Biomedical subjects

J E Mitchell

Publications and source records attributed to J E Mitchell.

At least 37 records · Page 2Linked to original sources

PubMed2001

Sexual trauma and personality: developmental vulnerability and additive effects.

Two types of sexual trauma, sexual abuse in childhood and rape in adulthood, were investigated in terms of possible effects on personality. Four groups of participants were studied: women who had experienced sexual abuse in childhood, women who had experienced rape as adults, women who had experienced both of these sexual traumas, and a control group of women who had experienced no sexual trauma. Personality functioning was assessed using the Dimensional Assessment of Personality Pathology. Groups who had experienced childhood sexual abuse displayed the highest degree of personality disturbance; however, the additive effects of repeated sexual trauma were limited. These findings may reflect the outcome of specific adversity in childhood on the psychobiological constructs underlying personality.

Adult↗

PubMed2000

Social adjustment over 10 years following diagnosis with bulimia nervosa.

OBJECTIVE: The authors sought to describe social adjustment among women diagnosed with bulimia nervosa more than a decade earlier. METHOD: A cohort of women who were diagnosed with bulimia nervosa between 1981 and 1987 were located and invited to participate in follow-up assessments. RESULTS: Although the current sample demonstrated considerable improvement in disordered eating behaviors and social adjustment, measures of social adjustment suggested continued impairment in interpersonal relationships and only a modest association with eating disorder outcome. DISCUSSION: Continued difficulties in social adjustment may reflect an underlying vulnerability from which disordered eating developed. Treatments for bulimia nervosa may benefit from including interpersonal skills training.

Adult↗

PubMed2000

Utilization of empirically supported psychotherapy treatments for individuals with eating disorders: A survey of psychologists.

OBJECTIVE: The purpose of this study was to assess the primary methods used by psychotherapists in treating individuals with eating disorders and to determine the extent to which certain empirically supported psychotherapies (i.e., cognitive behavioral therapy [CBT] and interpersonal psychotherapy [IPT]) are used in clinical settings. METHOD: Surveys developed for this study were sent to 500 psychologists randomly selected from a list of all licensed doctoral-level psychologists in an upper midwestern state. RESULTS: Despite the findings that CBT techniques were reported to be frequently used, most respondents identified something other than CBT or IPT as their primary theoretical approach. In addition, the majority of respondents indicated not having received training in the use of manual-based, empirically supported treatment approaches for working with individuals with eating disorders, although most reported a desire to obtain such training. CONCLUSIONS: Although commonly referred to as the "treatments of choice" in research literature, manual-based, empirically supported approaches to working with individuals with eating disorders has not received adequate dissemination.

Adolescent↗

PubMed2000

Establishing guidelines for pharmacotherapy trials in bulimia nervosa and anorexia nervosa.

OBJECTIVE: This paper addresses the lack of a standard protocol for pharmacotherapy trials for patients with bulimia nervosa (BN) and anorexia nervosa (AN). METHOD: Twenty-two surveys were sent to established researchers in the field of eating disorders to elicit their opinions regarding medication trials, including baseline laboratory tests, the optimal length/frequency of medication management sessions, and the information that should or should not be included in these sessions. RESULTS: Sixteen of 22 researchers completed and returned the survey. Their answers are the basis of the data presented. DISCUSSION: We propose a battery of screening laboratory tests for both conditions. We suggest 30-45-min initial medication management sessions in both AN and BN trials with 15-min follow-ups to be held weekly for AN subjects, and weekly for 2 weeks, then biweekly for 2 weeks, then monthly, for BN subjects. We also recommend that published trials should include explicit details of medication management.

Anorexia Nervosa↗

PubMed2000

Predictors of treatment outcome for binge eating disorder.

OBJECTIVE: The purpose of this study was to identify predictors of short-term treatment outcome for individuals with binge eating disorder (BED). METHOD: Fifty women who met DSM-IV criteria for BED were enrolled in a manual-based group cognitive-behavioral therapy that consisted of fourteen 1-hr sessions over an 8-week period. Baseline measures included the frequency of self-reported binge eating from the Eating Behaviors-IV (EB-IV), severity of binge eating and dietary restraint using the Binge Eating Scale (BES) and Three-Factor Eating Questionnaire (TFEQ), depressive symptoms as assessed by the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS), and self-esteem as measured by the Rosenberg Self-Esteem Questionnaire (RSEQ). RESULTS: Logistic regression analyses indicated that the baseline frequency of self-reported episodes of binge eating that were objectively large predicted the likelihood of such episodes at the end of treatment. No variables predicted the likelihood of binge eating episodes that were objectively and subjectively large at the conclusion of treatment. DISCUSSION: This study indicates that the frequency of binge eating episodes at baseline is predictive of outcome status at the end of treatment, suggesting that meaningful prognostic factors in BED are identifiable.

