Biomedical subjects

Roz Shafran

Publications and source records attributed to Roz Shafran.

11 recordsLinked to original sources

PubMed2004

Body checking and its avoidance in eating disorders.

OBJECTIVE: One expression of the core psychopathology of eating disorders is the repeated checking and avoidance of shape or weight. Two studies are reported. The primary purpose of the first was to describe the phenomenology of such body checking and avoidance. The aim of the second was to compare body checking and avoidance in women with and without a clinical eating disorder. METHOD: In Study 1, 64 female patients with clinical eating disorders participated in a semistructured interview assessing the features of body checking and avoidance. In the second study, a self-report questionnaire was used to compare body checking and avoidance in women with and without a clinical eating disorder (n = 110). RESULTS: The majority (92%) of the patients in Study 1 checked their bodies to assess their shape or weight and this was associated significantly with eating disorder symptoms. In Study 2, the clinical group had significantly more body checking and avoidance than the comparison group, and there was a strong association between eating disorder psychopathology and body checking and avoidance. CONCLUSIONS: These findings support the view that body checking and avoidance are direct expressions of the overevaluation of shape and weight. Further work is needed to determine whether these expressions contribute to the maintenance of eating disorders.

Adolescent↗

PubMed2004

The Vancouver Obsessional Compulsive Inventory (VOCI).

The original Maudsley Obsessional Compulsive Inventory (MOCI) has been widely used and is considered to be one of the best available self-report instruments for measuring observable obsessive-compulsive problems such as washing and checking. However, it has several limitations and requires updating. Our revision of the MOCI, the Vancouver Obsessional Compulsive Inventory (VOCI), was designed to provide assessment of a range of obsessions, compulsions, avoidance behaviour, and personality characteristics of known or theoretical importance in obsessive-compulsive disorder (OCD). The development of the VOCI is described, and we provide evidence of its reliability and validity. Our findings in samples of people with OCD, people with other anxiety disorders or depression, community adults, and undergraduate students suggest that the VOCI is a promising new measure. We anticipate that, like its predecessor, the VOCI will have widespread use in both research and clinical settings.

Adult↗

PubMed2004

Information processing biases in eating disorders.

Research has supported a link between emotional disorders (such as depression and anxiety) and information processing biases of attention and memory. This article reviews the extension of this approach to such biases in eating disorders. Two paradigms are considered in detail: the modified Stroop task and the dot probe task. In addition, the relative merits and problems associated with both approaches are considered. The limitations of the current research for clinical practice are discussed and suggestions are made for ways in which the research may be made more ecologically valid.

Affective Symptoms↗

PubMed2004

Thought-shape fusion in eating disorders.

OBJECTIVES: The aims of the present study were (1) to examine the association between a cognitive distortion ('thought-shape fusion') and eating disorder psychopathology and (2) to examine the degree of thought-shape fusion in people with eating disorders and a non-eating-disorder control group. DESIGN: Associations between thought-shape fusion and eating disorder psychopathology were examined and the degree of thought-shape fusion was compared between people with and without clinical eating disorders. METHOD: Forty-two women with clinical eating disorders and a group of 42 age-matched women with no self-reported history of an eating disorder completed self-report questionnaires to assess thought-shape fusion, eating disorder symptoms, body checking and body avoidance, and depression. RESULTS: Thought-shape fusion was significantly associated with eating disorder psychopathology. The majority of the associations remained significant when controlling for levels of depression. Patients with eating disorders showed significantly more thought-shape fusion than the non-clinical controls. CONCLUSIONS: Thought-shape fusion is a cognitive distortion associated with eating disorders. It may be a direct expression of the overevaluation of eating, shape and weight. It is recommended that thought-shape fusion be tackled directly in cases where it is a barrier to changing the core psychopathology of eating disorders.

Adolescent↗

PubMed2003

Body size estimation: testing a new mirror-based assessment method.

OBJECTIVE: The aim of the current study was to compare a new ecologically valid method of body size estimation with an existing, commonly used method. METHOD: The new method uses a "mirror-sized" image and measures perception rather than memory of body size. Fifty-five healthy women participated in the study. RESULTS: Body size estimations with the new method were significantly larger than with the existing method (p <.001). This difference was specific to body size and was not seen for estimation of neutral images. DISCUSSION: The results of the study show that different body size estimations are made with the new more ecologically valid method compared with the existing method. This finding has important implications for research into the factors influencing the perception of body size.

Adult↗

PubMed2003

Spontaneous decay of compulsive urges: the case of covert compulsions.

