| 1. |
- Birgegård, Andreas, et al.
(author)
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Anorexic self-control and bulimic self-hate : differential outcome prediction from initial self-image
- 2009
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In: International Journal of Eating Disorders. - : Wiley. - 0276-3478 .- 1098-108X. ; 42:6, s. 522-530
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Journal article (peer-reviewed)abstract
- 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. CONCLUSION:: 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.
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| 2. |
- Björck, Caroline, et al.
(author)
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Negative self-image and outcome in eating disorders : results at 3-year follow-up.
- 2007
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In: Eating Behaviors. - : Elsevier BV. - 1471-0153 .- 1873-7358. ; 8:3, s. 398-406
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Negative self-image has been hypothesised to be of aetiological significance in eating disorders; however, its relationship to outcome remains unclear. The present study examined the relationship between self-image and follow-up status in a heterogeneous sample of eating disorder patients (N=246). METHODS: Patients were assessed at intake and after 36 months. Self-image was measured using SASB, and a general outcome measure was calculated comprising eating disorder symptoms, occupational status, interpersonal relationships and general psychopathology. RESULTS: SASB self-hate was the most important variable for predicting poor outcome, followed by occupational status, interpersonal relationships, eating disorder symptoms, SASB self-emancipation and general psychiatric symptoms. Together these variables predicted 23% of the variance in outcome. DISCUSSION: High levels of self-hate may increase the risk of poor outcome in eating disorders by adversely affecting interpersonal relationships and making it difficult for patients to engage in treatment.
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| 3. |
- Björck, Caroline, et al.
(author)
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Self-image and treatment drop-out in eating disorders
- 2008
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In: Psychology and Psychotherapy. - Leicester, UK : British Psychological Society. - 1476-0835 .- 2044-8341. ; 81:1, s. 95-104
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Journal article (peer-reviewed)abstract
- 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.
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| 4. |
- Björk, Tabita, et al.
(author)
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The impact of different outcome measures on estimates of remission in a 3-year follow-up of eating disorders
- 2011
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In: European eating disorders review. - : John Wiley & Sons. - 1072-4133 .- 1099-0968. ; 19:1, s. 2-11
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Journal article (peer-reviewed)abstract
- Objective: To examine the impact of using different outcome measures on estimates of remission rates in eating disorders (ED).Method: Adult ED patients (n = 334) included in a naturalistic, longitudinal project were assessed 3 years after intake. Remission was operationally defined using six different measures of outcome. Pairwise analyses of agreement between outcome measures were also calculated.Results: Remission rates for the entire group varied considerably from 24.3 to 77.8% depending on how remission was defined and who made the assessment (experts or patients). Outcome measures performed differently depending on diagnosis, and agreement between measures varied from none to very good.Conclusion: The impact of different definitions of outcome on remission estimates is considerable. There is a need to validate different estimates of remission by examining them in relation to multiple domains of outcome over time and by critically examining their relative merits both empirically and clinically.
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| 5. |
- Björk, Tabita, et al.
(author)
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What happened to the ones who dropped out? Outcome in eating disorder patients who complete or prematurely terminate treatment
- 2009
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In: European eating disorders review. - New York : Wiley. - 1072-4133 .- 1099-0968. ; 17:2, s. 109-119
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Journal article (peer-reviewed)abstract
- 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.
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| 6. |
- Bratland-Sanda, S., et al.
(author)
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Physical activity in treatment units for eating disorders : Clinical practice and attitudes
- 2009
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In: Eating and Weight Disorders. - 1124-4909 .- 1590-1262. ; 14:2-3, s. E106-E112
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Physical activity (PA) in eating disorders (ED) may be harmful, but in a therapeutic setting also beneficial. The purpose of this survey was to examine these contradictory aspects of PA in ED specialist treatment settings. We examined whether 1) PA is assessed by the unit, 2) the units have guidelines for managing excessive PA, 3) the units have staff with higher education and special competence in PA and exercise science, 4) how units regard PA in ED, 5) whether regular PA is integrated in the treatment programs, and 6) how the units rate the role of PA in the treatment of ED compared with other mental disorders. METHODS: Of the 49 units located in Scandinavia and the United Kingdom, 41 (84%) responded to a questionnaire. RESULTS: In 28 units (68%) PA was assessed regularly. Excessive PA was considered a harmful symptom in ED, and most units reported guidelines to manage excessive PA. Thirty-two units included PA in their treatment programmes. Clinicians found PA most relevant in the treatment of obesity and, except for binge eating, less for ED. CONCLUSION: PA was more commonly integrated in treatment compared to previous studies. Future research should address how to manage excessive PA, and the potential beneficial role of PA in the treatment of ED. (Eating Weight Disord. 14: e106-e112, 2009). (C) 2009, Editrice Kurtis
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| 7. |
- de Man Lapidoth, Joakim, et al.
