30
EDRS 2013
T29
Assessment of quality of life in people with severe and enduring
anorexia nervosa: A comparison of generic and specific instruments
Phillipa Hay
1,2
,
Deborah Mitchison
3
,
Scott Engel
4,5
,
Ross Crosby
4,5
,
Daniel
Le Grange
6
,
Hubert Lacey
7
,
Jonathan Mond
8,9
,
Shameran Slewa-Younan
3
,
Stephen Touyz
10
1
Centre for Health Research, School of Medicine, University of Western
Sydney, Sydney, Australia,
2
School of Medicine, James Cook University,
Townsville, Australia,
3
School of Medicine, University of Western Sydney,
Sydney, Australia,
4
Neuropsychiatric Research Institute, Fargo, ND, USA,
5
School of Medicine and Health Sciences, University of North Dakota,
Grand Forks, ND, USA,
6
Department of Psychiatry and Behavioral
Neuroscience, University of Chicago, Chicago, IL, USA,
7
Eating Disorders
Research Team, Division of Population Health Sciences and Education,
St George’s, University of London, London, United Kingdom,
8
School of
Medicine and Public Health, University of Newcastle, Orange, Australia,
9
School of Sociology, Australian National University, Canberra, Australia,
10
School of Psychology, University of Sydney, Sydney, Australia
Criticism of generic measures of health-related quality of life (HRQoL)
has spurred the development of disease-specific measures. This study
compared the psychometric properties of the SF-12 (generic) to the Eating
Disorder Quality of Life scale (EDQOL; disease-specific).
Methods
: 63
participants with AN completed the SF-12, EDQOL, eating
disorder examination (EDE), Work and Social Adjustment Scale (WSAS),
and days out of role (DOR) question pre and post treatment. Cronbach’s
α was computed for the SF-12 and EDQOL (internal consistency).
Correlations were computed between the SF-12/EDQOL and EDE/WSAS/
DOR (convergence validity). Multiple linear regressions were conducted
with the SF-12/EDQOL as predictors, and change in EDE/WSAS/DOR
from baseline to post-treatment and 6 to 12 month follow-up as dependent
variables (predictive validity).
Results
:
The EDQOL had stronger internal
consistency (α = 0.92 vs. 0.80) and convergence with the EDE (
r
p
= -0.01
to 0.48 vs. -0.01 to -0.37). The SF-12 had stronger convergence with DOR
and WSAS (
r
p
= -0.31 to -0.63 vs. 0.06 to 0.70), and stronger predictive
validity (β = -0.55 to 0.29) and sensitivity to change in ED severity (β =
-0.47
to 0.32).
Conclusions
:
The SF-12 may be preferred in research
comparing EDs to other populations and as an indicator of functional
impairment. The EDQOL may be preferred by clinicians and researchers
interested in impairment specifically associated with an ED and as an
additional indicator of ED severity.
T30
EDNOS and Binge Eating is Associated with Grieving the Loss of
Food After Roux-en-Y Gastric Bypass (RYGB)
Leslie J Heinberg, Megan Lavery, Julie Merrell, Kathleen Ashton
Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
Bariatric surgery is the most effective treatment for severe obesity but
maladaptive eating behaviors have been associated with poorer weight
loss and quality of life outcomes. Unlike loss of control and binge eating,
post-operative grieving the loss of food has not been empirically examined
although frequently noted by patients. Patients (N=343) who received a
RYGB (72.2% Female; 73.4% Caucasian; M age=46.5; M BMI= 49.17
kg/m
2
)
were assessed pre-operatively and at 1 and 3 months post-
operatively. Participants endorsing grieving the loss of food at 1 and 3
months post-RYGB (GLF+; n=23) were compared to those denying this
experience (GLF-; n=320) on pre-operative subjective binge frequency,
the Binge Eating Scale (BES) total score, the Cleveland Clinic Behavioral
Rating Scale (CCBRS), pre-surgical diagnosis of EDNOS, and %
excess BMI lost (%EBMIL) at 1, 3, 6, and 12-months. GLF+ patients had
significantly higher pre-operative BES scores (19.68 vs 12.30;
t
=4.30;
p
<.001) and disordered eating (2.67 vs 3.01;
t
=2.37;
p
<.02) on the CCBRS
than GLF- patients. GLF+ patients were more likely to have received a
diagnosis of EDNOS at their initial evaluation (40.9% vs 20.3%;
X
2
=7.89;
p
=.01). Subjective binge frequency and %EBMIL at each time-point were
not statistically different. Pre-operative disordered eating may be linked to
greater difficulty in the early adjustment to RYGB. However, experiencing
grief over the loss of food was not associated with early weight loss.
