Showing papers by "Stephen Touyz published in 2014"
TL;DR: Specific evidence based psychological and pharmacological treatments are recommended for most eating disorders but more trials are needed for specific therapies in anorexia nervosa, and research is urgently needed for all aspects of ARFID assessment and management.
Abstract: Objectives:This clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clini...
418 citations
TL;DR: It is suggested that full recovery from chronic anorexia nervosa is possible and the importance of hope, motivation, self-efficacy, and support from others in the recovery process is emphasized.
Abstract: In this study, we aimed to explore the process of recovery over time from the perspective of those who had fully recovered from chronic anorexia nervosa (AN), using stringent recovery criteria. Eight women, assessed as fully recovered from chronic AN, told their story of the process of recovery. Data were analyzed using the qualitative method, narrative inquiry. Recovery was identified as a long and complex process that spanned four phases: from being unable or unready to change, to experiencing a tipping point where motivation increased and changed in quality, allowing the women to take action against the AN and finally allowing them to reflect and rehabilitate. Results provide a framework for understanding this complex process. Findings suggest that full recovery from chronic AN is possible and emphasize the importance of hope, motivation, self-efficacy, and support from others in the recovery process.
104 citations
TL;DR: A large effect of character diagnosis on masculinity was observed, such that characters with anorexia nervosa were perceived as less masculine than characters with muscle dysmorphia, and this effect was more pronounced among male participants, but no significant corresponding effects were observed for femininity.
Abstract: Objective: The nature and extent of stigma toward individuals with anorexia nervosa and muscle dysmorphia remains underexplored. This study investigated attitudes and beliefs likely to be conducive to stigmatization of individuals with these conditions. Method: Male and female undergraduate students (n 5 361) read one of four vignettes describing a fictional male or female character with anorexia nervosa or muscle dysmorphia, after which they responded to a series of questions addressing potentially stigmatizing attitudes and beliefs toward each character. Results: Characters with anorexia nervosa were more stigmatized than characters with muscle dysmorphia, female characters were more stigmatized than male characters, and male participants were more stigmatizing than female participants. A large effect of character diagnosis on masculinity was observed, such that characters with anorexia nervosa were perceived as less masculine than characters with muscle dysmorphia, and this effect was more pronounced among male participants. However, no significant corresponding effects were observed for femininity. Discussion: Females with anorexia nervosa may be particularly susceptible to stigmatization, especially by males. Anorexia nervosa and muscle dysmorphia are perceived as “female” and “male” disorders respectively, in line with societal gender role expectations, and this stigmatization is tied more strongly to perceptions of sufferers’ masculinity than
75 citations
TL;DR: It is proposed that the recovery model might offer a way in which to add to current practice and might have particular relevance for those with chronic AN.
Abstract: Objective:Treatments in anorexia nervosa (AN) have not been wholly effective and, accordingly, practices need to be reviewed. The recovery model is an approach to treatment that has become a guidin...
52 citations
02 Oct 2014
TL;DR: The results from the studies reviewed suggest that compulsive exercise is an evident problem within adolescent eating disorders; however, the specific psychopathological risks associated with this behaviour cannot be reliably summarised.
Abstract: This review aims to critically examine and summarise the existing research that has studied the prevalence and psychopathological correlates of compulsive exercise in adolescents with eating disorders. A systematic electronic database search (PsycINFO, Medline, and Web of Science) of published studies was completed in May 2013. A search strategy was developed to identify all studies of adolescents with eating disorders, in which the prevalence and/or psychological correlates of compulsive exercise had been formally assessed through clinical interview or reliable and valid clinical measures. A total of 11 studies met the inclusion criteria for the review, of which 10 studies provided comparable prevalence estimates and 4 studies identified psychopathological correlates of compulsive exercise. For the relevant data, the prevalence of compulsive exercise in adolescents with eating disorders ranged from 16.7% to 85.3%. There is some evidence to suggest that compulsive exercise is associated with increased eat...
46 citations
TL;DR: Four moderators of treatment outcome emerged: eating disorder psychopathology (EDE Global), depression (BDI), age, and AN subtype, which suggest older patients with more severe eating-related psychopathology and depression have better outcomes in a behaviorally targeted treatment such as CBT-AN rather than a supportive treatmentsuch as SSCM.
44 citations
TL;DR: Results from 132 male undergraduates showed that muscularity dissatisfaction was uniquely associated with both emotion regulation difficulties and an attentional bias toward rejecting faces, and disordered eating was uniquelyassociated with emotionregulation difficulties.
