No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Eating disorders: The big issue
... In non-clinical populations, ARFID has been associated with impaired mental health related quality-of-life in adults [21,22] and impaired social functioning in children [23]. Despite growing evidence of the physical and psychosocial impairment associated with ARFID, the prevalence of ARFID remains unclear with wideranging estimates. ...
... While previous research on the prevalence of ARFID in the general population has examined samples of younger children [24][25][26]28] and adults [21,22,27], to date there has been no research on the prevalence of ARFID among adolescents. This is a particularly important risk group to examine given that it is represents the peak period of risk for the development of other eating disorders [23] On the other hand, evidence suggests that unlike eating disorders, ARFID has an onset that typically occurs during childhood [12]. Thus it will be important to contrast the prevalence of ARFID and its prevalence distribution across early to late adolescence to the prevalence of other eating disorders during adolescence [30]. ...
... This may suggest that quality of life impairment becomes more significant the longer someone is impacted by ARFID, as previous studies have shown psychosocial quality of life impairment in adults with ARFID, whereas the present study examined an adolescent population [21,22]. In keeping with this hypothesis, another previous study conducted with a sample of children identified with ARFID found no impairment in psychological and physical well-being relative to a control group [23]. On the other hand, this study did find that children with ARFID had relative deficits in peer relations and autonomy from their parents-which may indicate that these are either risk factors or important early indicators of ARFID impairment in younger age groups. ...
Background
Little is known about the prevalence and impairment associated with possible Avoidant/restrictive food intake disorder (ARFID) in community adolescent populations. We aimed to investigate the prevalence, health-related quality of life (HRQoL), and psychological distress associated with possible ARFID in a sample of adolescents from the general population in New South Wales, Australia.
Methods
A representative sample of 5072 secondary school students aged between 11 and 19 years completed the online EveryBODY survey in 2017. The survey included demographic data, eating behaviours, psychological distress and both physical and psychosocial health-related quality of life.
Results
The prevalence of possible ARFID was 1.98% (95% CI 1.63–2.41) and did not differ significantly across school years 7–12. The weight status of participants with possible ARFID did not differ significantly from those without possible ARFID. When measuring gender identity, the ratio of males to females with possible ARFID was 1:1.7. This was statistically significant, however, the effect size was very small. Psychological distress and HRQoL did not differ significantly between the possible ARFID and non-ARFID group.
Conclusions
The prevalence of possible ARFID was found to be similar to that of anorexia nervosa and binge eating disorder in the general adolescent population. Adolescents who identify as girls rather than boys may be more likely to develop ARFID, replication with new samples is required to confirm these findings. The impact of ARFID on HRQoL may be minimal in adolescence and become more significant in adulthood, further research using longitudinal design, healthy control groups and/or diagnostic interviews is required.
... Eating disorders (EDs) are serious psychiatric disorders that have major impacts on individuals, significant others, and society in general with a peak age onset in adolescence and emerging adulthood (APA, 2013;Schmidt et al., 2016). EDs are significantly associated with medical (e.g., hypotension, gastritis, osteoporosis), psychiatric (e.g., mood disorders, suicidal behaviours, anxiety disorders, substance abuse) and socio-economic difficulties (e.g., isolation, stigmatization, unemployment, high treatment costs) (Keski-Rahkonen & Mustelin, 2016;Schaumberg et al., 2017;Schmidt et al., 2016;Wu et al., 2020). ...
... Eating disorders (EDs) are serious psychiatric disorders that have major impacts on individuals, significant others, and society in general with a peak age onset in adolescence and emerging adulthood (APA, 2013;Schmidt et al., 2016). EDs are significantly associated with medical (e.g., hypotension, gastritis, osteoporosis), psychiatric (e.g., mood disorders, suicidal behaviours, anxiety disorders, substance abuse) and socio-economic difficulties (e.g., isolation, stigmatization, unemployment, high treatment costs) (Keski-Rahkonen & Mustelin, 2016;Schaumberg et al., 2017;Schmidt et al., 2016;Wu et al., 2020). ...
... Awareness regarding EDs is increasing in the community and a range of treatments are available (Schaumberg et al., 2017;Treasure et al., 2015a;Wade, 2017), symptoms of EDs are either not detected or treated in a large number of individuals (Schmidt et al., 2016). In fact, a majority of individuals do not seek treatment or receive treatment (Kazdin et al., 2017). ...
No prevention program targeting female university students at risk for eating disorders (EDs) is currently available in Turkey. Accordingly, this study investigated the feasibility, acceptability, and preliminary efficacy of a new cognitive behavioural theory based prevention program designed to reduce the risk of developing EDs. 38 female university students who were randomised to either to 6 sessions Healthy Eating Attitudes and Behaviours Group Program (experimental condition) or one of the two control conditions (single session workshop vs. wait-list) participated in the study. EDs symptoms and risk factors were measured at baseline, post-assessment, and 1-month follow-up. Feasibility and acceptability were measured with a feedback form at the post-assessment time point. The experimental condition resulted in significantly higher reductions in EDs behaviours, body dissatisfaction, emotion regulation difficulties and internalization of thin/low body fat ideal with the high level of effect size compared with control conditions. The attendance rate and satisfaction with the program were high. Preliminary data suggested that the Healthy Eating Attitudes and Behaviours Group Program is feasible and acceptable, and appears promising in reducing EDs symptoms and risk factors in Turkish female university students. Findings also provided the groundwork for future clinical trials aiming to reduce EDs risk in this population.
