How do mothers signal shared feeling-states to their infants? An investigation of affect attunement and imitation during the first year of life.

The present study examined how mothers signal shared feeling-states to their infants. Affect attunement and imitation were investigated cross-culturally in 39 mother-infant dyads from Sweden (N = 22) and the former Yugoslavia (N = 17) during the first year of life. Video-recordings of playful interaction between mothers and their infants were analysed using the Affect Attunement Protocol. A significant negative association between imitation and age was found, while there was a significant positive association between affect attunement and age. Single occurrences of affect attunement appeared already at two or three months of age, and by 6 months of age episodes of affect attunement were more common than imitation. Frequencies of imitation and affect attunement were similar cross-culturally and in terms of gender, although there was a significant interaction between age and gender. The results suggest that the signalling of shared feeling-states is not a static process. Mothers do not signal shared feeling-states in the same manner at different ages. Imitation is the most important process during the earliest months, but is superseded by affect attunement earlier than previously thought. The functional implications of this developmental variation are discussed.

Why do eating disorder patients drop out?

BACKGROUND: Dropout from psychotherapy is an important problem that has received little systematic attention. Although previous research suggests that the number of patients who drop out is considerable, it is not clear why they drop out or what might be done to limit the problem. The present study attempted to examine the role of the patient-therapist relationship as well as other variables for dropout among eating disorder patients. METHODS: Eating disorder patients and their therapists were assessed on a measure of treatment expectations previously developed by the author: the former were also assessed on measures of psychiatric symptoms (Crown-Crisp Experiential Index) and eating disorder psychopathology (Eating Disorder Inventory), as well as relevant background and treatment variables. Patients were divided into those who had completed their course of treatment, and those who dropped out during assessment or treatment. RESULTS: Lack of congruence between patients' and therapists' expectations of potential treatment interventions was associated with increased risk of dropout, whereas other patient-, therapist- and treatment-specific factors were not. In particular, dropouts had significantly greater expectations of being helped by insight-related interventions than their therapists. CONCLUSIONS: Dropout among eating disorder patients appears to be related to the patient-therapist relationship. It may be important for therapists to openly discuss patient expectations of treatment from the outset, and focus on particular areas of discrepancy to limit potential dropout.

The eating disorders spectrum of DSM-III-R. Clinical features and psychosocial concomitants of 86 consecutive cases from a Swedish urban catchment area.

The diagnostic spectrum of eating disorders according to DSM-III-R was examined in a sample of 86 consecutive cases from a defined urban catchment area of Stockholm, Sweden. Presenting diagnoses were: bulimia nervosa 65%; atypical eating disorders, 20%; anorexia nervosa, restricting subtype, 9%; and, anorexia nervosa, bulimic subtype, 6%. All groups showed an extreme fear of weight gain. Restricting anorexics were older, had the latest age of onset of eating disorder, and had the shortest duration of illness. Bulimic anorexics had the longest duration of illness, earliest age of onset, and greater eating disorder psychopathology than restricting anorexics and atypicals. Bulimics exhibited significantly greater eating disorder psychopathology compared with atypicals. Both bulimics and bulimic anorexics presented with significantly greater general psychopathology compared with restricting anorexics and atypicals. Atypicals appeared to be the least disturbed group, whereas bulimic anorexics were the most disturbed. Results are discussed in terms of the relative merits of DSM-III and DSM-III-R, the characteristics of particular disorders, and the possibility of an underlying sequential course of illness in the eating disorders.

Attitudes to food, eating and weight in acutely ill and recovered anorectics.

A between-groups experimental design was used to test groups of acutely ill anorectics (n = 15), former anorectic patients who had been judged recovered at discharge (n = 14), psychiatric controls (n = 10) and normals (n = 24) on the Eating Attitudes Test (EAT). It was hypothesized that both acutely ill and recovered anorectics would show significantly greater distorted attitudes to food, eating and weight than controls, as assessed by the EAT. Results supported the hypothesis and suggest that anorectics may continue to show distorted attitudes to food, eating and weight after they have recovered from the gross physical and behavioural features of the disorder, although these attitudes appear to be somewhat less extreme than during the acute phase. It is concluded that an important aspect of anorexia nervosa appears to be largely unaltered by present treatment.