Biomedical subjects

Carlos M Grilo

Publications and source records attributed to Carlos M Grilo.

At least 37 records · Page 2Linked to original sources

PubMed2006

Relation of childhood sexual abuse and other forms of maltreatment to 12-month postoperative outcomes in extremely obese gastric bypass patients.

BACKGROUND: The prognostic significance of sexual abuse for extremely obese patients who undergo bariatric surgery is uncertain. This study examined self-reported childhood sexual abuse and other forms of childhood maltreatment in relation to preoperative presentation and to 12-month postoperative outcomes in gastric bypass patients. METHODS: 137 extremely obese patients undergoing gastric bypass surgery completed a questionnaire battery before surgery and again 12 months after surgery. Weight loss was determined with measured weight and height, childhood maltreatment was assessed with the Childhood Trauma Questionnaire, and associated eating disorder and psychological functioning were assessed with established measures. RESULTS: 32% of patients self-reported childhood sexual abuse, 37% reported some form of non-sexual childhood abuse or neglect, and 31% reported no form of childhood maltreatment. Significant and clinically robust improvements in weight and in all measures of eating and psychological functioning were observed at 12 months after surgery. Patients who reported histories of childhood sexual abuse and other forms of childhood maltreatment differed little from patients who reported no childhood maltreatment in body mass index, eating disorder features, and psychological functioning both pre- and postoperatively at 12-month follow-up. Patients who reported childhood sexual abuse had statistically significantly higher levels of depression at 12 months after surgery, although the depression levels represented significant reductions from pre-surgery and fell within the non-depressed range. CONCLUSION: Extremely obese patients who seek gastric bypass surgery report higher rates of childhood maltreatment than normative community samples. A history of childhood maltreatment, including reports of sexual abuse, does not appear to be a negative prognostic indicator for gastric bypass surgery.

Adult↗

PubMed2006

Correlates of body image dissatisfaction in extremely obese female bariatric surgery candidates.

BACKGROUND: This study investigated correlates of body image dissatisfaction in 131 extremely obese female bariatric surgery candidates. METHODS: Female gastric bypass surgery candidates participating in a comprehensive psychiatric evaluation completed a battery of established self-report measures of body image and psychosocial functioning. Nine predictors of body image dissatisfaction were considered: body mass index (BMI), ethnicity, childhood onset of obesity, childhood teasing about weight, binge eating, depression, self-esteem, shame, and perfectionism. RESULTS: Stepwise multiple regression analysis revealed that the nine variables jointly accounted for 48% of the variance; three variables, depression, self-esteem and perfectionism, made significant independent contributions. CONCLUSION: Our findings highlight the importance of adult psychological functioning (depression, self-esteem and perfectionism) for predicting body image dissatisfaction in extremely obese female bariatric surgery candidates.

Adult↗

PubMed2006

A prospective study of body dissatisfaction and concerns in extremely obese gastric bypass patients: 6- and 12-month postoperative outcomes.

BACKGROUND: Body image is a multifaceted construct commonly associated with obesity. This study examined changes in body dissatisfaction, and shape and weight concerns in bariatric surgery patients from baseline to 6 and 12 months post-surgery. METHODS: 109 extremely obese patients who underwent gastric bypass surgery completed the Body Shape Questionnaire (BSQ), and the Shape and Weight Concern subscales of the Eating Disorder Examination-Questionnaire (EDE-Q) at baseline, and 6 and 12 months post-surgery. RESULTS: Patients experienced substantial weight loss and reported statistically significant reductions in BSQ, and Shape and Weight Concern scores from baseline to 6 and 12 months post-surgery. Improvements on the BSQ and Shape Concern scale were maintained between 6 and 12 months post-surgery, while patients reported continued reductions in weight and Weight Concern scale scores. Moreover, at 6 and 12 months follow-up, over 80% of female patients had body image scores comparable to published norms. Correlations between change in BMI and the body image measures were variable, and degree of weight loss did not predict body image scores 6 or 12 months post-surgery. CONCLUSIONS: Results from the present study illustrate significant and immediate post-surgical reductions in body dissatisfaction and concerns, along with weight loss in bariatric patients. Such improvements indicate a normalization of body image-related concerns in these patients, the majority of who remain overweight or obese despite the substantial post-surgical weight losses. Changes in weight and body image relate poorly to each other, suggesting that mediating factors may be involved.

Adolescent↗

PubMed2006

Clarifying the convergence between obsessive compulsive personality disorder criteria and obsessive compulsive disorder.

