Schema Modes, Trauma, and Disordered Eating.

Maladaptive schema modes may mediate between trauma and disordered eating, however there is little relevant evidence. This study aimed to predict disordered eating from modes, trauma, and age and gender. Also, to re-examine the factor structure of the Schema Mode Inventory for Eating Disorders, using an online cross-sectional survey of 612 volunteer participants aged 18 to 65, recruited from online eating disorder support groups, including people with and without diagnosed eating disorders. Measures were sociodemographic variables, the Schema Mode Inventory for Eating Disorders (Short Form; SMI-ED-SF), the Eating Disorder Examination Questionnaire (EDE-Q), and the Trauma History Questionnaire (THQ). Confirmatory factor analysis produced 16 factors similar to the 16 modes. Differences were that Vulnerable Child, Happy Child, and Healthy Adult appeared as a one factor, that all ED items appeared as one factor, and that Bully & Attack and Self-Aggrandizer modes appeared combined. In stepwise linear regression, EDE-Q scores was predicted by Total maladaptive mode score (37.3% of variance), Total adaptive mode score (1.5%) variance, Vulnerable Child (2.8%), Detached Self-Soother (1.5%). Other modes accounted for 1% or less of variance. Schema modes predicted EDE-Q, but the stable existence of discrete persona-like modes was less clear. Further research should refine the structure of SMI-ED-SF and relate modes to interpersonal traumas.

Schizotypy but not Cannabis Use Modestly Predicts Psychotogenic Experiences: A Cross-Sectional Study Using the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE).

OBJECTIVE: Cannabis use predicts psychosis in longitudinal studies, but it is difficult to infer causation. Some precursor variables predict both, including childhood trauma and adversity. Additionally, some of the desired effects of cannabis use resemble the symptoms of psychosis. It would be preferable to assess psychotomimetic or "unusual" experiences that include psychotic symptoms but without assuming pathology. Finally, it is possible that similar people are prone to psychosis and drawn to cannabis use, perhaps, because they are sensitive or attracted to unusual experiences. Schizotypy provides a trait measure of proneness to unusual experiences. The study aimed to examine cross-sectionally relationships between cannabis use, schizotypy, and unusual experiences whilst controlling for current trauma symptoms. METHOD: A volunteer online sample (n = 129, 64% women, predominantly students) who had used cannabis at least once was recruited. People who reported active effects of past trauma were excluded with a brief primary care posttraumatic stress disorder screen. Participants completed the Oxford-Liverpool Inventory of Feelings and Experience, the Cognitive Failures Questionnaire, and measures of substance use and sociodemographics. RESULTS: The majority of respondents recounted unusual experiences after cannabis use, and many of these might have been considered symptoms of psychosis if they had received medical attention. In regression analysis, the only predictor of the unusual experiences scale of O-LIFE was schizotypy (measured by the remaining subscales; 4% of variance). There were no correlations between cannabis use frequency and schizotypy or unusual experiences. CONCLUSIONS: These findings suggest that, after controlling for schizotypy and excluding people who are actively experiencing the effects of past trauma, frequency of cannabis use does not predict unusual experiences. However, individuals with schizotypal personality traits may have more unusual experiences when using cannabis.

Testing the Constraint Theory of Addiction: Cannabis Constraints Discriminate Users from Nonusers and Heavy from Light Users.

Constraint theory (Hammersley, 2014) offers a novel way of understanding addiction as a lack of cognitive, behavioural, and social constraints on substance use. Here, cannabis constraints were studied in a large online opportunity sample: N = 302; 205 men, 97 women. Age ranged from 14 to 60 years (mean = 25, SD = 8.0). Most participants were from UK or North America. Participants completed a questionnaire assessing 15 cannabis constraints and standard self-report frequency measures of drug use. Factor analysis of the constraint questionnaire found 15 factors, similar to those proposed theoretically. These factors could discriminate well between past and current users and heavy and light users. The best discriminator was concerns about the possibility of becoming addicted; the less concerned the heavier was use, although those who actually felt addicted were more concerned than others. Past users also constrained due to using legal highs instead, concerns about illegality, and using only when others used. Light users constrained due to availability and cost issues, as well as unpleasant effects. These findings suggest that there is utility in constraint theory and that heavy use occurs due to a relative lack of constraints.

Stuffing down feelings: Bereavement, anxiety and emotional detachment in the life stories of people with eating disorders.

