Recent Submissions

  • Transitions from intensive eating disorder treatment settings: qualitative investigation of the experiences and needs of adults with anorexia nervosa and their carers

    Arcelus, Jon (2022)
    BACKGROUND: Relapse rates for individuals with anorexia nervosa after intensive hospital treatment (in-patient or full-time day care) are high. Better knowledge about the difficulties and opportunities that arise during this transition is needed to identify factors that support or hinder continued recovery upon discharge. AIMS: The aim of this study was to explore the experiences of adult patients and their chosen carers on the process of transitioning from intensive eating disorder treatment settings to the community. METHOD: Semi-structured interviews were conducted with patients with anorexia nervosa (n = 11) discharged from day or in-patient care from specialised eating disorder units across the UK, and their chosen carers (n = 20). Data were analysed with inductive thematic analysis. RESULTS: Four interrelated themes were identified for both groups. For patients, themes were continuity of care, ambivalence about continued recovery, the value of social support and a call for enhanced transition support. For carers, themes were the impact of the eating disorder on themselves and the family, perceptions of recovery and support post-discharge, the impact of previous treatment and care experiences, and desire to create a supportive transition process. CONCLUSIONS: The study provides an insight into the unique challenges that individuals with anorexia nervosa face upon leaving intensive treatment. A lack of post-discharge planning, support system and identity formation outside of anorexia nervosa were perceived as barriers to continued recovery. Patients and carers advocated for transition support that incorporates a phased, inclusive approach with accessible professional and social support in the community.
  • The clinical effectiveness and cost-effectiveness of a ‘stepping into day treatment’ approach versus inpatient treatment as usual for anorexia nervosa in adult specialist eating disorder services (DAISIES trial): a study protocol of a randomised controlled multi-centre open-label parallel group non-inferiority trial

    Arcelus, Jon (2022)
    Anorexia nervosa (AN) is a serious and disabling mental disorder with a high disease burden. In a proportion of cases, intensive hospital-based treatments, i.e. inpatient or day patient treatment, are required, with day patient treatment often being used as a ‘step-down’ treatment after a period of inpatient treatment. Demand for such treatment approaches has seen a sharp rise. Despite this, the relative merits of these approaches for patients, their families, and the NHS and wider society are relatively unknown. This paper describes the rationale for, and protocol of, a two-arm multi-centre open-label parallel group non-inferiority randomised controlled trial, evaluating the effectiveness and cost-effectiveness of these two intensive treatments for adults with severe AN: inpatient treatment as usual and a stepped care day patient approach (the combination of day patient treatment with the option of initial inpatient treatment for medical stabilisation). The main aim of this trial is to establish whether, in adults with severe AN, a stepped care day patient approach is non-inferior to inpatient treatment as usual in relation to improving body mass index (BMI) at 12 months post-randomisation.
  • Evaluating a motivational and psycho-educational self-help intervention for athletes with mild eating disorder symptoms: A mixed methods feasibility study

    Arcelus, Jon (2022)
    OBJECTIVEThe primary aim was to assess the feasibility of undertaking a study evaluating the novel Motivational and Psycho-Educational Self-Help Programme for Athletes with Mild Eating Disorder Symptoms (MOPED-A). A mixed-methods approach was adopted to explore the feasibility of recruiting and retaining participants, and to evaluate the acceptability of measures, procedures and the intervention. A secondary aim was to explore the potential efficacy of MOPED-A in reducing athletes' eating disorder symptoms.METHODThirty-five athletes were recruited. Participation involved completing MOPED-A over a 6-week period and completing self-report measures at baseline (T1), post-intervention (T2) and 4-week follow-up (T3). A subsample (n = 15) completed an interview at T2.RESULTSRetention was good throughout the study (n = 28; 80%). Quantitative and qualitative feedback suggested the format, delivery, content and dosage of MOPED-A were acceptable. Athletes valued that the intervention was tailored to them, and this facilitated both participation and completion. Over a third of participants reported disclosing their eating difficulties and deciding to seek further support. Large reductions in eating disorder symptoms were detected at T2 and sustained at T3.CONCLUSIONSThe MOPED-A intervention can be feasibly implemented, is acceptable to participants, and demonstrates potential for reducing symptoms in athletes. A larger, controlled trial is warranted.
  • Clinicians' perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings

