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Intensity effect sizes of criteria for recovery. Circles represent criteria for recovery and are based on the intensity effectsizes. The larger the circle, the larger the intensity effectsize. Circles that are labeled with a text have moderate, substantial or strong evidence for a recovery criteria. Circles that are not labeled with a text are the remaining criteria
Source publication
Background
Outcome studies for eating disorders regularly measure pathology change or remission as the only outcome. Researchers, patients and recovered individuals highlight the importance of using additional criteria for measuring eating disorder recovery. There is no clear consensus on which additional criteria are most fundamental. Studies focu...
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Objectives
This review aimed (i) to identify all positive psychology measures in use with family carers and (ii) to determine their psychometric properties.
Design
Literature searches were made in Ovid MEDLINE, PsychINFO, and Web of Science. The identified measures were then subjected to analysis via an established quality appraisal tool.
Results...
The aim of this study is to explore the relationship between exercise motivation and eating disorder and the mediating effect of anxiety in physical exercise. Athletes are in a social network, and the different human-machine relationships and situations generated in this may produce different sports motivations and anxiety states for athletes. The...
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Resilience is a positive psychological trait associated with a lower risk of some physical and mental chronic diseases and could be an important protective factor against eating disorders (EDs). The aim of this study was to assess cross-sectional and longitudinal associations between resilience and ED in a large cohort of French adults. In 2017, a...
Citations
... Finally, it is important to note that this study does not include an AN symptom assessment, making it impossible to examine the direct effect of PBI on these symptoms. Thus, despite psychological well-being as a central criterion for eating disorder recovery [68], we cannot assume that PBI would be associated with a decrease in AN-related symptomatology. Exploring this question in future research would be intriguing. ...
Recent data suggest a close association between positive body image (PBI) and eating disorder recovery. Nevertheless, the specific mechanisms through which PBI may facilitate recovery from anorexia nervosa (AN) remain unknown. To advance understanding of these mechanisms, this study examined core indices of PBI within AN, exploring its association with emotion regulation and well-being outcomes. Data were collected from 159 female participants, 64 with AN diagnosis and 95 healthy controls (HCs), who completed measures of PBI (body appreciation, functionality appreciation, and body responsiveness), emotion regulation, and psychological well-being (depression, anxiety, stress, and psychological quality of life). The AN group reported lower levels of PBI and psychological well-being, along with greater difficulties in regulating emotions, relative to HCs. PBI variables significantly predicted emotion regulation and psychological well-being in AN, accounting for 36% to 72% of the variance, with body appreciation emerging as the strongest predictor. These findings lend credence to the view that PBI can serve as a catalyst for psychological health. We hypothesize that enhancing PBI can improve interoceptive awareness, which is crucial for emotion regulation and reducing maladaptive food-related coping. Emphasizing a mindâbody connection in lifestyle could be a relevant element to consider for both treating and preventing AN.
... Social narratives are influential in shaping assumptions about ED presentation and experiences in treatment, where the ED 'stereotype' [46,69] is particularly salient and may play a role in how some individuals identify with aspects of recovery and/ or illness. Quality-of-life is often a central concern for those experiencing what becomes known as 'recovery' [70], though it is not always included in clinical remission perspectives. Indeed, people in recovery may articulate a high subjective quality-of-life even without full symptom remission [38]. ...
