In the current dissertation the effectiveness and cost-effectiveness of Featback, an internet-based self-help intervention for eating disorders, and online support by individuals with a lived... Show moreIn the current dissertation the effectiveness and cost-effectiveness of Featback, an internet-based self-help intervention for eating disorders, and online support by individuals with a lived experience of an eating disorder were investigated. The findings suggest that low-threshold internet-based interventions for eating disorders, such as Featback, can complement existing treatment options in three ways. First, they have been repeatedly found to be effective in reducing eating disorder symptomatology. Second, such interventions can reach individuals that are currently not reached by other forms of treatment and stimulate them to get professional help. Finally, internet-based interventions are likely to be cost-effective compared to care as usual. Concordantly, implementing highly scalable and easily accessible interventions like Featback likely helps to reduce both the individual and societal burden of eating disorders. Show less
Purpose: Most of the network approaches in eating disorders found the highest degree of centrality for symptoms related to weight and shape concerns. However, longitudinal analyses are scarce and... Show morePurpose: Most of the network approaches in eating disorders found the highest degree of centrality for symptoms related to weight and shape concerns. However, longitudinal analyses are scarce and may increase our insight of the complex characteristics and dynamics over time. In the current study, an alternative non-linear method to perform longitudinal network analyses, the dynamic time warp approach, was used to examine whether robust dimensions of eating disorder psychopathology symptoms could be found based on the individual dynamic interplay of eating disorder symptoms co-occurrence patterns in time. Methods: The study sample included a naturalistic cohort of patients (N = 255) with all eating disorder subtypes who were assessed with the eating disorder examination questionnaire (EDE-Q) at a minimum of four times during treatment. Dynamic time warp analyses yielded distance matrices within each individual patient, which were subsequently aggregated into symptom networks and dimensions at the group level. Results: Aggregation of the individual distance matrices at the group level yielded four robust symptom dimensions: 1. restraint/rules, 2. secret eating/fasting, 3. worries/preoccupation, and 4. weight and shape concern. The items 'fear of weight gain' and 'guilt' were bridge symptoms between the dimensions 1, 3 and 4. Conclusion: Dynamic time warp could capture the within-person dynamics of eating disorder symptoms. Sumscores of the four dimensions could be used to follow patients over time. This approach could be applied in the future to visualize eating disorder symptom dynamics and signal the central symptoms within an individual and groups of patients. Show less
Background: The prognosis for underweight individuals with an eating disorder (ED) and posttraumatic stress disorder (PTSD) is worse than for their peers without these comorbid symptoms. This... Show moreBackground: The prognosis for underweight individuals with an eating disorder (ED) and posttraumatic stress disorder (PTSD) is worse than for their peers without these comorbid symptoms. This qualitative study explores the experiences of trauma-focused Imagery Rescripting (ImRs) therapy of underweight inpatients being treated for an ED. Objective: To test the feasibility and to improve ImRs by understanding the experiences and perspectives of people with an ED and PTSD who, when underweight, received ImRs as an adjunct to their inpatient ED treatment. Method: To explore how underweight people with an ED experience and perceive ImRs, we used a qualitative study design involving semi-structured interviews with 12 participants. After analysis, the data were summarized and classified within a thematic framework that focused on experiences and improving the ImRs method. Results:The thematic analysis resulted in the following 6 main themes; (1) Expectations of ImRs; (2) Ability to participate in ImRs; (3) Effect of ImRs; (4) Experience of ImRs technique; (5) Conditions under which ImRs is given; (6) In depth-analysis. The results show that despite the fear of disappointment the participants appreciate addressing the PTSD and ED symptoms simultaneously. Further, results showed that it had been possible for them to attend ImRs but that the effects of ImRs were not uniformly perceived. Also, participants indicated that a caring context is important and that ImRs should not be scheduled immediately before a meal. Finally, the treatment generated hope. Conclusions: The findings of this study demonstrated the feasibility of the integration of ImRs trauma treatment for individuals who are being treated in an ED inpatient treatment setting, and are in contrast to standard practice where the focus of inpatient treatment has been ED-symptom improvement without comprehensively addressing past traumatic experiences during an underweight phase. Show less
Rohrbach, P.J.; Dingemans, A. E.; Spinhoven, P.; Ginkel, J.R. van; Fokkema, M.; Wildermans, T.F.; ... ; Furth, E.F. van 2022
