Self-Injurious Behavior And Its Relationship To Eating Disorder Symptom Severity

Widely held clinical assumptions about self-harming eating disorder patients were tested in this project. Specifically, the present study had two aims: (1) to confirm research that suggests patients with self-injurious behavior exhibit greater severity in eating disorder symptomology; and (2) to document the treatment course for these patients (e.g. reported change in eating disorder attitudes, beliefs, and behaviors) from admission to discharge. Data from 43 participants who received treatment at a Partial Hospitalization Program (PHP) for Eating Disorders were used in the current study. The length of treatment required for study inclusion reflected mean lengths of stay (Williamson, Thaw, & Varnardo-Sullivan, 2001) and meaningful treatment lengths in prior research (McFarlane et al., 2013; McFarlane, Olmsted, & Trottier, 2008): five to eight weeks. Scores on the Eating Disorder Inventory-III (Garner, 2004) at the time of admission and discharge were compared. These results suggest that there are no significant differences between eating disordered patients who engage in self-injury and those who do not in terms of symptom severity or pathology at admission. The results further suggest that patients in both groups see equivalent reductions in symptoms from admission to discharge across domains and also share non-significant changes in emotional dysregulation over the course of treatment. Importantly, these results also suggest that general psychological maladjustment is higher at discharge for eating disordered patients who engage in self-injury.

Eating disorders in children and adolescents: an update

Purpose of review Children and adolescents with eating disorders frequently present to child mental health and paediatric services and have significant morbidity, psychosocial impairment and mortality. Efforts to treat these individuals have been hampered by a poor evidence base for effective interventions. This article reviews research published during 2004 with a primary focus on this challenging clinical area. Recent findings Research published during 2004 has replicated past epidemiological findings and expanded our understanding of the relationship of family meal structure and disordered eating. Research has provided assistance in the well known clinical conundrums of excessive exercising in anorexia nervosa and predicting when return of menses will occur. There has also been clarification of adolescent bingeing. Potential advances include a new, noninvasive method of measuring body composition and investigations in adolescents on leptin, neuro and gastrointestinal peptides. Importantly, further evidence of the effectiveness of family therapy for anorexia nervosa and short-term benefits from intervention programs have been published. Summary The research base that will influence clinical practice in child and adolescent eating disorders is increasing. More research is required in all areas of intervention.

A Transdiagnostic Approach to Understanding Eating Disorders

Categorical models dominate the eating disorder field, but the tandem use of categorical and dimensional models has been proposed. A transdiagnostic dimensional model, number of lifetime eating disorder behaviors (LEDB), was examined with respect to (1) its relationship to a variety of indicators of the individual's functioning, (2) the degree to which it was influenced by genetic and environmental risk factors, and (3) exposure to specific environmental risk factors. Data from self-report and interview from 1002 female twins (mean age = 34.91 years, SD = 2.09) were examined. While 15.4% women met criteria for a lifetime eating disorder, 29% had at least one LEDB. The dimensional measure provided an indicator of associated functioning, and was influenced primarily by the nonshared environment. The number of LEDB was associated with the degree of impaired functioning. This impairment was associated with conflict between parents and criticism from parents when growing up.

Use of latent profile analysis to identify eating disorder phenotypes in an adult Australian twin cohort

Context: The relationships among the different eating disorders that exist in the community are poorly understood, especially for residual disorders in which bingeing or purging occurs in the absence of other behaviors. Objective: To examine a community sample for the number of mutually exclusive weight and eating profiles. Design: Data regarding lifetime eating disorder symptoms and weight range were submitted to a latent profile analysis. Profiles were compared regarding personality, current eating and weight, retrospectively reported life events, and lifetime depressive psychopathology. Setting: Longitudinal study among female twins from the Australian Twin Registry in whom eating was assessed by a telephone interview. Participants: A community sample of 1002 twins (individuals) who had participated in earlier waves of data collection. Main Outcome Measures: Number and clinical character of latent profiles. Results: The best fit was a 5-profile solution with women who were (1) of normal weight with few lifetime eating disorders (4.3%), (2) overweight (10.6% had a lifetime eating disorder), (3) underweight and generally had no eating disorders except for 5.3% who had restricting anorexia nervosa, (4) of low to normal weight (89.0% had a lifetime eating disorder), and (5) obese (37.0% had a lifetime eating disorder). Each profile contained more than 1 type of lifetime eating disorder except for the third profile. Women in the first and third profiles had the best functioning, with women in the fourth and fifth profiles having similarly poorer functioning. The women in the fourth group had a symptom profile distinctive from the other 4 groups in terms of severity; they were also more likely to have had lifetime major depression and suicidality. Conclusion: Lifetime weight ranges and the severity of eating disorder symptoms affected clustering more than the type of eating disorder symptom.