... Without being able to publish in high-impact journals, research can be difficultly disseminated at the expense of patients. In fact, it has been recently authoritatively stated: "the loss of academic programs has rendered treatment for AN a luxury commodity" [15], and "no formal training structures are in place for young researchers in Europe that reflect the transdisciplinary needs of the EDs specialty" [16]. This is particularly true in the field of EDs, since patients require a highly specialized multidisciplinary approach, with individualized treatment plans targeting each motivation phase. ...
... As a result, only a minority of patients with EDs receive proper care (report UK), and frequently after a prolonged (and costly) untreated illness [17]. Taken together, these data show how compelling is the need for extensive research on evidence-based treatments [18], notwithstanding inadequate funding in both Europe [16,19] and the USA [15]. Therefore, with the overarching aim to clarify the extent of current research productivity and visibility in the ED field from a top-rank journal perspective, we decided to perform a comparison of publications in top-rank psychiatry journals between EDs and schizophrenia. ...
... Recent data from Australia showed that schizophrenia received funding 60 times higher than those allocated to EDs [50]. Funding is particularly welcome in the ED field to implement formal training structures able to provide the extensive multidisciplinary skills that are required to work with patients with EDs whose clinical needs are particularly complex [15,16]. Still, in contrast with the ED field, schizophrenia research can rely on multiple pharmacological strategies which may have specific funding agencies in pharmaceutical industries, further boosting research productivity. ...
Purpose
Eating disorders (EDs) are mental illnesses with severe consequences and high mortality rates. Notwithstanding, EDs are considered a niche specialty making it often difficult for researchers to publish in high-impact journals. Subsequently, research on EDs receives less funding than other fields of psychiatry potentially slowing treatment progress. This study aimed to compare research vitality between EDs and schizophrenia focusing on: number and type of publications; top-cited articles; geographical distribution of top-ten publishing countries; journal distribution of scientific production as measured by bibliometric analysis; funded research and collaborations.
Methods
We used the Scopus database, then we adopted the Bibliometrix R-package software with the web interface app Biblioshiny. We included in the analyses 1,916 papers on EDs and 6491 on schizophrenia.
Results
The ED field published three times less than schizophrenia in top-ranking journals – with letters and notes particularly lacking—notwithstanding a comparable number of papers published per author. Only 50% of top-cited articles focused on EDs and a smaller pool of journals available for ED research (i.e., Zones 1 and 2 according to Bradford's law) emerged; journals publishing on EDs showed an overall lower rank compared to the schizophrenia field. Schizophrenia research was more geographically distributed and more funded; in contrast, a comparable collaboration index was found between the fields.
Conclusion
These data show that research on EDs is currently marginalized and top-rank journals are seldom achievable by researchers in EDs. Such difficulties in research dissemination entail potentially serious repercussions on clinical advancements.
Level of evidence
Level V: opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
... The prevalence of eating disorders (ED) has increased and expanded over the last decade (Galmiche et al., 2019;James et al., 2018;Schmidt et al., 2016), resulting in a similar economic and healthcare burden caused by anxiety and depression (Murray et al., 2017;Schmidt et al., 2016). Despite best efforts, the treatment of ED is characterized by high dropout rates (DeJong et al., 2012), especially in anorexia, where responses to available therapies are characterized by partial and low recovery rates (Goddard et al., 2013;Hay, 2013;Reel, 2013). ...
... The prevalence of eating disorders (ED) has increased and expanded over the last decade (Galmiche et al., 2019;James et al., 2018;Schmidt et al., 2016), resulting in a similar economic and healthcare burden caused by anxiety and depression (Murray et al., 2017;Schmidt et al., 2016). Despite best efforts, the treatment of ED is characterized by high dropout rates (DeJong et al., 2012), especially in anorexia, where responses to available therapies are characterized by partial and low recovery rates (Goddard et al., 2013;Hay, 2013;Reel, 2013). ...
Purpose: This study aimed to adapt and assess the validity and reliability of the Spanish version of the Exercise in Eating Disorders Questionnaire (EED-Q) in order to diversify and offer a more comprehensive, effective, and standardized assessment of maladaptive exercise (ME) in ED.
Methods: The EED-Q is a self-reported questionnaire that assesses eating disorders (ED) patients’ attitudes towards exercise. Based on the four-factor model of the original version, the EED-Q was adapted through forward and back-translation and inconsistencies were addressed through a committee of experts. Then, the EED-Q Spanish version (S-EED-Q) was administered to 172 patients with eating disorders (age= 15.28 ± 1.64 years). An exploratory factor analysis was computed to assess the construct validity. Inter-item correlations, item-factor correlations, McDonald’s Omega, and Cronbach’s Alpha were estimated to test the internal consistency (reliability). In addition, convergent validity was tested by relating EED-Q and the Eating Disorders Inventory 2 (EDI-2) scores, discriminant validity was assessed comparing EED-Q item-factor correlations, and divergent validity was conducted by analyzing EED-Q factor correlations.
Results: The S-EED-Q revealed significant generalized correlations among the scale items and showed good reliability scores (McDonald’s Omega and Cronbach’s alpha >0.7) except for Factor 2 (McDonald’s Omega = 0.63 and Cronbach’s alpha = 0.58). After eliminating items 8 and 15 due to their low factor loadings, the EFA revealed a robust empirical factor structure, adequate to the theoretical model, with good levels of total explained variance (65%). Convergent, discriminant and divergent validity showed good performance: results showed expected correlations between EED-Q and EDI-2, all items achieved higher item-factor correlations in their theoretical factor than in the others, and all factor-factor correlations were as expected.
