A ‘response shift’ may lessen motivation to recover.
Reprinted from Eating Disorders Review
July/August 2010 Volume 21, Number 4
©2010 Gürze Books
Although quality of life is often difficult to characterize, the World Health Organization (WHO) defines it as ‘an individual’s perception of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards and concerns'(Social Science and Medicine 1995; 10:1403). Increasingly, the quality of life of eating disorders patients has become an important measure of treatment outcome, and it is also helpful for understanding the full impact of the illness.
A recent study evaluated the quality of life of individuals with eating disorders, with an emphasis on the effects of body mass index (BMI, kg/m2 ), and duration and severity of illness (Eur Eat Disorders Rev 2010; 18:147). Drs. Bryony Bamford and Richard Sly, of St. George’s, University of London, evaluated 156 adults (148 women, 8 men) who were currently being treated for an eating disorder. Drs. Bamford and Sly evaluated each of the areas of these patients’ quality of life according to specific eating disorder diagnoses. The patients ranged in age from 18 to 58 years, and the largest group, 56 patients (36%), had anorexia nervosa (AN), restrictive type. Forty other patients (26%) had bulimia nervosa (BN); 24 (15%) had binge-purge type AN; and 36 (23%) had eating disorder not otherwise specified (EDNOS).
The participants were diagnosed by experienced eating disorder clinicians using a semi-structured clinical interview based on the Eating Disorder Examination. The largest group, 98 patients (63%) came from an outpatient service. The participants also were evaluated with the Eating Disorders Quality of Life (EDQOL) scale, a 25-item self-report measure with four subscales (Psychological, Physical/Cognitive, Work/School and Financial). The EDQOL uses a 5-point scoring scale ranging from “never” to “always” to gauge the degree to which an individual feels his or her eating disorder affects their quality of life. A higher score equates to lower quality of life.
Severity of illness, but not duration, affected quality of life
The authors found that increased severity of illness correlated with lower quality of life. They reported that scores across all subscales of the EDQOL were higher than in the previous eating disorder sample assessed by Engel et al in 2006 (Int J Eat Disord 2006;39:62). This may have been due to the fact that the participants in the current study were all at the beginning of treatment for eating disorders and thus were likely to have more severe illness. Also in this group, BMI emerged as a significant predictor of quality of life, with lower BMIs contributing to a lower self-reported quality of life. Although significant differences were found on psychological and physical/cognitive quality of life subscales between those diagnosed with AN and those diagnosed with EDNOS, this might be in part due to the difference in BMIs between these groups. It suggests that BMI, in addition to other specific behavioral issues related to diagnosis, may have a direct impact on this group’s quality of life.
Contrary to expectations, longer duration of illness did not result in poorer quality of life. This finding agrees with results of previous studies that have suggested that the global functioning of eating disorders patients does not decrease even with the continuation of eating symptoms. The authors note that this ‘response shift”– or adaptation to deceased function by changing values and/or expectations and finding ways to carry on with daily function despite the illness–is seen as a desirable outcome of adaptation to physical illness. However, in the case of mental illnesses, such as chronic AN, such a shift is likely to contribute to the low levels of motivation for recovery and possibly to their often strong denial that their illness has had any negative effect upon them.
The authors suggest that those who treat persons with eating disorders spend enough time using motivational approaches to help patients, and take time to explore with their patients ways in which the patients’ values or expectations may have changed over time.