The role of interpersonal functioning in the maintenance of eating psychopathology:a systematic review and testable model

This review aims to systematically evaluate the empirical literature relating to the interpersonal functioning of those with eating disorder psychopathology and presents a preliminary model to help the formulation of patients' problems. Following a thorough literature search, 35 papers were included in this systematic review. The vast majority of studies indicate a strong association between eating psychopathology and certain maladaptive personality traits. The origins of social anxiety and poor social support that have been described as maintaining eating disorders appear to differ according to diagnostic groups. Interpersonal difficulties in people with restrictive behaviors such as anorexia appear to be related to the avoidance of expressing feelings to others and to giving priority to other people's feeling over their own. While interpersonal difficulties in patients with bulimia nervosa appear to be more related to interpersonal distrust and negative interaction and conflict with others. These concepts are presented in a preliminary model of interpersonal functioning in the eating disorders. © 2012 Elsevier Ltd.

The relationship of spirituality and the health promoting behaviors of diet and exercise of African -American women

Public health data show that African-Americans have not adopted health-promoting behaviors of diet and exercise. Spirituality, important in the lives of many African-American women, may be associated with health-promoting behaviors. This study was designed to determine how spirituality relates to health-promoting behaviors in African-American women. Burkhardt's theoretical framework for spirituality was adopted and measures were selected for the three elements of the framework: connectedness with self, others, and environment. ^ The study used a descriptive cross sectional correlational design to investigate the relationships of the independent variables of spirituality, sociodemographics, and BMI, to the dependent variables of diet and exercise, to answer the two primary questions: What is the role of spirituality in impacting the health-promoting behaviors of African-American women? Of the independent variables of spirituality, sociodemographics, and BMI, which are the best predictors of diet and exercise? ^ Central and South Floridian African-American women (n = 260) between 18 and 82 years of age completed several questionnaires: Rosenberg's Self-Esteem Scale, Health Promoting Lifestyle Profile II, Spiritual Perspective Scale, Brief Block Food Frequency, and socio-demographic information. ^ Hierarchical regression identified 40% of the variability of diet to be explained by socio-demographic (education) and spirituality variables (stress management and health responsibility) (p < .001). Twenty-nine percent of the variability of exercise was explained by socio-demographic (education) and spirituality variables (stress management) (p < .001). Canonical correlation analysis identified a significant pair of canonical variates which indicated individuals with good nutrition (.95), increased physical activity (.79), and healthy eating (.42) also had better stress management (.88), better health responsibility (.67), higher spiritual growth (.66), better interpersonal relations (.50), more education (.49), and higher self-esteem (.33). The set explained 57% of the variability (p < .001). ^ An understanding of the factors that influence these women's decision to utilize health-promoting strategies could provide health professionals with additional information to enable them to design culturally and spiritually related health messages for African-American women. The findings of this present study speak of the importance of focusing on stress management, health responsibility, spiritual growth, interpersonal relations and self-esteem along with diet and exercise; this will likely provide improvement in the health-promoting behaviors of African-American women. ^

The use of motivational interviews by nurses to promote health behaviors in adolescents: a scoping review protocol

