Benefits of yoga in the treatment of eating disorders: Results of a randomized controlled trial.

Yoga has begun to be incorporated into the treatment of eating disorders despite limited empirical support for this practice. The purpose of this study was to investigate the efficacy of incorporating Yoga into the treatment of eating disorders. This preliminary randomized controlled trial investigated the benefits of participating in an eight-week Kripalu Yoga program for 53 women with symptoms of bulimia nervosa and binge eating disorder. Compared to waitlist controls, Yoga participants experienced decreases in binge eating frequency, emotional regulation difficulties and self-criticism, and increases in self-compassion. Yoga participants also experienced increases in state mindfulness skills across the eight weeks of the Yoga program. While these results are encouraging and suggest Yoga may have a valuable role to play in the treatment of eating disorders, it is important to stress their tentative nature. Further research, adopting a more rigorous design, is needed to address the limitations of the present study and expand on these findings.

How do women with eating disorders experience a new treatment combining guided physical exercise and dietary therapy? An interview study of women participating in a randomised controlled trial at the Norwegian School of Sport Sciences.

OBJECTIVES: To investigate how women with bulimia nervosa (BN) and binge eating disorder (BED) experience participating in a new treatment programme for eating disorders, based on guided physical exercise and dietary therapy. DESIGN AND PARTICIPANTS: Six women with BN and four with BED were semistructurally interviewed. Transcribed interviews were analysed using a text-condensing analytic approach. RESULTS: The analysis resulted in four main categories: (1) 'a renewed attitude towards physical activity', (2) 'a new perception of food', (3) 'mixed feelings of being in a heterogeneous treatment group' and (4) 'insight in one's own recovery process', each with 2-4 subcategories to express nuances. CONCLUSION: The treatment was experienced as beneficial. Improvements in the implementation of the programme were suggested. TRIAL REGISTRATION NUMBER: NCT02079935.

[The group connected bike to help fight addiction]. / Le vélo connecté en groupe pour aider à maintenir l'abstinence.

As part of the individualised management of patients with an addiction, a relapse prevention strategy for people dependent on alcohol or with bulimia has been developed by Sainte-Anne general hospital. Nursing support based on the use of a connected bike with virtual riding software recreates an environment which is considerably enriched on a social, motor and cognitive level.

Predicting onset and maintenance of men's eating disorders / Predictores de inicio y desarrollo de patología alimentaria en hombres

Background/Objective: Eating disorders (EDs) represent serious yet understudied mental health issues, particularly amongst young adult men attending colleges, who are at the average age of onset. Despite this and recent evidence that in young adult men the core ED symptoms are prevalent and remain relatively stable over the college period, little is known about factors associated with both the onset and maintenance of diagnosable EDs in this population. This work sought to address these research gaps. Method: Logistic regression analyses were conducted using data from an on-going longitudinal study of eating and mental health issues to examine the influence of theoretically relevant factors in predicting the onset and maintenance of men's (DSM-5) EDs at 4-year follow-up (N=2,507). Results: Body dissatisfaction, self-objectification, appearance-ideal internalization, dieting, and negative affectivity were all predictors of ED onset and maintenance. Self-objectification was the largest contributor to both ED onset and maintenance. Conclusions: The findings highlight potentially similar psychosocial foci for prevention and treatment efforts. Implications for improving existing preventive and treatment approaches are discussed (AU)

Antecedentes/Objetivo: Los trastornos de la conducta alimentaria (TCAs) representan graves, aunque poco estudiados, problemas de salud mental en las universidades, especialmente en hombres jóvenes, quienes se encuentran en la edad media de inicio. A pesar de la evidencia de que en hombres adultos jóvenes los principales síntomas de TCA son frecuentes y se mantienen relativamente estables durante el período universitario, poco se sabe sobre los factores asociados con la aparición y el mantenimiento de los TCAs en esta población. Este trabajo trata de abordar estas lagunas de investigación. Método: Se realizaron análisis de regresión logística utilizando datos de un estudio longitudinal en curso sobre alimentación y salud mental para examinar la influencia de factores teóricamente relevantes para predecir la aparición y el mantenimiento de los TCAs (DSM-5) en hombres durante 4 años de seguimiento (N=2.507). Resultados: La insatisfacción corporal, la auto-objetivación, la internalización de la apariencia ideal, las dietas, y la afectividad negativa fueron predictores de inicio y mantenimiento de TCA. La auto-objetivación fue el mayor contribuyente a la aparición y mantenimiento de TCA. Conclusiones: Los resultados destacan focos similares para su prevención y tratamiento. Se discuten las implicaciones para mejorar los enfoques preventivos y de tratamiento existentes (AU)

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study.

