| 1. |
- Schaumberg, Katherine, et al.
(author)
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Patterns of diagnostic transition in eating disorders : a longitudinal population study in Sweden
- 2019
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In: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 49:5, s. 819-827
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Journal article (peer-reviewed)abstract
- BACKGROUND: Transition across eating disorder diagnoses is common, reflecting instability of specific eating disorder presentations. Previous studies have examined temporal stability of diagnoses in adult treatment-seeking samples but have not uniformly captured initial presentation for treatment. The current study examines transitions across eating disorder diagnostic categories in a large, treatment-seeking sample of individuals born in Sweden and compares these transitions across two birth cohorts and from initial diagnosis.METHODS: Data from Swedish eating disorders quality registers were extracted in 2013, including 9622 individuals who were seen at least twice from 1999 to 2013. Patterns of remission were examined in the entire sample and subsequently compared across initial diagnoses. An older (born prior to 1990) and younger birth cohort were also identified, and analyses compared these cohorts on patterns of diagnostic transition.RESULTS: Although diagnostic instability was common, transition between threshold eating disorder diagnoses was infrequent. For all diagnoses, transition to remission was likely to occur following a diagnosis state that matched initial diagnosis, or through a subthreshold diagnostic state. Individuals in the younger cohort were more likely to transition to a state of remission than those in the older cohort.CONCLUSIONS: Results indicate more temporal continuity in eating disorder presentations than suggested by previous research and highlight the importance of early detection and intervention in achieving remission.
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| 2. |
- Andersén, Mikael, 1985-, et al.
(author)
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Diagnosis‐specific self‐image predicts longitudinal suicidal ideation in adult eating disorders
- 2017
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In: International Journal of Eating Disorders. - : John Wiley & Sons. - 0276-3478 .- 1098-108X. ; 50:8, s. 970-978
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Journal article (peer-reviewed)abstract
- Objective: Eating disorders (ED) are prevalent, serious illnesses with elevated mortality, mainly attributable to suicide. Predictors of suicidality include binge/purge symptomatology, impulsivity, and psychiatric comorbidity, as well as personality factors. Recent research has also shown self‐image (the Structural Analysis of Social Behavior, SASB, model) to predict manifest suicide attempts in ED, and the study explored suicide risk prediction to increase knowledge of warning signs and intervention targets.Method: Participants were adult ED patients registered in the Stepwise clinical database (N = 1537) with anorexia nervosa (AN), bulimia nervosa (BN), binge‐eating disorder (BED), or other specified feeding and eating disorder (OSFED). The SASB self‐image questionnaire was used in stepwise regressions to predict 12‐month suicidal ideation, both self‐ and clinician‐rated, in models both excluding and including baseline clinical variables.Results: Validation analyses showed fair correspondence between outcome variables as well as with suicide attempts. Different variables predicted suicidality in different diagnoses, over and above baseline clinical variables in all but one regression model. Low Self‐protection was important in AN and BN, high Self‐control in AN, and high Letting go of the self in BN. For BED, self‐blame explained variance, and in OSFED, lack of self‐love.Discussion: Findings are in line with research showing differential self‐image‐based prediction of important outcomes in ED, with noteworthy consistencies across diagnoses and suicidality variables. Strengths included the large sample, and limitations pertained to measures, attrition and Type II error risk. Replication is needed, but findings are consistent with some previous work and offers clinical and research implications.
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| 3. |
- Barbui, Tiziano, et al.
(author)
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Philadelphia-Negative Classical Myeloproliferative Neoplasms : Critical Concepts and Management Recommendations From European LeukemiaNet
- 2011
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In: Journal of Clinical Oncology. - 0732-183X .- 1527-7755. ; 29:6, s. 761-770
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Journal article (peer-reviewed)abstract
- We present a review of critical concepts and produce recommendations on the management of Philadelphia-negative classical myeloproliferative neoplasms, including monitoring, response definition, first-and second-line therapy, and therapy for special issues. Key questions were selected according the criterion of clinical relevance. Statements were produced using a Delphi process, and two consensus conferences involving a panel of 21 experts appointed by the European LeukemiaNet (ELN) were convened. Patients with polycythemia vera (PV) and essential thrombocythemia (ET) should be defined as high risk if age is greater than 60 years or there is a history of previous thrombosis. Risk stratification in primary myelofibrosis (PMF) should start with the International Prognostic Scoring System (IPSS) for newly diagnosed patients and dynamic IPSS for patients being seen during their disease course, with the addition of cytogenetics evaluation and transfusion status. High-risk patients with PV should be managed with phlebotomy, low-dose aspirin, and cytoreduction, with either hydroxyurea or interferon at any age. High-risk patients with ET should be managed with cytoreduction, using hydroxyurea at any age. Monitoring response in PV and ET should use the ELN clinicohematologic criteria. Corticosteroids, androgens, erythropoiesis-stimulating agents, and immunomodulators are recommended to treat anemia of PMF, whereas hydroxyurea is the first-line treatment of PMF-associated splenomegaly. Indications for splenectomy include symptomatic portal hypertension, drug-refractory painful splenomegaly, and frequent RBC transfusions. The risk of allogeneic stem-cell transplantation-related complications is justified in transplantation-eligible patients whose median survival time is expected to be less than 5 years.
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| 4. |
- Barbuil, Tiziano, et al.
(author)
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Philadelphia chromosome-negative classical myeloproliferative neoplasms : revised management recommendations from European LeukemiaNet
- 2018
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In: Leukemia. - : Nature Publishing Group. - 0887-6924 .- 1476-5551. ; 32:5, s. 1057-1069
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Research review (peer-reviewed)abstract
- This document updates the recommendations on the management of Philadelphia chromosome-negative myeloproliferative neoplasms (Ph-neg MPNs) published in 2011 by the European LeukemiaNet (ELN) consortium. Recommendations were produced by multiple-step formalized procedures of group discussion. A critical appraisal of evidence by using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology was performed in the areas where at least one randomized clinical trial was published. Seven randomized controlled trials provided the evidence base; earlier phase trials also informed recommendation development. Key differences from the 2011 diagnostic recommendations included: lower threshold values for hemoglobin and hematocrit and bone marrow examination for diagnosis of polycythemia vera (PV), according to the revised WHO criteria; the search for complementary clonal markers, such as ASXL1, EZH2, IDH1/IDH2, and SRSF2 for the diagnosis of myelofibrosis (MF) in patients who test negative for JAK2V617, CALR or MPL driver mutations. Regarding key differences of therapy recommendations, both recombinant interferon alpha and the JAK1/JAK2 inhibitor ruxolitinib are recommended as second-line therapies for PV patients who are intolerant or have inadequate response to hydroxyurea. Ruxolitinib is recommended as first-line approach for MF-associated splenomegaly in patients with intermediate-2 or high-risk disease; in case of intermediate-1 disease, ruxolitinib is recommended in highly symptomatic splenomegaly. Allogeneic stem cell transplantation is recommended for transplant-eligible MF patients with high or intermediate-2 risk score. Allogeneic stem cell transplantation is also recommended for transplant-eligible MF patients with intermediate-1 risk score who present with either refractory, transfusion-dependent anemia, blasts in peripheral blood > 2%, adverse cytogenetics, or high-risk mutations. In these situations, the transplant procedure should be performed in a controlled setting.