Adolescents - defined as young people between 10 and 19 years of age1 - are, in general, a relatively healthy segment of the population.2 However, the developmental changes that take place during adolescence may affect their subsequent risk for diseases and for a variety of health-related behaviors. In fact, early onset of preventable health problems (e.g. obesity, malnutrition, STDs) and the engagement in health risk behaviors (e.g., sedentary life style, excessive alcohol consumption, unprotected sex) during adolescence, are likely to put them at greater risk for physical and mental health problems at a later stage in life. Moreover, health related problems and health risk behaviors may disrupt adolescents' physical and cognitive development and therefore may affect their ability to think and act in relation to decisions about their health in the future.1 In summary, health-related behaviors in adolescence, apart from their influence on the continuum of "health-disease", they also have the potential to influence future behaviors. In fact, several studies have shown that past behaviors are good predictors of future behaviors .3,4 Thus, promoting healthy practices during adolescence and taking measures to better protect young people from health risks are essential for the prevention of health problems in adulthood.5 According to the World Health Organization, the main problems affecting young people include mental health problems (such as behavioral disorders, eating disorders, suicide, anxiety or depression), the use of substances (illegal substances, alcohol and tobacco), interpersonal violence, nutrition (a proper nutrition consists of healthy eating habits and physical exercise), unintentional injuries (which are a leading cause of death and disability among young people, with road traffic injuries accounting for about 700 deaths per day), sexual and reproductive health (for example, risky sexual behaviors, early pregnancy and childbirth) and HIV (resulting from sexual transmission and drug injection).5,6 On the other hand, the number of children and youth with chronic health conditions has increased dramatically in the past four decades7 as larger numbers of chronically ill children survive beyond the age of 10.8 Despite the lack of data on adolescents' health making it difficult to determine the prevalence of chronic illnesses in this age group9, it is known that one in ten adolescents suffers from a chronic condition worldwide.10 In fact, national population based studies from Western countries show that 20-30% of teenagers have a chronic illness, defined as one that lasts longer than six months.8 The most prevalent chronic illness among adolescents is asthma and the one with the highest incidence is diabetes mellitus, particularly type II.9 Traditionally, healthcare professionals have been mainly investing in health education activities, through the transmission of knowledge with a view to creating habits, customs and behaviors, and promoting healthy lifestyles. However, empowering people does not only consist of giving them the right information11 , i.e. good information is not enough to cause people to make changes.12 The motivation or desire to change unhealthy behaviors and habits depends on many factors, namely intrinsic motivation, control over personal decisions, self-confidence and perception of effectiveness, personal ambivalence, and individualized assistance.12 Many professionals assume that supplying knowledge is sufficient for behavioral changes; however, even very good advice often fails to generate behavioral change. After all, people continue to engage in unhealthy behaviors despite clearly knowing what they should do and how to change. "What is lacking is the motivation to apply that knowledge".13, p.1233 In fact, behavioral change is a complex phenomenon with multiple determinants that also includes motivational variables. It is associated with ambivalent processes expressed in the dilemma between keeping the current status and moving on to new ways of acting. For example, telling adolescents that if they keep on engaging in a certain behavior, they are increasing the risk of developing a long-term condition such as cardiovascular disease, stroke or diabetes is rarely enough to trigger the desired behavioral change; people are more likely to change when they believe that the change is really effective and that they are able to implement it.12 Therefore, it is essential to provide specific training for "healthcare professionals to master motivational techniques, avoid confrontation with the users, and facilitate behavioral changes".14 In this context, motivating patients to make behavioral changes is also an important nursing task where change in lifestyle is a major element of patients' treatment and preventive interventions.15 One of the nurse's goals is to help improve a patient's health or help them to manage existing health conditions. Once nurses are in a position where they have to focus on accomplishing tasks and telling patients what needs to be accomplished16, the role of the nurse is expanding even more into the use of motivational strategies.17 MI is bringing nurses back to therapeutic communication and moving them closer to successful health promotion and disease management, by promoting behavior change and empowering their patients. As the nursing profession evolves, MI is seen as a challenge and the basis of nurse's interactions with individuals, families and communities.16, 17 In the same way, MI may be taken as an essential tool in the provision of nursing care to adolescents, being itself a workspace with possible therapeutic effects regarding problems, clarification of doubts, and