34 citations
04 Mar 2014
TL;DR: In this article, the authors investigated the severity and nature of compulsive exercise in males and females with anorexia nervosa (AN) and found that males relied significantly more heavily on avoiding negative affect and increasing positive affect, and endorsed more rigid and repetitive exercise habits than females.
Abstract: Objective: To investigate the severity and nature of compulsive exercise in males and females with anorexia nervosa (AN). Method: Male (n = 27) and female (n = 24) patients with AN completed measures of compulsive exercise and eating disorder symptomatology. Results: Males reported significantly greater overall compulsive exercise pathology than females. Analysis of subscale scores on the compulsive exercise test showed that males relied significantly more heavily on avoiding negative affect and increasing positive affect, and endorsed more rigid and repetitive exercise habits than females. Discussion: Compulsive exercise appears to be more severe in males with AN relative to females. For males in particular, exercise may function to regulate affect by both reducing negative emotionality and increasing positive emotionality, indicating an important psychological function of exercise beyond the physiological effects of expunging calories. Furthermore, the exercise behaviours endorsed by males were more dee...
34 citations
TL;DR: This study supported previous findings of associations between attrition and purging subtype and found associations between a potentially important cycle of attrition, and poorer EDQoL, which has not been previously reported.
Abstract: Attrition is common in the treatment of anorexia nervosa and its causes are complex and incompletely understood. In particular, its relationship with adaptive function and motivational stage of change has been little studied. This study aimed to (1) investigate and (2) compare the strength of associations between adaptive function, stage of change and other previously found factors such as illness sub-type and treatment attrition in women with severe and enduring anorexia nervosa (SE-AN). Participants were 63 adult women with SE-AN of at least 7 years duration who were enrolled in a multi-site randomized controlled trial conducted from July 2007 through June 2011. Treatment comprised 30 outpatient visits over 8 months of either Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN) or Specialist Supportive Clinical Management (SSCM) both of which were modified for severe and enduring illness. Assessments were done at baseline, end of treatment, and 6 and 12 month post treatment follow-up. Demographic variables, duration of illness, specific and generic health related quality of life (QoL), eating disorder (ED) and mood disorder symptoms, social adjustment, body mass index (BMI), and motivation for change were assessed with interview and self-report questionnaires. Treatment attrition was defined as leaving therapy after either premature termination according to trial protocol or self-instigated discharge. Binary logistic regression was used to investigate relative strength of associations. Those who did not complete treatment were significantly more likely to have the purging sub-type of anorexia nervosa and poorer ED related QoL. There were no significant differences between attrition and which therapy was received, educational level, and global ED psychopathology, stage of change, BMI, social adjustment, duration of illness or level of depression. The strongest predictors on multivariable analysis were ED QoL and AN-purging subtype. This study supported previous findings of associations between attrition and purging subtype. Furthermore, we found associations between a potentially important cycle of attrition, and poorer EDQoL, which has not been previously reported. Contrary to expectations we did not find an association with BMI, severity of ED symptoms, low level of motivation to change ED features, or level of education.
33 citations
TL;DR: Acupuncture and acupressure and massage may improve the patient's subjective sense of wellbeing, and further research is needed.
Abstract: Objectives: This study examined the feasibility of conducting a randomized controlled trial of acupuncture compared with an active control in an inpatient setting, to examine individuals' experience of the interventions, clinical outcomes from the trial, and to integrate data to explain the trial findings. Design: This was a pilot randomized controlled trial with in-depth interviews with trial participants. Setting: The study was conducted at a private medical facility in Sydney, Australia. Subjects: Twenty-six (26) patients with anorexia nervosa who were medically stable were the subjects. Interventions: Treatment as usual was administered, and the intervention was delivered twice a week for the first 3 weeks, followed by weekly treatment for three weeks. The acupuncture group received acupuncture at the points Hegu (LI4), Zusanli (ST36), Neiguan (PC6), Taichong (LR3), Yanglingquan (GB34), and additional points based on the Traditional Chinese Medicine diagnosis. The control group received acupr...
25 citations
TL;DR: Outcomes supported the effectiveness of overall treatment but suggested that adding direct treatment of perfectionism did not enhance treatment, and no significant interaction effects were found on variables measuring eating pathology and perfectionism.
