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BACKGROUND: Patients with anorexia nervosa (AN) have a persistent distorted experience of the size of their body. Previously we found that the Rubber Hand Illusion improves hand size estimation in this group. Here we investigated whether a Full Body Illusion (FBI) affects body size estimation of body parts more emotionally salient than the hand. In the FBI, analogue to the RHI, participants experience ownership over an entire virtual body in VR after synchronous visuo-tactile stimulation of the actual and virtual body. METHODS AND RESULTS: We asked participants to estimate their body size (shoulders, abdomen, hips) before the FBI was induced, directly after induction and at ~2 hour 45 minutes follow-up. The results showed that AN patients (N = 30) decrease the overestimation of their shoulders, abdomen and hips directly after the FBI was induced. This effect was strongest for estimates of circumference, and also observed in the asynchronous control condition of the illusion. Moreover, at follow-up, the improvements in body size estimation could still be observed in the AN group. Notably, the HC group (N = 29) also showed changes in body size estimation after the FBI, but the effect showed a different pattern than that of the AN group. CONCLUSION: The results lead us to conclude that the disturbed experience of body size in AN is flexible and can be changed, even for highly emotional body parts. As such this study offers novel starting points from which new interventions for body image disturbance in AN can be developed.

Soldiers and veterans diagnosed with PTSD benefit less from psychotherapy than non-military populations. The current meta-analysis identified treatment predictors for traumatised soldiers and veterans, using data from studies examining guideline recommended interventions, namely: EMDR, exposure, cognitive, cognitive restructuring, cognitive processing, trauma-focused cognitive behavioural, and stress management therapies. A systematic search identified 57 eligible studies reporting on 69 treated samples. Exposure therapy and cognitive processing therapy were more effective than EMDR and stress management therapy. Group-only therapy formats performed worse compared with individual-only formats, or a combination of both formats. After controlling for study design variables, EMDR no longer negatively predicted treatment outcome. The number of trauma-focused sessions, unlike the total number of psychotherapy sessions, positively predicted treatment outcome. We found a relationship between PTSD pretreatment severity levels and treatment outcome, indicating lower treatment gains at low and high PTSD severity levels compared with moderate severity levels. Demographic variables did not influence treatment outcome. Consequently, soldiers and veterans are best served using exposure interventions to target PTSD. Our results did not support a group-only therapy format. Recommended interventions appear less effective at relatively low and high patient PTSD severity levels. Future high-quality studies are needed to determine the efficacy of EMDR.

Background A longitudinal study was conducted in order to assess the impact of the Ghislenghien disaster (July 30th, 2004) on physical, mental and social health in the affected population. Objectives The present study explored the risk for the development of four types of mental health disturbances (MHD) due to exposure to different aspects of this technological disaster in comparison with data obtained from previous health surveys among the population of the same province. Methods/Design Surveys were conducted 5 months (T1) and 14 months (T2) after the disaster. Potential adult victims (≥ 15 years) were included (n=1027 and 579 at T1 and T2 respectively). The "Symptom Checklist-90-Revised" (SCL-90-R) has been used in order to compute actual prevalence rates of somatization-, depression-, anxiety- and sleeping disturbances for three defined exposure categories: direct witnesses who have seen human damage (SHD), direct witnesses who have not seen human damage (NSHD) and indirect witnesses (IW). Those prevalence rates were compared with overall rates using the inhabitants of the province of Hainaut (n=2308) as reference population. A mental health comorbidity index was computed. Relative risks were estimated using logistic regression models. Results Prevalence rates of the four MHD were much higher for the SHD than for the other exposure groups, at T1 and T2. Moreover, NSHD and IW had no increased risk to develop one of the 4 types of MHD compared to the reference population. The SHD had at T1 and T2 good 5-times a higher risk for somatization, about 4-times for depression and sleeping disorders, and 5- to 6-times for anxiety disorders respectively. Further, they suffered 13 times, respectively 17 times more from all mental disorders together. Conclusions The present study calls attention to the fact that mental health problems disturbances are significantly more prevalent and long-lasting among survivors who have directly been exposed to human damage.

BACKGROUND: This paper investigates risk factors for the development of posttraumatic stress symptoms in the different survivor groups involved in a technological disaster in Ghislenghien (Belgium). A gas explosion instantly killed five firefighters, one police officer and 18 other people. Moreover, 132 people were wounded among which many suffered severe burn injuries. METHODS: In the framework of a large health survey of people potentially involved in the disaster, data were collected from 3,448 households, of which 7,148 persons aged 15 years and older, at 5 months (T1) and at 14 months (T2) after the explosion. Hierarchical regression was used to determine the significant predictors and to assess their proportion in variance accounted for. RESULTS: The degree of exposure to the disaster was a predictor of the severity of posttraumatic stress symptoms. Peritraumatic dissociation appeared to be the most important predictor of the development of posttraumatic stress symptoms at T1. But at T2, posttraumatic stress symptoms at T1 had become the most important predictor. Dissatisfaction with social support was positively linked to development of posttraumatic stress symptoms at T1 and to the maintenance of these symptoms at T2. Survivors who received psychological help reported significant benefits. CONCLUSIONS: In harmony with the findings from studies on technological disasters, at T1 6,0% of the respondents showed sufficient symptoms to meet all criteria for a full PTSD. At T2, 6,6% still suffered from posttraumatic stress symptoms. The symptoms of the different victim categories clearly indicated the influence of the degree of exposure on the development of posttraumatic stress symptoms. Problems inherent to retrospective scientific research after a disaster are discussed.

We conducted a three-wave prospective study among patients with burns (N = 178) to examine the prospective influence of coping self-efficacy (CSE) perceptions on trajectories of posttraumatic stress symptoms in the first 12 months after burn injuries. Using linear growth curve modeling, we corrected for demographics, the number of surgeries during initial admittance, trait coping styles, and changing levels of health-related quality of life. CSE during initial admission was by far the strongest predictor of both initial PTSD symptoms and degree of symptom change with higher CSE levels associated with lower initial symptoms and a steeper decline of symptoms over time. Of the other variables only avoidant coping was associated with higher initial symptom levels, and only emotional expression associated with greater rate of recovery. Current findings suggest that CSE plays a pivotal role in recovery from posttraumatic stress after a burn injury, even when the role of burn-related impairments is taken into consideration. Implications of findings are discussed.

