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  1. AU="Tortolani, Christina C"
  2. AU="Patel, Jenil R"
  3. AU="Aires, Rafaela"
  4. AU="Habibelahi, Abbas"
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  1. Article ; Online: The parents aren't alright, either: Commentary on Wilksch (2023).

    Goldschmidt, Andrea B / Tortolani, Christina C

    The International journal of eating disorders

    2023  Volume 56, Issue 7, Page(s) 1289–1292

    Abstract: Eating disorders (EDs) present high costs to the individual and society, and need for services far surpasses their availability. Caregivers are often on the "front lines" of managing their child's illness yet may have very little support to sustain them ... ...

    Abstract Eating disorders (EDs) present high costs to the individual and society, and need for services far surpasses their availability. Caregivers are often on the "front lines" of managing their child's illness yet may have very little support to sustain them in this role. It is well-established that caregiver burden related to EDs is high, although most research has focused on caregivers of adult patients. Wilksch describes the need for additional attention to caregivers of children and adolescents with EDs, given the elevated psychological, interpersonal, and financial burden incurred on this segment of the population. In this commentary, we describe three major gaps in service delivery and research that may exacerbate caregiver stress: (1) limited exploration of "nontraditional" delivery modalities that could enhance access to care; (2) lack of research into viability of caregiver peer coaching/support models including respite resources; and (3) scarcity of accessible ED training for healthcare providers (particularly physicians) which increases length to receipt of competent care as families search for well-trained providers and/or languish on waitlists. We propose prioritizing additional research in these areas to help alleviate caregiver burden associated with pediatric EDs, and facilitate delivery of prompt, comprehensive, and competent care to support optimal prognosis.
    MeSH term(s) Adult ; Adolescent ; Child ; Humans ; Parents/psychology ; Caregivers/psychology ; Feeding and Eating Disorders ; Health Personnel
    Language English
    Publishing date 2023-05-05
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 603170-5
    ISSN 1098-108X ; 0276-3478
    ISSN (online) 1098-108X
    ISSN 0276-3478
    DOI 10.1002/eat.23983
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1749: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article: A qualitative assessment of provider-perceived barriers to implementing family-based treatment for anorexia nervosa in low-income community settings.

    Egbert, Amy H / Irizarry, Bailey / Lualdi, Elisabeth / Tortolani, Christina C / Donaldson, Deidre L / Goldschmidt, Andrea B

    Journal of eating disorders

    2024  Volume 12, Issue 1, Page(s) 51

    Abstract: Background: Family-based treatment (FBT) is a front-line empirically supported intervention for adolescent anorexia nervosa, but it is often inaccessible to families from lower income backgrounds, as it is most typically available in specialty research ... ...

    Abstract Background: Family-based treatment (FBT) is a front-line empirically supported intervention for adolescent anorexia nervosa, but it is often inaccessible to families from lower income backgrounds, as it is most typically available in specialty research and private practice settings. In preparation for a pilot trial of FBT delivered in the home setting, this study qualitatively examined provider perceptions of implementing FBT in lower-income communities.
    Methods: Eating disorder clinicians working in community clinics (therapists, medical doctors, dietitians, and social workers; n = 9) were interviewed about their experiences using FBT. Interview transcripts were analyzed both deductively, using an approach consistent with applied thematic analysis, and inductively, using the Replicating Effective Programs implementation framework, to examine barriers to FBT implementation.
    Results: Prevailing themes included concern about the time and resources required of caregivers to participate in FBT, which may not be feasible for those who work full time, have other caregiving demands, and/or lack family support. Psychosocial problems outside of the eating disorder, such as food insecurity, other untreated mental health concerns (in themselves or other family members), or externalizing behaviors on the part of the adolescent, were also discussed as barriers, and participants noted that the lack of cohesive treatment teams in the community make it difficult to ensure continuity of care.
    Conclusion: Findings from this qualitative study indicate the need to address systemic socioeconomic barriers to improve the efficacy of implementation of FBT in the community and to understand how provider perceptions of these barriers influence their uptake of FBT.
    Language English
    Publishing date 2024-04-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 2699357-0
    ISSN 2050-2974
    ISSN 2050-2974
    DOI 10.1186/s40337-024-01008-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Adapting family-based treatment for adolescent anorexia nervosa delivered in the home: A novel approach for improving access to care and generalizability of skill acquisition.

    Goldschmidt, Andrea B / Tortolani, Christina C / Accurso, Erin C / Dunbar, Eva-Molly Petitto / Egbert, Amy H / Donaldson, Deidre / Donaldson, Abigail A

    Journal of eating disorders

    2023  Volume 11, Issue 1, Page(s) 130

    Abstract: Background: Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is ... ...

    Abstract Background: Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach.
    Results: Adaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills.
    Conclusions: Implementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed.
    Language English
    Publishing date 2023-08-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 2699357-0
    ISSN 2050-2974
    ISSN 2050-2974
    DOI 10.1186/s40337-023-00850-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Implementation and outcomes of home-based treatments for adolescents with anorexia nervosa: Study protocol for a pilot effectiveness-implementation trial.