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40-50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses.

A qualitative study of young women's experiences of recovery from bulimia nervosa.

AIM: To describe experiences of recovery from bulimia nervosa among young adult women. BACKGROUND: Most studies into recovery from eating disorders focus on anorexia nervosa, although some include both anorexia and bulimia nervosa. Recovery has been described as beginning with renewed self-esteem. DESIGN: Qualitative interview study. METHODS: Fourteen women were invited to participate; five women, between 23-26 years of age, who assessed themselves as healthy for at least 2 years agreed to take part in narrative interviews. Tape-recorded interviews lasting 45-60 minutes (median 49 minutes) were conducted from February-April 2010 and transcribed verbatim. Data were analysed using qualitative content analysis. FINDINGS: The interviews revealed four themes in recovery from bulimia nervosa: feeling stuck in bulimia nervosa, getting ready to change, breaking free of bulimia nervosa and grasping a new reality, each comprising two or more subthemes. The process of recovery was not linear, but rather went back and forth between progress and relapse. The women expressed strong ambivalence about leaving the illness behind. An important part of their recovery was their ability to accept themselves. It was essential for their recovery to be supported in developing a unique explanation of the cause of their illness. CONCLUSION: Women's ability to recover from bulimia nervosa and take control over their lives is based on their self-efficacy. Effective care should therefore strive to strengthen women's beliefs in their own abilities, to instil hope for recovery and thus to bolster their self-efficacy.

A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa.

PURPOSE: The purpose of this systematic review was to summarise the evidence from randomised controlled trials examining the effectiveness of physical therapy compared with care as usual or a wait-list condition on eating pathology and on physiological and psychological parameters in patients with anorexia and bulimia nervosa. METHOD: EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and The Cochrane Library were searched from their inception until February, 2013. Articles were eligible if they utilised a randomised controlled trial design, compared physical therapy with a placebo condition, control intervention, or standard care and included patients with anorexia and bulimia nervosa. The methodological quality was assessed with the Jadad scale. RESULTS: Eight randomised controlled trials involving 213 patients (age range: 16-36 years) met all selection criteria. Three of the 8 included studies were of strong methodological quality (Jadad score≥3). Major methodological weaknesses were attrition and selection bias. The main results demonstrate that aerobic and resistance training result in significantly increased muscle strength, body mass index and body fat percentage in anorexia patients. In addition, aerobic exercise, yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive symptoms in both anorexia and bulimia nervosa patients. No adverse effects were reported. CONCLUSIONS: The paucity and heterogeneity of available studies limits overall conclusions and highlights the need for further research. Implications for Rehabilitation Supervised physical therapy might increase weight in anorexia nervosa patients. Aerobic exercise, massage, basic body awareness therapy and yoga might reduce eating pathology in patients with anorexia and bulimia nervosa. Aerobic exercise, yoga and basic body awareness therapy might improve mental and physical quality of life in patients with an eating disorder.

[Integrated day-hospital treatment in subjects with overeating disorders]. / Il trattamento integrato in day-hospital per i disturbi del comportamento alimentare caratterizzati da iperalimentazione.