    Arcelus, Jon (2022)
    BACKGROUND: Admissions to intensive treatment (i.e., inpatient [IP] and/or day patient [DP]) for individuals with severe anorexia nervosa (AN) are common. Growing literature indicates potential risks and benefits of each intensive treatment approach; however, existing research has focused on patient and carer perspectives of these treatments. Also, there is scant empirical evidence available for guiding the parameters of intensive treatments for AN. We therefore explored clinicians' perspectives and experience of supporting adults with severe AN in intensive settings. METHODS: We conducted twenty one semi-structured interviews with clinicians who deliver intensive treatments (i.e., IP and/or DP) for individuals with severe AN across four specialist Eating Disorder Services in the United Kingdom between May 2020 and June 2021. We asked clinicians about their views and experiences of supporting individuals with severe AN in intensive treatment settings and the challenges and opportunities associated with IP and DP treatment. Data were analysed using reflexive thematic analysis supported by NVivo software. RESULTS: Five broad and interrelated themes were identified: (1) Intensive Support; (2) The Severity of Patients' Illnesses; (3) Hope and Recovery; (4) Which Treatment When; (5) Limited Resources; and (6) Carer Burden. We identified various similarities between the two intensive treatment approaches, including the value of intensive and multidisciplinary support and carer involvement, and the challenge of managing complex and unique needs in resource-limited intensive settings. We also found differences in the relationship of treatment to patients' home environments, the necessity of patient motivation, and the management of risk. CONCLUSIONS: Both intensive treatment settings are valued by clinicians; however, there are unique challenges and opportunities for supporting individuals with severe AN within each. Our findings suggest DP treatment may be used as an alternative to IP treatment for individuals with severe AN. However, clear questions remain over which intensive treatment setting is best suited to which patient when and should be the focus of future research. Some people with anorexia nervosa will need intensive treatment (e.g., inpatient and day patient treatment) during the course of their illness. We interviewed twenty-one clinicians working in Specialist Eating Disorder Services to explore their views on supporting people with severe anorexia nervosa in inpatient and day patient services and about the perceived advantages and disadvantages of these. We analysed the transcripts of these interviews using thematic analysis. We identified similarities between the two intensive treatment approaches. These included the value of intensive and multidisciplinary support, the importance of carer involvement, and the challenge of managing patient’s complex and unique needs in services with limited resources. We also found differences between inpatient and day patient treatment. These included how treatment relates to patients’ home environments, the importance of patient motivation, and managing risk. Day patient treatment may be an alternative to inpatient treatment for people with severe anorexia nervosa. Future research should investigate which intensive treatment setting is best suited to which patient and when.
  • Olanzapine in the treatment of children and adolescents with anorexia nervosa-A systematic review