Conclusion: This study is the first to adapt and validate the S-EED-Q. The psychometric properties of the S-EED-Q compared to the original version were supported with some limitations. Although the psychometric properties of the scale are adequate and the construct, convergent, discriminant and divergent validity are endorsed, some of the original items are questionable. Likewise, the items of the positive and healthy exercise factor require an in-depth revision.
... Eating Disorders (EDs) are "characterised by a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food, and impairs physical health or psychosocial functioning" (DSM-5, 2013;"Feeding and Eating Disorders,"). EDs have one of the highest mortality rates of all chronic mental health conditions in young people (Neale and Hudson, 2020;Schmidt et al., 2016) and are associated with co-morbid mental health conditions -such as anxiety, mood disorders, depression, and substance problems (Micali et al., 2015). Although the primary aetiology of EDs remains unknown (Collaboration, 2017), research suggests that EDs most likely develop from a complex interaction of biological (genetics, age, early developmental trauma and predisposed mental health concerns), psychological (perfectionism, neuroticism, core low self-esteem, distorted body image, negative emotionality and obsessive-compulsivity) and cultural/environmental factors (peer influence, perinatal and parental factors, media, exposure and internalisation of the thin ideal; and a discrepancy between self and ideal, leading to body dissatisfaction and atypical eating behaviours) (Culbert et al., 2015;Park and Im, 2021). ...
... OSFED includes the diagnoses of higher weight or atypical AN, purging disorder and subthreshold BN, and is applied when ED thoughts and behaviours predominate and significantly impact different aspects of the individual's life, but do not satisfy the full criteria for a specific disorder (DSM-5, 2013). The peak age of onset for the development of EDs is between 15 and 25 years, with an average illness duration of six years (Schmidt et al., 2016). ...
Background
Although the primary aetiology of Eating Disorders (ED) remains unknown, research suggests a complex interplay of biological, psychological, and cultural/environmental factors. This paper aims to systematically review the literature on neuroimaging studies that measure socio-cognitive factors, in the context of body dissatisfaction and EDs in young people. Specifically, our aim was to identify patterns in the findings linked to social media-type behaviours.
Methods
The review was conducted in accordance with PRISMA guidelines using PubMed, Scopus, and Web of Science databases. 799 papers were identified in the database search and 38 studies were selected based on exclusion and inclusion criteria. Selected studies were assessed using the National Institute of Health study quality assessment tool.
Results
Findings point to state-related impairments in inhibitory control and salient emotional processing. Anorexia Nervosa(AN) showed impaired set-shifting abilities, working memory and decision making, while altered activation in attention networks and associated difficulties with conflict resolution were seen for Bulimia Nervosa(BN) and Other Specified Feeding and Eating Disorders(OSFED). AN and BN also demonstrated altered sensitivity to food-related stimuli in striatal regions, suggesting aberrant top-down emotional-cognitive control. ED participants also show deficits in body representation, impaired control over social behaviours and altered integration of visual and body perception.
Discussion
These findings support the notion that socio-cognitive dysfunctions in ED are underpinned by a distributed network of structural and functional brain changes which influence the way young people with ED interact with and respond to social media, and ultimately places at them at increased risk for body image disturbances.
This Review was registered with the PROSPERO International Register of Systematic Reviews, Registration number CRD42021270696.
... Eating disorders (EDs) are serious psychological and psychiatric illnesses which frequently have an adolescent onset. 1 Experimental studies provide evidence of poorer decisionmaking in adults with EDs relative to non-ED controls. [2][3][4] This evidence; however, relied largely on cross-sectional adult samples usually recruited from ED clinics. ...
... Open access able to make advantageous decisions under conditions of risk in childhood might offer some prevention from prodromal eating pathology occurring at the time when most people who are later identified to have developed a clinical illness appear to be most at risk of developing this disorder (ie, mid adolescence). 1 These findings were developed further using latent class analysis (LCA), 9 which identified two groups within the cohort at age 14, one endorsing prodromal eating pathology and the other without prodromal eating pathology. Logistic regression models showed higher risk-taking scores were associated with a 60% greater probability of being in the prodromal eating pathology group, and higher scores on quality of decision-making were associated with a 30% lower probability of being in the prodromal eating pathology group. ...
Objectives
We examined whether decision-making at age 11 and 14 is associated with prodromal eating pathology at age 14 and whether it would persist across adolescence and also be present at age 17.
Design
This prospective, observational, population-based cohort study used a longitudinal design.
Setting
Data from the Millennium Cohort Study (MCS), a UK longitudinal cohort study involving 19 244 families from England, Scotland, Wales and Northern Ireland, were analysed.
Participants
We modelled data from 8922 boys and girls aged 11, 14 and 17 (MCS sweeps 5, 6 and 7).
Primary and secondary outcomes
We investigated decision-making using the risk-taking, quality of decision-making, deliberation time, delay aversion and risk adjustment subscales of the Cambridge Gambling Task and prodromal eating pathology through binary response items measuring: body dissatisfaction (whether the participant perceived their body as being too overweight); intention to lose weight (whether participants reported a strong desire to lose weight); dietary restriction (whether participants reported actively eating less to influence their shape/weight) and excessive exercise (whether participants reported exercising in a driven way in order to influence weight/shape). Data were analysed using latent class analysis and logistic regression.
