Recent Submissions

  • 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)
  • Psychometric properties of the Chinese version of the eating attitudes test in young female patients with eating disorders in mainland China

    Arcelus, Jon (2017)
    The study aimed to investigate the reliability and validity of the Chinese version of the eating attitudes test (EAT-26) among female adolescents and young adults in Mainland China. This scale was administered to 396 female eating disorder patients and 406 noneating disorder healthy controls, in addition 35 healthy controls completed a retest after a 4-week intervals. Tests for reliability, convergent validity and receiver operating characteristic analysis were performed to detect the psychometric properties. The EAT-26 demonstrated good internal consistency (Cronbach's alpha = 0.822-0.922), test-retest reliability (interclass correlation coefficient = 0.817) and convergent validity(r = 0.450-0.750). The receiver operating characteristic analysis showed that the cut-off 14 for anorexia nervosa and 15 for bulimia nervosa represented good compromises with approximate sensitivity (0.66-0.68) and specificity (0.85-0.86). Our findings provided evidence that the Chinese version of the EAT-26 was a psychometrically reliable and valid self-rating instrument for identifying people suffering from an eating disorder in Mainland China. A clinical cut-off range between 14 and 15 could be used, but caution should be exercised because of the low sensitivity of the tool. Copyright (c) 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
  • MotivATE: A pretreatment web-based program to improve attendance at UK outpatient services among adults with eating disorders

    Arcelus, Jon (2017)
    BACKGROUND: In the UK, eating disorders affect upward of 725,000 people per year, and early assessment and treatment are important for patient outcomes. Around a third of adult outpatients in the UK who are referred to specialist eating disorder services do not attend, which could be related to patient factors related to ambivalence, fear, and a lack of confidence about change. This lack of engagement has a negative impact on the quality of life of patients and has implications for service costs. OBJECTIVE: To describe the development of a Web-based program ("MotivATE") designed for delivery at the point of referral to an eating disorder service, with the aim of increasing service attendance. METHODS: We used intervention mapping and a person-based approach to design the MotivATE program and conducted a needs assessment to determine the current impact of service nonattendance on patients (via a review of the qualitative evidence) and services (through a service provision survey to understand current issues in UK services). Following the needs assessment, we followed the five steps of program development outlined by Bartholomew et al (1998): (1) creating a matrix of proximal program objectives; (2) selecting theory-based intervention methods and strategies; (3) designing and organizing the program; (4) specifying adoption and implementation plans; and (5) generating program evaluation plans. RESULTS: The needs assessment identified current nonattendance rates of 10%-32%. We defined the objective of MotivATE as increasing attendance rates at an eating disorder service and considered four key determinants of poor attendance: patient ambivalence about change, low patient self-efficacy, recognition of the need to change, and expectations about assessment. We chose aspects of motivational interviewing, self-determination theory, and the use of patient stories as the most appropriate ways to enable change. Think-aloud piloting with people with lived experience of an eating disorder resulted in positive feedback on the MotivATE program. Participants related well to the stories used. Nonetheless, because of feedback, we further modified the program in line with patients' stage of change and addressed issues with the language used. A consultation with service staff meant that we could make clear implementation plans. Finally, a randomized controlled trial is currently underway to evaluate the MotivATE program. CONCLUSIONS: Using intervention mapping, we have developed a novel pretreatment Web-based program that is acceptable to people with eating disorders. To our knowledge, this is the first such program. The model of development described here could be a useful template for designing further programs for other difficult-to-engage populations.
  • Food refusal in prison

    Larkin, Emmet P. (1991)
    The prevalence of mental disorder amongst prisoners refusing food was studied by examining the prison records of a remand prison and a dispersal prison. Food refusal occurred predominantly in the remand prison. Less than one per cent of the annual remand population engaged in this behaviour. The results indicate that prisoners refusing food do so as a form of protest and that the prevalence of mental disorder among such prisoners is high. The majority respond to observation and counselling. Important indicators of psychosis are: (i) the inability of the prisoner to divulge reasons for his behaviour; and (ii) the refusal by the prisoner of both food and fluids. In such cases transfer to hospital for treatment may be urgently required.
  • Treating young people with eating disorders: Transition from child mental health to specialist adult eating disorder services

    Bouman, Walter P. (2008)
    Background: The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) of young people with eating disorders may pose a number of difficulties, including an inconsistent referral process and age boundaries. Methods: We compared young adults referred to a specialist Adult Eating Disorders Service (AEDS) who had previous involvement with CAMHS for the treatment of their eating disorder with those who did not. Information regarding the socio-demographic characteristics and eating disorders symptomatology of patients assessed by an AEDS over a 4-year period was collected. Results: Patients who had previous involvement with CAMHS (particularly the ones treated as in-patients) presented with a lower self-esteem and more maturity fears (MF) than those without previous involvement. Conclusions: This study discusses the implication of these results in transitional arrangements between CAMHS and Adult services. It also highlights the need for heightened awareness of particular issues of self-esteem and maturation in these patients moving between services. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.

View more