Eating disorders (EDs) are complex, multifaceted conditions that significantly impact quality-of-life, often co-occur with multiple medical and psychiatric diagnoses, and are associated with a high risk of medical sequelae and mortality. Fortunately, many people recover even after decades of illness, although there are different conceptualisations of recovery and understandings of how recovery is experienced. Differences in these conceptualisations influence categorisations of ED experiences (e.g., longstanding vs. short-duration EDs), prognoses, recommended treatment pathways, and research into treatment outcomes. Within recent years, the proposal of a âterminalâ illness stage for a subset of individuals with anorexia nervosa and arguments for the prescription of end-of-life pathways for such individuals has ignited debate. Semantic choices are influential in ED care, and it is critical to consider how conceptualisations of illness and recovery and power dynamics influence outcomes and the ED âstagingâ discourse. Conceptually, âterminalityâ interrelates with understandings of recovery, efficacy of available treatments, iatrogenic harm, and complex co-occurring diagnoses, as well as the functions of an individualâs eating disorder, and the personal and symbolic meanings an individual may hold regarding suffering, self-starvation, death, health and life. Our authorship represents a wide range of lived and living experiences of EDs, treatment, and recovery, ranging from longstanding and severe EDs that may meet descriptors of a âterminalâ ED to a variety of definitions of ârecoveryâ. Our experiences have given rise to a shared motivation to analyse how existing discourses of terminality and recovery, as found in existing research literature and policy, may shape the conceptualisations, beliefs, and actions of individuals with EDs and the healthcare systems that seek to serve them.
... This complexity is exacerbated by inconsistent conceptualisations of ED recovery that are predominantly biomedical (e.g., weight restoration, absence of ED behaviours), neglecting psychosocial dimensions and ED cognitions (e.g., subjective well-being, freedom from weight concerns) [19,20]. Relapse risks persist until these underlying factors improve [21,22]. Patients often describe their recovery as a protracted process with multiple 'ups and downs' that may take years to stabilise [23]. ...
Background
Eating disorders (EDs) are serious, often chronic, conditions associated with pronounced morbidity, mortality, and dysfunction increasingly affecting young people worldwide. Illness progression, stages and recovery trajectories of EDs are still poorly characterised. The STORY study dynamically and longitudinally assesses young people with different EDs (restricting; bingeing/bulimic presentations) and illness durations (earlier; later stages) compared to healthy controls. Remote measurement technology (RMT) with active and passive sensing is used to advance understanding of the heterogeneity of earlier and more progressed clinical presentations and predictors of recovery or relapse.
Methods
STORY follows 720 young people aged 16â25 with EDs and 120 healthy controls for 12 months. Online self-report questionnaires regularly assess ED symptoms, psychiatric comorbidities, quality of life, and socioeconomic environment. Additional ongoing monitoring using multi-parametric RMT via smartphones and wearable smart rings (âĆura ringâ) unobtrusively measures individualsâ daily behaviour and physiology (e.g., Bluetooth connections, sleep, autonomic arousal). A subgroup of participants completes additional in-person cognitive and neuroimaging assessments at study-baseline and after 12 months.
Discussion
By leveraging these large-scale longitudinal data from participants across ED diagnoses and illness durations, the STORY study seeks to elucidate potential biopsychosocial predictors of outcome, their interplay with developmental and socioemotional changes, and barriers and facilitators of recovery. STORY holds the promise of providing actionable findings that can be translated into clinical practice by informing the development of both early intervention and personalised treatment that is tailored to illness stage and individual circumstances, ultimately disrupting the long-term burden of EDs on individuals and their families.
... As the aim for patients, families and clinicians is full recovery from AN, this has led to a comprehensive literature base on factors impacting AN recovery, and subsequently, a vast landscape of possible definitions of recovery [14]. Many researchers have attempted to operationalise 'recovery', with a widely accepted modern view that this should include a combination of biological, physical, and cognitive constructs [15], as well as measures of psychological and social wellbeing [16]. However, the concept of recovery remains somewhat abstract due to the variability in the individual's experience and the personal nature of recovery for each person, which together have led to difficulties with measuring recovery, its predictors and with producing replicable studies [8]. ...
Purpose
Eating disorder recovery is a poorly defined concept, with large variations among researchersâ definitions. Weight maintenance is a key aspect of recovery that remains relatively underexplored in the literature. Understanding the role of weight maintenance may help guide the development of treatments. This paper aims to address this by (1) investigating the factors predicting long-term weight maintenance in anorexia nervosa (AN) patients; (2) exploring differences in predictive factors between adolescent and adult populations; and (3) exploring how weight maintenance is conceptualised in the literature. Methods: We conducted a systematic review following PRISMA guidelines to address our research questions. Five databases were searched and filtered according to our exclusion criteria.
