Targeting habits in anorexia nervosa: a proof-of-concept randomized trial

2018 ◽  
Vol 48 (15) ◽  
pp. 2584-2591 ◽  
Author(s):  
Joanna E. Steinglass ◽  
Deborah R. Glasofer ◽  
Emily Walsh ◽  
Gabby Guzman ◽  
Carol B. Peterson ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Caloric Intake ◽  
Habit Strength ◽  
Self Report ◽  
Proof Of Concept ◽  
Supportive Psychotherapy ◽  
Eating Disorder Examination ◽  
End Of Treatment ◽  
The Impact

AbstractBackgroundHabits are behavioral routines that are automatic and frequent, relatively independent of any desired outcome, and have potent antecedent cues. Among individuals with anorexia nervosa (AN), behaviors that promote the starved state appear habitual, and this is the foundation of a recent neurobiological model of AN. In this proof-of-concept study, we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines.MethodsThe primary intervention target was habit strength; we also measured clinical impact via eating disorder psychopathology and actual eating. Twenty-two hospitalized patients with AN were randomly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aimed at cues for maladaptive behavioral routines, Regulating Emotions and Changing Habits (REaCH).ResultsCovarying for baseline, REaCH was associated with a significantly lower Self-Report Habit Index (SRHI) score and significantly lower Eating Disorder Examination-Questionnaire (EDE-Q) global score at the end-of-treatment. The end-of-treatment effect size for SRHI was d = 1.28, for EDE-Q was d = 0.81, and for caloric intake was d = 1.16.ConclusionsREaCH changed habit strength of maladaptive routines more than an active control therapy, and targeting habit strength yielded improvement in clinically meaningful measures. These findings support a habit-based model of AN, and suggest habit strength as a mechanism-based target for intervention.

scholarly journals Anomalous self-experience, body image disturbance, and eating disorder symptomatology in first-onset anorexia nervosa

2021 ◽  
Author(s):  
Lorenzo Moccia ◽  
Eliana Conte ◽  
Marianna Ambrosecchia ◽  
Delfina Janiri ◽  
Salvatore Di Pietro ◽  
...  
Keyword(s):  
Body Image ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Distribution Patterns ◽  
The Body ◽  
Body Image Disturbance ◽  
Level Of Evidence ◽  
Eating Disorder Examination ◽  
First Onset ◽  
The Impact

Abstract Purpose Anorexia nervosa-restrictive subtype (AN-R) is a life-threatening disorder relying on behavioural abnormalities, such as excessive food restriction or exercise. Such abnormalities may be secondary to an “objectified” attitude toward body image and self. This is the first study exploring the impact of anomalous self-experience (ASEs) on abnormal body image attitude and eating disorder (ED) symptomatology in individuals with AN-R at onset. Methods We recruited Italian female participants, 40 with AN-R (mean age 18.3 ± 2.3) and 45 age and educational level-matched healthy controls (HCs) (mean age 18.2 ± 2.6). ASEs, body image attitude, and ED symptom severity were assessed through the examination of anomalous self-experience (EASE), the body uneasiness test (BUT), and the eating disorder examination questionnaire (EDE-Q), respectively. We conducted multivariate analysis of variance to investigate distribution patterns of variables of interest, and mediation analysis to test the effect of ASEs and body image on ED symptomatology. Results Individuals with AN-R scored higher than HCs on the EASE (p < .0001). A direct effect of ASEs on ED severity (p = 0.009; bootstrapped LLCI = 0.067, ULCI = 0.240) was found in AN-R. After modelling the effect of abnormal body image attitude, the relationship between EASE total score and ED symptomatology was significantly mediated by BUT (p = 0.002; bootstrapped LLCI = 0.001, ULCI = 0.172). Conclusion Although the exact pathways linking AN-R to self-disorder remain to be identified, a broader exploration of transdiagnostic features in AN, including explorations of different dimensions of self-experience and intersubjectivity, may shed further light on the clinical phenomenology of the disorder. Level of evidence Level III, case–control analytic study.

scholarly journals Ultra-processed foods and binge eating: A retrospective observational study

