Effects of family-based treatment on adolescent outpatients treated for anorexia nervosa in the Eating Disorder Unit of Helsinki University Hospital.

BACKGROUND: Family therapy for adolescent anorexia nervosa (AN) has stronger evidence of efficacy in comparison with individual therapy, and family-based treatment (FBT) is the most evaluated in numerous randomized clinical trials. However, few studies have focused on how FBT performs outside of research settings. The current study is the first to assess clinical outcomes of FBT for adolescent AN in Finland, in a specialized outpatient clinic. AIM: The naturalistic outcome of outpatient FBT for adolescent AN was investigated. METHODS: Fifty-two female patients and their families who received FBT at a tertiary eating disorders unit participated in the study. Data on their pre-treatment parameters, treatment details, and condition at the end of treatment (EOT) was collected from their medical records. RESULTS: At EOT, a majority (61.5%) had achieved a full weight restoration [percentage of expected body weight (%EBW) ≥ 95%]. Participants with an %EBW ≥ 95 at EOT had a significantly higher pre-treatment %EBW than those with an EBW < 95% at EOT. Participants with an EBW ≥ 95% at EOT showed significantly higher total weight gain during the treatment period, a higher rate of regular menstrual periods at EOT, significantly lower rates of dietary restrictions, and less cognitive or behavioral symptoms of the eating disorder overall, compared to participants who did not achieve a normal body weight. In 22 cases (42.3%), there was no need for further treatment at the end of FBT. Participants who needed further treatment after FBT, compared to those who did not, showed significantly higher rates of psychiatric comorbidity, history of mental health treatment, and need for psychopharmacological treatment. CONCLUSIONS: In this naturalistic study, and in line with previous studies, FBT for AN appeared to be an effective and sometimes sufficient intervention, especially for patients with milder weight deficit and less severe psychiatric comorbidities. The results show that FBT can be successfully implemented in Finland and suggest that training more ED clinicians in FBT would be beneficial. TRIAL REGISTRATION: The study was retrospectively registered on February 8th, 2023, in ClinicalTrials.gov Protocol Registration and Results System, identifier: NCT05734573.

Family-based treatment (FBT), a form of family therapy for eating disorders (ED) in young patients, has proven to be effective in numerous large-scale studies. This study aims to evaluate outcomes of the treatment for anorexia nervosa (AN) in a 'real-world' setting in a specialized outpatient clinic in Helsinki, Finland. Fifty-two young female patients seen for treatment between June 2013 and December 2017 were included in the study. Demographic and treatment characteristics, weight, and ED symptoms before and after treatment are reported. At the end of treatment, most patients had a good outcome, including normalization of their body weight and reduced ED symptoms. The majority of patients who needed further treatment after FBT suffered from an additional psychiatric disorder together with AN.

A novel outpatient treatment model for patients with severe and enduring anorexia nervosa: an observational study of patient characteristics, treatment goals, and treatment course.

BACKGROUND: Approximately 20-30% of people with anorexia nervosa develop an enduring form of the disorder. In the present study a newly developed outpatient treatment unit for patients with severe and enduring anorexia nervosa was described. The treatment model is flexible, patient-centered, and aims at enhancing quality of life, maintaining medical stability, and minimizing harm. Treatment contents, patient characteristics, treatment goals, and course of treatment from the first five years of operation were described and analyzed. METHODS: The participants (N = 22) consisted of all referrals resulting in an assessment or treatment period at the unit between May 2017 and May 2022. All participants were women. The study was a registry study. Information regarding patient characteristics, treatment goals, and the course of treatment was gathered from medical records. RESULTS: On average, the participants had had a diagnosed eating disorder for 12.80 years, and self-reported eating disorder symptoms for 19 years. Their symptomatology included severe eating disorder symptoms, psychiatric comorbidities, extreme underweight, and co-occurring medical conditions. Their treatment goals commonly concerned improving physical health, reducing eating disorder symptoms, improving psychological well-being, and improving quality of life. The majority of participants for whom this information was available benefited from the treatment (60%) and their treatment goals were met or partly met (66.6%), as measured by evaluations made by the patient or the treatment team. More than two thirds (69.2%) of the participants for whom this information was available remained weight stable or showed an increase in BMI. CONCLUSIONS: This observational study suggests that many individuals with severe and enduring anorexia nervosa may benefit from flexible treatment, aiming at supporting quality of life. The results highlight the importance of coordinating and integrating the treatment of severe and enduring anorexia nervosa and co-occurring psychiatric disorders as well as medical complications. Further research and international dialogue about the how treatment for this vulnerable patient group should best be organized is called for. Trial registration Trial registration number: NCT05708404. Date of registration: 01/23/2023 (retrospectively registered).

