Health service utilization for eating disorders: Findings from a community-based study
Prior use of health services was examined in a community sample of women with bulimic-type eating disorders.
Participants (n = 159) completed a structured interview for the assessment of eating disorder psychopathology as well as questions concerning treatment-seeking and type of treatment received.
Whereas a minority (40.3%) of participants had received treatment for an eating problem, most had received treatment for a general mental health problem (74.2%) and/or weight loss (72.8%), and all had used one or more self-help treatments. Where treatment was received for an eating or general mental health problem, this was from a primary care practitioner in the vast majority of cases. Only half of those participants who reported marked impairment associated with an eating problem had ever received treatment for such a problem and less than one in five had received such treatment from a mental health professional.
Women with bulimic-type eating disorders rarely receive treatment for an eating problem, but frequently receive treatment for a general mental health problem and/or for weight loss. The findings underscore the importance of programs designed to improve the detection and management of eating disorders in primary care.
Available from: Hannah DeJong
- "A limitation of the current study is the use of a treatment-seeking sample. Many individuals with EDs do not seek treatment from specialist services [44-47] and so findings in this sample may not generalise to other groups, such as community samples of people with EDs. Bohn and colleagues  note that it is often psychosocial impairment that leads people with EDs to seek help and so we might expect that a treatment-seeking sample will be particularly impaired. "
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This study aimed to assess differences in Quality of Life (QoL) across eating disorder (ED) diagnoses, and to examine the relationship of QoL to specific clinical features.
199 patients with a diagnosed ED completed the Clinical Impairment Assessment (CIA) [Cognitive Behavior Therapy and Eating Disorders, 315–318, 2008] and the Eating Disorders Examination (EDE) [Int J Eat Disord 6:1–8]. Differences between diagnostic groups were examined, as were differences between restrictive and binge-purge subtypes.
CIA scores and EDE scores were positively correlated and higher in groups with binge-purge behaviours. CIA scores were not correlated with BMI, illness duration or frequency of bingeing/purging behaviours, except in the binge-purge AN group, where CIA scores negatively correlated with BMI.
Patients with EDs have poor QoL and impairment increases with illness severity. Patients with binge/purge diagnoses are particularly impaired. It remains unclear which clinical features best predict the degree of impairment experienced by patients with EDs.
International Journal of Eating Disorders 11/2013; 1(1):43. DOI:10.1186/2050-2974-1-43 · 3.13 Impact Factor
Available from: PubMed Central
- "Inclusion of BED as a formal diagnosis is significant, though, because it will have the effect of reducing the proportion of individuals with eating disorders who would otherwise have fallen into the DSM-5 “Feeding or Eating Disorder Not Elsewhere Classified” category [15,28]. Currently, as many as half of individuals with eating disorders receive the DSM-IV diagnosis of EDNOS and this is the case in both community and clinical samples [30,31]. Not surprisingly, concerns have been expressed about a classification scheme that relegates such a high proportion of cases to a residual category [31,32]. "
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ABSTRACT: Proposed changes to the classification of bulimic-type eating disorders in the lead up to the publication of DSM-5 are reviewed. Several of the proposed changes, including according formal diagnostic status to binge eating disorder (BED), removing the separation of bulimia nervosa (BN) into purging and non-purging subtypes, and reducing the binge frequency threshold from twice per week to once per week for both BN and (BED), have considerable empirical evidence to support them and will likely have the effect of facilitating clinical practice, improving access to care, improving public and professional awareness and understanding of these disorders and stimulating the additional research needed to address at least some problematic issues. However, the omission of any reference to variants of BN characterized by subjective, but not objective, binge eating episodes, and to the undue influence of weight or shape on self-evaluation or similar cognitive criterion in relation to the diagnosis of BED, is regrettable, given their potential to inform clinical and research practice and given that there is considerable evidence to support specific reference to these distinctions. Other aspects of the proposed criteria, such as retention of behavioral indicators of impaired control associated with binge eating and the presence of marked distress regarding binge eating among the diagnostic for BED, appear anomalous in that there is little or no evidence to support their validity or clinical utility. It is hoped that these issues will be addressed in final phase of the DSM-5 development process.
International Journal of Eating Disorders 08/2013; 1(1):33. DOI:10.1186/2050-2974-1-33 · 3.13 Impact Factor
Available from: Phillipa Hay
- "Only four participants (2.5%) with eating disorders were currently underweight (BMI < 18.5), none of whom met the criteria for AN. Less than half (40.3%) of women with eating disorders had ever received advice or treatment from a health professional for an eating problem, typically a primary care practitioner (Mond et al., 2007a). "
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ABSTRACT: Studies of quality of life among individuals with eating disorders have relied almost exclusively on clinical samples. We examined impairment in quality of life in a community sample of women with eating disorders recruited as part of an epidemiological study.
Measures of health-related quality of life (Medical Outcomes Study 12-item Short-Form Physical and Mental Component Summary scales) and subjective well-being (WHOQOL-BREF Psychological Functioning and Social Relationships subscales) were completed by women with eating disorders (n = 159), primarily variants of bulimia nervosa and binge eating disorder, and a comparison group of healthy women (n = 232).
When compared with healthy women, women with eating disorders reported substantial impairment in aspects of quality of life relating to mental health, although item-level analysis indicated considerable variation in the extent to which specific aspects of emotional well-being were affected. Impairment in social relationship and in physical health was less pronounced and due, at least in part, to between-group differences in age, body weight and demographic characteristics. Impairment in certain aspects of perceived physical health was, however, apparent among women with eating disorders, even after controlling for between-group differences in body weight.
Community cases of women with eating disorders experience marked impairment in quality of life as this relates to mental health functioning and at least some impairment in physical health functioning. Personality characteristics and ego-syntonic aspects of eating-disordered behaviour may complicate the interpretation of findings relating to impairment in specific aspects of quality of life.
Australian and New Zealand Journal of Psychiatry 06/2012; 46(6):561-8. DOI:10.1177/0004867411433967 · 3.41 Impact Factor
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