Gymnastik- och idrottshögskolan, GIH

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  • 1.
    Birgegard, Andreas
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Abbaspour, Afrouz
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Borg, Stina
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Clinton, David
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Forsén Mantilla, Emma
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Savva, Androula
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Termorshuizen, Jet D.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Bulik, Cynthia M.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Univ N Carolina, Dept Psychiat, Chapel Hill, NC 27515 USA.;Univ N Carolina, Dept Nutr, Chapel Hill, NC 27515 USA..
    Longitudinal experiences and impact of the COVID-19 pandemic among people with past or current eating disorders in Sweden2021In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 30, no 6, p. 602-617Article in journal (Refereed)
    Abstract [en]

    The study aimed to document the impact of the COVID-19 pandemic on the health and well-being of individuals with past and current eating disorders (ED) in Sweden. We re-contacted participants with a known lifetime history of ED from two previous Swedish studies. Participants completed an online survey about health and functioning at baseline early in the pandemic (Wave 1 ca May/June 2020; N= 982) and six months later (Wave 2 Dec/Jan 2020/21; N= 646). Three important patterns emerged: 1) higher current ED symptoms were associated with greater anxiety, worry, and pandemic-related ED symptom increase; 2) patterns were fairly stable across time, although a concerning percentage (23%) who were symptom-free at Wave 1 reported the re-emergence of symptoms at Wave 2; and 3) only a minority of participants (<50%) with a current ED were in treatment, and of those in treatment, many reported fewer treatment sessions and decreased quality of care. The COVID-19 pandemic appears to pose serious health challenges for individuals with an ED, whether currently symptomatic or in remission. We encourage health service providers and patient advocates to be alert to the needs of individuals with ED and to take active measures to ensure access to appropriate evidence-based care both during and following the pandemic.

  • 2.
    Forsén Mantilla, Emma
    et al.
    Karolinska Inst, Dept Clin Neurosci, Norra Stn Gatan 69,7 Tr, S-11364 Stockholm, Sweden.;Stockholm Cty Council, Ctr Psychiat Res, Norra Stn Gatan 69,7 Tr, S-11364 Stockholm, Sweden..
    Birgegard, Andreas
    Karolinska Inst, Dept Clin Neurosci, Norra Stn Gatan 69,7 Tr, S-11364 Stockholm, Sweden.;Stockholm Cty Council, Ctr Psychiat Res, Norra Stn Gatan 69,7 Tr, S-11364 Stockholm, Sweden..
    Clinton, David
    Karolinska Inst, Dept Clin Neurosci, Norra Stn Gatan 69,7 Tr, S-11364 Stockholm, Sweden.;Stockholm Cty Council, Ctr Psychiat Res, Norra Stn Gatan 69,7 Tr, S-11364 Stockholm, Sweden.;Inst Eating Disorders, Kruses Gata 8, N-0263 Oslo, Norway..
    Factor analysis of the adolescent version of the Eating Disorders Examination Questionnaire (EDE-Q): results from Swedish general population and clinical samples2017In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 5, article id 19Article in journal (Refereed)
    Abstract [en]

    Background: Although 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. Methods: The 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. Results: The 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. Conclusions: The 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.

  • 3.
    Forsén Mantilla, Emma
    et al.
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Norra Stn Gatan 69, S-11364 Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Clinton, David
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Norra Stn Gatan 69, S-11364 Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.;Inst Eating Disorders, Oslo, Norway..
    Birgegard, Andreas
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Norra Stn Gatan 69, S-11364 Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Insidious: The relationship patients have with their eating disorders and its impact on symptoms, duration of illness, and self-image2018In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 91, no 3, p. 302-316Article in journal (Refereed)
    Abstract [en]

    ObjectivesIn published clinical and autobiographical accounts of eating disorders, patients often describe their disorder in personified ways, that is, relating to the disorder as if it were an entity, and treatment often involves techniques of externalization. By encouraging patients to think about their eating disorder as a relationship, this study aimed to examine how young female patients experience their eating disorder as acting towards them, how they react in response, and whether these interactions are associated with symptoms, illness duration, and self-image. DesignStructural Analysis of Social Behavior (SASB) was used to operationalize how patients experience the actions of their eating disorder and their own reactions to the disorder. MethodThe relationship between patients (N=150) and their eating disorders was examined with respect to symptoms, duration of illness, and self-image. Patients were also compared on their tendency to react with affiliation in relation to their disorder. ResultsPatients' responses on the SASB indicated that they tended to conceptualize their eating disorders as blaming and controlling, and they themselves as sulking and submitting in response. Greater experience of the eating disorder as being controlling was associated with higher levels of symptomatology. Patients reacting with more negative affiliation towards their disorder were less symptomatic. ConclusionsWhen encouraging patients to think about their eating disorder as a relationship, comprehensible relationship patterns between patients and their eating disorders emerged. The idea that this alleged relationship may resemble a real-life relationship could have theoretical implications, and its exploration may be of interest in treatment. Practitioner points Patients were able to conceptualize their eating disorder as a significant other to whom they relate when encouraged to do so. Patients tended to experience their disorder as controlling and domineering. Exploring the hypothetical patient-eating disorder relationship may prove helpful in understanding dysfunctional relational patterns. Helping patients to rebel against their eating disorder could potentially aid in symptom reduction.