Approximately 20­30% of individuals with the eating disorder anorexia nervosa develop an enduring form of the illness. In this study a newly developed treatment unit for patients with severe and enduring anorexia nervosa was described. The treatment is flexible and aims at enhancing quality of life. Patient characteristics, treatment goals, and course of treatment from the first five years of operation were analyzed. The participants were patients treated at the new treatment unit. All participants were women. The study was based on patient records. On average, the participants had had a diagnosed eating disorder for more than 12 years, and self-reported eating disorder symptoms for 19 years. Many participants had severe eating disorder symptoms, other psychiatric illnesses, extreme underweight, and other medical conditions. Their own treatment goals concerned improving physical health, reducing eating disorder symptoms, improving psychological well-being, and improving quality of life. Many participants benefited from the treatment. This study shows that individuals with severe and enduring anorexia can benefit from flexible treatment that supports quality of life.

Cognitive Behavioral and Cognitive Remediation Strategies for Managing Co-Occurring Anorexia Nervosa and Elevated Autism Spectrum Traits.

Anorexia nervosa (AN) is a potentially severe eating disorder whose core characteristics include energy intake restriction leading to low body weight. Autism spectrum disorder (ASD) is a developmental disorder characterized by deficits in social interaction and communication as well as repetitive, stereotyped behavior and interests. Both high ASD traits and diagnosed ASD are overrepresented among individuals with AN, and AN and ASD appear to share certain neurocognitive features. These features are associated with the severity of eating disorder symptoms and prolongation of AN. Thus, individuals with AN and high ASD traits or ASD may benefit less from traditional treatment when compared to those with low ASD traits. No previous reviews have summarized what is known about treatment adaptations for individuals with AN and high ASD traits or ASD. The purpose of this narrative review was to investigate the feasibility of cognitive remediation therapy (CRT), cognitive remediation and emotional skill training (CREST), and cognitive behavioral therapy (CBT), and give an overview of treatment modifications for individuals with AN and co-occurring ASD or high ASD traits. We found nine studies that fulfilled our inclusion criteria. The combined results suggest that individuals with AN and high ASD traits or ASD benefit less from CRT, CREST, and CBT than those with AN and low ASD traits. However, CRT and CREST administered in individual format may be associated with improved cognitive flexibility, motivation for change, and decreased alexithymia among adults with AN and high ASD traits or ASD. Individuals with comorbid AN and ASD themselves highlight the importance of treatment adaptations that take the characteristics of ASD into account. In the future, controlled studies of the treatment strategies for individuals with AN and ASD/high ASD traits are needed in order to improve the outcome of individuals with this challenging comorbidity.

Characteristics of autism spectrum disorders are associated with longer duration of anorexia nervosa: A systematic review and meta-analysis.

OBJECTIVE: Anorexia nervosa (AN) is associated with neuropsychological characteristics such as impairments in central coherence, cognitive flexibility, and emotion recognition. The same features also manifest in autism spectrum disorders (ASD) and have been suggested to be associated with illness prolongation in AN. The purpose of this meta-analysis was to examine whether pronounced neuropsychological characteristics related to ASD are associated with illness duration in AN. METHOD: Four databases (Medline, PsycINFO, Scopus, PubMed) were searched for eligible studies. Search terms were (a) "anorexia nervosa" and (b) "cognitive flexibility" or "set-shifting" or "central coherence" or "emotion recognition" or "theory of mind". The final sample consisted of 53 studies. Duration of AN was divided into three categories in order to investigate differences between the groups with varying illness duration. The meta-analysis was performed with Review Manager using a random-effects model. RESULTS: Deficits in central coherence, cognitive flexibility, and emotion recognition were pronounced among individuals with prolonged AN compared to those with shorter illness duration. DISCUSSION: A prolonged course of AN appears to be associated with underlying neuropsychological characteristics that are also distinctive to ASD. Neuropsychological impairments may lead to prolonged AN, and prolonged illness may contribute to the subsequent "neurological scar effect," further strengthening these impairments.

