Gina Dimitropoulos

Predictors of family functioning in carers of individuals with anorexia nervosa

OBJECTIVE The objective of the present study was to determine influences on caregiver distress and family functioning in AN using the stress process model. METHOD Using a cross-sectional design, self-report measures were disseminated to 63 family members of inpatients with long-term AN. Outcome measures included the Family Assessment Device and the General Health Questionnaire. RESULTS Multiple regression analysis of family functioning resulted in a model predicting 38% of the variance. Burden, conflict regarding AN and the caregiving role, attitudes and actions of other family members toward the person with AN, family stigma, and social support were predictive of family functioning. In contrast, caregiver psychological distress was poorly predicted by the independent variables, with only 11% of the variance explained. CONCLUSION These findings demonstrate the utility of the stress process model for predicting family functioning in this population, and suggest potential targets of intervention for clinicians working with caregivers.

Caring for a sibling with anorexia nervosa: a qualitative study.

OBJECTIVE Few studies have explored eating disorders from the perspective of non-affected siblings. The aim of this investigation was to explore the unique experiences and challenges of siblings of women with anorexia nervosa (AN). METHOD Twelve semi-structured qualitative interviews were conducted with sibling participants to ascertain their perspective of caring for a sister with chronic AN. RESULTS Qualitative analyses gleaned six themes: (1) the sibling role as protector and mediator; (2) familial factors that influence and reinforce these sibling roles; (3) consequences and benefits of AN to non-affected sibling; (4) coping strategies; (5) current and future intentions of caregiving and (6) professional and informal support. DISCUSSION The findings from this qualitative study provide a window into the perceptions, feelings, and roles of siblings of women afflicted with AN. An intervention guided by the elicited themes may facilitate family functioning that is more adaptive for both siblings.

Navigating the transition from pediatric to adult eating disorder programs: Perspectives of service providers

OBJECTIVE This study aims to conduct qualitative research on the perspectives of service providers regarding the transition process from pediatric to adult specialized eating disorder tertiary care programs. METHOD Two focus groups with a diverse group of clinicians in pediatric and adult eating disorder programs and five qualitative interviews with clinicians in the community were conducted. RESULTS Three themes were identified as challenges during the transition process: (1) illness related factors (ambivalence and denial); (2) the interruption of normative adolescent developmental processes by the illness; and, (3) the impact of decreased parental involvement in the adult compared to pediatric eating disorder programs. DISCUSSION These themes were compared with empirical evidence on other chronic mental or physical health concerns for the purpose of identifying ways to facilitate a more successful service transition for young adults with anorexia nervosa. Future research and clinical implications are delineated.

Challenges in Making the Transition Between Pediatric and Adult Eating Disorder Programs: A Qualitative Study From the Perspective of Service Providers

There is scant research regarding the transition from pediatric to adult eating disorder programs. This study aims to increase understanding of the factors that impede or facilitate successful service transition for individuals with anorexia nervosa moving from pediatric to adult eating disorder programs. Participants included service providers representing pediatric and adult eating disorder programs, in addition to community treatment providers in a large city. The following themes were identified: a) readiness, not age, should determine service transition; and b) implementation of interventions for facilitating transition from pediatric to adult eating disorder programs including appropriate medical follow-up. These findings delineate various factors that may help facilitate or interrupt a seamless and coordinated transition from pediatric to adult eating disorder programs.

Inpatients with Severe Anorexia Nervosa and Their Siblings: Non-shared Experiences and Family Functioning

OBJECTIVES The aims of this study were the following: to identify perceptions of patients with anorexia nervosa (AN) and their siblings regarding differential experiences within and external to the family including sibling interactions, parental treatment, relationships with peers and events that are unique to each sibling; (2) to compare how patients and their siblings perceive eating disorder symptoms, parental affection/control, social support and stigma; and (3) to test associations with family functioning for patients with AN and their siblings. METHOD A total of 26 patients paired with their siblings were recruited from an Eating Disorder Program and administered standardized instruments measuring different experiences within and external to the family, the impact of eating disorder behaviours, stigma, social support and family functioning. RESULTS Patients rated high on the differential experience of jealousy in contrast to their siblings. Patients scored higher than their siblings on eating symptoms, whereas siblings scored higher on social support. The impact of AN on the family, stigma towards the individual and family, and social support accounted for 37% of the variance in family functioning from the sibling perspective after controlling for age and gender. Of these variables, impact of AN on the family made the largest contribution. DISCUSSION Family-based and sibling-based interventions that aim to reduce the effects of the illness on the sibling relationship and the family are recommended.

A Qualitative Study on the Experiences of Young Adults With Eating Disorders Transferring From Pediatric to Adult Care

The study’s objective was to identify systemic facilitators and barriers of transferring young adults (ages 17–21) with eating disorders from pediatric to adult health and mental health services. Qualitative interviews were conducted and three themes emerged: (a) difficulties navigating care during the transfer period; (b) challenges achieving and maintaining recovery due to systemic barriers after the transfer of care;and (c) recommendations for facilitating the transfer between systems of care. From the perspective of young adults with eating disorders our study shows that the transition to adult care services may be improved with increased coordination, communication, and collaborative partnerships between pediatric and adult providers.

