Staffan Sohlberg

Impulsivity and long-term prognosis of psychiatric patients with anorexia nervosa/bulimia nervosa.

Few if any reliable indicators of long-term outcome have been found in eating disorders. Impulsivity was the strongest predictor in the present study of 35 adults with anorexia nervosa or bulimia nervosa. This variable accounted for 25% of anorectic symptoms at 2 to 3 years follow-up and 14% at 4 to 6 years (Eating Attitudes Test). The relationship was specific insofar as impulsivity predicted neither depression nor overall mental health. Cognitive impairment may be one reason for the poor prognosis of impulsive patients.

Outcome, recovery, relapse and mortality across six years in patients with clinical eating disorders

The study describes course and outcome over 6 years for adults with eating disorders. Special interest is paid to clinically critical events such as relapse and premature death. Seventy‐seven per cent of the 30 prospectively studied patients had no eating disorder diagnosis after 6 years. Among the recovered patients, the total risk of relapse was 48%. The mortality was 17.8 times higher than expected. The overall pattern of results confirm earlier ones for anorexia nervosa and extend the limited database for bulimia nervosa. Of particular importance may be 1) that no patient in this sample suffered more than one major relapse and 2) that the risk for premature death may be twice as high among bulimic as among restricting patients.

Interpersonal profiles in eating disorders: ratings of SASB self-image.

INTRODUCTION Although evidence suggests that interpersonal psychotherapy may be an efficacious treatment for eating disorders, there is surprisingly little systematic knowledge about the interpersonal world of these patients. METHOD SASB self-image ratings were used to explore interpersonal profiles in a large heterogeneous sample of eating disorders (N = 830), matched normal controls (N = 105) and a small group of controls with subclinical depression (N = 26). RESULTS Eating disorder patients clearly presented with significantly more negative interpersonal profiles compared to controls. Within the eating disorder group, anorexics were characterized by high self-control, self-blame and self-attack. Patients with binge eating disorder expressed the least negative self-image, and were significantly more self-affirming than bulimics and less self-controlling than patients with atypical eating disorders. CONCLUSIONS Eating disorder patients may have distinct interpersonal profiles that increase the risk of negative therapeutic reaction. Better knowledge of interpersonal processes in eating disorders may help to improve both diagnostic assessment and treatment.

What happened to the ones who dropped out? Outcome in eating disorder patients who complete or prematurely terminate treatment.

INTRODUCTION There is a lack of knowledge about the outcome of eating disorder patients who terminate treatment prematurely. The present study followed-up eating disorder patients who had previously dropped out of treatment and examined clinical status 36 months after intake. METHOD Dropouts (n = 30) were compared with treatment completers (n = 52) on diagnostic status, clinical symptoms, psychosocial adjustment and treatment satisfaction at follow-up. Patterns of change from intake to follow-up within groups, as well as between groups, were explored. RESULTS No significant differences were found between groups at follow-up, except for more treatment dissatisfaction reported among dropouts. When patterns of change were examined between groups, patients who completed treatment were found to have made significantly greater changes (less eating disorder symptoms, less psychological problems and more positive self-image) compared to dropouts. DISCUSSION Although no significant differences in outcome were found between dropouts and completers, greater clinical improvement was found among those who completed treatment. The dropouts examined in this study did well despite premature termination of treatment. Clinical and research implications are discussed.

There's More in a Number than You Think: New Validity Data for the Global Assessment Scale

Holcomb and Otto (1988) recently suggested that the widely used Global Assessment Scale may have “… questionable validity as an index of psychopathology.” The present paper points out procedural and conceptual problems in their study and presents extensive evidence supporting the concurrent and predictive validity of the scale.