Adolescent↗

PubMed2000

Impact of definitions on the description and prediction of bulimia nervosa outcome.

OBJECTIVE: The authors sought to compare definitions of eating disorder outcome found in the bulimia nervosa literature and to determine the impact of definitions on the description and prediction of outcome. METHOD: Definitions of outcome were identified from studies involving a follow-up duration of at least 5 years. Definitions were applied to a sample of women (N = 173) assessed more than 10 years following presentation with bulimia nervosa. RESULTS: Across definitions, the percentage of women considered fully recovered ranged from 38% to 47% in the follow-up sample. Associations between eating disorder outcome and other measures of outcome were relatively unaffected by differences in definitions. Conversely, the significance of various prognostic variables differed substantially among definitions. DISCUSSION: Our findings suggest that differences in definitions influence the description and prediction of eating disorder outcome significantly. Consistency in defining recovery is needed in order to explore other areas of outcome such as relapse.

Adult↗

PubMed2000

Eating disorders in patients with cystic fibrosis.

This study was designed to examine rates of eating disorders and psychopathology in patients with cystic fibrosis (CF). Fifty-eight CF patients and 43 healthy control participants were evaluated using structured psychiatric interviews and rating scales. Two control participants and no CF patients were diagnosed with an eating disorder. Additionally, 11 CF patients were diagnosed with one or more psychiatric disorders. Group means on the rating scales did not show clinically meaningful elevations in either group. These data indicate no evidence for elevated rates of eating disorders in CF patients. Similarly, rates of other psychiatric disorders in the CF group were not greater than the prevalence reported in the general population.

Adolescent↗

PubMed2000

Commitment to treatment goals in prediction of group cognitive-behavioral therapy treatment outcome for women with bulimia nervosa.

The purpose of this study was to investigate potential client variables that predict favorable response to group cognitive-behavioral therapy in a sample of women (N = 143) seeking treatment for bulimia nervosa. Similar to findings of previous studies, bulimic symptom remission at end of treatment was predicted by baseline degree of bulimic symptom severity but not by depressive symptomatology or perfectionism. After these variables were controlled for, both pretreatment ratings of desire to discontinue bulimic behaviors and expected success significantly added to prediction of treatment outcome. The primary variable found to predict longer term outcome was symptom remission at the end of treatment and at the 1-month follow-up.

Adult↗

PubMed2000

Relationship of childhood sexual abuse and eating disturbance in children.

OBJECTIVE: To test the hypothesis that childhood sexual abuse increases the risk of eating disturbance in children. METHOD: Data obtained from 20 sexually abused children were compared with data obtained from 20 nonabused control children. All subjects were female and between the ages of 10 and 15 years. Subjects completed a battery of tests assessing eating disorder behaviors, body image concern, and childhood trauma history. RESULTS: Comparison of the 2 groups revealed that the abused children had higher levels of weight dissatisfaction and purging and dieting behavior. Furthermore, abused children reported eating less than control children when they felt emotionally upset. Abused children were less likely than control children to exhibit perfectionistic tendencies, but more likely to desire thinner body types. CONCLUSIONS: This is the first controlled study to examine the relationship between childhood sexual abuse and eating disturbance which relied on children as subjects. The results support previous findings with adult subjects which indicate that a history of childhood sexual abuse is associated with weight and body dissatisfaction, along with purging and dietary restriction.

Adolescent↗

PubMed2000

Predictive validity of bulimia nervosa as a diagnostic category.

OBJECTIVE: The authors sought to investigate the predictive validity of bulimia nervosa as a diagnostic category. METHOD: More than 10 years after they appeared as patients with bulimia nervosa, 177 women (participation rate=79.7%) completed follow-up assessments. RESULTS: Among the women with a current eating pathology, most engaged in recurrent binge eating and purging. Anorexia nervosa and binge eating disorder were relatively uncommon. Eating disorder outcome was significantly related to the presence of mood, substance use, and impulse control disorders but not to the presence of anxiety disorders. CONCLUSIONS: These results support the validity of bulimia nervosa as a diagnostic category that is distinct from anorexia nervosa. Furthermore, these results suggest that bulimic symptoms are associated with disorders involving distress and disinhibition.

