Posttraumatic stress disorder (PTSD) and complex PTSD in eating disorder treatment-seekers: Prevalence and associations with symptom severity.

Although childhood trauma and posttraumatic stress disorder (PTSD) have been well-researched in eating disorder epidemiology, prevalence rates are unavailable for complex PTSD (CPTSD). Under recently introduced ICD-11 criteria, individuals with CPTSD have both PTSD symptoms and additional disturbances in self-organization (DSO). Using ICD-11 criteria, this study aimed to determine the prevalence of PTSD and DSO symptoms, diagnostic rates of PTSD and CPTSD, and childhood trauma exposure in eating disorder treatment-seekers. Participants (N = 217) were individuals attending residential, partial hospitalization, and outpatient services who completed measures of eating disorder- and trauma-related symptoms and childhood adverse experiences. One third of participants reported PTSD symptoms, and over half reported DSO symptoms, with probable ICD-11 diagnostic rates of 3.8% for PTSD and 28.4% for CPTSD. CPTSD was significantly more prevalent than PTSD and more common in higher levels of care. Both PTSD and DSO symptom severity were positively correlated with eating disorder symptoms and impairment, rs = .285-.642. DSO symptom severity was a significant and unique explanatory factor of eating disorder severity and impairment. The findings highlight the prevalence of CPTSD in eating disorder populations and the association between DSO symptoms and eating psychopathology independent of PTSD symptoms. Implications are discussed for adjunct treatment approaches for individuals with comorbid eating disorders and PTSD or CPTSD.

An informal reconstruction of the free-energy framework, examining the conceptual problems that arise.

Recent decades have seen increasing attention given to the free-energy framework. This proposes that many of the phenomena we associate with life, intelligence and adaptation can be explained in terms of a single, mathematical precept: the free-energy principle. This is claimed to apply to the adaptive behavior of primitive organisms as much as it does to the physiological structures of human brains. The proposal is potentially of interest to theorists from multiple disciplines. But as presentations often make intensive use of mathematical notation, it can be hard to understand, even for experts. The present article presents an informal reconstruction, using schematic illustrations. Mathematical notation is largely avoided, while detail and precision are retained as far as possible. The specifically conceptual problems that come to notice in the reconstruction are highlighted and discussed.

Intuitive Eating Scale-2: psychometric properties and clinical norms among individuals seeking treatment for an eating disorder in private practice.

PURPOSE: Intuitive Eating (IE) is an approach to eating designed to facilitate a positive relationship with food. Its use in clinical settings and in the community is rapidly growing in popularity. The Intuitive Eating Scale 2 (IES-2) is a widely used measure that indexes intuitive eating motivations and behaviour, however evidence of its validity in populations with clinical eating disorders remains scarce. The objective of the proposed study was thus to evaluate the factor structure of the IES-2 in a large sample of individuals seeking treatment for eating disorders in private practice. METHODS: Data collected from 569 women and men aged 12-68 years seeking treatment for an eating disorder in one of eight specialist private outpatient eating disorder clinics were examined using confirmatory factor analysis (CFA). Relationships between IES-2 scores and measures of psychopathology were also examined. RESULTS: Results were relatively consistent with the purported four-factor structure of the IES-2. The measure displayed strong construct validity and good internal consistency. Scores on the IES-2 were inversely associated with scores of depression, anxiety, and disordered eating, providing evidence for divergent validity of the measure. Clinical norms are provided for anorexia nervosa (AN) spectrum disorders and bulimia nervosa (BN) spectrum disorders, as well as for the clinical sample as a whole. CONCLUSION: Findings suggest that the IES-2 may be an appropriate measure for evaluating behaviours relating to IE in community outpatient eating disorder settings, and provide further evidence for the association between IE and positive health outcomes. LEVEL OF EVIDENCE: III, evidence obtained from well-designed cohort or case-control analytic studies.

Challenging rigidity in Anorexia (treatment, training and supervision): questioning manual adherence in the face of complexity.

