Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity

Department of Psychology, University of North Carolina at Chapel Hill, 27599, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 11/2009; 48(3):194-202. DOI: 10.1016/j.brat.2009.11.001
Source: PubMed

ABSTRACT Conceptually, eating disorder recovery should include physical, behavioral, and psychological components, but such a comprehensive approach has not been consistently employed. Guided by theory and recent recovery research, we identified a "fully recovered" group (n = 20) based on physical (body mass index), behavioral (absence of eating disorder behaviors), and psychological (Eating Disorder Examination-Questionnaire) indices, and compared them with groups of partially recovered (n = 15), active eating disorder (n = 53), and healthy controls (n = 67). The fully recovered group was indistinguishable from controls on all eating disorder-related measures used, while the partially recovered group was less disordered than the active eating disorder group on some measures, but not on body image. Regarding psychosocial functioning, both the fully and partially recovered groups had psychosocial functioning similar to the controls, but there was a pattern of more of the partially recovered group reporting eating disorder aspects interfering with functioning. Regarding other psychopathology, the fully recovered group was no more likely than the controls to experience current Axis I pathology, but they did have elevated rates of current anxiety disorder. Results suggest that a stringent definition of recovery from an eating disorder is meaningful. Clinical implications and future directions regarding defining eating disorder recovery are discussed.

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    • "In addition, the outcome measures used in the study demonstrate good psychometric properties, and this allows for generalizability to other samples. Finally, the current study closely replicates findings from the diverse-diagnosis primary care sample utilized by Bardone-Cone et al. [21] in a diverse-diagnosis sample of adult females seeking specialized treatment at a higher level of intensity (89.7% received inpatient programming in the current study). However, several limitations should be considered. "
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    ABSTRACT: To compare remission rates, determine level of agreement and identify quality of life (QoL) distinctions across a broad spectrum of remission definitions among patients with eating disorders (ED). Women (N=195; 94 AN, 24 BN, and 77 EDNOS) from inpatient and partial hospital ED programs participated in a study of treatment outcomes. Remission rates were evaluated with percentages, kappa coefficients identified level of agreement and Mann-Whitney-Wilcoxon tests with Bonferroni corrections determined differences in quality of life between remitted and not remitted patients by remission definition. Depending on remission definition used, the percent of remitted patients varied from 13.2% to 40.5% for AN, 15.0% to 47.6% for BN and 24.2% to 53.1% for EDNOS. Several definitions demonstrated "very good" agreement across diagnoses. Remission was associated with higher quality of life in psychological, physical/cognitive, financial and work/school domains on a disease-specific measure, and in mental but not physical functioning on a generic measure. Remission rates vary widely depending on the definition used; several definitions show strong agreement. Remission is associated with quality of life, and often approximates scores for women who do not have an eating disorder. The ED field would benefit from adopting uniform criteria, which would allow for more accurate comparison of remission rates across therapeutic interventions, treatment modalities and facilities. We recommend using the Bardone-Cone criteria because it includes assessment of psychological functioning, was found to be applicable across diagnoses, demonstrated good agreement, and was able to distinguish quality of life differences between remitted and not remitted patients.
    Journal of psychosomatic research 01/2014; 76(1):12-8. DOI:10.1016/j.jpsychores.2013.10.002 · 2.84 Impact Factor
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    • "All RAN participants had maintained a minimum body mass index (BMI) >17.5 and had menstrual cycles for at least 2 months, with no reported binging or purging behaviors during the previous month. All RAN subjects had met full criteria for AN within the previous 2 years; this time period was chosen because several studies have shown that psychological recovery from anorexia lags the physical or physiological weight gain by at least 2 years (Strober et al., 1997; Bachner-Melman et al., 2006; Bardone-Cone et al., 2010). Ten of the RAN subjects had maintained a stable weight with menses and BMI > 19 for over 6 months. "
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    ABSTRACT: Anorexia nervosa (AN) patients exhibit a disparity in their actual physical identity and their cognitive understanding of their physical identity. Functional magnetic resonance imaging (fMRI) tasks have contributed to understanding the neural circuitry involved in processing identity in healthy individuals. We hypothesized that women recovering from AN would show altered neural responses while thinking about their identity compared with healthy control women. We compared brain activation using fMRI in 18 women recovering from anorexia (RAN) and 18 healthy control women (CON) using two identity-appraisal tasks. These neuroimaging tasks were focused on separable components of identity: one consisted of adjectives related to social activities and the other consisted of physical descriptive phrases about one's appearance. Both tasks consisted of reading and responding to statements with three different perspectives: Self, Friend and Reflected. In the comparisons of the RAN and CON subjects, we observed differences in fMRI activation relating to self-knowledge ('I am', 'I look') and perspective-taking ('I believe', 'Friend believes') in the precuneus, two areas of the dorsal anterior cingulate, and the left middle frontal gyrus. These data suggest that further exploration of neural components related to identity may improve our understanding of the pathology of AN.
    Social Cognitive and Affective Neuroscience 09/2012; DOI:10.1093/scan/nss093 · 5.88 Impact Factor
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    • "The former have an established role in recovery (Bachner-Melman, Zohar, & Ebstein, 2006; Hilde Bruch, 1962; H Bruch, 1974; Cogley & Keel, 2003), similarly to the cognitive aspects of the latter (American Psychiatric Association – APA, 1994; Cogley & Keel, 2003). However, the emotional and social aspects of the latter are harder to measure and are often omitted from recovery definitions (Bardone-Conea et al., 2010; Deter & Herzog, 1994; Kordy et al., 2002; Manz, Deter, & Herzog, 1992; Hsu, 1980), despite evidence that a failure to address the psychosocial elements of eating difficulties leaves individuals with significant Hardin, 2003; Root, 1990), and it has been argued that it may be less important whether the sufferer fulfils a number of predefined recovery criteria but rather what might be more important is a self-defined recovery status (Bjork & Ahlstrom, 2008). However , when experts and sufferers are compared in terms of their recovery judgements, experts tend to be more stringent and are less likely to declare someone as recovered than sufferers would judge themselves (Björk et al., 2011). "
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    ABSTRACT: Disagreement exists on how to define recovery from eating disorders. Definitions typically include a combination of physical, cognitive, emotional, psychological and social factors. However, none provides multidimensional recovery models, addressing and comparing sufferers' and clinicians' viewpoints. This study investigates those recovery perspectives. Two-hundred and thirty-eight participants (individuals with eating difficulties and clinicians working in the field) completed a checklist, rating the importance of somatic, psychological, emotional, social, eating-related and body experience-related recovery criteria. Recovery criteria fell into meaningful factors (psychological-emotional-social, weight-controlling behaviours, non-life-threatening and life-threatening features and evaluation of one's own appearance). Sufferers and clinicians agreed on the ranking of importance of these factors. However, sufferers considered 'psychological-emotional-social' and 'evaluation of one's own appearance' criteria as more important to recovery than clinicians. Findings are discussed in relation to existing research, together with study limitations and future research. Clinical implications are outlined, focusing on the facilitation of recovery.
    European Eating Disorders Review 09/2012; 20(5):363-72. DOI:10.1002/erv.2159 · 1.38 Impact Factor
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