  • 4.
    Forsén Mantilla, Emma
    et al.
    Karolinska Inst, Stockholm Cty Council, Ctr Psychiat Res, Dept Clin Neurosci, Norra Stationsgatan 69,7 Tr, S-11364 Stockholm, Sweden..
    Clinton, David
    Karolinska Inst, Stockholm Cty Council, Ctr Psychiat Res, Dept Clin Neurosci, Norra Stationsgatan 69,7 Tr, S-11364 Stockholm, Sweden.;Inst Eating Disorders, Oslo, Norway..
    Birgegard, Andreas
    Karolinska Inst, Stockholm Cty Council, Ctr Psychiat Res, Dept Clin Neurosci, Norra Stationsgatan 69,7 Tr, S-11364 Stockholm, Sweden..
    The unsafe haven: Eating disorders as attachment relationships2019In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 92, no 3, p. 379-393Article in journal (Refereed)
    Abstract [en]

    Objectives Some patients with eating disorders (EDs) seem to experience their illness as an entity, a symbolic other to whom they relate, and which may influence both symptom levels and self-image. Extending previous research, this study investigated whether the patient-ED relationship has attachment qualities. Design Structural Analysis of Social Behaviour was used to operationalize the patient-ED relationship, and the Attachment Style Questionnaire was used to measure attachment. Method We examined ED patients' (N = 148) relationship with their ED, attachment behaviour, symptoms, and self-image. Attachment dimensions of Confidence, Anxious/ambivalence, and Avoidance were found to be significantly correlated with aspects of the patient-ED relationship. Introjection (i.e., whether ED actions were incorporated into patients' self-image) was investigated by examining the match between self-image profiles and the actions of patients' EDs. A double mediation model was tested in which ED control/emancipation and patients' Self-blame mediated the effect of attachment security on ED symptoms. Results Attachment insecurity was associated with greater ED control and patient submission. In 28.5% of patients, there was a high degree of correlation between self-image and ED action profile. Data supported the mediation model. Conclusions Attachment processes appear to be associated with the manner in which ED patients relate to their disorder, at least in some cases. Attempts to maintain psychological proximity to the ED as an introjected attachment figure may help to explain treatment resistance and ambivalence about change. This perspective may be useful in treatment. Practitioner points Attachment behaviours are associated with the patient-ED relationship, in which attachment insecurity is correlated with greater eating disorder control and patient submission. Some patients seem to incorporate the actions of the ED in their self-image, suggesting the presence of introjection. The patient-ED relationship may help explain patients' anxiety and ambivalence about change, seen from an attachment perspective. In treatment, it may be important to explore alternative safe havens and secure bases to the ED, such as interpersonal relationships and activities.

  • 5.
    Forsén Mantilla, Emma
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Clinton, David
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Monell, Elin
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Levallius, Johanna
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Birgegard, Andreas
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Impulsivity and compulsivity as parallel mediators of emotion dysregulation in eating-related addictive-like behaviors, alcohol use, and compulsive exercise2022In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 12, no 1, article id e2458Article in journal (Refereed)
    Abstract [en]

    Introduction Transdiagnostically relevant psychological traits associated with psychiatric disorders are increasingly being researched, notably in substance use and addictive behaviors. We investigated whether emotion dysregulation mediated by impulsivity and/or compulsivity could explain variance in binge eating, food addiction, self-starvation, and compulsive exercise, as well as alcohol use (addictive-like behaviors relevant to the obesity and eating disorder fields). Method A general population sample of adults (N = 500, mean age = 32.5 years), females (n = 376) and males (n = 124), completed the Difficulties in Emotion Regulation Scale-16, the Trait Rash Impulsivity Scale, the Obsessive-Compulsive Inventory-Revised, the Eating Disorders Examination Questionnaire, the Self-Starvation Scale, the Exercise Dependence Scale, the Yale Food Addiction Scale, and the Alcohol Use Disorders Identification Test online. Besides gender comparisons and intercorrelations between measures, we used predefined multiple mediation models with emotion dysregulation as independent variable, impulsivity and compulsivity as parallel mediators, to investigate whether these factors contributed explanatory power to each addictive-like behavior as outcome, also using age and body mass index as covariates. Results Females scored higher than males on emotion dysregulation and the eating-related addictive-like behaviors food addiction, self-starvation, and binge eating. Intercorrelations between measures showed that emotion dysregulation and compulsivity were associated with all outcome variables, impulsivity with all except compulsive exercise, and the eating-related behaviors intercorrelated strongly. Mediation models showed full or partial mediation of emotion dysregulation for all behaviors, especially via compulsivity, suggesting a behavior-specific pattern. Mediation models were not affected by age or gender. Discussion Addictive-like behaviors seemed to be maintained by trait levels of emotion dysregulation, albeit channeled via trait levels of compulsivity and/or impulsivity. The role of emotion dysregulation may help us to understand why addictive-like behaviors can be difficult to change in both clinical and nonclinical groups, and may be informative for treatment-planning in patients where these behaviors are present. Our findings support adopting a more dimensional approach to psychiatric classification by focusing psychological facets such as those studied.