Abstract: The aim of this pilot study was to investigate the impact of the direct treatment of perfectionism on the outcome of perfectionism and eating disorder pathology. Sixty-one participants, attending day hospital treatment, participated in a randomised controlled study, in which treatment as usual (TAU) was compared with TAU combined with a clinician-lead cognitive behavioural treatment for perfectionism (TAU+P). Linear mixed model analysis revealed no significant interaction effects but significant main effects for time on variables measuring eating pathology and perfectionism. Outcomes supported the effectiveness of overall treatment but suggested that adding direct treatment of perfectionism did not enhance treatment. The results are discussed in relation to the existing literature on the treatment of perfectionism.
04 Mar 2014
TL;DR: The results indicate that the effects of AN on the sibling relationship can be variable, with older siblings with a pre-existing close relationship with the patient faring the best.
Abstract: Purpose: There is growing evidence that siblings have a role to play in the recovery from adolescent anorexia nervosa (AN), yet we know very little about the effect that AN has on them and what they do to cope. This study aims to investigate the impact of AN on adolescent siblings. Method: Semi-structured interviews were conducted with 20 adolescent siblings of young people being treated for AN, and analysed using thematic analysis. Results: The results indicate that the effects of AN on the sibling relationship can be variable, with older siblings with a pre-existing close relationship with the patient faring the best. Siblings described a number of factors that supported coping, including knowing more about the illness, the need for regular ‘time-out’ from stressful events and interactions and close supportive relationships with family members. Involvement in family-based treatment appeared to improve understanding of AN and enhanced communication within the family. Problems with family-based therapy (F...
TL;DR: This guidebook is truly a comprehensive guide with a focus not only on existing eating disorders but on which early warming signs to look out far as well.
Abstract: Review This is a short affordable softcover guide book for families, carers and patients. As Professor Bob Palmer so elegantly points out on the cover of this guidebook, it will be an excellent resource. The road to recovery is often a difficult and challenging one with what appear to be insurmountable obstacles to overcome. This journey will now be considerably easier with both the knowledge and support found in this guidebook. This book is written in a warm and friendly manner and is easy to read. It provides a wealth of clinical information often in the form of clinical vignettes and practical exercises to aid recovery for patients and/or families. The message throughout is one of hope and inspiration despite the innumerable odds faced by so many of these patients. It is truly a comprehensive guide with a focus not only on existing eating disorders but on which early warming signs to look out far as well. Greta Noordenbos is one of the few experts in the field of eating disorders who has a special clinical/research interest in recovery. Her rich knowledge and clinical experience brings this book alive. She is at pains to point out that recovery is much more than normalizing eating behavior and weight as well as ceasing to binge or purge. She provides excellent commentary on the importance of a positive body attitude, improving self esteem, expressing emotions and improving interpersonal relationships. Other important topics such as extreme dieting, the negative consequences of eating disorders, the turning point and motivation to recovery normalizing eating habits and physical recovery are also given due diligence. Those reading the book will never be short of inspiration and hope in their own journeys. Clinicians with a special interest in recovery will also find the insights gained very useful to use in their own clinical sessions. Professor Stephen Touyz
TL;DR: The aim of the current study was to determine the efficacy of recovery narratives as a means of improving motivation and self-efficacy, using a randomised controlled trial design and results regarding the effectiveness of the intervention are presented.
Abstract: Low motivation to change and low self-efficacy have been associated with poorer outcome in anorexia nervosa (AN). There is evidence to suggest that sharing personal accounts of successful recovery with patients might improve motivation as well as helplessness and hopelessness associated with recovery, providing an important resource for sufferers. However, no research to date has explored the helpfulness or unhelpfulness of recovery narratives, despite many patients accessing such stories. The aim of the current study was to determine the efficacy of recovery narratives as a means of improving motivation and self-efficacy, using a randomised controlled trial design. The primary outcome variable was change in motivation as measured by intentions to recover from AN and stage of change. More than fifty individuals with AN and subclinical AN participated in this online study. Participants were randomised to either receive recovery stories or to a wait-list controlled group. After completing base-line measures, participants read five short stories about recovery from AN, and completed post-intervention measures two weeks later. Preliminary findings revealed that participants self-reported varying levels of usefulness. Full results regarding the effectiveness of the intervention as a means of improving motivation and self-efficacy are presented and clinical and research implications discussed.
This abstract was presented in the Learning from Consumers stream of the 2014 ANZAED Conference.
