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  Objective: Problems with the current DSM-IV eating disorder (ED) section have resulted in proposed changes toward the upcoming DSM-5 (http://www.dsm5.org/ProposedRevisions/Pages/EatingDisorders.aspx). We investigated consequences of these by implementing the proposal in a large naturalistic database.

Method: Patients were 2584 children/adolescents and adults enrolled at specialized ED clinics in Sweden. DSM-IV diagnoses anorexia nervosa, bulimia nervosa, and “not otherwise specified” examples were compared with DSM-5 anorexia, bulimia and binge eating disorder, as well as atypical anorexia, subthreshold bulimia and binge eating, purging disorder, and the residual unspecified category. Assessment methods included a semi-structured diagnostic interview and self-ratings of ED- and psychiatric symptoms.

Results: We studied age-separated diagnostic distributions and explained variance in clinical variables associated with the two systems. Results showed some improvement of diagnostic specification as well as a slight increase in explained variance.

Discussion: Remaining problems with the proposed changes were also highlighted, and possible further refinement is discussed.

OBJECTIVE: Improvements in psychological symptoms and weight have often been demonstrated following eating disorder (ED) treatment, but it is not clear to what extent eating behaviour itself is normalised. This cross-sectional study aimed to investigate dietary habits and eating behaviour in ED patients three years after entering treatment. METHOD: ED patients (N=70) were divided into those who had recovered (N=36), and those who still suffered from bulimic (N=18) or anorexic (N=16) psychopathology. Patients were compared to a female normal control group of similar age (N=61), and assessments were made on a dietary questionnaire, as well as the BDI, EDI-2, SASB and SCL-90. RESULTS: With some notable exceptions eating patterns in recovered patients resembled those of con- trols. Dieting was most evident in recovered and current bulimic patients, while restrictive eating and vegetarianism was found in recovered or current anorexic patients. A majority of the patients with ongoing EDs avoided fatty foods. DISCUSSION: Risk behaviours such as restrictive eating, dieting and food avoidance, may have an important impact on relapse rates, and it may therefore be imperative to continue to monitor eating behaviour in ED patients following treatment termination to ensure better long-term outcome.

Optimal use of assessment instruments for the detection and diagnosis of eating disorders (ED) depends on the availability of normative data. The aim of this work was to, for the first time, collect norms for both the Eating Disorder Examination Questionnaire (EDE-Q) and the newly developed Clinical Impairment Assessment (CIA) Scale from a general population of young women in Sweden, as well as from a clinical population of ED patients in Sweden. Participants were composed of both a randomized sample from the general population of women aged 18-30 years (N = 760) as well as from a clinical population aged 18-66 years (N = 2383). Data for the clinical population was extracted from the Stepwise database. Mean scores, standard deviations and percentile ranks for the global for the EDE-Q (as well as its subscales) and the CIA are presented. Prevalence figures of key eating disorder behaviors are also reported. Comparisons are made between the results in the present study with other existing normative studies on the EDE-Q and the CIA. The present study contributes to improving the accuracy of the interpretation of scores of the widely used self-report measure of ED, the EDE-Q, and the CIA, both of which play important roles in for diagnosis, prevention and intervention of ED.

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Computer-based quality assurance of specialist eating disorder (ED) care is a possible way of meeting demands for evaluating the real-life effectiveness of treatment, in a large-scale, cost-effective and highly structured way. The Internet-based Stepwise system combines clinical utility for patients and practitioners, and provides research-quality 

naturalistic data. Stepwise was designed to capture relevant variables concerning EDs and general psychiatric status, and the database can be used for both clinical and research purposes. The system comprises semi-structured diagnostic interviews, clinical ratings and self-ratings, automated follow-up schedules, as well as administrative functions to facilitate registration compliance. As of June 2009, the system is in use at 20 treatment units and comprises 2776 patients. Diagnostic distribution (including subcategories of eating disorder not otherwise specified) and clinical characteristics are presented, as well as data on registration compliance. Obstacles and keys to successful implementation of the Stepwise system are discussed, including possible gains and on-going challenges inherent in largescale, Internet-based quality assurance. Copyright # 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