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| 5. |
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| 6. |
- 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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| 7. |
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| 8. |
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| 9. |
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| 10. |
- Birgegård, Andreas, et al.
(author)
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New methodological advice for research in subliminal psychodynamic activation
- 1999
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In: Perceptual and Motor Skills. - 0031-5125 .- 1558-688X. ; 88:3, s. 747-755
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Journal article (peer-reviewed)abstract
- Recent integration among approaches to perception without awareness has brought the usefulness of Subliminal Psychodynamic Activation into renewed locus. Several authors have discussed the possible detrimental impact on interpretation when control phrase
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| 11. |
- Birgegård, Andreas, 1972-
(author)
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Producing, Preventing, and Explaining Persistent Complex Subliminal Stimulation Effects
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Strong recent focus on unconscious processes has increased interest in subliminal stimulation and similar experimental technologies. Assumptions about the persistence of effects of unconscious stimulation are generally conservative, referring to seconds or minutes (Silverman, 1977; Velmans, 1991). In Study I, five experiments (N = 365) showed complex effects of unconscious stimulation ten days after subliminal exposure, implying that persistence estimates need reevaluation. Experimental stimuli were "mommy and I are one" (MIO) and "mommy and I are dissimilar" (MIDIS), and neutral control stimuli. Effects consisted of higher correlations between measures pertaining to the self-mother relationship and measures of psychological adjustment. These ethically problematic findings prompted investigation in Study II of whether debriefing information to participants could prevent persistent effects of subliminal stimuli, an issue not previously investigated. Two experiments (N=188) tested two kinds of information to participants following subliminal MIDIS or control stimulation. Results showed different persistent effects depending on participant sex. Simple information about the stimulus was effective in preventing these, but elaborate information describing the effects and mechanisms for them was not. The findings have implications for ethical recommendations for subliminal research, and suggest that this unexplored area requires more attention. In Study III, a theoretical account for the persistent effects is presented, based on unconscious activation of a relational schema containing goal motivation. Unless the goal is fulfilled or activation dissipates due to attributability or irrelevance of the goal, the activation will be maintained (motivated maintenance). Being unconscious, the influence results in automatic schematic processing of environmental cues, including perceptual, judgment, and behavioral biases. These in turn interactively maintain the activation of the schema (interactive maintenance). The discussion includes the conclusion that previous estimates of the persistence of unconscious stimulation effects need revision. Theoretical and empirical questions concerning the studies are discussed and ethical research implications are considered.
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| 12. |
- Birgegård, Andreas, et al.
(author)
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Quality assurance of specialised treatment of eating disorders using large-scale Internet-based collection systems : methods, results and lessons learned from designing the Stepwise database.
- 2010
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In: European eating disorders review. - : Wiley. - 1072-4133 .- 1099-0968. ; 18:4, s. 251-9
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Journal article (peer-reviewed)abstract
- Computer-based quality assurance of specialist eating disorder (ED) care is a possible way of meeting demands for evaluating the real-life effectiveness of treatment, in a large-scale, cost-effective and highly structured way. The Internet-based Stepwise system combines clinical utility for patients and practitioners, and provides research-quality naturalistic data. Stepwise was designed to capture relevant variables concerning EDs and general psychiatric status, and the database can be used for both clinical and research purposes. The system comprises semi-structured diagnostic interviews, clinical ratings and self-ratings, automated follow-up schedules, as well as administrative functions to facilitate registration compliance. As of June 2009, the system is in use at 20 treatment units and comprises 2776 patients. Diagnostic distribution (including subcategories of eating disorder not otherwise specified) and clinical characteristics are presented, as well as data on registration compliance. Obstacles and keys to successful implementation of the Stepwise system are discussed, including possible gains and on-going challenges inherent in large-scale, Internet-based quality assurance.
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| 13. |
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| 14. |
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| 15. |
- Bulik, Cynthia M., et al.
(author)
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SUBJECTIVE EXPERIENCES OF ANOREXIA NERVOSA IN PATIENTS WITH HIGH VS LOW ANOREXIA NERVOSA POLYGENIC RISK
- 2023
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In: European Neuropsychopharmacology. - : Elsevier. - 0924-977X .- 1873-7862. ; 75:Suppl. 1, s. S14-S14
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Journal article (other academic/artistic)abstract
- Recent genome-wide association studies (GWAS) suggest that genetic factors play a key role in its development and expression and that anorexia nervosa (AN) might have both psychiatric and metabolic underpinnings. One hypothesis is that those with high genetic vulnerability to AN may experience negative energy balance (NEB) (i.e., expending more energy than you consume) in a positive manner, rendering self-starvation and excessive exercise exceptionally reinforcing. This “paradoxical” response to NEB may also complicate recovery. In the Polygenic risk of Anorexia nervosa and its Clinical Expression (PACE) study, we explored differences in clinical and phenomenological/experiential phenotypes (i.e., how patients reported their experience of illness) in 10 individuals with AN who were in the top decile of AN polygenic risk (PRS) and 10 individuals with AN who were in the lowest decile in the Swedish subsample of the Anorexia Nervosa Genetics Initiative (ANGI) study. We interviewed the participants in a double-blind study design using a structured interview guide focusing on the experience of AN, including experiences of NEB (e.g., hunger, satiety, dietary restriction), the development of symptoms, as well as the reactions of others including family members and treatment providers to patients’ experiences of NEB. All interviews have been coded and the blind will be broken in May 2023 at which point group comparisons will be analyzed. This is the first study, to our knowledge, to explore experiential impact of genetic risk. Findings may aid in understanding risk, clinical course, and individual experience of AN and contribute suggestions for tailoring interventions with input from genetic risk profiles.
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| 16. |
- Claesson, Katja, et al.
(author)
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Shame : Mechanisms of activation and consequences for social perception, self-image, and general negative emotion
- 2007
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In: Journal of personality. - : Wiley. - 0022-3506 .- 1467-6494. ; 75:3, s. 595-628
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Journal article (peer-reviewed)abstract
- In two experiments we explored Tomkins's (1963) concept of shame, comparing conscious versus unconscious shame activation. In line with Tomkins' theory, an impeded positive feedback sequence, consciously or unconsciously perceived, elicited more shame than continuously negative feedback. This was, however, true only for participants with an initially low degree of internalized shame. Participants with a high degree of internalized shame unexpectedly displayed shame following the positive feedback intended to elicit positive emotion. Whether this has implications for Tomkins's theory or rather for methodological issues is discussed. Exploring consequences of shame for social perception and self-image, we found reversed results depending on level of consciousness. Effects were consistently greater for women, although at marginal significance levels. Results partly support Tomkins's notion of shame, but imply that his theory might need modification in terms of the role played by consciousness and, possibly, by individual differences such as sex and shame proneness.