This study aimed to explore the life stories of people with eating disorders (EDs) in order to better understand possible contributing factors to their development. It used a qualitative Life Story method, in order to reduce the tendency to focus on the negative in the lives of people with EDs. Sixteen people in contact with an EDs charity participated. Data were analysed using a thematic analysis. Despite the attempt to elicit both positive and negative information, most themes from the life stories were negative. Here, the focus is on the three most common themes reported, which are less often reported in previous research: (a) substantial bereavement and loss; (b) major issues with anxiety and (c) difficulties coping with emotions. A model is proposed whereby major losses and the resultant anxiety can lead to emotional deadening and 'stuffing down feelings' with food, leading on to an ED. This model implies that interventions need to consider psychological factors in an ED, especially the use of it as a dysfunctional coping strategy, as well as the behavioural and physiological aspects of an ED.

Ranking the harm of non-medically used prescription opioids in the UK.

A panel of nine experts applied multi-criteria decision analysis (MCDA) to determine the relative overall harm to users and harms to others of street heroin (injected and smoked) and eleven non-medically used prescription opioids. The experts assessed harm scores for each of the 13 opioids on each of 20 harm criteria, weighted the criteria and explored the resulting weighted harm scores for each opioid. Both forms of heroin scored very high: overall harm score of 99 for injected heroin and 72 for smoked heroin on a scale of 0-100. The main feature that distinguishes both forms of street heroin use is that their harm to others is more than five times that of the other eleven opioids. The overall harm score of fentanyl (including injection of fentanyl extracted from patches) and diamorphine (medically prescribed form of heroin) was 54 and 51, respectively, whereas that of orally used opioids ranged from 32 (pethidine) to 11 (codeine-containing pharmaceuticals). Injected street heroin, fentanyl and diamorphine emerged as most harmful to users, with the latter two very low in harm to others. Pethidine, methadone, morphine and oxycodone are also low in harm to others, while moderate in harm to users. We conclude that the overall harms of non-medically used prescription opioids are less than half that of injected street heroin. These data may give a basis for precautionary regulatory measures that should be considered if the rising trend in non-medical use of prescription opioids were to become evident in the UK.

Aspartame sensitivity? A double blind randomised crossover study.

BACKGROUND: Aspartame is a commonly used intense artificial sweetener, being approximately 200 times sweeter than sucrose. There have been concerns over aspartame since approval in the 1980s including a large anecdotal database reporting severe symptoms. The objective of this study was to compare the acute symptom effects of aspartame to a control preparation. METHODS: This was a double-blind randomized cross over study conducted in a clinical research unit in United Kingdom. Forty-eight individual who has self reported sensitivity to aspartame were compared to 48 age and gender matched aspartame non-sensitive individuals. They were given aspartame (100mg)-containing or control snack bars randomly at least 7 days apart. The main outcome measures were acute effects of aspartame measured using repeated ratings of 14 symptoms, biochemistry and metabonomics. RESULTS: Aspartame sensitive and non-sensitive participants differed psychologically at baseline in handling feelings and perceived stress. Sensitive participants had higher triglycerides (2.05 ± 1.44 vs. 1.26 ± 0.84mmol/L; p value 0.008) and lower HDL-C (1.16 ± 0.34 vs. 1.35 ± 0.54 mmol/L; p value 0.04), reflected in 1H NMR serum analysis that showed differences in the baseline lipid content between the two groups. Urine metabonomic studies showed no significant differences. None of the rated symptoms differed between aspartame and control bars, or between sensitive and control participants. However, aspartame sensitive participants rated more symptoms particularly in the first test session, whether this was placebo or control. Aspartame and control bars affected GLP-1, GIP, tyrosine and phenylalanine levels equally in both aspartame sensitive and non-sensitive subjects. CONCLUSION: Using a comprehensive battery of psychological tests, biochemistry and state of the art metabonomics there was no evidence of any acute adverse responses to aspartame. This independent study gives reassurance to both regulatory bodies and the public that acute ingestion of aspartame does not have any detectable psychological or metabolic effects in humans. TRIAL REGISTRATION: ISRCTN Registry ISRCTN39650237.

Food choice by people with intellectual disabilities at day centres: A qualitative study.

People with intellectual disabilities experience a range of health inequalities. It is important to investigate possible contributory factors that may lead to these inequalities. This qualitative study identified some difficulties for healthy eating in day centres. (1) Service users and their family carers were aware of healthy food choices but framed these as diets for weight loss rather than as everyday eating. (2) Paid carers and managers regarded the principle of service user autonomy and choice as paramount, which meant that they felt limited in their capacity to influence food choices, which they attributed to the home environment. (3) Carers used food as a treat, a reward and for social bonding with service users. (4) Service users' food choices modelled other service users' and carers' choices at the time. It is suggested that healthy eating should be made more of a priority in day care, with a view to promoting exemplarily behaviour that might influence food choice at home.

How to measure mood in nutrition research.