    Goldschmidt, Andrea B / Tortolani, Christina C / Egbert, Amy H / Brick, Leslie A / Elwy, A Rani / Donaldson, Deidre / Le Grange, Daniel

    The International journal of eating disorders

    2022  Volume 55, Issue 11, Page(s) 1627–1634

    Abstract: Objective: Although family-based treatment (FBT) is considered a first-line treatment for adolescent anorexia nervosa (AN), it is underutilized in community settings and is unavailable to many families for a multitude of practical reasons (e.g., costs ... ...

    Abstract Objective: Although family-based treatment (FBT) is considered a first-line treatment for adolescent anorexia nervosa (AN), it is underutilized in community settings and is unavailable to many families for a multitude of practical reasons (e.g., costs of treatment, transportation constraints). Adapting FBT interventions for delivery in home-based and community-based settings may reduce pragmatic barriers to treatment uptake and engagement.
    Methods: This pilot effectiveness-implementation trial will assess outcomes, implementation, and mechanisms of FBT adapted for the home setting (FBT-HB), delivered in the context of community-based behavioral health agencies. Adolescents with AN-spectrum disorders (n = 50) and their caregivers will be randomly assigned to either FBT-HB or home-based treatment as usual (TAU; integrated family therapy approach). Caregivers and adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self-efficacy and adolescent eating-related and weight-related distress. Implementation constructs of feasibility, acceptability, and appropriateness will be measured among providers and participating families.
    Hypotheses: We expect that FBT-HB will be feasible, acceptable, and appropriate, and will outperform TAU in terms of improvements in adolescent weight and eating-related psychopathology. We further expect that caregiver self-efficacy and adolescent eating-related and weight-related distress, but not general distress, will show greater improvements in FBT-HB relative to TAU and will be associated with better adolescent weight and eating outcomes in FBT-HB.
    Potential implications: The proposed study has clear potential to advance scientific and clinical understanding of the real-world effectiveness of FBT for AN, including whether adapting it for the home setting improves its accessibility and effects on treatment outcome.
    MeSH term(s) Adolescent ; Humans ; Anorexia Nervosa/therapy ; Family Therapy/methods ; Treatment Outcome ; Randomized Controlled Trials as Topic ; Home Care Services
    Language English
    Publishing date 2022-08-16
    Publishing country United States
    Document type Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 603170-5
    ISSN 1098-108X ; 0276-3478
    ISSN (online) 1098-108X
    ISSN 0276-3478
    DOI 10.1002/eat.23796
    Database MEDical Literature Analysis and Retrieval System OnLINE

    Full text online

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1749: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article: Childhood abuse and neglect in body dysmorphic disorder.

    Didie, Elizabeth R / Tortolani, Christina C / Pope, Courtney G / Menard, William / Fay, Christina / Phillips, Katharine A

    Child abuse & neglect

    2006  Volume 30, Issue 10, Page(s) 1105–1115

    Abstract: Objective: No published studies have examined childhood abuse and neglect in body dysmorphic disorder (BDD). This study examined the prevalence and clinical correlates of abuse and neglect in individuals with this disorder.: Methods: Seventy-five ... ...

    Abstract Objective: No published studies have examined childhood abuse and neglect in body dysmorphic disorder (BDD). This study examined the prevalence and clinical correlates of abuse and neglect in individuals with this disorder.
    Methods: Seventy-five subjects (69.3% female, mean age=35.4+/-12.0) with DSM-IV BDD completed the Childhood Trauma Questionnaire and were interviewed with other reliable and valid measures.
    Results: Of these subjects, 78.7% reported a history of childhood maltreatment: emotional neglect (68.0%), emotional abuse (56.0%), physical abuse (34.7%), physical neglect (33.3%), and sexual abuse (28.0%). Forty percent of subjects reported severe maltreatment. Among females (n=52), severity of reported abuse and neglect were .32-.57 standard deviation units higher than norms for a health maintenance organization (HMO) sample of women. Severity of sexual abuse was the only type of maltreatment significantly associated with current BDD severity (r=.23, p=.047). However, severity of sexual abuse did not predict current BDD severity in a simultaneous multiple regression analysis with age and current treatment status. There were other significant associations with childhood maltreatment: history of attempted suicide was related to emotional (p=.004), physical (p=.014), and sexual abuse (p=.038). Childhood emotional abuse was associated with a lifetime substance use disorder (r=.26, p=.02), and physical abuse was negatively associated with a lifetime mood disorder (r=-.37, p=.001).
    Conclusions: A high proportion of individuals with BDD reported childhood abuse and neglect. Certain types of abuse and neglect appear modestly associated with BDD symptom severity and with gender, suicidality, and certain disorders.
    MeSH term(s) Adult ; Child ; Child Abuse ; Female ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Somatoform Disorders/etiology ; Surveys and Questionnaires ; United States
    Language English
    Publishing date 2006-10
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 799143-5
    ISSN 1873-7757 ; 0145-2134
    ISSN (online) 1873-7757
    ISSN 0145-2134
    DOI 10.1016/j.chiabu.2006.03.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1437: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

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