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Abstract The field of eating disorders is currently at a crossroads and faces important challenges of sustainability. These challenges include problems with the current diagnostic classification of eating disorders and the divide between scientific research and clinical practice. If not addressed, there is a danger that the field will fail to evolve adaptively, risking increased stagnation and reduced relevance. To meet these challenges, researchers and clinicians must work toward a more holistic ecology of eating disorders based on the interaction of theory, research and practice. The present paper proposes six steps towards increased sustainability based on developing clinically relevant diagnosis, using systematic quality assurance, expanding the scope of treatment research and the definition of evidence, promoting therapist development, as well as stimulating diversity and discourse. If we rise to the occasion and face these challenges, then we will be better equipped to meet the evolving needs of clinicians, researchers, and most importantly patients. Länk till artikeln.

OBJECTIVE: The study investigated initial self-image (structural analysis of social behavior) and its relation to 36-month outcome, among patients with anorexia nervosa and bulimia nervosa. Hypotheses were that degree of different aspects of self-image would predict outcome in the groups. METHOD:: Participants were 52 patients with anorexia and 91 with bulimia from a longitudinal naturalistic database, and outcome measures included eating disorder and psychiatric symptoms and a general outcome index. Stepwise regression was used to investigate which self-image variables were related to outcome, and multiple regression contrasted the groups directly on each obtained predictor. RESULTS:: Consistent with hypotheses, in bulimia degree of self-hate/self-love moderately predicted outcome, whereas self-control-related variables powerfully predicted outcome in anorexia. CONCLUSION:: It is important to focus on self-image in the treatment of both diagnostic groups, but especially in anorexia nervosa, where control-submission interactions between patient and therapist should be handled with care. (c) 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009. Länk till artikeln

INTRODUCTION: There is a lack of knowledge about the outcome of eating disorder patients who terminate treatment prematurely. The present study followed-up eating disorder patients who had previously dropped out of treatment and examined clinical status 36 months after intake. METHOD: Dropouts (n = 30) were compared with treatment completers (n = 52) on diagnostic status, clinical symptoms, psychosocial adjustment and treatment satisfaction at follow-up. Patterns of change from intake to follow-up within groups, as well as between groups, were explored. RESULTS: No significant differences were found between groups at follow-up, except for more treatment dissatisfaction reported among dropouts. When patterns of change were examined between groups, patients who completed treatment were found to have made significantly greater changes (less eating disorder symptoms, less psychological problems and more positive self-image) compared to dropouts. DISCUSSION: Although no significant differences in outcome were found between dropouts and completers, greater clinical improvement was found among those who completed treatment. The dropouts examined in this study did well despite premature termination of treatment. Clinical and research implications are discussed.

Introduction. Drop-out from treatment is a serious problem in eating disorders which remains poorly understood. The present study investigated whether self-image and interpersonal theory could help to explain why eating disorder patients drop out of treatment.

Method. Intake data on eating disorder patients who terminated treatment prematurely (N = 54) were compared with patients who had completed treatment (N = 54) and those who were still in treatment after 12 months (N = 54). Self-image was assessed using the structural analysis of social behaviour (SASB), and comparisons were made on demographic and clinical variables.

Results. Patients who dropped out had initially presented with less negative self- image and fewer psychological problems compared with remainers. Low levels of SASB self-blame discriminated drop-outs from completers and remainers and significantly predicted treatment drop-out.

Discussion. Drop-out in eating disorders appears to be a complex phenomenon, not necessarily as pathological as often assumed. There may be important differences in the treatment goals of drop-outs and therapists; patients who drop out may be choosing to disengage at a time when symptom improvement creates space for closer examination of interpersonal issues.

