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Biomedical subjects

J Treasure

Publications and source records attributed to J Treasure.

At least 55 records · Page 3Linked to original sources
PubMed1997

Is there a specific trauma precipitating anorexia nervosa?

BACKGROUND: The aims of this study were to explore the role of life events and difficulties in the onset of anorexia nervosa and bulimia nervosa and to find out whether events and difficulties with a specific meaning, i.e. those of a certain sexual nature, are important in the onset of anorexia nervosa. METHODS: Seventy-two patients with anorexia nervosa (AN) and 29 with bulimia nervosa (BN) were assessed with the life events and difficulties schedule (Brown & Harris, 1978), the year before onset was studied. A new dimension to measure specific meaning of life events and difficulties called 'pudicity' was developed. Subjects from two community cohorts were used as comparison groups (Brown & Harris, 1978; Andrews et al. 1990). RESULTS: Anorexic patients, bulimic patients and community controls did not differ in proportion of patients with at least one severe event; however, significantly more AN and BN patients than community controls had experienced a major difficulty. Sixty-seven per cent of anorexics and 76% of bulimia nervosa patients had either a severe event or a marked difficulty during the year before onset. In AN and BN the most common serious life stresses before onset concerned close relationships with family and friends with BN patients being significantly more often than AN patients directly involved in the problem (interpersonal events). Patients with anorexia nervosa had significantly more pudicity events before onset than BN patients or community controls. CONCLUSION: While serious life stresses commonly precede the onset of anorexia nervosa and bulimia nervosa, problems with sexuality seem to be specific in triggering the onset of anorexia nervosa.

Adolescent↗
PubMed1997

Eating disorders and the dental practitioner.

Eating disorders are an increasing problem for society and the medical professions. The dental practitioner has an important role both in identifying the illnesses and in minimising its affects on the dentition. This paper highlights the features of the most common eating disorders and discusses the possible role of the dental profession in the long-term care of patients suffering from the problem.

Anorexia Nervosa↗
PubMed1996

Season of birth and eating disorders.

A statistically significant season of birth variation is found in an unselected nationwide sample of 1,939 eating disorders patients, with peak season of birth occurring in May. However, among younger patients (n = 882), peak season of birth is in March, which is statistically significantly different to that expected from the general population season of birth cycle. This finding may imply links between etiology of earlier-onset eating disorders and the psychoses; similar first quarter peak seasonal patterns of birth have been found in schizophrenic and affective psychoses--with birth peaks in January and February. In contrast, for the neuroses and personality disorders, birth peaks have been found to be in June and August, similar to the June birth peak found in this study for later-onset eating disorders (n = 1,057), which was not statistically significantly different to season of birth peaks expected from general population data.

Adult↗
PubMed1996

Compliance with a self-care manual for bulimia nervosa: predictors and outcome.

Self-directed treatment has been shown to be effective in the treatment of bulimia nervosa. This paper shows that compliance with a manual is related to outcome. Forty per cent of high compliers achieved full remission after eight weeks with a manual, compared with only 5 per cent of low compliers. Furthermore, patients with greater weight and shape concerns were less likely to use a manual while those with a longer duration of illness were more likely to use it.

Adult↗
PubMed1996

To change or not to change--'how' is the question?

The objective was to apply the 'trans-theoretical' model of change to a group of patients with eating disorders. Patients were studied in an in-patient setting. Two sets of questionnaires were used, one to assess 'stage' of change, the other to measure the 'processes' used to achieve change. Three stages and eight processes were examined. Thirty-five patients completed the study. Highest scores were found in the contemplation, and lowest in the precontemplation stage. The most frequently used processes of change were self-reevaluation, helping relationships and consciousness raising, with different processes predominating at different stages. Covariance analysis supported an association between two latent variables 'stage' and 'process'. Despite the limitations of small numbers, our results are in broad agreement with others using the 'trans-theoretical' model, supporting its use in eating disorders. Although further work is necessary, the model suggests a way of thinking about helping this very ambivalent group of patients to institute and sustain change.

Adolescent↗
PubMed1996

Sequential treatment for bulimia nervosa incorporating a self-care manual.

BACKGROUND: The aim of this study was to evaluate the effectiveness of a stepped care approach to the treatment of bulimia nervosa: a self-care manual followed, if necessary, by a course of attenuated cognitive behavioural treatment (CBT) in comparison with standard CBT. METHOD: One hundred and ten patients, presenting at a tertiary referral centre with ICD-10 bulimia nervosa or atypical bulimia nervosa, were randomly assigned to one of two treatment conditions; a) a sequential treatment group: 8 weeks with a self-care manual followed by up to eight sessions of CBT (if still symptomatic) or b) 16 sessions of CBT. RESULTS: Bulimic symptoms improved significantly in both groups with no significant differences between the two groups on any of the measures at the end of treatment or at 18 months follow-up. At end of treatment 30% (95% CI: 18-46%) of the sequential group and 30% (95% CI: 17-47%) of the standard treatment group were free from all bulimic symptoms. Sixteen of those in the sequential group improved significantly with self-care and did not require additional treatment. The median number of sessions taken by the sequential group was three (95% CI: 0-6). At 18 months follow-up 40% (95% CI: 23-59%) of the sequential group and 41% (95% CI: 25-59%) of the CBT group were symptom free. CONCLUSIONS: A sequential approach to the treatment of bulimia may be as effective as standard CBT and can considerably reduce the amount of therapist contact required.