To evaluate the adequacy of pain management in burn care, pain measurement is essential. The visual analogue thermometer (VAT) and graphic numeric rating scale (GNRS) are frequently used self-report instruments for burn pain. To legitimise their interchangeable use in research and practice, we aimed to compare self-reports obtained by the VAT and GNRS, the ability of the scales to differentiate background from procedural pain, and to compare potential cutpoints. Adults with acute burns (N = 319) participated in the study (67% male, mean age 40.3 years (SD 16), mean TBSA 9.9% (SD 10.4). Correlation coefficients between VAT and GNRS were 0.64 and 0.55 for, respectively, morning and afternoon background pain and 0.51 for procedural pain (p < 0.01). VAT scores were lower than GNRS scores for all pain types (p < 0.01). Both scales could differentiate background from procedural pain: procedural pain was higher (p < 0.01). The standardized response mean was moderate (0.518 for VAT and 0.571 for GNRS). Self-reported thresholds for 'unacceptable pain' by GNRS were higher than by VAT (p < 0.001). ROC analyses showed that the highest sensitivity was reached for pain score 2 for both scales. The results suggest that the instruments cannot be used interchangeably without taking their differences into account.

Thirty to fifty percent of posttraumatic stress disorder (PTSD) patients do not respond to treatment. Understanding the neural mechanisms underlying treatment response could contribute to improve response rates. PTSD is often associated with decreased inhibition of fear responses in a safe environment. Importantly, the mechanism of effective treatment (psychotherapy) relies on inhibition and so-called contextual cue processing. Therefore, we investigate inhibition and contextual cue processing in the context of treatment. Forty-one male war veterans with PTSD and 22 healthy male war veterans (combat controls) were scanned twice with a 6- to 8-month interval, in which PTSD patients received treatment (psychotherapy). We distinguished treatment responders from nonresponders on the base of percentage symptom decrease. Inhibition and contextual cue processing were assessed with the stop-signal anticipation task. Behavioral and functional MRI measures were compared between PTSD patients and combat controls, and between responders and nonresponders using repeated measures analyses. PTSD patients showed behavioral and neural deficits in inhibition and contextual cue processing at both time points compared with combat controls. These deficits were unaffected by treatment; therefore, they likely represent vulnerability factors or scar aspects of PTSD. Second, responders showed increased pretreatment activation of the left inferior parietal lobe (IPL) during contextual cue processing compared with nonresponders. Moreover, left IPL activation predicted percentage symptom improvement. The IPL has an important role in contextual cue processing, and may therefore facilitate the effect of psychotherapy. Hence, increased left IPL activation may represent a potential predictive biomarker for PTSD treatment response.

Despite increased attention to the role of fathers within families, there is still a dearth of studies on the impact of trauma on father-involvement. This study investigates the quantity of father-involvement and the influence of posttraumatic stress on the quality of involvement in a refugee and asylum seeker population. Eighty refugees and asylum seekers and their young children (aged 18-42 months) were recruited. Measures included assessment of parental trauma (Harvard Trauma Questionnaire), quantity and quality of involvement (quantity of caregiving and Emotional Availability Scales), and perception of the father-child relationship (interview). The results show that fathers were less involved in caregiving tasks and play activities than mothers. No parental gender differences were found on each of the Emotional Availability Scales. Traumatic stress symptoms negatively affected the perception and the actual quality of parent-child interaction (sensitivity, structuring, nonhostility). Nevertheless, almost all fathers described their relationship with their child as good and their child as very important to them. As the quality of father-involvement is of importance to the development of the child, traumatized fathers are as much in need of clinical intervention as mothers. Despite the impact of posttraumatic stress, refugee fathers clearly are involved in the lives of their children. Mechanisms such as a deliberate withdrawal when stressed and compensation might enable affected fathers to step into the interaction when needed, raise the quality of involvement with their child, and diminish the negative impact of stress resulting from trauma and migration. Language: en

Background Hundreds of individuals lost one or more significant others in the MH17 plane crash in 2014 in Ukraine. The current study is the first to explore subgroups of disaster-bereaved individuals based on presence of psychopathology clusters. This may inform the development of diagnostic instruments and tailored interventions. Objective Aims of the current study were to examine (1) subgroups based on presence of Prolonged Grief Disorder (PGD), Major Depressive Disorder (MDD), and Posttraumatic Stress Disorder (PTSD) symptom clusters and (2) associations between class membership, disaster-related variables (i.e., experiencing multiple losses, conducting multiple burials for the same deceased, and time to confirmation of death), and a sense of unrealness. Method Self-rated PGD (10 items of the Traumatic Grief Inventory represented in two symptom clusters), MDD (16-item Quick Inventory of Depressive Symptomatology represented in one symptom cluster), and PTSD (20-item PTSD Checklist for DSM-5 represented in four symptom clusters) from 167 participants were subjected to latent class analysis to identify subgroups (i.e., classes). Correlates of class membership were assessed using the three-step approach. Results A three-class solution yielded the best model fit. Class 1 (Resilient class; 20.0%) was predominantly characterized by low probability of PGD, MDD, and PTSD symptom clusters, class 2 (PGD class; 41.8%) by moderate to high probability of presence of PGD, and class 3 (Combined class; 38.2%) by moderate to high probability of presence of PGD, MDD, and PTSD symptom clusters. Compared with the Resilient class, a sense of unrealness was more likely to be experienced by individuals in the PGD class and the Combined class. Conclusions Our results indicate that subgroups of disaster-bereaved individuals can be distinguished based on the presence of PGD, MDD, and PTSD symptom clusters. A sense of unrealness was the strongest distinguishing feature of the subgroups.

Aspects of the socio-economic costs of bereavement in Scotland were estimated using three sets of data. Spousal bereavement was associated with increased mortality and longer hospital stays, with additional annual cost of around £20 million. Cost of bereavement coded consultations in primary care was estimated at around £2.0 million annually. Additionally, bereaved people were significantly less likely to be employed in the year of and two years after bereavement than non-bereaved matched controls, but there were no significant differences in income between bereaved people and matched controls before and after bereavement.

Despite their intentions, weight-concerned individuals generally fail to control their eating behavior. However, it is unknown whether this failure is due to a lack of effortful self-control, or to not experiencing an internal conflict between weight goals and food temptations. The present study used fMRI, eye tracking and reaction times to assess the degree of conflict experienced by weight-concerned women during food choices that posed either a self-control dilemma (i.e., requiring a choice between healthy and palatable foods), or not. Contrary to the common assumption in self-control theory that food choices posing a self-control dilemma evoke internal conflict, we found that choices requiring self-control induced no conflict, as demonstrated by lower reaction times, fixation durations, number of gaze switches between snacks, and lower activation of the anterior cingulate cortex. Our results suggest that self-control failure might be due to a lack of experienced conflict, rather than to failing to act upon the perception of such conflict. This implies that effectiveness of weight maintenance interventions might be improved if they also focus on increasing the ability to detect a self-control dilemma, in addition to the current focus on increasing self-regulatory capacity.

