Quality assurance of specialised treatment of eating disorders using large‐scale internet‐based collection systems: Methods, results and lessons learned from designing the Stepwise database

Birgegård, Andreas; Björck, Caroline; Clinton, David

doi:10.1002/erv.1003

Cited by 77 publications

(86 citation statements)

References 17 publications

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“…Data came from the Stepwise database, a nationwide Swedish longitudinal clinical database of ED patients seeking treatment at specialist psychiatric treatment units [26]. All patients aged 13–17 registered in the database from 2005-03-07 (start of the database) through 2015-06-16 were extracted ( N = 3982).…”

Section: Methodsmentioning

confidence: 99%

Now you see it, Now you don’t: compulsive exercise in adolescents with an eating disorder

2017

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BackgroundCompulsive exercise (CE) has been proposed as significant in the etiology, development and maintenance of eating disorders (EDs), resulting in more severe and enduring pathology. However, few studies have investigated CE longitudinally in adolescents with EDs. We aimed to test if adolescents show the same associations between CE and other clinical variables as previous research has found in adults.MethodsThree thousand one hundred sixteen girls and 139 boys from a clinical ED database were investigated regarding prevalence and frequency of CE and its relation to psychiatric symptoms, associated features and outcome. Denial of illness is common among adolescents and was therefore adjusted for.ResultsAdjusted CE prevalence in girls was 44%, and CE was most prevalent in bulimia nervosa. As previously found in adults, those with CE scored significantly higher than non-CE on total ED severity, level of restriction and negative perfectionism. However, there were only minor differences between CE and non-CE patients on emotional distress, hyperactivity, suicidality and self-esteem. Among boys, adjusted CE prevalence was 38%, and CE boys scored significantly higher than non-CE on total ED severity. Initial CE did not influence 1-year outcome, although cessation of CE was associated with remission.ConclusionsCE is a common clinical feature in adolescents with EDs and cessation is associated with remission. When controlling for denial of illness, CE had less detrimental impact than predicted. We recommend controlling for denial in studies on ED adolescents and further exploration of classification and treatment implications of CE.

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Section: Methodsmentioning

confidence: 99%

Now you see it, Now you don’t: compulsive exercise in adolescents with an eating disorder

2017

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“…The ED sample was extracted from the Stepwise database, a large Internet-based quality assurance and data collection system used across Sweden [22]. The database was set up in 2005 and includes more than 40 clinics across the country.…”

Section: Methodsmentioning

confidence: 99%

Factor analysis of the adolescent version of the Eating Disorders Examination Questionnaire (EDE-Q): results from Swedish general population and clinical samples

2017

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BackgroundAlthough the Eating Disorder Examination Questionnaire (EDE-Q) is perhaps the single most widely used self-report measure of eating disorder (ED) symptoms, important questions remain about its validity and applicability in relation to particular groups of individuals, especially adolescents of both genders.MethodsThe present study investigated the factor structure of the adolescent version of the Eating Disorder Examination Questionnaire (EDE-Q) in samples of Swedish girls and boys from the general population and girls with a diagnosed eating disorder. Girls (N = 239) and boys (N = 248) aged between 13 and 15 years who were attending school, and girls (N = 570) aged between 12 and 14 years who were in treatment for an eating disorder at a specialist eating disorder clinic were assessed on the adolescent version of the EDE-Q.ResultsThe adolescent version of the EDE-Q demonstrated satisfactory levels of internal consistency. However, confirmatory factor analysis (CFA) failed to support the four-factor model of the EDE-Q. Parallel analysis (PA) and subsequent exploratory factor analysis (EFA) suggested that the adolescent version of the EDE-Q comprises one underlying factor in young adolescent girls (both clinical and general population), centred on Dissatisfaction with Shape and Weight. In boys three factors were found: Weight-related Concerns, Body Discomfort and Restraint.ConclusionsThe EDE-Q appears to measure different underlying aspects of eating disorder psychopathology in young teenagers compared to adults. The dimensions underlying disordered eating in young girls may become increasingly differentiated with time. There appear to be important gender-based differences in the dimensions underlying the EDE-Q in young teenagers. Therapists should be alert to beliefs that girls have about the importance of shape and weight, while in boys it may be more important to be attentive to how they feel about their bodies in relation to weight.

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“…All participants were assessed with Stepwise, a web-based quality assurance system for clinical ED care [31]. From Stepwise we used data from the Structured Eating Disorder Interview (SEDI) [32] for ED diagnoses according to the DSM, fourth edition, Text Revision (DSM-IV TR).…”

Section: Methodsmentioning

confidence: 99%

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among adult eating disorder patients

et al. 2017

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BackgroundVery little is known about the prevalence of ADHD symptoms in Bulimia Nervosa and Binge Eating Disorder and even less in other eating disorders. This knowledge gap is of clinical importance since stimulant treatment is proven effective in Binge Eating Disorder and discussed as a treatment possibility for Bulimia Nervosa. The objective of this study was to explore the prevalence and types of self-reported ADHD symptoms in an unselected group of eating disorder patients assessed in a specialized eating disorder clinic.MethodsIn total 1165 adults with an eating disorder were assessed with a battery of standardized instruments, for measuring inter alia ADHD screening, demographic variables, eating disorder symptoms and psychiatric comorbidity. Chi-square tests were used for categorical variables and Kruskal-Wallis tests for continuous variables.ResultsAlmost one third (31.3 %) of the patients scored above the screening cut off indicating a possible ADHD. The highest prevalence rates (35–37 %) were found in Bulimia Nervosa and Anorexia Nervosa bingeing/purging subtype, while Eating Disorder Not Otherwise Specified type 1–4 and Binge Eating Disorder patients reported slightly below average (26–31 %), and Anorexia Nervosa restricting subtype patients even lower (18 %). Presence of binge eating, purging, loss of control over eating and non-anorectic BMI were related to results indicating a possible ADHD. Psychiatric comorbidity correlated to ADHD symptoms without explaining the differences between eating disorder diagnoses.ConclusionsThere is a high frequency of ADHD symptoms in patients with binge eating/purging eating disorders that motivates further studies, particularly concerning the effects of ADHD medication. The finding that the frequency of ADHD symptoms in anorexia nervosa with binge eating/purging is as high as in bulimia nervosa highlights the need also for this group.

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Quality assurance of specialised treatment of eating disorders using large‐scale internet‐based collection systems: Methods, results and lessons learned from designing the Stepwise database

Cited by 77 publications

References 17 publications

Now you see it, Now you don’t: compulsive exercise in adolescents with an eating disorder

Now you see it, Now you don’t: compulsive exercise in adolescents with an eating disorder

Factor analysis of the adolescent version of the Eating Disorders Examination Questionnaire (EDE-Q): results from Swedish general population and clinical samples

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among adult eating disorder patients

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