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Eating disorder severity and functional impairment: moderating effects of illness duration in a clinical sample

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Notes

  1. Patients with a BMI below 20 were considered underweight and therefore received another type of treatment than patients with a BMI above 20.

References

  1. APA (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington

    Google Scholar 

  2. APA (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Arlington

    Google Scholar 

  3. Ashmore JA, Friedman KE, Reichmann SK, Musante GJ (2008) Weight-based stigmatization, psychological distress, and binge eating behavior among obese treatment-seeking adults. Eat Behav 9(2):203–209. doi:10.1016/j.eatbeh.2007.09.006

    Article  PubMed  Google 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)

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bamford B, Sly R (2010) Exploring quality of life in the eating disorders. Eur Eat Disord Rev 18(2):147–153. doi:10.1002/erv.975

    Article  PubMed  Google Scholar 

  6. Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182. doi:10.1037/0022-3514.51.6.1173

    Article  CAS  PubMed  Google Scholar 

  7. Berg KC, Peterson CB, Frazier P, Crow SJ (2012) Psychometric evaluation of the eating disorder examination and eating disorder examination-questionnaire: a systematic review of the literature. Int J Eat Disord 45(3):428–438. doi:10.1002/eat.20931

    Article  PubMed  Google Scholar 

  8. Cochran SD, Mays VM, Sullivan JG (2003) Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol 71(1):53–61. doi:10.1037/0022-006X.71.1.53

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cohen J, Cohen P, West SG, Aiken LS (2003) Applied multiple regression/correlation analysis for the behavioral sciences, vol 3. Routledge, New York

    Google 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

    Article  Google Scholar 

  11. Danish Health Authorities (2005) Eating disorders. Recommendations for organisation and treatment. Spiseforstyrrelser. Anbefalinger for organisation og behandling, Danish

    Google 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

    Article  PubMed  PubMed Central  Google Scholar 

  13. Day J, Ternouth A, Collier DA (2009) Eating disorders and obesity: two sides of the same coin? Epidemiol Psichiatr Soc 18(2):96–100 (editorial)

    Article  PubMed  Google Scholar 

  14. DeJong H, Oldershaw A, Sternheim L, Samarawickrema N, Kenyon MD, Broadbent H, Schmidt U (2013) Quality of life in anorexia nervosa, bulimia nervosa and eating disorder not-otherwise-specified. J Eat Disord 1(43):1–8. doi: 10.1186/2050-2974-1-43

    Article  Google Scholar 

  15. Derogatis LR, Lipman RS, Covi L (1973) SCL-90: an outpatient psychiatric rating scale—preliminary report. Psychopharmacol Bull 9(1):13–28

    CAS  PubMed  Google Scholar 

  16. Derogatis LR, Rickels K, Rock AF (1976) The SCL-90 and the MMPI: a step in the validation of a new self-report scale. Br J Psychiatry 128:280–289. doi:10.1192/bjp.128.3.280

    Article  CAS  PubMed  Google Scholar 

  17. Errichiello L, Iodice D, Bruzzese D, Gherghi M, Senatore I (2016) Prognostic factors and outcome in anorexia nervosa: a follow-up study. Eat Weight Disord 21(1):73–82. doi:10.1007/s40519-015-0211-2

    Article  PubMed  Google 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 317–360

    Google Scholar 

  19. Fairburn CG, Harrison PJ (2003) Eating disorders. Lancet 361(9355):407–416. doi:10.1016/S0140-6736(03)12378-1

    Article  PubMed  Google Scholar 

  20. Frable DE, Platt L, Hoey S (1998) Concealable stigmas and positive self-perceptions: feeling better around similar others. J Pers Soc Psychol 74(4):909–922. doi:10.1037/0022-3514.74.4.909

    Article  CAS  PubMed  Google Scholar 

  21. Frazier PA, Tix AP, Barron KE (2004) Testing moderator and mediator effects in counseling psychology research. J Couns Psychol 51(1):115–134. doi:10.1037/0022-0167.51.1.115

    Article  Google Scholar 

  22. Goffman E (1963) Stigma. Notes on the management of spoiled identity. Simon & Schuster Inc, New York

    Google Scholar 

  23. IBM, C. (2010) IBM SPSS Statistics for Windows, Version 19.0. IBM Corp, Armonk

    Google Scholar 

  24. Jacoby RJ, Leonard RC, Riemann BC, Abramowitz JS (2014) Predictors of quality of life and functional impairment in obsessive-compulsive disorder. Compr Psychiatry 55(5):1195–1202. doi:10.1016/j.comppsych.2014.03.011

    Article  PubMed  Google Scholar 

  25. Jenkins PE, Hoste RR, Meyer C, Blissett JM (2011) Eating disorders and quality of life: a review of the literature. Clin Psychol Rev 31(1):113–121. doi:10.1016/j.cpr.2010.08.003

    Article  PubMed  Google Scholar 

  26. Johnson J, Spitzer R, Williams J (2001) Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynaecology patients. Psychol Med 31(08):1455–1466. doi:10.1017/S0033291701004640

    Article  CAS  PubMed  Google 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

    Article  CAS  PubMed  Google Scholar 

  28. Maxwell SE, Cole DA (2007) Bias in cross-sectional analyses of longitudinal mediation. Psychol Methods 12:23–44. doi:10.1037/1082-989X.12.1.23