2020 ◽  
Author(s):  
Agnes Ayton ◽  
Ali Ibrahim ◽  
James Dugan ◽  
Eimar Galvin ◽  
Oliver Wroe-Wright
Keyword(s):  
Eating Disorder ◽  
Observational Study ◽  
Binge Eating ◽  
Clinical Sample ◽  
Self Report ◽  
Retrospective Observational Study ◽  
Processed Foods ◽  
Eating Behaviours ◽  
Male Patients ◽  
The Impact

OBJECTIVEThere is increasing evidence of the impact of ultra-processed foods on multiple metabolic and neurobiological pathways, including those involved in eating behaviours, both in animals and in humans. In this pilot study, we aimed to explore ultra-processed foods and their link with disordered eating in a clinical sample. METHODSThis was a single site, retrospective observational study in a specialist eating disorder service using self report on the electronic health records. Patients with a DSM-5 diagnosis of anorexia nervosa (AN), bulimia nervosa (BN) or binge eating disorder (BED) were randomly selected from the service database in Oxford from 2017 to 2019. The recently introduced NOVA classification was used to determine the degree of industrial food processing in each patient’s diet. Frequencies of ultra-processed foods were analysed for each diagnosis, at each mealtime and during episodes of bingeing.RESULTS71 female and 3 male patients were included in the study. 22 had AN, 25 BN and 26 had BED. Patients with AN reported consuming 55% NOVA-4 foods, as opposed to approximately 70% in BN and BED. Binge foods were 100% ultra-processed.DISCUSSIONFurther research into the metabolic and neurobiological effects of reducing ultra-processed food intake on bingeing behaviour is needed.

scholarly journals The Influence of Food Reinforcement and Eating Disorder Pathology on Weight Change in Adolescents (P21-057-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Katherine Balantekin ◽  
Amanda Crandall ◽  
Amanda Ziegler ◽  
Jennifer Temple
Keyword(s):  
Eating Disorder ◽  
Weight Gain ◽  
Weight Change ◽  
Weight Status ◽  
Food Reinforcement ◽  
Self Report ◽  
Schedules Of Reinforcement ◽  
Eating Disorder Examination ◽  
Funding Sources ◽  
Median Split

Abstract Objectives Both the relative reinforcing value (RRV) of food, or the motivation to obtain food, and eating disorder (ED) pathology have been shown to independently predict weight gain. However, less is known about how the interaction between the RRV of food and ED pathology predicts weight gain over time. Therefore, the purpose of this study was to examine the combined effects of the RRV of food and ED pathology on weight change over 6 months in a sample of adolescents. Methods Participants included 77 12–14 year old adolescents participating in a longitudinal study examining factors that predict changes in weight status. Data presented are from baseline and 6 months. The RRV of food was assessed using a computer task. Participants earned points for energy dense food by pressing a mouse button on a computer across escalating schedules of reinforcement. Participants were classified as “low” or “high” in RRV based on a median split of their total responses. Global ED pathology was assessed at baseline using adolescent self-report on the Eating Disorder Examination Questionnaire. Participants were classified as “low” or “high” in ED pathology based on a median split of their global ED pathology. Four groups were created: low ED pathology/low RRV (n = 20), high ED pathology/low RRV (n = 23), low ED pathology/high RRV (n = 15), and high ED pathology/high RRV (n = 19). Height and weight were measured at both baseline and 6 months and used to calculate zBMI. ANOVA was used to examine differences in zBMI change over 6 months by RRV/ED pathology group. Results zBMI change from baseline to 6 months differed by RRV/ED pathology group (P < .05). Changes in zBMI over 6 months were as follows: - 0.025 ± 0.298 for low ED pathology/low RRV; 0.010 ± 0.322 for high ED pathology/low RRV; - 0.095 ± 0.181 for low ED pathology/high RRV; and 0.186 ± 0.268 for high ED pathology/high RRV. Follow-up contrasts revealed that the high ED pathology/high RRV group experienced greater zBMI changes than the other groups (ps < 0.05). Conclusions While the RRV of food and ED pathology are both independently associated with weight gain, the current study indicates that there may be something unique about the combination of high RRV of food and high ED pathology related to risk of weight gain. Future work is needed to identify strategies to limit weight gain in this vulnerable population. Funding Sources National Institutes of Health.