Introduction: Negative self-image has been hypothesised to be of aetiological significance in eating disorders; however, its relationship to outcome remains unclear. The present study examined the relationship between self-image and follow-up status in a heterogeneous sample of eating disorder patients (N=246). Methods: Patients were assessed at intake and after 36 months. Self-image was measured using SASB, and a general outcome measure was calculated comprising eating disorder symptoms, occupational status, interpersonal relationships and general psychopathology.

Results: SASB self-hate was the most important variable for predicting poor outcome, followed by occupational status, interpersonal relationships, eating disorder symptoms, SASB self-emancipation and general psychiatric symptoms. Together these variables predicted 23% of the variance in outcome. Discussion: High levels of self-hate may increase the risk of poor outcome in eating disorders by adversely affecting interpersonal relationships and making it difficult for patients to engage in treatment.

The present study explored treatment satisfaction among eating disorder patients participating in a Swedish multicentre study (N=469) who had been followed up 36 months after initial assessment. Satisfaction was measured using a questionnaire focusing on initial reception at the treatment unit, suitability of treatment, ability of staff to listen and understand, confidence in the unit and agreement on treatment goals. After 36 months, 38% of patients were ‘highly satisfied’ with treatment, while 39% were ‘satisfied’ and 23% were ‘unsatisfied’. Satisfaction was predicted by treatment interventions focusing on support and increased control of eating problems. Although unsatisfied patients were characterized by significantly higher levels of eating disorder psychopathology and psychiatric symptoms as well as more negative interpersonal profiles at follow-up, these patients had been virtually indistinguishable from the other groups at initial assessment, with a few notable exceptions. Unsatisfied patients had previously been less prepared to change their eating habits, had higher levels of conflict with their fathers, had a lesser degree of present weight acceptance and tended to expect less from treatment interventions focusing on control of eating problems. It is concluded that, although we may be successful in engaging and satisfying patients who are predisposed to therapeutic strategies focusing on support and control of eating problems, we may be less successful with those who have a greater number of interpersonal problems and who are not as focused on their symptoms of disordered eating. 

IIntroduction. The optimal classification of eating disorders has been a matter of considerable debate. The present paper tackles this issue using cluster analysis with large independent samples of eating-disorder patients.

Method. Two samples of adult female patients from Sweden (n=631) and England (n=472) were classified on the basis of 10 key clinical variables of primary significance for diagnosing eating disorders. A separate series of cluster analyses were conducted on each sample.

Results. Results suggested that a three-cluster solution was optimal in both samples. The first cluster (‘generalized eating disorder’) was characterized by high levels of eating-disorder psy- chopathology on all variables except weight and menstrual functioning. The second cluster (‘anorexics’) was typified by low weight, amenorrhoea and the absence of binge eating, and seemed to correspond to the clinical picture of anorexia nervosa. The third cluster (‘overeaters’) was characterized by high weight and moderate levels of binge eating and compensatory behaviour.

Conclusions. Results suggest that patients presenting to eating-disorder services in different coun- tries have clinical features that fall into very similar patterns. These patterns resemble, but are not identical to, existing diagnostic categories.

 Introduction: Although evidence suggests that interpersonal psychotherapy may be an ef􏰟cacious treatment for eating disorders, there is surprisingly little systematic knowledge about the interpersonal world of these patients.

Method: SASB self-image ratings were used to explore interpersonal pro􏰟les in a large heterogeneous sample of eating disorders (N = 830), matched normal controls (N = 105) and a small group of controls with subclinical depression (N = 26).

Results: Eating disorder patients clearly presented with signi􏰟cantly more negative interpersonal pro􏰟les compared to controls. Within the eating disorder group, anorexics were characterized by high self-control, self-blame and self-attack. Patients with binge eating disorder expressed the least negative self-image, and were signi􏰟cantly more self-af􏰟rming than bulimics and less self-controlling than patients with atypical eating disorders.

Conclusions: Eating disorder patients may have distinct interpersonal pro􏰟les that increase the risk of negative therapeutic reaction. Better knowledge of interpersonal processes in eating disorders may help to improve both diagnostic assessment and treatment.