In this study we examined the convergence between obsessive-compulsive personality disorder (OCPD) criteria and obsessive-compulsive disorder (OCD). Baseline assessments of 629 participants of the Collaborative Longitudinal Personality Disorders Study were used to examine the associations between OCPD criteria and diagnoses of OCD. Three of the eight OCPD criteria--hoarding, perfectionism, and preoccupation with details--were significantly more frequent in subjects with OCD (n = 89) than in subjects without OCD (n = 540). Logistic regressions were used to predict the probability of each OCPD criterion as a function of Axis I diagnoses (OCD, additional anxiety disorders, and major depressive disorder). Associations between OCD and these three OCPD criteria remained significant in the logistic regressions, showing unique associations with OCD and odds ratios ranging from 2.71 to 2.99. In addition, other anxiety disorders and major depressive disorder showed few associations with specific OCPD criteria. This study suggests variability in the strength of the relationships between specific OCPD criteria and OCD. The findings also support a unique relationship between OCPD symptoms and OCD, compared to other anxiety disorders or major depression. Future efforts to explore the link between Axis I and Axis II disorders may be enriched by conducting analyses at the symptom level.

Adult↗

PubMed2006

Psychiatric comorbidity in binge-eating disorder as a function of smoking history.

OBJECTIVE: To examine the comorbidity of psychiatric disorders in obese women with binge-eating disorder (BED) as a function of smoking history. METHOD: A consecutive series of 103 obese treatment-seeking women with current DSM-IV diagnoses of BED were administered structured diagnostic interviews to assess all DSM-IV Axis I psychiatric disorders. Participants were classified as "never" or "daily" smokers, and lifetime rates of comorbid psychopathology were compared across smoking groups using logistic regression. The study was conducted from February 2003 to March 2005. RESULTS: Smokers were significantly more likely to meet criteria for co-occurring diagnoses of major depressive disorder (p = .03), panic disorder (p = .01), posttraumatic stress disorder (p < .05), and substance abuse or dependence (p = .01). Even after excluding participants with substance use disorders, significant differences remained, with lifetime smokers having significantly higher rates of co-occurring anxiety disorders. CONCLUSIONS: It is possible that for some obese women with BED, binge eating and cigarette smoking share common functions, i.e., both behaviors may serve to modulate negative affect and/or anxiety. Although the current findings are consistent with a view of a common diathesis for the development of impulsive eating, cigarette or other substance use, and additional Axis I psychopathology, prospective longitudinal studies are needed to elucidate the nature of potential pathways.

Anxiety Disorders↗

PubMed2006

Psychiatric disorder comorbidity and association with eating disorders in bariatric surgery patients: A cross-sectional study using structured interview-based diagnosis.

OBJECTIVE: This study examined the prevalence of DSM-IV Axis I psychiatric disorders in severely obese bariatric surgery candidates and explored whether eating disorders were associated with psychiatric comorbidity. METHOD: The Structured Clinical Interview for DSM-IV Axis I Disorders was administered to a study group of 174 consecutively evaluated bariatric surgery candidates. All evaluations were completed between September 2002 and November 2004. RESULTS: Overall, 36.8% of the participants met criteria for at least one lifetime psychiatric disorder, with 24.1% meeting criteria for a current disorder. The most commonly observed lifetime psychiatric diagnoses were affective disorders (22.4%), anxiety disorders (15.5%), and eating disorders (13.8%). Participants with eating disorders were significantly more likely than those without eating disorders to meet criteria for psychiatric disorders overall (66.7% vs. 26.7%) and specifically for anxiety disorders (45.8% vs. 10.7%). CONCLUSIONS: Psychiatric disorders are not uncommon among severely obese patients who present for bariatric surgery. The observed prevalence rates based on structured diagnostic interviews are lower than previously reported based on questionnaire, clinical, and chart review methods but are similar to those reported for nationally representative samples. Among bariatric surgery candidates, the presence of eating disorders is associated with higher rates of other psychiatric disorders. The findings highlight the importance of systematic diagnostic assessment using a structured diagnostic interview for determining the full spectrum of Axis I disorders.

Anastomosis, Roux-en-Y↗

PubMed2006

The prognostic significance of regular binge eating in extremely obese gastric bypass patients: 12-month postoperative outcomes.