    Chand, Parveen; Kulkarni, Meghana; Sayal, Kapil; Majumder, Pallab (2020)
    Objective: Olanzapine is a commonly used antipsychotic drug in the treatment of children and adolescents under the age of 18 years with Anorexia Nervosa (AN) to promote weight restoration. This systematic review aims to assess the effectiveness of Olanzapine in influencing weight gain; its effect on eating disorder symptoms, comorbid anxiety and depressive symptoms and its safety for use in children and adolescents with AN. Method: A Systematic search of the databases MEDLINE, EMBASE, PsycINFO, PubMed, Cochrane was conducted for the period between 1996 and September 2019 for all study designs except reviews, published in English, focussing on olanzapine use for the treatment of Anorexia Nervosa in children and adolescents. Inclusion Criteria Population: Children and Adolescents under 18 years of age with a diagnosis of Anorexia Nervosa or Eating Disorder not otherwise specified(EDNOS) / Other Specified Feeding or Eating Disorder(OSFED) according to Diagnostic and Statistical Manual of Mental Disorders(DSM IV, IV TR or V )or an ICD 10 diagnosis of Anorexia Nervosa or Atypical anorexia nervosa. AN could be a clinical or research diagnosis. Intervention: Olanzapine used as a treatment of Anorexia Nervosa either alone or in combination with other interventions (except antipsychotics) in both outpatient and inpatient settings. Outcomes: Weight gain and BMI, Eating disorder (ED) symptoms including ED cognitions and Behaviours, anxiety, depression and adverse effects. Study design: All studies (including case reports and case series) in English language published between the years 1996 and 2019, except reviews. Exclusion Criteria: 1.Concurrent use of any other antipsychotic medication. 2.Anorexia Nervosa Comorbid with severe neurological disorder or medical conditions that would be considered to significantly impact treatment or recovery from the eating disorder. 3.Co-morbid mental disorders like Schizophrenia, Bipolar Affective Disorder, Psychosis Not Otherwise Specified. Results: From the pool of 246 potentially eligible references, 28 studies were included (2 randomised controlled trials, 10 before and after studies, 3 case series and 13 case reports). Overall, these studies suggest that, albeit small, there is evidence that olanzapine use promotes weight restoration and improves eating disorder symptoms, especially in patients with low baseline body mass index (BMI). Initiation of olanzapine at low doses and slow titration minimises likelihood of adverse effects. Longer duration of treatment (10 weeks and more) appears to have potentially sustainable benefits on improving eating disorder symptoms. Clinical Implications: For those on the higher range (BMI more than 17.5) a smaller dose and slow titration needs to be considered to avoid rapid and excess weight gain. Small doses between 2.5 to 10mg were found to be effective. Low doses at initiation and slow titration avoids emergence of adverse effects. Though duration of treatment as early as 5 weeks has shown benefit with weight restoration, durations longer than 10 weeks show sustainable improvements with weight and other associated eating disorder symptoms. Research/Methodological implications: A major difficulty with recruiting patients with Anorexia nervosa for randomized controlled research trials and high dropout rates has been mentioned in published articles (Norris et al 2007) as the objective of weight restoration can be contrary to the belief held by the patients with AN. As studies with longer duration of follow up show promising benefits with improvement in eating disorder symptoms, it is important for future research to design trials with longer follow up durations to truly understand the effectiveness of Olanzapine in improving the eating disorder symptoms including ED cognitions and behaviours measured by standardized rating scales. Future trials must consider the challenges associated and hence develop innovative study designs with larger sample size, consider longer duration of follow up, use weight measures and rating scales which are comparable and evaluate the impact on comorbidities like depression and anxiety of olanzapine treatment. Conclusion: There is emerging evidence of the potentially beneficial role of Olanzapine treatment in children and adolescents with anorexia nervosa. Due to the difficulties in recruitment of cases for randomized controlled trials (RCTs) in this population innovative study designs are needed to expand the evidence base for the use of olanzapine treatment in AN. Longer term studies are important to understand the role of olanzapine in improving eating disorder symptoms and other comorbidities including its effect on weight restoration.
  • Service user and eating disorder therapist views on anorexia nervosa recovery criteria

    McDonald, Sarah (2021)
    OBJECTIVES: Recovery from anorexia nervosa (AN) is difficult to define, and efforts to establish recovery criteria have led to several versions being proposed. Using the perspectives of people with histories of AN and therapists working in the field, we sought to explore the face validity of Khalsa et al (2017) as one of the most recent examples of proposed systematic recovery criteria. DESIGN: We interviewed 11 health service users (SUs) with histories of AN who had previously received treatment alongside 8 eating disorder therapists (EDTs), exploring their views on the proposed AN recovery criteria. METHODS: Data from verbal and written interviews were analysed thematically. Separate thematic analyses of SU and EDT interviews highlighted where concerns converged and diverged across participants. RESULTS: Both groups saw some merits of having universally recognized recovery criteria, and the multidimensional approach was welcomed, but EDTs were uncomfortable with considering their use in therapy and SUs felt key components were missing around emotional coping and life quality. SUs disliked the prominence of body mass index (BMI) in the criteria, and all struggled with the proposed duration for recovery. Conceptually, the notion of recovery as an endpoint rather than a journey was contested. CONCLUSIONS: Our findings indicate disparities between academically derived recovery criteria and lived experiences and indicate perceived challenges in using such criteria in therapeutic settings. Including SUs and EDTs in the development of criteria may improve the likelihood of consolidating AN recovery criteria, but conceptual challenges remain. PRACTITIONER POINTS: AN recovery is complex, and the use of research-based AN recovery criteria in therapeutic settings could have a detrimental effect on SUs' outcomes. EDTs should be aware of efforts to define AN recovery criteria. EDTs should engage with debates on defining AN recovery and seek to promote participation in such debates to SUs.
  • The role of negative urgency in risky alcohol drinking and binge-eating in United Kingdom male and female students