Cognitive Model of Eating Disorders

2001 ◽  
Vol 15 (4) ◽  
pp. 331-340 ◽  
Author(s):  
Wayne A. Bowers
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Empirical Studies ◽  
Cognitive Model ◽  
Cognitive Behavior ◽  
Eating Disorder Psychopathology ◽  
End Of Treatment ◽  
Negative Thoughts ◽  
Initial Research

Cognitive behavior Therapy (CBT) has been shown to be more effective or at least as effective as other psychotherapies in the treatment of bulimia nervosa with change being maintained 5 years after the end of treatment. Additionally, empirical studies demonstrate that CBT is superior to antidepressant medications in the treatment of bulimia nervosa. Less is known about CBT for anorexia nervosa but initial research suggests it may play a prominent role in treatment. CBT can influence changes in negative thoughts and schemas in anorexia nervosa as well as influence core eating disorder psychopathology and alter depressed mood. CBT may prevent relapse in the treatment of anorexia nervosa. More research is needed on the use of CBT in anorexia nervosa.

Shame traumatic memories and body image shame in Binge Eating Disorder: Can memories of warmth and safeness buffer this link?

2017 ◽  
Vol 41 (S1) ◽  
pp. S549-S549
Author(s):  
C. Duarte ◽  
J. Pinto-Gouveia
Keyword(s):  
Body Image ◽  
Eating Disorder ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Self Report ◽  
Childhood And Adolescence ◽  
Moderator Effect ◽  
Traumatic Memories ◽  
Emotional Memories ◽  
The Impact

IntroductionGrowing research show that body image-related shame plays a particularly important role in the vulnerability to and persistence of Binge eating symptoms. Also, shame experiences from childhood and adolescence were found to function as traumatic memories and are significantly associated with eating psychopathology. Nonetheless, little is known about the effect of shame traumatic memories in Binge Eating Disorder (BED), and whether early positive emotional memories of warmth and safeness may buffer against the impact of shame memories on body image shame.AimsThis study examined the moderator effect of positive emotional memories on the association between shame traumatic memories and current body image shame in women diagnosed with BED.MethodsParticipants (N = 109) were assessed through the eating disorder examination and the shame experiences interview, and answered to self-report measures assessing the traumatic features of a key shame memory, positive emotional memories s and body image shame.ResultsBody image-related experiences were most frequently recalled as significant shame memories. Positive emotional memories were negatively associated with shame traumatic memories and body image shame, and had a significant moderator effect on the association between shame traumatic memories and current body image shame.ConclusionsThis study was the first to demonstrate that early shame experiences may contribute for BED patients’ shame based on their body image. Data suggest that the access to memories of early feelings of affiliation and safeness may be key to tone down negative affect. These findings have important implications for the conceptualization and treatment of BED.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Emotion regulation difficulties in anorexia nervosa: associations with improvements in eating psychopathology

2021 ◽  
Author(s):  
Marsha Rowsell ◽  
Danielle E. MacDonald ◽  
Jacqueline C. Carter
Keyword(s):  
Emotion Regulation ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Intensive Treatment ◽  
Self Report ◽  
Eating Psychopathology ◽  
Eating Disorder Symptoms ◽  
Core Deficit ◽  
Eating Disorder Psychopathology ◽  
Regulation Strategies

Background Difficulties with emotion regulation have been established as a core deficit in anorexia nervosa (AN). However, limited research has evaluated whether weight gain is associated with improvements in emotion regulation difficulties in AN and whether improvements in emotion regulation are associated with reductions in eating disorder psychopathology. The aims of this study were threefold: 1) to examine the nature and extent of emotion regulation difficulties in AN; 2) to determine whether these difficulties improved during intensive treatment for the eating disorder; and 3) to study whether improvements in emotion regulation were associated with improvements in eating disorder psychopathology. Method The participants were 108 patients who met DSM-IV-TR criteria for AN and were admitted to a specialized intensive treatment program. Self-report measures of eating disorder symptoms and difficulties with emotion regulation were administered at admission to and discharge from the program. Results Patients with the binge-purge subtype of AN reported greater difficulties with impulse control when upset and more limited access to emotion regulation strategies when experiencing negative emotions than those with the restricting subtype. Among those who completed treatment and became weight restored, improvements in emotion regulation difficulties were observed. Greater pre-to-post treatment improvements in emotional clarity and engagement in goal directed behaviours when upset were associated with greater reductions in eating disorder psychopathology during treatment. Conclusions These findings add to growing evidence suggesting that eating disorder symptoms may be related to emotion regulation difficulties in AN and that integrating strategies to address emotion regulation deficits may be important to improving treatment outcome in AN.