Adolescent↗
PubMed1996

The demand for eating disorder care. An epidemiological study using the general practice research database.

BACKGROUND: An epidemiological study of anorexia nervosa and bulimia nervosa in primary care was performed using the General Practice Research Database (GPRD). METHOD: The GPRD was screened between 1988 and 1994 for newly diagnosed cases of anorexia nervosa and bulimia nervosa. The validity of the computer diagnosis was established by obtaining clinical details from a random sample of the general practitioners (GPs). RESULTS: Incidence rates for detection of cases by GPs in 1993 was 4.2 per 100,000 population for anorexia nervosa, and 12.2 per 100,000 for bulimia nervosa. The relative risks of females to males was 40:1 for anorexia nervosa and 47:1 for bulimia nervosa. A threefold increase in the recording of bulimia nervosa was found from 1988 to 1993. Eighty per cent of anorexia nervosa cases and 60% of bulimia nervosa cases were referred to secondary care. CONCLUSION: There is a continuing expansion of service need for bulimia nervosa. The majority of cases of eating disorders are referred to secondary services. There is scope for more effective management of bulimia nervosa in primary care.

Adolescent↗
PubMed1996

Physical measures of recovery from anorexia nervosa during hospitalised re-feeding.

OBJECTIVE: To examine the relationship between weight gain, changes in body composition and physiological characteristics of fitness during the recovery from anorexia nervosa. DESIGN: Longitudinal over eight weeks of intensive inpatient re-feeding (Wk 0-8). SETTING: The London Hospital Medical College. SUBJECTS: Ten female patients who agreed to participate. Seven completed the protocol. INTERVENTIONS: Dual-energy X-ray absorptiometry (dexa) and skinfold thickness measures at Wk 0 and 8. Weekly measures of peak expiratory flow rate and cycle ergometry (several variables relating to aerobic work recorded at rest and during cycling at low loads (0-60 W)). Blood samples for lactate and potassium measures, taken during cycling at Wk 0, 4 and 8 only. RESULTS: (1) Body composition: Mean weight gain over eight weeks was 9.6 kg, dexa and skinfold measures showing fat gain to contribute 62% and 54%, respectively. Both methods showed significant changes in percentage body fat with refeeding (P < 0.01 and P < 0.001, respectively), however there were significant differences in results between methods before (P < 0.01) but not after (P = 0.2) refeeding. (2) Physiological function: Between weeks 0 and 8, mean peak expiratory flow rate rose to 85% of predicted values, cycle ergometry performance improved in six subjects (three never reached 60 W load), mean respiratory exchange ratio (RER) during cycling fell at 0 W and 20 W loads (both P < 0.05), and oxygen pulse increased at rest and 0 W load cycling (both P < 0.05), Wk 8 values being well below normal. Oxygen uptake at rest and all loads increased in line with body weight gain only. No significant changes were seen in heart rate or blood lactate and potassium levels. CONCLUSIONS: (1) Lean body and fat mass increased significantly during eight weeks of refeeding. The methodological difference in initial body fat measurements requires further investigation. (2) The women had severely impaired physiological function. Variables studied were only slowly improving with refeeding, and work capacity was still well below normal.

Absorptiometry, Photon↗
PubMed1995

Patterns of punitiveness in women with eating disorders.

The level and direction of hostility in patients with bulimia nervosa, anorexia nervosa and a comparison group were measured using the the Hostility and Direction of Hostility Questionnaire. A semistructured interview developed by Harris, Brown, and Bifulco (Psychological Medicine, 16, 641-659, 1986) was used to assess childhood care to examine whether a link exists between childhood exposure to aggression or parental neglect and adult hostility. Patients with eating disorders had significantly higher hostility levels and were significantly more intropunitive than the comparison group. Patients with bulimia nervosa were significantly more intropunitive than the comparison group. Patients with bulimia nervosa were significantly more hostile than patients with anorexia nervosa. Anorexia nervosa patients were more likely to direct hostility inwardly, rather than outwardly, when compared with bulimia nervosa patients. Impulsivity was associated with extrapunitiveness whereas intropunitiveness was associated with depression. Although some measures of poor childhood care correlated with adult hostility levels no clear pattern emerged.

Adolescent↗
PubMed1995

A pilot study of a randomised trial of cognitive analytical therapy vs educational behavioral therapy for adult anorexia nervosa.