OBJETIVO: La Anorexia Nerviosa (AN) está asociada con características neuropsicológicas como alteraciones en la coherencia central, flexibilidad cognitiva, y reconocimiento de emociones. Las mismas características también se manifiestan en los trastornos del espectro autista (TEA), y se ha sugerido que se asocian con una prolongación de la enfermedad de la AN. El propósito de este meta-análisis fue examinar si las características neuropsicológicas pronunciadas relacionadas al TEA están asociadas con la duración de la enfermedad en la AN. MÉTODOS: Se investigó en cuatro bases de datos (Medline, PsycINFO, Scopus, PubMed) para encontrar estudios elegibles. Los términos de búsqueda fueron 1) "anorexia nerviosa", y 2) "flexibilidad cognitiva" o "cambio de un tipo de información a otro (set shifting)" o "coherencia central" o "reconocimiento de emociones" o "teoría de la mente". La muestra final consistió en 53 estudios. La duración de la AN fue dividida en tres categorías para poder investigar las diferencias entre los grupos con una duración variable de la enfermedad. El meta-análisis fue realizado con Review Manager utilizando un modelo de efecto aleatorio. RESULTADOS: Los déficits en la coherencia central, flexibilidad cognitiva, y el reconocimiento de emociones fueron más pronunciados en los individuos con AN prolongada en comparación con aquellos con una menor duración de la enfermedad. DISCUSIÓN: Un curso prolongado de AN parece estar asociado con características neuropsicológicas subyacentes que también son distintivas de los TEA. Las alteraciones neuropsicológicas pueden llevar a una AN prolongada y la enfermedad prolongada puede contribuir al posterior "efecto de cicatriz neurológica", reforzando aún más estas alteraciones.

A Comparison of Personality, Life Events, Comorbidity, and Health in Monozygotic Twins Discordant for Anorexia Nervosa.

Genetic and environmental factors contribute to the etiology of anorexia nervosa (AN). The co-twin control design is one of the most powerful methods available to evaluate environmental factors that could contribute to differences between monozygotic (MZ) twins who are discordant for AN. Using available data from a unique and rare sample of 22 Swedish female MZ pairs discordant for AN, we compared personality, life events, comorbidity, and health factors. Twins with AN had significantly higher perfectionism scores than unaffected co-twins and reported younger ages at first diet than unaffected co-twins who had dieted. Consistent with previous literature, more twins with AN reported gastrointestinal problems than unaffected co-twins. Although not significant due to low statistical power, more unaffected co-twins reported experiencing emotional neglect than twins with AN. Early dieting may be a harbinger of the development of AN or an early symptom. Higher perfectionism may represent a risk factor, sequela, or both. Sibling perception of neglect is noteworthy given the impact of an ill child with AN on family function and wellbeing. The health and wellbeing of siblings should be addressed clinically when one child in the family suffers from AN.

[Effect of sex reassignment on mental well-being and quality of life]. / Sukupuolen korjauksen vaikutus psyykkiseen hyvinvointiin ja elämänlaatuun.

Transgender people find their natal sex and the corresponding gender role unpleasant and alien, and wish to be able to live in the gender role and body of the other sex. Gender dysphoria is effectively alleviated by sex reassignment treatments. Quality of life is improved among the majority of patients, and regrets are rare. Psychiatric symptoms at the initiation of the transition process, discrimination, negative attitudes, losses in relationships, and complications in somatic treatments may deteriorate the social integration and quality of life of the transgender people. Health-care professionals can ease the transition process by organizing support for transgender individuals according to the same principles as they do for other people.

Readiness and motivation for change among young women with broadly defined eating disorders.

Readiness and motivation for change were examined in 32 women with broadly defined eating disorders who took part in a 10-week Cognitive Behavioral Therapy (CBT)-based group intervention. Readiness for change and eating disorder psychopathology were assessed before and after the intervention. The results revealed significant negative associations between degree of eating disorder symptoms and degree of readiness for change before the intervention started. In particular, higher levels of eating concern, shape concern, and body dissatisfaction were associated with lower motivation for change. No significant associations between degree of readiness for change before the intervention started and changes in eating disorder symptoms at the end of intervention were found. Readiness for change increased from the beginning to the end of the intervention, indicating that group CBT may be a cost-effective and time-efficient way of enhancing readiness and motivation for change in individuals with eating psychopathology.

Binge eating and menstrual dysfunction.

OBJECTIVE: The relation between eating disorders and menstrual function has been widely studied, but it is unknown whether the behavior of binge eating itself is related to menstrual dysfunction. METHODS: The 11,503 women included in this study were from the Swedish Twin study of Adults: Genes and Environment. The associations between menstrual dysfunction and binge eating were analyzed using logistic regression or multiple linear regression models with generalized estimation equations. RESULTS: Women who reported lifetime binge eating were more likely to report either amenorrhea or oligomenorrhea than women who reported no binge eating. These results persisted when controlling for compensatory behaviors including self-induced vomiting, laxative use, and diuretic use. No differences between women with and without a history of binge eating were observed for age at menarche. CONCLUSION: Even when controlling for the effect of compensatory behaviors, the behavior of binge eating is associated with menstrual dysfunction. Metabolic and endocrinological factors could underlie this association. Careful evaluation of menstrual status is warranted for women with all eating disorders, not just anorexia nervosa.