BACKGROUND: Anorexia Nervosa is a debilitating illness. While there have been many advancements to treatment protocols and outcomes for people with eating disorders, the field acknowledges there remains considerable room for improvement. This timely Special Edition of the Journal of Eating Disorders has invited those of us in the field to consider a range of topics in aid of this task, including potential modifications and implementation of evidence-based practice, specific and common psychotherapy factors, treatment manuals, adherence and individualising treatment approaches for individuals and families. BODY: In this paper, we briefly outline the key manualised treatments currently available to treat children, adolescents and adults with Anorexia Nervosa, considering the benefits, potential reasons for adaptations and limitations. We then review the current evidence for training strict adherence to treatment manuals which is often a key focus in training and supervision, questioning the association of increased treatment adherence with improved therapeutic outcome. We then summarise some key evidence behind other therapeutic factors which have been demonstrated to affect outcome regardless of which manual is implemented, such as readiness to change and therapeutic alliance. CONCLUSION: The paper concludes with implications and considerations for future research, clinical guidelines, training and supervision, highlighting the need to consider the therapeutic relationship and processes alongside manual content to conduct best evidence-informed practice.

While there have been many advancements to treatment options and recovery rates for people with eating disorders, the field acknowledges there remains a long way to go. The development of treatment manuals for clinicians to use has many benefits, including promoting rigorous research, clear training and clinical guidelines, broader dissemination and accessibility, a common language for professionals, platforms from which to research necessary adaptations, and a set of core treatment principles. While it is often assumed that strict adherence to manuals will lead to the best treatment outcomes, research tells us a different story; that working flexibly and collaboratively with service users in an individually tailored way, focusing on meeting them where they're at, and building trust and understanding between them may actually be the best way to improve treatment experience and outcomes. This paper highlights the need for this way of working to be embraced as a crucial part of evidence-informed practice, with some suggestions for further research, treatment guidelines, training and supervision provided.

Extensional Superposition and Its Relation to Compositionality in Language and Thought.

Semantic composition in language must be closely related to semantic composition in thought. But the way the two processes are explained differs considerably. Focusing primarily on propositional content, language theorists generally take semantic composition to be a truth-conditional process. Focusing more on extensional content, cognitive theorists take it to be a form of concept combination. But though deep, this disconnect is not irreconcilable. Both areas of theory assume that extensional (i.e., denotational) meanings must play a role. As this article demonstrates, they also have the potential to fulfill a mediative function. What is shown is that extensional meanings are themselves inherently compositional. On this basis, it becomes possible to model semantic composition without assuming the existence of any specifically linguistic/conceptual apparatus. Examples are presented to demonstrate this direct style of modeling. Abstract connections between composition in thought and language can then be made, raising the prospect of a more unified, theoretical account of semantic composition.

ANZAED practice and training standards for mental health professionals providing eating disorder treatment.

INTRODUCTION: The Australia & New Zealand Academy for Eating Disorders (ANZAED) recently developed general principles and clinical practice standards recommended for mental health clinicians and dietitians providing treatment for people with eating disorders. Separate mental health practice and training standards were then devised as a foundation for strengthening the workforce and providing guidance to professional training programs and service providers on the minimal standards required for practice in the eating disorder field. RECOMMENDATIONS: The present recommendations for mental health professionals providing eating disorder treatment describe the following practice and training standards: eating disorder treatment foundations (including co-ordination of services, establishing a positive therapeutic alliance, professional responsibility and knowledge of levels of care), assessment, diagnosis, intervention (including evidence-based intervention, managing psychiatric risk and managing co-morbid mental health problems), and monitoring and evaluation. CONCLUSIONS: Further work is required to disseminate these standards to clinicians providing services across Australia to people with eating disorders, and to support adherence in the clinic room where they can translate to improved outcomes for clients. Pathways to supporting adherence include expert supervision of practice, incorporation in training and supervised practice in university settings, and support with checklists that can be used by consumers and referring professionals.

