Showing papers by "Phillipa Hay published in 2016"

A clinical profile of compulsive exercise in adolescent inpatients with anorexia nervosa

Abstract: The aim of the current study was to contribute to the development of a clinical profile of compulsive exercise in adolescents with Anorexia Nervosa (AN), by examining associations between compulsive exercise and eating and general psychopathology. A sample of 60 female adolescent inpatients with AN completed a self-report measure of compulsive exercise and a series of standardized self-report questionnaires assessing eating and general psychopathology. Higher levels of compulsive exercise were associated with increased levels of eating disorder psychopathology and anxiety. Specifically, the avoidance aspect (negatively reinforced) of compulsive exercise was associated with elevated scores on measures of eating disorder, anxiety, depression, and obsessive compulsiveness psychopathology, as well as lower self-esteem scores. The mood improvement value (positively reinforced) of compulsive exercise, however, did not reflect such trends. Compulsive exercise driven by avoidance of negative affect is associated with more severe psychological features in adolescent inpatients with AN. The current findings emphasize the need for research and clinical efforts in the development of treatments addressing avoidance of negative affect and compulsive exercise in adolescents with AN.

White matter alterations in anorexia nervosa: A systematic review of diffusion tensor imaging studies

Abstract: AIM: To identify findings concerning white matter (WM) fibre microstructural alterations in anorexia nervosa (AN). METHODS: A systematic electronic search was undertaken in several databases up to April 2015. The search strategy aimed to locate all studies published in English or Spanish that included participants with AN and which investigated WM using diffusion tensor imaging (DTI). Trials were assessed for quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist and a published quality index guideline. RESULTS: A total of 6 studies met the inclusion criteria, four of people in the acute state of the illness, one included both recovered and unwell participants, and one included people who had recovered. Participants were female with ages ranging from 14 to 29 years. All studies but one measured a range of psychopathological features. Fractional anisotropy and mean diffusivity were the main DTI correlates reported. Alterations were reported in a range of WM structures of the limbic system, most often of the fornix and cingulum as well as the fronto-occipital fibre tracts, i.e., regions associated with anxiety, body image and cognitive function. Subtle abnormalities also appeared to persist after recovery. CONCLUSION: This diversity likely reflects the symptom complexity of AN. However, there were few studies, they applied different methodologies, and all were cross-sectional.

Quality of life as a vulnerability and recovery factor in eating disorders: a community-based study

Abstract: Emerging evidence suggests that changes in quality of life (QoL) predicts later changes in eating disorder (ED) symptoms. The objective of this study was to explore individual sufferers’ perspectives on the influence of QoL on the onset, maintenance, and/or remission of ED symptoms. 19 women from the community with a history of eating disorders (n = 13 currently symptomatic; n = 6 recovered) were interviewed about their observations on the relationship between QoL and ED symptoms over time in their own lives. Interviews were audio-taped and transcribed, and then thematically analysed. Thematic analysis uncovered two major themes: 1. QoL as a Vulnerability Factor, and 2. QoL as a Recovery Factor. In relation to the first theme, onset of ED symptoms was discussed by women in this study as having been triggered by impairment in QoL, including a general sense of lacking control in life, stress, abusive intimate relationships, poor role modelling from family, physical impairment related to obesity, peer pressure, and weight-related teasing. On the other hand, and in relation to the second theme, subsequent improvement in QoL was nominated as central to symptom improvement and recovery. QoL improvement was described by participants differently, but included increased general satisfaction in life, emotional maturation, prioritising and improving physical health, the development of a supportive intimate relationship and social relationships, and having children. Impairment in QoL may act as a trigger for the onset and maintenance of ED symptoms, whereas improvement in QoL may be central to eating disorder improvement and eventual recovery. Treatment should involve consideration of a core focus on QoL improvement as a potential ‘backdoor’ approach to improving ED symptoms.

Risk Factors for Binge Eating Disorder

Abstract: reported more childhood obesity and more exposure to negative comments about shape, weight, and eating. Certain childhood traits and pronounced vulnerability to obesity distinguished the subjects with bulimia nervosa from those with binge eating disorder. Conclusions: Binge eating disorder appears to be associated with exposure to risk factors for psychiatric disorder and for obesity. When compared with the wide range of risk factors for bulimia nervosa, the risk factors for binge eating disorder are weaker and more circumscribed. Premorbid perfectionism, negative self-evaluation, and vulnerability to obesity appear especially to characterize those in whom bulimia nervosa subsequently develops. Arch Gen Psychiatry. 1998;55:425-432

Predictors of therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa.