OBJECTIVE: The prognostic significance of binge eating for extremely obese patients who undergo bariatric surgery is uncertain. We examined the relation of preoperative binge eating to preoperative presentation and 12-month postoperative outcomes. METHODS: 139 extremely obese gastric bypass surgery patients completed assessments of binge eating and eating disorders (Eating Disorder Examination-Questionnaire version), body dissatisfaction (Body Shape Questionnaire), depression (Beck Depression Inventory), and self-esteem (Rosenberg Self-Esteem Scale) before surgery and again 12 months postsurgery. RESULTS: At baseline, 60% of patients denied binge eating, 16% reported binge eating infrequently (less than once weekly), and 24% reported binge eating at least weekly. At 12 months postsurgery, 8.8% reported infrequent binge eating and only 0.7% reported binge eating weekly. At baseline, infrequent binge eaters and regular binge eaters differed little from each other but had significantly elevated eating and psychosocial problems relative to non-binge eaters. Statistically significant and clinically robust improvements in weight and in all measures of functioning were observed at 12 months postsurgery across all groups. At 12-month follow-up, patients who reported regular binge eating at baseline had significantly higher levels of eating-specific concerns (but not psychosocial concerns) than the infrequent binge eaters and non-binge eaters; the infrequent and non-binge eaters did not differ from each other. Significant time-by-binge eating interactions indicated that the regular versus infrequent binge-eating groups improved differently over time; infrequent binge eaters had sharper improvements than regular binge eaters and non-binge eaters. CONCLUSION: Binge eating is common in extremely obese bariatric surgery candidates and is associated with heightened eating and psychological problems. Regular binge eating preoperatively, however, does not appear to be a potent negative prognostic indicator for gastric bypass surgery. Our findings, which are limited to 12 months postsurgery, highlight substantial improvements in weight and psychosocial functioning, and these robust improvements differ little by binge-eating status.

Adult↗

PubMed2005

Eating patterns and breakfast consumption in obese patients with binge eating disorder.

This study examined eating patterns and breakfast consumption, and their relationships to weight and binge eating, in obese individuals with binge eating disorder (BED). One-hundred seventy-three consecutively evaluated men (n=46) and women (n=127) with BED were administered semi-structured interviews and self-report measures to assess the frequency of meals and snacks eaten, as well as binge eating and eating disorder features. Overall, those who consumed more frequent meals, particularly breakfast, and snacks, weighed less. Breakfast, which was eaten on a daily basis by less than half of participants (n=74; 43%), was the least frequently eaten meal of the day. Participants (n=56; 32%) who ate three meals per day weighed significantly less, and had significantly fewer binges, than participants (n=117; 68%) who did not regularly eat three meals per day. Thus, eating more frequently, having breakfast and consuming three meals every day, have potentially important clinical applications for the treatment of BED given that the effectiveness of specific interventions within treatments for BED are unknown, and that weight loss outcome for BED has been poor.

Adolescent↗

PubMed2005

Prediction of drug and alcohol abuse in hospitalized adolescents: comparisons by gender and substance type.

The authors examined psychosocial correlates of drug and alcohol abuse in 462 hospitalized adolescents, and the extent to which these associations may be affected by gender or by substance type. Participants completed a battery of psychometrically-sound, self-report measures of psychological functioning, environmental stress, drug abuse, and alcohol abuse. Four multiple regression analyses were conducted to determine the joint and independent predictors of drug abuse and alcohol abuse, for males and for females. Multiple regression analysis revealed that seven variables--age, depression, impulsivity, low self-esteem, delinquent predisposition, low peer insecurity, and history of child abuse--jointly predicted both drug and alcohol abuse, for both males and females. However, several differences were found with respect to which variables made independent contributions to the predictive models--with only delinquent predisposition making a significant independent contribution for all four conditions. We found distinct patterns of psychosocial predictor variables for drug and alcohol abuse, as well as distinct patterns for males and females. These results may reflect differing risk factors for drug abuse and alcohol abuse in adolescent psychiatric patients--and differing risk factors for males and females. Such differences have potential implications for prevention and treatment.

Adolescent↗

PubMed2005

Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates.

This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.