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| 17. |
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| 18. |
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| 19. |
- Emanuel, Robyn M, et al.
(author)
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Myeloproliferative Neoplasm (MPN) Symptom Assessment Form Total Symptom Score : Prospective International Assessment of an Abbreviated Symptom Burden Scoring System Among Patients With MPNs
- 2012
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In: Journal of Clinical Oncology. - 0732-183X .- 1527-7755. ; 30:33, s. 4098-4103
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Journal article (peer-reviewed)abstract
- PURPOSE Myeloproliferative neoplasm (MPN) symptoms are troublesome to patients, and alleviation of this burden represents a paramount treatment objective in the development of MPN-directed therapies. We aimed to assess the utility of an abbreviated symptom score for the most pertinent and representative MPN symptoms for subsequent serial use in assessing response to therapy.PATIENTS AND METHODSThe Myeloproliferative Neoplasm Symptom Assessment Form total symptom score (MPN-SAF TSS) was calculated as the mean score for 10 items from two previously validated scoring systems. Questions focus on fatigue, concentration, early satiety, inactivity, night sweats, itching, bone pain, abdominal discomfort, weight loss, and fevers.RESULTS MPN-SAF TSS was calculable for 1,408 of 1,433 patients with MPNs who had a mean score of 21.2 (standard deviation [SD], 16.3). MPN-SAF TSS results significantly differed among MPN disease subtypes (P < .001), with a mean of 18.7 (SD, 15.3), 21.8 (SD, 16.3), and 25.3 (SD, 17.2) for patients with essential thrombocythemia, polycythemia vera, and myelofibrosis, respectively. The MPN-SAF TSS strongly correlated with overall quality of life (QOL; r = 0.59; P < .001) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) functional scales (all P < .001 and absolute r ≥ 0.50 except social functioning r = 0.48). No significant trends were present when comparing therapy subgroups. The MPN-SAF TSS had excellent internal consistency (Cronbach's α = .83). Factor analysis identified a single underlying construct, indicating that the MPN-SAF TSS is an appropriate, unified scoring method.CONCLUSIONThe MPN-SAF TSS is a concise, valid, and accurate assessment of MPN symptom burden with demonstrated clinical utility in the largest prospective MPN symptom study to date. This new prospective scoring method may be used to assess MPN symptom burden in both clinical practice and trial settings.
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| 20. |
- Forsén Mantilla, Emma, et al.
(author)
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Exercise caution : Questions to ask adolescents who may exercise too hard
- 2018
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 15:4
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Journal article (peer-reviewed)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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| 21. |
- Forsén Mantilla, Emma, et al.
(author)
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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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In: Brain and Behavior. - : John Wiley & Sons. - 2162-3279 .- 2162-3279. ; 12:1
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Journal article (peer-reviewed)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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| 22. |
- Forsén Mantilla, Emma, et al.
(author)
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The enemy within: the association between self-image and eating disorder symptoms in healthy, non help-seeking and clinical young women
- 2015
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In: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 3
-
Journal article (peer-reviewed)abstract
- Background: Previous research has shown self-image according to the interpersonal Structural Analysis of SocialBehavior model, to relate to and predict eating disorder symptoms and outcomes.Methods: We examined associations between self-reported self-image and ED symptoms in three groups of 16–25year old females: healthy (N = 388), non help-seeking (N = 227) and clinical (N = 6384). Analyses were divided intoage groups of 16–18 and 19–25 years, and the patient sample was divided into diagnostic groups.Results: Stepwise regressions with self-image aspects as independent variables and eating disorder symptoms asdependent showed that low self-love/acceptance and high self-blame were associated with more eating disordersymptoms in all groups, except older patients with bulimia nervosa where self-hate also contributed. Associationswere generally weaker in the healthy groups and the older samples.Conclusions: We put forward that older age, low desirability of symptoms, poorly working symptoms, and beingacknowledged as ill, may weaken the association, with implications for treatment and prevention.
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| 23. |
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| 24. |
- Geyer, Holly L., et al.
(author)
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Associations between gender, disease features and symptom burden in patients with myeloproliferative neoplasms : an analysis by the MPN QOL International Working Group
- 2017
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In: Haematologica. - : Ferrata Storti Foundation (Haematologica). - 0390-6078 .- 1592-8721. ; 102:1, s. 85-93
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Journal article (peer-reviewed)abstract
- The myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia and myelofibrosis, are distinguished by their debilitating symptom profiles, life-threatening complications and profound impact on quality of life. The role gender plays in the symptomatology of myeloproliferative neoplasms remains under-investigated. In this study we evaluated how gender relates to patients' characteristics, disease complications and overall symptom expression. A total of 2,006 patients (polycythemia vera=711, essential thrombocythemia=830, myelofibrosis=460, unknown=5) were prospectively evaluated, with patients completing the Myeloproliferative Neoplasm-Symptom Assessment Form and Brief Fatigue Inventory Patient Reported Outcome tools. Information on the individual patients' characteristics, disease complications and laboratory data was collected. Consistent with known literature, most female patients were more likely to have essential thrombocythemia (48.6% versus 33.0%; P<0.001) and most male patients were more likely to have polycythemia vera (41.8% versus 30.3%; P<0.001). The rate of thrombocytopenia was higher among males than females (13.9% versus 8.2%; P<0.001) and males also had greater red-blood cell transfusion requirements (7.3% versus 4.9%; P=0.02) with shorter mean disease duration (6.4 versus 7.2 years, P=0.03). Despite there being no statistical differences in risk scores, receipt of most therapies or prior complications (hemorrhage, thrombosis), females had more severe and more frequent symptoms for most individual symptoms, along with overall total symptom score (22.8 versus 20.3; P<0.001). Females had particularly high scores for abdominal-related symptoms (abdominal pain/discomfort) and microvascular symptoms (headache, fatigue, insomnia, concentration difficulties, dizziness; all P<0.01). Despite complaining of more severe symptom burden, females had similar quality of life scores to those of males. The results of this study suggest that gender contributes to the heterogeneity of myeloproliferative neoplasms by influencing phenotypic profiles and symptom expression.
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| 25. |
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| 26. |
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| 27. |
- Geyer, Holly L., et al.