Background Behavioral migraine approaches are effective in reducing headache attacks. Availability of treatment might be increased by using migraine patients as trainers. Therefore, Mérelle and colleagues developed and evaluated a home-based behavioral management training (BMT) by lay trainers ( 1 ). The maintenance of effects at long-term follow-up is studied in the present study. Method Measurements were taken pre-BMT (T0), post-BMT (T1), at six-month follow-up (T2), and at long-term follow-up, i.e. two to four years after BMT (T3). Data of 127 participants were analyzed with longitudinal multi-level analyses. Results Short-term improvements in attack frequency and self-efficacy post-BMT were maintained at long-term follow-up ( dT0–T3 = −.34 and dT0–T3 = .69, respectively). The level of internal control that increased during BMT decreased from post-BMT to long-term follow-up ( dT0–T3 = .18). Quality of life and migraine-related disability improved gradually over time ( dT0–T3 = .45 and dT0–T3 = −.26, respectively). Conclusions Although the results should be interpreted with caution because of the lack of a follow-up control group and the inability to gather information about additional treatments patients may have received during the follow-up period, the findings suggest that lay BMT for migraine may be beneficial over the long term. If so, this could make migraine treatments more widely available.

Two different types of ruminative coping, depressive rumination and grief rumination, negatively influence bereavement outcome. Although grief-specific rumination is likely to be relevant in the bereavement context no internationally validated scale to measure grief rumination exists. Therefore, the current contribution aims to validate the Utrecht Grief Rumination Scale (UGRS), a scale developed to measure grief-specific rumination, in an English sample. Psychometric properties of the English UGRS were compared with those in a Dutch sample. 204 British adults (89 % women, 11 % men), bereaved on average 16 months ago, and 316 Dutch adults (88 % women, 12 % men), bereaved on average 12 months ago, filled out online questionnaires. Different types of rumination (grief rumination, brooding, reflection, trait rumination) and symptoms of psychopathology (anxiety, depression, complicated grief) were measured. A correlated five factor model provided the best fit for the UGRS. Multi-group comparisons showed that the factor structures of the English and Dutch version of the UGRS were highly similar across language groups. The UGRS showed excellent reliability. Results further supported the construct, convergent, divergent and concurrent validity of the English UGRS. The psychometric properties of the Dutch UGRS corroborated these findings. The UGRS appears a valid instrument to assess grief-specific rumination in international research and may have potential applicability as a clinical instrument to assess rumination in individuals with problematic grief.

Good communication is important for patients and can elicit placebo effects: true psychobiological effects not attributable to the medical-technical intervention.- It is, however, often unclear which communication behaviours influence specific patient outcomes.- In this article we present insights into the potential effect of specific communication, via specific mechanisms, on specific patient outcomes, including patients' perception of pain.- A recent systematic review and additional literature demonstrate that (a) manipulating patients' expectations, (b) demonstrating empathy, and (c) providing procedural information, might influence patient outcomes.- These placebo effects probably occur via (a) neurobiological responses comparable to the effects of pain medication, (b) reduction of anxiety and stress, and

A new report from the King’s Fund entitled Bringing Together Physical and Mental Health: a New Frontier for Integrated Care not only reviews the case for integration, but also provides real practical examples of how it has been achieved. Importantly, the report describes both the barriers to and facilitators of its successful implementation on the basis of interviews of those involved. The barriers are many and not all will be overcome simply by colocation of services (colocation is not integration). They include deeply ingrained cultural factors in the workforce that reinforce division and the separate organisational and payment systems for physical and mental health care. Key facilitators to achievement of integration include strong leadership for change at both clinical and board level and a willingness to innovate in the relevant organisations. Policy developments in various countries, including the new models of care introduced by the National Health Service Five Year Forward View in England and the growth of accountable care organisations in the USA have the exciting potential to facilitate integration of physical and mental health care. However, this integration will only happen if psychiatrists and other professionals now actively engage with these developments and use them as opportunities to advocate for and lead new forms of collaborative or even integrated working. The idea of so-called parity of esteem for patients’ mental and physical health care, which has been successfully championed by the Royal College of Psychiatrists, has achieved considerable influence. Indeed, in England, the Health and Social Care Act 2012 created a new legal responsibility for the National Health Service to deliver parity of esteem between physical and mental health, something that the Government has pledged to achieve by 2020. However, interpretations of parity of esteem vary. One interpretation is simply for existing mental health services to be as well funded and provide as good care as existing physical health services. Although this interpretation is an important ambition, the report from the King’s Fund7 raises sights much higher than this ambition to a vision in which mental health care is not only as good as physical care is, but is also delivered as part of all health and care services. This challenge should be addressed and the opportunity seized if we are to repair the harm caused by 100 years of separation.

Objective. The aim of the current study was to compare obese and nonobese type 2 diabetes patients at baseline and after participating in an existing self-management intervention (i.e., Beyond Good Intentions) on cognitive, self-care, and behavioral measures to examine whether both groups are equally prepared and able to adopt self-management approaches. Methods. A total of 94 type 2 diabetes patients were included, of whom 64 (59% male) completed the study. The final sample consisted of 27 obese (33% male) and 37 nonobese (78% male) patients. The intervention comprised one individual and four group sessions and aimed to improve self-management behavior by enhancing proactive coping skills (i.e., setting concrete goals, identifying barriers, coping with difficult situations, action planning, and progress evaluation). Cognitive (i.e., proactive coping, self-control, self-efficacy), self-care (i.e., adherence to lifestyle recommendations), and behavioral (i.e., diet, exercise) measures were assessed at baseline and after completing the intervention. Results. At baseline, obese patients reported to possess lower cognitive skills and lower adherence to lifestyle recommendations compared with nonobese patients. The intervention was effective in improving cognitive skills, self-care activities, as well as dietary and exercise behaviors. Improvements were equal for obese and nonobese patients. However, obese patients were more likely to drop out. Conclusions. Although obese type 2 diabetes patients were found to possess limited skills at baseline compared with nonobese patients, the self-management course proved to be equally effective for both groups.