ANZAED eating disorder treatment principles and general clinical practice and training standards.

INTRODUCTION: Eating disorders are complex to manage, and there is limited guidance around the depth and breadth of knowledge, skills and experience required by treatment providers. The Australia & New Zealand Academy for Eating Disorders (ANZAED) convened an expert group of eating disorder researchers and clinicians to define the clinical practice and training standards recommended for mental health professionals and dietitians providing treatment for individuals with an eating disorder. General principles and clinical practice standards were first developed, after which separate mental health professional and dietitian standards were drafted and collated by the appropriate members of the expert group. The subsequent review process included four stages of consultation and document revision: (1) expert reviewers; (2) a face-to-face consultation workshop attended by approximately 100 health professionals working within the sector; (3) an extensive open access online consultation process; and (4) consultation with key professional and consumer/carer stakeholder organisations. RECOMMENDATIONS: The resulting paper outlines and describes the following eight eating disorder treatment principles: (1) early intervention is essential; (2) co-ordination of services is fundamental to all service models; (3) services must be evidence-based; (4) involvement of significant others in service provision is highly desirable; (5) a personalised treatment approach is required for all patients; (6) education and/or psychoeducation is included in all interventions; (7) multidisciplinary care is required and (8) a skilled workforce is necessary. Seven general clinical practice standards are also discussed, including: (1) diagnosis and assessment; (2) the multidisciplinary care team; (3) a positive therapeutic alliance; (4) knowledge of evidence-based treatment; (5) knowledge of levels of care; (6) relapse prevention; and (7) professional responsibility. CONCLUSIONS: These principles and standards provide guidance to professional training programs and service providers on the development of knowledge required as a foundation on which to build competent practice in the eating disorder field. Implementing these standards aims to bring treatment closer to best practice, and consequently improve treatment outcomes, reduce financial cost to patients and services and improve patient quality of life.

Predictive processing simplified: The infotropic machine.

On a traditional view of cognition, we see the agent acquiring stimuli, interpreting these in some way, and producing behavior in response. An increasingly popular alternative is the predictive processing framework. This sees the agent as continually generating predictions about the world, and responding productively to any errors made. Partly because of its heritage in the Bayesian brain theory, predictive processing has generally been seen as an inherently Bayesian process. The 'hierarchical prediction machine' which mediates it is envisaged to be a specifically Bayesian device. But as this paper shows, a specification for this machine can also be derived directly from information theory, using the metric of predictive payoff as an organizing concept. Hierarchical prediction machines can be built along purely information-theoretic lines, without referencing Bayesian theory in any way; this simplifies the account to some degree. The present paper describes what is involved and presents a series of working models. An experiment involving the conversion of a Braitenberg vehicle to use a controller of this type is also described.

Stigma resistance in eating disorders.

PURPOSE: Stigma resistance, described as the capacity to counteract or remain unaffected by the stigma of mental illness, may play a crucial role in the fight against stigma. Little is known, however, about stigma resistance and its correlates in people with eating disorders. This study investigated stigma resistance in people currently diagnosed (n = 325) and recovered (n = 127) from anorexia nervosa, bulimia nervosa, and EDNOS. METHODS: Participants completed an Internet survey that included the Stigma Resistance subscale of the Internalized Stigma of Mental Illness Scale together with a battery of psychosocial and psychiatric measures. RESULTS: A minimal-to-low level of stigma resistance was exhibited by 26.5% of currently diagnosed participants compared to just 5.5% of recovered participants. Stigma resistance was significantly higher among the recovered than the currently diagnosed (Cohen's d = 0.25) after controlling for differences in eating disorder and depression symptoms, attitudes about seeking psychological help, self-esteem, years between symptom onset and diagnosis, and years since diagnosis. Greater stigma resistance among the currently diagnosed was associated with less marked eating disorder and depression symptoms, higher self-esteem, more positive attitudes about seeking psychological treatment, and lower internalized stigma. CONCLUSIONS: Stigma resistance is a promising concept that warrants further study. Researchers should consider designing interventions that specifically cultivate stigma resistance in people with eating disorders as a complement to current interventions that target public perceptions of eating disorders. Clinicians may consider incorporating the concept into their practice to help patients rebuff the adverse effects of mental illness stigmatization.

