new insights into the prevention and treatment of bulimia nervosa

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118 New Insights into the Prevention and Treatment of Bulimia Nervosa Bulimic participants were slightly older than anorexic participants and lived more often outside the family. The level of education was similar between groups. Anorexic participants were more often recruited as inpatients and showed a more severe clinical picture compared to bulimics. Comparisons between groups on depression measures at inclusion show a differential picture. Purging anorexics had significant higher scores than restricting anorexics and bulimics concerning the severity of depression assessed with the BDI. On the contrary, we did not observe any significant differences between groups in levels of self-definition (Selfcritical and Efficacy) and interpersonal relatedness (Neediness and Relatedness). The negative scores on the Efficacy factor (calculated according to factor scores of the control group) highlights that this factor seems to measure a developmental more mature capacity. Sociodemographic and clinical characteristics of the sample at inclusion are presented in table 1. (1) (2) (3) (4) (5) (6) (7) (8) - Body Mass Index (1) Clinical Global Impression (2) -0.19 - Binge eating behaviors (3) 0.55** -0.20 - Beck Depression Inventory (4) -0.01 0.22 0.11 - DEQ Self-Criticism (5) -0.03 0.19 0.09 0.46** - DEQ Efficacy (6) 0.12 0.03 0.11 -0.21* 0.25* - DEQ Relatedness (7) 0.24* 0.15 0.18 0.37** 0.31** -0.02 - DEQ Neediness (8) 0.11 0.17 0.30 0.44** 0.41** -0.08 0.69** - DEQ = Depressive Experience Questionnaire; Table 2. Correlations between variables at inclusion (* p < 0.05. ** p < 0.05). Correlations between variables at inclusion showed that the clinical severity of the eating disorder and the presence of binge eating behaviors were unrelated with BDI and with the subscales of the DEQ. The BDI showed a positive correlation with all DEQ subscales (correlations were in the medium range going from 0.37 to 0.46) with the exception of the Efficacy factor that was negatively correlated to depression (-0.21). These moderate correlations indicate that the DEQ scales are not equivalent to severity scales but identify specific personality traits (Table 2). The mean duration of the follow-up was 30.66 months. According to the Psychiatric Status Rating Scale (PSRS), 44% (N=41) of the initial sample still presented an eating disorder fulfilling DSM-IV criteria. A higher proportion of patients (63%) still presented symptoms of an eating disorder (PSRS≥3). The persistence of a diagnosis was independent from the initial subtype of eating disorder. The group of purging anorexics was the most instable in terms of the subtype of eating disorder presented at follow-up. 17% of the patients showed an unfavorable social outcome at follow-up without differences between groups. All patients received at the same rates a pharmacotherapy or a psychotherapy or a combination of the two. Restricting and purging anorexics were more often rehospitalized during the follow-up compared to bulimics (Table 3). Considering that eating disorder subtypes did not show any difference in DEQ measures at inclusion, the regression analysis was conducted on the entire simple of eating disorders (N= 94). The logistic regression analysis significantly discriminated between participants with (N=41) and without (N=53) a persisting diagnosis of eating disorder (2logL = 111.0, Model F(df =3)= 12.1 , p=0.01, Nagelkerke R² 0.17). The model included the severity of the eating
The Quality of Depressive Experience as a Prognostic Factor in Eating Disorders disorder (CGI), the Neediness subscale and the Relatedness subscales of the DEQ at inclusion. The Neediness subscale (Wald Z=6.19, p=0.013; OR=1.09, IC 1.02-1.17) and the severity of the eating disorder (Wald Z=4.00, p=0.045; OR=1.62, IC 1.01-2.61) at inclusion were significantly associated with the persistence of an eating disorder. The Relatedness subscale, which was negatively associated with diagnostic persistency, just missed the level of significance (Wald Z=3.74, p=0.053, OR=0.91, IC 0.82-1.00)(Table 4). Treatments delivered during the follow-up had no impact on the results. Finally, social outcome was significantly predicted by a model including the severity of depression and the Relatedness subscale of the DEQ (2logL = 58.0, Model F(df =2)= 17.7, p=0.003, Nagelkerke R² 0.32). BDI was positively associated with the social outcome (B=0.14, Wald Z=7.87, p=0.01; OR=1.15, IC 1.04-1.26); Relatedness was negatively associated with the social outcome (B=-0.017, Wald Z=4.63, p=0.03; OR=0.84, IC 0.72-0.98). Outcome variables R-AN (N=42) P-AN (N=19) BN (N=33) Total (N=94) Statistics ² /ANOVA with Bonferroni F P< ≠ DURATION OF THE FOLLOW-UP (M±SD) 31.2±6 28.8±5 31.2±6 30±6 0.81 ns - ED SYMPTOMS (PSRS≥3)(N, %) 26 (62) 12 (63) 21 (64) 59 (63) 0.02 ns - ED DIAGNOSIS (PSRS≥5)(N, %) 19 (45) 9 (47) 13 (39) 41 (44) 0.39 ns - SUBTYPES OF ED (N, %) 26.2
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VI Contents Chapter 7 Bulimia Nervo
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X Preface al. Untested approaches t
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Interpersonal Problems in People wi
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Application of Psychodrama and Obje
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Gastrointestinal Aspects of Bulimia
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1. Introduction Treatment Strategie
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Treatment Strategies for Eating Dis
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Part 2 Early Identification and Int
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58 All (n = 355) New Insights into
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60 Self-Reported BMI New Insights i
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Physical Activity and Exercise in B
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1. Introduction 12 Personality and
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Personality and Coping in Groups Wi
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