(author)
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The role of sexuality symptoms in myeloproliferative neoplasm symptom burden and quality of life : An analysis by the MPN QOL International Study Group
- 2016
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In: Cancer. - : Wiley. - 0008-543X .- 1097-0142. ; 122:12, s. 1888-1896
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Journal article (peer-reviewed)abstract
- BACKGROUNDPatients with myeloproliferative neoplasms (MPNs) including polycythemia vera, essential thrombocythemia, and myelofibrosis, are faced with oppressive symptom profiles that compromise daily functioning and quality of life. Among these symptoms, sexuality-related symptoms have emerged as particularly prominent and largely unaddressed. In the current study, the authors evaluated how sexuality symptoms from MPN relate to other patient characteristics, disease features, treatments, and symptoms. METHODSA total of 1971 patients with MPN (827 with essential thrombocythemia, 682 with polycythemia vera, 456 with myelofibrosis, and 6 classified as other) were prospectively evaluated and patient responses to the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ C30) were collected, along with information regarding individual disease characteristics and laboratory data. Sexuality scores were compared with an age-matched, healthy control population. RESULTSOverall, patients with MPN were found to have greater sexual dysfunction compared with the healthy population (MPN-SAF score of 3.6 vs 2.0; P<.001), with 64% of patients with MPN describing some degree of sexual dysfunction and 43% experiencing severe symptoms. The presence of sexual symptoms correlated closely with all domains of patient functionality (physical, social, cognitive, emotional, and role functioning) and were associated with a reduced quality of life. Sexual problems also were found to be associated with other MPN symptoms, particularly depression and nocturnal and microvascular-related symptoms. Sexual dysfunction was more severe in patients aged >65 years and in those with cytopenias and transfusion requirements, and those receiving certain therapies such as immunomodulators or steroids. ConclusionsThe results of the current study identify the topic of sexuality as a prominent issue for the MPN population, and this area would appear to benefit from additional investigation and management. Cancer 2016;122:1888-96. (c) 2016 American Cancer Society. Sexuality problems impact all domains of functionality, depression, microvascular symptoms, and overall quality of life among patients with myeloproliferative neoplasms. These problems correlate with patient age, the presence of cytopenias, transfusion requirements, and common therapies for myeloproliferative neoplasms. See also pages 1804-6.
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| 28. |
- Hedman, Anna, et al.
(author)
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Bidirectional relationship between eating disorders and autoimmune diseases
- 2019
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In: Journal of Child Psychology and Psychiatry. - Stockholm : Blackwell Publishing. - 0021-9630 .- 1469-7610. ; 60:7, s. 803-812
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Journal article (peer-reviewed)abstract
- BACKGROUND: Immune system dysfunction may be associated with eating disorders (ED) and could have implications for detection, risk assessment, and treatment of both autoimmune diseases and EDs. However, questions regarding the nature of the relationship between these two disease entities remain. We evaluated the strength of associations for the bidirectional relationships between EDs and autoimmune diseases.METHODS: In this nationwide population-based study, Swedish registers were linked to establish a cohort of more than 2.5 million individuals born in Sweden between January 1, 1979 and December 31, 2005 and followed up until December 2013. Cox proportional hazard regression models were used to investigate: (a) subsequent risk of EDs in individuals with autoimmune diseases; and (b) subsequent risk of autoimmune diseases in individuals with EDs.RESULTS: We observed a strong, bidirectional relationship between the two illness classes indicating that diagnosis in one illness class increased the risk of the other. In women, the diagnoses of autoimmune disease increased subsequent hazards of anorexia nervosa (AN), bulimia nervosa (BN), and other eating disorders (OED). Similarly, AN, BN, and OED increased subsequent hazards of autoimmune diseases.Gastrointestinal-related autoimmune diseases such as, celiac disease and Crohn's disease showed a bidirectional relationship with AN and OED. Psoriasis showed a bidirectional relationship with OED. The previous occurence of type 1 diabetes increased the risk for AN, BN, and OED. In men, we did not observe a bidirectional pattern, but prior autoimmune arthritis increased the risk for OED.CONCLUSIONS: The interactions between EDs and autoimmune diseases support the previously reported associations. The bidirectional risk pattern observed in women suggests either a shared mechanism or a third mediating variable contributing to the association of these illnesses.
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| 29. |
- Hubel, Christopher, et al.
(author)
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Latent anxiety and depression dimensions differ amongst patients with eating disorders : A Swedish nationwide investigation
- 2023
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In: International Journal of Methods in Psychiatric Research. - : John Wiley & Sons. - 1049-8931 .- 1557-0657. ; 32:3
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Journal article (peer-reviewed)abstract
- ObjectiveAnxiety and depression symptoms are common in individuals with eating disorders. To study these co-occurrences, we need high-quality self-report questionnaires. The 19-item self-rated Comprehensive Psychopathological Rating Scale for Affective Syndromes (CPRS-S-A) is not validated in patients with eating disorders. We tested its factor structure, invariance, and differences in its latent dimensions.MethodPatients were registered by 45 treatment units in the Swedish nationwide Stepwise quality assurance database for specialised eating disorder care (n = 9509). Patients self-reported their anxiety and depression symptoms on the CPRS-S-A. Analyses included exploratory and confirmatory factor analyses (CFA) in split samples, and testing of invariance and differences in subscales across eating disorder types.ResultsResults suggested a four-factor solution: Depression, Somatic and fear symptoms, Disinterest, and Worry. Multigroup CFA indicated an invariant factor structure. We detected the following differences: Patients with anorexia nervosa binge-eating/purging subtype scored the highest and patients with unspecified feeding and eating disorders the lowest on all subscales. Patients with anorexia nervosa or purging disorder show more somatic and fear symptoms than individuals with either bulimia nervosa or binge-eating disorder.ConclusionOur four-factor solution of the CPRS-S-A is suitable for patients with eating disorders and may help to identify differences in anxiety and depression dimensions amongst patients with eating disorders.
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| 30. |
- Högdahl, Louise, et al.
(author)
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How effective is bibliotherapy-based self-help cognitive behavioral therapy with Internet support in clinical settings? Results from a pilot study.
- 2013
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In: Eating and Weight Disorders. - : Springer Science and Business Media LLC. - 1124-4909 .- 1590-1262. ; 18:1, s. 37-44
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Journal article (peer-reviewed)abstract
- Cognitive behavioral therapy-based guided self-help (CBT-GSH) via the Internet has been shown to be effective in the treatment of bulimia nervosa (BN) and similar eating disorders (EDs), but it is rarely offered, and little is known about the effects, in clinical settings. The present study investigated the effects of a bibliotherapy-based CBT-GSH with Internet support in a clinical setting. Participants were 48 adult outpatients who were recruited without randomization from a specialized ED clinic, diagnosed with BN or similar eating disorder. Forty-eight patients in an intensive day patient program (DPP) were used as comparison group. The Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Disorder Inventory 2 measured pre- and post treatment symptoms. Results showed that both groups attained significant improvements in core- as well as related ED symptoms in both instruments. As expected, treatment effects were larger in the more intensive DPP. Nonetheless, bibliotherapy CBT-GSH appears to be a cost-effective treatment that represents a new way to provide more CBT in clinical settings.
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| 31. |
- Högdahl, Louise, et al.