Disorders of Extreme Stress Not Otherwise Specified (DESNOS), also known as Complex posttraumatic stress disorder, was assessed in a sample (N = 472) of adult psychiatric patients with confirmed diagnoses of Borderline Personality Disorder (BPD), Somatoform Disorders (SoD), comorbid BPD + SoD, or Affective or Anxiety Disorders (Psychiatric Controls, PC). BPD + SoD patients had the most extensive childhood trauma histories and were most likely (38%) to meet DESNOS criteria, followed by BPD (26%), PC (17%), and SoD (10%), The BPD + SoD and BPD-only groups reported significantly higher levels of DESNOS symptoms than the SoD or PC groups, and did not differ from each other except for greater severity of DESNOS somatic symptoms by the BPD + SoD group. DESNOS warrants further investigation with psychiatrically impaired adults as a potential independent syndrome or as a marker identifying a subgroups of affectively or both affectively and somatically dysregulated patients diagnosed with BPD who have childhood trauma histories. (PsycINFO Database Record (c) 2012 APA, all rights reserved) Complex Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder and Somatoform Disorders (PDF Download Available). Available from: http://www.researchgate.net/publication/232491929_Complex_Posttraumatic_Stress_Disorder_in_Patients_With_Borderline_Personality_Disorder_and_Somatoform_Disorders [accessed Oct 29, 2015].

Background and objectives Safety behaviours are widely held to impede the beneficial effects of exposure, certainly in OCD. Recently, Rachman, Radomsky, Shafran, and Zysk (2011) challenged this view. Healthy volunteers repeatedly touched a contaminant in two sessions. Half of the participants did not engage in safety behaviours after touching (exposure + response prevention), while the other half did (exposure + safety behaviours, i.e., cleaning hands with a hygienic wipe). Scores of contamination, fear, danger, and disgust decreased in both sessions and the effects were not impeded by safety behaviours. Three potential artefacts were identified in the Rachman et al. study: a no-treatment control group was lacking, the stop rules for ending exposure differed between conditions, and positive expectations may have been induced in the safety behaviours group. We tried to critically replicate the main findings. Method The Rachman et al. (2011) study was replicated, with 44 volunteers but stop rules and expectations were similar between treatments, and effects were also assessed in a no-intervention control group. Results Relative to the control condition, both exposure interventions induced reliable decreases in feelings of contamination, fear, danger, and disgust. The decline followed an exponential curve with the largest gains at the first trials of each session. Limitations Findings were obtained from a non-clinical sample. Conclusion The findings attest to the robustness of the Rachman et al. findings, and challenge the notion that safety behaviours should be dismissed categorically in exposure treatments.

Samenvatting Eye Movement and Desensitisation Reprocessing (EMDR) is een effectieve behandeling van traumasymptomen en de positieve effecten worden teruggevonden in het laboratorium, onder goed gecontroleerde omstandigheden. Dat biedt de mogelijkheid om na te gaan hoe EMDR werkt. Er wordt verslag gedaan naar de bevindingen uit een lange reeks experimenten. De hypothese dat oogbewegingen (of andere taken die worden uitgevoerd tijdens het ophalen van herinneringen) overbodig zijn en dat de exposure aan aversieve herinneringen tijdens EMDR de effecten verklaart, is niet houdbaar. Het idee dat ‘bilaterale stimulatie’ noodzakelijk is, snijdt evenmin hout. Je kunt net zo goed de ogen van boven naar beneden laten bewegen of taken laten doen waarbij helemaal geen oogbewegingen worden gemaakt. Belangrijk is dat de taak het werkgeheugen belast. Uit de werkgeheugenverklaring van EMDR is een lange reeks voorspellingen af te leiden. Die blijken wonderwel bestand tegen kritische experimentele tests en er tekent zich een solide verklaring af van hoe EMDR werkt. Die theorie en de empirische bevindingen hebben allerhande implicaties voor de techniek van EMDR. Abstract Eye Movement and Desensitization Reprocessing (EMDR) is an effective treatment of trauma symptoms, while beneficial effects can be reproduced under controlled laboratory conditions. This opens the door for testing how EMDR works. The paper reports data from a long series of experiments. The hypothesis that eye movements (or other dual tasks) are superfluous and that EMDR effects are explained by exposure is untenable. The idea that ‘bilateral stimulation’ is crucial, does not match the data either. One can just as well move the eyes vertically, or carry out tasks that do not involve eye movements. The crucial factor seems to be that the dual task is taxing working memory. From the working memory account of EMDR a long series of predictions can be derived. The predictions survived critical experimental tests. The theory and empirical data have a range of technical implications for carrying out EMDR. These implications are discussed.

The Dual Process Model of Coping with Bereavement (DPM; Stroebe & Schut, 1999) is described in this article. The rationale is given as to why this model was deemed necessary and how it was designed to overcome limitations of earlier models of adaptive coping with loss. Although building on earlier theoretical formulations, it contrasts with other models along a number of dimensions which are outlined. In addition to describing the basic parameters of the DPM, theoretical and empirical developments that have taken place since the original publication of the model are summarized. Guidelines for future research are given focusing on principles that should be followed to put the model to stringent empirical test.

Aim The current study examined occurrence and within-family associations of traumatic stress reactions after child burn injury, while in the same model addressing the role of parents’ own symptoms in their reports of child symptoms. Methods One-hundred children (8–18 years old), and their mothers (n = 90) and fathers (n = 74) were assessed within the first month (T1) and three months (T2) after burn. Parents and children rated child traumatic stress reactions on the Children’s Responses to Trauma Inventory (CRTI) and parents rated their own reactions on the Impact of Event Scale (IES). Cross-sectional associations at the two occasions were examined using a structural equation model. Results Occurrence of traumatic stress symptoms in the clinical range was higher in parents (T1: 24–50%; T2: 14–31%) than children (T1: 0–11%; T2: 3–5%, depending on whether children, mothers or fathers reported on symptoms). Traumatic stress symptoms of mothers at T1 and of both parents at T2 were significantly related to child self-reported symptoms. Moreover, mothers who experienced higher stress symptoms themselves gave higher ratings of their child’s symptoms at both time points, while for fathers, this was only found at T2. Conclusions The current study demonstrates the impact of pediatric burn injury on the family level, and shows simultaneous existence of within-family interrelatedness of traumatic stress and an influence of parents’ own symptoms on their perception of child symptoms. Findings highlight the need for trauma symptom screening in all family members and for considering informants’ symptoms to understand the child’s functioning in particular.