Results
Lower scores on quality of decision-making (OR=0.46) and deliberation time (OR=0.99) at age 14 were associated with prodromal eating pathology at both ages 14 and 17 (all p<0.05), indicating an association between less frequently opting to bet on the most likely outcome and taking less time to decide on which bet to choose and the persistence of prodromal eating pathology over adolescence. Lower deliberation time (OR=0.99) and delay aversion (OR=0.62) at 11 and lower risk-taking scores at 14 (OR=0.43) were associated with the absence of prodromal eating pathology at 14 and 17 (all p<0.05), indicating that a moderate approach under conditions of risk in childhood and mid-adolescence is associated with reduced eating pathology across adolescence.
Conclusions
Training advantageous decision-making might protect from later prodromal eating pathology.
... 30 Remission rates increase with longer follow-up, particularly for AN, demonstrating that it is not uncommon to experience an ED for a substantial number of years before reaching recovery. [30][31][32] Adolescents are argued to recover more successfully than adults with AN and family-based treatments generally show high effectiveness for adolescent AN. [33][34][35] However, relapse is common; a systematic review revealed that around 31% of those with AN relapse after treatment, with younger patients with AN at the same risk of relapse as older patients. 36 Being able to identify and increase understanding of early-stage presentations via staging concepts may improve early effective management for EDs and shift the trend of EDs becoming persistent, to illnesses that do not become so protracted. ...
Introduction
Clinical staging models in psychiatry assert that there are earlier, less severe or more malleable forms of illness that are distinguishable from later, more chronic forms of illness, and that these stages may have different prognostic and treatment implications. Previous reviews on clinical staging in eating disorders (EDs) suggest a staging heuristic could be useful for anorexia nervosa, but less research is available on how this applies to other EDs. An up-to-date review is required to synthesise new and heterogenous avenues of research. This scoping review aims to explore the extent and types of evidence in relation to illness staging for EDs and how these concepts are associated with treatment response and outcomes.
Methods and analysis
This protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer’s Manual. We will consider any documents providing evidence for clinical staging such as those which describe full or partial staging models, for all EDs, across various domains of assessment and functioning. Participants will include clinical or non-clinical population samples with full-syndrome EDs or disordered eating behaviour. PubMed, PsycINFO, MEDLINE and Web of Science databases will be systematically searched for relevant literature. Two authors will export documents and screen titles, abstracts and full texts. Data will be extracted into a charting form drafted by the authors. A narrative summary of the documents will be conducted in line with the study aims. Finally, clinical and research recommendations will be outlined.
Ethics and dissemination
Ethical approval will not be required to synthesise published and unpublished literature. The study will be published in a peer-reviewed journal and shared at conferences, via social media, and in other communications.
... Therefore, a large proportion of patients with AN go on to develop a protracted, or "severe-enduring" form of the illness, which is associated with a greater reduction in life expectancy (Strober, 2010) as well as more frequent presentation to specialist medical facilities, eating disorder (ED) services and hospital admission (Hay et al., 2012). This high proportion of protracted cases is attributable also to a paucity of evidence-based treatments, due to chronic underfunding of ED research Schmidt et al., 2016), as well as inequalities in access to treatment (Downs, 2023). There is controversy on how to define severe-enduring AN (SE-AN), with most definitions placing illness duration and number of previously failed treatment attempts at the centre of diagnosis, but with differing criteria for the number of years of illness (e.g. ...
Objective
Treatment for anorexia nervosa (AN) remains challenging; there are no approved psychopharmacological interventions and psychotherapeutic strategies have variable efficacy. The investigation of evidence‐based treatments has so far been compounded by an underdeveloped understanding into the neurobiological changes associated with the acute stages of AN. There is converging evidence of deficiencies in neuroplasticity in AN.
Method
This paper provides an overview of neuroimaging, neuropsychological, molecular and qualitative findings relating to neuroplasticity in AN, translating these findings to the identification of novel biological and psychotherapeutic strategies.
Results
Novel psychopharmacological approaches that may ameliorate deficiencies in neuroplasticity include medications such as ketamine, psilocybin and human recombinant leptin. Anti‐inflammatory medications and brain‐derived neurotrophic factor mimetics may emerge as potential treatments following further research. Psychotherapeutic strategies that may target neuroplastic deficiencies, as well as having wider effects on identity, include imagery rescripting, memory specificity training, cognitive remediation therapy, exposure therapies, narrative therapies, cultural interventions (e.g. music and arts therapies) and yoga/mindfulness‐based interventions.
Conclusions
Treatments specifically targeted towards mitigating the neurobiological sequalae of AN are warranted, and emerging neurobiological and neuropsychological research utilising longitudinal designs and large sample sizes, as well as initial feasibility studies, are necessitated to bolster translational efforts.
... Eating disorders (ED) are characterised by severe and persistent disturbances in eating behaviours in a way that deviates from cultural norms (Miller & Pumariega, 2001;Schmidt et al., 2016) and are associated with significant psychological distress and reduced quality of life (Bamford et al., 2014). A recent systematic literature review has suggested a global lifetime prevalence of 8.4% [confidence interval (CI) 3.3%-18.6%] ...
Objectives
Many individuals with eating disorders (EDs) report the experience of an ‘Anorexic voice’ (AV). Negative experiences of loneliness are also often associated with EDs. This study sought to explore the relationship between experiences of loneliness, the frequency of the AV and the impact of this on ED symptom severity.
Design
165 individuals (mean age 27.54 years) who accessed online forums relating to EDs participated in this study. The sample included individuals who have experienced an AV [AV group ( N = 141)] and those who have not [non‐AV group ( N = 23)].