(author)
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Internet-based cognitive behavioral therapy for bulimic eating disorders in a clinical setting : Results from a randomized trial with one-year follow-up
- 2023
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In: Internet Interventions. - : Elsevier. - 2214-7829. ; 31
-
Journal article (peer-reviewed)abstract
- BackgroundThose who suffer from eating disorders often experience serious impairment in quality of life and the majority never receive treatment. Treatment availability may be increased by implementing methods that demand less resources and are more easy accessible such as internet-based treatments, but knowledge about their effects is still insufficient. The study evaluated effects of two types of internet-based cognitive behavioral therapy and a structured day patient program, the latter being a standard treatment at an eating disorder clinic at the time for the study.Methods150 participants with bulimic eating disorders randomized to two types of internet based treatments (one pure online treatment and one based on a self-help guide in book-format) or an intensive 16-week day patient program. The number of participants that started treatment was 120 of which 98 in internet treatment and 22 in the day program. Outcome assessments were carried out at baseline, post treatment, and at one-year follow-up.ResultsAll treatments were associated with significantly improved eating disorder pathology, self-image, and clinical impairment. Although the day program generally showed larger effects, only one significant difference found was in diagnostic remission post treatment; 51 % of the participant was in remission in internet treatment and 88 % in the day program. At one-year follow-up, participants in the internet treatments had continued to improve, whereas in the day patient program the effect sustained. Internet treatment had a 36 % drop out rate, there were no dropouts found in the day program.ConclusionsAll treatments were comparable in effect at follow-up, suggesting that internet treatment is a conceivable alternative to standard treatment. Internet treatment in a book-based format was also equally effective as a pure online format. Internet delivered cognitive behavioral treatment forms can make important contributions to achieve increased access to treatment for patients with bulimic eating disorders. Future research and clinical implications for internet delivered treatments in eating disorder services are discussed.
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| 32. |
- Högdahl, Louise, et al.
(author)
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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
-
In: Internet Interventions. - : Elsevier. - 2214-7829. ; 5, s. 44-50
-
Journal article (peer-reviewed)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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| 33. |
- Ingemarson, Maria
(author)
-
PS – a school-wide prevention programme : effects, core components and implementation.
- 2018
-
Doctoral thesis (other academic/artistic)abstract
- PS is multi-component intervention at the primary prevention level and aims at creating a positive learning environment and decreasing problem behaviours among students in the school years 4-9. During 2009-2012 the programme was both implemented and studied for the first time in a Swedish context. The present thesis comprises four studies of PS and applies a mixed methods approach. The thesis aims to study: 1) If the programme is effective in enhancing the classroom climate, and decreasing problem behaviours among students (Study I), 2) teachers and school staff’s perceptions of programme and implementation (study II and III) and 3) if teacher’s use of praise and clarity of school rules, regardless of programme use, are useful as classroom management techniques, and if there are any differences between classes in terms of disruption (study IV). A quasi-randomized trial was conducted in study I, comprising 3207 students in school grades 5-7 and 188 teachers in 23 schools in the wider area of Stockholm. The participating children and their head teachers answered self-report questionnaires on three occasions: At baseline and one and two years after programme initiation. Degree of implementation in the schools was also measured. Further, a qualitative design with semi-structured interviews and thematic content analysis was used in study II and III. The interviews were conducted in seven PS schools with seven school leaders and 13 school teachers during 2010 and 2011. In study IV, students (n=2266) and classes were divided into two groups, based on teacher ratings of disruptive students in class. Baseline and 12-month follow-up responses were used to perform multiple regression analysis, to compare groups and to investigate possible longitudinal associations. Study I showed no significant effects on students’ problem behaviours and classroom climate at last follow-up. The findings from study II indicated barriers to programme commitment in terms of lack of consensus, collaboration barriers and insufficient process management. It was concluded that leadership, coaching and staff selection need particular attention when implementing a programme like PS, since those factors have been defined as important implementation drivers, both in this study and previously. Study III showed that teachers’ professional identity, programme understanding and experience of change were factors affecting implementation. Ambiguities regarding the boundaries of the social assignment, opposition against the theoretical underpinnings and an unclear core component were identified as implementation barriers. In study IVit was shown that clarity of school rules did not substantially contribute to classroom climate, whereas teacher’s use of praise to some extent did. The hypothesis on weaker associations in the low disruption group could not be confirmed. This thesis cannot provide an answer to the question whether PS is effective or not, since findings indicate that the implementation did not succeed. However, findings in the last study indicate that teacher’s use of praise may contribute to improve the classroom climate. If the PS programme is to be used again there is a need for revisions, and sufficient time for schools to consider programme adoption will be crucial. Aspects of programme implementation are further discussed.
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| 34. |
- Ingemarson, Maria, et al.
(author)
-
Teacher’s use of praise, clarity of school rules and classroom climate : comparing classroom compositions in terms of disruptive students
- 2020
-
In: Social Psychology of Education. - : Springer Science and Business Media LLC. - 1381-2890 .- 1573-1928. ; 23:1, s. 217-232
-
Journal article (peer-reviewed)abstract
- Clarity of school rules and teachers’ use of praise are strategies suggested to facilitate a positive classroom climate. Studies indicate difficulties for teachers to use such approaches in classrooms with higher levels of disruption. To study (1) if student-rated clarity of school rules, use of praise, and classroom climate differ between students in classes with lower numbers of disruptive students versus classes with higher numbers, (2) if clarity of school rules and teacher’s use of praise are longitudinally associated with classroom climate, (3) if the possible longitudinal association differs between groups, classes (n = 109) in school grades 5–7 were divided into two groups, based on head teacher ratings of disruptive students in class. Baseline and 12-month follow-up responses collected within a Swedish trial were used to perform multiple regression analysis, to compare groups and to investigate possible longitudinal associations. Students in classes with less disruption rated all variables more positively. Classroom climate deteriorated over time in both groups, even if the low disruption group perceived their climate as more positive at follow up. Clarity of school rules did not substantially contribute to classroom climate longitudinally, whereas teacher’s use of praise to some extent did. The difference in longitudinal associations between groups was marginal, hence our hypothesis on weaker associations in the high disruption group could not be confirmed. Clarity of school rules is not longitudinally associated with classroom climate, but teachers may positively influence the learning environment by giving praise, regardless of level of disruption.
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| 35. |
- Javaras, Kristin N., et al.
(author)
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Sex- and age-specific incidence of healthcare-register-recorded eating disorders in the complete swedish 1979-2001 birth cohort
- 2015
-
In: International Journal of Eating Disorders. - : Wiley-Blackwell. - 0276-3478 .- 1098-108X. ; 48:8, s. 1070-81
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate the sex- and age-specific incidence of healthcare-register-recorded anorexia nervosa (AN) and other eating disorders (OED) in a complete birth cohort, and assess whether incidence varies by diagnostic period and (sub-) birth cohort.METHOD: We used the actuarial method and Poisson models to examine the incidence of AN and OED from 1987 to 2009 (when individuals were 8-30 years old) for a cohort of 2.3 million individuals (48.7% female) born from 1979 to 2001 in Sweden, identified using Swedish registers.RESULTS: For both sexes, incidences of AN and OED increased considerably for diagnostic periods after 2000, but differed little by birth cohort. In 2009, AN incidence in the peak age category was 205.9 cases/100,000 persons (95% CI: 178.2, 233.5) for females (14-15 years), versus 12.8 cases/100,000 (95% CI: 5.6, 20.1) for males (12-13 years). OED incidence in the peak age category was 372.1 cases/100,000 (95% CI: 336.4, 407.9) for females (16-17 years), versus 22.2 cases/100,000 (95% CI: 13.3, 31.1) for males (14-15 years).DISCUSSION: Our finding of an increase in healthcare-register-recorded eating disorders for diagnostic periods after 2000 likely reflects improved detection and expanded register coverage in Sweden. The peak of eating disorder incidence in adolescence, which began unexpectedly early for AN in males, suggests the importance of vigilance for signs of AN in young boys and early primary prevention efforts. Waiting until later could miss critical windows for intervention that could prevent disorders from taking root.
