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Biomedical subjects

Carlos M Grilo

Publications and source records attributed to Carlos M Grilo.

At least 19 recordsLinked to original sources
PubMed2007

Physical activity and its correlates in treatment-seeking obese patients with binge eating disorder.

OBJECTIVE: This study examined the physical activity levels reported by obese individuals with binge eating disorder (BED), as well as the relationships between physical activity and body mass index (BMI), features of eating disorders, and associated psychological variables. METHOD: A series of 166 obese treatment-seeking adults (121 women and 45 men) with BED were administered structured diagnostic interviews and self-report questionnaires. RESULTS: This clinical group was found to be extremely sedentary. Self-reported physical activity levels, measured by the Paffenbarger Physical Activity Questionnaire, were comparable with those reported by obese samples with or without binge eating in other studies, but were considerably lower than those reported by a community sample. Lifestyle physical activity (e.g., amounts of walking and stair climbing) and sports and recreational physical activity were unrelated to most clinical characteristics. BMI was significantly, albeit weakly, associated with reported sports and recreational activities in women, but not in men. CONCLUSION: Our findings highlight the degree to which obese patients with BED are inactive. Physical activity was largely uncorrelated with measures of eating disorder and psychological functioning in both men and women but was significantly, but weakly, correlated with BMI in women. Additional research is needed to determine the clinical value of physical activity for this patient group.

Adult↗
PubMed2007

Symptom severity in obese women with binge eating disorder as a function of smoking history.

OBJECTIVE: To compare obese female former smokers with binge eating disorder (BED) to women with BED with no smoking history in the severity of binge eating and associated symptoms. METHOD: A consecutive series of 91 obese women with current diagnoses of BED were administered structured diagnostic and investigator-based interviews and self-report questionnaires to assess symptoms associated with eating disorders. Participants were classified as "never" or "former" smokers and symptom profiles were compared across smoking groups. RESULTS: Former and never-smoking groups did not differ in age, body mass index, or current binge frequency. Former smokers reported significantly higher levels of dietary restraint, rigid dieting strategies, and avoidance of eating. CONCLUSION: Former smokers were significantly more likely than never-smokers to endorse specific symptoms of eating pathology (i.e., rigid dieting strategies). Despite the average 15-year interval since smoking cessation, the former smokers in this patient group resembled current smokers with other eating disorders in terms of rigid and restrictive weight control methods. Obese patients with a smoking history may benefit from treatment to address rigid/pathological dieting and strategies.

Bulimia Nervosa↗
PubMed2007

Timing and sequence of the onset of overweight, dieting, and binge eating in overweight patients with binge eating disorder.

OBJECTIVE: To examine the self-reported sequence and timing of onset of overweight, binge eating, and dieting in adult patients diagnosed with binge eating disorder (BED). METHOD: Participants were 284 treatment-seeking adults (73 men and 211 women) who met DSM-IV research criteria for BED. Patients were interviewed with structured diagnostic interviews and were queried regarding history of overweight, dieting, and binge eating behaviors. Questionnaires were also administered to assess current eating disturbances, body dissatisfaction, and general functioning. Participants were classified as Overweight First, Binge First, or Diet First, and the three groups were compared on developmental sequence and using the battery of measures. RESULTS: Sixty-three percent of the 284 participants reported becoming overweight prior to the onset of dieting or binge eating. Participants who reported they were overweight first had significantly greater BMI at the time of assessment. The 16% of the participants who reported binge eating first were significantly younger at the onset of BED diagnosis and reported significantly less dietary restraint. Onset order differed significantly by gender; proportionally more women (25%) than men (11%) reported that dieting preceded overweight or binge eating. CONCLUSION: Weight problems preceded dieting and binge eating behaviors for a majority of treatment-seeking overweight participants diagnosed with BED.

Adaptation, Psychological↗
PubMed2006

Comparison of alternative models for personality disorders.