BACKGROUND: The efficacy of a multidisciplinary, intensive and integrated day-hospital treatment was evaluated in a group of overeaters (bulimia nervosa, binge eating disorder, obesity without binging). METHODS: The study sample included 72 subjects consecutively admitted to DH who were evaluated at the first contact with the service, on admission, after 5 weeks of treatment, and at discharge. The primary outcome was the total score at the Eating Disorder Inventory (EDI), and the secondary outcome was change in body mass index (BMI). The effects of the duration of treatment on results were also assessed. The improvement of EDI and BMI was compared between the two groups of bingers and non-bingers. RESULTS: Four patients dropped during the treatment period. In the whole sample, both EDI and BMI improved significantly after 5 weeks (p=0.00) and continued to improve until the end of treatment (p=0.00). The duration of treatment did not have a significant impact on BMI improvement (p=0.07), but significantly affected EDI improvement (p=0.006), although only during the treatment period. No significant differences were observed between obese/overweight bingers and non-bingers in BMI improvement (p=0.41), whereas EDI improvement was higher in bingers (p=0.02). CONCLUSIONS: The relatively good compliance and the efficacy data suggest that in overeating subjects resistant to previous outpatient treatments a more intensive DH treatment may be useful. Our findings show that such a multidisciplinary therapeutic-rehabilitative treatment significantly improves both total EDI score (especially in bingers) and BMI.

Analysis of multi-instrumental assessment of eating disorders: comparison between Anorexia and Bulimia.

INTRODUCTION: The origin and course of eating disorders constitute a multifactorial etiopathology. This is why it is important to consider the psychological, developmental, biological and socio - cultural evaluation of each patient. The Diagnostic and Statistical Manual DSM IV - TR (APA, 1994) distinguishes two main eating disorders: Anorexia Nervosa and Bulimia Nervosa. Together with them are described a broad and heterogeneous category (EDNOS) of "atypical eating disorders," that is a clinically significant eating disorder, but that does not meet all the diagnostic criteria for Anorexia Nervosa or Bulimia Nervosa. The aim of this pilot study was to analyze the differences detectable in anorexic and bulimic patients in relation to several factors of mental functioning, particularly with respect to the presence of distinctive characteristics and symptoms and the associated substrate personality. METHOD: 20 patients with eating disorders who have a residential rehabilitation program, all women, 10 diagnosed with AN aged between 18 years and 31 years, including (5 Restrictive and 5 with Purging) and 10 diagnosed with BN aged between 19 years and 31 years (including 5 with Purging). RESULTS: The pictures of AN and BN can be placed within a continuum of symptoms that distinguishes them exclusively for the presence or absence of bulimic episodes; also the symptom of bulaemia can be considered a most important aspect in the distinction between anorexia and bulimia as all other aspects of mental functioning appear to be similar in almost direct measurement, and finally some food pathological events are associated with personality characteristics, Axis I symptoms and quality of life, linked to specific types of global functioning. DISCUSSION: Some symptoms may have different functions depending on the patient's personality style: a patient may develop a symptom of anorexia because it is competitive and a perfectionist, another as a form of self-punishment or as a strategy to regulate the feeling of being out of control, another again as a phenotypic expression of an underlying mood disorder, in the same way the purging may represent a reaction for a patient who is emotionally dysregulated or a measure of weight control which is more deliberate for a patient who is highly controlled perfectionist. CONCLUSION: There is a need to look at eating disorders within a global view of mental functioning, these conditions may be considered "diagnostic trans', ie disturbances traveling along a continuum, and are therefore characterized by a "diagnostic migration."

Video games as a complementary therapy tool in mental disorders: PlayMancer, a European multicentre study.

BACKGROUND: Previous review studies have suggested that computer games can serve as an alternative or additional form of treatment in several areas (schizophrenia, asthma or motor rehabilitation). Although several naturalistic studies have been conducted showing the usefulness of serious video games in the treatment of some abnormal behaviours, there is a lack of serious games specially designed for treating mental disorders. AIM: The purpose of our project was to develop and evaluate a serious video game designed to remediate attitudinal, behavioural and emotional processes of patients with impulse-related disorders. METHOD AND RESULTS: The video game was created and developed within the European research project PlayMancer. It aims to prove potential capacity to change underlying attitudinal, behavioural and emotional processes of patients with impulse-related disorders. New interaction modes were provided by newly developed components, such as emotion recognition from speech, face and physiological reactions, while specific impulsive reactions were elicited. The video game uses biofeedback for helping patients to learn relaxation skills, acquire better self-control strategies and develop new emotional regulation strategies. In this article, we present a description of the video game used, rationale, user requirements, usability and preliminary data, in several mental disorders.