Anorexia Nervosa↗

PubMed2000

Outcome predictors for the cognitive behavior treatment of bulimia nervosa: data from a multisite study.

OBJECTIVE: The aim of this study was to discover clinically useful predictors of attrition and outcome in the treatment of bulimia nervosa with cognitive behavior therapy. METHOD: Pretreatment, course of treatment, and outcome data were gathered on 194 women meeting the DSM-III-R criteria for bulimia nervosa who were treated with 18 sessions of manual-based cognitive behavior therapy in a three-site study. Differences between dropouts and nondropouts and between recovered and nonrecovered participants were first examined descriptively, and signal detection analyses were then used to determine clinically significant cutoff points predicting attrition and abstinence. RESULTS: The dropouts were characterized by more severe bulimic cognitions and greater impulsivity, but it was not possible to identify clinically useful predictors. The participants with treatment failures were characterized by poor social adjustment and a lower body mass index, presumably indicating greater dietary restriction. However, early progress in therapy best predicted outcome. Signal detection analyses revealed that poor outcome was predicted by a reduction in purging of less than 70% by treatment session 6, allowing identification of a substantial proportion of prospective failures. CONCLUSIONS: A cutoff point based on reduction of purging by session 6 usefully differentiates patients who will and will not respond to cognitive behavior therapy for bulimia nervosa, potentially allowing early use of a second therapy.

Adult↗

PubMed2000

Do patients know which healthcare professionals are doctors?

Using an anonymous questionnaire survey this study aimed to determine patients' knowledge of professional qualifications and which healthcare professionals are required to have undergone medical school training. Four hundred patients were questioned equally distributed between four general practices in Roehampton, London. The mean age of the sample was 43 y. Gender ratio was skewed with 31% men and 63% women (6% missing data). Amongst the three professional groups, just over 50% scored correctly. Almost 25% of respondents failed to correctly identify the listed doctors and medical non-doctors. The mean score of incorrectly identified alternative practitioners was 13%. There were significant age-related differences for scores, identified by chi-square and trend analysis, with the younger groups scoring better. Patients were largely unsure in identifying professional qualifications. It is concluded that confusion exists amongst patients as to which health-workers are doctors. Listing of professional qualifications does not help in clarifying this. Health-workers whose work involves invasive procedures or drug therapy are more likely to be thought of as medically qualified doctors. This confusion appears not to exist with alternative practitioners. Given the growing regard to appropriate and useful skill mix of health professionals (patients are increasingly seen in the first instance by non-doctors, eg nurse practitioners), it would seem appropriate that patients are made fully aware of who they are consulting.

Adolescent↗

PubMed1999

Long-term outcome of bulimia nervosa.

BACKGROUND: Since bulimia nervosa's introduction to the psychiatric nomenclature in 1979, data concerning long-term outcome have been largely unavailable. METHODS: Women with the diagnosis of bulimia nervosa between 1981 and 1987 who participated in 1 of 2 studies were located and invited to participate in follow-up assessments. RESULTS: More than 80% of the women from these studies participated in follow-up assessments and the results represent findings for 173 women. More than 10 years following presentation (mean+/-SD length of follow-up, 11.5+/-1.9 years), 11% of this sample met full criteria for bulimia nervosa, and 0.6% met full criteria for anorexia nervosa. An additional 18.5% met criteria for eating disorder not otherwise specified, and 69.90% of this sample were either in full or in partial remission. For predictive factors, only the duration of the disorder at presentation and history of substance use problems demonstrated prognostic significance. Baseline treatment condition was not associated with remission of disordered eating symptoms by the follow-up assessment. CONCLUSIONS: The findings suggest that the number of women who continue to meet full criteria for bulimia nervosa declines as the duration of follow-up increases; approximately 30%, however, continued to engage in recurrent binge eating or purging behaviors (incidence rate, 0.026 cases per person-years). A history of substance use problems and a longer duration of the disorder at presentation predicted worse outcome.

Adult↗

PubMed1999

Psychosocial and pharmacological treatment of eating disorders: a review of research findings.

Research on the treatment of eating disorders has focused primarily on cognitive-behavioral therapy (CBT) and, more recently, interpersonal psychotherapy (IPT). Numerous studies have shown that CBT is helpful in reducing symptoms of bulimia nervosa and binge-eating disorder. In addition, CBT has been found to be superior or comparable to other psychotherapies in reducing bulimic symptoms. Preliminary findings indicate that CBT and IPT produce similar results at follow-up for bulimia nervosa and binge-eating disorder. Antidepressant medications are also useful in the treatment of bulimia nervosa and binge-eating disorder, but are less likely to result in remission of symptoms than CBT. The results from comparison studies are inconsistent, with modest evidence that combining antidepressant medication and psychotherapy produces greater improvement in bulimic symptoms. Limited research has been conducted on the treatment of anorexia nervosa, although preliminary studies suggest that psychotherapy and fluoxetine may be helpful in preventing relapse after weight restoration.

