Paul E. Jenkins

Eating disorders and quality of life: A review of the literature

Following recent scientific interest in the quality of life (QoL) of individuals with eating disorders (EDs), this paper aims to provide a summary of the relevant evidence. A literature review on QoL in EDs (EDQoL) was carried out and relevant articles are described in six main sections. Following an introduction to the area and a summary of the methods used in the review, assessment of QoL in EDs is discussed. The third section represents the body of the review and appraises EDQoL in more detail, discussing what idiosyncratic features of EDs might be important in affecting QoL. The review concludes with suggestions for further research in this evolving area and summarizes the main findings. An evidence base is constructed supporting the idea that those with EDs have impaired QoL compared to other psychiatric and physical health conditions. However, what determines impairments in QoL is yet to be delineated although ideas for such variables, such as the presence of bingeing and purging, are suggested. Development of ED-specific measures has aided greatly in the pursuit of clarity, although equivocal conclusions in this complex area necessitate further research.

Perception of control during episodes of eating : relationships with quality of life and eating psychopathology

OBJECTIVE Experience of loss of control (LOC) during eating is an important indicator of pathology, although this concept has not received a great deal of research attention. The present study explores how quality of life (QoL) is related to LOC during eating. METHOD Three hundred and thirty-nine female university students completed measures of eating pathology, general psychiatric symptomatology, and QoL. They were subsequently categorized according to the degree of LOC experienced during eating into one of five groups: no binge eating (NBE); objective overeating (OOE); objective binge eating (OBE); subjective binge eating (SBE); and a mixed OBE/SBE group (Mixed). RESULTS Individuals who experienced LOC during eating reported significantly poorer QoL and more psychiatric symptoms. DISCUSSION In a nonclinical female sample, LOC during eating appeared to be a more important marker of pathology and poorer self-reported QoL than the amount of food eaten.

Psychometric validation of the Clinical Impairment Assessment in a UK eating disorder service.

A number of studies have provided data on young women for the Clinical Impairment Assessment (CIA, v. 3.0), a measure of psychosocial impairment in eating disorders. However, little data exists on eating disorder samples. The aim of the current study was to investigate psychometric properties of the CIA in a clinical sample, using confirmatory factor analysis based on the originally-proposed model. The CIA was administered alongside with the Eating Disorder Examination (EDE) to 190 individuals referred to an eating disorder service. Psychometric properties of the CIA were acceptable, based on model fit and factor loadings. The CIA appears to be a useful and valid measure for the assessment of impairment in eating disorders.

Health-related quality of life among adolescents with eating disorders

OBJECTIVE Health-related quality of life (HRQoL) is an emerging area of research in eating disorders (EDs) that has not been examined in adolescents in detail. The aim of the current study is to investigate HRQoL in an adolescent ED sample, examining the impact of ED symptoms on HRQoL. METHODS Sixty-seven treatment-seeking adolescents (57 females) with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) completed self-report measures of HRQoL and ED symptoms. RESULTS Participants reported poorer HRQoL in mental health domains than in physical health domains. Disordered attitudes, binge eating, and compensatory behaviors were associated with poorer mental health HRQoL, and body dissatisfaction was associated with poorer physical health HRQoL. CONCLUSION The current study assessed HRQoL among adolescents with EDs, finding several consistencies with the literature on adults with EDs. Future research should compare adolescents and adults with EDs on HRQoL.

Active waiting list management: potential usefulness in a community eating disorders service

We explored the usefulness of an initiative for managing a treatment waiting list in a community eating disorders service. We sent 108 patients awaiting treatment an opt-in letter and, if necessary, a reminder 3 weeks later. Those who opted in were compared with those who did not. Of those receiving the letter, 67.6% opted in and did not differ significantly from those who opted out on measures of eating disorder pathology and general functioning. However, they had waited less time. Opt-in letters may help to identify those who no longer want to access services, thereby allowing resources to be directed towards those who still want treatment.

Discerning Thoughts From Feelings: The Cognitive-Affective Division in Eating Disorders

This article delineates the phenomenon of “cognitive-affective division” in eating disorders, used to refer to the difficulty some patients face in translating what they “think” cognitively to what they “feel” emotionally. A clinical description of cognitive-affective division is first presented, drawing on existing research, before moving on to discuss psychological theories that might shed some light on this often-seen but seldom understood phenomenon. These include the role of emotion awareness and alexithymia, cognitive and emotional development, and neuropsychological theories. We discuss implications for treatment and further research of the cognitive-affective division in eating disorders.

Who benefits most from guided self-help for binge eating? an investigation into the clinical features of completers and non-completers

Guided self-help (GSH) is a recommended first step in treatment for bulimia nervosa (BN) and binge eating disorder (BED) (NICE, 2004). It remains unclear what makes some individuals more likely to respond to this form of treatment than others. Forty-eight patients participated in this study using a GSH programme for binge eating. Profiles of treatment completers and non-completers are compared, and reasons for non-completion explored. Completion of treatment was associated with significant improvements in mood, general functioning and on measures of dietary restraint, frequency of objective binge eating (OBE), laxative misuse, self-induced vomiting (SIV) and driven exercise. Improvements were maintained at follow-up. Treatment non-completers reported significantly higher pre-treatment levels of depression and weight concern, and lower levels of general health and vitality. Reasons for discontinuing treatment were related to perceptions of the GSH programme; practicalities of the programme; and readiness to change. Whilst GSH can be effective for a sub-group of patients, factors such as pre-morbid level of depression, degree of weight concern, perceptions of the programme, and readiness to change may increase the likelihood of non-completion.

An investigation into the psychometric properties of the CORE-OM in patients with eating disorders

AbstractAim: The current study aimed to explore the psychometric properties of the CORE-OM (Clinical Outcomes in Routine Evaluation – Outcome Measure) when used in an eating disorder sample. Method: The CORE-OM was administered at assessment to 360 individuals referred to an eating disorders service. Principal component analysis was conducted to look at the psychometric structure of the CORE-OM, and psychometric properties were investigated using analyses of reliability and validity. Results: Analyses of the psychometric structure suggested a three-component solution reflecting negatively worded, positively worded and risk items. The CORE-OM showed good acceptability, acceptable internal and test-retest reliabilities, as well as good convergent and known groups validity. Conclusions: The results of the current study support the CORE-OM as a reliable and valid measure for assessing psychological distress in eating disorders.

Is being underweight associated with impairments in quality of life in the absence of significant eating disorder pathology

Few studies have compared low-weight individuals with eating disorder (ED) pathology with similar-weight individuals without significant pathology despite the fact that body weight is often used as a key outcome within ED research. This study compared quality of life (QoL) in one group with high levels of ED pathology to a group with low ED pathology, matched by body mass index (BMI). The high ED group reported significantly lower ED-specific quality of life (EDQoL) than the low ED group. These findings suggest that young women with high levels of ED pathology report significantly more impaired QoL than comparable young women with no ED pathology, and that being underweight alone is not a primary contributor to poorer EDQoL.

The Relation Between Eating Disorder Symptoms and Impairment

Abstract Although a number of studies have looked at what factors might mediate the relationship between symptoms and quality of life (QoL) in a number of psychiatric disorders, little research has addressed this issue in eating disorders. In the current study, female undergraduates (N = 339) completed questionnaires assessing eating disorder symptoms, social support, coping, QoL, and psychosocial impairment. Perceived family support and levels of substance misuse as a way of coping were identified as mediators of the symptom-impairment relationship and, in addition, maladaptive coping also mediated the relationship with QoL. These results highlight the role of coping and social support in impairment resulting from eating disorder symptoms.