Radically open-dialectical behavior therapy for adult anorexia nervosa: feasibility and outcomes from an inpatient program

Background Anorexia Nervosa (AN) is a highly life-threatening disorder that is extremely difficult to treat. There is evidence that family-based therapies are effective for adolescent AN, but no treatment has been proven to be clearly effective for adult AN. The methodological challenges associated with studying the disorder have resulted in recommendations that new treatments undergo preliminary testing prior to being evaluated in a randomized clinical trial. The aim of this study was to provide preliminary evidence on the effectiveness of a treatment program based on a novel adaptation of Dialectical Behavior Therapy (DBT) for adult Anorexia Nervosa (Radically Open-DBT; RO-DBT) that conceptualizes AN as a disorder of overcontrol. Methods Forty-seven individuals diagnosed with Anorexia Nervosa-restrictive type (AN-R; mean admission body mass index = 14.43) received the adapted DBT inpatient program (mean length of treatment = 21.7 weeks). Results Seventy-two percent completed the treatment program demonstrating substantial increases in body mass index (BMI; mean change in BMI = 3.57) corresponding to a large effect size (d = 1.91). Thirty-five percent of treatment completers were in full remission, and an additional 55% were in partial remission resulting in an overall response rate of 90%. These same individuals demonstrated significant and large improvements in eating-disorder related psychopathology symptoms (d = 1.17), eating disorder-related quality of life (d = 1.03), and reductions in psychological distress (d = 1.34). Conclusions RO-DBT was associated with significant improvements in weight gain, reductions in eating disorder symptoms, decreases in eating-disorder related psychopathology and increases in eating disorder-related quality of life in a severely underweight sample. These findings provide preliminary support for RO-DBT in treating AN-R suggesting the importance of further evaluation examining long-term outcomes using randomized controlled trial methodology.

Reply to: punishing food: what brain activity can tell us about the representation of food in recovered anorexia nervosa

Eating disorders are characterized by aberrant cognitions and behaviors around food. We used a novel functional magnetic resonance imaging task in a sample of recovered anorexia nervosa subjects to study the neural response to both pleasant and aversive food tastes and pictures compared with a group of matched female subjects who had never had the disorder. We report that individuals recovered from anorexia nervosa have an increased neural response to rewarding and aversive food stimuli, in the form of chocolate (e.g., in the ventral striatum) and moldy strawberries (e.g., in the caudate).

General practitioners' perspectives regarding competence and confidentiality in an adolescent with suspected anorexia nervosa: legal and ethical considerations

In Victoria, Australia, the legal position regarding young people's competence to make medical treatment decisions has not been clarified in legislation, and a number of often vague common law decisions must be relied on for guidance. This situation produces a degree of uncertainty about appropriate professional practice, while also potentially impeding young people's rights claims in health care settings. With this in mind, the present research explored general practitioners' competence and confidentiality decisions regarding a 17-year-old female who presented with symptoms of an eating disorder. Questionnaires were sent to a random sample of 500 Victorian general practitioners, of whom 190 responded. After reading a case vignette, general practitioners indicated whether they would find the hypothetical patient competent and if they would maintain her confidentiality. Seventy-three per cent of respondents found the patient competent and most would have maintained confidentiality, at least initially. However, subsequent analysis of the rationales supplied for these decisions revealed a wide diversity in general practitioners' understandings and implementations of extant legal authority. This research highlights the need for general practitioners to be exposed to up-to-date and clinically relevant explanations of contemporary legal positions.

Near normalisation of lumbar spine bone density in young women with osteopenia recovered from adolescent onset anorexia nervosa: a longitudinal study

To investigate the effect of the progression of adolescent onset anorexia nervosa (AN) on bone parameters we followed two cohorts (Disease cohort and recovered cohort) of adolescents for a total of 5.2 years. In the 'Disease' cohort (n = 18), lumbar spine bone density (BMD) was reduced by 0.6 SD after 0.8 years of disease and was reduced a further 1.0 SD after a total 2.5 years of disease (p < 0.001). At the third lumbar vertebra there was bone loss (-3.7%, p < 0.05) resulting in reduced volumetric BMD (-5.1%, p < 0.08). In the 'recovered' cohort, lumbar spine BMD was reduced by 1.9 SD after 1.7 years of disease, and increased by 1.5 SD after 2.7 years of recovery (p < 0.001). At the third lumbar vertebra there was an increase in bone mass (20.5%, p < 0.001) and bone volume (14.1%, p < 0.001), resulting in increased volumetric BMD (6.3%, p < 0.08). Normalisation of lumbar spine BMD may be achieved in patients with adolescent onset AN when the successful recovery of body weight is combined with the return of regular menses.

The lived experience of registered nurses caring for adolescent females diagnosed with anorexia nervosa on adolescent wards in public hospitals in Victoria

Explores in depth the experiences of registered nurses caring for female patients diagnosed with anorexia nervosa on adolescent wards in public hospitals in Victoria. The philosophy of Husserl and the procedural steps of analysis developed by Paul Colaizzi were the basis for investigating and extracting the essence of the lived experiences of participants.

Perceptions of family functioning and self-concept in adolescent anorexia nervosa [R]

Authors have highlighted the importance of the family for the development of positive self-concept and identity, not only in mental health research but also in various developmental and social psychology fields. With the increase in the incidence and prevalence of eating disorders in Australia and around the world, some researchers have attempted to understand how aspects of family functioning affect the onset and maintenance of the chronic illness, particularly for younger patients who are still undergoing drastic psychological changes and development. This study attempted to bridge gaps in the literature examining functioning and dyadic relations in families affected by eating disorders. More specifically, this study compared the perceptions of mothers, fathers and daughters about general family functioning to determine whether any discrepancies between the perceptions of family and how these affect self-concept in adolescent girls with anorexia nervosa.

Adolescent anorexia nervosa and self-concept [R]

Anorexia nervosa is an intriguing psychiatric disorder that is becoming a significant public health issue for adolescent girls around the world. Despite the proliferation of research and literature in the field, particularly concerning the aetiology, incidence and treatment for the disorder, little is understood about the aetiology of the disorder in the adolescent population. Researchers have suggested that low self-concept is one of many risk factors for eating disorders, including anorexia nervosa. Despite this, significant questions still remain about the relationship between self-concept and the severity and incidence of anorexia nervosa in adolescent girls in Australia. The pertinence of self-concept is undeniable due to its relevance to the personal and societal issues that exist in our society. This paper presents analyses of the multidimensional self-concepts of sixty-five adolescent girls with anorexia nervosa, and explores the relationships that exist between the distinct dimensions of the self-concept and eating disorder symptomotology.

The specifics of coping : parents of daughters with anorexia nervosa

In this article, the authors report on an interview study in which parents described the coping strategies they used to deal with the demands of having a daughter diagnosed with anorexia nervosa. They compare parents’ accounts with commonly used categorizations in quantitative studies of parental coping and adjustment. The study indicates that parents attribute multiple, complex, and unique motives to their actions that problematize quantitative constructions of types of coping. Parents often defined their actions differently and reported using coping strategies that were not considered or measured by the most widely used quantitative coping instruments. The analysis indicates that when the focus is on understanding and assisting parental coping in particular circumstances, situated, contextspecific analyses are necessary to design measures that accurately reflect parents’ coping efforts.