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| 36. |
- Levallius, Johanna, et al.
(author)
-
Binge eating and addictive-like behaviours in males and females
- 2022
-
In: Psychological Reports. - : Sage Publications. - 0033-2941 .- 1558-691X. ; 125:1, s. 148-166
-
Journal article (peer-reviewed)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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| 37. |
- Levallius, Johanna, et al.
(author)
-
Now you see it, now you don't : compulsive exercise in adolescents with an eating disorder
- 2017
-
In: Journal of eating disorders. - : BioMed Central (BMC). - 2050-2974. ; 5
-
Journal article (peer-reviewed)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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| 38. |
- Liao, Zhenxin, et al.
(author)
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Maladaptive exercise in eating disorders : lifetime and current impact on mental health and treatment seeking.
- 2024
-
In: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 12:1
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Many patients with eating disorders report exercise as a central symptom of their illness-as a way to compensate for food intake, prevent weight-gain, and/or reduce negative affect. Previous findings show associations between maladaptive exercise and more severe eating disorder pathology, higher risk for relapse, other co-morbid symptoms, and worse treatment outcome.METHODS: In this study, we included 8252 participants with eating disorders and investigated associations between maladaptive exercise (both lifetime and current) and ED pathology, illness duration, depression, anxiety, self-harm and suicidal ideation, and treatment seeking patterns in individuals with lifetime maladaptive exercise. Participants were included via the Swedish site of the large global study The Eating Disorders Genetics Initiative (EDGI) and completed measures of both lifetime and current symptomatology.RESULTS: Results indicate that lifetime maladaptive exercise is associated with higher prevalence of lifetime depression and anxiety and with patients more often receiving treatment, although these results need to be investigated in future studies. Current maladaptive exercise was associated with more severe ED symptoms, and higher levels of depression, anxiety, obsessive-compulsive traits, and suicidal ideation.CONCLUSIONS: Our findings point to the complexities of exercise as an eating disorder symptom and the need for clearly assessing and acknowledging this, as well as tailoring interventions to treat this symptom to achieve sustainable recovery.
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| 39. |
- Martin, Joanna, et al.
(author)
-
Investigating gender-specific effects of familial risk for attention-deficit hyperactivity disorder and other neurodevelopmental disorders in the Swedish population
- 2020
-
In: BJPsych Open. - : Cambridge University Press. - 2056-4724. ; 6:4
-
Journal article (peer-reviewed)abstract
- Background: Many psychiatric disorders show gender differences in prevalence. Recent studies suggest that female patients diagnosed with anxiety and depression carry more genetic risks related to attention-deficit hyperactivity disorder (ADHD) compared with affected males.Aims: In this register-based study, we aimed to test whether female patients who received clinical diagnoses of anxiety, depressive, bipolar and eating disorders are at higher familial risk for ADHD and other neurodevelopmental disorders, compared with diagnosed male patients.Method: We analysed data from a record-linkage of several Swedish national registers, including 151 025 sibling pairs from 103 941 unique index individuals diagnosed with anxiety, depressive, bipolar or eating disorders, as well as data from 646 948 cousin pairs. We compared the likelihood of having a relative diagnosed with ADHD/neurodevelopmental disorders in index males and females.Results: Female patients with anxiety disorders were more likely than affected males to have a brother with ADHD (odd ratio (OR) = 1.13, 95% CI 1.05-1.22). Results for broader neurodevelopmental disorders were similar and were driven by ADHD diagnoses. Follow-up analyses revealed similar point estimates for several categories of anxiety disorders, with the strongest effect observed for agoraphobia (OR = 1.64, 95% CI 1.12-2.39). No significant associations were found in individuals with depressive, bipolar or eating disorders, or in cousins.Conclusions: These results provide modest support for the possibility that familial/genetic risks for ADHD may show gender-specific phenotypic expression. Alternatively, there could be gender-specific biases in diagnoses of anxiety and ADHD. These factors could play a small role in the observed gender differences in prevalence of ADHD and anxiety.
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| 40. |
- Monell, Elin, et al.
(author)
-
Emotion dysregulation, self-image and eating disorder symptoms in University Women
- 2015
-
In: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 3:1
-
Journal article (peer-reviewed)abstract
- Background: We studied associations between emotion dysregulation, self-image and eating disorder (ED)symptoms in university women, and contrasted two indirect effect models to examine possible interveningmechanisms to produce ED symptoms.Methods: 252 female Swedish university students completed the Difficulties in Emotion Regulation Scale(DERS), the Structural Analysis of Social Behavior (SASB) self-image measure, and the Eating DisorderExamination Questionnaire (EDE-Q). Correlations between scales were followed by five simple mediationanalysis pairs with two possible pathways using five ED symptom variables as outcome. The models positedeither self-image or emotion dysregulation as mediator or independent variable, respectively. ED symptomswere EDE-Q Global score, objective binge eating episodes (OBE), subjective binge eating episodes (SBE), andtwo variants of EDE-Q excessive exercise.Results: Emotion dysregulation and self-image were strongly correlated, and both correlated moderately withEDE-Q Global score. There were distinct indirect effects through self-image on the relationship between emotiondysregulation and ED symptoms, but not vice versa. These indirect effects were evident in relation to cognitive EDsymptoms and both OBE and SBE, but not in relation to excessive exercise.Conclusions: Results suggest that even if closely related, emotion dysregulation and self-image both contributeunique knowledge in relation to ED symptoms. Self-image as an intervening mechanism between emotiondysregulation and ED symptoms is relevant for models of the development, maintenance and treatment of ED, as wellas treatment focus.
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| 41. |
- Monell, Elin, et al.
(author)
-
Factor structure and clinical correlates of the original and 16-item version of the Difficulties In Emotion Regulation Scale in adolescent girls with eating disorders
- 2022
-
In: Journal of Clinical Psychology. - : John Wiley & Sons. - 0021-9762 .- 1097-4679. ; 78:6, s. 1201-1219
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: The Difficulties in Emotion Regulation Scale (DERS) is increasingly used in adolescents. This study is the first to examine the factor structure, measurement, and structural invariance across age, reliability, and validity of the original 36-item and 16-item version of the DERS in adolescents with eating disorders.METHODS: Several models were examined using confirmatory factor analysis. Measurement and structural invariance were studied across age groups, and Omega, Omega Hierarchical, and criterion validity were examined.RESULTS: A bifactor model, with five subscales, showed acceptable fit in both DERS versions. Measurement and structural invariance held across age. The general factor had high reliability and accounted for a large proportion of variance in eating pathology and emotional symptoms.CONCLUSION: The Awareness subscale had a negative effect on fit in DERS, but both DERS versions were reliable and valid measures in both younger and older adolescents with eating disorders when using only five subscales.