  • 6.
    Levallius, Johanna
    et al.
    Karolinska Inst, Ctr Eating Disorders Innovat, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Monell, Elin
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Birgegard, Andreas
    Karolinska Inst, Ctr Eating Disorders Innovat, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Clinton, David
    Karolinska Inst, Ctr Eating Disorders Innovat, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.;Inst Eating Disorders, Oslo, Norway..
    Forsén Mantilla, Emma
    Karolinska Inst, Ctr Eating Disorders Innovat, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Binge Eating and Addictive-Like Behaviours in Males and Females2022In: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 125, no 1, p. 148-166, article id 0033294120971750Article in journal (Refereed)
    Abstract [en]

    Introduction Binge eating is a common behaviour that is strongly linked to both obesity and eating disorder. There is evidence that binge eating commonly co-occurs with other problematic and addictive-like behaviours; however, this has not been explored systematically. The present study aimed to examine the relationship between binge eating, body weight, disordered eating behaviours and associated addictive-like behaviours, with particular attention paid to gender differences. Method A community sample (N = 500; 75% female, M-age = 32.5 years) reported disordered eating behaviours (i.e. binge eating, purging, restriction of eating, compulsive exercise), body mass index (BMI), food addiction, starvation addiction, exercise dependence, tobacco use and alcohol consumption. Results 42% of females and 21% of males reported binge eating during the past four weeks. Binge eating was significantly associated with all investigated behaviours in females, and with purging, compulsive exercise and overweight/obesity in males. Controlling for BMI, self-starvation predicted binge eating in males (OR = 1.07), while food addiction (OR = 1.73) and alcohol dependence (OR = 1.11) predicted binge eating in females. Conclusions The multiple associations between binge eating and addictive-like behaviors supports broad screening and generalized prevention efforts. Prevention efforts should reflect gender differences.

  • 7.
    Petersson, Suzanne
    et al.
    Kalmar Reg Council, Dept Rehabil, Hus 13,Plan 7, S-39185 Lanssjukhuset, Kalmar, Sweden.;Linnaeus Univ, Dept Med & Optometry, Kalmar, Sweden..
    Birgegard, Andreas
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Brudin, Lars
    Region Kalmar Cty, Dept Clin Physiol, Kalmar, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Forsén Mantilla, Emma
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Karolinska Inst, Stockholm Hlth Care Serv, Ctr Psychiat Res, Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Monell, Elin
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Clinton, David
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Inst Eating Disorders, Oslo, Norway..
    Bjorck, Caroline
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Stockholm, Sweden..
    Initial self-blame predicts eating disorder remission after 9 years2021In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 9, no 1, article id 81Article in journal (Refereed)
    Abstract [en]

    Background Research into predictors of outcome in eating disorders (ED) has shown conflicting results, with few studies of long-term predictors and the possible importance of psychological variables that may act as risk- and maintenance factors. Aim To identify baseline predictors of ED remission nine years after initial clinical assessment using self-report measures of ED psychopathology, psychiatric symptoms, and self-image in a sample of adult ED patients (N = 104) treated at specialist units in Stockholm, Sweden. Sixty patients participated in the follow-up, of whom 41 patients (68%) had achieved remission. Results Results suggested that the only significant predictor of diagnostic remission after nine years was initial levels of self-blame. Conclusion In order to ensure long-term recovery in ED it may be important for clinicians to widen their therapeutic repertoire and utilise techniques that reduce self-blame and increase self-compassion. Plain English summary It is difficult to predict how an eating disorder will develop, and research has found varying factors that affect the outcome of the condition. Recovery rates vary from nearly nil to over 90%. This variation could be explained by different research factors, but are more likely due to varying definitions of 'recovery', with less stringent definitions yielding high recovery rates and more stringent definitions yielding lower rates. The present study investigated whether the severity of eating disorder symptoms and other psychiatric symptoms could predict recovery nine years from first admission to specialised eating disorder care. Sixty patients at three eating disorder treatment units participated, and their scores on self-report measures of symptoms were used as predictor variables. Forty-one participants had no eating disorder diagnosis at nine-year follow-up. Most participants with binge-eating disorder had recovered, while the poorest outcome was found for anorexia nervosa with slightly over half of patients recovered after nine years. The only predictor for the nine-year outcome was a higher initial rating of self-blame, measured with the Structural Analysis of the Social Behavior. It was concluded that it may be important for clinicians to detect and address self-blame early in the treatment of eating disorders in order to enhance the possibility of recovery. Treatment should focus on reducing self-blame and increasing self-acceptance.

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