    Jones, Katy A. (2020)
    Identifying students at risk of developing binge-eating and alcohol use disorders is a priority in the United Kingdom (UK). Although relationships between negative urgency (impulsive behavior during times of negative emotion), risky drinking, and binge-eating have been established in students from other countries, these links have yet to be replicated in male and female UK students. UK students aged 18-30 (n = 155) completed the: (1) the Urgency, Pre-meditation, Perseverance, Sensation Seeking (UPPS-P) negative urgency subscale; (2) Alcohol Use Disorders Identification Test (AUDIT); and (3) Binge-Eating Scale (BES). For categorical analysis, participants were assigned to one of four groups as a function of AUDIT and BES clinical cut-off scores: (1) no risk (28%); (2) risky drinkers (47%); (3) binge-eaters (6%); and (4) risky drinkers + binge-eaters (19%). For dimensional analysis, across students with non-zero AUDIT and BES scores (n = 141), BES, AUDIT, gender, and their interactions were entered as predictors in the same block of a regression. UPPS-P negative urgency was the dependent variable. Categorical results indicated that binge-eaters with and without risky drinking endorsed significantly higher negative urgency than students with no risk. Dimensional results showed that although higher BES and AUDIT scores were positively linked to higher negative urgency, but only the BES was significantly associated. Furthermore, BES shared substantially more variance with negative urgency than the AUDIT, and the BES-negative urgency relationship was stronger in male students than female students. High risk students may benefit the most from interventions that help regulate negative emotion.
  • A randomized controlled trial of the compuLsive Exercise Activity TheraPy (LEAP): A new approach to compulsive exercise in anorexia nervosa

    Arcelus, Jon (2018)
    OBJECTIVE: To compare the efficacy of the compuLsive Exercise Activity theraPy (LEAP) programme integrated with manualized cognitive behavioral therapy for anorexia nervosa (CBT-AN) compared to CBT-AN alone. METHOD: Seventy-eight adults were randomized to CBT-AN, delivered with or without eight embedded sessions of LEAP, for a total of 34 individual outpatient sessions. Participants were assessed at baseline, the end of the first phase of CBT-AN (which included LEAP), mid-therapy, end of therapy, and at 3 and 6 months follow-up. Linear mixed effects modelling was used for comparing trajectories over time by group in primary outcomes of pathological exercise cognitions and secondary outcomes of exercise frequency, BMI, eating disorder (ED) symptoms, AN stage of change, anxiety/depression, and health related quality of life. RESULTS: There were significant improvements over time in all outcomes. There were no significant differences between treatment groups in primary outcome measures. Fidelity and end-of-treatment participant satisfaction were satisfactory across both conditions. DISCUSSION: CBT-AN and LEAP added to CBT-AN resulted in improved attitudes and beliefs toward exercise and general improvements in BMI and ED psychopathology in people with AN.
  • An exploratory investigation of the experiences of partners living with people who have bulimia nervosa

    Huke, Katherine (2006)
    Objective: This study aimed to explore partners' experiences of living as a couple with someone with bulimia nervosa. Method: Transcripts of eight exploratory interviews with partners were analysed using Interpretative Phenomenological Analysis. Results: Five superordinate themes emerged: (1) Living with the secrecy and deception; (2) Struggling to understand and find reasons; (3) Discovering your powerlessness; (4) ‘It's like growing to live with it’; (5) Experiencing strengths and strains in the relationship. Discussion: Living with someone with bulimia presents many challenges for partners. They struggle to understand what is happening, can find the secrecy difficult to live with, and are often left feeling powerless. However, partners also look to find ways of accepting and living with the bulimia. It is suggested that partners could be offered opportunities to access support, and that their perspectives could be a useful resource for therapeutic interventions. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.
  • Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa

    Arcelus, Jon (2018)
    Background: For people with anorexia nervosa (AN), compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping/reducing exercise, dysregulation of affect, and inflexible exercise routines. It is associated with increased eating disorder psychopathology and poor clinical outcome. However, its relationships with two important clinical issues, quality of life (QoL) and motivation to change, are currently unknown. This study aimed to assess the cross-sectional relationships between compulsive exercise, QoL, psychological distress (anxiety and depressive symptoms, and obsessive-compulsive traits) and motivation to change in patients with AN. Method: A total of 78 adults with AN participated in this study, which was nested within a randomized controlled trial of psychological treatments for AN. At baseline (pre-treatment), participants completed questionnaires assessing compulsive exercise, eating disorder (ED) psychopathology, QoL, psychological distress and motivation to change. Results: Baseline correlational analyses demonstrated a moderate positive relationship between compulsive exercise and ED psychopathology, and a weak positive relationship between compulsive exercise and psychological distress. There was a moderate negative relationship between compulsive exercise and eating disorder QoL. Conclusions: These results indicate compulsive exercise is moderately associated with poorer QoL and weakly associated with higher distress. Targeting compulsive exercise in the treatment of anorexia nervosa may help reduce the burden of illness and improve patients' engagement in treatment. © 2018 The Author(s).
  • Risk factors for eating disorder psychopathology within the treatment seeking transgender population: The role of cross-sex hormone treatment

    Jones, Bethany A.; Bouman, Walter P.; Arcelus, Jon (2018)
    Many transgender people experience high levels of body dissatisfaction, which is one of the numerous factors known to increase vulnerability to eating disorder symptoms in the cisgender (non-trans) population. Cross-sex hormones can alleviate body dissatisfaction so might also alleviate eating disorder symptoms. This study aimed to explore risk factors for eating disorder symptoms in transgender people and the role of cross-sex hormones. Individuals assessed at a national transgender health service were invited to participate (N = 563). Transgender people not on cross-sex hormones reported higher levels of eating disorder psychopathology than people who were. High body dissatisfaction, perfectionism, anxiety symptoms, and low self-esteem were risk factors for eating psychopathology, but, after controlling for these, significant differences in eating psychopathology between people who were and were not on cross-sex hormones disappeared. Cross-sex hormones may alleviate eating disorder psychopathology. Given the high prevalence of transgender identities, clinicians at eating disorder services should assess for gender identity issues. Copyright (c) 2018 John Wiley & Sons, Ltd and Eating Disorders Association.
  • Eating disorders in athletes: Detection, diagnosis, and treatment

    Arcelus, Jon (2017)
    Sportsmen/women and dancers possess a distinct combination of physical and psychological attributes that can contribute toward their success within their sporting and dance context. This includes qualities such as physical and psychological resilience, an unyielding commitment to exercise, the continuous pursuit of excellence, and the ability to withstand intense physical exertion. However, because close attention to diet and weight control is very important in some sports and dance modalities, athletes are also at a significantly increased risk of developing an eating disorder. This chapter presents an overview of the current evidence on the presentation, prevalence, risk factors, and treatment strategies for eating disorders among athletes. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: chapter)
  • Eating disorders and disordered eating in the LGBTQ population

    Arcelus, Jon; Bouman, Walter P. (2017)
    An overall increased prevalence of eating disorders psychopathology has been reported among the LGBTQ population, particularly among gay men. For some transgender people transitioning post puberty, pressure to conform to a social gender role with the body of their assigned gender may precipitate body dissatisfaction and eating disorders as a consequence. For gay men in particular, trying to conform to specific roles, and the effect of the media, may also affect body dissatisfaction. In addition, concurrent mental health problems such as anxiety and depression may make the LGBTQ population more vulnerable to developing eating disorders. Helpful interventions for eating disorders in the LGBTQ population include addressing the maintaining factors of the eating disorder through therapy; improving interpersonal skills; and considering specific themes for this population, such as coming out, fears of rejection, and personal/societal acceptance.
  • Female athlete experiences of seeking and receiving treatment for an eating disorder