It is well established that many patients with obsessive-compulsive disorder have covert, or internal, compulsions. Empirical studies of this phenomenon, however, are limited. The present study followed the paradigm developed by Rachman and his colleagues for the study of overt compulsions. Patients with urges to carry out covert compulsions underwent an experimental procedure in which their compulsive urges were provoked, followed by a period of response prevention. The strength of the compulsive urges and associated discomfort were monitored. There was marked, and relatively rapid, spontaneous decay of both the compulsive urges and the discomfort. Implications of these results are discussed.

Adolescent↗

PubMed2003

Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment.

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.

Bulimia↗

PubMed2003

The preliminary development of a new self-report measure for OCD in young people.

The aim of this study was to develop a reliable self-report instrument to assess obsessive-compulsive disorder (OCD) in young people. The children's Obsessional Compulsive Inventory (CHOCI) had good internal consistency, criterion validity and was significantly correlated with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). This preliminary new measure could serve to provide a more efficient and accessible way of assessing OCD in young people.

Adolescent↗

PubMed2002

A new ecologically valid method to assess body size estimation and body size dissatisfaction.

OBJECTIVE: The primary aim of the present study was to develop an ecologically valid method for assessing the perception of body size (as opposed to the memory of body size). METHOD: Women with clinical eating disorders (N = 14) and no eating disorder (N = 24) estimated their actual and desired body size while looking in a mirror. Estimations were made using projected images that were the same height as the participants' reflections in the mirror. RESULTS: This new method assessed the perception of body size under conditions that resembled the real-life situation of viewing oneself in a mirror. Participants with eating disorders significantly overestimated their body size relative to controls (p <.05) and tended to be more dissatisfied with their body size (p =.07). DISCUSSION: It is argued that the new method assesses the perception of body size, is ecologically valid, and is the most clinically relevant of the methods developed to date.

Adult↗

PubMed2002

Clinical perfectionism: a cognitive-behavioural analysis.

This paper reviews the characteristics of clinical perfectionism and proposes a new definition of the phenomenon. It is suggested that the defining feature of clinically significant perfectionism is the overdependence of self-evaluation on the determined pursuit (and achievement) of self-imposed personally demanding standards of performance in at least one salient domain, despite the occurrence of adverse consequences. It is suggested that such clinical perfectionism is maintained by the biased evaluation of the pursuit and achievement of personally demanding standards. Specifically, it is suggested that people with perfectionism react to failure to meet their standards with self-criticism. If they do meet their standards, the standards are re-evaluated as being insufficiently demanding. Anorexia nervosa and bulimia nervosa are considered to have a particular relationship to perfectionism, with both disorders often being direct expressions of perfectionism. Under these circumstances self-evaluation is dependent on the pursuit and attainment of personally demanding standards in the domain of control over eating, shape and weight. The implications of this analysis for research and practice are considered.

Achievement↗

PubMedDate not supplied

Eating disorders guidelines from NICE.

CONTEXT: January, 2004, marked the publication of NICE guidelines for the treatment of eating disorders, a series of recommendations from a multidisciplinary, comprehensive, and rigorous process. The recommendations are assigned a grade from A (strong empirical support from well-conducted randomised trials) to C (expert opinion without strong empirical data). Over 100 recommendations were made, most of which were given a C grade. No specific recommendations were made for anorexia nervosa. Cognitive behavioural therapy for bulimia nervosa was assigned grade A because of the evidence showing that it is superior to other psychological and drug treatments. Antidepressants for bulimia nervosa were given grade B. No specific recommendations were made for atypical eating disorders except for binge-eating disorder (cognitive behavioural therapy was recommended [A]). STARTING POINT: The methodological rigour of the NICE guidelines is in contrast with the current Practice Guideline for Eating Disorders (PGED) of the American Psychiatric Association. PGED does not detail criteria for evaluating supporting research. Instead of making clear recommendations, PGED is uncritically inclusive and emphasises subjective judgment of individual clinicians. The NICE guidelines balance recommending specific treatments against the importance of clinical judgment when guideline recommendations are not readily applicable. WHERE NEXT: Evidence-based guidelines are limited by the quality of the available research and its clinical relevance. The NICE guidelines underscore the absence of sufficient evidence for guidance in several important areas, such as atypical eating disorders (eating disorders not otherwise specified) which are the most common. Research on the treatment of these atypical eating disorders is needed. Evidence-based psychological treatments are not routinely implemented in general practice. Dissemination of these demonstrably effective treatments poses a challenge, and learning how to implement evidence-based psychological treatments and monitor their use is a research priority.

Evidence-Based Medicine↗