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Comparison of Treatments for Eating Disorders

Project Title: Comparison of Treatments for Eating Disorders
Keywords or Terms (maximum of five): Eating disorders, bulimia, anorexia, binge eating
Abstract (250 words or less): Eating disorders are disorders of the brain characterized by maladaptive under eating or over eating accompanied with compensations such as purging, severe exercise or use of laxatives. It is a leading cause of death in young girls and can lead to mental health issues such as depression, substance abuse and suicide. This paper reviews the various treatments used to combat eating disorders.

 

Background

Eating disorders are disorders of the brain [1]. They are considered one of the leading causes of death in adolescent girls as well as young adult women[2]. Every 62 minutes, a person dies of an eating disorder related illness. Eating disorders are divided into three main categories; Anorexia Nervosa, Bulimia Nervosa and Binge eating disorder [2]. Anorexia nervosa is characterized by maladaptive under eating while bulimia and binge eating disorder are characterized by maladaptive over eating. Bulimia involves methods of compensation such as purging, severe exercise or use of laxatives [3]. Eating disorders can lead to impaired social functioning, depression, substance abuse and suicide [4] . The psychopathology of eating disorders includes behaviors such as food restraint, extreme methods of weight control, and obsession with eating, weight and body shape [5]. Excessive body checking and body avoidance are also key behavioral characteristics of eating disorders [6]. Body checking is the practice which involves the repeated checking of one’s body by self- weighing or mirror checking while body avoidance is the practice of avoiding situations where shape and weight may be visible [6]. This may involve refusing to be weighed or wearing of oversized clothing [6].  Individuals with eating disorders are found to have high serotonin uptake and low levels of circulating serotonin [7]. Cognitive-behavior therapy has been very effective in treating eating disorders (8).

Cognitive-behavioral theory of eating disorders explains the effect of cognition on the development and perpetuation of eating and excessive weight control behaviors [8]. It highlights the alteration of both maladjusted eating behavior and cognition related to body and to eating [8]. Another form of treatment involves interpersonal psychotherapy which involves conflict resolution with grief, interpersonal role disputes, role transitions and interpersonal deficits [9]. Other forms of treatment involve the use of selective serotonin reuptake inhibitors such as sertraline [10] and fluoxetine[11] .

 

Research Question

For this project, my goal was to explore safe and effective methods of treating eating disorders, compare these treatment methods and determine the most effective treatment. I also wanted to determine whether these methods are effective in completely curing affected individuals of these eating disorders and preventing future relapse.

Meta-Analysis

I performed a literature search using Google Scholar, Mendeley Desktop, and NCBI, using the key terms, “eating” and “treatment”. For every appropriate article, I noted the type of variable, inclusion and exclusion criteria, type of study (experiment or observational), and other pertinent information, which I logged in a database.  My search yielded 55 effect size estimates from 22 published studies [12][13][14][15][16][17][18][19][20][21][22][23][10][24][25][26][27][28][29][30][31][32].

All meta-analytic calculations were carried out with the metafor package for R [33]. For continuous data, effect sizes were estimated as standardized mean differences.  The escalc function was used to make these calculations.  A random effects model was used to estimate overall trends and a Forest plot was generated (using the forest function) to visualize effect size heterogeneity.

 

Results

The effect sizes show the effect of different methods of treatment on food restraint, weight concern, binge frequency and depression, and thus the overall effect on eating disorders. The results in the above forest plot show that treatment and intervention have a positive effect on these eating disorders since the interval from the random effects model does not overlap with 0. Even though there is some heterogeneity, overall there is a positive effect.

