN on the sibling relationship can be variable, with older siblings with a pre-existing close relationship with the patient faring the best. Siblings described a number of factors that supported coping, including knowing more about the illness, the need for regular ‘time-out’ from stressful events and interactions and close supportive relationships with family members. Involvement in family-based treatment appeared to improve understanding of AN and enhanced communication within the family. Problems with family-based therapy (FBT) were discussed. Conclusion: Addressing the needs of well siblings has the potential to improve outcomes for them and their sibling with AN. FBT goes some way towards doing this, but addressing difficulties that siblings experienced could lead to further improvements in treatment.

The effectiveness of family-based treatment for full and partial adolescent anorexia nervosa in an independent private practice setting: Clinical outcomes.

OBJECTIVE Anorexia nervosa (AN) is a severe psychiatric illness with little evidence supporting treatment in adults. Among adolescents with AN, family-based treatment (FBT) is considered first-line outpatient approach, with a growing evidence base. However, research on FBT has stemmed from specialist services in research/public health settings. This study investigated the effectiveness of FBT in a case series of adolescent AN treated in a private practice setting. METHOD Thirty-four adolescents with full or partial AN, diagnosed according to DSM-IV criteria, participated, and were assessed at pretreatment and post-treatment. Assessments included change in % expected body weight, mood, and eating pathology. RESULTS Significant weight gain was observed from pretreatment to post-treatment. 45.9% of the sample demonstrated full weight restoration and a further 43.2% achieved partial weight-based remission. Missing data precluded an examination of change in mood and ED psychopathology. DISCUSSION Effective dissemination across different service types is important to the wider availability of evidence-based treatments. These weight restoration data lend preliminary support to the implementation of FBT in real world treatment settings.