Breana Hessing 1, Amy Lampard 1, Kimberley Hoiles 2, Julie McCormack 2, Jasmine Smithers 2 * and Kirsty Bulloch 2 *

Transcription

1 EXAMINING COGNITIVE PSYCHOPATHOLOGY AND BEHAVIOURAL SYMPTOMS OF EATING DISORDERS ACROSS BINGE/PURGE PROFILES. Breana Hessing 1, Amy Lampard 1, Kimberley Hoiles 2, Julie McCormack 2, Jasmine Smithers 2 * and Kirsty Bulloch 2 * 1 School of Psychology and Speech Pathology, Curtin University, Perth, Australia 2 Eating Disorders Program, Specialised Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Australia AAAH Youth Health Conference Melbourne, 2015

2 Eating Disorders 22 AN binge purge AN restrictive BN purge type Binge Eating Disorder BN non purge type ED Not otherwise specified Fussy eating Selective eating

3 Case Study 15y.o. assessed Oct2014: Diagnosed with AN; hospitalised 6 month review: AN binge/purge type (episodes of self induced vomiting followed by restriction) 12 month review: BN purge type (purging 7 times daily)

4 Spectrum of Disordered Eating Natural Eating Dieting Disordered Eating Subclinical Eating Disorder Clinical Eating Disorder Positive body image Increasing body dissatisfaction Severe body dissatisfaction No good/bad foods Mostly positive feelings about shape/size Regular moderate exercise Normal, stable body weight Preoccupation with shape/size/eating Occasional guilt around eating bad foods Occasional binge eating Minimal or compulsive physical activity Unhealthy weight loss/gain Distress about weight/ shape/size/eating Preoccupation with food and body interferes with daily activities Working hard to change body and compensating for eating Rigidity with eating patterns Binge eating, fasting, vomiting, extreme or no exercise/physical activity Compromised physical status

5 Eating Disorder Program Services Princess Margaret Hospital WA Outpatient, outreach, day-patient & inpatient Responsive to acute and longer term Inter-disciplinary Training, consultation and supervision Research

6 HOPE Project Helping to Outline Paediatric Eating Disorders Clinical cohort project To cultivate discovery of new knowledge about paediatric eating disorders

7 Research Paper: Binge/Purge Profiles Subjective bing eating with purging All participants engage in purging Objective binge eating with purging Purging only (no BE)

8 Participants Inclusion criteria Female adolescents (13-17) from service inception (1996) to July 2015 Have engaged in purging behaviours Dx of DSM-5 eating disorder Males Children < 13 years N = 230 OBE n = 96 SBE n = 50 No BE n = 84

9 Previous Findings OBE vs. non-obe: (Binford & Le Grange, 2005) OBE vs. SBE: (Fitzsimmons-Craft et al., 2014) Both studies did not control for BMI Studies have yet to compare all 3 groups (OBE vs. SBE vs. Purging)

10 Study Aim OBE SBE Purging only Aim: Do these 3 groups differ on eating disorder symptoms?

11 Measures The Eating Disorder Examination (EDE; Fairburn & Cooper, 1993) Cognitive variables Restraint Eating concern Weight concern Shape concern Behavioural variables Fasting, self-induced vomiting, laxative and diuretic misuse, excessive exercise over the previous 28 days Medical Assessment Duration of illness (months) BMI z-score was calculated with Epi Info 7

12 Results - Descriptive Variables Mean age = 15.5, SD = 0.96 Duration of illness = 10 months BMI z-score (p <.001) Differed across the 3 groups: Purging 14% BN-low freq 6% UFED 4% AN-R 7% AN-B/P 15% SBE < No BE < OBE BN 31% Aty-AN 23%

13 Results Cognitive Variables MANOVA revealed a significant difference between the 3 groups (OBE, SBE, purge only) on the combined cognitive variables, F (8, 450) = 6.58, p = <.001, partial η 2 =.105. Weight concern F (2) = 5.31, p =.006, est. ω2 =.05 SBE & OBE > Purging only Shape concern F (2) = 7.38, p =.001, est. ω2 =.06 SBE & OBE > Purging only Eating concern F (2) = 17.65, p <.001, est. ω2 =.53 SBE & OBE > Purging only Restraint F (2) = 5.41, p =.005, est. ω2 =.04

14 Results Behavioural Variables After controlling for BMI-z score, the MANCOVA was non-significant, F (6,436) =.627, p =.709, partial h 2 =.009, indicating no group differences on self-induced vomiting, fasting and driven exercise OBE SBE No BE Self-induced vomiting episodes 21 ± 4-43 (0-141) 11 ± 4-29 (0-82) 16 ± 4-28 (0-140) Driven exercise (minutes per day) 30 ± 0-70 (0-203) 30 ± 0-60 (0-196) 30 ± 0-62 (0-239) Fasting 6 ± 5-6 (0-6) 6 ± (0-6) 6 ± 4-6 (0-6) Note: median and IQR (range are displayed.

15 Results - Discriminate Function Analysis DFA: to determine if the 3 groups could be differentiated by eating disorders cognitions and behaviours 2 discriminant functions Function 1: 80.6% of the variance, canonical R 2 =.17 Function 2: 19.4% of variance, canonical R 2 =.05. Together these discriminant functions differentiated the groups, Λ = 0.79, χ 2 (14) = 53.71, p<.001, but removing the first function showed that the second function did not differentiate the groups Λ = 0.95, χ 2 (6) = 11.03, p>.05. Function 1 2 Restraint Eating concern Shape concern Weight concern Fasting Self-induced vomiting Driven exercise

16 In Summary The purging only group had reported the least eating disorder cognitions compared to OBE and SBE The OBE and SBE group did not differ on eating, shape or weight concern. No difference in Restraint No difference in compensatory behaviours Higher levels of eating concern was the best predictor of group membership - Specifically, a higher eating concern predicted OBE

17 Food for Thought Symptom profile vs. diagnosis Purge only group least cognitions. Other factors? Size of BE vs. loss of control Restraint did not differ across groups Purge only groups reported lower cognitions, but same frequency of compensatory behaviours Co-morbidities - Watson et. Al (2013)

18 Limitations Cognitions and behaviours were assessed over a 28 day period Males could not be included (~7% of referrals) Findings are generalizable to a tertiary ED setting

19 References Binford, R. B., & le Grange, D. (2005). Adolescents with bulimia nervosa and eating disorder not otherwise specified-purging only.international Journal of Eating Disorders, 38, doi: /eat Fairburn, C.G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a Transdiagnostic theory and treatment. Behaviour Research and Therapy, 41, Fitzsimmons-Craft, E. E., Ciao, A. C., Accurso, E. C., Pisetsky, E. M., Peterson, C. B., Byrne, C. E., & Le Grange, D. (2014). Subjective and objective binge eating in relation to eating disorder symptomatology, depressive symptoms, and self-esteem among treatment-seeking adolescents with bulimia nervosa. European Eating Disorders Review,22, Doi: /erv Watson, H. J., McCormack, J., Hoiles, K. J., Forbes, D., & Potts, J. (2013). The HOPE (Helping to Outline Paediatric Eating Disorders) project: Development and debut of a paediatric clinical eating disorder registry.journal of Eating Disorders, 1, doi: /

20 ACKNOWLEDGEMENTS Supported by Department of Health in Western Australia Targeted Research Fund

21 Thank you Questions?