کار و سازگاری اجتماعی در بیماران مبتلا به بی اشتهایی عصبی

Objective and methods The Work and Social Adjustment Scale (WSAS) assesses patients' perceptions of impairment in everyday functioning and has been reported as a simple and reliable self-report measure in different psychiatric disorders. This study compared WSAS data from an anorexia nervosa (AN) patient group with that from healthy controls (HCs) and published data from other patient groups. A total of 160 female participants (AN, 77; HC, 83) completed the WSAS as well as measures of eating disorder symptom severity and brief assessments of anxiety and depression. Results Work and Social Adjustment Scale scores for the AN group were found to be in the severely impaired range, whereas the scores for those within the HC group indicated very little, or no impairment. Total WSAS scores in the AN group were significantly correlated with severity of clinical symptoms, and eating disorder–specific symptoms were the best predictor of social and occupational functional impairment. The greatest impairment in the AN group was reported in the realm of social leisure. Conclusions Consistent with reports in other clinical populations, it is suggested that the WSAS could be an extremely useful and meaningful measure to assess social and occupational functioning in people with eating disorders, in addition to eating disorder–specific assessments.

Anorexia nervosa (AN) is a complex psychiatric disorder with severe clinical symptoms and poor psychosocial functioning [1]. Attempts to measure functioning in everyday life are challenging, and the definition of recovery remains problematic [2]. An important aspect to consider when evaluating the severity of any health problem and how individuals measure their progress toward recovery is the extent to which individuals subjectively believe that their illness impairs their everyday functioning. The Work and Social Adjustment Scale (WSAS) [3] has been reported in the literature as a quick and reliable measure of social and occupational functioning in different mental and physical health disorders (eg, see Refs [4] and [5]). This measure has robust psychometric properties and comprises 5 brief questions that are easy to administer and score. Self-report WSAS scores have also been found to correlate highly with scores assigned by trained clinicians [4], although this has been found to differ between disorders [6]. As a result, the WSAS is often used as an outcome measure in treatment studies outside of the eating disorders (EDs) field. It has been reported that the WSAS is a sensitive measure of posttreatment changes in bipolar disorder [5], unipolar depression [7], obsessive-compulsive disorder (OCD) [4] and [8], and chronic fatigue syndrome [9]. In the ED population, however, only 2 published reports [10] and [11] are available that consider WSAS data. One study [10] compared 14 outpatients with AN to individuals with ED not otherwise specified (EDNOS) and bulimia nervosa (BN). This study concluded that this small group of patients with AN had a greater degree of functional impairment than those with EDNOS or BN. The second study [11] focused on a larger group of 123 participants with binge eating disorder, BN, or borderline ED diagnoses. The baseline WSAS scores reported in this study were lower compared with those reported in the Turner et al study [10]. However, the WSAS total scores in the Striegel-Moore et al study [11] were within the range that suggests significant functional impairment. Another body of research has explored social and functional impairment in EDs using more detailed but resource-expensive measures. For example, Rymaszewska et al [12] used a semistructured interview (the Groningen Social Disability Schedule [13]) to assess social disability in people with EDs and other psychiatric illness groups. This study found that individuals diagnosed with EDs had high levels of social disability that were not significantly different to individuals with schizophrenia or individuals with a personality disorder. In addition, the best predictor of the degree of social disability was severity of psychopathology, over and above other variables including diagnosis of mental disorder per se. The current study sought to build on the existing evidence base and provide data regarding work and social adjustment in a relatively large group of individuals diagnosed with AN. The primary objective of this exploratory study was to compare the WSAS scores of individuals with AN to those of a healthy control (HC) sample, as well as with existing published WSAS data in people with other EDs and people with other psychiatric diagnoses. In addition, the study sought to explore whether there is a relationship between WSAS scores and the severity of illness in AN. Based on previous research, which has demonstrated a significant association between symptom severity and social disability in EDs and other psychiatric illnesses (eg, see Ref [12]), we specifically predicted that greater severity of illness (as indexed by body mass index [BMI], duration of illness, and responses to self-report measures of ED symptoms and anxiety and depression) would be significantly associated with higher WSAS scores (ie, greater functional impairment).

Despite these limitations, the current study has demonstrated, using relatively large samples, that individuals with AN report significantly impaired work and social functioning compared with HCs. Individuals with AN also reported WSAS scores that are comparable with other clinical populations where functional impairment is well documented. Overall, the study suggests that the WSAS is a useful and brief measure to use in routine clinical practice to assess functional impairment alongside other important ED clinical indices (eg, ED-specific symptoms, anxiety and depression, BMI, biochemistry). It may also be used to identify life domains where individuals are experiencing particular difficulties and thus help in developing tailored treatment plans that focus on working toward valued life goals, in addition to addressing core ED symptoms and weight gain. This approach is very much in line with the burgeoning “recovery model” in mental health care, which advocates an individualized, holistic, and strength-focused approach to treatment and recovery. Further research in this area is warranted, particularly in relation to exploring social and occupational functioning in other EDs and exploring how functional impairment changes during the course of standard treatment of EDs.