Biomedical subjects

Carlos M Grilo

Publications and source records attributed to Carlos M Grilo.

At least 55 records · Page 3Linked to original sources

PubMed2005

Ethnicity and sampling bias in binge eating disorder: Black women who seek treatment have different characteristics than those who do not.

OBJECTIVE: The current study investigated sampling bias as it affects recruited clinic samples of Black and White women with binge eating disorder (BED). METHODS: Clinical characteristics of a recruited clinic sample (35 Black and 302 White consecutively evaluated women) with BED were compared with a community sample of Black and White women with BED drawn from the New England Women's Health Project. The clinic and community groups met the same definition of BED and were assessed with identical methods. RESULTS: Among White women, the clinic and community samples differed on some features (higher body mass index [BMI], and greater eating concerns and shape concerns in the clinic sample) but these differences reflected small to moderate effects sizes. In contrast, among Black women, the clinic sample had substantially higher levels (large effect sizes) of several features of eating disorders (eating concerns, dietary restraint, and shape concern), higher (moderate effect size) BMI, but lower frequency of binge eating (moderate effect size) than the community sample. A comparison of Black and White women within the clinic sample revealed little difference in clinical presentation, except for the significantly higher BMI among Black women. CONCLUSION: A sampling bias appears to exist between both White and Black recruited clinic samples of women with BED, although the bias appears to be substantially greater for Black women. Black women with BED who seek treatment have significantly different characteristics than those who do not.

Adult↗

PubMed2005

Body checking and avoidance and the core features of eating disorders among obese men and women seeking bariatric surgery.

This study examined two aspects of body checking and avoidance, and their relations to the core psychopathology of eating disorders (EDs), in severely obese men and women seeking bariatric surgery. A consecutive series of 260 (44 male and 216 female) gastric bypass candidates were administered measures to assess body checking and avoidance, binge eating, restraint, and overevaluation of weight and shape. The majority of patients 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 were observed between checking and restraint, and between avoidance and binge eating. Both checking and avoidance behaviors were significantly associated with overevaluation of weight and shape. The positive associations between each of the two behaviors (body checking and avoidance) with overevaluation of weight/shape remained significant even after controlling for the effects of avoidance on body checking and vice versa. Stepwise multiple regression analyses revealed that binge eating, body checking, and avoidance behaviors made significant unique contributions and jointly accounted for 22-25% of the variance in overevaluation of weight and shape, respectively. This study documents the presence of eating disorder psychopathology among severely obese patients seeking bariatric surgery. The findings support the view that body checking and avoidance behaviors are manifestations of overevaluation of weight and shape and disordered eating.

Adult↗

PubMed2005

A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge eating disorder.

We performed a randomized controlled study to test the relative efficacy of guided self-help (gsh) cognitive-behavioral therapy (CBTgsh) and behavioral weight loss treatment (BWLgsh) treatments for binge eating disorder (BED). To provide an additional partial control for non-specific influences of attention, a third control (CON) treatment condition was included. We tested the treatments using a guided self-help approach given the promising results from initial studies using minimal therapist guidance. Ninety consecutive overweight patients (19 males, 71 females) with BED were randomly assigned (5:5:2 ratio) to one of three treatments: CBTgsh (N=37), BWLgsh (N=38), or CON (N=15). The three 12-week treatment conditions were administered individually following guided self-help protocols. Overall, 70 (78%) completed treatments; CBTgsh (87%) and CON (87%) had significantly higher completion rates than BWLgsh (67%). Intent-to-treat analyses revealed that CBTgsh had significantly higher remission rates (46%) than either BWLgsh (18%) or CON (13%). Weight loss was minimal and differed little across treatments. The findings suggest that CBT, administered via guided self-help, demonstrates efficacy for BED, but not for obesity. The findings support CBT administered via guided self-help as a first step in the treatment of BED and provide evidence for its specific effects.

Adult↗

PubMed2005

Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years.