Adult↗

PubMed2005

Cognitive behavioral therapy guided self-help and orlistat for the treatment of binge eating disorder: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Cognitive behavioral therapy (CBT) has efficacy for binge eating disorder (BED) but not obesity. No controlled studies have tested whether adding obesity medication to CBT facilitates weight loss. We performed a randomized, placebo-controlled study of orlistat administered with guided self-help CBT (CBTgsh). METHODS: Fifty obese BED patients were randomly assigned to 12-week treatments of either orlistat plus CBTgsh (120 mg three times a day [t.i.d.]) or placebo plus CBTgsh and were followed in double-blind fashion for 3 months after treatment. RESULTS: Seventy-eight percent of patients completed treatments without differential dropout between orlistat+CBTgsh and placebo+CBTgsh. Intent-to-treat remission rates (zero binges for past 28 days on Eating Disorder Examination Interview) were significantly higher for orlistat+CBTgsh than placebo+CBTgsh (64% versus 36%) at posttreatment but not at 3-month follow-up (52% in both). Intent-to-treat rates for achieving 5% weight loss were significantly higher for orlistat+CBTgsh than placebo+CBTgsh at posttreatment (36% versus 8%) and 3-month follow-up (32% versus 8%). Significant and comparable improvements in eating disorder psychopathology and psychological distress occurred in both treatments. CONCLUSIONS: The addition of orlistat to CBTgsh was associated with greater weight loss than the addition of placebo to CBTgsh. Clinical improvements were generally maintained at 3-month follow-up after treatment discontinuation.

Adult↗

PubMed2005

Psychometric properties of the Food Craving Inventory among obese patients with binge eating disorder.

OBJECTIVE: To examine the psychometric properties of the Food Craving Inventory [FCI; White, M. A., Whisenhunt, B. L., Williamson, D. A., Greenway, F. L., & Netemeyer, R. G. (2002). Development and validation of the food-craving inventory. Obesity Research, 10 (107-114)] in a group of obese patients with binge eating disorder (BED). METHOD: Participants were 122 obese patients seeking treatment for BED who completed the FCI. Data from the original 28-item FCI were examined. The current study sample was then compared to a community sample of obese patients. RESULTS: Confirmatory factor analysis confirmed the 4-factor structure of the FCI. An improved model was found following the deletion of 3 items, yielding a 25-item questionnaire. Secondary analyses indicated differences in patterns of food cravings between BED patients and an obese comparison group. DISCUSSION: The current study confirmed the psychometric properties of the FCI for use with a group of treatment-seeking obese patients with BED. Collectively, the results imply that obese patients with BED may crave sweets to a heightened degree relative to other food classes.

Adolescent↗

PubMed2005

Efficacy of cognitive behavioral therapy and fluoxetine for the treatment of binge eating disorder: a randomized double-blind placebo-controlled comparison.

BACKGROUND: Cognitive behavioral therapy (CBT) and certain medications have been shown to be effective for binge eating disorder (BED), but no controlled studies have compared psychological and pharmacological therapies. We conducted a randomized, placebo-controlled study to test the efficacy of CBT and fluoxetine alone and in combination for BED. METHODS: 108 patients were randomized to one of four 16-week individual treatments: fluoxetine (60 mg/day), placebo, CBT plus fluoxetine (60 mg/day) or CBT plus placebo. Medications were provided in double-blind fashion. RESULTS: Of the 108 patients, 86 (80%) completed treatments. Remission rates (zero binges for 28 days) for completers were: 29% (fluoxetine), 30% (placebo), 55% (CBT+fluoxetine), and 73% (CBT+placebo). Intent-to-treat (ITT) remission rates were: 22% (fluoxetine), 26% (placebo), 50% (CBT+fluoxetine), and 61% (CBT+placebo). Completer and ITT analyses on remission and dimensional measures of binge eating, cognitive features, and psychological distress produced consistent findings. Fluoxetine was not superior to placebo, CBT+fluoxetine and CBT+placebo did not differ, and both CBT conditions were superior to fluoxetine and to placebo. Weight loss was modest, did not differ across treatments, but was associated with binge eating remission. CONCLUSIONS: CBT, but not fluoxetine, demonstrated efficacy for the behavioral and psychological features of BED, but not obesity.

Adult↗

PubMed2005

Body checking and avoidance in overweight patients with binge eating disorder.

OBJECTIVE: Repetitive body checking and avoidance are viewed as behavioral manifestations of the core psychopathology of eating disorders (EDs). We examined select body checking and avoidance behaviors in overweight patients with binge eating disorder (BED). METHOD: Three hundred seventy-seven overweight (body mass index [BMI] > or = 25) treatment-seeking BED patients (80 men and 297 women) were administered measures to assess body checking and avoidance, other key behavioral features of EDs (binge eating, dietary restraint, and disinhibition), and the core psychopathology of EDs (overevaluation of weight and shape). RESULTS: The majority of participants reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations emerged between checking and restraint, and conversely, between avoidance and binge eating. Both checking and avoidance were positively and significantly associated with overevaluation of weight and shape, even after controlling for their unique effects. DISCUSSION: These findings offer support to the potential role of checking and avoidance behaviors in the maintenance of BED.