development of skills.18 In fact, MI may be particularly applicable in work with adolescents because of their specific developmental stage. Adolescents attempt to establish their own autonomy and identity while struggling with social interactions and moral issues, which leads to ambivalence.19 Consistent with the developmental challenges during adolescence, "MI explicitly honors autonomy, people's right and irrevocable ability to decide about their own behavior"20 while allowing the person to explore possibilities for change of risky or maladaptive behaviours.19 MI can be defined as a directive, client-centred counselling style for eliciting behavior change by helping clients to explore and resolve ambivalence. It is most centrally defined not by technique but by its spirit as a facilitative style of interpersonal relationship.21 It is a set of strategies and techniques widely used in clinical practice based on the transtheoretical model of change. The Stages of Change model describes five stages of readiness—precontemplation, contemplation, preparation, action, and maintenance—and provides a framework for understanding behavior change.22 The MI has been widely tested and applied in different areas, such as modification of addictive behaviors, interventions with offenders in the context of justice, eating disorders, promotion of therapeutic adherence among chronic patients, promotion of learning in school settings or intervention with adolescents at risk.18,23 In general, clinical practice has been adopting the perspective of motivation as something relatively immutable, i.e., the adolescent is either motivated for change/treatment and, in these conditions, the professional's role is to help him/her, or the adolescent is not motivated and then change/treatment is not feasible. Alternatively the theoretical model underlying the MI technique postulates that the individual's adherence to change/treatment depends on his/her motivation, which can change throughout the therapeutic intervention. As several studies found positive results for effects of MI24-26 and its use by health professionals is encouraged23,27 nurses may play an important role in patients' process of change. As nurses have a crucial role in clinical contexts, they can facilitate the process of ending risk behaviors and/or adopting positive health behaviors through some motivational techniques, namely with adolescents. A considerable number of systematic reviews about MI already exist pointing to some benefits of its use in the treatment of a broad range of behavioral problems and diseases.13,28,29 Some of the current reviews focus on examining the effectiveness of MI for adolescents with diverse health risks/problems 30-32. However, to date there are no reviews that present and assess the evidence for the use of nurse-led MI in adolescents. Therefore, we have little knowledge of what works for whom (which adolescent subpopulation) under what circumstances (in which setting, for what problem) in relation to motivational interviewing by nurses. There is a clear need for scoping or mapping the use of MI by nurses with adolescents to identify evidence gaps and to inform opportunities for future development in nursing practice. On the other hand, information regarding nurse-led implemented and evaluated interventions, techniques and/or strategies used, contexts of application and adolescents subpopulation groups is dispersed in the literature33-36 which impedes the formulation of precise questions about the effectiveness of those interventions conducted by nurses and therefore the realization of a systematic review. In other words, it is known that different kind of motivational interventions have been implemented in different contexts by nurses, however does not exist a map about all the motivational techniques and/or strategies used. Furthermore the literature does not clarify which is the role of nurses at cross professional motivational intervention implemented programs and finally the outcomes and evaluation of interventions are unclear. Thus, the practical implication of this mapping will be clarifying all these aspects. Without this clarification is not possible to proceed to the realization of a systematic review about the effectiveness of the use of motivational interviews by nurses to promote health behaviors in adolescents, in a particular context and/or health risk behavior; or regarding the effectiveness of certain technique and/or strategy of MI. Consequently, there are important questions about the nature of the evidence in this area that need to be answered before formulating a precise question of effectiveness. This scoping review aims to respond to these questions. An initial search of the JBI Database of Systematic Reviews & Implementation Reports, Cochrane Database of Systematic Reviews, , Database of promoting health effectiveness reviews (DoPHER), The Campbell Library, Medline and CINAHL, has revealed that currently there is no Scoping Review (published or in progress) on the subject. In this context, this scoping review will examine and map the published and unpublished research around the use of MI by nurses implemented and evaluated to promote health behaviors in adolescents; to establish its current extent, range and nature and identify its feasibility, outcomes and gaps in the evidence defining research priorities in this field. This scoping review will be informed by the JBI methodology37 that suggests a five stage methodological framework for conducting scoping reviews which includes: identifying the research question, searching for relevant studies, selecting studies, charting data, collating, summarizing and reporting the results.