    Arcelus, Jon (2017)
    Clinical eating disorders are common among athletes; however research has yet to explore the process of seeking and receiving treatment for an eating disorder in this population. Semi-structured interviews were conducted with 13 female athletes currently receiving treatment for an eating disorder. A total of three themes emerged: challenges to treatment seeking, feeling out of place, and coping with exercise transitions. Athletes reported low levels of eating disorder literacy and lacked motivation to engage with therapy due to a lack of perceived relevance. Athletes found it challenging to relinquish exercise behaviours in treatment and expressed concerns around managing a return to sport. It may be necessary to provide additional support to athletes when embarking on and leaving treatment programs, particularly with regards to managing expectations about exercise.
  • Evaluation of a motivation and psycho-educational guided self-help intervention for people with eating disorders (MOPED)

    Arcelus, Jon (2016)
    High dropout rates and poor levels of engagement are well documented for patients with eating disorders. Utilising motivational techniques and providing psycho-education have been suggested as ways to reduce treatment disengagement. This study aimed to evaluate the effect of a newly developed motivational and psycho-educational (MOPED) guided self-help intervention for people with eating disorders on engagement and retention in therapy. Patients who received MOPED pre-treatment ( n = 79) were compared with a diagnosis-matched group of patients receiving treatment as usual (TAU; n = 79). The study found that patients receiving MOPED had a higher engagement rate than those within the TAU group. Specifically, patients in the anorexic spectrum were found to present with both higher rates of engagement and completion of therapy when issued with MOPED in comparison with TAU. Self-help packages using motivational style could be a valuable and cost-effective intervention for patients with eating disorders. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
  • Olfaction in eating disorders and abnormal eating behavior: a systematic review

    Arcelus, Jon (2015)
    The study provides a systematic review that explores the current literature on olfactory capacity in abnormal eating behavior. The objective is to present a basis for discussion on whether research in olfaction in eating disorders may offer additional insight with regard to the complex etiopathology of eating disorders (ED) and abnormal eating behaviors. Electronic databases (Medline, PsycINFO, PubMed, Science Direct, and Web of Science) were searched using the components in relation to olfaction and combining them with the components related to abnormal eating behavior. Out of 1352 articles, titles were first excluded by title (n = 64) and then by abstract and fulltext resulting in a final selection of 14 articles (820 patients and 385 control participants) for this review. The highest number of existing literature on olfaction in ED were carried out with AN patients (78.6%) followed by BN patients (35.7%) and obese individuals (14.3%). Most studies were only conducted on females. The general findings support that olfaction is altered in AN and in obesity and indicates toward there being little to no difference in olfactory capacity between BN patients and the general population. Due to the limited number of studies and heterogeneity this review stresses on the importance of more research on olfaction and abnormal eating behavior.
  • Detecting eating psychopathology in female athletes by asking about exercise: Use of the compulsive exercise test

    Arcelus, Jon (2017)
    The present study assessed the suitability of the Compulsive Exercise Test (athlete version; CET-A) for identifying female athletes with clinically significant features related to or comparable with eating psychopathology. Three hundred and sixty-one female athletes (including 12 with a clinically diagnosed eating disorder) completed the Eating Disorders Examination Questionnaire and the CET-A. Receiver operating curve analysis was employed to identify a cut-off value on the CET-A, which could indicate clinically significant features related to or comparable with eating psychopathology among female athletes. The analysis demonstrated that a CET-A score of 10 successfully discriminated female athletes with a current eating disorder. The results suggest that the CET-A may be a suitable tool for detecting eating psychopathology in female athletes. Additional longitudinal research is needed to evaluate the predictive value of the CET-A. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
  • The use of interpersonal psychotherapy for non-suicidal self-injury and eating disorders

    Bouman, Walter P. (2014)
    Interpersonal psychotherapy (IPT) is an effective treatment for depressive disorder. Over the last two decades, IPT has been modified to treat different mental health problems, including eating disorders. When working with patients presenting with eating disorder psychopathology, the eating disorder behaviour is used as a marker of "abnormality" that is linked lo the person's interpersonal difficulty. Non-suicidal self-injury behaviour (NSSI) within the eating disorder individual can be treated in the same way as the eating disorder behaviour. Within IPT, the therapist firstly aims to identify the interpersonal focus associated with the unhealthy behaviour, in order to work through this focus to reduce the behaviour. This chapter describes the modified version of IPT for eating disorders. It also makes suggestions how IPT may be used in a population of patients with eating disorders and NSSI, by including NSSI in addition to eating disorder behaviour as a marker of distress. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: chapter)

View more