A Qualitative Study on the Challenges Associated With Accepting Familial Support From the Perspective of Transition-Age Youth With Eating Disorders

ABSTRACT The aim of this study was to identify types of family support desired by young adults with eating disorders during the transfer of care from paediatric to adult eating disorders programs. Using constant comparative analysis, two salient themes from qualitative interviews with 15 young adults were identified: (a) uncertainty about the role of parents in maintaining recovery during the transfer; and (b) the need for parental support, defined as assistance with eating and maintenance of recovery. Young adults voiced that parental emotional involvement and assistance with navigating adult care services is critical to their successful transfer between the two systems of care.

Consequences of child emotional abuse, emotional neglect and exposure to intimate partner violence for eating disorders: a systematic critical review

BackgroundChild maltreatment and eating disorders are significant public health problems. Yet, to date, research has focused on the role of child physical and sexual abuse in eating-related pathology. This is despite the fact that globally, exposure to emotional abuse, emotional neglect and intimate partner violence are the three of the most common forms of child maltreatment. The objective of the present study is to systematically identify and critically review the literature examining the association between child emotional abuse (EA), emotional neglect (EN), and exposure to intimate partner violence (IPV) and adult eating-disordered behavior and eating disorders.MethodsA systematic search was conducted of five electronic databases: Medline, Embase, PsycINFO, CINAHL, and ERIC up to October 2015 to identify original research studies that investigated the association between EA, EN and children’s exposure to IPV, with adult eating disorders or eating-disordered behavior using a quantitative research design. Database searches were complemented with forward and backward citation chaining. Studies were critically appraised using the Quality in Prognosis Studies (QUIPS) tool.ResultsA total of 5556 publications were screened for this review resulting in twenty-three articles included in the present synthesis. These studies focused predominantly on EA and EN, with a minority examining the role of child exposure to IPV in adult eating-related pathology. Prevalence of EA and EN ranged from 21.0% to 66.0%, respectively. No prevalence information was provided in relation to child exposure to IPV. Samples included predominantly White women. The methodological quality of the available literature is generally low. Currently, the available literature precludes the possibility of determining the extent to which EA, EN or child exposure to IPV have independent explanatory influence in adult eating-related pathology above what has been identified for physical and sexual abuse.ConclusionsWhile a large proportion of adults with eating disorders or eating-disordered behavior report EA, EN, or child exposure to IPV , there is a paucity of high-quality evidence about these relationships.

“You don’t have anorexia, you just want to look like a celebrity”: perceived stigma in individuals with anorexia nervosa

Abstract Background: Minimal research has been conducted on how individuals with Anorexia nervosa (AN) undergoing treatment perceive public stigma. Aim: Explore how affected individuals with AN believe the general public perceives AN. Method: Using thematic analysis, 19 participants with AN were interviewed at the beginning of treatment. Results: Three interrelated themes were ascertained: (1) AN is not an illness; (2) eating disorder behaviours are volitional and the public endorses a socio-cultural explanation for the disorder; 3) affected individuals delay disclosing their illness and experience shame engaging in intensive treatment for AN as a result of their perception of stigma. Conclusions: Individuals with AN viewed the public as trivializing AN by viewing behaviours as within their control and by attributing eating disorder behaviours solely to socio-cultural factors. Participants believed that the public minimizes the challenges associated with treatment. Findings suggest that clinical interventions targeting stigma are required to counteract perceptions held by service users regarding how others view their illness. “Mental health literacy” interventions are needed for health professionals working with high risk groups likely to avoid seeking help due to fears of stigmatization.

Physical activity perceptions and behaviors among young adults with congenital heart disease: A mixed-methods study

OBJECTIVE A physically active lifestyle can help maintain positive physical and psychosocial health outcomes among adults with congenital heart disease (CHD). This study explored the physical activity perceptions and behaviors among young adults with CHD. DESIGN This was a cross-sectional, mixed-methods study that included objectively measured physical activity assessment (accelerometer), individual semistructured interviews, and psychosocial questionnaires. RESULTS Fifteen participants (67% male; 21 ± 3 years old) with moderate (n = 10) or complex (n = 5) CHD were recruited from an outpatient adult CHD clinic. Participants accumulated 26 ± 16 minutes of moderate-to-vigorous physical activity per day, and reported a high quality of life, moderate self-efficacy for exercise, and low cardiac-focused anxiety. Qualitative data indicated that participants reported more positive perceptions toward activity if their family members encouraged physical activity participation, including siblings that engaged in physical activity alongside participants. Participants described parents as supportive rather than overprotective. Activity precautions were perceived by participants as being instructions from cardiologists rather than restrictions by parents. Participants described some physical limitations compared to peers, but managed challenges by either working within their limitations or choosing activities that met their expectations and/or in which they could fully participate. Participants often described childhood physical activity in the context of school, physical education, and organized sports. Whereas physical activity in childhood was viewed as recreational, the cardiac health-promoting aspects became more prominent in adulthood. Activities performed during ones employment were considered sufficient to meet physical activity recommendation levels, and participants reported limited time and/or energy to participate in activity outside of work. CONCLUSIONS The influence of family appeared to help participants adopt a positive perception toward activity participation in childhood that was carried forward to young adulthood. Future clinical work should target adolescents with CHD with less social supports and/or negative perceptions toward physical activity.