Recovery from disordered eating: sufferers' and clinicians' perspectives.

OBJECTIVE: Disagreement exists on how to define recovery from eating disorders. Definitions typically include a combination of physical, cognitive, emotional, psychological and social factors. However, none provides multidimensional recovery models, addressing and comparing sufferers' and clinicians' viewpoints. This study investigates those recovery perspectives. METHOD: Two-hundred and thirty-eight participants (individuals with eating difficulties and clinicians working in the field) completed a checklist, rating the importance of somatic, psychological, emotional, social, eating-related and body experience-related recovery criteria. RESULTS: Recovery criteria fell into meaningful factors (psychological-emotional-social, weight-controlling behaviours, non-life-threatening and life-threatening features and evaluation of one's own appearance). Sufferers and clinicians agreed on the ranking of importance of these factors. However, sufferers considered 'psychological-emotional-social' and 'evaluation of one's own appearance' criteria as more important to recovery than clinicians. DISCUSSION: Findings are discussed in relation to existing research, together with study limitations and future research. Clinical implications are outlined, focusing on the facilitation of recovery.

Do schema processes mediate links between parenting and eating pathology?

OBJECTIVE: Adverse parenting experiences are commonly linked to eating pathology. A schema-based model of the development and maintenance of eating pathology proposes that one of the potential mediators of the link between parenting and eating pathology might be the development of schema maintenance processes--mechanisms that operate to help the individual avoid intolerable emotions. METHOD: To test this hypothesis, 353 female students and 124 female eating-disordered clients were recruited. They completed a measure of perceived parenting experiences as related to schema development (Young Parenting Inventory-Revised (YPI-R)), two measures of schema processes (Young Compensatory Inventory; Young-Rygh Avoidance Inventory (YRAI)) and a measure of eating pathology (Eating Disorders Inventory (EDI)). RESULTS: In support of the hypothesis, certain schema processes did mediate the relationship between specific perceptions of parenting and particular forms of eating pathology, although these were different for the clinical and non-clinical samples. DISCUSSION: In those patients where parenting is implicated in the development of eating pathology, treatment might need to target the cognitive processes that can explain this link.

Ethnic origins of patients attending specialist eating disorders services in a multiethnic urban catchment area in the United Kingdom.

OBJECTIVE: This study considered the impact of ethnicity on the referral process for patients with eating disorders, at the levels of referral rate, diagnosis, and treatment offered. METHOD: A catchment area cohort of 648 patients was referred and assessed at specialist eating disorders services in a multiethnic urban area (all boroughs in South London, UK). Each patient was diagnosed and offered treatment (or an alternative appropriate end-point to the referral), and self-identified their ethnicity. For comparison purposes, the local ethnic minority population was taken from census data. RESULTS: Ethnic minority patients were substantially less likely to be referred to the services than white patients, relative to the local population. The ethnic minority group were more likely to suffer from bulimia nervosa, and less likely to be found to have no eating disorder. However, the treatments offered did not differ substantially across the ethnic groups. DISCUSSION: Referrals to specialist eating disorder services do not reflect local populations' ethnic composition, though this disparity seems to be less by the time that the patient is offered treatment. It will be important to determine the source of these ethnic differences, and to take steps to reduce them.

Emotional awareness and core beliefs among women with eating disorders.

Patients with eating disorders have been shown to experience the emotional components of alexithymia-difficulties in identifying and describing emotions. In keeping with cognitive theories, which stress the role of schema-level beliefs in understanding emotions, this study examined the core beliefs that are associated with this difficulty in women with eating disorders. Seventy eating-disordered women completed standardised measures of core beliefs and alexithymia. There were no differences in alexithymia between diagnostic groups, so the women were treated as a single, transdiagnostic group. Multiple regression analyses showed specific patterns of association between the core beliefs and the emotional elements of alexithymia. Difficulties in identifying emotions were associated with entitlement beliefs, while difficulties in describing emotions were associated with both abandonment and emotional inhibition beliefs. These findings suggest that it may be necessary to work with core beliefs in order to reduce levels of alexithymia, prior to addressing the emotions that drive and maintain pathological eating behaviours.

Is comorbidity in the eating disorders related to perceptions of parenting? Criterion validity of the revised Young Parenting Inventory.

BACKGROUND: Recent studies support the reliability and validity of the Young Parenting Inventory-Revised (YPI-R) and its use in investigating the role of parenting in the aetiology and maintenance of eating pathology. However, criterion validity has yet to be fully established. To investigate one aspect of criterion validity, this study examines the association between parenting and comorbid problems in the eating disorders (including general psychopathology and impulsivity). METHOD: The participants were 124 women with eating disorders. They completed the YPI-R and the Brief Symptom Inventory (BSI; a measure of general psychopathology). They were also interviewed about their use of a number of impulsive behaviours. RESULTS: YPI-R scales were significant predictors of one of the nine BSI scales, and distinguished those patients who did or did not use specific impulsive behaviours. DISCUSSION: The criterion validity of the YPI-R is partially supported with regards to general psychopathology and impulsivity. The findings highlight the specificity of the parenting styles measured by the YPI-R, and the need for further research using this tool.

Social anxiety and agoraphobia in the eating disorders: associations with core beliefs.

The eating disorders have a high comorbidity with anxiety disorders, but it is not clear what cognitions underpin those anxiety symptoms. The present study investigated whether social anxiety and agoraphobia in eating-disordered individuals are associated with different types of unconditional core beliefs. The participants were 70 women meeting DSM-IV criteria for an eating disorder. The short version of Young's Schema Questionnaire (YSQ-S) was used as a measure of core beliefs, while the Social Phobia and Anxiety Inventory was used as a measure of levels of social anxiety and agoraphobia. Eating-disordered individuals reporting high levels of comorbid social anxiety had higher abandoment and emotional inhibition core beliefs. In contrast, patients with high levels of agoraphobia had higher vulnerability to harm beliefs. The findings highlight the importance of identifying and addressing core beliefs in subgroups of eating-disordered individuals presenting with comorbid anxiety. Implications for future research are discussed, including the need for longitudinal studies to elaborate on the specificity of the cognition-anxiety link in the eating disorders.

Family functioning in anorexia nervosa: British and Italian mothers' perceptions.

This study tested the hypothesis that cultural differences would influence individuals' perceptions of family functioning. Mothers of British and Italian children and adolescents with anorexia nervosa completed the Family Assessment Device (FAD). British mothers perceived their families' communication and role definition as less healthy than did the Italian mothers. In contrast, the Italians perceived their families' behavior control methods as less healthy than did the British mothers. The findings might be explained by differences between British and Italian interpretations of the role of "family," particularly giving the British emphasis on independence and the Italian emphasis on family life. It is suggested that these culturally divergent attitudes towards family life might have different influences on anorexia nervosa. Finally, implications for family therapy are discussed, taking into account those characteristics that are more relevant for each cultural group.