| 1. |
- Forsén Mantilla, Emma, et al.
(författare)
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Exercise caution : Questions to ask adolescents who may exercise too hard
- 2018
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 15:4
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Tidskriftsartikel (refereegranskat)abstract
- When the primary goal of exercise is to compensate for food intake and to alter body shape and weight, it is considered compulsive and may be harmful. Compulsive exercise (CE) is important in the pathogenesis of eating disorders (EDs). Many healthy adolescents engage in CE too, and this may indicate a risk for EDs. Our aim was to learn more about ED risk factors tied to CE and to try to isolate questions to ask in order to probe for high ED risk in adolescents engaging in CE. Using two well-established instruments (the Structural Analysis of Social Behavior and the Eating Disorders Examination Questionnaire), we studied associations between ED variables and CE in healthy adolescent boys and girls. We examined gender-specific items to generate the best possible fit for each gender. Individuals with CE displayed significantly greater ED pathology and more self-criticism, and this pattern was stronger in girls than in boys. Risk factors for ED among individuals with CE differed slightly for boys and girls. We put forward a set of gender-specific questions that may be helpful when probing for ED risk among adolescents engaging in CE.
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| 2. |
- Forsén Mantilla, Emma, et al.
(författare)
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Impulsivity and compulsivity as parallel mediators of emotion dysregulation in eating-related addictive-like behaviors, alcohol use, and compulsive exercise
- 2022
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Ingår i: Brain and Behavior. - : John Wiley & Sons. - 2162-3279 .- 2162-3279. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Transdiagnostically relevant psychological traits associated with psychiatric disorders are increasingly being researched, notably in substance use and addictive behaviors. We investigated whether emotion dysregulation mediated by impulsivity and/or compulsivity could explain variance in binge eating, food addiction, self-starvation, and compulsive exercise, as well as alcohol use (addictive-like behaviors relevant to the obesity and eating disorder fields).METHOD: A general population sample of adults (N = 500, mean age = 32.5 years), females (n = 376) and males (n = 124), completed the Difficulties in Emotion Regulation Scale-16, the Trait Rash Impulsivity Scale, the Obsessive-Compulsive Inventory-Revised, the Eating Disorders Examination Questionnaire, the Self-Starvation Scale, the Exercise Dependence Scale, the Yale Food Addiction Scale, and the Alcohol Use Disorders Identification Test online. Besides gender comparisons and intercorrelations between measures, we used predefined multiple mediation models with emotion dysregulation as independent variable, impulsivity and compulsivity as parallel mediators, to investigate whether these factors contributed explanatory power to each addictive-like behavior as outcome, also using age and body mass index as covariates.RESULTS: Females scored higher than males on emotion dysregulation and the eating-related addictive-like behaviors food addiction, self-starvation, and binge eating. Intercorrelations between measures showed that emotion dysregulation and compulsivity were associated with all outcome variables, impulsivity with all except compulsive exercise, and the eating-related behaviors intercorrelated strongly. Mediation models showed full or partial mediation of emotion dysregulation for all behaviors, especially via compulsivity, suggesting a behavior-specific pattern. Mediation models were not affected by age or gender.DISCUSSION: Addictive-like behaviors seemed to be maintained by trait levels of emotion dysregulation, albeit channeled via trait levels of compulsivity and/or impulsivity. The role of emotion dysregulation may help us to understand why addictive-like behaviors can be difficult to change in both clinical and nonclinical groups, and may be informative for treatment-planning in patients where these behaviors are present. Our findings support adopting a more dimensional approach to psychiatric classification by focusing psychological facets such as those studied.
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| 3. |
- Högdahl, Louise, et al.
(författare)
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Personality predicts drop-out from therapist-guided internet-based cognitive behavioural therapy for eating disorders : Results from a randomized controlled trial
- 2016
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 5, s. 44-50
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Tidskriftsartikel (refereegranskat)abstract
- Internet-based guided self-help cognitive behavioural therapy (ICBT) seems a promising way of delivering eating disorder treatment. However, treatment drop-out is a common problem and little is known about the correlates, especially in clinical settings. The study aimed to explore prediction of drop-out in the context of a randomized controlled trial within specialized eating disorder care in terms of eating disorder symptomatology, personality traits, comorbidity, and demographic characteristics. 109 outpatients diagnosed with bulimia nervosa or similar eating disorder were randomized to two types of ICBT. Participants were assessed with several clinical- and self-ratings. The average drop-out rate was 36%. Drop-out was predicted by lower scores in the personality traits Dutifulness and Assertiveness as measured by the NEO Personality Inventory Revised, and by higher scores in Self-affirm as measured by the Structural Analysis of Social Behaviour. Drop-out was also predicted by therapist factors: one therapist had significantly more drop-outs (82%) than the other three (M = 30%). Theoretical and clinical implications of the impact of the predictors are discussed.