Rumination is a risk factor in adjustment to bereavement. It is associated with and predicts psychopathology after loss. Yet, the function of rumination in bereavement remains unclear. In the past, researchers often assumed rumination to be a maladaptive confrontation process. However, based on cognitive avoidance theories of worry in generalised anxiety disorder (GAD) and rumination after post-traumatic stress disorder (PTSD), others have suggested that rumination may serve to avoid painful aspects of the loss, thereby contributing to complicated grief. To examine if rumination is linked withloss avoidance, an eye-tracking study was conducted with 54 bereaved individuals (27 high and 27 low ruminators). On 24 trials, participants looked for 10 seconds at a picture of the deceased and a picture of a stranger, randomly combined with negative, neutral or loss-related words. High ruminators were expected to show initial vigilance followed by subsequent disengagement for loss stimuli (i.e., picture deceased with a loss word) in the first 1500 ms. Additionally, we expected high ruminators to avoid these loss stimuli and to show attentional preference for non-loss-related negative stimuli (i.e., picturestranger with a negative word) on longer exposure durations (1500–10000 ms). Contrary to expectations, we found no evidence for an effect of rumination on vigilance and disengagement of loss stimuli in the first 1500 ms. However, in the1500–10000 ms interval, high ruminators showed shorter gaze times for loss stimuli and longer gaze times for negative (and neutral) non-loss-related stimuli, even when controlling for depression and complicated grief symptom levels. Effects of rumination on average fixation times mirrored these findings. This suggests that rumination and loss avoidance are closely associated. A potential clinical implication is that rumination and grief complications after bereavement may be reduced through the use of exposure and acceptance-based therapeutic techniques.

Background: Studies on hypothalamic-pituitary-adrenal axis (HPA-axis) function amongst patients with chronic pain show equivocal results and well-controlled cohort studies are rare in this field. The goal of our study was to examine whether HPA-axis dysfunction is associated with the presence and the severity of chronic multi-site musculoskeletal pain. Methods. Data are from the Netherlands Study of Depression and Anxiety including 1125 subjects with and without lifetime depressive and anxiety disorders. The Chronic Pain Grade questionnaire was used to determine the presence and severity of chronic multi-site musculoskeletal pain. Subjects were categorized into a chronic multi-site musculoskeletal pain group (n = 471) and a control group (n = 654). Salivary cortisol samples were collected to assess HPA-axis function (awakening level, 1-h awakening response, evening level, diurnal slope and post-dexamethasone level). Results: In comparison with the control group, subjects with chronic multi-site musculoskeletal pain showed significantly lower cortisol level at awakening, lower evening level and a blunted diurnal slope. Lower cortisol level at awakening and a blunted diurnal slope appeared to be restricted to those without depressive and/or anxiety disorders, who also showed a lower 1-h awakening response. Conclusions: Our results suggest hypocortisolemia in chronic multi-site musculoskeletal pain. However, if chronic pain is accompanied by a depressive or anxiety disorder, typically related to hypercortisolemia, the association between cortisol levels and chronic multi-site musculoskeletal pain appears to be partly masked. Future studies should take psychopathology into account when examining HPA-axis function in chronic pain. © 2014 Generaal et al.; licensee BioMed Central Ltd.

Little evidence is available on the extent, course and influencing factors of pain in young children with burns. At present, reliable and valid measurement instruments to assess pain behavior in these children are available, implying that valuable insight into these questions can now be obtained. The aim of this study is to document the extent and course of pain behavior with the COMFORT-B, and to assess factors that may influence procedural pain. First, cutpoints for COMFORT-B scores were established by Rasch analysis to assess clinically relevant changes. Second, the extent of background and procedural pain behavior was assessed by descriptive statistics. Third, the course and factors that may influence procedural pain behavior were investigated by latent growth modeling. Trained nurses collected pain behavior data in 168 children (mean age 20 months, mean TBSA 6%, mean length of stay 10 days). Cutpoints of COMFORT-B scores were as follows: 6-13 (mild pain), 14-20 (moderate pain) and 21-30 (severe pain). This study suggests that background pain is more adequately treated than procedural pain. Factors that influenced baseline pain scores and/or the course over 8 days included TBSA, the number of surgical procedures, acetaminophen administration by the referring hospital, and the application of hydrofiber dressings. The implications of these findings are discussed.

OBJECTIVES: While healthy eating patterns are of high importance in adolescence, most adolescents portray quite unhealthy eating behaviour. One reason for this may be that social norms among peers tend to be unsupportive of healthy eating. The current study investigates whether communicating health-promoting descriptive and injunctive norms influences adolescents' intended and actual fruit consumption. DESIGN: The study employed an experimental prospective design. METHODS: A norm message manipulation (descriptive vs. injunctive vs. no-norm control) was administered to high school students, after which fruit intake intention (N = 96) was assessed. At follow-up, actual fruit intake over 2 days (N = 80) was recorded. RESULTS: Adolescents receiving the descriptive norm did not report higher fruit intake intentions than the control group, but did consume (borderline, p = .057) significantly more fruit in the following 2 days (2.3 portions per day) than the control condition (1.7 portion per day). Adolescents receiving the injunctive norm reported lower fruit intake intentions than the other two groups, but actual fruit consumption (1.5 portions per day) was similar to that of the control group. CONCLUSIONS: Health-promoting injunctive norms not only had no positive effects on fruit intake but actually caused a decrease in fruit intake intentions, indicating that injunctive norms may be vulnerable to reactance. A health-promoting descriptive norm was found to positively affect fruit intake in adolescents. No effect on fruit intake intention was found. Results show that simple single-sentence norm messages hold the potential to substantially influence health behaviour.

People consistently over-eat when served a large compared with a small (appropriate) portion of food. However, the mechanism underlying this so-called portion size effect is not well understood. We argue that the process of anchoring and adjustment naturally describes this effect, such that the size of a presented portion works as an anchor that strongly influences consumption. The classical anchoring and adjustment paradigm was applied to six hypothetical eating situations. Participants were asked to imagine being served either a small or a large portion of food (i.e., low and high anchor) and to indicate whether they would consume more or less than this amount. Then, they indicated how much they would eat. These estimates were compared with a no-anchor condition where participants did not imagine a specific portion size but only indicated how much they would eat. In addition, half of participants in the anchoring conditions received a discounting instruction stating that the portion size they had been asked to imagine was randomly selected and thus not informative for their consumption estimate. As expected, participants who imagined to be served larger portions estimated to consume significantly more food than participants in the no-anchor condition, and participants who imagined to be served smaller portions estimated to consume significantly less food than participants in the no-anchor condition. The discounting manipulation did not reduce this effect of the anchors. We suggest that the process of anchoring and adjustment may provide a useful framework to understand the portion size effect and we discuss implications of this perspective.