Mood is widely assessed in nutrition research, usually with rating scales. A core assumption is that positive mood reinforces ingestion, so it is important to measure mood well. Four relevant theoretical issues are reviewed: (i) the distinction between protracted and transient mood; (ii) the distinction between mood and emotion; (iii) the phenomenology of mood as an unstable tint to consciousness rather than a distinct state of consciousness; (iv) moods can be caused by social and cognitive processes as well as physiological ones. Consequently, mood is difficult to measure and mood rating is easily influenced by non-nutritive aspects of feeding, the psychological, social and physical environment where feeding occurs, and the nature of the rating system employed. Some of the difficulties are illustrated by reviewing experiments looking at the impact of food on mood. The mood-rating systems in common use in nutrition research are then reviewed, the requirements of a better mood-rating system are described, and guidelines are provided for a considered choice of mood-rating system including that assessment should: have two main dimensions; be brief; balance simplicity and comprehensiveness; be easy to use repeatedly. Also mood should be assessed only under conditions where cognitive biases have been considered and controlled.

Effects on obese women of the sugar sucrose added to the diet over 28 d: a quasi-randomised, single-blind, controlled trial.

To investigate whether obese women can compensate for sucrose added to the diet when it is given blind, rather than gaining weight or exhibiting dysfunctional regulation of intake, in the present study, forty-one healthy obese (BMI 30-35 kg/m²) women (age 20-50 years), not currently dieting, were randomly assigned to consume sucrose (n 20) or aspartame (n 21) drinks over 4 weeks in a parallel single-blind design. Over the 4 weeks, one group consumed 4 × 250 ml sucrose drinks (total 1800 kJ/d) and the other group consumed 4 × 250 ml aspartame drinks. During the baseline week and experimental weeks, body weight and other biometric data were measured and steps per day, food intake using 7 d unweighed food diaries, and mood using ten- or seven-point Likert scales four times a day were recorded. At the end of the experiment, the participants weighed 1·72 (SE 0·47) kg less than the value predicted by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) model; the predicted body weight accounted for 94·3% of the variance in the observed body weight and experimental group accounted for a further 1·1% of the variance in the observed body weight, showing that women consuming sucrose drinks gained significantly less weight than predicted. The reported daily energy intake did not increase significantly, and sucrose supplements significantly reduced the reported voluntary sugar, starch and fat intake compared with aspartame. There were no effects on appetite or mood. Over 4 weeks, as part of everyday eating, sucrose given blind in soft drinks was partially compensated for by obese women, as in previous experiments with healthy and overweight participants.

Effects of sucrose drinks on macronutrient intake, body weight, and mood state in overweight women over 4 weeks.

The long-term effects of sucrose on appetite and mood remain unclear. Normal weight subjects compensate for sucrose added blind to the diet (Reid et al., 2007). Overweight subjects, however, may differ. In a single-blind, between-subjects design, soft drinks (4x25cl per day; 1800kJ sucrose sweetened versus 67kJ aspartame sweetened) were added to the diet of overweight women (n=53, BMI 25-30, age 20-55) for 4 weeks. A 7-day food diary gave measures of total energy, carbohydrate, protein, fat, and micronutrients. Mood and hunger were measured by ten single Likert scales rated daily at 11.00, 14.00, 16.00, and 20.00. Activity levels were measured by diary and pedometer. Baseline energy intake did not differ between groups. During the first week of the intervention energy intake increased slightly in the sucrose group, but not in the aspartame group, then decreased again, so by the final week intake again did not differ from the aspartame group. Compensation was not large enough to produce significant changes in the composition of the voluntary diet. There were no effects on hunger or mood. It is concluded that overweight women do not respond adversely to sucrose added blind to the diet, but compensate for it by reducing voluntary energy intake. Alternative explanations for the correlation between sugary soft drink intake and weight gain are discussed.

Managing eating disorder patients in primary care in the UK: a qualitative study.

It is the general practitioner's (GP's) responsibility to diagnose and manage the care of eating disorder patients but recent surveys suggest that there may be problems. In this qualitative study we have explored the perceptions of 20 GPs. In general they felt that eating disorders had little quantitative impact on their services due to low prevalence, but a high impact when they did occurr due to their complexity. Patients' needs in primary care include improved assessment, constructive holding and monitoring, staff training, referral and continuity of care.

Theorising transient mood after ingestion.

UNLABELLED: Ingesting foods or drugs can alter rated mood. Moods have been theorised as reinforcers that cause ingestion. This assumption may be incompatible with the current two-system models of affect, where 'moods' are less intense yet more protracted than emotions, and affective states are caused by primary rapid affect processing and secondary cognitive appraisal. In ingestion research, moods may be transient rather than protracted and significant changes on mood rating scales are found without reportable changes in mood. CONCLUSIONS: Transient mood is caused cognitively and the temporal dynamics of mood are important. Consequently, when ingestion directly causes changes in affect these may be brief emotions rather than moods. In the absence of emotion, ingestion may provide input to the cognitive processes that cause transient mood, but physiological change cannot easily be inferred backwards from mood ratings. There are a number of unresolved questions about the relationship between rapid affect processing, cognitive appraisal and learning.