BACKGROUND: The categorical classification system for personality disorder (PD) has been frequently criticized and several alternative dimensional models have been proposed. METHOD: Antecedent, concurrent and predictive markers of construct validity were examined for three models of PDs: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP) model and the DSM-IV in the Collaborative Study of Personality Disorders (CLPS) sample. RESULTS: All models showed substantial validity across a variety of marker variables over time. Dimensional models (including dimensionalized DSM-IV) consistently outperformed the conventional categorical diagnosis in predicting external variables, such as subsequent suicidal gestures and hospitalizations. FFM facets failed to improve upon the validity of higher-order factors upon cross-validation. Data demonstrated the importance of both stable trait and dynamic psychopathological influences in predicting external criteria over time. CONCLUSIONS: The results support a dimensional representation of PDs that assesses both stable traits and dynamic processes.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2006

The Spanish language version of the Eating Disorder Examination Questionnaire: comparison with the Spanish language version of the eating disorder examination and test-retest reliability.

This study compared the Spanish language questionnaire (S-EDE-Q) and interview (S-EDE) versions of the Eating Disorder Examination and examined the short-term test-retest reliability of the questionnaire version. Seventy-seven monolingual Spanish-speaking Latina women recruited from the community completed the S-EDE-Q and were then administered the S-EDE by fully bilingual doctoral-level research clinicians. The same assessment was repeated after approximately one week (5-14 days). The S-EDE-Q and the S-EDE were significantly correlated on frequencies of binge eating and all four subscales. Mean differences in the frequency of binge eating and the Restraint subscale were not significant, but scores on the Eating Concern, Weight Concern, and Shape Concern subscales differed significantly, with the S-EDE-Q yielding higher scores. Test-retest reliability for the S-EDE-Q was modest for binge eating but was excellent for the subscales (Spearman rho ranged 0.71-0.81), albeit somewhat variable for the individual items. Overall, the acceptable convergence between the S-EDE-Q and the S-EDE for many features of eating disorders and the good short-term test-retest findings provide preliminary support for the use of the S-EDE-Q. These findings, derived using a non-clinical sample of monolingual Spanish-speaking Latina women, require replication and extension. Evaluation with a clinical sample is necessary to further establish the reliability of the S-EDE-Q with an eating disordered group.

Adult↗
PubMed2006

Self-criticism, low self-esteem, depressive symptoms, and over-evaluation of shape and weight in binge eating disorder patients.

Despite the fact that negative self-evaluations are widely considered to be prominent in eating disorders, the role of self-criticism has received little empirical attention. The vast majority of research on the construct of self-criticism has focused on its role as a specific personality vulnerability factor in depression-related phenomena. In this study of 236 patients with binge eating disorder, confirmatory factor analysis supported self-criticism, self-esteem, depressive symptoms, and over-evaluation of shape and weight as distinct, albeit related, constructs. Structural equation modeling demonstrated that the relation between self-criticism and over-evaluation of shape and weight was partly mediated or explained by low self-esteem and depressive symptoms. Continued efforts to understand the role of self-criticism in eating disorders appear warranted.

Adult↗
PubMed2006

Body image and eating disordered behavior in a community sample of Black and Hispanic women.

OBJECTIVE: The current study examined body image concerns and eating disordered behaviors in a community sample of Black and Hispanic women. In addition, this study explored whether there are ethnic differences in the correlates or in the prediction of body image concerns. METHOD: Participants were 120 (67 Black and 53 Hispanic) women who responded to advertisements to participate in a study of women and health. Participants completed a battery of established self-report measures to assess body image, eating disordered behaviors, and associated psychological domains. RESULTS: Black and Hispanic women did not differ significantly in their self-reports of body image, eating disordered behaviors, or associated psychological measures. Comparisons performed separately within both ethnic groups revealed significant differences by weight status, with a general graded patterning of greater concerns in obese than overweight than average weight groups. In terms of predicting body image, multiple regression analyses testing a number of variables, including BMI, performed separately for Black and Hispanic women revealed that eating concern and depressive affect were significant predictors of body image concern for both groups. DISCUSSION: Overall, Black and Hispanic women differed little in their self-reports of body image, eating-disordered features, and depressive affect. Higher weight was associated with a general pattern of increased body image concerns and features of eating disorders in both groups and with binge eating in Black women. Eating concerns and depressive affect emerged as significant independent predictors of body image for both ethnic groups.

