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Biomedical subjects

D L Franko

Publications and source records attributed to D L Franko.

16 recordsLinked to original sources
PubMed2004

What predicts suicide attempts in women with eating disorders?

BACKGROUND: Suicide is a common cause of death in anorexia nervosa and suicide attempts occur often in both anorexia nervosa and bulimia nervosa. No studies have examined predictors of suicide attempts in a longitudinal study of eating disorders with frequent follow-up intervals. The objective of this study was to determine predictors of serious suicide attempts in women with eating disorders. METHOD: In a prospective longitudinal study, women diagnosed with either DSM-IV anorexia nervosa (n = 136) or bulimia nervosa (n = 110) were interviewed and assessed for suicide attempts and suicidal intent every 6-12 months over 8.6 years. RESULTS: Fifteen percent of subjects reported at least one prospective suicide attempt over the course of the study. Significantly more anorexic (22.1%) than bulimic subjects (10.9%) made a suicide attempt. Multivariate analyses indicated that the unique predictors of suicide attempts for anorexia nervosa included the severity of both depressive symptoms and drug use over the course of the study. For bulimia nervosa, a history of drug use disorder at intake and the use of laxatives during the study significantly predicted suicide attempts. CONCLUSIONS: Women with anorexia nervosa or bulimia nervosa are at considerable risk to attempt suicide. Clinicians should be aware of this risk, particularly in anorexic patients with substantial co-morbidity.

Adolescent↗
PubMed2001

Pregnancy complications and neonatal outcomes in women with eating disorders.

OBJECTIVE: This study reported pregnancy complications and neonatal outcomes for 49 live births in a group of women with eating disorders who were prospectively followed. METHOD: Subjects were recruited from 246 women participating in a longitudinal study of anorexia nervosa and bulimia nervosa, now in its 12th year. Subjects were interviewed by trained assistants and completed a brief self-report instrument that assessed both birth statistics and birth-related complications. Medical records and/or self-report data describing the neonates' birth status were obtained. RESULTS: The majority of the women with eating disorders had normal pregnancies, resulting in healthy babies. Across the group, the mean length of pregnancy was 38.7 weeks, the mean birth weight was 7.6 lb, and mean Apgar scores at 1 and 5 minutes after birth were 8.2 and 9.0, respectively. Most outcomes were positive; however, three babies (6.1%) had birth defects, and 17 (34.7%) of the women experienced postpartum depression. The mean number of obstetric complications in the group was 1.3, and 13 (26.5%) of the women delivered by cesarean section. Women who showed symptoms of either anorexia nervosa or bulimia nervosa during pregnancy had a higher frequency of birth by cesarean section and postpartum depression than did nonsymptomatic women. CONCLUSIONS: Pregnant women with active eating disorders appear to be at greater risk for delivery by cesarean section and for postpartum depression. Pregnant women with past or current eating disorders should be viewed as being at high risk and monitored closely both during and after pregnancy to optimize maternal and fetal outcomes.

Adult↗
PubMed2000

Detection and management of eating disorders during pregnancy.

Eating disorders such as anorexia nervosa and bulimia nervosa are associated with potential negative consequences during pregnancy, including higher rates of miscarriage, low birth weight, obstetric complications, and postpartum depression. Women with eating disorders are reluctant to disclose symptoms to health care providers, so it is important for obstetric clinicians to be aware of warning signs and assessment techniques to identify them. Signs suggestive of eating disorders include lack of weight gain, hyperemesis gravidarum, and a history of eating disorders. Recent studies showed that the Eating Disorder Examination, a newly developed assessment tool, can ascertain whether someone has an eating disorder. Questions from the Eating Disorder Examination about body image, food avoidance, food rules, and dieting behaviors have successfully differentiated women with eating disorders from healthy controls. We offer an approach to the clinical care of individuals identified or suspected of having eating disorders. We recommend a team approach that emphasizes ongoing communication and clear goal setting for the care of pregnant women with eating disorders.