Objective: Many individuals with an eating disorder do not receive appropriate care. Low-threshold interventions could help bridge this treatment gap. The study aim was to evaluate the... Show moreObjective: Many individuals with an eating disorder do not receive appropriate care. Low-threshold interventions could help bridge this treatment gap. The study aim was to evaluate the effectiveness of Featback, a fully automated online self-help intervention, online expert-patient support and their combination.Method: A randomized controlled trial with a 12-month follow-up period was conducted. Participants aged 16 or older with at least mild eating disorder symptoms were randomized to four conditions: (1) Featback, a fully automated online selfhelp intervention, (2) chat or email support from a recovered expert patient, (3) Featback with expert-patient support and (4) a waiting list control condition. The intervention period was 8 weeks and there was a total of six online assessments. The main outcome constituted reduction of eating disorder symptoms over time. Results: Three hundred fifty five participants, of whom 43% had never received eating disorder treatment, were randomized. The three active interventions were superior to a waitlist in reducing eating disorder symptoms (d = -0.38), with no significant difference in effectiveness between the three interventions. Participants in conditions with expert-patient support were more satisfied with the intervention. Discussion: Internet-based self-help, expert-patient support and their combination were effective in reducing eating disorder symptoms compared to a waiting list control condition. Guidance improved satisfaction with the internet intervention but not its effectiveness. Low-threshold interventions such as Featback and expert-patient support can reduce eating disorder symptoms and reach the large group of underserved individuals, complementing existing forms of eating disorder treatment. Public significance statement: Individuals with eating-related problems who received (1) a fully automated internet-based intervention, (2) chat and e-mail support by a recovered individual or (3) their combination, experienced stronger reductions in eating disorder symptoms than those who received (4) usual care. Such brief and easyaccess interventions play an important role in reaching individuals who are currently not reached by other forms of treatment. Show less
The results described in this thesis support the strong empirical evidence for the effectiveness of CBT-Ef for patients with an eating disorder and a BMI>17.5. When compared to TAU, we found... Show moreThe results described in this thesis support the strong empirical evidence for the effectiveness of CBT-Ef for patients with an eating disorder and a BMI>17.5. When compared to TAU, we found comparable effects on eating disorder psychopathology, however CBT-Ef is superior in enhancing self-esteem with significantly fewer sessions and within a shorter time. We found no support for the hypothesis that more severe self-esteem problems, higher levels of perfectionism, or more interpersonal problems would obstruct long-term improvement and would therefore need extra attention in an extended protocol. A broader use of CBT-Ef in clinical practice could result in more efficient and accessible treatment for patients with an eating disorder. In another study we found COMET to be effective in enhancing self-esteem in patients with an eating disorder. Since we did not find the predictive value of low self-esteem in CBT-E treatment outcome, we suggest to integrate COMET in an eating disorder treatment only when low self-esteem is pronounced and interferes with making progress. Show less
Background The prevalence of eating disorders has been assumed to be low in the Arab world, due to the alleged absence of the thin ideal. However, the Arab world is undergoing rapid sociocultural... Show moreBackground The prevalence of eating disorders has been assumed to be low in the Arab world, due to the alleged absence of the thin ideal. However, the Arab world is undergoing rapid sociocultural changes, and there are reports of an increase of the desire to be thin. This literature review therefore provides point-prevalence of Arabs at high risk for eating disorders, and a comprehensive synthesis of correlates of eating disorder symptoms, eating disorder-related variables and of a high risk for eating disorders. Method Several electronic databases were searched for published, peer-reviewed studies between 1986 and 2019 involving several key terms. From 317 screened studies, 81, mainly cross-sectional, were included. Preferred Reporting Items for Systematic reviews and meta-analyses was used as guidance and the quality of studies were assessed using the Newcastle-Ottawa scale. Results Estimates of individuals at high risk for eating disorders ranged from 2 to 54.8%. The eating disorder-related variables identified were desire to be thin, body dissatisfaction, disturbed-, and dieting- eating behavior. Identified correlates were increased affluence, media use, western influences, and obesity. An additional finding was that in some cases eating disorders were expressed somatically rather than psychiatrically. Discussion In the Arab world, females were most at risk for eating disorders and eating disorder symptoms. Sociocultural changes gave rise to the thin ideal and the prevalence of obesity, increasing the risk for the development of eating disorder-related variables and eating disorders. The literature on eating disorders in the Arab world suffers from potential limitations due to the use of non-validated assessment tools. Further research is necessary, particularly on the development and validation of a culturally sensitive assessment tool. Improved knowledge is likely to increase the number of people seeking treatment and decrease the stigma of psychotherapy. Show less
Yellowlees, R.; Dingemans, A.E.; Veldhuis, J.; Bij de Vaate, A.J.D. 2019