T31
Multicenter Randomized Comparison of Internet-Based Self-Help
and Cognitive-Behavioral Therapy in the Treatment of Binge Eating
Disorder (Interbed): Baseline Characteristics
Anja Hilbert
1
,
Brunna Tuschen-Caffier
2
,
Stephan Herpertz
3
,
Wolfgang
Herzog
4
,
Stephan Zipfel
5
,
Martina de Zwaan
6
1
University of Leipzig Medical Center, Leipzig, Germany,
2
University
of Freiburg, Freiburg, Germany,
3
Ruhr-University Bochum, Bochum,
Germany,
4
Medical University Hospital Heidelberg, Heidelberg, Germany,
5
Medical University Hospital Tübingen, Tübingen, Germany,
6
Hannover
Medical School, Hannover, Germany
Internet-based guided self-help based on cognitive-behavioral principles
(
GSH-I) appears to be efficacious in the treatment of binge eating disorder
(
BED), but efficacy in comparison to cognitive-behavioral therapy (CBT)
awaits clarification. This report of baseline characteristics and adherence
is based on a multicenter randomized non-inferiority trial of GSH-I versus
CBT. A total of 178 individuals with BED (DSM-IV-TR or subsyndromal)
and body mass index between 27-40 kg/m
2
were randomized to 4-month
GSH-I or individual CBT. Primary outcome (days with objective binge
eating over the past 28 days) and secondary outcomes were assessed
at baseline, mid and end of treatment, and 6- and 18-month follow-up.
Patients were mostly middle-aged obese women suffering from full-
syndrome BED (88.8%) at long duration. Compared to norms, patients
had increased rates of affective and anxiety disorders, increased eating
disorder and general psychopathology, and lowered self-esteem and
quality of life. Patient treatment expectations were positive, and attrition by
the end of treatment (4.5%) was low. Therapist adherence to GSH-I and
CBT was documented. These results show that patients with longstanding
and severe psychopathology sought treatment through either GSH-I
or CBT. Both treatments were acceptable and could be conducted in a
manual-conform way. Future analyses will compare the efficacy of GSH-I
versus CBT in the long-term, and address the identification of moderators
and mediators.
T32
Pathological Exercise as an Independent Dimension of Eating
Pathology
Lauren A. Holland, Pamela K. Keel
Florida State University, Tallahassee, FL, USA
Purpose:
Pathological exercise represents a nonpurging compensatory
behavior that has been hypothesized to be a core feature of specific
EDNEC, distinct from AN or BN. The present study sought to examine if
pathological exercise represents a separate dimension of eating pathology
in addition to restrictive and bulimic factors.
Methods:
Confirmatory
factor analysis assessed goodness-of-fit for a proposed model of eating
pathology in a sample of college women (n=991). The proposed model
included four latent factors: pathological exercise, restrictive, bulimic, and
cognitive factors, and was compared to three alternate models consisting
of a one-factor and two three-factor solutions, which loaded pathological
exercise on either the restrictive or bulimic factor.
Results:
Results
indicated that conceptualizing pathological exercise as a dimension of
eating pathology that is independent from bulimic or restrictive dimensions
provided the best fit to the data (RMSEA<.04, CFI=.98, TLI=.98,
WRMR=.75). Difference testing confirmed the four-factor solution fit
the data significantly better than the one-factor (X
2
d
(6)
=134.7,
p
<.001)
or three-factor solutions (X
2
d
(3)
=70.4,
p
<.001; X
2
d
(3)
=83.7,
p
<.001).
Conclusions
:
Results demonstrate that pathological exercise cannot be
adequately described by restrictive or bulimic symptomatology alone and
highlights the importance of conceptualizing pathological exercise as a
significant, and possibly independent, component of eating pathology.
T33
Momentary Correlates of “Feeling Fat” in a Binge-Eating and Non-
Binge-Eating Obese Sample
Leah M Jappe
1
,
Carol B Peterson
1
,
Kelly C Berg
1
,
Ross D Crosby
2
,
Scott
G Engel
2
1
University of Minnesota, Minneapolis, MN, USA,
2
Neuropsychiatric
Research Institute, Fargo, ND, USA
Introduction:
The subjective experience of “feeling fat” (FF) is frequently
reported in clinical settings by individuals with eating and weight disorders;
however, little empirical evidence exists in regards to the nature of this
experience and its effect on eating and emotion. This study aimed to
improve our understanding of momentary relationships between FF,
eating and emotion in a sample of obese binge and non-binge eaters.
Methods:
50
obese (BMI>30) adults completed an ecological momentary
assessment protocol where FF, positive (PA) and negative affect (NA)
were rated before and after eating episodes over two weeks. A minority
(
N=9) of participants met full or sub-threshold diagnostic criteria for
Binge Eating Disorder; however, 80% engaged in binge eating (BE)
during the study period.
Results:
FF was endorsed 59.7% of the time
prior to and 64.1% after eating. FF was significantly greater following
eating than before eating. FF was also greater on binge days compared
to non-binge days, where higher ratings were observed before and
after binges compared to non-binge episodes. FF was associated with
momentary ratings of NA (Sadness, Guilt, and Hostility) but not PA. (All
p-values<0.05).
Conclusions:
Momentary
experience of FF is commonly
reported by obese adults and is associated with NA and BE. These
findings provide important insight into how eating and weight-related
cognitions might be exacerbated by disordered eating but may also help
maintain the same behavior.
POSTER SESSION 1 ABSTRACTS