Dysfunctional self-talk associated with eating disorder severity and symptomatology.

BACKGROUND: While self-talk has been argued to play a crucial role in the development and maintenance of eating disorders (EDs), it has received limited research attention. This study aimed to explore the relationship of ED self-talk with ED severity and symptomatology. METHODS: Analysis of the existing literature, supplemented with a small-scale pilot study, identified 24 distinct categories of ED self-talk. The main study involved the completion of on-line questionnaires by 172 women aged 18-49, recruited through clinical services, ED websites, and the general population. Participants were assigned to clinical (n = 83) and non-clinical (n = 89) samples, using the Eating Disorder Examination Questionnaire to screen for ED psychopathology. RESULTS: Substantial differences in the levels of ED self-talk were found between the clinical and non-clinical populations. Principal components analysis, conducted within the clinical sample, revealed ED self-talk to have a two-component structure. Self-talk reflecting an 'abusive relationship' between the sufferer and the ED strongly predicted overall severity and several aspects of symptomatology. 'Ascetic attitudes' towards thinness were linked with compulsive exercising and lower BMIs but not with overall severity. CONCLUSIONS: Close examination of the 'abusive relationship' component suggests a need to loosen the connection between negative appraisals of the abused self and the abusive voice of the ED so that the former can fulfil their potential as a force for change. Further, in seeking to counter the impact of the ED voice, it is suggested that the seducer and abuser roles require primary clinical focus.

Investigating the beneficial traits of Trichoderma hamatum GD12 for sustainable agriculture-insights from genomics.

Trichoderma hamatum strain GD12 is unique in that it can promote plant growth, activate biocontrol against pre- and post-emergence soil pathogens and can induce systemic resistance to foliar pathogens. This study extends previous work in lettuce to demonstrate that GD12 can confer beneficial agronomic traits to other plants, providing examples of plant growth promotion in the model dicot, Arabidopsis thaliana and induced foliar resistance to Magnaporthe oryzae in the model monocot rice. We further characterize the lettuce-T. hamatum interaction to show that bran extracts from GD12 and an N-acetyl-ß-D-glucosamindase-deficient mutant differentially promote growth in a concentration dependent manner, and these differences correlate with differences in the small molecule secretome. We show that GD12 mycoparasitises a range of isolates of the pre-emergence soil pathogen Sclerotinia sclerotiorum and that this interaction induces a further increase in plant growth promotion above that conferred by GD12. To understand the genetic potential encoded by T. hamatum GD12 and to facilitate its use as a model beneficial organism to study plant growth promotion, induced systemic resistance and mycoparasitism we present de novo genome sequence data. We compare GD12 with other published Trichoderma genomes and show that T. hamatum GD12 contains unique genomic regions with the potential to encode novel bioactive metabolites that may contribute to GD12's agrochemically important traits.

Selective eating in a 9-year-old boy: family therapy as a first-line treatment.

Whilst empirical studies continue to demonstrate the efficacy of family-based therapy in the treatment of adolescent anorexia nervosa, less comprehensive evidence exists in guiding the treatment of pre-adolescent eating disorders, which are typically characterised by a greater variety of symptom presentation. We present the case of a pre-adolescent male who met criteria for selective eating who was treated into full remission with eating-disorder-focused family therapy. This family-based intervention deviated significantly from recently manualised family-based therapy interventions, and we suggest continued exploration of family therapy techniques in the treatment of pre-adolescent eating disorders.

Rapid point-of-care detection of the tuberculosis pathogen using a BlaC-specific fluorogenic probe.

