Predictors for good therapeutic outcome and drop-out in technology assisted guided self-help in the treatment of bulimia nervosa and bulimia like phenotype.

OBJECTIVE: Technology assisted guided self-help has been proven to be effective in the treatment of bulimia nervosa (BN). The aim of this study was to determine predictors of good long-term outcome as well as drop-out, in order to identify patients for whom these interventions are most suitable. METHODS: One hundred and fifty six patients with BN were assigned to either 7 months internet-based guided self-help (INT-GSH) or to conventional guided bibliotherapy (BIB-GSH), both guided by e-mail support. Evaluations were taken at baseline, after 4, 7, and 18 months. As potential predictors, psychiatric comorbidity, personality features, and eating disorder psychopathology were considered. RESULTS: Higher motivation, lower frequency of binge eating, and lower body dissatisfaction at baseline predicted good outcome after the end of treatment. Lower frequency of binge eating predicted good outcome at long-term follow-up. Factors prediciting drop-out were higher depression and lower self-directedness at baseline. CONCLUSION: Technology assisted self-help can be recommended for patients with a high motivation to change, lower binge-eating frequency and lower depression scores.

Is technology assisted guided self-help successful in treating female adolescents with bulimia nervosa?

OBJECTIVE: This study aims to evaluate the long-term outcome of new technology assisted guided self-help in adolescents with bulimia nervosa (BN). METHOD: One hundred and twenty-six patients with BN (29 adolescents and 97 adults) were randomly allocated to a cognitive behavioural therapy-based self-help program delivered by the Internet or bibliotherapy, both accompanied by e-mail guidance. Outcomes were assessed at baseline, month 4, 7 and 18 including remission rates and eating disorder associated psychopathology. RESULTS: In all, 44% of adolescents vs. 38.7% of adults were in remission at month 7, and 55% of adolescents vs. 62.5% of adults were in remission at follow-up. Objective binge eating and compensatory behaviour improved significantly over time in both groups, with the highest decrease during the first 4 months. A significant decrease over time and no group differences have been found in almost all EDI-2 subscales. CONCLUSIONS: E-mail guided self-help (delivered via the Internet or bibliotherapy) is equally effective for adolescents as for adults with BN, and can be recommended as an initial step of treatment for this younger age group.

Perception of autonomy and connectedness prior to the onset of anorexia nervosa and bulimia nervosa.

OBJECTIVE: This study examines retrospective correlates of nonshared family environment prior to onset of disease, by means of multiple familial informants, among anorexia and bulimia nervosa patients. METHODS: A total of 332 participants was included (anorexia nervosa, restrictive type (AN-R): n = 41 plus families); bulimic patients (anorexia nervosa, binge-purging type; bulimia nervosa: n = 59 plus families). The EATAET Lifetime Diagnostic Interview was used to establish the diagnosis; the Subjective Family Image Test was used to derive emotional connectedness (EC) and individual autonomy (IA). RESULTS: Bulimic and AN-R patients perceived significantly lower EC prior to onset of disease compared to their healthy sisters. Bulimic patients perceived significantly lower EC prior to onset of disease compared to AN-R patients and compared to their mothers and fathers. A low family sum - sister pairs sum comparison - of EC had a significant influence on the risk of developing bulimia nervosa. Contrary to expectations, AN-R patients did not perceive significantly lower levels of IA compared to their sisters, prior to onset of disease. Findings of low IA in currently ill AN-R patients may represent a disease consequence, not a risk factor. CONCLUSIONS: Developmental child psychiatrists should direct their attention to disturbances of EC, which may be present prior to the onset of the disease.

Perceptions of family relationships in adolescents with anorexia nervosa and their unaffected sisters.

The family relationships of patients with anorexia nervosa (AN) have been extensively studied over recent years. However, using case-control designs with unrelated controls is subject to various cultural and familial biases. Studying subjective differential perceptions of family relationships in sister-pairs discordant for the disorder may overcome some of these limitations. The aim of the present study was therefore, to investigate subjective perceptions of family environments in a clinically ill sample of female adolescent patients with acute AN and in their healthy sisters using the Subjective Family Image Test. We found significantly lower perceived individual autonomy and higher perceived cohesion in patients compared with their sisters but no difference in perceived emotional connectedness. Lower perceived individual autonomy of the ill children resulted mainly from their relationships with mothers but also in part from their relationships with fathers. This observed pattern might contribute to the maintenance of the disorder and should be addressed in individual and family interventions.

Characteristics of self-regulation in adolescent patients with anorexia nervosa.

The purpose of the study was to investigate the different modes of self-regulation in adolescent anorexia nervosa (AN). A self-system questionnaire, the Narcissism Inventory, was given to 61 adolescent females with AN and 61 controls. Patients with AN reported higher overall disturbances in self-regulation than controls. In particular, a highly unstable self-system, a tendency to use idealization as modus of regulation, and high narcissistic gain from their illness was found in the patient group; however, the patients did not report a 'classic narcissistic sellf'. Furthermore, we were able to differentiate between two clusters of patients, one with high (n = 34) and one with low (n = 27) disturbance in self-regulation; the latter reported a shorter duration of illness and lower oral control but did not differ on any other clinical variables. Stronger relationships were found between the dimension 'endangered self' and the overall scores of the Eating Attitudes Test (EAT) and the Eating Disorder Inventory (EDI) as well as two subscales of the EAT and five of the EDI. Our study in anorexic adolescents demonstrated that the self-system is experienced as highly unstable, that idealization is used as mode of regulation, and that the dimension of the 'classic narcissistic self' is less important in this patient group. It is important to evaluate the system of self-regulation for planning treatment in the individual patient according to their needs.