Personality heterogeneity in female adolescent inpatients with features of eating disorders.

OBJECTIVE: This study examined evidence for personality variability in adolescents with eating disorder features in light of previous evidence that personality variability in adult women with eating disorder symptoms carries important clinical implications. METHOD: Millon Adolescent Clinical Inventory personality data from adolescent girls with disturbed eating who were psychiatrically hospitalized were cluster analyzed, and resulting groups were compared in eating and comorbid psychopathology. RESULTS: Three subgroups were identified among the 153 patients with eating disorder features: high functioning, internalizing, and externalizing. The internalizing group was marked by eating-related and mood dysfunction; the externalizing group by elevated eating and mood psychopathology as well as impulsivity, aggression, and substance use; and the high-functioning group by lower levels of psychopathology and relatively high self-esteem. CONCLUSIONS: These findings converge with previous research using different personality models in adult samples and highlight the clinical use of considering personality heterogeneity among adolescent and adult women with disturbed eating.

Metacognitions in desire thinking: a preliminary investigation.

BACKGROUND: Desire thinking is defined as a voluntary thinking process orienting to prefigure images, information and memories about positive target-related experience. Recent research has highlighted the role of desire thinking in the maintenance of addictive, eating and impulse control disorders. Currently little is known about metacognitions in desire thinking. AIM: To investigate: (1) the presence and content of desire thinking during a desire experience; (2) the presence of metacognitive beliefs in desire thinking; (3) the goal of desire thinking; (4) attentional focus during desire thinking; and (5) the impact of desire thinking on craving. METHOD: Twenty-four individuals with a diagnosis of either alcohol abuse, bulimia nervosa, pathological gambling or smoking dependence were assessed using a semi-structured interview. RESULTS: Findings indicated that participants engaged in desire thinking and endorsed both positive and negative metacognitive beliefs about this process. The goal of desire thinking was to regulate internal states. Participants also reported that during a desire experience their attentional focus was continuously shifting between internal state and external context and that engaging in desire thinking increased craving. CONCLUSIONS: These findings provide preliminary evidence that metacognitions play a role in desire thinking.

Randomized controlled clinical trial of yoga in the treatment of eating disorders.

PURPOSE: This was a pilot project designed to assess the effect of individualized yoga treatment on eating disorder outcomes among adolescents receiving outpatient care for diagnosed eating disorders (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified). METHODS: A total of 50 girls and 4 boys aged 11-21 years were randomized to an 8-week trial of standard care vs. individualized yoga plus standard care. Of these, 27 were randomized to standard care and 26 to yoga plus standard care (attrition: n = 4). Standard care (every other week physician and/or dietician appointments) was required to meet ethical guidelines. The No Yoga group was offered yoga after study completion as an incentive to maintain participation. Outcomes evaluated at baseline, end of trial, and 1-month follow-up included Eating Disorder Examination (EDE), Body Mass Index (BMI), Beck Depression Inventory, State-Trait Anxiety Inventory, and Food Preoccupation questionnaire. RESULTS: The Yoga group demonstrated greater decreases in eating disorder symptoms. Specifically, the EDE scores decreased over time in the Yoga group, whereas the No Yoga group showed some initial decline but then returned to baseline EDE levels at week 12. Food preoccupation was measured before and after each yoga session, and decreased significantly after all sessions. Both groups maintained current BMI levels and decreased in anxiety and depression over time. CONCLUSIONS: Individualized yoga treatment decreased EDE scores at 12 weeks, and significantly reduced food preoccupation immediately after yoga sessions. Yoga treatment did not have a negative effect on BMI. Results suggest that individualized yoga therapy holds promise as adjunctive therapy to standard care.

Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial.

