Biomedical subjects

S Wonderlich

Publications and source records attributed to S Wonderlich.

12 recordsLinked to original sources

PubMed2001

Pathways mediating sexual abuse and eating disturbance in children.

OBJECTIVE: To examine the relationship between childhood maltreatment and eating disorders in a sample of children. METHOD: Twenty 10-15-year-old female children who were receiving treatment following reported childhood sexual abuse and 20 age-matched controls were compared on a series of measures assessing eating disorder behaviors, body image concerns, substance use, mood, impulsive behavior, and self-concept. RESULTS: Sexually abused children reported higher levels of eating disorder behaviors, impulsive behaviors, and drug abuse than controls. Furthermore, behavioral impulsivity provided the strongest mediational effect between a history of childhood sexual abuse and purging and restrictive dieting behavior. Drug use proved to be a significant secondary mediator of the childhood sexual abuse eating disorder behavior association. DISCUSSION: These data support the hypothesis that childhood sexual abuse is related to disordered eating in children, and extend similar findings that have been previously reported with adults. Behavioral impulsivity and drug use appear to be significant mechanisms that influence eating disorder behavior following childhood sexual abuse.

Adolescent↗

PubMed2001

The use of ecological momentary assessment approaches in eating disorder research.

OBJECTIVE: Eating disorder (ED) research is increasingly focusing on the proximal antecedents to disordered eating behavior. Such antecedents may include cognitions, environmental stimuli, social interactions, and affective states. Current ED theories suggest that the relationships between antecedents and eating behavior may be complex, including interaction associations, time-lagged effects, and associations that persist only for brief periods of time. Similarly, these theories often include the consequences of behavior-influencing variables of interest (e.g., short-term reductions in negative affect). Careful examination of such theories, however, has been limited by a reliance on data collection methods not appropriate for testing these effects. METHOD: This study examines alternative methods for data collection and analysis that overcome previously noted limitations, using data collected in several studies with eating-disordered participants. RESULTS: The development of a technique called ecological momentary assessment (EMA) allows the ongoing study of behavior in its natural context and reduces biases associated with retrospective recall. The development of technology that allows the sophisticated collection and storage of such data (e.g., palm-top computers), along with statistical procedures for analyzing hierarchically nested, repeated measures data, allow precise testing of complex theoretical models. DISCUSSION: We demonstrate several important features of this research: (1) patients are willing and able to engage in EMA studies, (2) data not possible to collect using other designs are obtainable, (3) complex theoretical models can be evaluated using these data and appropriate statistical methods, and (4) the collection and analysis of EMA data present unique difficulties to ED researchers. Finally, we endorse and provide recommendations for the use of EMA in future ED research and practice.

Data Collection↗

PubMed2001

Administering cognitive-behavioral therapy for bulimia nervosa via telemedicine in rural settings.

OBJECTIVE: This report describes the therapy of 2 women with bulimia nervosa who were treated using cognitive-behavioral therapy delivered via telemedicine. METHOD: The telecommunication link was established using a 128-Kbps ISDN switchable data line. RESULTS: Both cases were treated successfully and were doing well at 1-month follow-up. DISCUSSION: These cases illustrate that this methodology may make it possible to deliver manual-based psychotherapies to patients with eating disorders in remote areas.

Adult↗

PubMed2001

The role of personality in the onset of eating disorders and treatment implications.

The relationship of personality and eating disorders is largely unclear. The development of well-specified conceptual models of this relationship, developments in family history, behavior genetic and prospective longitudinal research methodology, and careful consideration of how trait constructs may interact with state variables to produce or maintain eating disorders all will help to advance this area of research.

Feeding and Eating Disorders↗

PubMed2001

Combining pharmacotherapy and psychotherapy in the treatment of patients with eating disorders.

The available treatment literature supports a role for medication management in the treatment of both AN and BN. The data on BN are clearer and suggest that antidepressant therapy--fluoxetine being the drug most widely studied--is superior to treatment with placebo but less effective than CBT alone, with one such study suggesting that the combination may provide optimal treatment. Specific recommendations as to when to add or not add antidepressants to CBT have been made, although the rules suggested here have yet to be empirically tested. Although the data on AN are much more limited, information available suggests a lack of efficacy for SSRIs in patients with AN at low weight and considerable use for SSRIs when used in combination with psychotherapy for patients with AN following weight recovery. Where do we go from here? Several pressing issues require careful study. First, in the case of patients with AN, can other agents, in particular the new atypical antipsychotics, be useful in treating patients when they are at low weight? In terms of relapse prevention, can the available findings indicating a role for antidepressants in relapse prevention be replicated, and, if so, can predictor variables that are associated with antidepressant response be identified? In the case of BN, clinicians need to know more about the best possible way to sequence interventions. It has been proposed to add medication to CBT early in treatment if the response to CBT alone is thought to be inadequate. However, other models should be considered, such as stepped-care models in which self-help manuals are used in conjunction with medications. The advantage of these interventions is they could be made more widely available than CBT, which requires a specialist's care. Also, several other new agents, such as sibutramine, which is a drug with serotonin and norepinephrine reuptake inhibition effects, should be tested empirically in subjects with BN, given their pharmacologic profiles.

Anorexia Nervosa↗

PubMed1998

Feeding laboratory studies in patients with eating disorders: a review.