Methods
The study utilised self‐report measures via an online questionnaire to explore the predictive validity of loneliness and frequency of the AV on ED symptom severity.
Results
Confirmatory analysis (AV group only) demonstrated the significance of the independent variables individually predicting ED symptom severity. However, a significant interaction was not found between the two primary variables in predicting ED symptom severity, more significantly than the influence of either variable alone. Exploratory analysis considered the differences between the two groups (AV and Non‐AV), as well as considering alternate predictors.
Conclusions
The findings offer insight into possible drivers behind engagement with the AV, as part of ED presentations in the community.
... While the presence of underweight is necessary for a diagnosis of AN, BN patients have a wide range of BMIs (>18.5 kg/m 2 ), and increased weight suppression, or the difference between one's current weight and their highest past weight at adult height, represents a common risk factor for both conditions (Stice et al., 2020). AN and BN have high rates of comorbidity with various medical (e.g., gastrointestinal problems, hypokalaemia, osteopenia) and psychiatric problems (suicidality), which contributes to increased mortality among affected individuals (Schmidt et al., 2016). Growing evidence implicates metabolic perturbations in the pathogenesis of these illnesses (Watson et al., 2019), and altered hypothalamic functioning has been observed in animal models (Sutton Hickey, 2022;Adan, 2011) and neuroimaging studies of gustatory learning and metabolic processing in AN (Frank et al., 2018;Simon et al., 2020). ...
The hypothalamus is an important neuroendocrine hub for the control of appetite and satiety. In animal studies it has been established that hypothalamic lesioning or stimulation causes alteration to feeding behaviour and consequently body mass, and exposure to high calorie diets induces hypothalamic inflammation. These findings suggest that alterations in hypothalamic structure and function are both a cause and a consequence of changes to food intake. However, there is limited in vivo human data relating the hypothalamus to obesity or eating disorders, in part due to technical problems relating to its small size. Here, we used a novel automated segmentation algorithm to exploratorily investigate the relationship between hypothalamic volume, normalised to intracranial volume, and body mass index (BMI). The analysis was applied across four independent datasets comprising of young adults (total n = 1,351 participants) spanning a range of BMIs (13.3 – 47.8 kg/m²). We compared underweight (including individuals with anorexia nervosa), healthy weight, overweight and obese individuals in a series of complementary analyses.
We report that overall hypothalamic volume is significantly larger in overweight and obese groups of young adults. This was also observed for a number of hypothalamic sub-regions. In the largest dataset (the HCP-Young Adult dataset (n = 1111)) there was a significant relationship between hypothalamic volume and BMI.
We suggest that our findings of a positive relationship between hypothalamic volume and BMI is potentially consistent with hypothalamic inflammation as seen in animal models in response to high fat diet, although more research is needed to establish a causal relationship. Overall, we present novel, in vivo findings that link elevated BMI to altered hypothalamic structure. This has important implications for study of the neural mechanisms of obesity in humans.
... Eating disorders (ED) are highly prevalent neuropsychiatric disorders with severe physical and psychological symptom profiles [118]. Eating disorders often also present with concomitant disorders such as depression and anxiety and have the highest mortality rate of all psychiatric disorders [119,120]. ...
The discovery of ketamine as a rapid-acting antidepressant led to a new era in the development of neuropsychiatric therapeutics, one characterized by an antidepressant response that occurred within hours or days rather than weeks or months. Considerable clinical research supports the use of-or further research with-subanesthetic-dose ketamine and its (S)-enantiomer esketamine in multiple neuropsychiatric disorders including depression, bipolar disorder, anxiety spectrum disorders, substance use disorders, and eating disorders, as well as for the management of chronic pain. In addition, ketamine often effectively targets symptom domains associated with multiple disorders, such as anxiety, anhedonia, and suicidal ideation. This manuscript: 1) reviews the literature on the pharmacology and hypothesized mechanisms of subanesthetic-dose ketamine in clinical research; 2) describes similarities and differences in the mechanism of action and antidepressant efficacy between racemic ketamine, its (S) and (R) enantiomers, and its hydroxynorketamine (HNK) metabolite; 3) discusses the day-to-day use of ketamine in the clinical setting; 4) provides an overview of ketamine use in other psychiatric disorders and depression-related comorbidities (e.g., suicidal ideation); and 5) provides insights into the mechanisms of ketamine and therapeutic response gleaned from the study of other novel therapeutics and neuroimaging modalities.
... Therefore, they might experience higher general and coach-related pressures compared to adult athletes. In adolescence, DE and ED most frequently occur [19,20]. A recent systematic review concluded that age did not moderate DE in women athletes [21]. ...