Early diagnosis of tuberculosis can dramatically reduce both its transmission and the associated death rate. The extremely slow growth rate of the causative pathogen, Mycobacterium tuberculosis (Mtb), however, makes this challenging at the point of care, particularly in resource-limited settings. Here we report the use of BlaC (an enzyme naturally expressed/secreted by tubercle bacilli) as a marker and the design of BlaC-specific fluorogenic substrates as probes for Mtb detection. These probes showed an enhancement by 100-200 times in fluorescence emission on BlaC activation and a greater than 1,000-fold selectivity for BlaC over TEM-1 ß-lactamase, an important factor in reducing false-positive diagnoses. Insight into the BlaC specificity was revealed by successful co-crystallization of the probe/enzyme mutant complex. A refined green fluorescent probe (CDG-OMe) enabled the successful detection of live pathogen in less than ten minutes, even in unprocessed human sputum. This system offers the opportunity for the rapid, accurate detection of very low numbers of Mtb for the clinical diagnosis of tuberculosis in sputum and other specimens.

Development of an antigen-based rapid diagnostic test for the identification of blowfly (Calliphoridae) species of forensic significance.

In this study we examine the limitations of currently used sequence-based approaches to blowfly (Calliphoridae) identification and evaluate the utility of an immunological approach to discriminate between blowfly species of forensic importance. By investigating antigenic similarity and dissimilarity between the first instar larval stages of four forensically important blowfly species, we have been able to identify immunoreactive proteins of potential use in the development of species-specific immuno-diagnostic tests. Here we outline our protein-based approach to species determination, and describe how it may be adapted to develop rapid diagnostic assays for the 'on-site' identification of blowfly species.

Representation recovers information.

Early agreement within cognitive science on the topic of representation has now given way to a combination of positions. Some question the significance of representation in cognition. Others continue to argue in favor, but the case has not been demonstrated in any formal way. The present paper sets out a framework in which the value of representation use can be mathematically measured, albeit in a broadly sensory context rather than a specifically cognitive one. Key to the approach is the use of Bayesian networks for modeling the distal dimension of sensory processes. More relevant to cognitive science is the theoretical result obtained, which is that a certain type of representational architecture is necessary for achievement of sensory efficiency. While exhibiting few of the characteristics of traditional, symbolic encoding, this architecture corresponds quite closely to the forms of embedded representation now being explored in some embedded/embodied approaches. It becomes meaningful to view that type of representation use as a form of information recovery. A formal basis then exists for viewing representation not so much as the substrate of reasoning and thought, but rather as a general medium for efficient, interpretive processing.

Australian and New Zealand clinical practice guidelines for the treatment of anorexia nervosa.

BACKGROUND: The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Ministry of Health. This CPG covers anorexia nervosa (AN). METHOD: The CGP team consulted with scientists, clinicians, carers and consumer groups in meetings of over 200 participants and conducted a systematic review of meta-analyses, randomized controlled trials and other studies. TREATMENT RECOMMENDATIONS: It is extremely difficult to draw general conclusions about the efficacy of specific treatment options for AN. There are few controlled clinical trials and their quality is generally poor. These guidelines necessarily rely largely upon expert opinion and uncontrolled trials. A multidimensional approach is recommended. Medical manifestations of the illness need to be addressed and any physical harm halted and reversed. Weight restoration is essential in treatment, but insufficient evidence is available for any single approach. A lenient approach is likely to be more acceptable to patients than a punitive one and less likely to impair self-esteem. Dealing with the psychiatric problems is not simple and much controversy remains. For patients with less severe AN who do not require in-patient treatment, out-patient or day-patient treatment may be suitable, but this decision will depend on availability of such services. Family therapy is a valuable part of treatment, particularly for children and adolescents, but no particular approach emerges as superior to any other. Dietary advice should be included in all treatment programs. Cognitive behaviour therapy or other psychotherapies are likely to be helpful. Antidepressants have a role in patients with depressive symptoms and olanzapine may be useful in attenuating hyperactivity.