Mixture Modeling to Characterize Anorexia Nervosa: Integrating Personality and Eating Disorder Psychopathology.

BACKGROUND: Efforts to examine alternative classifications (e.g., personality) of anorexia nervosa (AN) using empirical techniques are crucial to elucidate diverse symptom presentations, personality traits, and psychiatric comorbidities. AIMS: The purpose of this study was to use an empirical approach (mixture modeling) to test an alternative classification of AN as categorical, dimensional, or hybrid categorical-dimensional construct based on the co-occurrence of personality psychopathology and eating disorder clinical presentation. METHODS: Patients with AN (N = 194) completed interviews and questionnaires at treatment admission and 3-month follow-up. Mixture modeling was used to test whether indicators best classified AN as categorical, dimensional, or hybrid. RESULTS: A four-latent class, one-latent dimension mixture model that was variant across groups provided the best fit to the data. Results suggest that all classes were characterized by low self-esteem and self-harming and suicidality tendencies. Individuals assigned to Latent Class 2 (LC2; n = 21) had a greater tendency toward being impulsive and easily angered and having difficulties controlling anger compared with those in LC1 (n = 84) and LC3 (n = 66). Moreover, individuals assigned to LC1 and LC3 were more likely to have a poor outcome from intensive treatment compared with those in LC4 (n = 21). Findings indicate that the dimensional aspect within each class measured frequency of specific eating disorder behaviors but did not predict treatment outcomes. CONCLUSIONS: These results emphasize the complexity of AN and the importance of considering how facets of clinical presentation beyond eating disorder behaviors may have different treatment and prognostic implications.

Application of latent profile analysis to define subgroups of parenting styles and food parenting practices.

Food parenting practices and parenting styles are associated with child weight status, dietary intake, and eating behaviors. Although parents maintain a parenting style while also engaging in food parenting practices day-to-day, most studies have examined the separate impact of these two constructs on child outcomes. An examination of both practices and styles will facilitate the identification of how they mutually co-exist and influence child weight and weight-related outcomes. The current study examined the clustering of food parenting practices and parenting styles and evaluated the relationship between these parenting characteristics and child weight status, diet quality and eating behaviors. Children aged 5-7 and their parents (N = 150) from six racial/ethnic groups were recruited through primary care clinics. Latent class analysis classified subgroups based on parenting practices and styles. Regression analyses examined relationships between subgroups and child outcomes. The best-fitting model was two subgroups. Parents in subgroup 1 (n = 37) were more likely to restrict foods, pressure children to eat and less likely to engage in food modeling compared to subgroup 2 (n = 112). Parents in subgroup 1 were more likely to report authoritarian and permissive parenting styles and less likely to report an authoritative parenting style, compared to subgroup 2. Parents in subgroup 1 were more likely to report children who ate to obtain pleasure and who lacked internal cues for hunger than those in subgroup 2. There were no association between subgroups and child weight status, diet quality and other eating behaviors. Future research and interventions should take into consideration how parenting styles and practices mutually influence child weight and weight-related outcomes.

Relationship between desired weight constructs and eating disorder severity following treatment for anorexia nervosa.

BACKGROUND: Desired weight is an indicator of illness severity in youth with anorexia nervosa (AN), but its impact on eating disorder symptoms over time and in adults is unknown. This study examined longitudinal associations between two desired weight constructs (desired weight percentage, weight difference percentage) and eating disorder severity and body mass index (BMI) in patients aged 16-62 years old with AN presenting for inpatient or day hospital treatment. METHOD: Participants (N = 160) completed the Eating Disorder Examination and measures of height and weight at treatment admission, discharge, and 3, 6, and 12 months post-discharge. Desired weight percentage was calculated as [desired BMI(desired weight in kg/height in meters2 )/healthy BMI] × 100. weight difference percentage was calculated as [(actual weight-desired weight)/actual weight] × 100. RESULTS: At admission, participants were approximately 78.6% of a healthy BMI and desired to be 81% of a healthy BMI. During the year following treatment, participants were 89% of a healthy BMI, but wanted to be 86% of a healthy BMI. Individuals with lower desired weight percentage (wanting to be a lower percentage of a healthy BMI) or higher weight difference percentage (wanting to lose a larger percentage of weight) at treatment admission endorsed greater eating disorder severity across time. Additionally, individuals with higher desired weight percentage or weight difference percentage had higher BMIs at intake, and greater increases in BMI over time. DISCUSSION: Results highlight that desired weight constructs represent correlates of illness severity in AN and may inform an individual's likely weight trajectory during and after treatment.

Factor Structure of the Eating Disorder Examination-Questionnaire in a Clinical Sample of Adult Women With Anorexia Nervosa.