(author)
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A comparison of eating disorders among patients receiving surgical vs non-surgical weight-loss treatments
- 2008
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In: Obesity Surgery. - Berlin : Springer. - 0960-8923 .- 1708-0428. ; 18:6, s. 715-720
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Journal article (peer-reviewed)abstract
- BACKGROUND: Little is known about differences between patients in surgical and non-surgical weight-loss treatments (WLT) regarding eating disorders, level of general psychopathology, and health-related quality of life (HRQL). Such differences could indicate different clinical needs in the management of surgical compared to non-surgical WLT patients. METHODS: Participants were a subset of 100 patients from a Swedish study investigating the long-term effects of eating disorders in WLT. Participants filled out the Eating Disorders in Obesity Questionnaire as well as self-rating questionnaires of general psychopathology and HRQL before initiating surgical (n = 54) or non-surgical (n = 46) WLT. RESULTS: Eating disorders were found to be more common among patients accepted for surgical treatments, whereas binge eating (as a symptom) was found to be equally common in both groups. Surgical patients also indicated higher levels of psychopathology compared to those receiving non-surgical treatment. CONCLUSION: Patients in surgical WLT are younger, more obese, and indicate higher levels of eating disorders and psychopathology than non-surgical WLT patients. Results highlight the importance of surgical WLT units having adequate knowledge, resources, and methods for detecting and addressing issues of eating disorders and psychopathology before and during the WLT. Future longitudinal studies need to ascertain to what extent eating and general psychopathology influence the outcome of WLT in terms of lapses, complications, weight gain, quality of life, etc.
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| 8. |
- de Man Lapidoth, Joakim, et al.
(author)
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Eating disorders and disordered eating among patients seeking non-surgical weight-loss treatment in Sweden
- 2006
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In: Eating Behaviors. - : Elsevier BV. - 1471-0153 .- 1873-7358. ; 7:1, s. 15-26
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Journal article (peer-reviewed)abstract
- The aim of this cross-sectional descriptive study of 194 Swedish men and women seeking non-surgical weight-loss treatment was to investigate the presence of eating disorders and binge eating symptoms and to compare these two groups of patients with a group without eating disorder- or binge eating symptoms. The groups were compared in regard to co-morbid psychopathology, Health Related Quality of Life (HRQL) and anthropometric data. Of the total sample, 9.8% fulfilled criteria for any eating disorder. An additional 7.2% indicated binge eating symptoms without having an eating disorder. The three groups were significantly different in regard to psychopathology scales and most HRQL items. Eating disorders and binge eating symptoms are common among patients seeking non-surgical weight-loss treatments in Sweden and both groups showed elevated levels of co-morbid psychopathology and lower HRQL compared to patients without disordered eating. These findings point to the importance of assessing the full range of eating disorder symptoms and disorders as well as HRQL and co-morbid psychopathology before weight-loss treatment, as these factors might affect treatment outcome.
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| 9. |
- Forsén Mantilla, Emma, et al.
(author)
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Self-image and 12-month outcome in females with eating disorders : extending previous findings
- 2019
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In: Journal of Eating Disorders. - : BMC. - 2050-2974. ; 7
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Journal article (peer-reviewed)abstract
- BackgroundThe interpersonal Structural Analysis of Social Behavior (SASB) model of self-image has repeatedly proven valuable in relation to eating disorder (ED) symptoms and in predicting ED outcome.ObjectiveWe studied the association between initial self-image according to the SASB and 12-month outcome, in five diagnostic groups of female ED patients. Based on previous findings, we expected autonomy related variables (self-control/autonomy) would strongly predict outcome in anorexia nervosa (AN) groups, whereas variables related to affiliation (self-attack/love) would moderately predict outcome in bulimia nervosa (BN).MethodParticipants were adult female patients, of whom 457 had AN restrictive type, 228 AN binge/purge subtype, 861 BN, 505 other specified ED and 170 binge eating disorder. Data came from the Stepwise clinical database in Sweden. Outcomes were presence/absence of ED diagnosis and self-rated ED symptoms, and we controlled for baseline ED pathology, BMI, age and general psychiatric symptoms.ResultsRegression analyses showed that although the pattern differed somewhat between diagnostic groups, high initial self-love and low self-attack/self-blame predicted a more positive 12-month outcome. In some groups (AN/R in particular), these variables remained important even when baseline pathology and age were included in the analyses.DiscussionSelf-image aspects once again display substantial power in predicting outcome in EDs. In AN/R patients, self-love plays an almost as crucial a role as baseline ED pathology in relation to 12-month outcome.
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| 10. |
- Gustafsson, Sanna Aila, et al.
(author)
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How to deal with sociocultural pressures in daily life : reflections of adolescent girls suffering from eating disorders
- 2011
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In: Journal of Multidisciplinary Healthcare. - : Dove Medical Press Ltd. - 1178-2390. ; 4, s. 103-110
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Journal article (peer-reviewed)abstract
- Adolescent girls with eating disorders experience unattainable and contradictory expectations in daily life, which create stress and negatively affect their self-evaluation. Disordered eating may function as a way of seeking control and consistency. In order to make progress in the understanding of eating disorders, the aim of this study was to describe how adolescent girls with eating disorders reflect upon ways of dealing with sociocultural pressures in daily life. Eighteen interviews with girls aged 15–19 years were analyzed using a phenomenographic approach. The results were summarized into three conceptions: ‘Striving to be oneself" (conception A) was described as the most desirable, but also the hardest. "Adapting to various situations’ (conception B) was used without much reflection, as long as it worked, but when this way of dealing with everyday expectations was unsuccessful it was evaluated negatively. "Presenting oneself in a positive light" (conception C) was described negatively even when it was successful. Within these conceptions, the participants described various strategies that could be used more or less effectively depending on the circumstances. A common theme was their difficulties in finding a balance between trying harder to live up to perceived expectations from others on one hand, and trying to accept the situation as it was, without trying to change themselves or the situation, on the other hand. The participants believed that their eating disorder was partly a result of being unable to deal with sociocultural pressures in an effective way, and they experienced a conflict between societal values of being assertive and values of being interpersonally oriented. Implications for treatment are discussed.
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