Outcomes for binge eating disorder in a remote weight-inclusive treatment program: a case report.

BACKGROUND: There are no known published reports on outcomes for medically and psychiatrically compromised patients with binge eating disorder (BED) treated remotely in higher level of care settings. This case report presents outcomes of an intentionally remote weight-inclusive partial hospitalization and intensive outpatient program based on Health at Every Size® and intuitive eating principles. CASE PRESENTATION: The patient presented with an extensive trauma background and long history of disturbed eating and body image. She was diagnosed with BED along with several comorbidities, most notably major depressive disorder with suicidality and non-insulin dependent diabetes mellitus. She completed a total of 186 days in the comprehensive, multidisciplinary treatment program encompassing individual and group therapy, as well as other supportive services such as meal support and in vivo exposure sessions. Upon discharge, her BED was in remission, her major depressive disorder was in partial remission, and she no longer exhibited signs of suicidality. Overall, she showed decreases in eating disorder, depressive, and anxiety symptoms as well as increases in quality of life and intuitive eating throughout treatment, which were largely maintained after one year. CONCLUSIONS: This case highlights the potential of remote treatment as an option for individuals with BED, especially in cases where access to higher levels of care might be limited. These findings exemplify how a weight-inclusive approach can be effectively applied when working with this population.

Provisional posttraumatic stress disorder is associated with greater severity of eating disorder and comorbid symptoms in adolescents treated in residential care.

OBJECTIVE: Past traumatic events, subsequent posttraumatic stress disorder (PTSD) and related psychiatric comorbidities are commonly associated with eating disorders (EDs) in adults but remain understudied in adolescents. METHODS: Adolescent participants (mean [SD] age = 15.1 ± 1.5 years, 96.5% female) with EDs entering residential treatment (n = 647) at six sites in the United States completed validated self-report assessments of ED, PTSD, major depression, anxiety disorders and quality of life. Provisional DSM-5 PTSD diagnoses (PTSD+) were made via the Childhood Trauma Questionnaire, admission interviews and the PTSD Symptom Checklist for DSM-5. RESULTS: PTSD+ occurred in 35.4% of participants, and those with ED-PTSD+ had significantly higher scores on all assessments (p ≤ 0.001), including measures of ED psychopathology, major depression, anxiety disorders and quality of life, as well as significantly higher rates of all forms of childhood trauma. Those with PTSD+ also exhibited a significantly higher percent median body mass index for age and sex and a lower propensity toward anorexia nervosa, restricting type. CONCLUSIONS: Results confirm that adolescent patients in residential treatment with ED-PTSD+ are more symptomatic and have worse quality of life than their ED counterparts without PTSD. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed in ED programs that treat adolescents.

The association of traumatic events and posttraumatic stress disorder with greater eating disorder and comorbid symptom severity in residential eating disorder treatment centers.

OBJECTIVE: Traumatic events, posttraumatic stress disorder (PTSD) and related symptoms are commonly associated with eating disorders (ED). Several clinical features indicative of a more severe and complex course have been associated with traumatized ED patients, especially those with PTSD, who may be more likely admitted to residential treatment (RT). Research in this population is sparse but of increasing interest. METHOD: Adult participants (96.7% female) with EDs entering RT (n = 642) at seven sites in the U.S. completed validated self-report assessments of ED, PTSD, major depression, state-trait anxiety, and quality of life. Presumptive diagnoses of DSM-5 PTSD (PTSD+) were made via the Life Events Checklist-5 and the PTSD Symptom Checklist for DSM-5. RESULTS: PTSD+ occurred in 49.3% of patients. PTSD+ patients had significantly higher scores on all assessment measures (p ≤ .001), including measures of ED psychopathology, depression, state-trait anxiety, and quality of life. Those with PTSD+ had significantly higher numbers of lifetime traumatic event types, higher rates of almost all lifetime traumatic events, and a greater propensity toward binge-type EDs. DISCUSSION: Results confirm that ED-PTSD+ patients in RT are more symptomatic and have worse quality of life than ED patients without PTSD+. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed.

Flexibility is not always adaptive: affective flexibility and inflexibility predict rumination use in everyday life.

The present study examined whether cognitive flexibility in the processing of emotional material (i.e., affective flexibility) predicts the use of rumination in response to negative events in daily life. One hundred fifty-seven undergraduate participants completed daily diaries for six consecutive days. Affective flexibility was measured with a novel task-switching paradigm using emotional pictures. Results show that affective inflexibility when switching away from processing the emotional meaning of negative material was associated with increased use of rumination in daily life. In contrast, affective inflexibility when switching away from processing the emotional meaning of positive material was related to decreased use of rumination. Importantly, affective flexibility predicted use of rumination beyond non-affective measures of executive functioning. This is the first study to show that inflexibility is not uniformly associated with increased rumination but that inflexibility in the processing of positive material can predict lower levels of rumination.

Individual differences in reappraisal effectiveness: the role of affective flexibility.

The present study examined the relation between a specific type of executive control and cognitive emotion regulation. The authors propose that successful reappraisal is related to "affective flexibility": The ability to flexibly attend to and disengage from emotional aspects of a situation or a stimulus. A new affective task-switching paradigm that required participants to shift between categorizing positive and negative affective pictures according to emotional or nonemotional features was used to assess individual differences in affective flexibility. The results showed that greater affective flexibility (less switch costs) predicted the ability to use reappraisal to down-regulate emotions in response to a sad film clip. In particular, more efficient shifts toward the neutral aspects of negative pictures and toward the emotional aspects of positive pictures were found to predict reappraisal ability. The results imply that executive control of emotional material is a capacity that is closely associated with effective reappraisal.

Rumination moderates the effects of daily events on negative mood: results from a diary study.

Rumination describes a detrimental response to distress that involves repetitive thoughts about one's emotional state and its causes and potential consequences. Many experimental studies have shown that induced state rumination exacerbates the effect of laboratory stressors on negative affect. The current study examines whether use of rumination in response to specific real-life events moderates the association between unpleasant daily events and negative mood. One hundred fifty-seven undergraduate participants completed daily diaries for six consecutive days. The daily diaries assessed current mood, a survey of unpleasant daily events, and use of rumination in response to the most unpleasant daily event. Data were analyzed with a multilevel random coefficient modeling (MRCM) approach. It was predicted and found that use of rumination in daily life moderates the relation between unpleasant daily events and negative mood. On days when participants reported intense rumination use, higher levels of unpleasant daily events predicted higher levels of negative mood. By contrast, on days when participants reported lower use of rumination, higher levels of unpleasant events were not associated with higher levels of negative mood. This study is the first to demonstrate that real-life use of rumination moderates the relation between unpleasant events and mood in daily life. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Flexible control in processing affective and non-affective material predicts individual differences in trait resilience.

Trait resilience is a stable personality characteristic that involves the self-reported ability to flexibly adapt to emotional events and situations. The present study examined cognitive processes that may explain individual differences in trait resilience. Participants completed self-report measures of trait resilience, cognitive flexibility and working memory capacity tasks, and a novel affective task-switching paradigm that assesses the ability to flexibly switch between processing the affective versus non-affective qualities of affective stimuli (i.e., flexible affective processing). As hypothesised, cognitive flexibility and flexible affective processing were unique predictors of trait resilience. Working memory capacity was not predictive of trait resilience, indicating that trait resilience is tied to specific cognitive processes rather than overall better cognitive functioning. Cognitive flexibility and flexible affective processing were not associated with other trait measures, suggesting that these flexibility processes are unique to trait resilience. This study was among the first to investigate the cognitive abilities underlying trait resilience.