Eating disorders patients' views on their disorders and on an outpatient service: a qualitative study.

The objective of the study was to determine sufferers' views of outpatient treatment for eating disorders and provide practical recommendations for treatment practice. Twenty NHS outpatients participated in semi-structured interviews, which were subjected to thematic analysis. Respondents expressed ambivalence about whether their eating disorder is a way of exerting control or a disorder that controls them and this leads to them seeking treatment. Sufferers preferred a practical and sensitive approach and began to rely on treatment for recovery. Treatment needs to facilitate sufferers' need for control by striking a balance between practical and empathetic approaches that both involve patients in treatment decisions and give authoritative guidance.

Long-term dietary compensation for added sugar: effects of supplementary sucrose drinks over a 4-week period.

The long-term physiological effects of refined carbohydrates on appetite and mood remain unclear. Reported effects when subjects are not blind may be due to expectations and have rarely been studied for more than 24 h. The present study compared the effects of supplementary soft drinks added to the diet over 4 weeks on dietary intake, mood and BMI in normal-weight women (n 133). Subjects were categorised as 'watchers' or 'non-watchers' of what they ate then received sucrose or artificially sweetened drinks (4 x 250 ml per d). Expectancies were varied by labelling drinks 'sugar' or 'diet' in a counter-balanced design. Sucrose supplements provided 1800 kJ per d and sweetener supplements provided 67 kJ per d. Food intake was measured with a 7 d diary and mood with ten single Likert scales. By 4 weeks, sucrose supplements significantly reduced total carbohydrate intake (F(1,129) = 53.81; P<0.001), fat (F(2,250) = 33.33; P<0.001) and protein intake (F(2,250) = 28.04; P<0-001) compared with sweetener supplements. Mean daily energy intake increased by just under 1000 kJ compared with baseline (t (67 df) = 3.82; P< 0.001) and was associated with a non-significant trend for those receiving sucrose to gain weight. There were no effects on appetite or mood. Neither dietary restraint status as measured by the Dutch Eating Behaviour Questionnaire nor the expectancy procedure had effects. Expectancies influenced mood only during baseline week. It is concluded that sucrose satiates, rather than stimulates, appetite or negative mood in normal-weight subjects.

Patients' own assessments of quality of primary care compared with objective records based measures of technical quality of care: cross sectional study.

OBJECTIVE: To investigate the relation between older patients' assessments of the quality of their primary care and measures of good clinical practice on the basis of data from administrative and clinical records. DESIGN: Cross sectional population based study using the general practice assessment survey. SETTING: 18 general practices in the Basildon primary care trust area, south east England. PARTICIPANTS: 3487 people aged 65 or more. MAIN OUTCOME MEASURES: Correlations between mean practice scores on the general practice assessment survey and three evidence based measures on survey of case records (monitoring for, and control of, hypertension, and vaccination against influenza). RESULTS: 76% of people (3487/4563) responded to the general practice assessment survey. Correlations between patient assessed survey scores for technical quality and the objective records based measures of good clinical practice were 0.22 (95% confidence interval -0.28 to 0.62) for hypertension monitored, 0.30 (-0.19 to 0.67) for hypertension controlled, and -0.05 (-0.50 to 0.43) for influenza vaccination. CONCLUSIONS: Older patients' assessments are not a sufficient basis for assessing the technical quality of their primary care. For an overall assessment both patient based and records based measures are required.

Relationships between the Food Expectancy Questionnaire (FEQ) and the Food Frequency Questionnaire (FFQ).

The outcome expectancies of 250 respondents were examined using the Food Expectancy Questionnaire (FEQ), comparing expectancies about four different foods: fruit, vegetables, chocolate and sweets and plain biscuits. These expectancies were related to diet as assessed by a Food Frequency Questionnaire. As with alcohol expectancies [Jones, B. T., Corbin, W. & Fromme, K. (2001). A review of expectancy theory and alcohol consumption. Addiction, 96, 57-72], on which this research was modelled, positive and negative outcomes were the main factors for all foods, accounting jointly for between 33 and 40% of expectancy variance in factor analysis and predicting as much as 16% of the variance in relevant food intake measures by linear regression. Expected positive and negative outcomes of eating were predominantly immediate psychological after-effects, rather than including orosensory experiences, or longer-term effects on health or well-being. Other expectancies varied from food to food. FEQ expectancies for different foods have similar factor structure and were related to self-reported diet, the FEQ therefore shows promise as a means of modelling cognitions about eating.