NURTURE: development and pilot testing of a novel parenting intervention for mothers with histories of an eating disorder.

OBJECTIVE: To describe the treatment development and pilot testing of a group parenting intervention, NURTURE (Networking, Uniting, and Reaching out To Upgrade Relationships and Eating), for mothers with histories of eating disorders. METHOD: Based on focus group findings, extant research, and expert opinion, NURTURE was designed to be delivered weekly over 16 (1.5 h) sessions via an interactive web conferencing forum. It comprises four modules: (1) laying the foundation, (2) general parenting skills, (3) eating and feeding, and (4) breaking the cycle of risk. Pilot testing was conducted with three groups of 3-6 mothers (N = 13) who had children ages 0-3 years to determine feasibility (e.g., retention), acceptability (e.g., feedback questionnaire responses), and preliminary efficacy. Maternal satisfaction with NURTURE and changes in mother-child feeding relationship measures, maternal feeding style, maternal self-efficacy, and maternal psychopathology (eating disorder, depression, and anxiety symptoms) across three time points (baseline, post-treatment, 6-month follow-up) were examined. All outcomes were exploratory. RESULTS: The intervention was well tolerated with a 100% retention rate. Feedback from mothers was generally positive and indicated that the groups provided an engaging, supportive experience to participants. We observed changes suggestive of improvement in self-reported maternal self-efficacy and competence with parenting. There were no notable changes in measures of maternal feeding style or psychopathology. DISCUSSION: NURTURE is a feasible, acceptable, and potentially valuable intervention for mothers with eating disorder histories. Results of this pilot will inform a larger randomized-controlled intervention to determine efficacy and impact on child outcomes.

Disordered eating and gender identity disorder: a qualitative study.

The association between disordered eating and gender identity was examined in a sample of 20 (11 female-to-male, 9 male-to-female) transgender Finnish adults, aged 21-62 years. Using semi-structured interviews, participants' own understanding of the underlying causes of their disordered eating was analyzed, as well as the effect of gender reassignment on eating behaviors and cognitions. A majority of the participants reported current or past disordered eating. Participants most frequently described strive for thinness as an attempt to suppress features of one's biological gender, or accentuate features of one's desired gender. Gender reassignment was primarily perceived as alleviating symptoms of disordered eating.

The adult body: how age, gender, and body mass index are related to body image.

OBJECTIVE. Body image and perceived attractiveness were examined, and the impact of age, gender, and body mass index (BMI) was analyzed and discussed from an evolutionary and a sociocultural perspective. METHOD. The population-based sample consisted of 11,468 Finnish men and women aged 18 to 49 years. RESULTS. Both age-related decrease and increase in body satisfaction was detected as well as interactions between age and gender. Some effects were nonlinear. Women were generally less satisfied with their bodies than men. BMI had a stronger influence on women's body image than men's. DISCUSSION. It was proposed that it is insufficient to merely study how age affects general body image because adults might become more satisfied with some aspects of their bodies as a function of age and less satisfied with other aspects. Body satisfaction might also fluctuate during different phases of the adult life, and the patterns possibly differ between men and women.

Indicators of premature ejaculation and their associations with sexual distress in a population-based sample of young twins and their siblings.

INTRODUCTION: Recently, in anticipation of the Diagnostic and Statistical Manual of Mental Disorders V, much consideration has been given to the diagnostic criteria for premature ejaculation (PE). The scientific community is yet to agree not only on the etiology of PE, but also on the most suitable diagnosis and forms of treatment. It has been suggested that the diagnostic criteria of PE should be strictly empirical and rely on intravaginal latency time alone, whereas others stress the need to also include psychological and personal factors. AIM: To examine different indicators of PE and their relationship with and ability to predict sexual distress. MAIN OUTCOME MEASURES: Statistical analyses of data on sexual distress and different measures of ejaculatory function on a population-based sample of 3,332 Finnish men. METHODS: The present study involved a population-based sample of 3,332 males, of which 2,328 were twins aged 18-33, and 1,004 were over 18-year-old siblings to the aforementioned (M = 26.17 years of age). The individual contributions of different PE-indicator variables to experienced sexual distress were investigated by calculating correlations and performing a regression analysis. RESULTS: All included indicators of PE were significantly associated with sexual distress, and significant and logical differences in sexual distress were found between intravariable levels for several of the indicator variables. Only variables relating to subjective experience (e.g., worrying about PE) were uniquely related to sexual distress when other indicators were controlled for. CONCLUSIONS: The results suggest that variables measuring subjective experience may be useful when considering diagnostic criteria if indicators that are related to sexual distress are considered useful. However, overall, the association between PE and sexual distress is not especially strong, emphasizing the fact that more objective indicators of PE may not necessarily be associated with significant distress.

