Øyvind Rø

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.

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.

Disturbed Eating Behavior and Omission of Insulin in Adolescents Receiving Intensified Insulin Treatment: A nationwide population-based study

OBJECTIVE To establish the prevalence of disturbed eating behavior (DEB) and insulin omission among adolescents with type 1 diabetes using intensive insulin treatment in a nationwide population-based study. RESEARCH DESIGN AND METHODS The Diabetes Eating Problem Survey–Revised (DEPS-R) is a diabetes-specific screening tool for DEB. Clinical data and HbA1c were obtained from the Norwegian Childhood Diabetes Registry. RESULTS A total of 770 children and adolescents 11–19 years of age with type 1 diabetes completed the DEPS-R. A total of 27.7% of the females and 8.6% of the males scored above the DEPS-R cutoff. Participants scoring above the cutoff had significantly higher HbA1c (9.2% [77 mmol/mol]; SD, 1.6) than participants scoring below the cutoff (8.4% [68 mmol/mol]; SD, 1.3; P < 0.001). The prevalence of DEB increased significantly with age and weight, from 7.2% in the underweight group to 32.7% in the obese group, and from 8.1% in the youngest age-group (11–13 years) to 38.1% in the oldest age-group (17–19 years). A total of 31.6% of the participants reported insulin restriction and 6.9% reported insulin omission after overeating. Patients reporting insulin restriction had significantly higher HbA1c (9.0% [75 mmol/mol]; SD, 1.7) than nonrestrictors (8.3% [67 mmol/mol]; SD, 1.2; P < 0.001). CONCLUSIONS One-fourth of girls with type 1 diabetes scored above the cutoff for DEB and one-third reported skipping their insulin dose entirely at least occasionally after overeating. Both DEB and insulin restriction were associated with poorer metabolic control, which may increase the risk of serious late diabetes complications.

The impact of age and BMI on Eating Disorder Examination Questionnaire (EDE-Q) scores in a community sample

OBJECTIVES The primary objectives for this study were to establish normative data for the EDE-Q in a nationally representative sample of women and to investigate the unique and relative effects of age and BMI. METHODS A community sample of 3000 women aged 16-50 was randomly selected from the Norwegian National Population Register. RESULTS Mean global EDE-Q was 1.27 (SD=1.19). EDE-Q scores decreased significantly with age yet increased with BMI. In the regression model, BMI and age accounted for 19% versus 2%, respectively, of the global EDE-Q. Extreme shape and weight concerns appeared to drive the higher global EDE-Q scores for individuals with overweight or obesity, with 30-40% scoring above the recommended clinical cut-off for Shape and Weight Concern. CONCLUSIONS Higher EDE-Q scores, largely driven by elevated shape and weight concerns, appear normative among individuals with obesity in a nationally representative population. BMI should be routinely considered when establishing criteria for defining recovery and determining clinical significance using the EDE-Q.

Neuropsychological Functioning in Adolescents with Anorexia Nervosa Before and After Cognitive Remediation Therapy: A Feasibility Trial

OBJECTIVE To investigate neuropsychological functioning in adolescents with anorexia nervosa (AN) before and after receiving cognitive remediation therapy (CRT). METHOD Twenty young females with AN participated in an individually-delivered CRT treatment program. Neuropsychological and psychiatric assessments were administered before and after treatment. Weight, depression, anxiety, duration of illness, and level of eating disorder psychopathology were considered as covariates in statistical analyses. RESULTS Significant changes in weight, depression, visio-spatial memory, perceptual disembedding abilities, and verbal fluency were observed. Changes in weight had a significant effect on improvements in visuo-spatial memory and verbal fluency. Results also revealed a significant effect of depressive symptoms on perceptual disembedding abilities. DISCUSSION The results suggest improvements on a number of neuropsychological functions during the course of CRT. Future studies should explore the use of additional assessment instruments, and include control groups to assess the effectiveness of the intervention.

Norms for the Eating Disorder Examination Questionnaire (EDE-Q) Among High School and University Men

This study aimed to establish normative and reliability data for the Eating Disorder Examination-Questionnaire (EDE-Q) in a sample of high school and university men. A total of 250 men aged 15 to 30 years (mean = 19.7; SD = 2.3) with an average BMI of 23.1 (SD = 3.1) were administered the EDE-Q. Mean global EDE-Q was 0.44 (SD = 0.52), with subscale means ranging from 0.15 (SD = 0.38) for eating concern to 0.70 (SD = 0.81) for shape concern. EDE-Q scores among this non-clinical sample of normal-weight young men were significantly, and almost invariably, lower than similarly aged young women. The EDE-Q performed less reliably among men than women, and this is an important caveat. Owing to the overall pattern of low item endorsement, reliance upon this single instrument is unlikely to provide a comprehensive assessment of shape, weight, and eating concerns among normal-weight young men in the community.

Norms for the Eating Disorder Examination Questionnaire among female university students in Norway.

