Renee Rienecke Hoste

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.

Parental Expressed Emotion of Adolescents with Anorexia Nervosa: Outcome in Family-Based Treatment

OBJECTIVE The purpose of this study was to determine the relationship between expressed emotion (EE) and outcome in family-based treatment (FBT) for anorexia nervosa (AN). METHOD Eighty-six adolescents with AN participated in an RCT comparing two doses of FBT. Seventy-nine of these patients and their parents participated in a structured interview, from which EE ratings were made at baseline. Parents were compared on five subscales of EE as well as overall level of EE (high vs. low). RESULTS Overall EE levels were low with 32.9% of families presenting as High EE at baseline. Ratings of baseline warmth for both mothers (p = .014) and fathers (p = .037) were related to good outcome at end-of-treatment. DISCUSSION EE in parents of adolescents with AN is remarkably low. Notwithstanding, parental warmth may be a predictor of good outcome.

How do adolescents with bulimia nervosa rate the acceptability and therapeutic relationship in family-based treatment?

OBJECTIVE To describe therapeutic alliance and treatment acceptability ratings of adolescents with bulimia nervosa (BN) participating in family-based treatment (FBT-BN) and to explore how participant characteristics relate to these constructs. METHOD Adolescents with BN (n = 80) in a randomized controlled trial comparing FBT-BN and individual supportive psychotherapy (SPT), completed the Eating Disorder Examination, Rosenberg Self-esteem Scale, and Beck Depression Inventory prior to treatment. The Helping Relationship Questionnaire, patient expectancy for treatment, treatment suitability, and self-reported estimates of improvement ratings were obtained at multiple points throughout treatment. RESULTS Therapeutic alliance and treatment acceptability ratings were positive in both treatments and generally did not differ. Within FBT-BN, more severe eating disorder symptomatology pretreatment was related to lower alliance ratings mid-treatment (p < .05). However, reductions in binge and purge behaviors over the course of treatment were not related to alliance or acceptability for participants in FBT-BN (all ps > .10). CONCLUSION Contrary to expectations of FBT-BN, adolescents receiving both treatments develop a strong alliance with the therapist.

A Review of Family-Based Treatment for Adolescents with Eating Disorders

This review focuses on the use of family-based treatment (FBT) for adolescents with eating disorders, including anorexia nervosa (AN) and bulimia nervosa (BN). AN and BN are serious disorders with significant psychiatric and medical morbidity. Data support the use of family treatments for adolescents with eating disorders. Developed at the Maudsley Hospital, FBT is a theoretically agnostic approach that externalizes the illness from the patient and empowers families to actively work to bring about recovery in their relative with an eating disorder. FBT appears to be an effective treatment for adolescents with AN and support is developing for the treatment of adolescents with BN. Manual development is currently underway for the implementation of FBT for young adults with eating disorders, overweight adolescents, and those with subsyndromal AN. Further research is needed to determine the effectiveness of FBT with other populations. In this review, we will provide a critical overview of the literature by focusing upon empirical findings regarding FBT, with particular emphasis on studies conducted with adolescents.

Adolescent Focused Psychotherapy for Adolescents with Anorexia Nervosa

The paper describes a manualized specific form on individually based developmentally oriented therapy for Anorexia Nervosa (AN) in adolescents. Adolescent focused psychotherapy for AN is derived from a self-psychology model and is designed to address key deficits in development associated with AN. Adolescents with AN are viewed as using food and weight to avoid negative affective states associated with adolescent developmental issues that they perceive as intolerable. To develop a more constructive coping style and improve self-efficacy, adolescent patients need to first learn to identify and define their emotions, and later, to tolerate emotions, particularly negative ones. In withdrawing from the environment and situations which provoke distress through self-starvation and preoccupations with food and weight, emotional and psychological development is arrested. Learning to identify and cope adaptively with emotions and developmental challenges presented by the environment form the key therapeutic targets of treatment. Specific therapeutic procedures, a case illustration and discussion of therapeutic rationale are also provided.

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.

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.

Cultural Variability in Expressed Emotion among Families of Adolescents with Anorexia Nervosa

OBJECTIVE To examine the cultural variability in Expressed Emotion (EE) among families of white and ethnic minority adolescents with anorexia nervosa (AN). METHOD One-hundred and eighty-nine AN patients and their parents completed the Eating Disorder Examination and the Structured Clinical Family Interview, from which EE ratings were made. RESULTS No differences were found in the number of white and minority families classified as high EE. White families were higher on warmth (W) and tended to be higher on positive remarks (PR) than minority families. High EE was associated with a longer duration of illness, but was not related to eating disorder pathology. DISCUSSION Few differences were found between white and ethnic minority families on the EE dimensions of CC, hostility (H), or EOI. Differences between families on W and PR, however, may have important treatment implications.

Adolescent Bulimia Nervosa

Onset of bulimia nervosa (BN) typically occurs in adolescence and is frequently accompanied by medical and psychiatric sequelae that may have detrimental effects on adolescent development. Potentially serious medical consequences and high comorbid rates of mood disorders and suicidality underscore the need for early recognition and effective treatments. Research among adolescents with BN has lagged behind that of adults, although evidence is accumulating to support the efficacy of family-based interventions and cognitive behavioral treatments that are adapted for use with adolescent populations. The aim of the current article is to provide an overview of recent research on epidemiology, risk factors, diagnostic issues, and treatment interventions focusing on adolescent BN, and to highlight areas for future research.

Expressed emotion among white and ethnic minority families of adolescents with bulimia nervosa

Expressed emotion (EE), a measure of a relatives attitudes and behaviours towards an ill family member, has been found to be related to treatment outcome for both anorexia nervosa (AN) and bulimia nervosa (BN). Although cultural and ethnic background can influence the way in which family members interact, very little is known about cultural differences in EE among families of an eating disordered adolescent. As part of a treatment study for adolescent BN, 55 patients and 84 parents participated in a structured interview, from which EE ratings were made. White and ethnic minority families were compared on five subscales of EE as well as overall level of EE (high vs. low). No significant differences were found between white and minority families. These findings are consistent with previous studies suggesting that white and minority families of eating disorder patients may share several similarities.