Dysregulation of the immune system may play a role in chronic pain, although study findings are inconsistent. This cross-sectional study examined whether basal inflammatory markers and the innate immune response are associated with the presence and severity of chronic multisite musculoskeletal pain. Data were used on 1632 subjects of the Netherlands Study of Depression and Anxiety. The Chronic Pain Grade questionnaire was used to determine the presence and severity of chronic multisite musculoskeletal pain. Subjects were categorized in a chronic multisite musculoskeletal pain group (n = 754) and a control group (n = 878). Blood levels of the basal inflammatory markers C-reactive protein, interleukin-6, and tumor necrosis factor-alpha were determined. To obtain a measure of the innate immune response, 13 inflammatory markers were assessed after lipopolysaccharide (LPS) stimulation in a subsample (n = 707). Subjects with chronic multisite musculoskeletal pain showed elevated levels of basal inflammatory markers compared with controls, but statistical significance was lost after adjustment for lifestyle and disease variables. For some LPS-stimulated inflammatory markers, we did find elevated levels in subjects with chronic multisite musculoskeletal pain both before and after adjustment for covariates. Pain severity was not associated with inflammation within chronic pain subjects. An enhanced innate immune response in chronic multisite musculoskeletal pain may be examined as a potential biomarker for the onset or perpetuation of chronic pain. © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

OBJECTIVE: Patients' recall of provided information during bad news consultations is poor. According to the attentional narrowing hypothesis, the emotional arousal caused by the bad news might be responsible for this hampered information processing. Because affective communication has proven to be effective in tempering patients' emotional reactions, the current study used an experimental design to explore whether physician's affective communication in bad news consultations decreases patients' anxiety and uncertainty and improves information recall. METHOD: Two scripted video-vignettes of a bad news consultation were used in which the physician's verbal communication was manipulated (standard vs. affective condition). Fifty healthy women (i.e., analogue patients) randomly watched 1 of the 2 videos. The effect of communication on participants' anxiety, uncertainty, and recall was assessed by self-report questionnaires. Additionally, a moderator analysis was performed. RESULTS: Affective communication reduced anxiety (p = .01) and uncertainty (p = .04), and improved recall (p = .05), especially for information about prognosis (p = .04) and, to some extent, for treatment options (p = .07). The moderating effect of (reduced) anxiety and uncertainty on recall could not be confirmed and showed a trend for uncertainty. CONCLUSION: Physicians' affective communication can temper patients' anxiety and uncertainty during bad news consultations, and enhance their ability to recall medical information. The reduction of anxiety and uncertainty could not explain patients' enhanced recall, which leaves the underlying mechanism unspecified. Our findings underline the importance of addressing patients' emotions and provide empirical support to incorporate this in clinical guidelines and recommendations. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

An important part of inpatient treatment for adolescents with anorexia nervosa is to restore normal eating behaviour. Health-care professionals play a significant role in this process, but little is known about their interventions during patients' meals. The purpose of the present study was to describe nursing interventions aimed at restoring normal eating behaviour in patients with anorexia nervosa. The main research question was: 'Which interventions aimed at restoring normal eating behaviour do health-care professionals in a specialist eating disorder centre use during meal times for adolescents diagnosed with anorexia nervosa? The present study was a qualitative, descriptive study that used video recordings made during mealtimes. Thematic data analysis was applied. Four categories of interventions emerged from the data: (i) monitoring and instructing; (ii) encouraging and motivating; (iii) supporting and understanding; and (iv) educating. The data revealed a directive attitude aimed at promoting behavioural change, but always in combination with empathy and understanding. In the first stage of clinical treatment, health-care professionals focus primarily on changing patients' eating behaviour. However, they also address the psychosocial needs that become visible in patients as they struggle to restore normal eating behaviour. The findings of the present study can be used to assist health-care professionals, and improve multidisciplinary guidelines and health-care professionals' training programmes.

This thesis describes the mental health disturbances in the wake of the Ghislenghien gas explosion (July 30th 2004) which instantly killed five firefighters, one police officer and 18 other people. Moreover, 132 people were wounded among which many suffered severe burn injuries. The Ghislenghien studies aimed at clarifying the impact of a technological disaster, both phenomenologically and empirically. On the phenomenological side, the lived experiences of a disaster survivor are used to set the stage for a discussion on the conceptual differences between mainstream (Anglo-Saxon) trauma theories and the more classical (French) psychodynamic theories. On the empirical side, the study focused on the prevalence of posttraumatic stress symptoms in adult and child survivors of a massive gas explosion, in their family members as well in family members of deceased victims. Other research questions focused on the risk factors regarding the development of posttraumatic stress symptoms and other mental health disturbances. A secondary aim was also to better understand the challenges of the type and timing of psychological help in the wake of technological disaster. Therefore, this thesis consists of a phenomenological part and an empirical part. The phenomenological part consists of three chapters which provide contextual information on the trauma inflicted by a massive explosion. The empirical part consists of four chapters providing a quantitative approach of trauma-related mental health disturbances in adults and children after a technological disaster. The phenomenological part starts with the testimony of a survivor of the Ghislenghien disaster and the interpretation of this survival in terms of both empirical (Anglo-Saxon) trauma models and the psychodynamic (French) theories The phenomenological part also examines the conceptualization of psychological trauma in contemporary French theory and the disaster-related experiences in fire and emergency services personnel. The empirical part of this manuscript is based on a longitudinal study conducted in order to assess the impact of the disaster on physical, mental and social health. The study included adults (≥ 15 years) and children (8-14 years) at risk of developing adverse health effects related to the disaster at 5 months and 14 months after the disaster. Four chapters report on this study and discuss respectively: the strengths and weaknesses of the methodology employed, the difficulties and challenges encountered during the design of the study and the risk factors of developing trauma-related symptoms and mental health disturbances. The results clearly indicate the influence of the degree of exposure, peritraumatic dissociation and dissatisfaction with social support on the development of posttraumatic stress symptoms. The risk for the development of four types of mental health disturbances (somatization, depression, anxiety and sleeping disturbances) was much higher in direct witnesses who have seen human damage than in victims who have not seen human damage. In children, risk factors for the development of posttraumatic stress reactions were related to the type of exposure to the disaster, peritraumatic dissociation during or immediately after the disaster, and dissatisfaction with the received psychological help. This epilogue discusses possible future developments for early psychophysiological stabilization of disaster victims.