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| 42. |
- Monell, Elin, et al.
(author)
-
Running on empty : a nationwide large-scale examination of compulsive exercise in eating disorders
- 2018
-
In: Journal of eating disorders. - : BioMed Central (BMC). - 2050-2974. ; 6
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Compulsive exercise (CE) has been the neglected "Cinderella" among eating disorder (ED) symptoms, even though it seems to impact severity, treatment and outcome. This prompted a large-scale and systematic examination of the impact of CE in a representative ED sample.METHODS: CE was examined in over 9000 female and male patients from a clinical ED database (covering out-patient, day and/or residential treatment) with respect to prevalence, ED diagnosis, ED symptoms, clinical features, patient characteristics, and outcome at 1-year follow-up. Relationships between changes in CE behavior and remission were also examined.RESULTS: CE was a transdiagnostic symptom, present in nearly half of all patients (48%). It was associated with greater overall ED pathology, particularly dietary restraint, and negative perfectionism. Initial CE did not impact remission rate, but patients continuing or starting CE during treatment had considerably lower remission rates compared to patients who never engaged in, or ceased with, CE. Results were comparable for females and males.CONCLUSIONS: At baseline, there were few differences between patients with and without CE, except a somewhat higher symptom load for patients with CE, and CE did not predict ED outcome. However, how CE developed during treatment to 1-year follow-up considerably impacted remission rates. We strongly recommend CE to be systematically assessed, addressed, and continuously evaluated in all ED patients seeking treatment.
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| 43. |
- Mustelin, L., et al.
(author)
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Risk of eating disorders in immigrant populations
- 2017
-
In: Acta Psychiatrica Scandinavica. - Stockholm : Wiley. - 0001-690X .- 1600-0447. ; 136:2, s. 156-165
-
Journal article (peer-reviewed)abstract
- Objective: The risk of certain psychiatric disorders is elevated among immigrants. To date, no population studies on immigrant health have addressed eating disorders. We examined whether risk of eating disorders in first- and second-generation immigrants differs from native-born Danes and Swedes. Method: All individuals born 1984–2002 (Danish cohort) and 1989–1999 (Swedish cohort) and residing in the respective country on their 10th birthday were included. They were followed up for the development of eating disorders based on out-patient and in-patient data. Results: The risks of all eating disorder types were lower among first-generation immigrants compared to the native populations: Incidence-rate ratio (95% confidence interval) was 0.39 (0.29, 0.51) for anorexia nervosa, 0.60 (0.42, 0.83) for bulimia nervosa, and 0.62 (0.47, 0.79) for other eating disorders in Denmark and 0.27 (0.21, 0.34) for anorexia nervosa, 0.30 (0.18, 0.51) for bulimia nervosa, and 0.39 (0.32, 0.47) for other eating disorders in Sweden. Likewise, second-generation immigrants by both parents were at lower risk, whereas those with only one foreign-born parent were not. Conclusion: The decreased risk of eating disorders among immigrants is opposite to what has been observed for other psychiatric disorders, particularly schizophrenia. Possible explanations include buffering sociocultural factors and underdetection in health care.
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| 44. |
- Nordgren, Line, et al.
(author)
-
Factor Structure of the Difficulties in Emotion Regulation Scale in Treatment Seeking Adults with Eating Disorders
- 2020
-
In: Journal of Psychopathology and Behavioral Assessment. - : Springer. - 0882-2689 .- 1573-3505. ; 42:1, s. 111-126
-
Journal article (peer-reviewed)abstract
- The Difficulties in Emotion Regulation Scale (DERS) is extensively used as a measure of emotion (dys-)regulation ability in both clinical and nonclinical populations. This is the first study to examine the factor structure of both the original 36-item and short 16-item version of the DERS in adults with eating disorders and to test measurement invariance across diagnostic subgroups. The factor structure of the scale was examined using confirmatory factor analysis in a psychiatric sample of adults with eating disorders (N = 857). Four primary factor structures were fitted to the data: (1) a unidimensional model, (2) a six-factor correlated-traits model, (3) a higher-order factor solution, and (4) a bifactor model. Measurement invariance was tested for diagnostic subgroups of anorexia nervosa and bulimia nervosa and associations between factors and eating pathology were examined in each diagnostic group. Results indicated that a modified bifactor solution fitted the data adequately for both the 36-item and 16-item version of the DERS. A general factor explained most of the variance (86%) and reliability was high for the general factor of DERS (total) but lower for the subscales. Measurement invariance of the bifactor model was supported across diagnostic subgroups and test of factor means reveled that bulimia nervosa had a higher factor mean than anorexia nervosa on the general factor. The general factor accounted for a significant proportion of variance in eating pathology. Our results support the use of the total scale of both the 36-item and 16-item version among adults with eating disorders.
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| 45. |
- Nyman-Carlsson, Erika, 1982-, et al.
(author)
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Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial
- 2019
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In: European eating disorders review. - : John Wiley & Sons. - 1072-4133 .- 1099-0968. ; 27:1, s. 76-85
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: The prognosis in cases of anorexia nervosa (AN) is unsatisfactory, and it is therefore important to examine pretreatment predictors of outcome.METHODS: Female AN patients (N = 74) included in a randomised controlled trial receiving individual cognitive behavioural therapy (CBT) or family-based treatment (FBT) were included. Predictors of the outcome were explored using pretreatment eating disorder psychopathology.RESULTS: In the CBT group, lower levels of emotional dysregulation and greater deficits in identifying and coping with inner states were predictors of weight increase, explaining 37.7% of the variance. In the FBT group, lower interoceptive deficits predicted an increase in weight (explaining 17.7% of the variance), whereas bulimic behaviour (32.4%) and problems with emotional regulation (23.3%) were predictors of increased diagnostic symptoms.CONCLUSIONS: Bulimic symptoms and the ability to identify and cope with emotional states appear to be important aspects that should be addressed in the treatment of young adult patients with AN.
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| 46. |
- Petersson, Suzanne, et al.