A systematic review of environmental correlates of obesity-related dietary behaviors in youth

There is increasing interest in the role the environment plays in shaping the dietary behavior of youth, particularly in the context of obesity prevention. An overview of environmental factors associated with obesity-related dietary behaviors among youth is needed to inform the development of interventions. A systematic review of observational studies on environmental correlates of energy, fat, fruit/ vegetable, snack/fast food and soft drink intakes in children (4–12 years) and adolescents (13–18 years) was conducted. The results were summarized using the analysis grid for environments linked to obesity. The 58 papers reviewed mostly focused on sociocultural and economical–environmental factors at the household level. The most consistent associations were found between parental intake and children’s fat, fruit/vegetable intakes, parent and sibling intake with adolescent’s energy and fat intakes and parental education with adolescent’s fruit/ vegetable intake. A less consistent but positive association was found for availability and accessibility on children’s fruit/vegetable intake. Environmental factors are predominantly studied at the household level and focus on sociocultural and economic aspects. Most consistent associations were found for parental influences (parental intake and education).More studies examining environmental factors using longitudinal study designs and validated measures are needed for solid evidence to inform interventions.

Psychosocial predictors of intentions to engage in change supportive behaviors in an organizational context

This study utilized the Theory of Planned Behavior (TPB) to understand employee change readiness. The extent to which attitude, subjective norm, and perceived behavioral control predicted employees’ intentions to carry out activities that were supportive of a change event were investigated. The impact of group norm was examined as a further predictor of change-related intentions. The context of the research was a sample of 82 employees in the early stages of a re-brand. Results indicated that direct measures of attitude and subjective norm, as well as group norm, emerged as significant predictors of employees’ intentions to perform re-brand behaviors. To capture the indirect beliefs underlying attitude, subjective norm, and perceived behavioral control, participants also provided an assessment of their behavioral, normative, and control beliefs in regards to the change event, respectively. A series of MANOVAs revealed significant differences between moderate and high intenders on a range of underlying beliefs. Findings are discussed in terms of the application of the TPB for effective change management.

The relationship between basic need satisfaction and emotional eating in obesity

Emotional eating has been identified as a factor that promotes the development and maintenance of obesity and hinders its treatment. This study investigated the relationship between unsatisfied basic needs and emotional eating, including the mediating factors of self-esteem and coping strategies. The results from a survey of 136 obese individuals indicated support for a significant relationship between basic need satisfaction and emotional eating, with a mediating effect of negative coping strategies. These findings extend previous research and provide guidance on how to help individuals who engage in emotional eating by focusing on developing more adaptive coping strategies.

Imagery and strength of craving for eating, drinking and playing sport

The elaborated intrusion (EI) theory of desire (Kavanagh, Andrade, & May, 2005) attributes the motivational force of cravings to cognitive elaboration, including imagery, of apparently spontaneous thoughts that intrude into awareness. We report a questionnaire study in which respondents rated a craving for food or drink. Questionnaire items derived from EI theory formed a single factor alongside factors for anticipated reward/relief, resistance, and opportunity. In a multiple regression predicting strength of craving, the first three factors accounted for 36% of the variance. Opportunity did not enter the model. In a second study, the difference between individuals' strong and weak cravings to take part in a sporting activity was shown to be related to visual, auditory, and general imagery, and to anticipated reward or relief from engaging in the activity. Implications for treatment of craving-related disorders are discussed in the light of these results and of other research indicating that interference with imagery can reduce the strength of craving.

Acute compensatory eating following exercise is associated with implicit hedonic wanting for food

The efficacy of exercise to promote weight loss could potentially be undermined by its influence on explicit or implicit processes of liking and wanting for food which in turn alter food preference. The present study was designed to examine hedonic and homeostatic mechanisms involved in the acute effects of exercise on food intake. 24 healthy female subjects were recruited to take part in two counterbalanced activity sessions; 50 min of high intensity (70% max heart rate) exercise (Ex) or no exercise (NEx). Subjective appetite sensations, explicit and implicit hedonic processes, food preference and energy intake (EI) were measured immediately before and after each activity session and an ad libitum test meal. Two groups of subjects were identified in which exercise exerted different effects on compensatory EI and food preference. After exercise, compensators (C) increased their EI, rated the food to be more palatable, and demonstrated increased implicit wanting. Compensators also showed a preference for high-fat sweet food compared with non-compensators (NC), independent of the exercise intervention. Exercise-induced changes in the hedonic response to food could be an important consideration in the efficacy of using exercise as a means to lose weight. An enhanced implicit wanting for food after exercise may help to explain why some people overcompensate during acute eating episodes. Some individuals could be resistant to the beneficial effects of exercise due to a predisposition to compensate for exercise-induced energy expenditure as a result of implicit changes in food preferences.

Complexity and learning behaviors in product innovation

Successful product innovation and the ability of companies to continuously improve their innovation processes are rapidly becoming essential requirements for competitive advantage and long-term growth in both manufacturing and service industries. It is now recognized that companies must develop innovation capabilities across all stages of the product development, manufacture, and distribution cycle. These Continuous Product Innovation (CPI) capabilities are closely associated with a company’s knowledge management systems and processes. Companies must develop mechanisms to continuously improve these capabilities over time. Using results of an international survey on CPI practices, sets of companies are identified by similarities in specific contingencies related to their complexity of product, process, technological, and customer interface. Differences between the learning behaviors found present in the company groups and in the levers used to develop and support these behaviors are identified and discussed. This paper also discusses appropriate mechanisms for firms with similar complexities, and some approaches they can use to improve their organizational learning and product innovation.