Background: The Eating Disorder Examination (EDE) is a semi-structured interview used worldwide for diagnostic purposes and to assess the core psychopathology of an eating disorder. The Eating Disorder Examination Questionnaire 6.0 (EDE-Q) has been developed as a self-report questionnaire version of the full-length interview. Aim: This study was conducted to establish norms among female university students in Norway and to test the reliability of the Norwegian version of the EDE-Q. Method: The questionnaire was administered to 670 young adult women with a mean age (±standard deviation) of 24.8±6.9 years. Result: Participants’ mean global EDE-Q score was 1.42±1.07 and subscales means were as follows: 1.44±1.23 for restraint, 0.63±0.88 for eating concern, 2.00±1.42 for shape concern, and 1.63±1.36 for weight concern. Acceptable levels of internal consistency were observed; Cronbachs alpha coefficients were 0.94 for the global EDE-Q score and 0.75–0.90 for the subscales. To evaluate the temporal stability of the EDE-Q, a total of 159 participants completed the measure 1 week later. Spearmans correlation coefficients were 0.93 for global EDE-Q and for the subscales 0.82–0.91, indicating a satisfactory level of test–retest reliability. Conclusion: The EDE-Q was easily administered and required only a few minutes to complete. This brief questionnaire provides a psychometrically established and cost-savings method of quickly assessing the core psychopathology of an eating disorder.

Short-term follow-up of adults with long standing anorexia nervosa or non-specified eating disorder after inpatient treatment

Objective: There are few follow-up studies on outcome for patients with long standing anorexia nervosa (AN) or non-specified eating disorder with several comorbid psychiatric disorders. Inpatient treatment is one option for these patients. The aim of this prospective study was to report one-year follow-up for a consecutive sample of these patients after an inpatient treatment program. Method: All 24 patients with a mean age of 28 years and mean duration of an eating disorder of 11 years were treated in a 23-week inpatient group treatment program for AN. Patients were assessed using Eating Disorder Examination interview (EDE), Eating Disorder Inventory (EDI) and Symptom Check List (SCL-90-R) at pre-treatment, post-treatment and at one year after start of treatment. At the follow-up 24 patients were personally interviewed. On admission 12 (50%) had AN, 8 (33%) non-specified eating disorder (EDNOS) and 4 (17%) bulimia nervosa (BN). All had previously suffered from AN and were clinically evaluated to have mostly anorectic psychopathology. Results: Ten (42%) patients had improved at follow-up and 14 (58%) had a poor outcome. There was a moderate but significant improvement on the EDE, EDI and GSI from pre-treatment to follow-up. The improvement occurred during inpatient treatment, and no significant differences from post-treatment to follow-up were found. Patients with low weight on admission showed a significant mean weight increase of about 4 kg at the follow-up. Conclusions: At one-year follow-up there was a moderate reduction of eating disorder symptoms and general psychiatric symptoms for patients with long standing anorexic symptoms. The improvement occurred during inpatient treatment. Inpatient treatment may be a treatment option in long-time rehabilitation for some of these patients.

Exercise dependence score in patients with longstanding eating disorders and controls: The importance of affect regulation and physical activity intensity

OBJECTIVE To examine associations among exercise dependence score, amount of physical activity and eating disorder (ED) symptoms in patients with longstanding ED and non-clinical controls. METHODS Adult female inpatients (n = 59) and 53 age-matched controls participated in this cross sectional study. Assessments included the eating disorders examination, eating disorders inventory, exercise dependence scale, reasons for exercise inventory, and MTI Actigraph accelerometer. RESULTS Positive associations were found among vigorous, not moderate, physical activity, exercise dependence score and ED symptoms in patients. In the controls, ED symptoms were negatively associated with vigorous physical activity and not correlated with exercise dependence score. Exercise for negative affect regulation, not weight/appearance, and amount of vigorous physical activity were explanatory variables for exercise dependence score in both groups. CONCLUSIONS The positive associations among exercise dependence score, vigorous physical activity and ED symptoms need proper attention in the treatment of longstanding ED.

Co-Occurrence of Avoidant Personality Disorder and Child Sexual Abuse Predicts Poor Outcome in Long-Standing Eating Disorder

Few consistent predictive factors for eating disorder have been identified across studies. In the current 5-year prospective study, the objective was to examine whether (a) personality disorder and child sexual abuse predict the course of severity of eating disorder symptoms after inpatient treatment and (b) how the predictors interact. A total of 74 patients with long-standing eating disorder and mean age of 30 years were assessed at the beginning and end of inpatient therapy and at 1-, 2-, and 5-year follow-up. A mixed model was used to examine the predictors. Avoidant personality disorder and child sexual abuse interacted in predicting high levels of eating disorder over a long-term course. These results suggest that eating disorder, avoidant personality disorder, and sequelae after child sexual abuse are potential targets for treatment that need further investigation.