Motivational Patterns and Related Psychopathology in Chinese Patients with Eating Disorders
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2015-08
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University of Hawaii at Manoa
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Eating disorders (EDs) are serious mental disorders that have a tremendous negative impact on both physical and mental health. Despite the substantial cost of EDs on patients and their families, resistance to change has been a major obstacle to successful treatment and has recently become a focus of research interest. A variety of factors have been proposed to account for treatment resistance in Western ED patients, including ego-syntonic motivations related to overvaluation of thinness and various adaptive functions served by EDs. As EDs are becoming more prevalent in China, Chinese clinicians have encountered an increasing number of ED patients in clinical practice and experienced high resistance to change from this population. Although overvaluation of thinness has been denied as a major reason for symptoms by a significant proportion of patients with anorexia nervosa (AN) from Hong Kong, it is not clear whether or to what extent this overvaluation and resultant ego-syntonic motivations, along with other identified functions of EDs in Western populations, have contributed to the development and maintenance of EDs in individuals from Mainland China. The current study was designed to explore motivational patterns and related psychopathology in Chinese ED patients using clinical interviews and Western-developed questionnaires. Eighty-four Chinese patients seeking treatment for EDs at Shanghai Mental Health Center participated in the baseline assessment at intake and two-thirds of the sample, who remained in treatment after one month, completed the follow-up assessment. Both assessments involved completing an interview with the research psychiatrist and a set of Western-developed questionnaires translated using the back-translation method to evaluate motivational factors and clinical symptoms. The research psychiatrist made a DSM-IV-TR ED diagnosis for each participant based on the interview and collateral information following the baseline assessment. The research psychiatrist and each participant’s attending psychiatrist also assessed the individual’s motivation for change at both baseline and follow-up. The sample was composed of 39 Chinese patients with AN, 25 with bulimia nervosa (BN), and 20 with eating disorder not otherwise specified (EDNOS). All Western-developed measures showed acceptable to excellent internal consistency. Motivation measures demonstrated satisfactory convergent and concurrent validity, equivocal predictive validity, promising structural and discriminative validity, and sensitivity to change over time. Over the study period, Chinese ED patients identified the lack of self-efficacy, avoidance functions of EDs, and ego-syntonic motivations for symptoms as major motivational barriers to change. They also described experiencing more costs than benefits from their disorders, especially the consequence of EDs and guilt for loved ones. In addition, they endorsed the importance of weight and shape concerns in their ED psychopathology and exhibited mild depression over the first month of treatment. Compared to ED patients, attending psychiatrists put more emphasis on emotion regulation functions and less on ego-syntonic motivations as barriers to recovery but perceived a higher level of resistance to change in their patients. At baseline, Chinese BN patients were significantly more resistant and AN patients less symptomatic, with the exception of the body mass index (BMI), when they were compared to the other two diagnostic groups, respectively. After the first month of treatment, no significant group differences existed in motivation and symptoms except for the BMI between AN and the other two diagnostic groups and weight concern between BN and EDNOS groups. All three diagnostic groups showed some improvement in motivation for change and clinical psychopathology at one-month follow-up, with greater improvement found in BN patients than in the other two diagnostic groups. Subgroup analysis further revealed that only AN patients with low weight concern (LAN patients) but not those with high weight concern (HAN patients) were significantly less resistant to change than BN patients at baseline. At follow-up, LAN patients showed no improvement while HAN patients mild to moderate improvements in motivation and psychopathology, but HAN patients gained less weight than LAN patients and became the most resistant among all participants. Finally, motivational factors and clinical symptoms (except for the BMI of AN patients) demonstrated a positive cross-sectional relationship and correspondence in changes over time for all participants. In conclusion, some similar motivational factors seem to play an important role in treatment resistance for both Chinese and Western ED patients, such as self-efficacy concerns, avoidance functions, and ego-syntonic motivations. Patterns of motivation and psychopathology between different patient groups and over time are found to be more similar than different in Chinese and Western ED patients, particularly when Chinese AN patients with low and high weight concern are examined separately. Reducing treatment resistance may help improve clinical symptoms except for promoting weight gain in AN patients. Future cross-cultural studies with a time series design may further elucidate cultural differences between Chinese and Western ED patients and evaluate the causal relationship between motivational factors and clinical outcomes.
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Eating disorders, Culture, Motivation, psychopathology
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Theses for the degree of Doctor of Philosophy (University of Hawaii at Manoa). Psychology
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