The anorectic bulimic conflict. An alternative diagnostic approach to anorexia nervosa and bulimia

ABSTRACT The reported increase over the last decades in the incidence of eating disorders seems to be accompanied by a shift in the symptomatic spectrum, so that the clinician now more often comes in contact with individuals not matching the picture of the “typical” anorexia nervosa patient. Seventy-nine patients assessed at the clinic over the last two and a half years were studied with respect to the differential diagnostic problems arising in this context. A considerable overlap in symptomatology was found between all sub- categories (anorexia nervosa, bulimia, double diagnosis of anorexia ner- vosa5ulimia according to the DSM-Ill, and “anorexic-like’?. Furthermore, 49 % had previously passed through at least one phase when a diagnosis other than that currently applicable would have been appropriate. These results, in combination with similar observations reported several times in the literature, imply the existence of some common feature among all the pa- tients. In the ABC-model, a conflict between anorectic and bulimic impulses is suggested as a concept capable of expressing this commonality while still representing a phenomenon identifiable at a clinical-descriptive level. The possible difficulties in detecting the conflict in the everyday clinical work are discussed along with the practical and theoretical advantages associated with applying the ABC-model to diagnosis, prognosis and treatment in eating disorders.

Anorexic self-control and bulimic self-hate: differential outcome prediction from initial self-image.

OBJECTIVE The study investigated initial self-image (structural analysis of social behavior) and its relation to 36-month outcome, among patients with anorexia nervosa and bulimia nervosa. Hypotheses were that degree of different aspects of self-image would predict outcome in the groups. METHOD Participants were 52 patients with anorexia and 91 with bulimia from a longitudinal naturalistic database, and outcome measures included eating disorder and psychiatric symptoms and a general outcome index. Stepwise regression was used to investigate which self-image variables were related to outcome, and multiple regression contrasted the groups directly on each obtained predictor. RESULTS Consistent with hypotheses, in bulimia degree of self-hate/self-love moderately predicted outcome, whereas self-control-related variables powerfully predicted outcome in anorexia. DISCUSSION It is important to focus on self-image in the treatment of both diagnostic groups, but especially in anorexia nervosa, where control-submission interactions between patient and therapist should be handled with care.

Ego functioning in eating disorders: Description and relation to diagnostic classification

A working assumption for many clinicians is that differences in personality functioning among eating-disordered patients are crucial for treatment planning and prognosis. However, the empirical documentation is scarce. The present study used analyses of 13 objectively rated ego functions in a sample of 48 eating-disordered patients to try to establish a firmer empirical basis in the area. The variation in ego functioning was great, and a cluster analysis identified four clusters. These were tentatively named “higher neurotic,” “lower neurotic,” “borderline,” and “borderline-psychotic.” The clusters were unrelated to DSM-III-R eating disorder diagnoses and to the restricter/bulimic distinction and related markedly differently from those classifications to other clinical variables. The most interesting associations occurred between ego functioning and variables of possible prognostic value. Ego functioning thus constitutes a complementary diagnostic dimension of potential importance for prognosis.

Prediction of the course of anorexia nervosa/bulimia nervosa over three years.

The search for course and outcome predictors in anorexia nervosa has a long but not very successful history. In the present investigation, 32 adults with anorexia nervosa or bulimia nervosa were studied 1, 2, and 3 years after presentation to a university hospital psychiatric clinic. As predicted, status after 1 year was strikingly poorer for those with less ego strength and more stressful life events (44% variance explained). However, this result was not replicated after 2 and 3 years. Instead, social support was strongly predictive of third year status. Weak but recurring associations with poor follow-up status were found for binging-purging and distrust of other people (Eating Disorder Inventory).

Self-image and treatment drop-out in eating disorders

INTRODUCTION Drop-out from treatment is a serious problem in eating disorders which remains poorly understood. The present study investigated whether self-image and interpersonal theory could help to explain why eating disorder patients drop out of treatment. METHOD Intake data on eating disorder patients who terminated treatment prematurely (N=54) were compared with patients who had completed treatment (N=54) and those who were still in treatment after 12 months (N=54). Self-image was assessed using the structural analysis of social behaviour (SASB), and comparisons were made on demographic and clinical variables. RESULTS Patients who dropped out had initially presented with less negative self-image and fewer psychological problems compared with remainers. Low levels of SASB self-blame discriminated drop-outs from completers and remainers and significantly predicted treatment drop-out. DISCUSSION Drop-out in eating disorders appears to be a complex phenomenon, not necessarily as pathological as often assumed. There may be important differences in the treatment goals of drop-outs and therapists; patients who drop out may be choosing to disengage at a time when symptom improvement creates space for closer examination of interpersonal issues.