The aim of the present study was to compare disordered eating (DE), body image, and sociocultural and coach-related pressures between athletes of different age groups (adolescents and adults) and between athletes participating in weight-sensitive (WS) and less WS groups. A total of 1003 athletes participated in this study. The age range of the sample was 15 to 44 years, and the mean age was 18.9 ± 5.8 years (51.3% were female). Athletes who voluntarily agreed to participate in the study were provided with the study measures on DE, body image and sociocultural attitudes towards appearance. Vomiting, laxative misuse and excessive exercise were more prevalent in adolescent female athletes than adults, while dietary restraint was more common in adult male athletes than adolescents. Adolescent female athletes experienced higher sociocultural (family, peers) and sport-related (coach) pressures and a less positive body image compared with adult female athletes. Adult male athletes experienced higher overweight preoccupation, more DE and unhealthy eating habits, and engaged in more frequent self-weighing behaviour compared with adolescent males. When the effect of weight sensitivity in sports was tested, a higher prevalence of DE and overweight preoccupation, more frequent self-weighing, and higher body-image-related pressure from coaches were observed in female athletes participating in aesthetic weight-sensitive (WS) sports as compared with those participating in less WS sports. No differences in positive body image were observed in female WS and less WS sports. Special DE prevention and positive body image promotion programs are necessary for female competitive athletes and parents of adolescent female athletes, especially those participating in aesthetic ones. For adult male athletes, special programs aiming to promote healthy eating should be implemented to prevent DE and body image concerns. Special education about DE prevention is compulsory for coaches who train female athletes.
... It is characterized by restricted energy intake associated with extreme underweight, disturbed body perception, and anxiety about gaining weight [1]. The clinical relevance is high, as during adolescence, AN is the third most common chronic disease, with a lifetime prevalence of 1-4% in 12-to 18-year-old girls in Europe, and the mortality risk is the highest of all psychiatric disorders [1][2][3][4]. Currently, a multimodal therapeutic approach is used, including weight rehabilitation and psychotherapy, but the treatment success is limited [5]. ...
Anorexia nervosa (AN) is a severe and often chronic eating disorder that leads to alterations in the gut microbiome, which is known to influence several processes, such as appetite and body weight regulation, metabolism, gut permeability, inflammation, and gut–brain interactions. Using a translational activity-based anorexia (ABA) rat model, this study examined the effect of chronic food starvation, as well as multistrain probiotic supplementation and refeeding, on the structure of the gut and gut-associated lymphatic tissue (GALT). Our results indicated that ABA had an atrophic influence on intestinal morphology and increased the formation of GALT in the small bowel and colon. Higher formation of GALT in ABA rats appeared to be reversible upon application of a multistrain probiotic mixture and refeeding of the starved animals. This is the first time that increased GALT was found following starvation in the ABA model. Our results underscore a potential role of gut inflammatory alterations in the underlying pathophysiology of AN. Increased GALT could be linked to the gut microbiome, as probiotics were able to reverse this finding. These results emphasize the role of the microbiome–gut–brain axis in the pathomechanisms of AN and point to probiotics as potentially beneficial addendum in the treatment of AN.
... 6,7 Os ônus familiares, econômicos e sociais também são destacados, sobretudo pelo fato de tais transtornos culminarem em um processo de morbidade prolongado e significarem um importante fator de risco para o suicídio. [8][9][10] Em relação ao tratamento, as recomendações mais atuais consistem em abordagens de equipes multidisciplinares com vistas à recuperação dos pacientes, considerando suas múltiplas dimensões. 11 Portanto, um destaque importante tem sido dado à atuação do enfermeiro nessas equipes, tendo em vista o seu potencial enquanto cuidador, educador e pesquisador. ...
Objetivo: analisar a atuação da Enfermagem junto a pacientes com transtornos alimentares em filmes sobre o assunto. Método: trata-se de um estudo descritivo-exploratório desenvolvido a partir de dados secundários. Utilizaram-se a base de dados cinematográfica Internet Move Database e descritores em português e inglês, que foram: “anorexia”, “bulimia” e/ou “transtornos alimentares”. Adotaram-se como critérios de inclusão: criações audiovisuais produzidas entre 1998 e 2020; o conteúdo estar disponível nas plataformas de streaming elencadas; as criações terem áudio e/ou legendas em português; e o filme ter alguma cena com o profissional de Enfermagem. Seis mídias atenderam a esses critérios e foram analisadas a partir de um roteiro que investiga a abordagem da Enfermagem no tratamento dos transtornos alimentares. Para elencar a produção mais indicada para finalidade didática, foram considerados seis critérios objetivos. Resultados: a maioria dos enredos veiculou a Enfermagem de modo estereotipado e com pouca autonomia, além de atribuir uma postura de “mau” ou “bom ajudante do médico” a esses profissionais. Embora nenhum enredo tenha atendido a todos os critérios objetivos de maneira satisfatória, a produção audiovisual que correspondeu à maior parte dos critérios foi aquela indicada para a finalidade didática. Conclusão: as produções, de um modo geral, condizem mais com o modelo médico assistencialista, na qual o enfermeiro desenvolve ações de prevalência tecnicistas, de supervisão e desintegradas da equipe multiprofissional em detrimento do modelo biopsicossocial, o qual demanda raciocínio clínico, pensamento crítico e conhecimento científico fundamentado.
... Eating disorders (EDs) are severe psychological conditions that negatively impact individuals' eating behaviours and perception of their bodies [1]. At their extreme, they can cause permanent health issues and may be lethal [2]. ...
Eating disorders (EDs), including anorexia nervosa (AN), are severe psychological disorders that affect individuals’ eating behaviours and body perception. Previous research has shown that people with EDs often report poorer sleep. Some literature has suggested that it is mood dysregulation that mediates the link between EDs and sleep. However, the majority of previous studies only focused on females, while male ED patients have been overlooked. Therefore, the present study aimed to investigate the relationships between EDs, mood, and sleep among male ED patients. Using a mixture of actigraphy recordings and self-reported questionnaires, the current study analysed a total 33 adult male participants diagnosed with AN. The participants first wore an actigraphy device for seven continuous days, following which their ED severity and mood were assessed by the Eating Disorder Examination Questionnaire (EDE-Q) and Depression Anxiety Stress Scale (DASS), respectively. The descriptive actigraphy results suggested that, similar to females, males with AN also showed disturbed sleep, including insomnia, sleep fragmentation, low sleep efficiency, and increased napping sessions. However, when ED severity was correlated against actigraphy data and mood, no significant relationships were found between them. Thus, it was suggested that future studies may investigate discrete ED symptoms instead of global ED severity interacting with sleep and mood. Overall, this study represents an initial step in the investigation of EDs and sleep and mood dysregulation among an under-represented sample.