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| 4. |
- Levallius, Johanna, et al.
(författare)
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Binge eating and addictive-like behaviours in males and females
- 2022
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Ingår i: Psychological Reports. - : Sage Publications. - 0033-2941 .- 1558-691X. ; 125:1, s. 148-166
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Binge eating is a common behaviour that is strongly linked to both obesity and eating disorder. There is evidence that binge eating commonly co-occurs with other problematic and addictive-like behaviours; however, this has not been explored systematically. The present study aimed to examine the relationship between binge eating, body weight, disordered eating behaviours and associated addictive-like behaviours, with particular attention paid to gender differences.METHOD: A community sample (N = 500; 75% female, Mage = 32.5 years) reported disordered eating behaviours (i.e. binge eating, purging, restriction of eating, compulsive exercise), body mass index (BMI), food addiction, starvation addiction, exercise dependence, tobacco use and alcohol consumption.RESULTS: 42% of females and 21% of males reported binge eating during the past four weeks. Binge eating was significantly associated with all investigated behaviours in females, and with purging, compulsive exercise and overweight/obesity in males. Controlling for BMI, self-starvation predicted binge eating in males (OR = 1.07), while food addiction (OR = 1.73) and alcohol dependence (OR = 1.11) predicted binge eating in females.CONCLUSIONS: The multiple associations between binge eating and addictive-like behaviors supports broad screening and generalized prevention efforts. Prevention efforts should reflect gender differences.
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| 5. |
- Levallius, Johanna
(författare)
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Eating disorders and personality
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Eating disorders are serious psychiatric conditions often demanding specialized psychiatric care. Several effective treatments have been developed and disseminated, but more needs to be done, as not all patients respond well to intervention, let alone achieve recovery. Obvious candidates such as eating disorder diagnosis, symptoms and psychiatric comorbidity have generally failed to explain variability in prognosis and outcome, warranting investigation of a wider range of relevant factors. Accumulating evidence suggests personality as an avenue to better understand psychopathology. This dissertation investigated how personality could increase the understanding of eating disorders and their treatment. The first aim was to investigate how patients with eating disorder differed from normal controls (Study I) on the five-factor model of personality. The second aim was to investigate if and how personality could explain variance in eating disorder symptoms and other psychopathology (Study I). The third aim was to test if personality could predict outcome from two different interventions: day-patient treatment (Study II) and internet-based treatment (Study III). Since personality is also susceptible to change, the final aim was to investigate personality change over time in patients and how change patterns related to treatment and course of the eating disorder (Study IV). Longitudinal data from a clinical sample of adult female patients with eating disorders was collected, including psychiatric diagnoses, symptoms, personality, and treatment. In Study I, patients were cross-sectionally compared to age-matched controls on personality. Study II examined if personality at admission could predict outcome from group-based psychodynamic day-patient treatment (DAY). Study III examined if personality could predict outcome from internet-based cognitive behavioral therapy (iCBT). In Study IV, personality was assessed at three time points, before treatment, at termination and at six-month follow-up. Patients differed significantly from controls on the majority of personality traits. Personality could further explain variance in both general and eating disorder specific psychopathology. Extraversion and Assertiveness predicted both eating disorder improvement and remission after DAY whereas both Openness to Experience and Conscientiousness predicted a better outcome from iCBT. Over time, patients decreased in Neuroticism and increased in Extraversion, Openness to Experience and Conscientiousness. There was considerable individual variability in personality change and more than a quarter of patients reliably changed per trait. Patients remitting after treatment showed similar change of increased Assertiveness, Competence, Self-discipline, Openness to Actions, and Positive Emotions. Patients’ personality differed significantly from controls and was associated with both psychopathology and treatment outcome. Personality changed significantly towards normalization, particularly in remitted patients. This project concludes that personality is meaningfully linked to eating disorders and is a malleable aspect of the patient. Greater consideration of personality may help improve treatment.
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| 6. |
- Levallius, Johanna, et al.
(författare)
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Maturation in patients with borderline personality disorder
- 2015
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Ingår i: Psychiatry Research. - : Elsevier. - 0165-1781 .- 1872-7123. ; 228:3, s. 950-952
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Tidskriftsartikel (refereegranskat)abstract
- Patients with borderline personality disorder have a characteristic and extreme personality associated with psychopathology. The aim was to investigate personality change in relation to suicidality following treatment. 21 patients were assessed before and after psychotherapy on personality (NEO PI-R) and suicidality (SUAS). At follow-up, Neuroticism and Conscientiousness normalized along with six lower-order facets; Depression, Impulsiveness, Competence, Achievement Striving, Self-Discipline and Deliberation. Thirteen patients showed a positive personality development paralleled by a lesser degree of suicidality.