BACKGROUND: A defining feature of personality disorder (PD) is an enduring pattern of inner experience and behavior that is stable over time. Follow-up and follow-along studies have shown considerable diagnostic instability of PDs, however, even over short intervals. What, then, about personality disorder is stable? The purpose of this study was to determine the stability of impairment in psychosocial functioning in patients with four different PDs, in contrast to patients with major depressive disorder (MDD) and no PD, prospectively over a 2-year period. METHOD: Six hundred treatment-seeking or treated patients were recruited primarily from clinical services in four metropolitan areas of the Northeastern USA. Patients were assigned to one of five diagnostic groups: schizotypal (STPD) (n=81), borderline (BPD) (n=155), avoidant (AVPD) (n=137), or obsessive-compulsive (OCPD) (n=142) personality disorders or MDD and no PD (n=85), based on the results of semi-structured interview assessments and self-report measures. Impairment in psychosocial functioning was measured using the Longitudinal Interval Follow-up Evaluation (LIFE) at baseline and at three follow-up assessments. RESULTS: Significant improvement in psychosocial functioning occurred in only three of seven domains of functioning and was largely the result of improvements in the MDD and no PD group. Patients with BPD or OCPD showed no improvement in functioning overall, but patients with BPD who experienced change in personality psychopathology showed some improvement in functioning. Impairment in social relationships appeared most stable in patients with PDs. CONCLUSION: Impairment in functioning, especially social functioning, may be an enduring component of personality disorder.

Activities of Daily Living↗

PubMed2005

Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity.

In this study, the authors examined prospectively the 24-month natural course of remission from major depressive disorder (MDD) as a function of personality disorder (PD) comorbidity. In 302 participants (196 women, 106 men), psychiatric and PDs were assessed at baseline with diagnostic interviews, and the course of MDD was assessed with the Longitudinal Interval Follow-Up Evaluation at 6-, 12-, and 24-month follow-ups. Survival analyses revealed an overall 24-month remission rate of 73.5% for MDD that differed little by gender. Participants with MDD who had certain forms of coexisting PD psychopathology (schizotypal, borderline, or avoidant) as their primary PD diagnoses had a significantly longer time to remission from MDD than did patients with MDD without any PD. These PDs emerged as robust predictors of slowed remission from MDD even when controlling for other negative prognostic predictors.

Adolescent↗

PubMed2005

Recent life events preceding suicide attempts in a personality disorder sample: findings from the collaborative longitudinal personality disorders study.

Few studies have examined the relationship between life events, suicide attempts, and personality disorders (PDs), in spite of the strong associations between PDs and suicidal behavior, and the poor coping strategies often exhibited by these individuals. The authors examined whether participants with PDs who attempted suicide during the first 3 years of a prospective, longitudinal study were more likely to experience specific life events in the month during and preceding the suicide attempt. Of 489 participants with PDs, 61 attempted suicide during the 3-year, follow-up interval. Results indicated that negative life events, particularly those pertaining to love-marriage or crime-legal matters, were significant predictors of suicide attempts, even after controlling for baseline diagnoses of borderline PD, major depressive disorders, substance use disorders, and a history of childhood sexual abuse. Therefore, certain types of negative life events are unique risk factors for imminent suicide attempts among individuals with PDs.

Adult↗

PubMed2005

Binge eating disorder and night eating syndrome: a comparative study of disordered eating.

The authors compared eating patterns, disordered eating, features of eating disorders, and depressive symptoms in persons with binge eating disorder (BED; n = 177), with night eating syndrome (NES; n = 68), and in an overweight comparison group without BED or NES (comparison; n = 45). Participants completed semistructured interviews and several established measures. Depressive symptoms were greater in the BED and NES groups than in the comparison group. NES participants ate fewer meals during the day and more during the night than BED and comparison participants, whereas BED participants ate more during the day than the comparison participants. BED participants reported more objective bulimic and overeating episodes, shape/weight concerns, disinhibition, and hunger than NES and comparison participants, whereas NES participants reported more eating pathology than comparison participants. This evaluation provides strong evidence for the distinctiveness of the BED and NES constructs and highlights their clinical significance.

Adult↗

PubMed2005

Differential impairment as an indicator of sex bias in DSM-IV criteria for four personality disorders.

The aim of the present study was to investigate the possibility of sex bias in the diagnostic criteria for borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders. A clinical sample of 668 individuals was evaluated for personality disorder criteria using a semistructured interview, and areas of functional impairment were assessed with both self-report and semistructured interview. The authors used a regression model of bias to identify bias as differences in slopes or intercepts between men and women in the relationship between each diagnostic criterion and level of impairment. The results suggest that most of the diagnostic criteria examined do not seem to display sex bias. However, those criteria that displayed evidence of bias came largely from the borderline diagnosis.