Female sexual function and its associations with number of children, pregnancy, and relationship satisfaction.

Associations between number of children, pregnancy, and overall relationship satisfaction were explored in a population-based sample of 2081 women, aged 33-43 years. Multiparous women had less orgasm problems compared to nulliparous women. Nulliparous women had more pain problems and were sexually less satisfied compared to women with children, regardless of the number. Women pregnant with the first child had fewer pain problems compared to a matched nonpregnant control and were sexually more satisfied. Being more satisfied with the overall relationship was related to higher sexual satisfaction and less sexual function problems.

Genetic effects on male sexual coercion.

The genetic and environmental influences on sexual coercion, and to what extent its associations with alcohol use and psychopathy depend on shared genetic and environmental effects, were explored in a Finnish population-based sample of 938 men, aged 33-43 years, using the classical twin study design. All three phenotypes were associated positively and affected by genes (sexual coercion 28%, alcohol use 60%, psychopathy 54%), with 46% of the correlation between sexual coercion and psychopathy, 89% of the correlation between alcohol use and psychopathy and 100% of the correlation between sexual coercion and alcohol use being explained by shared genetic effects. Further, the results showed that a proportion of the variance in sexual coercion was derived from a highly genetic source that was common with alcohol use and psychopathy. This latent factor was hypothesized to reflect a general tendency for antisocial behavior that is pervasive across different situations. Relevant theories on sexual coercion were discussed in light of the results.

Premature and delayed ejaculation: genetic and environmental effects in a population-based sample of Finnish twins.

INTRODUCTION: A number of different theoretical approaches to understanding the etiology of ejaculatory dysfunction have been proposed, but no behavior genetic study has yet, to our knowledge, been conducted to explore the genetic and environmental influences on ejaculatory dysfunction. AIM: The aim of the present study was to explore the genetic and environmental effects on premature (PE) and delayed (DE) ejaculation in a population-based sample. METHODS: The genetic and environmental influences on PE and DE were investigated in a population-based sample of 1,196 Finnish male twins, age 33-43 years, with 91 identical and 110 complete twin pairs. Several different aspects of ejaculatory function were measured by a self-report questionnaire (e.g., latency time, subjective experience of ejaculatory control). Factor analyses distinguished two subcomponents of ejaculatory function, and subsequently, composite variables measuring PE and DE were created. Structural equation modeling was performed on the composite variables. MAIN OUTCOME MEASURES: Measurement of genetic and environmental effects on PE and DE. RESULTS: The results suggested moderate genetic influence (28%) on PE, but not on DE (0%). There was a moderate familial effect on DE with shared environmental effects accounting for 24% of the variance. However, omission of the shared environmental component did not directly result in a significantly decreased model fit for DE, and omission of the additive genetic component did not directly result in a significantly decreased fit for the PE model. CONCLUSIONS: The findings from the present study provide useful information regarding the etiology and understanding of ejaculatory dysfunction.

Genetic and environmental effects on sexual excitation and sexual inhibition in men.

The Sexual Inhibition and Sexual Excitation Scales (SIS/SES) measure the propensity for sexual inhibition and excitation in men. According to the theoretical model underlying the SIS/SES, sexual response and associated behavior depend on dual control mechanisms in the brain involving the balance of excitatory and inhibitory systems which impinge on sexual response. Previous research with the SIS/SES has indicated one higher-order excitatory factor and two higher-order inhibitory factors affecting sexual response. The present study analyzed the item structure and the psychometric properties of the instrument in a population based sample of Finnish male twins (N = 1,289), and, including 37 out of 45 items of the original scales, estimated the heritability of and the environmental influences on the excitatory and inhibitory mechanisms. The twin correlations and the structural equation modeling suggested modest heritability for both inhibitory mechanisms. Sexual excitation, in contrast, was not influenced by genetic effects and similarities between twins for this mechanism seemed to be caused by the common environment of the twins.