The aim of this study was to compare two forms of outpatient treatment, educational behavioural treatment and cognitive analytical therapy for adult anorexia nervosa. Thirty patients were randomly allocated to the two treatments. At one year, the group had gained 6.8 kg, 19/30 (63%) had a good or intermediate recovery in terms of nutritional outcome. The group given cognitive analytical treatment reported significantly greater subjective improvement but there were no differences in other outcome parameters. In conclusion outpatient treatment of adult onset anorexia nervosa leads to an improvement in two thirds of cases. Larger studies will be needed to determine the most effective form of treatment in this group.

Anorexia Nervosa↗
PubMed1995

Puberty, sexual milestones and abuse: how are they related in eating disorder patients?

In order to assess the relationship pubertal development, sexual milestones and childhood sexual abuse in women with eating disorders, 44 patients with restricting anorexia nervosa (RAN), 26 with bulimic anorexia nervosa (BAN), 29 with bulimia nervosa and also with a history of anorexia nervosa (BN/HistAN), and 69 with bulimia nervosa but without a history of anorexia nervosa (BN) completed questionnaires on pubertal and sexual development and unpleasant sexual experiences. Forty-four female college students complete the sexual development questionnaire only. Different eating disorder groups were found to be similar in terms of their pubertal development. All eating disorder groups showed delays in aspects of their psychosexual development (age at first kiss, masturbation, genital fondling and first sexual intercourse) compared with the control group, although to a different degree. The RAN group was delayed on almost all sexual milestones whereas the other groups were delayed on only some. On some variables, most noticeably on first sexual intercourse, restricters also were more delayed than the other eating disorder groups. Similarly, the median number of sexual partners differed significantly between groups (RAN = 1, BAN = 2, BN/HistAN = 4, BN = 4, controls = 5, P < 0.0001). Eating disorder patients, in particular RAN patients, were less positive about sexual relationships than controls, but did not differ from controls in attitudes to masturbation, marriage, children or pregnancy. Of the eating disorder patients 22-31% had been sexually abused during childhood. A history of abuse affected attitudes to masturbation, but did not appear to affect sexual development.

Adolescent↗
PubMed1995

Characteristics of the eating disorder in Prader-Willi syndrome: implications for treatment.

Over-eating and resultant obesity is well recognized as a central feature of the Prader-Willi Syndrome (PWS). The eating behaviour of 13 subjects with PWS was been studied retrospectively over a 28-day period and also by direct observation when given free access to food. Changing cognitions normally associated with food intake (e.g. changes in hunger) were assessed using visual analogue scales (VAS) and by asking subjects to rate photographs of particular foods. Eight out of 13 subjects (61%) with PWS had to have their access to food severely restricted. Ten (77%) ate excessive amounts when given free access to food, and although feelings of 'hunger', 'desire to eat' and 'fullness' changed in the expected direction, these changes were delayed, compared to a control group, and only occurred after eating a significantly greater amount of food. Ratings of 'hunger' and 'fullness' started to return to pre-meal levels sooner than in the controls. The present authors consider that PWS is an example of genetic obesity secondary to an impaired satiety response. These observations have important implications for treatment.

Adolescent↗
PubMed1995

Doubly disabled: diabetes in combination with an eating disorder.

We present a series of patients with both an eating disorder and diabetes mellitus and compare these to a group of non-diabetic patients from the same clinic. Significantly more of the diabetic patients had previous attempts at treatment for their eating disorder. A high incidence of diabetic complications was noted with clear implications, both clinically and economically, for early intervention. The incidence of childhood trauma was lower in the diabetic than the non-diabetic group. In the majority of patients, diabetes developed before the eating disorder, suggesting that diabetes itself may provide the vulnerability and increase the risk of developing an eating disorder. Early intervention in diabetic clinics may prevent the development of serious eating disorders.

Adult↗
PubMed1994

First step in managing bulimia nervosa: controlled trial of therapeutic manual.

OBJECTIVE: To test the short term efficacy of a self directed treatment manual for bulimia nervosa. DESIGN: Randomised controlled trial of the manual against cognitive behavioural therapy and a waiting list. SETTING: Tertiary referral centre. SUBJECTS: 81 consecutive referrals presenting with bulimia nervosa or atypical bulimia nervosa. MAIN OUTCOME MEASURES: Frequency of binge eating, vomiting, and other behaviours to control weight as well as abstinence from these behaviours. RESULTS: Cognitive behavioural treatment produced a significant reduction in the frequency of binge eating, vomiting, and other behaviours to control weight. The manual significantly reduced frequency of binge eating and weight control behaviours other than vomiting, and there was no change in the group on the waiting list. Full remission was achieved in five (24%) of the group assigned to cognitive behavioural treatment, nine (22%) of the group who used the manual, and two (11%) of the group on the waiting list. CONCLUSIONS: A self directed treatment manual may be a useful first intervention in the treatment of bulimia nervosa.

Adult↗