THE ROLE OF PERFECTIONISM IN TREATMENT OUTCOME OF FEMALE YOUTHS WITH EATING DISORDERS

Size: px

Start display at page:

Download "THE ROLE OF PERFECTIONISM IN TREATMENT OUTCOME OF FEMALE YOUTHS WITH EATING DISORDERS"

Jonas Frank Owens
5 years ago
Views:

THE ROLE OF PERFECTIONISM IN TREATMENT OUTCOME OF FEMALE YOUTHS WITH EATING DISORDERS Jack Johnston 2, Patrick Clarke 2, Kimberley Hoiles 1, Chloe Shu 1 Presented by Desley Davies 1 1 Eating

1 THE ROLE OF PERFECTIONISM IN TREATMENT OUTCOME OF FEMALE YOUTHS WITH EATING DISORDERS Jack Johnston 2, Patrick Clarke 2, Kimberley Hoiles 1, Chloe Shu 1 Presented by Desley Davies 1 1 Eating Disorders Program, Specialised Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Department of Health in Western Australia, Perth, Australia 2 School of Psychology and Speech Pathology, Curtin University, Perth, Australia London International Eating Disorders 2017

Perfectionism in EDs Perfectionism has been implicated in the theories and treatment of EDs: Cognitive-interpersonal model of AN (Schmidt & Treasure, 2006)

2 Perfectionism in EDs Perfectionism has been implicated in the theories and treatment of EDs: Cognitive-interpersonal model of AN (Schmidt & Treasure, 2006) Three factor model of BN (Bardone-Cone et al., 2006) Transdiagnostic theory of EDs (Fairburn et al., 2003) A treatment target in CBT-E if indicated (Fairburn, 2008)

Perfectionism in EDs 22 Strong support of relationship between perfectionism and eating disorders in adults, but limited research looking into perfectionism in paediatric eating disorders Some

3 Perfectionism in EDs 22 Strong support of relationship between perfectionism and eating disorders in adults, but limited research looking into perfectionism in paediatric eating disorders Some retrospective childhood reports of the link between perfectionism and eating disorders (Southgate et al., 2008; Fairburn et al., 1997; 1999) Few prospective studies have confirmed a strong link between perfectionism and ED among nonclinical youths (Bento et al., 2010; Boone et al., 2010)

4 Rationale 22 Can these findings be generalised to a clinical sample of children and adolescents with eating disorders? We need a prospective study in a clinical sample of children and adolescents with EDs

5 Study Aim 1.To examine the relationship between intake perfectionism and ED psychopathology across intake, 6 and 12-month review. 2. Does higher intake perfectionism predict lower remission rates at 12- month review, after controlling for intake BMI z-score?

HOPE Project Helping to Outline Paediatric Eating Disorders Clinical cohort project World s largest paediatric ED registry Measures: Medical

6 HOPE Project Helping to Outline Paediatric Eating Disorders Clinical cohort project World s largest paediatric ED registry Measures: Medical assessment BMI z-score Eating Disorder Inventory 3 Perfectionism Subscale (EDI-3; Garner, 2004) Eating Disorder Examination (EDE; Fairburn & Beglin, 1994)

Participants Female First presentation to EDP DSM-5 eating disorder Completed intake EDI-P (introduced in 2012) N = 195 at intake N = 112 at 6 months review (57.

7 Participants Female First presentation to EDP DSM-5 eating disorder Completed intake EDI-P (introduced in 2012) N = 195 at intake N = 112 at 6 months review (57.4% of intake) N = 79 at 12 months review (40.5% of intake) Age 14.6 years old (SD = 1.26) Duration of illness months (SD = 8.02) Most common DSM-5 diagnoses were Anorexia Nervosa-Restricting (n = 72; 36.9%) Atypical Anorexia Nervosa (n = 54, 27.7%) Unspecified Feeding and Eating Disorders (n = 29, 5.13%)

8 Results Does perfectionism at intake account for significant variance in ED psychopathology at intake? Hierarchical Multiple Regression Step 1: Intake BMI z-score accounted for 6.8% of variance in ED psychopathology at intake, F (1, 153) = 11.1, p <.001, small effect size. Step 2: Intake Perfectionism accounted for an additional 8.8% in ED psychopathology at intake, F (1, 152) = 15.8, p <.001, small effect size. Together, intake BMI z-score and intake perfectionism significantly accounted for 15.5% of intake eating disorder symptom variance, F (2, 152) = 14.0, p <.001, small effect size. Intake perfectionism was able to predict eating disorder psychopathology at intake.

