Matching women with binge eating disorder to group treatment based on attachment anxiety: outcomes and moderating effects.

We hypothesized that compared to therapy groups homogeneously composed of women with binge eating disorder (BED) and low attachment anxiety, groups with high attachment anxiety would have better outcomes and a greater alliance-outcome relationship. We assigned 102 women with BED to therapy groups homogeneously composed of low attachment anxiety (n =52) or high attachment anxiety participants (n=50) who received Group Psychodynamic Interpersonal Psychotherapy (GPIP). GPIP resulted in improved outcomes with large effects. Attachment anxiety condition did not moderate outcomes. However, attachment anxiety condition did moderate the alliance-outcome relationship: i.e., group alliance growth was associated with improved binge eating only in the high attachment anxiety condition. Clinicians should be attentive to and encourage the growth of group therapy alliance especially for anxiously attached individuals.

Testing a maintenance model for eating disorders in a sample seeking treatment at a tertiary care center: a structural equation modeling approach.

Fairburn et al (Fairburn, CG, Cooper, Z, Shafran, R. Behav Res Ther 2003;41:509-528) proposed additional maintenance mechanisms (ie, interpersonal difficulties, mood intolerance, low self-esteem, and perfectionism) for some individuals with eating disorders in addition to core eating disorder psychopathology (ie, overevaluation of eating, weight, and shape and their control). This is the first study to both elaborate and test this maintenance model as a structural model. Adults seeking treatment of an eating disorder (N = 1451) at a specialized tertiary care center were included in this cross-sectional study. In the first part of the study, diagnostically heterogeneous participants (n = 406) were randomly selected to test a structural model based on the maintenance model. In the second part of the study, remaining participants (n = 1045) were grouped according to eating disorder diagnosis to test for invariance of the structural paths of the final model across diagnoses. Overall, the structural model with core and additional mechanisms fit the data well and, with 1 exception, represented maintenance processes for each of the diagnostic groups. Treatment models based on both core and additional maintenance factors for those seeking therapy at a specialized tertiary care center may result in improved treatment outcomes for these patients with eating disorders.

Increasing public awareness about hepatitis C: development and validation of the brief hepatitis C knowledge scale.

Hepatitis C virus (HCV) is silently becoming a major public health problem. Currently, no validated HCV knowledge measures exist. This study aimed to develop and validate a brief measure to assess general knowledge about HCV risk factors, modes of transmissions, and treatment options. A total of 406 individuals participated in this cross-sectional study. All participants completed the proposed 19-item Brief HCV Knowledge Scale. Participants were: HCV mono-infected patients (n = 83), HCV-human immunodeficiency virus (HIV) co-infected patients (n = 24), HIV mono-infected patients (n = 128) community healthcare workers (n = 89), and college students (n = 82). Two-week test-retest data were collected for the college student sample. Psychometric evaluation of the proposed scale demonstrated high levels of validity (content and construct validity) and reliability (internal consistency and retest stability). Factor analysis indicated a one-factor solution, which accounted for 49% of the variance. HCV knowledge was positively correlated with length of time since HCV diagnosis (r = 0.29, p < 0.05). HCV treatment-experienced patients obtained significantly higher HCV knowledge scores (82% correct) than HCV treatment-naïve patients (72% correct) (p < 0.05). HCV knowledge in College students (43% correct) and HIV patients (54% correct) was significantly lower than in HCV patients (77% correct) and community healthcare workers (80% correct) (p < 0.001). Community workers' HCV knowledge was positively correlated with years of HCV work experience (r = 0.30, p < 0.01). This self-administered Brief HCV Knowledge scale has high levels of validity and reliability across patient, healthcare provider and college student populations. It has valuable applications as a clinical teaching tool with patients and healthcare providers and could be used as an outcome indicator in novel HCV educational intervention studies.

Personality dimensions among women with an eating disorder: towards reconceptualizing DSM.

OBJECTIVE: To evaluate the incremental validity of a dimensional assessment of personality, after controlling for diagnostic category, in accounting for meaningful variation in eating disorder attitudes and behaviours and in current affective distress among a clinical sample of eating disordered women. METHODS: 244 treatment seeking eating disordered women and 116 non-eating disordered women were assessed with the NEO five factor inventory (NEO-FFI), and with measures of eating disorder attitudes and of affective distress using a cross sectional design. RESULTS: As predicted, differences were found between eating disordered and non-eating disordered women on several NEO-FFI scales, which provided a context for subsequent analyses. NEO-FFI scales accounted for meaningful variation in eating disordered attitudes and behaviours as well as in levels of current affective distress over and above DSM-IV diagnostic category. CONCLUSION: A flexible approach to diagnosis, which includes personality dimensions along with a description of eating disorder symptoms, may result in a more inclusive and useful diagnostic scheme for treating women with eating disorders.

Psychometric properties of self-monitoring of eating disorder urges among treatment seeking women: ecological momentary assessment using a daily diary method.

OBJECTIVES: The psychometric properties of an ecological momentary assessment (EMA) method used to evaluate eating disorder (ED) urges were examined. METHODS: Participants, 139 women who sought treatment for an ED, completed a daily diary measuring ED urges after each meal for a three week period at the start of treatment, and a measure of ED attitudes and behaviors pre- and post-treatment. RESULTS: The construct validity of this method was indicated by a two factor solution representing binge eating urges and ED compensatory behavior urges, and by significant differences between ED diagnostic groups on ED urge type. Correlations of ED urges early in therapy with outcomes provided evidence for predictive validity. Correlations at pre-treatment between ED urges and ED attitudes and behaviors supported criterion validity. EMA of ED urges showed good retest stability. CONCLUSIONS: EMA of ED urges is a valid and reliable approach that is associated with ED symptom severity, and predictive of treatment outcome.

Review of controlled psychotherapy treatment trials for binge eating disorder.

This paper reviews investigations of psychotherapy outcome studies for binge eating disorder, which has recently been intensively studied as several researchers have undertaken the task of delineating which treatment options are the most effective. Several randomized, controlled clinical trials have provided important findings. A current debate concerns what the initial course of treatment should be, reducing binge eating patterns or reducing weight. Several limitations to this literature are mentioned, including the dearth of studies investigating treatment for men and boys with binge eating disorder.

Creativity, unique designs, and schizotypy in a nonclinical sample.

The present study examined whether creativity and novel design construction differ in 60 individuals who scored low and high (based on a median split) on a measure of schizotypy. Groups differed on one measure, total designs made, but not on creativity.

A brief review of selective mutism literature.

Selective mutism is a disorder characterized by a persistent failure to speak in certain social situations. It is typically diagnosed in childhood, and the disorder can last from just a few months to several years in some individuals. Debate surrounds the origins and causes of this disorder. Recent literature suggests that selective mutism may be a form of social phobia. The present article is a brief review of the literature on the etiology, assessment, comorbid diagnoses, and treatment perspectives from several theoretical orientations, including behavioral, family systems, and psychopharmacological.