Birth Weight↗
PubMed1999

Subclinical eating disorders in adolescent women: a test of the continuity hypothesis and its psychological correlates.

Subclinical eating disorders are common in adolescent women. In this study the severity of disturbed eating and its psychological correlates were examined in 207 college freshmen. The results indicated that 9% fell into the probable bulimic or dieter at-risk categories, 23% were classified as intensive dieters, 17% as casual dieters, and over half (51%) of the sample was classified as non-dieters. Depression, dysfunctional thinking, and disturbed eating attitudes were found to correlate with the severity of eating pathology. Support was found for the continuity hypothesis of eating disorders.

Adolescent↗
PubMed1997

Retrospective perceptions of parents' child-rearing conduct by same-sex sibling trios in African American and European American families.

Adult (M = 33 years) trios of 20 sisters and 6 brothers from 15 African American and 11 European American intact families retrospectively described their parents' child-rearing conduct on the Parent-Child Relations Questionnaire II (Siegelman & Roe, 1979). Respondents' mean education (15.1 years) and family size exceeded U.S. averages. Fitting cultural stereotypes, mothers were depicted as more loving, more attentive, and less rejecting than fathers. African American parents were described as more demanding and less lenient than European American parents, although this finding was confounded with the latter's greater education (M = 14.4 years vs. 10.9 years). Daughter trios tended to differ more than son trios on their ratings of each parent, suggesting that daughters may be more attentive to intrafamilial events. The uniqueness of the sample and the small number of brother trios limit the generalizability of these findings.

Adult↗
PubMed1997

Phagophobia: a form of psychogenic dysphagia. A new entity.

There is a group of patients presenting with either acute or chronic dysphagia secondary to fear of swallowing. We have termed this entity phagophobia. It is characterized by various significant swallowing complaints in the face of normal findings on head and neck examination, oropharyngeal swallowing videofluoroscopy, and standard barium swallow study. Ten patients who received diagnoses of phagophobia after a full evaluation at our swallowing disorders center are presented. Each patient was then evaluated by a psychologist, and an attempt at therapy was undertaken. We discuss the specific clinical features, assessment, and treatment of this frequently misdiagnosed disorder.

Adult↗
PubMed1996

Countertransference in the treatment of patients with eating disorders.

THE term countertransference has undergone considerable change in meaning in recent decades. Freud (1910/1957) defined countertransference as the emotional reaction of the analyst to a patient's transference. It was seen as the unresolved needs and conflicts of the therapist, often unconscious, which interfered with his/her understanding of the patient. Recently, Abend (1989) chronicled the shift in the definition of the term and noted Kernberg's (1965) more totalistic" description of countertransference. In Kernberg's view, the therapist's reactions have more to do with the patient's often intense transference and with the therapist's capacity to withstand the subsequent stress and anxiety, than with any particular problem from the patient's past. Abend (1989) concluded that most clinicians refer to countertransference in this revised way and used the term quite broadly to denote "all those reactions of the analyst to the patient that may help or hinder treatment" (Slakter 1987, p. 3).

Adolescent↗
PubMed1994

Elevated sweet taste pleasantness ratings in bulimia nervosa.

Recent studies suggest that some patients with bulimia nervosa may experience elevated pleasantness responses to sweet taste. This study explored possible associations between symptoms patterns and pleasantness ratings for sucrose solutions in bulimic patients. Subjects included 15 women meeting DSM III-R criteria for narrowly defined bulimia nervosa (no history of other eating disorder); five patients with current bulimia nervosa and a past history of anorexia nervosa; and 20 healthy age-matched female controls. Subjects ate a standardized breakfast prior to the morning study visit. Sucrose-water solutions (0% to 40% sucrose) were rated for sweetness intensity and pleasantness. Patients with narrowly defined bulimia nervosa showed significantly higher pleasantness ratings for 40% sucrose solutions than controls and patients with a history of anorexia nervosa. Pleasantness ratings were not significantly correlated with frequency of binge eating or purging behaviors. These results extend previous evidence for altered sweet taste pleasantness responses in bulimia nervosa, and for differences in eating-related behaviors between patients with narrowly defined bulimia nervosa vs. those with past anorexia nervosa.