BACKGROUND: Even though the evidence supporting the presence of a heritable component in the aetiology of anorexia nervosa (AN) is strong, the underlying genetic mechanisms remain poorly understood. The recent publication of a genome-wide association study (GWAS) of AN (Boraska, Mol Psychiatry, 2014) was an important step in genetic research in AN. OBJECTIVE: To briefly sum up strengths and weaknesses of candidate-gene and genome-wide approaches, to discuss the genome-wide association studies of AN and to make predictions about the genetic architecture of AN by comparing it to that of schizophrenia (since the diseases share some similarities and genetic research in schizophrenia is more advanced). METHOD: Descriptive literature review. RESULTS: Despite remarkable efforts, the gene-association studies in AN did not advance our knowledge as much as had been hoped, although some results still await replication. DISCUSSION: Continuous effort of participants, clinicians and researchers remains necessary to ensure that genetic research in AN follows a similarly successful path as in schizophrenia. Identification of genetic susceptibility loci provides a basis for follow-up studies. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:814-825).

BACKGROUND: Anorexia nervosa (AN), which is the most serious of the eating disorders, starts earlier in life and often continues into adulthood. AIM: To discuss the typical features of AN in adolescents. METHOD: We present an overview based on the literature about AN in adolescents and on analysis performed by experts. RESULTS: Youngsters with AN run considerable physical risks because their bodies are less well developed and are more easily injured. These injuries can be a lifelong handicap if the patient's body weight does not rapidly return to normal. However, if the body weight recovers satisfactory, this can point to the possibility of a full psychological recovery. The best route to recovery is to start dining again with the family, to go back to school and to participate in social activities. So far, no other types of treatment have proved to be entirely successful. CONCLUSION: Further research is needed into matters such as an ideal weight for the patient and the best ways of increasing his or her food-intake. We need to find out how best to deal with a patient's disturbed body image and how to treat any comorbid disease that often accompanies AN.

Objective Quality of life (QOL) is one of the leading outcomes in burn care research. This study classifies subscales of common QOL measures within the International Classification of Functioning disability and health (ICF) framework to determine to which extent the measures are complementary or overlapping and to investigate whether the instruments are able to describe the full spectrum of patients’ functioning. Methods A literature search was performed to determine the most frequently used questionnaires in burn research. The subscales of the three mostly used questionnaires were classified within the ICF framework. Results Two generic measures, the Short Form-36 items (SF-36) and the European Quality of Life 5 Dimensions (EQ-5D), and a disease specific measure, the Burn Specific Health Scale-Brief (BSHS-B), were analyzed. The BSHS-B covered most domains and was the only scale that included personal factors. The SF-36 included only one domain in the activity limitations and similar to the EQ-5D no contextual factors were included. Environmental factors were not addressed in the questionnaires, even though these may have an impact on the quality of life in patients with burns. Conclusion To capture the full spectrum of dysfunctioning a combination of the BSHS-B with a generic questionnaire seems obligatory. However still some domains of functioning remain uncovered.

Bereavement research has focused on individual rather than interdependent processes in coping with loss. Yet bereavement takes place in a social context, and relationship partners are likely to influence each other's grieving process. We examined the impact of a dynamic, interpersonal phenomenon, partner-oriented self-regulation (POSR): the avoidance of talking about loss and remaining strong in the partner's presence to protect the partner. Two hundred nineteen couples who had lost a child participated 6, 13, and 20 months after their loss. Consistent with predictions, results showed that one partner's POSR was associated not only with an increase in his or her own grief, but also with an increase in the other partner's grief. These relationships persisted over time: Self-reported and partner-reported POSR predicted later grief. These results are paradoxical: Although parents try to protect their partners through POSR, this effort has the opposite of the desired outcome. These findings underline the importance of further investigating interpersonal dynamics of coping with bereavement. © The Author(s) 2013.

In the aftermath of a traumatic event, many people suffer from psychological distress, but only a minority develops posttraumatic stress disorder (PTSD). Pre-trauma individual differences in fear conditioning, most notably reduced extinction learning, have been proposed as playing an important role in the etiology of PTSD. However, prospective data are lacking. In this study, we prospectively tested whether reduced extinction was a predictor for later posttraumatic stress. Dutch soldiers (N = 249) were administered a conditioning task before their four-month deployment to Afghanistan to asses individual differences in extinction learning. After returning home, posttraumatic stress was measured. Results showed that reduced extinction learning before deployment predicted subsequent PTSD symptom severity, over and beyond degree of pre-deployment stress symptoms, neuroticism, and exposure to stressors on deployment. The findings suggest that reduced extinction learning may play a role in the development of PTSD. © 2012 Elsevier Ltd.

Using data of 56 bereaved individuals, this study examined associations of various manifestations of continuing bonds, assessed at 7–12 months post-loss, with concurrent and prospective (9 months later) symptoms of grief and depression. Among other things it was found that, independent of initial symptom levels, manifestations of continuing bonds differed in their associations with subsequent grief and depression. That is, continuing bonds through recovering memories was a strong predictor of grief but not depression, whereas continuing bonds through the use of the deceased's possessions was a weak predictor of both grief and depression. In part, these findings contradict earlier prospective findings.

Typically, it is believed that palatable, high caloric foods signal reward and trigger indulgent responses. However, Counteractive Control Theory suggests that, to the extent that people are concerned about their weight, a confrontation with palatable foods should also trigger ‘alarm bell responses’ which promote successful self-control. Our study is the first to investigate such counteractive control processes in the brain employing functional magnetic resonance imaging (fMRI) in a sample of successful self-regulators. Indeed, besides the traditional finding that foods elicit heightened attention as witnessed by greater activation of primary visual cortex, we found that viewing palatable foods elicited brain activation in areas associated with self-regulation. Crucially, brain activation in self-regulation areas was related to diet importance. Thus, our results are the first to show that food cues not only evoke hedonic brain responses; in successful self-regulators they also trigger alarm bell responses, which may reflect the neural processes underlying successful self-control.

Objective : The present studies examined the role of environmental cues in steering people’s dietary decisions in response to food temptations. Based on the notion that people show a tendency to conform to eating standards derived from the eating behavior of others, it was hypothesized that communication of other people’s dietary decisions through environmental cues affect whether and what people eat. Methods : Conformity to environmental cues about food intake was assessed in a local bakery (Study 1, N = 144) and a lab setting (Study 2, N = 65). Participants were unobtrusively presented with a bowl of individually wrapped chocolates. The presence of empty wrappers was manipulated, to indicate whether others who had been in the same situation had or had not eaten. Conformity to environmental cues about food choice was assessed in Study 3 ( N = 90). Participants were required to choose between a healthy and an unhealthy snack. Food wrappers indicated whether previous participants had chosen the healthy or the unhealthy snack. Results : As expected, participants were more likely to take chocolates in the presence of an environmental cue that others did too. Also, participants were more likely to choose a snack that was consistent with the choice of others. Conclusions : Together, these findings support our main hypothesis that environmental cues steer people’s decisions concerning food intake and food choice. Moreover, the results suggest that only small changes in the environment may support healthy eating behavior.