Discussion

My research showed that the most common methods of treating eating disorders include the use cognitive or interpersonal therapy, yoga, meditation and the use of selective serotonin reuptake inhibitors. The largest effect size was seen in patients that received dialectical behavior therapy [31].  Dialectical behavior therapy (DBT), is a treatment approach that uses several treatment modes such as individual therapy, consultation, and mobile phone coaching to tackle shortcomings in interpersonal relationships, group skills training, telephone coaching, team consultation to address deficits in interpersonal relationships and influence regulation and impulse control [31]. The use of drugs such as fluoxetine, sertraline and sodium oxybate seemed to help treat eating disorders however cognitive behavioral therapy had the most significant effect on eating disorders by reducing behaviors such as food restraint, binge frequency, weight concern as well as depression which are considered the main psychopathologies of eating disorders [5]. Cognitive behavioral therapy aims to change the individual’s distorted thoughts about food, weight and body, improve emotional engagement and in effect change the individuals behavior [8]. There were two particular effect sizes from the forest plot that showed that treatment had a negative effect on eating disorders. In this study the individuals were suffering from attachment insecurity in addition to eating disorders [26]. The main categories of attachment functioning include reflective functioning, affect regulation, interpersonal style and coherence of mind [26]. Because symptom based therapy and intervention could not effectively treat these individuals, the researchers concluded that other forms of treatment options that incorporated attachment theory should be developed to tailor to the needs of these particular patients [26]. There didn’t seem to be a treatment that completely cured these patients of their eating disorders. The longest time period over which patients were tracked was over a course of 6 years. Research showed that during treatment, patients demonstrated a significant improvement and decrease in symptoms during treatment, around 3 years after treatment there was decrease in improvement and some symptoms returned, however 6 years after treatment there was improvement and stabilization of symptoms and majority of the patients were no longer suffering from eating disorders [22]. The researchers observed that though symptoms of eating disorders still persisted in some patients, they were not as severe as they were at the start of treatment [22].

In conclusion, the best and most effective treatment for eating disorders is cognitive behavioral therapy. This method of intervention is able to successfully reduce the cognitive behaviors associated with eating disorders in addition to reducing mental illnesses such as depression caused by eating disorders.

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2.  Fairburn CG, Harrison PJ. Eating disorders: MinerQuest. In: The Lancet. Feb 1, 2003, Vol. 361 Issue 9355, p407. 2003.

3.  Nicholls D. Eating disorders and weight problems. BMJ. 2005; doi:10.1136/bmj.330.7497.950

4.  Stice E, Desjardins CD. Interactions between risk factors in the prediction of onset of eating disorders: Exploratory hypothesis generating analyses. Behav Res Ther. 2018; doi:10.1016/j.brat.2018.03.005

5.  Harlowe J, Farrar S, Stopa L, Turner H. The impact of self-imagery on aspects of the self-concept in individuals with high levels of eating disorder cognitions. J Behav Ther Exp Psychiatry. 2018; doi:10.1016/j.jbtep.2018.05.002

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8.  Williamson DA, Muller SL, Reas DL, Thaw JM. Cognitive bias in eating disorders: Implications for theory and treatment. Behavior Modification. 1999. doi:10.1177/0145445599234003

9.  Wilfley DE, Robinson Welch R, Stein RI, Spurrell EB, Cohen LR, Saelens BE, et al. A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Arch Gen Psychiatry. 2002; doi:10.1001/archpsyc.59.8.713

10.  McElroy SL, Casuto LS, Nelson EB, Lake KA, Soutullo CA, Keck PE, et al. Placebo-controlled trial of sertraline in the treatment of binge eating disorder. Am J Psychiatry. 2000; doi:10.1176/appi.ajp.157.6.1004

11.  Grilo CM, Masheb RM, Wilson GT. Efficacy of cognitive behavioral therapy and fluoxetine for the treatment of binge eating disorder: A randomized double-blind placebo-controlled comparison. Biol Psychiatry. 2005; doi:10.1016/j.biopsych.2004.11.002

12.  Horney AC, Stice E, Rohde P. An Examination of Participants Who Develop an Eating Disorder Despite Completing an Eating Disorder Prevention Program: Implications for Improving the Yield of Prevention Efforts. Prev Sci. 2015; doi:10.1007/s11121-014-0520-0

13.  Pacanowski CR, Diers L, Crosby RD, Neumark-Sztainer D. Yoga in the treatment of eating disorders within a residential program: A randomized controlled trial. Eat Disord. 2017; doi:10.1080/10640266.2016.1237810

14.  Stice E, Rohde P, Butryn M, Menke KS, Marti CN. Randomized Controlled Pilot Trial of a Novel Dissonance-Based Group Treatment for Eating Disorders. Behav Res Ther. 2015; doi:10.1016/j.brat.2014.12.012

15.  Turner H, Marshall E, Stopa L, Waller G. Cognitive-behavioural therapy for outpatients with eating disorders: Effectiveness for a transdiagnostic group in a routine clinical setting. Behav Res Ther. 2015; doi:10.1016/j.brat.2015.03.001