Activities of Daily Living↗

PubMed2005

Childhood maltreatment in extremely obese male and female bariatric surgery candidates.

OBJECTIVE: To examine rates of self-reported childhood maltreatment in extremely obese bariatric surgery candidates and to explore associations with sex, eating disorder features, and psychological functioning. RESEARCH METHODS AND PROCEDURES: Three hundred forty (58 men and 282 women) extremely obese consecutive candidates for gastric bypass surgery completed a questionnaire battery. The Childhood Trauma Questionnaire was given to assess childhood maltreatment. RESULTS: Overall, 69% of patients self-reported childhood maltreatment: 46% reported emotional abuse, 29% reported physical abuse, 32% reported sexual abuse, 49% reported emotional neglect, and 32% reported physical neglect. Except for higher rates of emotional abuse reported by women, different forms of maltreatment did not differ significantly by sex. Different forms of maltreatment were generally not associated with binge eating, current BMI, or eating disorder features. At the Bonferonni-corrected significance level, emotional abuse was associated with higher eating concerns and body dissatisfaction, and emotional neglect was associated with higher eating concerns. In terms of psychological functioning, at the Bonferonni-corrected level, emotional abuse and emotional neglect were associated with higher depression and lower self-esteem, and physical abuse was associated with higher depression. DISCUSSION: Extremely obese bariatric surgery candidates reported rates of maltreatment comparable with those reported by clinical groups and roughly two to three times higher than normative community samples. Reported experiences of maltreatment differed little by sex and were generally not significantly associated with current BMI, binge eating, or eating disorder features. In contrast, maltreatment-notably emotional abuse and neglect-were significantly associated with higher depression and lower self-esteem.

Adult↗

PubMed2005

Application of cultural constructs in the care of first generation Latino clients in a community mental health setting.

As the Latino population in the United States grows, it is imperative to attend to the appropriateness of the mental health care that is being provided to its members. Latinos experience many of the same behavioral health disorders as other ethnic and cultural groups in the United States, but underutilize services relative to many other groups. Such underutilization may be related to issues such as stigma, language, and acculturation level, all of which often create barriers to treatment. First generation Latinos (i.e., individuals born outside the United States) are especially vulnerable to adverse experiences when seeking and receiving treatment. This may be due in part to acculturation and language issues which may further contribute to future underutilization of services. A well established therapeutic alliance developed through the appropriate use of cultural constructs may help mitigate some of the barriers faced by some Latino groups, especially those who are first generation. This paper reviews several cultural constructs that have been highlighted in the Hispanic behavioral health literature and discusses their potential implications for clinical care. This paper offers a number of practical clinical guidelines for mental health professionals who work with Latino groups. These clinical recommendations are based on a synthesis of selected cultural constructs and the clinical experiences of the authors' work in a large community-based Hispanic mental health clinic.

Acculturation↗

PubMed2005

Inter-rater and test-retest reliability of the Spanish language version of the eating disorder examination interview: clinical and research implications.

BACKGROUND: To examine the inter-rater and test-retest reliability of the Spanish Language version of the Eating Disorder Examination (S-EDE) in monolingual Latina women. Established measures are needed to study Latino groups, and short-term test-retest reliability findings are needed to provide context for clinical treatment and outcome studies. METHODS: Inter-rater reliability (IRR) and short-term (5-14 days) test-retest reliability (TRR) of the S-EDE (using intraclass correlation coefficients [ICCs]) were examined in a non-clinical study group of 60 monolingual Latina women. RESULTS: IRR was excellent for objective bulimic episodes (ICC = 0.99) but was modest for subjective bulimic episodes (ICC = 0.55). TRR was good for objective bulimic episodes (ICC = 0.79) but was unacceptable for subjective bulimic episodes (ICC = 0.22). IRR and TRR kappa coefficients (0.56 and 0.37, respectively) for identifying the presence or absence of objective bulimic episodes were modest. For the S-EDE subscales, both IRR (ICCs ranged from 0.80 to 0.98) and TRR (ICCs ranged from 0.67 to 0.90) were good to excellent. CONCLUSIONS: These findings provide preliminary support for the reliability of the S-EDE for use with Latina women. The constructs of eating disorder psychopathology measured by the S-EDE subscales (restraint, eating concern, weight concern, and shape concern) and the core feature of binge eating (objective bulimic episodes) show high short-term consistency. The results for subjective bulimic episodes are consistent with previous studies that have questioned whether these eating behaviors are reliable indicators of eating disorders. Additional evaluation is needed with clinical groups.