    Article  PubMed  Google Scholar 

  29. Noordenbos G (2013) Negative consequences of eating disorders. In: Noordenbos G (ed) Recovery from eating disorders: a guide for clinicians and their clients. John Wiley & Sons Ltd., New York

    Chapter  Google Scholar 

  30. Olsen LR, Mortensen EL, Bech P (2004) Prevalence of major depression and stress indicators in the Danish general population. Acta Psychiatr Scand 109(2):96–103. doi:10.1046/j.0001-690X.2003.00231.x

    Article  CAS  PubMed  Google Scholar 

  31. Pachankis JE (2007) The psychological implications of concealing a stigma: a cognitive-affective-behavioral model. Psychol Bull 133(2):328–345. doi:10.1037/0033-2909.133.2.328

    Article  PubMed  Google 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):16–21

    Google Scholar 

  33. Perez M, Warren CS (2012) The relationship between quality of life, binge-eating disorder, and obesity status in an ethnically diverse sample. Obesity 20(4):879–885. doi:10.1038/oby.2011.89

    Article  PubMed  Google 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

    Article  CAS  PubMed  Google Scholar 

  36. Sheehan DV, Rush AJ, Pincus HA, First MB (2000) Sheehan disability scale. Handbook of psychiatric measures. American Psychiatric Association, Washington DC, pp 113–115

  37. Sheehan KH, Sheehan DV (2008) Assessing treatment effects in clinical trials with the discan metric of the Sheehan Disability Scale. Int Clin Psychopharmacol 23(2):70–83. doi:10.1097/YIC.0b013e3282f2b4d6

    Article  PubMed  Google Scholar 

  38. Smart L, Wegner DM (1999) Covering up what can’t be seen: concealable stigma and mental control. J Pers Soc Psychol 77(3):474–486. doi:10.1037/0022-3514.77.3.474

    Article  CAS  PubMed  Google Scholar 

  39. Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus MD, Stunkard A, Horne RL (1993) Binge eating disorder: its further validation in a multisite study. Int J Eat Disord 13(2):137–153. doi:10.1002/1098-108X(199303)13:2<137::AID-EAT2260130202>3.0.CO;2-%23

    Article  CAS  PubMed  Google Scholar 

  40. Steinhausen HC, Weber S (2009) The outcome of bulimia nervosa: findings from one-quarter century of research. Am J Psychiatry 166(12):1331–1341. doi:10.1176/appi.ajp.2009.09040582

    Article  PubMed  Google Scholar 

  41. Storch EA, Abramowitz JS, Keeley M (2009) Correlates and mediators of functional disability in obsessive-compulsive disorder. Depress Anxiety 26(9):806–813. doi:10.1002/da.20481

    Article  PubMed  Google Scholar 

  42. Storch EA, Wu MS, Small BJ, Crawford EA, Lewin AB, Horng B, Murphy TK (2014) Mediators and moderators of functional impairment in adults with obsessive-compulsive disorder. Compr Psychiatry 55:489–496. doi:10.1016/j.comppsych.2013.10.014

    Article  PubMed  Google Scholar 

  43. Striegel RH, Bedrosian R, Wang C (2012) Comparing work productivity in obesity and binge eating. Int J Eat Disord 45(8):995–998. doi: 10.1002/eat.22069

    Article  PubMed  Google 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 76–108

    Google Scholar 

  45. Treasure J, Stein D, Maguire S (2015) Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Interv Psychiatry 9(3):173–184. doi:10.1111/eip.12170 (review)

    Article  PubMed  Google Scholar 

  46. Vall E, Wade TD (2015) Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. Int J Eat Disord. doi:10.1002/eat.22411

    Article  PubMed  Google Scholar 

  47. Vandereycken W, Van Humbeeck I (2008) Denial and concealment of eating disorders: a retrospective survey. Eur Eat Disord Rev 16(2):109–114. doi:10.1002/erv.857

    Article  PubMed  Google Scholar 

  48. Williams SE, Watts TKO, Wade TD (2012) A review of the definitions of outcome used in the treatment of bulimia nervosa. Clin Psychol Rev 32(4):292–300. doi:10.1016/j.cpr.2012.01.006

    Article  PubMed  Google Scholar 

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Acknowledgments

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.

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Authors and Affiliations

  1. Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Stolpegaardsvej 20, 2820, Gentofte, Denmark

    Annika Helgadóttir Davidsen, Mette Waaddegaard & Marianne Lau

  2. Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen K., Denmark

    Annika Helgadóttir Davidsen

  3. Department of Counseling Psychology, School of Education, UW-Madison, Madison, USA

    William T. Hoyt

  4. Department of Psychology, University of Copenhagen, Copenhagen, Denmark

    Stig Poulsen

Authors
  1. Annika Helgadóttir Davidsen
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  2. William T. Hoyt
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  3. Stig Poulsen
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  4. Mette Waaddegaard
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  5. Marianne Lau
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Corresponding author

Correspondence to Annika Helgadóttir Davidsen.

Ethics declarations

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

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Davidsen, A.H., Hoyt, W.T., Poulsen, S. et al. Eating disorder severity and functional impairment: moderating effects of illness duration in a clinical sample. Eat Weight Disord 22, 499–507 (2017). https://doi.org/10.1007/s40519-016-0319-z

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  • DOI: https://doi.org/10.1007/s40519-016-0319-z

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