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Using Multivariate Statistics

The reference human genome sequence set the stage for studies of genetic variation and its association with human disease, but epigenomic studies lack a similar reference. To address this need, the NIH Roadmap Epigenomics Consortium generated the largest collection so far of human epigenomes for primary cells and tissues. Here we describe the integrative analysis of 111 reference human epigenomes generated as part of the programme, profiled for histone modification patterns, DNA accessibility, DNA methylation and RNA expression. We establish global maps of regulatory elements, define regulatory modules of coordinated activity, and their likely activators and repressors. We show that disease- and trait-associated genetic variants are enriched in tissue-specific epigenomic marks, revealing biologically relevant cell types for diverse human traits, and providing a resource for interpreting the molecular basis of human disease. Our results demonstrate the central role of epigenomic information for understanding gene regulation, cellular differentiation and human disease.

Integrative analysis of 111 reference human epigenomes

The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication

Self-esteem has become a household word. Teachers, parents, therapists, and others have focused efforts on boosting self-esteem, on the assumption that high self-esteem will cause many positive outcomes and benefits-an assumption that is critically evaluated in this review. Appraisal of the effects of self-esteem is complicated by several factors. Because many people with high self-esteem exaggerate their successes and good traits, we emphasize objective measures of outcomes. High self-esteem is also a heterogeneous category, encompassing people who frankly accept their good qualities along with narcissistic, defensive, and conceited individuals. The modest correlations between self-esteem and school performance do not indicate that high self-esteem leads to good performance. Instead, high self-esteem is partly the result of good school performance. Efforts to boost the self-esteem of pupils have not been shown to improve academic performance and may sometimes be counterproductive. Job performance in adults is sometimes related to self-esteem, although the correlations vary widely, and the direction of causality has not been established. Occupational success may boost self-esteem rather than the reverse. Alternatively, self-esteem may be helpful only in some job contexts. Laboratory studies have generally failed to find that self-esteem causes good task performance, with the important exception that high self-esteem facilitates persistence after failure. People high in self-esteem claim to be more likable and attractive, to have better relationships, and to make better impressions on others than people with low self-esteem, but objective measures disconfirm most of these beliefs. Narcissists are charming at first but tend to alienate others eventually. Self-esteem has not been shown to predict the quality or duration of relationships. High self-esteem makes people more willing to speak up in groups and to criticize the group's approach. Leadership does not stem directly from self-esteem, but self-esteem may have indirect effects. Relative to people with low self-esteem, those with high self-esteem show stronger in-group favoritism, which may increase prejudice and discrimination. Neither high nor low self-esteem is a direct cause of violence. Narcissism leads to increased aggression in retaliation for wounded pride. Low self-esteem may contribute to externalizing behavior and delinquency, although some studies have found that there are no effects or that the effect of self-esteem vanishes when other variables are controlled. The highest and lowest rates of cheating and bullying are found in different subcategories of high self-esteem. Self-esteem has a strong relation to happiness. Although the research has not clearly established causation, we are persuaded that high self-esteem does lead to greater happiness. Low self-esteem is more likely than high to lead to depression under some circumstances. Some studies support the buffer hypothesis, which is that high self-esteem mitigates the effects of stress, but other studies come to the opposite conclusion, indicating that the negative effects of low self-esteem are mainly felt in good times. Still others find that high self-esteem leads to happier outcomes regardless of stress or other circumstances. High self-esteem does not prevent children from smoking, drinking, taking drugs, or engaging in early sex. If anything, high self-esteem fosters experimentation, which may increase early sexual activity or drinking, but in general effects of self-esteem are negligible. One important exception is that high self-esteem reduces the chances of bulimia in females. Overall, the benefits of high self-esteem fall into two categories: enhanced initiative and pleasant feelings. We have not found evidence that boosting self-esteem (by therapeutic interventions or school programs) causes benefits. Our findings do not support continued widespread efforts to boost self-esteem in the hope that it will by itself foster improved outcomes. In view of the heterogeneity of high self-esteem, indiscriminate praise might just as easily promote narcissism, with its less desirable consequences. Instead, we recommend using praise to boost self-esteem as a reward for socially desirable behavior and self-improvement.

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Does High Self-Esteem Cause Better Performance, Interpersonal Success, Happiness, or Healthier Lifestyles?

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

Objective This pilot study evaluated group skills training for parents of adolescents with anorexia nervosa, an adjunct to family-based treatment (FBT).Method Training was provided in two formats (six weekly sessions or a two-day intensive) to 22 parents who were in any way engaged with FBT with their child and had been referred from public and private services providing eating disorder treatment to young people. Program feedback, perceived outcomes of the group, and parental wellbeing were assessed using self-report. Child height and weight were also collected. Data were collected at pre- and post-intervention and 3-month follow-up.Results The training was rated as being very helpful and relevant. It resulted in significant perceived improvements in understanding, knowledge, skills, and confidence in managing eating/the eating disorder. No changes in parent wellbeing or child body mass index were found.Conclusion Parent group skills training improves understanding, knowledge, skills, and confidence in managing eating/the eating disorder. An intensive format of delivery seems as feasible as the per protocol weekly sessions. 