BACKGROUND: In bulimia nervosa, more intense treatments are recommended if outpatient treatment fails. This is the first randomized controlled trial comparing the options of inpatient versus day clinic treatment. METHOD: Patients with severe bulimia nervosa were randomly assigned to inpatient or day clinic treatment of similar length and intensity. Specific and general psychopathology was assessed at the end of treatment and a 3-month follow-up. RESULTS: Fifty-five patients were randomized; 22 day clinic patients and 21 inpatients started the program. At the end of treatment, a significant reduction of general and specific pathology was found in both settings. Following discharge, there was more deterioration in bulimic symptoms after inpatient treatment, but overall, results were comparable. CONCLUSIONS: Inpatient and day clinic programs are effective treatments for severely disturbed bulimic patients with similar results at the 3-month follow-up. Further follow-up will show if a higher instability of results after inpatient treatment is of importance in the long term.

Balance in patients with anorexia and bulimia nervosa.

AIM: Neuro-muscular adaptations to the loss or increase in body weight may induce postural alterations. The aim of this study was to investigate the effect of body weight alterations on postural stability in patients with anorexia nervosa and bulimia. METHODS: The study enrolled 15 women affected by anorexia nervosa (AN), (mean body mass index [BMI] 15.8+/-1.8 kg/m(2)), 15 women affected by bulimia nervosa (BN), (mean BMI 20.1+/-2.9 kg/m(2)) and 11 healthy matched women (HC), (mean BMI 20.1+/-1 kg/m(2)). Two quiet standing conditions with eyes open (EO) and closed (EC) were analysed with an optoelectronic system (Vicon 460, Viconpeak, Oxford, UK) with passive markers to estimate the centre of mass (CoM) position. RESULTS: BN patients were more unstable than HC, showing statistically significant differences in antero-posterior CoM excursions and path length. AN patients showed non significant differences from HC. Only HC showed differences between EO and EC conditions, with significantly greater excursions in medio-lateral direction in EC condition (P<0.013) as well as an increased sway area (P<0.022). CONCLUSIONS: In BN, musculoskeletal factors seem to play a major role in the diminished postural control, which appear to be linked to body weight fluctuations rather than to BMI absolute values. No clear-cut postural instability was demonstrated in patients with AN as compared to HC. Visual input appears not to affect balance in patients with eating disorders. Possible further causes of postural instability in BN and implications for rehabilitation treatment are discussed.

Understanding women's experiences of developing an eating disorder and recovering: a life-history approach.

Qualitative inquiry into eating disorders is burgeoning, offering valuable and innovative insights into various aspects of the condition. This study used life-history interviews with 20 women who had recovered from anorexia nervosa, bulimia nervosa or both and who had remained healthy. The interviews focused on the women's narratives and experience rather than a diagnostic therapeutic model. Three themes of control, connectedness and conflict emerged as significant in the development, experience of, and recovery from an eating disorder. The development of the condition was attributed to a lack of control, a sense of non-connectedness to family and peers and extreme conflict with significant others. Recovery occurred when the women re-engaged with life, developed skills necessary for conflict resolution and rediscovered their sense of self. Rather than viewing the development of, and recovery from an eating disorder as separate and discrete events, the data from the life-history interviews suggest they are better viewed as one entity - that is, the journey of an individual attempting to discover and develop their sense of self. This perspective challenges some current constructs of eating disorders; it is not a condition in and of itself but a symptom of deeper issues that if addressed, when the individual is 'ready' to make that choice, will lead to recovery.

Cognitive-behavioural therapy for individuals with bulimia nervosa and a co-occurring substance use disorder.

A significant percentage of individuals with bulimia nervosa (BN) also can be diagnosed with a co-occurring substance use disorder (SUD). Although studies have addressed the frequency of overlap between the disorders, etiology and shared personality traits, limited research is available about the treatment of these comorbid patients. Adapting cognitive-behaviour therapy (CBT) to serve as an integrated treatment for patients with both BN and a SUD is a viable option, as studies of CBT suggest that this form of treatment is efficacious for both disorders independently. The shared strategies in CBT for BN and SUDs facilitate the development of a combined treatment for individuals with both disorders with the addition of modules designed to address some common features of these disorders, such as motivation, difficulty with interpersonal relationships, reward sensitivity and impulsivity. Future research should begin to evaluate the efficacy of an integrated CBT in treating individuals with BN and a SUD.