Adolescent↗
PubMed2006

Emotional overeating and its associations with eating disorder psychopathology among overweight patients with binge eating disorder.

OBJECTIVE: The current study examined emotional overeating in overweight patients with binge eating disorder (BED). A new measure--the Emotional Overeating Questionnaire (EOQ)--was developed to measure the frequency of overeating in response to emotions. The internal consistency, test-retest reliability, and factor structure of this measure were examined, and its associations with eating disorder psychopathology, depression, and gender were explored. METHOD: Two hundred twenty consecutive overweight (body mass index [BMI] > or = 25) treatment-seeking BED patients (48 men and 172 women) were administered the EOQ, which assesses overeating frequency in response to six emotions (anxiety, sadness, loneliness, tiredness, anger, and happiness). A subset of patients (n = 83) completed the measure again approximately 1 week later. BMI was measured, and participants completed measures of eating disorder psychopathology. RESULTS: The EOQ was internally consistent (alpha =.85), its items were significantly and moderately correlated (range .32 to .70) with each other, and principal components analysis revealed one factor accounting for 58% of the variance. The EOQ items and total score were characterized by good test-retest reliability (intraclass correlation coefficients [ICCs] ranged from .62 to .73). Significant correlations were found between the emotional overeating items and total score, and binge frequency, eating disorder features, and depressive symptomatology. Emotional overeating was unrelated to BMI, and men and women reported similar rates of emotional overeating. CONCLUSION: Emotional overeating was significantly associated with binge frequency, eating disorder features, and depression, but was not related to BMI or gender.

Adult↗
PubMed2006

Body Checking Questionnaire: psychometric properties and clinical correlates in obese men and women with binge eating disorder.

OBJECTIVE: Body checking is considered a behavioral manifestation of the overevaluation of shape and weight, which is characteristic of patients with eating disorders. We examined the initial psychometric properties of the Body Checking Questionnaire (BCQ) and the frequency and nature of body checking behaviors in obese men and women with binge eating disorder (BED). METHOD: Participants were a consecutive series of 73 (22 men, 51 women) treatment-seeking obese adults who met research criteria for BED as defined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). Participants were administered measures to assess body checking, body image concerns, and the core psychopathology of eating disorders, and general psychological functioning. Semistructured interviews were used to establish the diagnosis of BED. RESULTS: Psychometric evidence was found to support the reliability and validity of the BCQ in patients with BED. Women reported significantly greater levels of body checking than men. Participants with greater body dissatisfaction reported more frequent checking than participants with less dissatisfaction. Among women, the frequency of checking was related to younger age, lower body mass index (BMI), body dissatisfaction, overevaluation of body shape and weight, greater depression, and lower self-esteem. CONCLUSION: There exist significant gender and age-related differences in both the frequency and correlates of body checking behaviors. Among obese women with BED, body checking is related to the overevaluation of shape as well as with associated psychopathology.

Body Image↗
PubMed2006

Evaluating oneself by shape and weight is not the same as being dissatisfied about shape and weight: A longitudinal examination in severely obese gastric bypass patients.

OBJECTIVE: This study examined two related and confused body image constructs--overevaluation and body image dissatisfaction--and tested their distinctiveness by examining their longitudinal associations with changes in self-esteem and negative affect. METHOD: One hundred forty-five obese (mean BMI = 51.6, SD = 7.5) patients (16 men and 129 women) completed a battery of self-report measures prior to and six months after undergoing gastric bypass surgery. Measures of body image (overevaluation of shape and weight, and body image dissatisfaction), self-esteem, and negative affect were assessed. RESULTS: Overevaluation and body image dissatisfaction both improved substantially following surgery. Change in overevaluation was significantly correlated only with change in self-esteem (after controlling for negative affect). Whereas change in body image dissatisfaction was significantly correlated with changes in both self-esteem and negative affect; findings for partial correlations remained unchanged. CONCLUSION: These findings demonstrate that evaluating oneself by shape and weight is related to, but not the same as, being dissatisfied about shape and weight. Given that overevaluation is less likely to be influenced by mood, it appears to be a more stable marker for disturbance in body image than body image dissatisfaction. This distinction has important implications for how clinicians and researchers assess these constructs.