16.  Fairburn CG, Cooper Z, Doll HA, O’connor ME, Bohn K, Hawker DM, et al. Transdiagnostic Cognitive-Behavioral therapy for patients with eating disorders: A two-site trial with 60-week follow-up. Am J Psychiatry. 2009; doi:10.1176/appi.ajp.2008.08040608

17.  Bhatnagar KAC, Wisniewski L, Solomon M, Heinberg L. Effectiveness and Feasibility of a Cognitive-Behavioral Group Intervention for Body Image Disturbance in Women With Eating Disorders. J Clin Psychol. 2013; doi:10.1002/jclp.21909

18.  Breithaupt L, Eickman L, Byrne CE, Fischer S. REbeL Peer Education: A model of a voluntary, after-school program for eating disorder prevention. Eat Behav. 2017; doi:10.1016/j.eatbeh.2016.08.003

19.  Chen EY, Matthews L, Allen C, Kuo JR, Linehan MM. Dialectical behavior therapy for clients with binge-eating disorder or bulimia nervosa and borderline personality disorder. Int J Eat Disord. 2008; doi:10.1002/eat.20522

20.  Hudson JI, McElroy SL, Raymond NC, Crow S, Keck PE, Carter WP, et al. Fluvoxamine in the treatment of binge-eating disorder: A multicenter placebo-controlled, double-blind trial. Am J Psychiatry. 1998; doi:10.1176/ajp.155.12.1756

21.  Kristeller JL, Hallett CB. An exploratory study of a meditation-based intervention for binge eating disorder. J Health Psychol. 1999; doi:10.1177/135910539900400305

22.  Fichter MM, Quadflieg N, Gnutzmann A. Binge eating disorder: Treatment outcome over a 6-year course. J Psychosom Res. 1998; doi:10.1016/S0022-3999(97)00263-8

23.  Marco JH, Perpiñá C, Botella C. Effectiveness of cognitive behavioral therapy supported by virtual reality in the treatment of body image in eating disorders: One year follow-up. Psychiatry Res. 2013; doi:10.1016/j.psychres.2013.02.023

24.  McElroy SL, Guerdjikova AI, Winstanley EL, O’Melia AM, Mori N, Keck PE, et al. Sodium oxybate in the treatment of binge eating disorder: An open-label, prospective study. Int J Eat Disord. 2011; doi:10.1002/eat.20798

25.  McElroy SL, Arnold LM, Shapira NA, Keck PE, Rosenthal NR, Karim MR, et al. Topiramate in the treatment of binge eating disorder associated with obesity: A randomized, placebo-controlled trial. Am J Psychiatry. 2003; doi:10.1176/appi.ajp.160.2.255

26.  Tasca GA, Ritchie K, Balfour L. Implications of attachment theory and research for the assessment and treatment of eating disorders. Psychotherapy. 2011. doi:10.1037/a0022423

27.  Thaler L, Drapeau CE, Leclerc J, Lajeunesse M, Cottier D, Kahan E, et al. An adjunctive, museum-based art therapy experience in the treatment of women with severe eating disorders. Arts Psychother. 2017; doi:10.1016/j.aip.2017.08.002

28.  Trunko ME, Schwartz TA, Berner LA, Cusack A, Nakamura T, Bailer UF, et al. A pilot open series of lamotrigine in DBT-treated eating disorders characterized by significant affective dysregulation and poor impulse control. Borderline Personal Disord Emot Dysregulation. 2017; doi:10.1186/s40479-017-0072-6

29.  Turner H, Marshall E, Wood F, Stopa L, Waller G. CBT for eating disorders: The impact of early changes in eating pathology on later changes in personality pathology, anxiety and depression. Behav Res Ther. 2016; doi:10.1016/j.brat.2015.11.011

30.  Wilson GT, Wilfley DE, Agras WS, Bryson SW. Psychological treatments of binge eating disorder. Arch Gen Psychiatry. 2010; doi:10.1001/archgenpsychiatry.2009.170

31.  Wisniewski L, Ben-Porath DD. Dialectical behavior therapy and eating disorders: The use of contingency management procedures to manage dialectical dilemmas. American Journal of Psychotherapy. 2015.

32.  Wonderlich SA, Peterson CB, Crosby RD, Smith TL, Klein MH, Mitchell JE, et al. A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa. Psychol Med. 2014; doi:10.1017/S0033291713001098

33.  Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010; doi:10.1103/PhysRevB.91.121108



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