Anorexia Nervosa↗

PubMed1999

Hedonics of binge eating in women with bulimia nervosa and binge eating disorder.

OBJECTIVE: Potential differences in the hedonics of binge eating between female subjects with bulimia nervosa (BN) and female subjects with binge eating disorder (BED) were examined. METHOD: Women seeking treatment for BN (N = 29) and BED (N = 49) completed the Eating Hedonics Questionnaire. RESULTS: Subjects in both groups reported similar precipitants and levels of distress associated with binge eating. Of interest, BED subjects were more likely to report that they enjoyed the food, the taste of the food, the smell and the texture of the food while binge eating. In addition, the BED group reported more relaxation and less physical discomfort and anxiety as a consequence of binge eating compared to the BN group. DISCUSSION: There are interesting and potentially important differences between individuals with BN and BED in the cognitions and behaviors associated with binge eating.

Adult↗

PubMed1999

Eating disorders and psychiatric disorders in the first-degree relatives of obese probands with binge eating disorder and obese non-binge eating disorder controls.

OBJECTIVE: The purposes of the present study were to examine the possibility of a familial tendency for binge eating disorder (BED) among the obese, to clarify the relationship between BED and other eating disorders, and to test the relationship between BED and other psychiatric disorders. METHOD: We studied 32 female BED outpatients and 23 obese females without BED. A possible history of eating disorders was assessed using the Structured Clinical Interview for DSM-III-R-Eating Disorders section administered by telephone interview. Family history information for other psychiatric disorders was collected using the Family History Research Diagnostic Criteria RESULTS: The frequency of all eating disorders and the risk for other psychiatric disorders were not significantly different between the relatives of the two groups. These results were consistent across generation and gender. DISCUSSION: This study failed to show a familial tendency for BED, or any significant familial relationship between BED and other eating disorders, and did not support the hypothesis of coaggregation of other psychiatric disorders with BED.

Adult↗

PubMed1999

The neglected link between eating disturbances and aggressive behavior in girls.

OBJECTIVES: Research has linked eating disturbances with behavioral impulsivity. Little is known, however, about whether eating disturbances and aggressive behavior have a tendency to co-occur in the same girls. This article assesses the eating disturbance-aggressive behavior association and then examines the extent to which these factors confer a risk on drug use and attempted suicide. METHOD: Survey data were gathered from 3,630 girls in grades 6 through 12 in the upper Midwest. Girls responded anonymously to questions regarding binge eating and purging, dietary restriction, aggressive behavior, drug use, and attempted suicide. Logistic regression analysis was used to assess the unique contribution of demographic variables, eating disturbances, and aggression on drug use and attempted suicide. RESULTS: Eating disturbances were significantly associated with aggressive behavior. Girls who endorsed binge eating and purging or dietary restriction had odds of aggressive behavior 2 to 4 times higher than girls who did not endorse these items. Logistic regression revealed that eating disturbances and aggressive behavior were significantly associated with both drug use and attempted suicide. CONCLUSIONS: Eating disturbances are significantly associated with aggressive conduct in adolescent girls. The constellation of eating disturbances and aggressive behavior is associated with a greater risk of drug use and attempted suicide.

Adolescent↗

PubMed1998

Agreement between survey and interview measures of weight control practices in adolescents.

OBJECTIVE: The present study examined agreement between survey and interview measures of weight control practices in a nonclinical sample of adolescents. METHOD: Surveys were administered in three school health classes. Clinical interviews were conducted in a student subsample (N = 43). RESULTS: Survey-based prevalences for eating behaviors in the past month were: trying to lose weight, 44%; binge eating, 41%; vomiting, 4.7%; laxative use, 0%; and fasting, 14%. Interview-based prevalences were 30%, 11.6%, 0%, 0% and 0%, respectively. Sensitivity was high for all behaviors assessed. However, positive predictive values were low. DISCUSSION: Surveys may be useful as preliminary screening tools for prevention programs, but may yield inflated estimates of unhealthy weight control practices in nonclinical adolescent populations. Research is needed to examine whether adolescents overreport weight control practices on surveys or whether they are less willing to disclose such practices in a private interview.

Adolescent↗