Group skills training for parents of adolescents with anorexia nervosa: a pilot evaluation

People with anorexia nervosa often exhibit inefficiencies in executive functioning (central coherence and set shifting) that may negatively impact on treatment outcomes. It is unclear from previous research whether these inefficiencies can change over treatment. We aimed to (1) investigate whether executive functioning can improve over treatment, (2) determine whether baseline executive functioning moderates treatment outcome, and (3) examine whether baseline executive functioning predicts early change (i.e., increase in body mass index over the first 13 weeks of treatment) or remission.We conducted linear mixed model and logistic regression analyses on data from the Strong Without Anorexia Nervosa trial (Byrne et al. in Psychol Med 47:2823-2833, 2017). This study was a randomised controlled trial of three outpatient treatments for people with anorexia nervosa: Enhanced Cognitive Behavioural Therapy, Maudsley Model Anorexia Nervosa Treatment for Adults, and Specialist Supportive Clinical Management.While set shifting clearly improved from baseline to end of treatment, the results for central coherence were less clear cut. People with low baseline central coherence had more rapid reductions in eating disorder psychopathology and clinical impairment than those with high baseline central coherence. Baseline executive functioning did not predict early change or remission.The detail-focused thinking style commonly observed among people with anorexia nervosa may aid treatment outcomes. Future research that is more adequately powered should replicate this study and examine whether the same pattern of results is observed among people with non-underweight eating disorders.People with anorexia nervosa often have difficulty thinking flexibly and in terms of the big picture. We investigated whether these thinking styles (1) change over treatment, (2) influence response to treatment, or (3) predict whether people gain weight or overcome the eating disorder. We found that people were able to think more flexibly after treatment. We also found that people who had more difficulty seeing the big picture prior to treatment had a more rapid decrease in eating disorder symptoms and clinical impairment in treatment. Thinking styles did not predict whether people gained weight early in treatment or overcame the eating disorder. Our findings suggest that the detail-focused thinking style commonly observed among people with anorexia nervosa can be both a vulnerability and a strength. 

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An exploratory examination of executive functioning as an outcome, moderator, and predictor in outpatient treatment for adults with anorexia nervosa

Targeting perfectionism in psychological treatment has shown to be effective in improving negative affect, one of the two most potent risk factors for eating disorders (Fittig & Jacobi, 2010), and decreasing symptomology of disordered eating.

The study aimed to evaluate the efficacy of a guided self-help intervention focussed on perfectionism to improve negative affect and the symptoms of disordered eating, anxiety and depression. Participants were assessed at five time points, creating a four-week control and a four-week information-only condition prior to the commencement of eight treatment sessions, and three-month follow-up. All were above the community mean for perfectionism. Of the 33 participants that completed the first three waves (baseline period), 21 participants (64%) reported symptoms of disordered eating on at least one assessment. The presentation will focus on this clinical subsample. Nineteen participants reported disordered eating symptomology over the baseline period. Of the 14 that completed treatment, eight no longer met criteria for an eating disorder at post-treatment, however two failed to maintain this improvement to follow-up. Changes in severity and comorbidities will be discussed along with investigations of the outcome variables, negative affect and weight and shape concern. The presentation will provide results comparing pre-and post-intervention and follow-up assessments.

This abstract was presented in the Disordered Eating – Characteristics & Treatment stream of the 2013 ANZAED Conference.

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Can guided self-help for perfectionism improve disordered eating?

Genetic influences on eating and the eating disorders

Methods Approximately N = 2,000 Grade 7 and Grade 8 girls and boys from schools in Victoria, South Australia and Western Australia participated. Classes in each school were randomly allocated to one of three 8-lesson programs: Media Smart; Life Smart; the HELPP Initiative (Helping, Encouraging, Listening and Protecting Peers) or to a control condition (usual school classes) with risk factor and weight status assessments at baseline; postprogram; 6-month follow-up and 12-month follow-up. Media Smart and HELPP have both shown promise in previous eating disorder prevention trials while Life Smart was piloted and developed for this RCT. All three programs target one or more risk factors relevant to both eating disorders and obesity.

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Tracey D. Wade

Papers

Group skills training for parents of adolescents with anorexia nervosa: a pilot evaluation

An exploratory examination of executive functioning as an outcome, moderator, and predictor in outpatient treatment for adults with anorexia nervosa

Can guided self-help for perfectionism improve disordered eating?

Genetic influences on eating and the eating disorders

Prevention across the spectrum: findings from an RCT of three programs aimed at reducing risk factors for both eating disorders and obesity