... It has previously been outlined that clinical research in anorexia nervosa is affected by specific challenges, including insufficient research funding, low prevalence of anorexia nervosa, and high treatment ambivalence in affected patients, which make the completion of large-scale efficacy trials especially challenging [10,141,142]. It will therefore be important to continue to join forces in networks of experienced clinical researchers to conduct these trials and to continue to raise awareness on the necessity for ongoing support of anorexia nervosa research to reduce illness burden. ...
Introduction:
Anorexia nervosa is a frequent eating disorder that affects predominantly young women and may take a severe and chronically worsening course of disease contributing to its high mortality rate. Although a multitude of treatment options exist, this disease still bears a high relapse rate. In light of these facts, an improvement of existing and development of new treatment targets and options is warranted.
Areas covered:
The present review article covers recent developments in psychotherapy associated with the respective neuropsychological and brain alterations as well as highlights current and future pharmacotherapeutic options.
Expert opinion:
Several encouraging developments in the field of psychotherapy such as interventions targeting neurocognitive profiles or addressing reward processing, brain stimulation as well as pharmacological modulation of hormones, namely leptin, oxytocin, ghrelin and nesfatin-1 signaling might be - most likely as part of a multimodal treatment approach - efficacious in order to improve treatment of patients with anorexia nervosa, especially those with a severe course of disease as well as comorbidities. As anorexia nervosa represents a complex and severe mental disorder, it seems most likely that a combination and integration of different evidence-based treatment approaches and settings will contribute to an improved prognosis of this eating disorder. This should be further explored in future studies.
... Eating Disorders (EDs) are mental health issues that can affect eating behaviors and body weight [1]. Forms of EDs are described in the International Classification of Diseases and Related Health Problems (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). ...
The prevalence of eating disorders (EDs) is growing, and early screening is important to prevent related health complications. The Eating Disorder Examination Questionnaire (EDE-Q) has been widely used as a diagnostic tool to identify cases of EDs; however, a validated Arabic version of the tool is needed to help in the screening process of EDs. The aim of this study was to validate the Arabic version of EDE-Q. A cross-sectional study included a sample of 549 adults, who were recruited mainly from the four major provinces in Saudi Arabia. A forward-backward translation method was conducted, and then the tool was validated using the confirmatory factor analysis (CFA). The dataset was split for further convergent analysis using exploratory factor analysis (EFA) and CFA. The results of CFA from the main dataset did not support the four-factor original EDE-Q. The results of EFA from the first data-split suggested a three-factor EDE-Q-14 Arabic version. This was supported by the results of CFA of the second data-split. A total of five items were allocated in each shape and weight concern, and restraint component, with correlations ranging from 0.969 and 0.462 and from 0.847 to 0.437, respectively. A total of four items were allocated in eating concern, with correlations ranging from 0.748 to 0.556. The internal consistency of the global and the three subscales were high, with Cronbach's α ranging from 0.762 to 0.900. Findings of the current study suggest that the Arabic version of the EDE-Q-14 is a valid and reliable tool to screen for EDs among adults in Saudi Arabia.
... Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, and related syndromes) refers to highly distinctive psychiatric disorders characterized by severe disturbances in eating-related behavior and body weight (Columb & Atkinson, 2016;Schmidt et al., 2016). It is estimated that approximately 8.4% of women and 2.2% of men will receive a diagnosis for an eating disorder throughout their lifetime (Galmiche et al., 2019). ...
Psychological stress has been shown to influence the development and progression of disordered eating. Psychophysiological studies have reported that individuals with disordered eating behavior exhibit atypical cardiovascular reactions to acute psychological stress. However, prior studies have been limited by small sample sizes and have examined cardiovascular responses to a singular stress exposure. The current study examined the association between disordered eating and cardiovascular reactivity, as well as cardiovascular habituation to acute psychological stress. A mixed-sex sample (N = 450) of undergraduate students were categorized into a disordered eating or non-disordered eating group using a validated disordered eating screening questionnaire and attended a laboratory stress testing session. The testing session included two identical stress-testing protocols, each consisting of a 10-minute baseline and 4-minute stress task. Cardiovascular parameters including heart rate, systolic/diastolic blood pressure and mean arterial pressure (MAP) were recorded throughout the testing session. Post task measures of self-reported stress, as well as positive affect and negative affect (NA) reactivity were used to assess psychological reactions to stress. The disordered eating group exhibited greater increases in NA reactivity in response to both stress exposures. Additionally, in comparison to the control group, those in the disordered eating group exhibited blunted MAP reactivity to the initial stress exposure and less MAP habituation across both stress exposures. These findings indicate that disordered eating is characterized by dysregulated hemodynamic stress responsivity, which may constitute a physiological mechanism leading to poor physical health outcomes.
... Eating Disorders (EDs) are mental health issues that can affect eating behaviors and body weight [1]. Forms of EDs are described in the International Classification of Diseases and Related Health Problems (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). ...