Results
From the search, 1059 studies were yielded, and 13 studies were included for review. A range of weight, biological and psychological factors were found to predict weight maintenance among these papers. BMI at admission and discharge from inpatient treatment was the most common predictor among the papers. Few studies investigated biological factors and mixed evidence was found for psychological factors. We found no observable differences between adult and adolescent populations. Finally, weight maintenance was defined and measured differently across studies.
Conclusion
This reviewâs findings can help contribute to a well-rounded understanding of weight maintenance, and ultimately, of recovery. This can help support clinicians in tailoring interventions to improve long-term outcomes in AN. Future research should aim to replicate studies to better understand the relationship between the factors identified and weight maintenance.
Level I
Systematic review.
... Although Lock et al. (2013) indicated that the definition of recovery might be related to the aim of the treatment and the studies, clinicians require a standardised definition to understand the end goals of the interventions, answer patients' and carers' questions and provide hope for the sufferers that think recovery is impossible (Bardone-Cone et al., 2010;Bardone-Cone et al., 2018;Lock et al., 2013;Morgan & Hayward, 1988) There are two types of studies conducted as follows 1) quantitative studies and 2) qualitative to define recovery, and it is suggested to perceive them as a bridge for each other instead of separate approaches (Bardone-Cone et al., 2018). Quantitative studies follow two empirical methodologies to validate the definition of recovery (Bardone-Cone et al., 2018) whereas qualitative studies investigate patients' and their relatives' perspectives (Bachner-Melman et al., 2018;Bardone-Cone et al., 2018;de Vos et al., 2017). As a first methodology for quantitative studies, the researcher compares disordered eating psychopathologies (i.e. ...
Anorexia Nervosa (AN) is an eating disorder that causes physical, behavioural and psychological deterioration. Although diagnostic criteria are clearly defined, there has been no consensus on what recovery is. This study aimed to review prior studies indicating recovery criteria, as well as recovery rates of patients with adolescent-onset AN. Related studies were searched through databases MEDLINE, PsycINFO and CINAHL. A total of 15 English studies with patients had adolescent-onset and DSM-5/ICD-11 diagnoses. A systematic review was conducted by following the PRISMA expanded checklist and qualities of eligible articles were evaluated via the Quality Criteria Checklist (QCC). Of the 15 studies, two studies mentioned only physical dimension of recovery, whereas rest of the 13 studies covered behavioural and psychological dimensions. EDE-Q was found as the most frequently used scale. Follow-up years of the patients fluctuated from one to 30 years, and the recovery rate varied from 30.6% to 72%. There are some difficulties faced in defining recovered patients. Since no consensus was achieved, every researcher set their recovery criteria. Until the policymakers of field standardize definition of recovery from AN, researchers should be aware of the fact that inconsistencies in definition can affect results of their research.
... This section aimed to evaluate the overall well-being of the adolescents during the pandemic, and was assessed in the same way as in the first study by asking the dimensions of the improvement criteria for ED, previously stated in a qualitative study by de Vos et al. 19 Emotional, psychological, and social well-being items with self-adherence dimensions that seem to be related to well-being were selected in both studies and were adapted to 11 questions on a three-point Likert-type scale. In addition, two questions were asked to assess quality of life (QoL) in the past month. ...