OBJECTIVE: The authors review the available literature on feeding lab studies in individuals with anorexia nervosa, bulimia nervosa, and binge eating disorder. METHOD: Studies were grouped by the research groups which have conducted such studies since these studies have tended to cluster in certain research settings, using specific methodologies at each sites. RESULTS: The results of this review indicate that although there are several inherent limitations in this type of research, various groups of investigators have demonstrated that eating disorder patients will engage in pathological eating behaviors in structured laboratory settings and that results can be obtained fairly consistently. Also interesting clinically significant differences have emerged across groups. Subtle differences in technique, such as the instructions regarding eating behavior, probably result in different behavioral responses. DISCUSSION: Feeding laboratory studies provide useful information that can validate, suggest, or challenge established clinical assumptions and diagnostic criteria. However, there are limitations to these methodologies.

Anorexia Nervosa↗

PubMed1997

Performance variability as a new theoretical mechanism regarding eating disorders and cognitive processing.

Bulimic (n = 23) and control subjects (n = 28) were compared on four neuropsychological tests and several clinical variables. Between-group differences were observed on neuropsychological measures that reflected marked impulsivity and problem-solving deficits in the bulimics. Additional between-group comparisons, based on the variability of performance on the neuropsychological tests, revealed that bulimics were more variable than controls on approximately 50% of the tests given Performance variability on the remaining two tests was equal across the bulimic and control groups. This represents the first known application of this performance variability analysis in subjects with bulimia nervosa. It is proposed that there may be considerable variability in performance among bulimics and that by examining performance from this "sub-group" perspective may lead to a more analytic understanding of this eating disorder.

Adolescent↗

PubMed1997

Do individuals at risk for eating disorders exhibit negative priming deficits?

Fifty people (25 at risk for an eating disorder, 25 controls) performed a simple reaction-time (SRT) task and a negative-priming (NP) task. The two groups did not differ on the SRT task. For the NP task, the controls displayed the NP effect (responses on critical trials were slower than responses on control trials). At-risk participants, however, revealed no such NP effect. Although the pattern of NP performance in the at-risk participants may indicate that they as a group had deficiencies in their ability to inhibit irrelevant information, it is also possible that issues related to obsessionality, perfectionism, and restraint in the at-risk group affected the results.

Adult↗

PubMed1996

Relationship of social perceptions and self-concept in bulimia nervosa.

Although numerous studies have examined the families of bulimic individuals, none have explicitly addressed how family factors relate to self-concept among patients with bulimia. This study used L. Benjamin's' structural analysis of social behavior (1974) rating scales to assess how perceptions of parental relationships relate to self-concept. The results indicate that female patients with bulimia perceive both parents as hostilely disengaged. Furthermore, the self-concepts of patients with bulimia were significantly associated with perceptions of paternal attack/friendliness, which differentiated them from control participants. The results are discussed in terms of the possible relations between family factors and self-concept in bulimia.

Adolescent↗

PubMed1994

Perceptions of nonshared childhood environment in bulimia nervosa.

OBJECTIVE: The aim of this research was to identify perceptions of nonshared childhood environmental factors associated with bulimia nervosa and the comorbid personality traits associated with this disorder. METHOD: Twenty-nine individuals with bulimia nervosa and 27 normal controls compared themselves to a sibling on a measure specifically designed to assess perceptions of nonshared environmental factors in parental, peer, and sibling relationships. Also, bulimic individuals' primary clinicians completed a series of ratings for each of the DSM-III personality disorders. RESULTS: Bulimic individuals were more likely than controls to rate their fathers as showing less affection and more control toward them than toward their sibling. Among bulimic individuals, borderline personality disorder ratings were associated with the perception that both mother and father showed less affection toward the bulimic individual than toward her sibling. Avoidant and depressive personality ratings were associated with perceptions of unique experiences with peers. CONCLUSION: These data provide preliminary evidence suggesting that the paternal relationship may be a source of nonshared environmental experience associated with bulimia nervosa. Borderline personality disorder among bulimics appears related to more pervasive within-family experiences across both the maternal and paternal relationship, while depressive and avoidant personality seems related to unique peer experiences.

Adolescent↗

PubMed1993

House of Games: a cinematic study of countertransference.

In this paper we have described how examining the film House of Games can lead to an enriched understanding of the concept of countertransference for both neophyte and experienced psychotherapists. This absorbing film portrays countertransference phenomena from a number of crucial perspectives: predispositions to countertransference, direct and indirect indicators, countertransference in the "totalistic" sense as well as countertransference in the "classical" sense, parallel-process dynamics between therapy and supervision and the value of social and professional support in managing this inevitable burden. Cinema is another method, along with more traditional supervisory and didactic approaches, of assisting therapists to increase their cognitive and affective mastery of countertransference phenomena by encouraging them to analyze their emotional reactions to patients. This is no small task. In summary, we believe that the recognition, analysis and management of countertransference reactions is a necessary and life long professional task for any serious psychotherapist.

Countertransference↗

PubMed1986

Self-referent processing of age-specific material.

College students and elderly subjects made self- and other-descriptiveness judgments about trait adjectives that were age-specific descriptors. The young adults favored endorsement of traits that had been judged descriptive of young adults, compared to traits that had been judged descriptive of elderly adults. However, elderly adults endorsed an equivalent number of young and elderly traits. This indicates that content specificity with regard to age is more a characteristic of young adults than elderly people, with elderly adults being "schematic" for descriptors of both young and older people. Nonetheless, for the elderly subjects, the speed of self-reference decisions was slower for the young traits relative to the elderly traits, as if the young traits were somewhat less accessible. Although elderly adults recalled fewer adjectives overall than young adults, their pattern of recall was similar for self- versus other-referenced items. Thus, it seem unlikely that age differences in spontaneous self-referencing account for the general age deficit in retention.

Adolescent↗