Jan H. Rosenvinge

Prevalence of eating disorders and the predictive power of risk models in female elite athletes: a controlled study

The purposes of this study were to examine the percentage of female elite athletes and controls with disordered eating (DE) behavior and clinical eating disorders (EDs), to investigate what characterize the athletes with EDs, and to evaluate whether a proposed method of screening for EDs in elite athletes does not falsely classify sport‐specific behaviors as indicators of EDs. All athletes representing the national teams at the junior or senior level, aged 13–39 years (n=938), and age‐group matched, randomly selected population‐based controls (n=900) were invited to participate. From the screening data, a random sample of athletes (n=186) and controls (n=145) were subjects for a clinical interview. More athletes in leanness sports (46.7%) had clinical EDs than athletes in non‐leanness sports (19.8%) and controls (21.4%) (P<0.001). Variables predicting clinical EDs, and thus candidates for valid screening procedures, were menstrual dysfunction in leanness athletes, self‐reported EDs in non‐leanness athletes, and self‐reported use of pathogenic weight control methods in controls. Hence, statistically based risk factors are not universally valid, but specifically related to athletes and non‐athletes, respectively.

Social support in a wired world: Use of online mental health forums in Norway

This study explored the use of the four major Norwegian mental-health-related online discussion forums; who participate, why, and what implications use may have. The objective was to provide a basis for proposing relevant research questions and issues for public policy attention. A total of 492 responses to a web-based questionnaire were received. The respondents, predominantly women (78%) in the age range 18-35 years, found forum participation useful for information, and social contact and support. A majority (75%) found it easier to discuss personal problems online than face-to-face, and almost half say they discuss problems online that they do not discuss face-to-face. A majority would not have participated had they not had the option of using a pseudonym. Respondents perceive discussion groups as a supplement rather than a replacement of traditional mental health services, reporting no change in the amount or type of service used. A clear majority want professionals to take an active role in these types of forum. Comments from respondents indicate that forums may have an empowering effect. We believe that online interaction can have unique benefits for people suffering from mental disorders. Professionals will need new knowledge and perceptions of their roles, and public authorities will have to decide their role in influencing the quality of services offered, and the social values conveyed, to those who seek help through the Internet.

A New Scale for Adolescent Resilience: Grasping the Central Protective Resources Behind Healthy Development

Abstract In this study, the Resilience Scale for Adolescents (READJ was developed with confirmatory factor analysis and cross-validated factor model. The results show that the READ has sound psychometric qualities and that it measures all the central aspects of the psychological construct of resiliency.

Validating the Eating Disorder Inventory-3 (EDI-3): A Comparison Between 561 Female Eating Disorders Patients and 878 Females from the General Population

The Eating Disorder Inventory (EDI) is used worldwide in research and clinical work. The 3rd version (EDI-3) has been used in recent research, yet without any independent testing of its psychometric properties. The aim of the present study was twofold: 1) to establish national norms and to compare them with the US and international norms, and 2) to examine the factor structure, the internal consistency, the sensitivity and the specificity of subscale scores. Participants were Danish adult female patients (N = 561) from a specialist treatment centre and a control group (N = 878) was women selected from the Danish Civil Registration system. Small but significant differences were found between Danish and international, as well as US norms. Overall, the factor structure was confirmed, the internal consistency of the subscales was satisfactory, the discriminative validity was good, and sensitivity and specificity were excellent. The implications from these results are discussed.

The comorbidity of eating disorders and personality disorders: A metaanalytic review of studies published between 1983 and 1998

Comorbid personality disorders in eating disordered patients may seriously affect the treatment and course of their illness. Several studies show such a comorbidity, though with inconsistent findings. Qualitative reviews attribute this to methodological shortcomings, but the qualitative method may itself create new shortcomings. To circumvent this, the present, more extensive review applies a meta-analytic approach. Using the databases MEDLINE and PSYCHLIT, the 28 articles published between 1983 and 1998 that presented empirical evidence for an eating disorder and personality disorder comorbidity suitable for meta-analysis were included. We found a higher proportion of eating disordered patients with any personality disorder (average proportion =0.58) related to comparison groups (average proportion =0.28). Compared with anorexia nervosa patients, a higher proportion of patients with bulimia nervosa had a concurrent cluster B personality (average proportion =0.44 ) and a borderline personality disorder (average proportion =0.31). However, no differences between anorexia nervosa and bulimia nervosa patients in proportions of cluster C were found (average proportion =0.45 and 0.44 respectively). Patients with eating disorders and patients with bulimia nervosa in particular, should be routinely assessed for a concurrent personality disorder using structured clinical interviews. In future research, more stringent assessment procedures are highly recommended to address the question of causality between eating disorders and personality disorders, and how eating disorder symptoms and personality disorder symptoms are related to treatment effects.