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| 7. |
- Levallius, Johanna, et al.
(författare)
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Now you see it, now you don't : compulsive exercise in adolescents with an eating disorder
- 2017
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Ingår i: Journal of eating disorders. - : BioMed Central (BMC). - 2050-2974. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Compulsive exercise (CE) has been proposed as significant in the etiology, development and maintenance of eating disorders (EDs), resulting in more severe and enduring pathology. However, few studies have investigated CE longitudinally in adolescents with EDs. We aimed to test if adolescents show the same associations between CE and other clinical variables as previous research has found in adults.METHODS: Three thousand one hundred sixteen girls and 139 boys from a clinical ED database were investigated regarding prevalence and frequency of CE and its relation to psychiatric symptoms, associated features and outcome. Denial of illness is common among adolescents and was therefore adjusted for.RESULTS: Adjusted CE prevalence in girls was 44%, and CE was most prevalent in bulimia nervosa. As previously found in adults, those with CE scored significantly higher than non-CE on total ED severity, level of restriction and negative perfectionism. However, there were only minor differences between CE and non-CE patients on emotional distress, hyperactivity, suicidality and self-esteem. Among boys, adjusted CE prevalence was 38%, and CE boys scored significantly higher than non-CE on total ED severity. Initial CE did not influence 1-year outcome, although cessation of CE was associated with remission.CONCLUSIONS: CE is a common clinical feature in adolescents with EDs and cessation is associated with remission. When controlling for denial of illness, CE had less detrimental impact than predicted. We recommend controlling for denial in studies on ED adolescents and further exploration of classification and treatment implications of CE.
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| 8. |
- Levallius, Johanna, et al.
(författare)
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Personality as predictor of outcome in internet-based treatment of bulimic eating disorders
- 2020
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Ingår i: Eating Behaviors. - : Elsevier. - 1471-0153 .- 1873-7358. ; 36
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Tidskriftsartikel (refereegranskat)abstract
- Internet-based cognitive behavioral therapy (ICBT) for bulimic eating disorders has demonstrated clinical utility and cost efficiency, but is associated with low patient preference, low credibility, sizeable dropout and only moderate symptom reduction. To improve outcome it is imperative to learn more about who might benefit from internet-based interventions. To do this, the current study investigated the Five Factor Model of personality as predictor of outcome in patients with full or sub-threshold bulimia nervosa (n = 109). Patients in a randomized controlled trial of ICBT were assessed prior to and at the end of treatment. Patients showed significant symptom reduction over time (Cohen's d = 1.0, p < .001). Remission as well as overall symptom reduction was positively predicted by Openness to Experience and Conscientiousness. Binge eating cessation specifically, was positively predicted by Extraversion. The study supports the use of personality assessment for patient selection and outcome optimization in internet-based treatment of bulimic eating disorders.
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| 9. |
- Levallius, Johanna, et al.
(författare)
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Take charge : Personality as predictor of recovery from eating disorder
- 2016
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Ingår i: Psychiatry Research. - : Elsevier. - 0165-1781 .- 1872-7123. ; 246, s. 447-452
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Tidskriftsartikel (refereegranskat)abstract
- Many treatments for eating disorders (ED) have demonstrated success. However, not all patients respond the same to interventions nor achieve full recovery, and obvious candidates like ED diagnosis and symptoms have generally failed to explain this variability. The current study investigated the predictive utility of personality for outcome in ED treatment. One hundred and thirty adult patients with bulimia nervosa or eating disorder not otherwise specified enrolled in an intensive multimodal treatment for 16 weeks. Personality was assessed with the NEO Personality Inventory Revised (NEO PI-R). Outcome was defined as recovered versus still ill and also as symptom score at termination with the Eating Disorder Inventory-2 (EDI-2). Personality significantly predicted both recovery (70% of patients) and symptom improvement. Patients who recovered reported significantly higher levels of Extraversion at baseline than the still ill, and Assertiveness emerged as the personality trait best predicting variance in outcome. This study indicates that personality might hold promise as predictor of recovery after treatment for ED. Future research might investigate if adding interventions to address personality features improves outcome for ED patients.
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| 10. |
- Levallius, Johanna, et al.
(författare)
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Who do you think you are? - Personality in eating disordered patients.
- 2015
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Ingår i: Journal of Eating Disorders. - : Springer Science and Business Media LLC. - 2050-2974. ; 3:3
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Tidskriftsartikel (refereegranskat)abstract
- The Five-Factor Model of personality is strongly linked to common mental disorders. Yet the relationship between the lower order personality traits (facets) of the model and eating disorder (ED) features remains unclear. The aim of the study was to explore how patients with non-anorexic ED differ from controls in personality and to examine the ability of personality facets to explain psychopathology.
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