Eating disorder severity and functional impairment: moderating effects of illness duration in a clinical sample
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The aim was to examine duration of illness and body mass index as possible moderators of the relationship between eating disorder severity and functional impairment, as well as psychological distress as a possible mediator of this relationship.
The study included 159 patients diagnosed with bulimia nervosa, binge eating disorder or eating disorder not otherwise specified. Regression analysis was applied to assess the effect of the hypothesized moderators and mediators. Eating disorder severity was measured with the Eating Disorder Examination Questionnaire, functional impairment was measured with the Sheehan Disability Scale, and psychological distress was measured with the Symptom Check List-90-R. Duration of illness and body mass index were assessed clinically.
Duration of illness significantly moderated the relationship between eating disorder severity and functional impairment; the relationship was strongest for patients with a shorter duration of illness. Psychological distress partly mediated the relationship between eating disorder severity and functional impairment. Duration of illness significantly moderated the relationship between psychological distress and functional impairment; the strongest relationship was seen for patients with a shorter duration of illness. Body mass index was not a significant moderator of the relationship between ED severity and functional impairment.
Overall, this study established a link between ED severity, psychological distress and functional impairment indicating that both eating disorder severity and psychological distress are more strongly related to impaired role functioning for patients with more recent onset of an eating disorder. More research in the complex relationship between ED severity and functional impairment is needed.
KeywordsFunctional impairment Eating disorder severity Psychological distress Duration of illness Body weight
We acknowledge the participation of the patients at a difficult time in their lives, and we are grateful to our clinical and research colleagues at Stolpegaard Psychotherapy Centre for their contribution.
Compliance with ethical standards
The research was carried out at Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark. It was funded by Innovation Fund Denmark (Grant Number 10-084080); the Mental Health Services in the Capital Region of Denmark (no Grant Number), and by the Royal Danish Academy of Sciences and Letters [Inge Lehman’s scholarship (no Grant Number)].
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.APA (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, WashingtonGoogle Scholar
- 2.APA (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, ArlingtonGoogle Scholar
- 4.Baiano M, Salvo P, Righetti P, Cereser L, Baldissera E, Camponogara I, Balestrieri M (2014) Exploring health-related quality of life in eating disorders by a cross-sectional study and a comprehensive review. BMC Psychiatry 14:165. doi: 10.1186/1471-244X-14-165 (review) CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Cohen J, Cohen P, West SG, Aiken LS (2003) Applied multiple regression/correlation analysis for the behavioral sciences, vol 3. Routledge, New YorkGoogle Scholar
- 10.Cooper Z, Fairburn CG (2006) The eating disorder examination: a semi-structured interview for the assessment of the specific psychopathology of eating disorders. Int J Eat Disord 6(1):1–8. doi: 10.1002/1098-108X(198701)6:1<1::AID-EAT2260060102>3.0.CO;2-9 CrossRefGoogle Scholar
- 11.Danish Health Authorities (2005) Eating disorders. Recommendations for organisation and treatment. Spiseforstyrrelser. Anbefalinger for organisation og behandling, DanishGoogle Scholar
- 12.Davidsen AH, Poulsen S, Waaddegaard M, Lindschou J, Lau M (2014) Feedback versus no feedback in improving patient outcome in group psychotherapy for eating disorders (F-EAT): protocol for a randomized clinical trial. Trials 15(1):138. doi: 10.1186/1745-6215-15-138 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Fairburn CG, Cooper Z (1993) The Eating Disorder Examination (12th edn). In: Fairburn CG, Wilson GT (eds) Binge eating: nature, assessment and treatment. Guilford Press, New York, pp 317–360Google Scholar
- 22.Goffman E (1963) Stigma. Notes on the management of spoiled identity. Simon & Schuster Inc, New YorkGoogle Scholar
- 23.IBM, C. (2010) IBM SPSS Statistics for Windows, Version 19.0. IBM Corp, ArmonkGoogle Scholar
- 27.Kessler RC, Shahly V, Hudson JI, Supina D, Berglund PA, Chiu WT, Xavier M (2014) A comparative analysis of role attainment and impairment in binge-eating disorder and bulimia nervosa: results from the WHO World Mental Health Surveys. Epidemiol Psychiatr Sci 23(1):27–41. doi: 10.1017/S2045796013000516 CrossRefPubMedGoogle Scholar
- 32.Padierna AA, Lopez JM, Horcajo MJ, Madrazo A, Ecenarro R (2004) Cronicidad y calidad de vida en los trastornos de la conducta alimentaria. Anales de Psiquiatria 20(1):16–21Google Scholar
- 34.R, C. T. (2013). R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. http://www.R-project.org/. Accessed 15 sept 2016
- 35.Reas DL, Williamson DA, Martin CK, Zucker NL (2000) Duration of illness predicts outcome for bulimia nervosa: a long-term follow-up study. Int J Eat Disord 27(4):428–434. doi: 10.1002/(SICI)1098-108X(200005)27:4<428::AID-EAT7>3.0.CO;2-Y CrossRefPubMedGoogle Scholar
- 36.Sheehan DV, Rush AJ, Pincus HA, First MB (2000) Sheehan disability scale. Handbook of psychiatric measures. American Psychiatric Association, Washington DC, pp 113–115Google Scholar
- 44.Tillmann LM (1996) A secret life in a culture of thinness: reflections on body, food, and bulimia. In: Ellis C, Bochner AP (eds) Composing ethnography: alternative forms of qualitative writing. AltaMira Press, Walnut Creek, pp 76–108Google Scholar