IntroductionWith the rise of camera phones, selfie-taking has become a normative part of our modern culture. However, little is known about how this behavior may relate to eating disorder (ED)... Show moreIntroductionWith the rise of camera phones, selfie-taking has become a normative part of our modern culture. However, little is known about how this behavior may relate to eating disorder (ED) characteristics, particularly in those who already have eating disorder symptoms of clinical severity. The current study investigated how selfie-posting and selfie-taking with no intention of posting online (offline selfies) were related to ED symptoms.MethodA total of 152 females (average age 22.44 years) with ED symptoms of clinical severity completed self-report questionnaires measuring selfie-frequency (online and offline), frequency of non-selfie photo posting, social networking site use, body dissatisfaction, body checking, ED symptom severity, self-esteem and body avoidance. Responses were collected via an ED social community.ResultsNo direct relationship, or indirect association via body dissatisfaction, was found between selfie behavior and ED symptom severity. However, the more offline selfies an individual took, the more frequently they body checked, and this, in turn, was related to greater ED symptom severity.ConclusionsThese results suggest that offline selfies may be a modern form of body checking. Our findings are the first to imply that offline selfie-taking may be a problematic behavior and a potential maintenance factor for individuals with severe ED symptoms. Show less
Aardoom, J.J.; Dingemans, A.E.; Fokkema, M.; Spinhoven, P.; Furth, E.F. van 2017
The aim of this dissertation was to investigate whether and how E-health can help to improve health care for individuals with eating disorder symptoms. The main goal was to evaluate two E-health... Show moreThe aim of this dissertation was to investigate whether and how E-health can help to improve health care for individuals with eating disorder symptoms. The main goal was to evaluate two E-health interventions: e-community ‘Proud2Bme’ and fully automated Internet-based intervention ‘Featback’. The effectiveness and cost-effectiveness of Featback with and without therapist support in comparison to a waiting was examined in a randomized controlled trial. Furthermore, potential moderators and mediators were investigated: what works for whom and what is the psychological mechanism that explains how Featback achieves its beneficial effects? Also, all online therapist communication within the Featback intervention was qualitatively examined. What did therapists actually do within the online support sessions as offered in addition to Featback? And can therapist behaviors predict participants’ outcome and satisfaction? Finally, this dissertation includes a systematic review of treating eating disorders over the Internet, as well a chapter about the emerging findings, issues, and opportunities regarding E-health for eating disorders in the past few years (2013-2015). How effective are Internet-based self-help interventions, -treatment, and -relapse prevention programs? What is the potential of Smartphone applications in treating eating disorders? What are the opportunities and challenges for the development and implementation of E-health for eating disorders? Show less
Jong, M. de; Korrelboom, K.; Meer, I. van der; Deen, M.; Hoek, H.W.; Spinhoven, P. 2016
The first aim of this study was to provide norms for the Eating Disorder Examination Questionnaire (EDE-Q) in a diverse and large clinical sample of individuals with an eating disorder (ED), and a... Show moreThe first aim of this study was to provide norms for the Eating Disorder Examination Questionnaire (EDE-Q) in a diverse and large clinical sample of individuals with an eating disorder (ED), and a general population sample without an ED. Norms for individuals with obesity without an ED were also provided, as a more relevant comparison group for individuals with binge eating disorder. The second aim was to investigate the discriminative validity of the EDE-Q. A sample of females with an ED (N=935), women from the general population without an ED (N=235), and obese females without an ED (N=321) completed the EDE-Q Explorative factor analyses did not support the theorized four subscales of the EDE-Q. Norms for EDE-Q global scores were provided for each of the three samples. Within the ED sample, norms were provided separately for patients with different ED diagnoses. Receiver operating characteristic analyses showed the EDE-Q global score to be highly accurate in discriminating individuals with an ED from those without, and moderately accurate in discriminating individuals with binge eating disorder from those with obesity. The presented norms contribute to a more accurate interpretation of EDE-Q scores, providing an index of the severity level of ED psychopathology. Furthermore, these norms can be used to assess clinical significant change during treatment. In addition, this study demonstrates that the EDE-Q when using its global score, is a valid instrument to assess levels of ED psychopathology. (C) 2012 Elsevier Ltd. All rights reserved. Show less
In this thesis, a series of studies on different aspects of the genetics of eating disorders is presented. The heritability of disordered eating behavior and attitudes in relation with body mass... Show moreIn this thesis, a series of studies on different aspects of the genetics of eating disorders is presented. The heritability of disordered eating behavior and attitudes in relation with body mass index (BMI) was evaluated in a large adolescent twin-family sample ascertained through the Netherlands Twin Registry. Furthermore, the association of four candidate genes with anorexia nervosa and eating disorders characterized by self-induced vomiting was tested in a female patient group from the Genetics of Eating Disorder (GenED) study and a female control group from the Netherlands Twin Registry. Subsequently the observed association between the Tryptophan Hydroxylase 2 (TPH2) gene and eating disorders was investigated further. In a group of random controls and a group of patients with an eating disorder it was evaluated if the TPH2 gene was also associated with two potential risk factors for eating disorders: perfectionism and impulsivity. The results shed more light on the relationship between these factors and eating disorders. Show less