Abstract: Background Therapeutic alliance (TA) has been found to be a significant predictor of outcome for patients with severe and enduring anorexia nervosa (SE-AN), accounting for more variance than treatment type. To better understand how to promote TA for this population, the aim of the current study was to investigate predictors of TA in adults with SE-AN.

Identifying Persuasive Public Health Messages to Change Community Knowledge and Attitudes About Bulimia Nervosa

Abstract: Addressing stigma through social marketing campaigns has the potential to enhance currently low rates of treatment seeking and improve the well-being of individuals with the eating disorder bulimia nervosa. This study aimed to evaluate the persuasiveness of health messages designed to reduce stigma and improve mental health literacy about this disorder. A community sample of 1,936 adults (48.2% male, 51.8% female) from Victoria, Australia, provided (a) self-report information on knowledge and stigma about bulimia nervosa and (b) ratings of the persuasiveness of 9 brief health messages on dimensions of convincingness and likelihood of changing attitudes. Messages were rated moderately to very convincing and a little to moderately likely to change attitudes toward bulimia nervosa. The most persuasive messages were those that emphasized that bulimia nervosa is a serious mental illness and is not attributable to personal failings. Higher ratings of convincingness were associated with being female, with having more knowledge about bulimia nervosa, and with lower levels of stigma about bulimia nervosa. Higher ratings for likelihood of changing attitudes were associated with being female and with ratings of the convincingness of the corresponding message. This study provides direction for persuasive content to be included in social marketing campaigns to reduce stigma toward bulimia nervosa.

Chew and Spit (CHSP): a systematic review

Abstract: Background This systematic review is an evaluation of the empirical literature relating to the disordered eating behaviour Chew and Spit (CHSP). Current theories postulate that CHSP is a symptom exhibited by individuals with recurrent binge eating and Bulimia Nervosa.

Exercise for the compulsive exercisers? An exploratory study in adolescent inpatients with anorexia nervosa

Abstract: Objective: This study aimed to explore whether exercise produced acute psychological benefits for adolescent inpatients receiving treatment for anorexia nervosa (AN). Specifically, the study examined whether a supervised inpatient exercise programme resulted in negative or positive affective changes over time, and if the participant’s reported level of compulsive exercise influenced such changes. Method: Forty-seven adolescent female inpatients with a DSM-5 diagnosis of AN completed a measure of compulsive exercise at admission to an eating-disorder inpatient programme. Participants routinely attended physiotherapy sessions (exercise condition) and school lessons (school condition) throughout their admission, and completed visual analogue scales assessing anxious, depressed, and positive affect immediately prior to and after both conditions. Results: Participants reported a significant decrease in anxious and depressed affect, and an increase in positive affect after the exercise condition compare...

Evaluation of an antenatal acupuncture intervention as an adjunct therapy for antenatal depression (AcuAnteDep): study protocol for a pragmatic randomised controlled trial

Abstract: Depressed pregnant women face difficulty navigating a course between the potentially serious consequences of leaving depression untreated and significant limitations associated with conventional therapies, such as foetal toxicity and teratogenicity. Preliminary evidence is suggestive that acupuncture may provide a safe and effective alternative treatment option for antenatal depression; however, additional research is required. The purpose of this study is to further investigate this treatment possibility, with an additional examination of a potential biomechanistic acupuncture effect. In this pragmatic randomised controlled trial, we will compare individually tailored, flexible antenatal depression-oriented acupuncture with equivalent attention progressive muscle relaxation and routine antenatal depression hospital care. Eligible women at 24 weeks of gestation with Edinburgh Postnatal Depression Scale scores of 13 or more will be recruited from 2 antenatal clinics in South Western Sydney, Australia. The recruitment goal of 96 is powered to demonstrate a significant difference in Edinburgh Postnatal Depression Scale score severity between acupuncture and usual care, with intervention groups receiving weekly 1-h treatments for 8 weeks from 24 to 31 weeks of gestation. Mental health and quality-of-life assessments will occur at study commencement, intervention weeks 4 and 8 and 6 weeks post-natally via the collection of completed Edinburgh Postnatal Depression Scale scores, Depression, Stress and Anxiety Scale scores and World Health Organisation Quality of Life Scale scores. Adjustment to mothering will also be evaluated at 6 weeks post-natally using the Being a Mother Scale. A putative biomechanistic effect of acupuncture on the oxytocinergic system will additionally be examined by comparing baseline salivary hormone levels with those measured at intervention weeks 4 and 8, as well as leucocyte oxytocin receptor expression at baseline and intervention week 8. Ethical approval was received in February 2015, and recruitment is underway and expected to be completed in July 2016. Australian New Zealand Clinical Trials Registry ACTRN12615000250538 , Registered on 19 March 2015.