Adult↗

PubMed2005

Binge eating and self-esteem predict body image dissatisfaction among obese men and women seeking bariatric surgery.

OBJECTIVE: We examined body image dissatisfaction (BID) in extremely obese men and women seeking bariatric surgery. METHODS: The following predictors of BID were examined in a consecutive series of 260 (44 men and 216 women) gastric bypass candidates: gender, ethnicity, body mass index (BMI), age at onset of overweight, childhood maltreatment, binge eating, depression, and self-esteem. RESULTS: Women reported significantly higher levels of BID than men. Stepwise multiple regression analyses revealed that gender, binge eating, and self-esteem levels accounted for 41% of the variance in BID. In predicting BID levels separately by gender, binge eating and self-esteem accounted for 56% of the variance among men and for 33% of the variance among women. DISCUSSION: Among bariatric surgery candidates, women reported significantly higher BID than men. Our findings suggest the importance of binge eating and lower self-esteem for understanding BID in both men and women who are extremely obese.

Adult↗

PubMed2005

Treatment preferences of patients with binge eating disorder.

OBJECTIVE: The current study examined the treatment preferences of obese patients with binge eating disorder (BED). METHOD: Participants were 103 consecutive patients with BED who responded to advertisements for treatment studies looking for persons who wanted to "stop binge eating and lose weight." In addition to completing comprehensive assessment batteries, participants were provided descriptions of cognitive-behavioral therapy (CBT) and behavioral weight loss therapy (BWL) after which they were asked to choose and rate their preferred treatment. RESULTS: Sixty-three percent of participants stated they preferred CBT. Treatment preferences were not associated with (1) histories of obesity, dieting, binge eating, or weight cycling, (2) current obesity or eating disorder features, or (3) psychological features such as depression or self-esteem levels. In contrast, participants' stated treatment preferences were aligned with their perception of their primary problem (eating disorder vs. obesity) and their primary goals for treatment (stop binge eating vs. lose weight). The patients who preferred CBT based their treatment selection more on their problem perception than on their primary treatment goal, whereas the patients who preferred BWL selected treatment based more on their primary treatment goal (weight loss) than on their problem perception. DISCUSSION: Obese patients with BED express treatment preferences that are not associated with variability in their clinical characteristics but are aligned with their perception of their primary problem and with their primary goals for treatment.

Adult↗

PubMed2005

Ethnic differences in the prediction of eating and body image disturbances among female adolescent psychiatric inpatients.

OBJECTIVE: The current study examined predictors of eating and body image disturbances in psychiatrically hospitalized female adolescents and investigated whether the predictors differ by ethnicity. METHOD: Participants were 427 (320 Caucasian, 53 Latina, 54 African American) female adolescent psychiatric inpatients. Predictors of eating disorder features (dietary restraint, binge eating, and purging) and body image dissatisfaction (BID) were tested separately for the three ethnic groups. In addition to the eating and BID variables, the following predictor variables were considered: depression, anxiety, impulsivity, negative self-esteem, peer insecurity, and abuse. RESULTS: Caucasians reported significantly higher levels of dietary restraint and BID than Latinas and African Americans, whereas reports of binge eating did not differ by ethnicity. Regression analyses revealed that the predictor variables accounted for significant and substantial amounts of the variance in the four eating and body image domains. Different psychological and social variables predicted eating disorder symptoms and BID across ethnic groups. DISCUSSION: These findings suggest, for psychiatrically hospitalized adolescent females, that different patterns of factors may contribute to the maintenance of eating and body image disturbances across ethnic groups. Future research testing models of the etiology or maintenance of these disturbances needs to include ethnicity to ascertain whether the hypothesized components operate differently by ethnicity.

Adolescent↗

PubMed2005

Correlates of body image dissatisfaction in treatment-seeking men and women with binge eating disorder.

OBJECTIVE: We examined body image dissatisfaction (BID) in patients with binge eating disorder (BED). METHOD: Six predictors were considered in 343 consecutive treatment-seeking BED patients (76 men, 267 women): body mass index (BMI), age onset of overweight childhood teasing about weight or size childhood teasing about general appearance, depression, and self-esteem. RESULTS: Women reported higher BID than men. In women, depression, self-esteem, and childhood teasing about weight or size jointly accounted for 28.4% of the variance in BID. In men, depression, self-esteem, and BMI jointly accounted for 47.4% of the variance in BID. DISCUSSION: Findings highlight gender differences and the importance of adult psychological functioning (depression and self-esteem) for predicting BID in treatment-seeking men and women with BED.

Adult↗