9 Results Does perfectionism at intake account for significant variance in eating disorder psychopathology at 6 months review? Hierarchical Multiple Regression Step 1: Intake BMI z-score accounted for 9.8% of variance in ED psychopathology at 6 months review, F (1, 110) = 12.0, p <.001, small effect size. Step 2: Intake Perfectionism accounted for an additional non-significant 2.3% in ED psychopathology at 6 months review, F (1, 109) = 2.88, p =.092 Together, intake BMI z-score and intake perfectionism significantly accounted for 12.2% of variance of ED psychopathology at 6 months review, F (2, 109) = 7.54, p <.001, small effect size. Intake perfectionism was not able to predict eating disorder psychopathology at 6 months review

10 Results Does perfectionism at intake account for significant variance in eating disorder psychopathology at 12 months review? Hierarchical Multiple Regression Step 1: Intake BMI z-score accounted for 18.6% of variance in ED psychopathology at 12 months review, F (1, 77) = 17.55, p <.001, medium effect size Step 2: Intake Perfectionism accounted for an additional non-significant 3.9% in ED psychopathology at 12 months review, ΔF (1, 76) = 3.78, p =.055 Together, intake BMI z-score and intake perfectionism significantly accounted for 22.4% of variance of ED psychopathology at 12 months review, F (2, 76) = 11.0, p <.001, medium effect size. Intake perfectionism was not able to predict eating disorder psychopathology at 12 months review, although it was approaching statistical significance.

11 Results Does perfectionism at intake predict remission rates at 12 months review? At 12 months review, 24% had full remission (n = 18), 76% had an eating disorder (n = 56) Logistic Regression Step 1: Intake BMI z-score accounted for 12.2% of variance in remission rates at 12 months review, χ 2 (1) = 6.31, p =.012 Step 2: Intake Perfectionism accounted for an additional 8.3% in remission rates at 12 months review, χ 2 (1) = 4.64, p =.031 Together, intake BMI z-score and intake perfectionism significantly accounted for 20.5% of remission rates at 12 months review, χ 2 (2) = 11.0, p =.004 Intake perfectionism was able to predict eating disorder remission rates at 12 months review

After controlling for intake BMI z-score, intake perfectionism accounted for: an additional significant 8.8% of variance for intake ED psychopathology, a non-significant 2.

12 After controlling for intake BMI z-score, intake perfectionism accounted for: an additional significant 8.8% of variance for intake ED psychopathology, a non-significant 2.3% for ED psychopathology at 6 months review, and a trending though non-significant 3.9% for ED psychopathology at 12 months review. After controlling for intake BMI z-score, intake perfectionism accounted for an additional significant 8.3% of variance in remission rates at 12 months review A female paediatric patient with ED with low intake BMI and higher intake perfectionism levels will take a longer time to recover than a patient with higher intake BMI and lower intake perfectionism levels, with all other variables held constant

Discussion Given the non-significant or small effect sizes that intake perfectionism accounted for ED psychopathology across time, there may be other more important factors that contribute to the

13 Discussion Given the non-significant or small effect sizes that intake perfectionism accounted for ED psychopathology across time, there may be other more important factors that contribute to the maintenance of ED psychopathology across time e.g., low weight, comorbid depressive or anxious symptoms, self-harm or suicidal ideation The effects may be small or non-significant in light of the assessments being conducted relatively early in the span of illness: the average length of illness of eating disorder is 7.2 years (Herzog et al., 2000)

Strengths & Limitations Strengths First known prospective study examining perfectionism in a clinical paediatric sample Limitations High dropout rates At 6 months, 43% had dropped out (n = 83) At 12

14 Strengths & Limitations Strengths First known prospective study examining perfectionism in a clinical paediatric sample Limitations High dropout rates At 6 months, 43% had dropped out (n = 83) At 12 months, 59% had dropped out (n = 116) - Consistent with eating disorder research (Hoste et al., 2007) - Nature of reviews patients may find it distressing to attend either because they are still preoccupied with ED symptoms or have recovered and do not wish to come back to see other patients Unable to examine males with ED due to low numbers in sample

Future directions Longer follow-ups Including more variables to understand to understand the degree of influence each variable contributes at

15 Future directions Longer follow-ups Including more variables to understand to understand the degree of influence each variable contributes at different timepoints across the illness e.g., intake depression, anxiety, family functioning; capturing treatment frequency and type Including males with EDs

16 Questions?

Eating Disorders Are we doing enough? Tracey Wade Professor, School of Psychology

Eating Disorders Are we doing enough? Tracey Wade Professor, School of Psychology 25 June 2013 Myth 1 Anorexia nervosa is the most serious eating disorder Isabelle Caro 1982-2010 Fact 1 All eating disorders