SELF-EFFICACY

Self-efficacy relating to Eating Disorder education of family and friends

Self-efficacy relating to Eating Disorder education of family and friends

Introduction

Anorexia nervosa (AN) and bulimia nervosa (BN) are chronic psychiatric disorders that are further complicated by high relapse rates and persistent subthreshold symptomatology.1-3 Only a modest percentage of patients with AN achieve full recovery and as many as two thirds of patients with AN restricting type (AN-R) subsequently develop binge eating behavior.2-4 In a 7-year follow-up study of a large cohort of patients with eating disorders, Herzog et al.3 demonstrated that although 34% of patients with AN achieved full recovery at some point, 17% did not experience any extended period of symptom remission during follow-up.

Although recovery rates for BN are higher than those for AN, long-term follow-up studies indicate that approximately one third of patients relapse at some point during a 6-year period after remission of symptoms and as many as 20% continue to meet full criteria for BN.3,5 High rates of relapse and persistent eating disordered behavior in patients with AN and BN have prompted researchers to examine how dimensions of behavior change, such as motivation, may be related to treatment progress and outcome.6-8

A construct that has demonstrated powerful predictive utility across numerous behaviors, but has not been systematically evaluated among patients with AN and BN, is self-efficacy. As described by Bandura,9 self-efficacy represents an individual's perceived ability to successfully perform a particular behavior andmediates future attempts to carry out that behavior. Efficacy beliefs affect several phases of the change process, including intention to change, amount of effort put forth to achieve the goal, and perseverance toward the goal despite barriers and setbacks. High levels of self-efficacy promote greater effort expenditure and motivation to act whereas low self-efficacy interferes with task performance and is associated with negative affect.9-11

The utility of self-efficacy as a predictor of behavior change and treatment outcome has been dem-

1 Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island

2 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland

3 Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio

4 Department of Psychology, University of Maryland Baltimore County, Baltimore, Maryland Accepted 28 May 2005

*Correspondence to: Angela Marinilli Pinto, PhD, Brown Medical School/The Miriam Hospital, 196 Richmond Street, Providence, RI

02903. E-mail: Angela_Marinilli@brown.edu Published online 9 March 2006 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/eat.20256

VVC 2006 Wiley Periodicals, Inc.

REGULAR ARTICLE

onstrated across health behaviors such as weight loss, physical activity, and smoking cessation,12-15

and across psychiatric disorders including anxiety, depression, and alcohol dependence.9,16,17 Recently, investigators have examined the role of eating self-efficacy (e.g., confidence to resist eating in various situations) in the treatment outcome of obese binge eaters. For instance, Wolff and Clark18

showed improved self-efficacy in 12 obese women participating in cognitive-behavioral group treatment for binge eating disorder (BED). In addition, Goodrick et al.19 evaluated the relation between eating self-efficacy and binge eating severity in 125 obese adult female binge eaters enrolled in an 18-month treatment program for ...