Sustaining burns is considered a stressful life event that has the power to elicit depressive symptoms. This study aimed to identify predictors of depressive symptoms by investigating the role of demographic variables, the number of operations (burn severity), neuroticism, and cognitive emotion regulation styles as possible influencing factors. Data from 242 patients with burns were analyzed employing latent growth modeling. The level of depressive symptoms across the 2-year interval was associated with burn severity, higher levels of neuroticism and rumination, and lower levels of positive refocusing. Notably, rumination partly mediated the effect of neuroticism on the course of depressive symptoms. Correlational analysis suggested a specific effect of burn severity on rumination. The results indicate that screening for symptoms of depression, rumination, and neuroticism in burn patients is useful. Early interventions focusing on cognitive restructuring could assist in improving the cognitive emotional adaptation process following a burn event.

Background : The analysis of small data sets in longitudinal studies can lead to power issues and often suffers from biased parameter values. These issues can be solved by using Bayesian estimation in conjunction with informative prior distributions. By means of a simulation study and an empirical example concerning posttraumatic stress symptoms (PTSS) following mechanical ventilation in burn survivors, we demonstrate the advantages and potential pitfalls of using Bayesian estimation. Methods : First, we show how to specify prior distributions and by means of a sensitivity analysis we demonstrate how to check the exact influence of the prior (mis-) specification. Thereafter, we show by means of a simulation the situations in which the Bayesian approach outperforms the default, maximum likelihood and approach. Finally, we re-analyze empirical data on burn survivors which provided preliminary evidence of an aversive influence of a period of mechanical ventilation on the course of PTSS following burns. Results : Not suprisingly, maximum likelihood estimation showed insufficient coverage as well as power with very small samples. Only when Bayesian analysis, in conjunction with informative priors, was used power increased to acceptable levels. As expected, we showed that the smaller the sample size the more the results rely on the prior specification. Conclusion : We show that two issues often encountered during analysis of small samples, power and biased parameters, can be solved by including prior information into Bayesian analysis. We argue that the use of informative priors should always be reported together with a sensitivity analysis. Keywords: Bayesian estimation; maximum likelihood; prior specification; power; repeated measures analyses; small samples; burn survivors; mechanical ventilation; PTSS Responsible Editor: Cherie Armour, University of Ulster, United Kingdom. For the abstract or full text in other languages, please see Supplementary files in the column to the right (under ‘Article Tools’). (Published: 11 March 2015) Citation: European Journal of Psychotraumatology 2015, 6 : 25216 - http://dx.doi.org/10.3402/ejpt.v6.25216

Post-traumatic stress disorder (PTSD) is an anxiety disorder that is associated with structural and functional alterations in several brain areas, including the anterior cingulate cortex (ACC). Here, we examine resting state functional connectivity of ACC subdivisions in PTSD, using a seed-based approach. Resting state magnetic resonance images were obtained from male veterans with (n = 31) and without (n = 25) PTSD, and healthy male civilian controls (n = 25). Veterans with and without PTSD (combat controls) had reduced functional connectivity compared to healthy controls between the caudal ACC and the precentral gyrus, and between the perigenual ACC and the superior medial gyrus and middle temporal gyrus. Combat controls had increased connectivity between the rostral ACC and precentral/middle frontal gyrus compared to PTSD patients and healthy civilian controls. The resting state functional connectivity differences in the perigenual ACC network reported here indicate that veterans differ from healthy controls, potentially due to military training, deployment, and/or trauma exposure. In addition, specific alterations in the combat controls may potentially be related to resilience. These results underline the importance of distinguishing trauma-exposed (combat) controls from healthy civilian controls when studying PTSD.

Anorexia nervosa (AN) is een eetstoornis die bij veel mensen bekend is, mogelijk omdat patiënten niet alleen ernstig ziek zijn, maar er ook nog eens sterk vermagerd uitzien. Een van de meest intrigerende symptomen van deze aandoening is de verstoorde beleving van het eigen lichaam. Hoe kan het dat patiënten aangeven dat ze zich – letterlijk – dikker voelen dan ze daadwerkelijk zijn? En waarom blijven ze zich vaak zo voelen na behandeling? Om deze vragen te beantwoorden zullen wij het ‘jezelf dik voelen’ dat zo kenmerkend is voor AN benaderen vanuit de neurowetenschappen.

Contains fulltext : 76692.pdf (Publisher’s version ) (Closed access) Objective: Not all morbidly obese patients attain sufficient weight loss after laparoscopic adjustable gastric banding (LAGB). We examined patients' explanations for unsuccessful weight loss and self-awareness regarding food intake. Methods: Interviews with 11 patients (10 female/1 male; mean age 46 years) with unsuccessful weight loss were transcribed and analyzed with the MAXqda2 program. Results: Interviewees were disappointed with the postoperative outcome. Some showed no awareness of their own role, while others were inefficacious to continue the actions needed to maintain weight loss, especially during times of stress. Typical statements that distinguished interviewees were: 'It didn’t work out', 'I don’t care anymore', 'I know I have to do it', 'I know I can do it'. Conclusion: Some patients with unsuccessful weight loss after LAGB are insufficiently aware that their own effort is needed to maintain weight loss. Others have self-awareness, but find it difficult to turn awareness into action. Practice implications: This group could perhaps be helped by tailoring postoperative guidance to the stage of change of an individual patient. Counseling could include increasing awareness of the need to self-control eating and offering assistance to turn intentions into action and to deal with stress, emotions and physical problems. 6 p.

OBJECTIVE: Compulsory in-patient refeeding of patients with severe anorexia nervosa (AN) has caused considerable controversy. The effects of such treatment on longer-term outcome are not well known. The objective of this article is to review the evidence on the outcome of compulsory treatment for AN. METHOD: Three large databases were searched for studies regarding compulsory treatment in AN. RESULTS: Detained patients have more severe symptoms and comorbidity and a longer duration of inpatient stay. In the short term compulsory refeeding in AN appears to be beneficial, but the longer term effects remain uncertain. Clinicians report no worsening of the therapeutic relationship after compulsory treatment. DISCUSSION: In severe cases of AN where the patient refuses life-saving treatment compulsory treatment needs to be considered. Future research should focus on the longer term effects of compulsory treatment and also on questions related to mental capacity in AN. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:845-852).