Participatory action research for women with anorexia nervosa.

Abstract: AIM To discuss the application of the principles of participatory action research (PAR) in a project that developed and evaluated a mentor-mentee support programme for women with anorexia nervosa. BACKGROUND A programme was developed and implemented in which mentors and mentees participated in workshops, social activities and focus groups that sought to support and develop resilience for those experiencing anorexia nervosa. DISCUSSION PAR principles were mirrored in the programme, paying respect to the views and needs of each participant, an open trajectory to possible conclusions and a continuous feedback cycle. Mentees had a sense of empowerment, ownership of the programme and hope that recovery was possible. It allowed their voices to be heard and provided them with belief they could begin new relationships and friendships. CONCLUSION The principles of PAR suited a project aimed at developing self-determination and resilience in women with anorexia nervosa. IMPLICATIONS FOR RESEARCH/PRACTICE PAR would be readily transferable to a number of mental health settings where empowerment is of paramount concern.

An empirical evaluation of the translation to Brazilian Portuguese of the Loss of Control over Eating Scale (LOCES)

Abstract: Background Loss of control over eating is a key feature of the most prevalent eating disorders. The Loss of Control over Eating Scale (LOCES) enables a thorough assessment of loss of control over eating. Objective This study empirically evaluated the translation of the LOCES from English to Brazilian Portuguese. Methods The scale was translated to Brazilian Portuguese and back translated to English in order to check accuracy of the translation. Two hundred and ninety-three medicine and nursing students, 60 males and 233 females, 18-55 years old, with mean body mass index (BMI) 23.2 kg/m2 (SD 4.1), recruited between August and December 2014, answered the Brazilian Portuguese LOCES. An exploratory factor analysis was performed. Results Exploratory factor analysis of the Brazilian Portuguese LOCES showed three distinct factors of the loss of control over eating (disgust/negative sensations, cognitive experiences/dissociation, and “positive” effects) as well as moderate consistency with previous reports of exploratory factor analysis of the English version. Discussion This study showed satisfactory translation of the LOCES from English to Brazilian Portuguese, which is now ready for further validation.

Antipsychotic drugs for anorexia nervosa

Abstract: Reason for withdrawal from publication This protocol was withdrawn on 23rd May 2016 due to lack of progress.

Editorial: globalisation and the journal of eating disorders.

Abstract: Author(s): Phillipa Hay[sup.1] and Stephen Touyz[sup.2] Editorial This year's Editorial began its life in the Antipodean summer in a bay close to where the sounds of bell birds and tui, "the most melodious wild music" first received international attention from records of Cook's journeys in the eighteenth century [1]. At that time global journeys were dangerous and rare and their scientific discoveries took years to reach a publisher. Now we live in a world community with rapid communications that means that (on a good day) one can communicate to anywhere with an internet connection from the shores Cook took refuge in in 1770. Eating Disorders, like communications, are now global. By its inherent qualities of open access the Journal of Eating Disorders is in a position to disseminate and reach every corner of the world, and the people within them working in the field of eating disorders who have access to the internet. Alongside this there is an imperative that we understand eating disorders and how to manage them in ways that are helpful beyond our own perspective. In 2015 the Journal of Eating Disorders published its first special series on "The Current Status of Eating Disorders: General and Special Population studies". Many of the papers that were submitted were from Asia and the accompanying review by Pike and Dunne [2] underscores the rise in eating disorders across Asia in particular. Another article in the special series points to the increasing prevalence of eating disorders across all age groups, both sexes and throughout all socio-economic groups in Australia [3]. Furthermore throughout 2015 the Journal's website conveyed an invitation from the World Health Organization Global Clinical Practice network for readers to contribute their expertise in Eating and Feeding Disorders to the current revisions to the ICD-11 [4]. Whilst similar to the DSM-5 [5] there will be differences in diagnostic criteria reflecting global cultural and clinical diversity. In 2016 researchers and clinicians working across the world thus have the opportunity to have input into the ICD-11 and its final criteria scheduled to be published in 2017. Along with globalisation and revisions to diagnostic criteria there are increasing challenges to our conceptualisation of "What is an eating disorder". Pike and Dunne's [2] review points to the diversity of expression of an eating disorder within population samples in Asia. For example, they report a study which found no body image disorder and/or no fat phobia in a large minority of Japanese women with anorexia nervosa. In their review they also point to the factors of industrialization and urbanization as being as great if not more significant than "Westernization" cultural values in understanding the rise of eating disorders in Asia and other parts of the globe. Taken together this underscores the degree to which eating disorders classification is in a state of flux and subject to diverse socio and cultural influences. With the Research Domain Criteria (RDoC) [6] movement leading the way we may come closer to an understanding of the neuroscience of appetite, satiety and its relationship to eating and weight facilitating a new understanding of disorders of feeding and eating. We anticipate increasing science in this area written and published in the Journal. It is also important to distil the science and disseminate it to clinicians and the wider community and in this regard the systematic and scientific review is imperative. The Pike and Dunne, and other reviews published in the journal reflect this and for the first time this year we gave a prize both for a primary research paper and for a review paper. We congratulate again our prize winners, for 2015: Dr Loa Clausen [7] and Dr Carmel Harrison [8]. Finally, reflecting the growing globalisation of science, the journal encourages and endeavours to support papers from non-English speaking countries. We recognise however that it is imperative to better develop the processes that allow that to occur, and to have efficient processes in place. …