An exploratory factor analysis on the Eating Disorder Examination-Questionnaire (EDE-Q) is presented for a clinical sample of women with anorexia nervosa. THE EDE-Q was completed by 169 participants after admission to an inpatient unit for eating disorders. Results of the current study did not support the four-factor model presented by the EDE-Q. A new four-factor solution was obtained with two factors showing similarity to the Restraint and Eating Concern subscales of the original model. The Shape and Weight Concern items primarily loaded together on one factor, along with preoccupation with food and fear of losing control over eating, two Eating Concern items. Finally, an appearance factor was obtained that supports the results of prior research. [Journal of Psychosocial Nursing and Mental Health Services, 56(5), 33-39.].

Trajectories of Change in Body Weight During Inpatient Treatment for Anorexia Nervosa.

BACKGROUND: Identifying distinct trajectories of change in body weight during inpatient treatment for anorexia nervosa (AN) may provide knowledge about the process of weight restoration and may help detect optimal body weight response patterns among individuals who are at risk for not achieving weight restoration or leaving treatment prematurely. OBJECTIVE: This study explored the extent to which distinct trajectories of change in body weight existed among individuals during inpatient treatment for AN. DESIGN: Group-based trajectory modeling was used to identify distinct trajectories of change in body weight among 500 individuals receiving inpatient treatment for AN. RESULTS: Four distinct trajectories were identified: weight gain ( n = 197), treatment resistant ( n = 177), weight plateau ( n = 82), and weight fluctuate ( n = 44). CONCLUSION: Clinically, it is important to consider the heterogeneity of changes in body weight during inpatient treatment to help guide interventions and outcomes.

The Roy Adaptation Model: A Theoretical Framework for Nurses Providing Care to Individuals With Anorexia Nervosa.

Using a nursing theoretical framework to understand, elucidate, and propose nursing research is fundamental to knowledge development. This article presents the Roy Adaptation Model as a theoretical framework to better understand individuals with anorexia nervosa during acute treatment, and the role of nursing assessments and interventions in the promotion of weight restoration. Nursing assessments and interventions situated within the Roy Adaptation Model take into consideration how weight restoration does not occur in isolation but rather reflects an adaptive process within external and internal environments, and has the potential for more holistic care.

Intermittent explosive disorder and eating disorders: Analysis of national comorbidity and research samples.

OBJECTIVE: Clinical studies suggest comorbidity between eating disorders and aggressive behaviors. This study examined the pattern of comorbidity between intermittent explosive disorder (IED) and eating disorders (ED). METHODS: Data were analyzed from both the adult and adolescent samples of the National Comorbidity Survey-Replication (n = 19,430) and a clinical research sample (n = 1,642). RESULTS: Lifetime prevalence of Any ED was elevated in IED vs. non-IED for both the community and clinical research samples. Though anorexia nervosa displayed no relationship with IED in either sample, bulimia nervosa was associated with IED in the community sample and binge eating disorder was associated with IED in both the community and clinical research samples. Onset of IED preceded onset of Any ED in at least 70% of comorbid IED/ED cases in both community and clinical research samples. Associations of IED with Any ED and bulimia nervosa in the community sample, and associations of IED with binge eating disorder in the clinical research sample, remained significant after controlling for other psychiatric disorders. CONCLUSIONS: Individuals with IED are more likely to report lifetime prevalence of ED, particularly bulimic spectrum disorders. This finding, and the observation that the onset of IED occurs prior to the onset of ED in the majority of individuals, suggests that longitudinal studies are needed to clarify this relationship and determine whether IED is a risk factor for the development of ED. Early identification of individuals with IED or impulsive aggression may provide clinically useful information to determine most effective treatment interventions.

Eating Disorder Examination-Questionnaire (EDE-Q): Norms for a Clinical Sample of Males.

Normative data on the Eating Disorder Examination Questionnaire (EDE-Q) for a clinical sample of males in the United States are presented. Thirty-eight males completed the EDE-Q at time of admission to an inpatient unit for eating disorders. The majority of males were diagnosed with unspecified eating disorder (73.7%, n=28). Mean age at time of admission was 24.4 years (SD=12.6), mean body mass index at time of admission was 21.5kg/m2 (SD=9.5), and mean length of stay was 13.6 days (SD=9.3). Mean scores, standard deviations, and percentile ranks for the global and subscale scores are provided. Although the prevalence of eating disorders remains lower among males compared to females, body dissatisfaction and eating disorder psychopathology are fairly common among males.

Binge eating among racial minority groups in the United States: an integrative review.

BACKGROUND: Binge eating (BE) is a disordered eating behavior that has been linked to the development of eating disorders and obesity, with the latter being a condition with higher prevalence rates among some racial minority groups. Although researchers have begun to examine characteristics of BE among racial minority groups, it is unclear how these differ from White populations. OBJECTIVE: This article provides an integrative review of published literature within the past decade reporting on the characteristics of BE in minority compared with White racial groups. METHOD: Health care computerized databases were searched using key terms. RESULTS: Eighteen research studies met the inclusion criteria. More than half of the studies reviewed reported racial differences in some aspect of BE; however, heterogeneity in the definition and measurement of BE limits the ability to compare findings across studies. CONCLUSIONS: BE is reported across racial groups. To determine whether meaningful differences in BE exist by race, further studies using the same conceptual and operational definitions of BE are needed.