(author)
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Evaluation of the Affect School as supplementary treatment of Swedish women with eating disorders : a randomized clinical trial
- 2022
-
In: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 10:1
-
Journal article (peer-reviewed)abstract
- Background Despite solid research there remains a large group of patients with eating disorders who do not recover. Emotion dysregulation has been shown to be a feature in the different eating disorders. A manualized group intervention developed in Sweden, the Affect School, aims to enhance emotional awareness and the ability to perceive and express emotions. Aim This study aimed to test the hypothesis that participation in the Affect School as a complement to ordinary eating disorder treatment would enhance awareness and regulation of emotions and reduce alexithymia and cognitive eating disorder symptoms in a sample of patients with eating disorders at a Swedish specialized outpatient clinic. Method Forty patients with various eating disorders were randomized to either participation in the Affect School as a supplement to treatment as usual (TAU), or to a TAU control group. Participants were assessed with the Eating Disorder Examination Questionnaire, the Deficits in Emotion Regulation Scale-36, and the Toronto Alexithymia Scale-20 at start, end of intervention, and at the 6- and 12-month follow-ups. Results No significant differences were observed post-treatment but Affect School participants had improved significantly more than controls on eating disorder cognitions and behaviours and emotion dysregulation at the 6- and 12-month follow-ups and had significantly less alexithymia at the 6-month follow-up. Conclusion Difficulties with emotion recognition and/or regulation can complicate fulfilment of personal needs and obstruct communication and relationships with others. The present study indicates that adding Affect School group sessions to regular treatment enhances emotional awareness and emotion regulation and decreases eating disorder symptoms and alexithymia. Plain English summary Patients with eating disorder diagnoses have described problems with emotional management, for example: lower emotional awareness and difficulties in using adaptive emotional regulatory strategies compared to people without eating disorders. It has been suggested that interventions aiming at enhancing emotional awareness and acceptance would be beneficial in treatment. In the present study we explored whether adding the Affect School to regular treatment would enhance awareness and regulation of emotions and decrease eating disorder symptoms. Forty women with an eating disorder were randomly allocated to either an additional participation in a group treatment for 8 weeks or usual treatment only. The treatment contained education on different affects such as joy, fear, interest, shame, anger, disgust, and worry. The education was followed by discussions on own experiences. Participants filled in self-assessment forms that measured eating disorder symptoms, emotional recognition, and emotion regulation before the start and at the end of the group treatment, and after 6 and 12 months respectively. The results when comparing the two groups suggested that the Affect School could be an effective additional treatment. Participants in the Affect School improved their scorings but the change took time and did not show until at the 6- and 12 months follow-ups.
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| 47. |
- Petersson, Suzanne, 1964-, et al.
(author)
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Initial self-blame predicts eating disorder remission after 9 years.
- 2021
-
In: Journal of Eating Disorders. - : Springer Science and Business Media LLC. - 2050-2974. ; 9:1
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Research into predictors of outcome in eating disorders (ED) has shown conflicting results, with few studies of long-term predictors and the possible importance of psychological variables that may act as risk- and maintenance factors.AIM: To identify baseline predictors of ED remission nine years after initial clinical assessment using self-report measures of ED psychopathology, psychiatric symptoms, and self-image in a sample of adult ED patients (N = 104) treated at specialist units in Stockholm, Sweden. Sixty patients participated in the follow-up, of whom 41 patients (68%) had achieved remission.RESULTS: Results suggested that the only significant predictor of diagnostic remission after nine years was initial levels of self-blame.CONCLUSION: In order to ensure long-term recovery in ED it may be important for clinicians to widen their therapeutic repertoire and utilise techniques that reduce self-blame and increase self-compassion. It is difficult to predict how an eating disorder will develop, and research has found varying factors that affect the outcome of the condition. Recovery rates vary from nearly nil to over 90%. This variation could be explained by different research factors, but are more likely due to varying definitions of 'recovery', with less stringent definitions yielding high recovery rates and more stringent definitions yielding lower rates. The present study investigated whether the severity of eating disorder symptoms and other psychiatric symptoms could predict recovery nine years from first admission to specialised eating disorder care. Sixty patients at three eating disorder treatment units participated, and their scores on self-report measures of symptoms were used as predictor variables. Forty-one participants had no eating disorder diagnosis at nine-year follow-up. Most participants with binge-eating disorder had recovered, while the poorest outcome was found for anorexia nervosa with slightly over half of patients recovered after nine years. The only predictor for the nine-year outcome was a higher initial rating of self-blame, measured with the Structural Analysis of the Social Behavior. It was concluded that it may be important for clinicians to detect and address self-blame early in the treatment of eating disorders in order to enhance the possibility of recovery. Treatment should focus on reducing self-blame and increasing self-acceptance.
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| 48. |
- Scotch, Allison H, et al.
(author)
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Symptom burden profile in myelofibrosis patients with thrombocytopenia : Lessons and unmet needs
- 2017
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In: Leukemia Research. - : Elsevier BV. - 0145-2126 .- 1873-5835. ; 63, s. 34-40
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Journal article (peer-reviewed)abstract
- Myelofibrosis is a myeloproliferative neoplasm associated with progressive cytopenias and high symptom burden. MF patients with thrombocytopenia have poor prognosis but the presence of thrombocytopenia frequently precludes the use of JAK2 inhibitors. In this study, we assessed quality of life and symptom burden in 418 MF patients with (n = 89) and without (n = 329) thrombocytopenia using prospective data from the MPN-QOL study group database, including the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) and Total Symptom Score (MPN10). Thrombocytopenia, defined as platelet count < 100 x10(9)/L (moderate 51-100 x 10(9)/L; severe <= 50 x10(9)/L), was associated with anemia (76% vs. 45%, p < 0.001), leukopenia (29% vs. 11%, p < 0.001), and need for red blood cell transfusion (35% vs. 19%, p = 0.002). Thrombocytopenic patients had more fatigue, early satiety, inactivity, dizziness, sad mood, cough, night sweats, itching, fever, and weight loss; total symptom scores were also higher (33 vs. 24, p < 0.001). Patients with severe thrombocytopenia were more likely to have anemia (86% vs. 67%, p = 0.04), leukopenia (40% vs. 20%, p = 0.04), and transfusion requirements (51% vs. 20%, p = 0.002) but few differences in symptoms when compared to patients with moderate thrombocytopenia. These results suggest that MF patients with thrombocytopenia experience greater symptomatic burden than MF patients without thrombocytopenia and may benefit from additional therapies.
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- Welch, Elisabeth, et al.
(author)
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Eating Disorder Examination Questionnaire and Clinical Impairment Assessment Questionnaire : General population and clinical norms for young adult women in Sweden
- 2011
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In: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 49:2, s. 85-91
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Journal article (peer-reviewed)abstract
- Optimal use of assessment instruments for the detection and diagnosis of eating disorders (ED) depends on the availability of normative data. The aim of this work was to, for the first time, collect norms for both the Eating Disorder Examination Questionnaire (EDE-Q) and the newly developed Clinical Impairment Assessment (CIA) Scale from a general population of young women in Sweden, as well as from a clinical population of ED patients in Sweden. Participants were composed of both a randomized sample from the general population of women aged 18-30 years (N = 760) as well as from a clinical population aged 18-66 years (N = 2383). Data for the clinical population was extracted from the Stepwise database. Mean scores, standard deviations and percentile ranks for the global for the EDE-Q (as well as its subscales) and the CIA are presented. Prevalence figures of key eating disorder behaviors are also reported. Comparisons are made between the results in the present study with other existing normative studies on the EDE-Q and the CIA. The present study contributes to improving the accuracy of the interpretation of scores of the widely used self-report measure of ED, the EDE-Q, and the CIA, both of which play important roles in for diagnosis, prevention and intervention of ED.
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