Adult↗
PubMed2006

Differential relationships of childhood abuse and neglect subtypes to PTSD symptom clusters among adolescent inpatients.

This article investigates whether childhood abuse and neglect subtypes (i.e., physical, sexual, and emotional abuse, and physical and emotional neglect) differentially predict the severity of individual posttraumatic stress disorder (PTSD) symptom clusters and overall posttraumatic stress. Eighty-nine patients admitted to the short-term adolescent treatment unit of a psychiatric hospital completed a battery of psychological assessments. Findings of multiple regression analyses showed that emotional and sexual abuse rather than physical abuse, emotional neglect, or physical neglect is related to individual symptom cluster severity and overall posttraumatic stress. Results suggested that a greater level of specificity is necessary when assessing child abuse and posttraumatic stress because each level provides more specific information about how to intervene to reduce the risk of negative outcomes.

Adolescent↗
PubMed2006

Personal standards and evaluative concerns dimensions of "clinical" perfectionism: a reply to Shafran et al. (2002, 2003) and Hewitt et al. (2003).

Shafran, Cooper, and Fairburn (2002, 2003) provided a cognitive-behavioral analysis of "clinical" perfectionism, a construct they considered to involve both the determined pursuit of self-imposed standards and extremely vulnerable self-evaluation. They argued against a multidimensional perspective to studying perfectionism. We respond to Shafran et al. (2002, 2003) and Hewitt, Flett, Besser, Sherry, and McGee's (2003) reply to Shafran et al. (2002) by considering the theoretical, empirical, and clinical implications of findings identifying two higher-order dimensions of perfectionism reflecting personal standards (PS) and self-critical evaluative concerns. Analyses of data from two diverse study groups, a college student sample (N = 527) and a clinical sample of patients with binge eating disorder (N = 236), revealed that self-criticism accounts for the relation between perfectionism measures and depressive, anxious, and eating disorder symptoms. We conclude that possessing high PS is not by itself maladaptive. Rather, self-critical evaluative tendencies are more relevant than PS to the critical processes Shafran et al. (2002) suggested contribute to the maintenance of clinical perfectionism.

Adult↗
PubMed2006

Reliability of the Eating Disorder Examination-Questionnaire in patients with binge eating disorder.

This study examined the test-retest reliability of the Eating Disorder Examination-Questionnaire (EDE-Q) in patients with binge eating disorder (BED). Short-term (mean days = 4.8; SD = 3.6) test-retest reliability of the EDE was examined in a sample of 86 patients with BED. Test-retest reliability was excellent for objective bulimic episodes (correlation = .84), but poor to unacceptable for subjective bulimic episodes and objective overeating episodes (correlations = .51 and .39, respectively). Test-retest reliabilities were good for the EDE-Q scales (correlations = .66 to .77), albeit somewhat variable for the individual EDE-Q items (.54 to .78). These findings support the reliability of the EDE-Q for patients with BED. The EDE-Q has utility for assessing the number of binge eating episodes (objective bulimic episodes) and associated features of eating disorders in patients with BED. The results for subjective bulimic episodes are consistent with previous studies in suggesting that these eating behaviors may not be reliable indicators of eating disorders for patients with BED.

Adult↗
PubMed2006

Rapid response to treatment for binge eating disorder.