scholarly journals Impact of COVID-19 lockdown measures on a cohort of eating disorders patients

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Paulo P. P. Machado ◽  
Ana Pinto-Bastos ◽  
Rita Ramos ◽  
Tânia F. Rodrigues ◽  
Elsa Louro ◽  
...  
Keyword(s):  
Emotion Regulation ◽  
Eating Disorder ◽  
Negative Impact ◽  
Self Report ◽  
Specialized Hospital ◽  
Impact Scale ◽  
Difficulties In Emotion Regulation ◽  
Clinical Impairment ◽  
Current Survey ◽  
The Impact

Abstract Background Lockdown implemented to prevent the COVID-19 spread resulted in marked changes in the lifestyle. The objective of the current study was to assess the impact of lockdown measures on a cohort of eating disorder (ED) patients being followed as part of an ongoing naturalistic treatment study. Methods Ninety-nine patients aged 18 or older, currently or previously, in treatment at a Portuguese specialized hospital unit were contacted by phone and invited to participate in the current survey. Fifty-nine agreed to be interviewed by phone, and 43 agreed to respond to a set of self-report measures of ED symptoms, emotion regulation difficulties, clinical impairment, negative urgency, and COVID-19 impact, during the week after the end of the lockdown period. Results Data showed that of the 26 patients currently in treatment: 8 remained unchanged (31%), 7 deteriorated (27%), and 11 reliably improved (42%). Of the 17 participants not currently in treatment: 3 deteriorated (18%), 9 remained unchanged (53%), and 5 (29%) improved after the lockdown period. The Coronavirus Impact Scale showed that most patients considered their routines moderately or extremely impacted, experienced stress related to coronavirus, and showed difficulty in maintaining physical exercise and feeding routines. Results suggest that higher impact of COVID-19 lockdown was significantly correlated with eating disorder symptoms and associated psychopathology, impulsivity, difficulties in emotion regulation and clinical impairment measured at post-lockdown. In addition, the impact of COVID-19 and lockdown measures on clinical impairment was mediated by difficulties in emotion regulation. Conclusions Findings suggest that some ED patients may experience worsening of their condition, especially if associated with difficulties in emotion regulation, and these difficulties might be exacerbated in the context of a stressful crisis and lockdown measures, highlighting the need for intervention strategies to mitigate its negative impact.

Prevention of Eating Disorders

2017 ◽  
pp. 335-362
Author(s):  
Evelyn Attia ◽  
Anne E. Becker ◽  
Cynthia M. Bulik ◽  
Alison E. Field ◽  
Neville H. Golden ◽  
...  
Keyword(s):  
Risk Factors ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Weight Maintenance ◽  
Eating Disorder Prevention ◽  
Effectiveness Trials ◽  
Low Prevalence ◽  
The Impact ◽  
Disorder Prevention

This chapter examines risk factors for the development of eating disorders and efforts to prevent them. A number of variables are considered to be risk factors; however, extant research has notable limitations, including the low prevalence of these conditions within the general population, which complicates the identification of reliable risk factors. The impact of culture on eating disorders is reviewed, as well as social and biological factors thought to exert complementary impact and to contribute synergistically to risk. Considerable progress has been made in developing and evaluating models for prevention since the publication of the prior edition of this book. These advances include the publication of several large effectiveness trials, the development of models to prevent the onset of anorexia nervosa and combined eating disorder prevention and weight maintenance/loss programs, and the availability of interventions for both boys and girls.

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