Physical activity and exercise dependence during inpatient treatment of longstanding eating disorders: An exploratory study of excessive and non‐excessive exercisers

OBJECTIVE To describe changes in physical activity (PA) and exercise dependence score during treatment of eating disorders (ED), and to explore correlations among changes in PA, exercise motivation, exercise dependence score and ED psychopathology in excessive and non-excessive exercisers. METHOD Thirty-eight adult females receiving inpatient treatment for anorexia nervosa, bulimia nervosa or ED not otherwise specified participated in this prospective study. Assessments included accelerometer assessed PA, Exercise Dependence Scale, Reasons for Exercise Inventory, ED Examination, and ED Inventory. RESULTS Amount of PA was significantly reduced in non-excessive exercisers during treatment, in excessive exercisers there was a trend towards reduced amount of PA from admission to discharge. In excessive exercisers, reduced ED psychopathology was correlated with reduction in exercise dependence score and perceived importance of exercise to regulate negative affects, but not with importance of exercise for weight/appearance. These associations were not found in non-excessive exercisers. DISCUSSION Excessive exercise is an important issue in longstanding ED, and the excessive exercising patients need help to develop alternative strategies to regulate negative affects.

Comorbidity of personality disorders in anxiety disorders: A meta-analysis of 30 years of research

BACKGROUND A comprehensive meta-analysis to identify the proportions of comorbid personality disorders (PD) across the major subtypes of anxiety disorders (AD) has not previously been published. METHODS A literature search identified 125 empirical papers from the period 1980-2010 on patients with panic disorders, social phobia, generalised anxiety, obsessive-compulsive (OCD) and post-traumatic stress disorder (PTSD). Several moderators were coded. RESULTS The rate of any comorbid PD was high across all ADs, ranging from .35 for PTSD to .52 for OCD. Cluster C PDs occurred more than twice as often as cluster A or B PDs. Within cluster C the avoidant PD occurred most frequently, followed by the obsessive-compulsive and the dependent PD. PTSD showed the most heterogeneous clinical picture and social phobia was highly comorbid with avoidant PD. A range of moderators were examined, but most were non-significant or of small effects, except an early age of onset, which in social phobia increased the risk of an avoidant PD considerably. Gender or duration of an AD was not related to variation in PD comorbidity. LIMITATIONS Blind rating of diagnoses was recorded from the papers as an indication of diagnostic validity. However, as too few studies reported it the validity of the comorbid estimates of PD was less strong. CONCLUSIONS The findings provided support to several of the proposed changes in the forthcoming DSM-5. Further comorbidity studies are needed in view of the substantial changes in how PDs will be diagnosed in the DSM-5.

Treatment for eating disorders from a patient satisfaction perspective: a Norwegian replication of a British study

The purpose of this study was to replicate a British survey on patient satisfaction with treatment for eating disorders, factors associated with satisfaction and the consumers suggestions on how to improve the quality of health care services. A questionnaire was completed by 321 members of the Norwegian organizations for eating disorder patients. The British results were replicated as subjects were highly satisfied with outpatient individual and group psychotherapy, and to a less extent with family therapy. Also, a similar delay of 5–6 years from the first subject recognition of eating disorder symptoms to the time of seeking help was found. However, we found a relation between treatment delay and treatment satisfaction. Inpatient treatment was more favourably experienced in the UK than in Norway. Subjects who experienced therapists as competent on eating disorders reported higher treatment satisfaction. The results imply a critical view on the issue of early detection, a more selective use of family therapy, the need for more competence on eating disorders among clinicians, and a closer cooperation between professionals and the services provided by the patient organizations. Copyright

Five-year prospective study of personality disorders in adults with longstanding eating disorders.

OBJECTIVE To (1) report the occurrence of personality disorders (PDs) in adults with eating disorders (EDs) during inpatient treatment, and at 1-, 2-, and 5-year follow-up, (2) compare the changes of PDs in anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and (3) investigate if recovered patients had lower frequency of PDs. METHOD Seventy-four patients with EDs were assessed with Structured Clinical Interview for DSM-IV Axis II disorders during inpatient treatment, and at 1-, 2-, and 5-year follow-up. RESULTS During inpatient treatment, 58 patients (78%) had one or more PDs and this was reduced to 32 (43%) at 5-year follow-up. Dimensional PD scores changed significantly over time in both AN, BN, and EDNOS, but no significant differences emerged among the ED groups. Recovered patients had lower frequency of PDs (p < 0.01). DISCUSSION The substantial 5-year follow-up reductions in the frequency of PDs in patients with EDs present an optimistic clinical scenario for treating patients with comorbid ED and PD.

Online group interaction and mental health: An analysis of three online discussion forums

The present study examined interactions on three Norwegian online discussion forums, and attempted to identify differences in interactions and plausible outcomes of thematically dissimilar forums. Four categories were applied to the forums in order to distinguish potentially constructive and destructive uses. Interaction along the constructive-destructive dimension was contingent upon the themes discussed, as well as the level and nature of professional involvement. Interaction adhering to a destructive dimension was identified only in relation to the forum for eating disorders. Discovering to what extent theme and professional involvement influence interactions in discussion forums might guide further professional involvement in online group settings and the design of appropriate online environments.