Reflections on the 'State of the Evidence' for treatments in anorexia nervosa.

Abstract: The meta-analysis by Solmi et al. (1) on bone mineral density, osteoporosis and fractures among people with eating disorders is a tour de force in systematic reviewing. The authors conducted a comprehensive literature search identifying nearly 5000 papers and analysing and applying quantitative synthesis to 57 papers. Although their results may be of no surprise to experts in the area of eating disorders, the new information on size of effects in the meta-analyses is important. They found that indeed people with anorexia nervosa suffer an increased risk of osteoporosis, osteopenia and fractures, and furthermore, that this increased risk is moderated by duration of illness and amenorrhoea. Somewhat less expected was that body weight (body mass index) in itself did not moderate the risk of osteoporosis. They also found insufficient evidence for moderators and risk of osteoporosis in people with other eating disorders. Most studies found no significant differences in bone mineral density between people with bulimia nervosa vs. healthy controls. However, there was a trend for people with bulimia nervosa to have reduced lumbar spine bone mineral density vs. controls, and another recently published meta-analysis (with some differences in which studies were included) has reported significantly reduced spinal bone density in bulimia nervosa (2). This distillation of the evidence (1) is followed in the discussion with a clear exposition of the state of evidence of treatments that accords with clinical practice guidelines and other reviews (3–5) and the second meta-analysis (2). We learn that despite this risk being long-known and easily identifiable, the treatment options for people with anorexia nervosa who suffer osteopenia are limited. Commonly prescribed vitamin D and calcium has little to no evidence of effect. Bisphosphonates are ineffectual in adolescent years and may cause harm in younger women. This lack of evidence also includes other anabolic/anticatabolic medications commonly used in postmenopausal osteoporosis. Oral oestrogen or the contraceptive pill commonly thought to be helpful has insufficient or little evidence of efficacy. The only potential agent on the horizon is transdermal oestrogen, possibly because it does not suppress IGF1 secretion. In the course of writing this Editorial, the author reflected on a 1989 publication that used a now outdated technology to measure bone density, CT scan. The final sentence was ‘The principal conclusion of this study [which found no protective effect of oral contraceptive use] is that management that succeeds in averting prolonged amenorrhoea and low weight is likely to be the most effective way of countering bone loss in anorexia nervosa’ (6). Over a quarter of a century later, progress seems to have been very slow. The state of knowledge of the treatment of this important, potentially irreversible adverse effect of suffering anorexia nervosa is salutary. It exists in the context of similar deficits of knowledge in the primary treatment of anorexia nervosa. For example, although the number of randomized control trials (RCTs) of psychological therapy of anorexia nervosa in adults has improved in recent years, and notably studies from Germany by Zipfel et al. and the United Kingdom by Schmidt et al. have markedly increased the number and quality of RCTs, there still remain fewer than fifteen including two completed and yet unpublished trials (5). The body of knowledge concludes that while specialist treatments and expertise in anorexia nervosa appear to be a necessary condition for efficacy, no trial yet published has supported any specific psychological therapy vs. any other psychological therapy as offering an advantage in outpatient treatment in adults in a ‘head-to-head’ comparison (4, 5). The lack of difference in outcomes between specialist lead therapies underscores the limitations of underlying theoretical paradigms that may provide an understanding of the illness itself, its aetiology and treatment. There are more studies and robust evidence for treatments of other eating disorders and in anorexia nervosa for family based treatments and pharmacological therapy (3–5). There is consensus, for example that family therapy is the approach of first choice in children and adolescents and that antidepressants are ineffective, but antipsychotics may offer some help in reducing anxiety in people in the acute phase of the illness, with the caveat that these