Adult↗

PubMed2005

Effects of personality disorders on functioning and well-being in major depressive disorder.

BACKGROUND: Patients with depressive disorders have limitations in physical and emotional functioning comparable to patients with chronic medical conditions. Personality disorders (PDs) are also known to be associated with functional impairment. AIMS: To determine the effects of PDs on the functioning and well-being of patients with major depressive disorder (MDD). METHOD: In the Collaborative Longitudinal Personality Disorders Study, 668 patients who met criteria for schizotypal, borderline, avoidant, or obsessive-compulsive PDs or for MDD and no PD were assessed with semi-structured interviews at baseline, 6, 12, 24, and 36 months. In this study, 151 patients who met criteria for current MDD at the 36-month follow-up were compared on the basis of the presence (n = 118) or absence (n = 33) of persistent PD. Physical and social/emotional functioning and well-being were assessed using the Medical Outcomes Study (MOS) Short-Form Health Survey (SF-36). These results were compared with those of a sample of patients with MDD seen in the mental health specialty sector who were followed in the Medical Outcomes Study. RESULTS: Patients with MDD and co-occurring PD had significantly more impairment on scales measuring role limitations due to emotional problems, social functioning, and general health perceptions than patients with MDD and no PD. Although patients with MDD and no PD were found to have levels of functioning and well-being that were lower in several domains than those previously reported in depressed patients recruited from mental health settings, patients with MDD and co-occurring PD were found to have much lower levels of functioning in all areas than reported samples. CONCLUSIONS: Co-occurring PDs contribute significantly to impairment in social and emotional functioning and reduced well-being in patients with MDD.

Adolescent↗

PubMed2005

A comparison of adolescent inpatients with and without a history of violence perpetration: impulsivity, PTSD, and violence risk.

How childhood maltreatment and violence victimization contributes to subsequent violent behavior remains an understudied area. We examined 130 psychiatrically hospitalized adolescents and compared those with a history of perpetrating violence to those without a history of violence perpetration. Perpetrators of physical violence were significantly more likely to have been a victim and/or witness to family and community violence and also reported significantly higher levels of a broad range of psychopathology than nonperpetrators. Correlational analyses with the study group of violence perpetrators revealed that higher levels of impulsivity, dissociation, and PTSD were significantly associated with higher levels of violence. Furthermore, multiple regression analysis showed that symptoms of impulsivity and PTSD contributed significantly to the prediction of violence risk. Our findings demonstrate that violence exposure and childhood maltreatment are indeed common negative life events among adolescent inpatients, and that symptoms of PTSD may predispose traumatized youth toward impulsive violent behavior.

Adolescent↗

PubMed2005

Dimensional representations of DSM-IV personality disorders: relationships to functional impairment.

OBJECTIVE: This study compared three-dimensional representations of DSM-IV personality disorders and standard categories with respect to their associations with psychosocial functioning. METHOD: Six hundred sixty-eight patients with semistructured interview diagnoses of schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders or with major depressive disorder and no personality disorder completed questionnaires assessing three-factor and five-factor dimensional models of personality. Personality disorder categories, dimensional representations of the categories based on criteria counts, and three- and five-factor personality dimensions were compared on their relationships to impairment in seven domains of functioning, as measured by the Longitudinal Interval Follow-up Evaluation-Baseline Version. RESULTS: Both the categorical and dimensional representations of DSM-IV personality disorders had stronger relationships to impairment in functioning in the domains of employment, social relationships with parents and friends, and global social adjustment and to DSM-IV axis V ratings than the three- and five-factor models. DSM-IV dimensions predicted functional impairment best of the four approaches. Although five-factor personality traits captured variance in functional impairment not predicted by DSM-IV personality disorder dimensions, the DSM-IV dimensions accounted for significantly more variance than the measures of personality. CONCLUSIONS: Scores on dimensions of general personality functioning do not appear to be as strongly associated with functional impairment as the psychopathology of DSM personality disorder. A compromise in the ongoing debate over categories versus dimensions of personality disorder might be the dimensional rating of the criteria that comprise traditional categories.

Adaptation, Psychological↗

PubMed2005

Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders.