TL;DR: Avoidance seemed to diminish the therapeutic impact of the family meal for a significant number of families and strategies to challenge avoidance during the session are suggested.
Abstract: Results Two types of family meal were identified. The first was characterised by processes that were consistent with the Maudsley model, and resulted in the patient eating one mouthful more than they were prepared to. The second was defined by processes that were mixed in terms of their consistency with the model, and resulted in the patient eating what was asked of them with little to no difficulty. Therapist and family avoidance differentiated the second meal type from the first. Discussion Avoidance seemed to diminish the therapeutic impact of the family meal for a significant number of families. Strategies to challenge avoidance during the session are suggested. This abstract was presented in the Peter Beumont Young Investigator award finalist stream of the 2014 ANZAED Conference.
TL;DR: The gold standard assessment instrument in Eating Disorders research, the Eating Disorder Examination (EDE) and its self-report sister instrument the EDE-Q require little adaptation and indeed have benefited from the alignment of criteria for presence of bulimia behaviours across disorders.
Abstract: Authors: Phillipa Hay (corresponding author) [1,2]; Stephen Touyz [3] Editorial Some of us can recall the fervour and excitement surrounding the introduction of the third revision of the American Psychiatric Association?s Diagnostic and Statistical Manual of Mental Disorders (DSM) [1] onto the international psychiatric stage in 1980. History will judge the fifth revision of the DSM (DSM-5) [2] and whilst the response thus far appears more muted there are a number of substantive changes already impacting on clinicians and academics. For example, lecturers revising their power-points find it a much simpler system to explain with no axes to distinguish it from general medical classifications or to be a proxy for a simplified formulation. In assessment, Engel [3] and colleagues? ?biopsychosocial? approach to psychiatric formulation may thus resume importance in capturing the understanding of the patient?s problems beyond the diagnosis. Whether the WHO disability scale [4] will have the utility and familiarity as the Global Assessment of Function (GAF [5]) is also unknown, particularly given the highly variable use of the GAF. Beyond the clinician what do the changes mean for academics? Already instruments like the Mini International Neuropsychiatric Interview [6] need urgent official upgrades. Fortunately the gold standard assessment instrument in Eating Disorders research, the Eating Disorder Examination (EDE) [7] and its self-report sister instrument the EDE-Q [8] require little adaptation and indeed have benefited from the alignment of criteria for presence of bulimia behaviours across disorders. Thus researchers will no longer have to inquire about binge eating over the past 6-months (as it is now diagnosed over 3-months) and the final question on menstrual function is no more a diagnostic item for anorexia nervosa. Will Journal of Eating Disorders accept papers using DSM-IV [5] criteria? The short answer is in most instances ?no?, unless authors make a compelling argument. For example in a longitudinal study it is usually not possible to reclassify participants diagnosed according to DSM-IV criteria at entry to the study. There will be an expectation that authors doing systematic reviews carefully check the criteria used for diagnoses in papers. Many applied broad criteria for bulimia nervosa or anorexia nervosa (e.g., the ?Oxford? criteria of once weekly binge eating [7]) that now accord with DSM-5 criteria and this should be reported in the review. What about the alternate international scheme, the World Health Organisation?s International Classification of Diseases and Related Health Problems (ICD)? The tenth revision of the ICD (ICD-10) and DSM-IV schemes currently use similar diagnostic terms and the same numerical systems. This assisted hospital administrators who need to convert DSM-IV into ICD-10 for government data collection and similar purposes, but it was of less interest to researchers and academics. Now however there is potential for confusion with the DSM-5 using some ICD-10 terms, e.g., ?atypical? anorexia nervosa and bulimia nervosa, with different criteria. In addition, the 11th revision of the ICD [9] may remove the requirement of an objectively large amount in the criterion for binge eating episodes. These changes are of notable concern to researchers attempting to estimate incidence and prevalence data across time and space. With loosening of some diagnostic criteria (e.g., removal of the amenorrhoea criteria for anorexia nervosa) and expansion of the field to new and added disorders of feeding and eating (e.g., Avoidant/Restrictive Food Intake Disorder (ARFID)), care will need to be taken to avoid artificial increases in estimates of burden. And looking forward? We anticipate a stream of papers with reference to the new eating disorders, in particular ARFID. This is both from the child and adolescent and the adult fields as ARFID encompasses both. The area is wide open for research on ARFID assessment, epidemiology, treatment and outcome. …