The authors examined rapid response among 108 patients with binge eating disorder (BED) who were randomly assigned to 1 of 4 16-week treatments: fluoxetine, placebo, cognitive-behavioral therapy (CBT) plus fluoxetine, or CBT plus placebo. Rapid response, defined as 65% or greater reduction in binge eating by the 4th treatment week, was determined by receiver operating characteristic curves. Rapid response characterized 44% of participants and was unrelated to participants' demographic or baseline characteristics. Participants with rapid response were more likely to achieve binge-eating remission, had greater improvements in eating-disorder psychopathology, and had greater weight loss than participants without rapid response. Rapid response had different prognostic significance and distinct time courses for CBT versus pharmacotherapy-only treatments. Rapid response has utility for predicting outcomes and provides evidence for specificity of treatment effects with BED.

Adolescent↗
PubMed2006

Predictors of 2-year outcome for patients with borderline personality disorder.

OBJECTIVE: The primary purpose of this report was to investigate whether characteristics of subjects with borderline personality disorder observed at baseline can predict variations in outcome at the 2-year follow-up. METHOD: Hypothesized predictor variables were selected from prior studies. The patients (N=160) were recruited from the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. Patients were assessed at baseline and at 6, 12, and 24 months with the Structured Clinical Interview for DSM-IV Axis I Disorders; the Diagnostic Interview for DSM-IV Personality Disorders, a modified version of that instrument; the Longitudinal Interval Follow-Up Evaluation; and the Childhood Experiences Questionnaire-Revised. Univariate Pearson's correlation coefficients were calculated on the primary predictor variables, and with two forward stepwise regression models, outcome was assessed with global functioning and number of borderline personality disorder criteria. RESULTS: The authors' most significant results confirm prior findings that more severe baseline psychopathology (i.e., higher levels of borderline personality disorder criteria and functional disability) and a history of childhood trauma predict a poor outcome. A new finding suggests that the quality of current relationships of patients with borderline personality disorder have prognostic significance. CONCLUSIONS: Clinicians can estimate 2-year prognosis for patients with borderline personality disorder by evaluating level of severity of psychopathology, childhood trauma, and current relationships.

Adult↗
PubMed2006

Descriptive and longitudinal observations on the relationship of borderline personality disorder and bipolar disorder.

OBJECTIVE: The purpose of this study was to test whether borderline personality disorder is a variant of bipolar disorder by examining the rates of co-occurrence in both disorders, the effects of co-occurrence on a longitudinal course, and whether the presence of either disorder confers the risk for new onsets of the other. METHOD: A prospective repeated-measures design with reliable independent diagnostic measures and 4 years of follow-up was used to assess 196 patients with borderline personality disorder and 433 patients with other personality disorders. RESULTS: Patients with borderline personality disorder had a significantly higher co-occurrence of bipolar disorder (19.4%) than did patients with other personality disorders. However, this co-occurrence did not appear to affect the subsequent course of borderline personality disorder. Although only 8.2% of the borderline personality disorder patients developed new onsets of bipolar disorder, this rate was higher than in patients with other personality disorders. Patients with other personality disorders with co-occurring bipolar disorder generally had more new onsets of borderline personality disorder (25%) than did patients with other personality disorders without co-occurring bipolar disorder (10%). CONCLUSIONS: A modest association between borderline personality disorder and bipolar disorder is reported.

Adolescent↗
PubMed2006

Prospective assessment of treatment use by patients with personality disorders.

OBJECTIVE: This study examined the utilization of mental health treatments over a three-year period among patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders compared with patients with major depressive disorder and no personality disorder. METHODS: A prospective, longitudinal study design was used to measure treatment use for 633 individuals aged 18 to 45 years during a three-year period. RESULTS: Patients with borderline personality disorder were significantly more likely than those with major depressive disorder to use most types of treatment. Furthermore, all patients continued using high-intensity, low-duration treatments throughout the study period, whereas individual psychotherapy attendance declined significantly after one year. CONCLUSIONS: Although our data showed that patients with borderline personality disorder used more mental health services than those with major depressive disorder, many questions remain about the adequacy of the treatment received by all patients with personality disorders.

Adolescent↗