OBJECTIVE: This study tracked the individual criteria of four DSM-IV personality disorders-borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders-and how they change over 2 years. METHOD: This clinical sample of patients with personality disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or obsessive-compulsive personality disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four personality disorders by their variation in prevalence and changeability (remission) over time. RESULTS: The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal personality disorder, affective instability and anger for borderline personality disorder, feeling inadequate and feeling socially inept for avoidant personality disorder, and rigidity and problems delegating for obsessive-compulsive personality disorder. The least prevalent and most changeable criteria were odd behavior and constricted affect for schizotypal personality disorder, self-injury and behaviors defending against abandonment for borderline personality disorder, avoiding jobs that are interpersonal and avoiding potentially embarrassing situations for avoidant personality disorder, and miserly behaviors and strict moral behaviors for obsessive-compulsive personality disorder. CONCLUSIONS: These patterns highlight that within personality disorders the relatively fixed criteria are more trait-like and attitudinal, whereas the relatively intermittent criteria are more behavioral and reactive. These patterns suggest that personality disorders are hybrids of traits and symptomatic behaviors and that the interaction of these elements over time helps determine diagnostic stability. These patterns may also inform criterion selection for DSM-V.

Adolescent↗

PubMed2005

The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications.

The Collaborative Longitudinal Personality Disorders Study (CLPS; Gunderson et al., 2000) was developed to fill gaps in our understanding of the nature, course, and impact of personality disorders (PDs). Here, we review published findings to date, discuss their implications for current conceptualizations of PDs, and raise questions that warrant future consideration. We have found that PDs are more stable than major depressive disorder, but that meaningful improvements are possible and not uncommon. We have confirmed also that PDs constitute a significant public health problem, with respect to associated functional impairment, extensive treatment utilization, negative prognostic impact on major depressive disorder, and suicide risk. At the same time, we have demonstrated that dimensional models of PDs have clinical validity that categories do not, especially greater temporal stability. Furthermore, dimensional personality traits appear to be the foundation of behaviors described by many PD criteria. Taken together, our results lead us to hypothesize that PDs may be reconceptualized as hybrids of stable personality traits and intermittently expressed symptomatic behaviors.

Anxiety Disorders↗

PubMed2004

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

OBJECTIVE: This study examined the interrater and test-retest reliabilities of the Eating Disorder Examination (EDE) in patients with binge eating disorder (BED). METHOD: Interrater reliability and short-term (6-14 days) test-retest reliability of the EDE were examined in two study groups of 18 patients with BED. RESULTS: Interrater reliability was excellent for objective bulimic episodes and days (correlations above .98) and very good for the EDE scales, albeit somewhat variable (correlations range from .65 to .96). Test-retest reliabilities were very good for objective bulimic episodes (.70) and days (.71) and were good (significant) for the EDE scales, albeit somewhat variable (correlations range from .50 to .88). Interrater reliability was excellent for subjective bulimic episodes and days but test-retest reliabilities were unacceptable. CONCLUSIONS: These findings support the reliability of the EDE for patients with BED. The EDE has utility for assessing the number of large binge episodes (objective bulimic episodes), as well as the number of days during which large binge episodes occurred. The EDE also demonstrates very good interrater and test-retest reliabilities for assessing the associated features of eating disorders in patients with BED. The results for subjective bulimic episodes are consistent with previous studies, suggesting that these eating behaviors may not be reliable indicators of eating disorders.

Adult↗

PubMed2004

Factorial structure and diagnostic efficiency of DSM-IV criteria for avoidant personality disorder in patients with binge eating disorder.

This study examined the factorial structure and diagnostic efficiency of the DSM-IV criteria for avoidant personality disorder (AVPD). Two hundred and twenty-eight consecutive outpatients (181 females and 47 males) with a primary diagnosis of binge eating disorder were reliably assessed with diagnostic interviews. Internal consistency of AVPD criteria was good, as suggested by coefficient alpha of 0.87, the pattern of inter-item correlations (range 0.41 to 0.64), and the lack of changes in alpha if any criteria are deleted. Exploratory factor analysis revealed a one-factor solution (56% of variance) supporting the unidimensionality of the AVPD criteria. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa coefficients) were calculated for each AVPD criterion, for the entire study group and separately by gender. Overall, the best inclusion criterion was 'fears being ridiculed,' which was also the best predictor overall. These psychometric findings did not differ by gender. The findings support certain important aspects of the AVPD diagnosis.

Adult↗