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Using Multivariate Statistics

The detection of psychiatric illness by questionnaire

Principles and Practice of Structural Equation Modeling (2nd ed.)

Recording of presentation introducing narrative analysis, outlining what it is, why it can be a useful approach, how to do it and where to find out more. Presentation given at methods@manchester seminar at University of Manchester on 4 March 2010.

What is Narrative Analysis

The Scope of Body Image Disturbance - the Big Picture An Overview of Assessment and Treatment Strategies Sociocultural Theory - the Media and Society Social Comparison Processes Appearance-Related Feedback Interpersonal Factors Peers, Parents and Perfect Strangers Feminist Perspectives Sexual Abuse and Sexual Harassment Behavioural Aspects of Disturbance - Conditioning, Context and Avoidance Cognitive Processing Models Future Directions - Integrative Theories, Multidimensional Assessment and Multicomponent Interventions

Exacting Beauty: Theory, Assessment, and Treatment of Body Image Disturbance

Delayed diagnosis, gaps in services and subsequent delays in specialist care and treatment lead to poorer health outcomes for individuals with eating disorders (EDs) and drive significant government healthcare expenditure. Given the significant disease burden associated with EDs, it is imperative that current implementation research is summarised to identify gaps in care and enable refinement for optimal patient outcomes. This review aimed to provide an updated synthesis on models of care for EDs in developed healthcare systems.This paper was conducted as part of a series of Rapid Reviews (RRs) to be published in a special series in the Journal of Eating Disorders. To provide a current and rigorous review, peer-reviewed articles published in the English language between 2009 and 2021 across three databases (ScienceDirect, PubMed and Ovid/Medline) were searched, with priority given to higher level evidence (e.g., meta-analyses, large population studies, Randomised Control Trials (RCTs)). The current review synthesises data from included studies investigating models of care for people with EDs.Sixty-three studies (4.5% of the original RR) were identified, which included several diagnostic populations, the most common being Anorexia Nervosa (AN) (30.51%). Across EDs, specialist care was found to improve patient outcomes, with many patients effectively being treated in outpatient or day programs with multi-disciplinary teams, without the need for lengthy inpatient hospitalisation. Few studies investigated the interaction of different ED services (e.g., inpatient, community services, primary care), however stepped care models emerged as a promising approach to integrate ED services in a targeted and cost-effective way. Issues surrounding low treatment uptake, underdiagnosis, long waiting lists and limited hospital beds were also evident across services.Findings suggested further research into alternatives to traditional inpatient care is needed, with partial and shorter 'hospitalisations' emerging as promising avenues. Additionally, to tackle ongoing resource issues and ensure timely detection and treatment of EDs, further research into novel alternatives, such as active waiting lists or a greater role for primary care clinicians is needed. This paper is part of a larger Rapid Review series carried out to guide Australia's National Eating Disorders Research and Translation Strategy 2021-2031. Rapid reviews aim to thoroughly summarise an area of research over a short time period, typically to help with policymaking in this area. This Rapid Review summarises the evidence relating to how we care for people with eating disorders in Western healthcare systems. Topics covered include inpatient/hospital care, residential care, day programs, outpatient/community care, and referral pathways. Findings suggested specialist eating disorder services may enhance detection, referral, and patient care. Stepped care models presented as a cost-effective approach which may help with linkage between different eating disorder services. There was a trend towards shorter hospital stays and approaches which allow for greater connection with the community, such as day programs. Evidence was also found of treatment delays, due to system issues (long waiting lists, lack of accurate assessment and diagnosis) and patient-related barriers (stigma, recognition). Upskilling and involving primary care clinicians in diagnosis and referral as part of a stepped care model may help to address some of these concerns. Further efforts to improve mental health literacy and de-stigmatise help-seeking for eating disorders are needed. 

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Models of care for eating disorders: findings from a rapid review

Very belatedly, given the potential for clinical psychology to play a major role in the delivery of mental health services in Australia, clinical psychologists are now finally grappling with the vexed issue of what constitutes optimum training for its profession. The scientist-practitioner model of training, which has survived for decades, Is now being re-examined with an eye on our role in mental health in the twenty-first century. The resolution of this important exercise will inevitably seal the fate of our profession. This paper provides a selective review of the evolution of clinical psychology with a particular emphasis on the preservation of the scientist-practitioner model. It argues for the introduction of a clinical doctoral degree with a postdoctoral internship In schools of clinical psychology established in general teaching hospitals throughout Australia.

Clinical Psychology in Dissent: The Challenge Ahead

/pdf/editorial-toward-an-improved-understanding-of-severe-and-ejjvtez850.pdf

Editorial: Toward an Improved Understanding of Severe and Enduring Anorexia Nervosa

It is not widely appreciated in the English-speaking world that a number of articles written in French and German do address the role played by death preoccupations and concerns in the development and maintenance of eating disorders, particularly anorexia nervosa. In previous published articles these important “hidden” threads have been highlighted in examining in some detail, the writings of the German authors Binswanger, Von Weizsacker, and Thoma. In this article, the writings of other German authors are also briefly reviewed as well as the French authors Bensoussan, Fouraste, Raimbault, and Thouzery-Loras. Implications and issues are posed for both the researchers and clinicians alike contributing to the literature in English on eating disorders, who do not necessarily embrace these themes in therapy and who may not reflect their significance to theory in the literature itself. © 1995 by John Wiley & Sons, Inc.

The theme of death in the French and German literature on eating disorders.

Characteristics of Severe and Enduring Anorexia Nervosa (SE-AN) are being investigated to differentiate the patients experiencing SE-AN from those at earlier stages of the AN disease. The current systematic review was the first step in exploring neuropsychological functioning as a potentially identifying characteristic for long-term presentations. With a subgroup of AN patients reflecting a unique neuropsychological profile that is proportionate to the quantity of patients that go on to develop SE-AN, it was the aim of this review to assess neuropsychological functioning in the later stage of the disease. In accordance with PRISMA guidelines, a literature search was conducted using four electronic databases (PsycINFO, MEDLINE, Web of Science, and Scopus) for neuropsychological research on AN participants with a seven or more year illness duration. Datasets that met inclusion criteria were screened for SE-AN participants (N = 166) and neuropsychological data extracted together with potentially confounding variables and information required to conduct a quality assessment. In research investigating decision-making, participants with a SE-AN presentation demonstrated significantly lower functioning compared to healthy controls. There was conflicting evidence for differences in intellectual functioning and set-shifting abilities with no variability indicated in central coherence, memory, attention, reasoning, or processing speed. If findings from this preliminary analysis are confirmed through empirical research, implications include earlier identification of SE-AN patients and more effective treatment development.

/pdf/the-neuropsychological-profile-of-severe-and-enduring-hkno146zuy.pdf

Stephen Touyz

Papers

Models of care for eating disorders: findings from a rapid review

Clinical Psychology in Dissent: The Challenge Ahead

Editorial: Toward an Improved Understanding of Severe and Enduring Anorexia Nervosa

The theme of death in the French and German literature on eating disorders.

The Neuropsychological Profile of Severe and Enduring Anorexia Nervosa: A Systematic Review.