Adult↗
PubMed1994

Hypnotizability, dissociation, and bulimia nervosa.

This study examined the levels of hypnotizability and dissociation in an outpatient sample of 17 normal-weight bulimic women and 20 healthy controls. Bulimic patients were significantly more hypnotizable than controls (p < .003) and scored higher on a self-report scale of dissociative experiences (p < .02). The results of measures of hypnotizability and dissociation showed a significant positive correlation in the combined subject group. These results are consistent with previous reports on hospitalized patients and college students and suggest that psychological factors associated with hypnotizability might play a role in the etiology and treatment of bulimia nervosa.

Adult↗
PubMed1993

Pregnancy and eating disorders: a review and clinical implications.

Pregnancy and eating disorders is a subject that has received relatively little attention in the literature. Yet, several serious complications have been found in both the mother and the fetus when a woman with an eating disorder becomes pregnant. In this paper the literature is reviewed for both anorexia nervosa and bulimia nervosa and suggestions for future research are offered. Clinical implications for the treatment of the pregnant eating disordered patient are discussed.

Anorexia Nervosa↗
PubMed1993

The use of a group meal in the brief group therapy of bulimia nervosa.

The group meal is a technique that can be easily incorporated into traditional forms of short-term group therapy for bulimia nervosa. It is a modification of the exposure and response-prevention model that has been used in the treatment of this population. Patients plan and eat a meal together with the group therapist during one of the group therapy sessions. Over the course of the meal, patients discuss thoughts and feelings as they experience them, allowing for greater depth of therapeutic work than when simply recalling events that occurred between sessions. A case example is described to illustrate several of the important themes that emerge, including reactions to feeling full, family meals, and the relationship between overeating and feelings about the self.

Behavior Therapy↗
PubMed1992

The Bulimic Automatic Thoughts Test: initial reliability and validity data.

The Bulimic Automatic Thoughts Test (BATT) was designed to address some of the limitations found in previous measures of the cognitions of bulimic patients. In this study, bulimic, depressed, obese, and normal subjects were differentiated on the BATT, which suggests that it is a useful measure for detecting cognitions specific to bulimic patients. Scores on the BATT improved after a trial of cognitive-behavioral therapy for the bulimic subjects. The BATT may be useful in predicting which bulimic women will continue to have distorted thinking after treatment and will require additional intervention.

Adult↗
PubMedDate not supplied

Alexithymia ratings in bulimia nervosa: clinical correlates.

Previous reports indicate that some patients with eating disorders have alexithymic characteristics, including affect deficit states and paucity of imagination. This study evaluated whether nonhospitalized patients with bulimia nervosa had elevated ratings of alexithymia in comparison to age-matched controls, and whether severity of bulimic symptoms was correlated with elevations in alexithymia ratings. Because alexithymia may be secondary to concurrent depression, this study was limited to patients with bulimia nervosa who were free of major depression. The authors compared alexithymia ratings for nonhospitalized normal weight women meeting DSM-III-R criteria for bulimia nervosa (N = 20) to healthy female volunteers (N = 20), utilizing the Toronto Alexithymia Scale (TAS) as the primary assessment instrument. Subjects also completed standardized rating scales for bulimic symptoms, depression, and anxiety. Alexithymia rating scale scores were significantly higher for patients with bulimia nervosa than for controls. In comparison to controls, patients had significant elevations on TAS factors reflecting affect deficit states, but normal scores for factors reflecting imagination and abstract thinking. Frequency of binge eating or purging behaviors was not correlated with alexithymia ratings. These data indicate that some patients with bulimia nervosa have alexithymic characteristics. Affect dysregulation was more prominent than limitation in fantasy or metaphorical thought. Additional studies are needed to assess whether presence of alexithymic characteristics may be predictive of response to treatment in patients with bulimia nervosa.

Adult↗