Background. At the onset of the pandemic, we conducted a study on adolescents with eating disorders (EDs) and found no deterioration in ED symptoms. The objective of this subsequent study was to conduct a follow-up evaluation of the same cohort and investigate the consequences of the prolonged pandemic. Methods. This longitudinal study was conducted one year after the first study between May 2021 and June 2021 with 37 adolescents aged 12-18 years (pre-existing EDs). The reassessment included an evaluation of sociodemographic and clinical characteristics, the impact of pandemic-related restrictions on ED behaviors, well-being, and quality of life. All the participants underwent a re-administration of the ED examination questionnaire (EDE-Q), Beck Depression Inventory, the State Anxiety Inventory for Children, and the Maudsley Obsessive Compulsive Inventory. Results. No significant difference was observed in the EDE-Q scores or the ED examination questionnaire scores between the initial (T1) and subsequent (T2) study. The ED-related quality of life was seen to have slightly improved in the later stage. While depression (T1: 18, T2: 15, p=0.883) and obsession scores (T1: 11, T2: 14, p: 0.536) showed no disparity between the studies, anxiety scores (T1: 38, T2: 43, p:0.011) exhibited a significant increase. Conclusions. Consistent with the early phase, no exacerbation of ED symptoms in adolescents was observed during the later stages of the pandemic. Close clinical monitoring during the pandemic might have been protective against the deteriorating effects of the pandemic. During social isolation, it is important to monitor adolescents with EDs continously for depression and anxiety.
... Really listening to an individual's expectations and goals (rather than imposing on them our research-based views of what constitutes "recovery") [63][64][65] can help patients and therapists make informed, collaborative decisions about treatment delivery. Research that has drawn on those with lived experience of an ED tells us that recovery is much more than simply achieving a certain BMI, scoring below a particular score on an ED questionnaire and exhibiting few ED behaviours [66][67][68]. When we listen to those with lived experience, we learn that recovery is a complex, moving target that can be defined differently for different people [36, 37, [68][69][70]. ...
In the twenty years since the publication of the most widely used treatment manuals describing evidence-based therapies for eating disorders, there have been some substantial advances in the field. New methods of delivering treatments have been trialled and our perception of mental health has advanced; significant cultural changes have led to shifts in our societal landscape; and new technologies have allowed for more in-depth research to be conducted. As a result, our understanding of eating disorders and their treatment has broadened considerably. However, these new insights have not necessarily been translated into improved clinical practice. This paper highlights the changes we consider to have had the greatest impact on our work as experienced clinical psychologists in the field and suggests a list of new learnings that might be incorporated into clinical practice and research design.
... The prevalence of EDs in males is increasing at a faster rate than in females 104 . Although some data point to similarities with females, some qualitative differences have been detected, such as a more frequent history of overweight and drive for leanness and muscu larity, which can promote the use of specific drugs (i.e., anabolic steroids) 105 . The sensitivity of most commonly used tools to quan tify ED symptoms may be suboptimal in males 106 , and EDs may be under detected in these individuals 106 108 . ...
... The sensitivity of most commonly used tools to quan tify ED symptoms may be suboptimal in males 106 , and EDs may be under detected in these individuals 106 108 . Our findings call for additional research examining sex and gender as moderators of different clinical characteristics and outcomes in EDs 105,109 . ...
Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and metaâanalysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICDâdefined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, allâcause and EDârelated hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean followâup: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44â49, n=283, mean followâup: 44.9±62.8 months, no significant EDâgroup difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at â„10 years. Overall chronicity occurred in 25% of patients (95% CI: 23â29, n=170, mean followâup: 59.3±71.2 months, no significant EDâgroup difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at â„10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2â0.7, n=214, mean followâup: 72.2±117.7 months, no significant EDâgroup difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 personâyears (95% CI: 4.4â6.1, n=167, mean followâup: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18â36, n=18, mean followâup: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Selfâinjurious behaviors were associated with lower recovery rates in pooled EDs. A higher socioâdemographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were familyâbased therapy, cognitiveâbehavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; selfâhelp, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.
... Of particular interest here is the extent to which positive mental health and psychopathology, i.e., depression and anxiety symptoms, respond independently to treatment. Possible differential effects would not only support the requirement to routinely assess both markers of positive and negative mental health in treatment studies (8), but also to complement categorical markers of treatment outcome (i.e., response and remission rates) with a more comprehensive marker of treatment outcome: complete mental health [cf., (37)]. ...
... a reduction in negative mental health -in patients already displaying moderate to high levels of positive mental health -so that patients were no longer classified as symptomatic but content but as completely mentally healthy. These findings support the dual-factor model's assumption that enhancing positive mental health and alleviating psychopathology do not always co-occur in treatment, and thereby underscore the importance of implementing measures of both constructs in clinical studies (37). To fully evaluate the effectiveness of a therapeutic intervention, both dimensions should be measured. ...
Background
The dual-factor model of mental health posits that mental health and mental illness constitute two distinct axes; accordingly the model identifies four mental health groups: (1) complete mental health, (2) troubled, (3) vulnerable, (4) symptomatic but content. Yet, only a few studies investigated effectiveness of therapy on both dimensions of mental health simultaneously. Against this background, the present study aimed to determine proportions and changes of group assignments in depressed inpatients undergoing therapy.
Method
N = 1,044 depressed inpatients (age in years: M = 53.36, SD = 9.81, range: 17â83) completed a pre- and a post-treatment survey including questionnaires on depression, anxiety, and positive mental health. A total of n = 328 persons completed the survey also at 6-month and 12-month follow-up assessments.
Results
In the classification that included depression symptoms and positive mental health, 49% of the participants were classified as troubled and 13.2% were classified as completely mentally healthy at the pre-treatment assessment. At the post-treatment, 9.5% were classified as troubled and 55.7% were classified as completely mentally healthy. In the classification that included anxiety symptoms and positive mental health, 21.9% of the participants were classified as troubled and 14.2% were classified as completely mentally healthy at the pre-treatment assessment. At the post-treatment, 3.7% were classified as troubled and 56.1% were classified as completely mentally healthy. About 10 to 20% of patients showed an improvement in depression/anxiety and positive mental health, whereas another 10 to 20% showed a reduction in depression/anxiety, but only a minor increase in positive mental health between pre- and post-treatment.
Conclusion
Findings are in line with past research inspired by the dual-factor model in showing that enhancing positive mental health and alleviating psychopathology do not always co-occur in treatment. It is therefore important to implement measures of both psychopathology and positive mental health in therapy outcome studies, and to promote interventions targeting both psychopathology and positive mental health.
... In another study, a DMT intervention was administered in women with obesity, showing significant decreases in psychological distress and body image distress, as well as decreased emotional eating and improved self-esteem. Although the sample did not include people with ED, the study is relevant because it showed that DMT impacted emotional eating, psychological distress, and body image, which are all factors related to ED [35]. These results provide evidence about the potential effectiveness of DMT in treating ED, but further confirmations are necessary. ...
Background:
There is growing support for considering Dance Movement Therapy (DMT) as an effective approach to improving physical and psychological symptoms in eating disorders (ED), but additional evidence is needed. The current study aims to investigate the effectiveness of a DMT intervention for inpatients with ED during an in-hospital rehabilitation program for ED in reducing emotion dysregulation and alexithymia and improving interoceptive awareness.
Methods:
Forty-nine consecutive inpatient young women with ED (aged between 18 and 34 years) recruited from a clinical center for the rehabilitation of obesity and ED received four group sessions of DMT intervention. All participants completed the Difficulties in Emotion Regulation Scale (DERS), the Toronto Alexithymia Scale (TAS), and the Multidimensional Assessment of Interoceptive Awareness Scale (MAIA) before (Time 0) and after the intervention (Time 1). Paired-sample t-tests were run to assess differences between Time 0 to Time 1.
Results:
From pre-to-post interventions, there was a significant reduction in the means of all of the subscales of DERS, suggesting an improvement in emotion regulation competencies, with the only exception for difficulties in awareness that increased (p = 0.016). We also found a significant reduction in alexithymia, as proved by significant differences in all of the subscales and the total score of TAS (p < 0.001), and significant improvements in interoceptive awareness as suggested by increased scores of the noticing (p = 0.043), emotional awareness (p < 0.001), body listening (p < 0.001), and trusting (p < 0.001) subscales of MAIA.
Conclusion:
Overall, our results point towards the efficacy of dance/movement in reducing symptoms of eating disorders. Our findings also suggest that dancing can be considered a useful intervention to increase emotional regulation, reduce alexithymia, and enhance interoceptive awareness.