The prevalence of eating disorders (EDs) is growing, and early screening is important to prevent related health complications. The Eating Disorder Examination Questionnaire (EDE-Q) has been widely used as a diagnostic tool to identify cases of EDs; however, a validated Arabic version of the tool is needed to help in the screening process of EDs. The aim of this study was to validate the Arabic version of EDE-Q. A cross-sectional study included a sample of 549 adults, who were recruited mainly from the four major provinces in Saudi Arabia. A forward–backward translation method was conducted, and then the tool was validated using the confirmatory factor analysis (CFA). The dataset was split for further convergent analysis using exploratory factor analysis (EFA) and CFA. The results of CFA from the main dataset did not support the four-factor original EDE-Q. The results of EFA from the first data-split suggested a three-factor EDE-Q-14 Arabic version. This was supported by the results of CFA of the second data-split. A total of five items were allocated in each shape and weight concern, and restraint component, with correlations ranging from 0.969 and 0.462 and from 0.847 to 0.437, respectively. A total of four items were allocated in eating concern, with correlations ranging from 0.748 to 0.556. The internal consistency of the global and the three subscales were high, with Cronbach’s α ranging from 0.762 to 0.900. Findings of the current study suggest that the Arabic version of the EDE-Q-14 is a valid and reliable tool to screen for EDs among adults in Saudi Arabia.
... Unfortunately, they are often misunderstood, omitted from nationally representative health surveys, and viewed as less important than other mental health disorders [12]. Reports of 41.9 million neglected eating disorder cases in 2019, combined with a surge in cases recorded by health systems and charities alike calls for a serious reconceptualisation of the disorder [36,90]. ...
Background
Eating disorders are a group of heterogenous, disabling and deadly psychiatric illnesses with a plethora of associated health consequences. Exploratory research suggests that social media usage may be triggering body image concerns and heightening eating disorder pathology amongst young people, but the topic is under-researched as a global public health issue.
Aim
To systematically map out and critically review the existing global literature on the relationship between social media usage, body image and eating disorders in young people aged 10–24 years.
Methods
A systematic search of MEDLINE, PyscINFO and Web of Science for research on social media use and body image concerns / disordered eating outcomes published between January 2016 and July 2021. Results on exposures (social media usage), outcomes (body image, eating disorders, disordered eating), mediators and moderators were synthesised using an integrated theoretical framework of the influence of internet use on body image concerns and eating pathology.
Results
Evidence from 50 studies in 17 countries indicates that social media usage leads to body image concerns, eating disorders/disordered eating and poor mental health via the mediating pathways of social comparison, thin / fit ideal internalisation, and self-objectification. Specific exposures (social media trends, pro-eating disorder content, appearance focused platforms and investment in photos) and moderators (high BMI, female gender, and pre-existing body image concerns) strengthen the relationship, while other moderators (high social media literacy and body appreciation) are protective, hinting at a ‘self-perpetuating cycle of risk’.
Conclusion
Social media usage is a plausible risk factor for the development of eating disorders. Research from Asia suggests that the association is not unique to traditionally western cultures. Based on scale of social media usage amongst young people, this issue is worthy of attention as an emerging global public health issue.
... Eating disorders include anorexia nervosa, atypical anorexia nervosa, bulimia nervosa, binge eating disorder and several other categories of feeding and eating disorders (18) . Eating disorders are severe mental and physical health conditions with a long duration (19) and high morbidity (2,20,21) . Despite misconceptions that eating disorders are diseases of individuals with lower body weight, the prevalence of eating disorders is higher in both men and women with obesity compared with their healthy weight peers (22) . ...
The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the program of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, based on personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.
... Eating disorders (ED) are a class of discrete mental disorders characterized by abnormal eating habits, with potential to cause major harm to the individual's psychosocial functions and physical health [3]. EDs affect a significant proportion of the population, with up to 8.4% of women and 2.2% of men diagnosed with lifetime ED [4]. ...
Food and sleep are critical for human survival. However, for individuals with eating disorders, they face two critical disruptions in terms of abnormal feeding patterns as well as poor sleep. These difficulties are exacerbated as a result of the recent coronavirus pandemic, which caused drastic changes in daily life schedules and living arrangements. The current study therefore aims to explore, through qualitative means, how individuals with eating disorders are affected during the subsequent lockdowns, with a particular emphasis on the pandemic’s impact on their sleep in Saudi Arabia. Two groups of participants were recruited: participants with eating disorders and healthy controls. Based on thematic analysis of focus group discussion data, it was found that both types of participants experienced poorer sleep and poorer mental health. Participants with eating disorders too showed a deterioration of their symptoms. However, healthy participants tended to show greater levels of recovery and coping. Based on the study findings, recommendations for future studies are made.
... Leczenie AN jest kosztowne i często pozwala na uzyskanie poprawy stanu zdrowia, ale nie całkowitej remisji (Schmidt i in., 2016;Westmoreland, Krantz, Mehler, 2016). Powodem tego są słabe efekty większości metod terapeutycznych (Bulik, Berkman, Brownley, Sedway, Lohr, 2007), wysoki wskaźnik nawrotów i chroniczności Keel, Dorer, Franko, Jackson, Herzog, 2005) oraz duża częstotliwość rezygnacji z leczenia wśród pacjentów (Fassino, Pierò, Tomba, Abbate-Daga, 2009). ...
Cel Pomimo rosnącego znaczenia terapii zorientowanej na ciało i szerokiego stosowania metod wykorzystujących pracę z ciałem brakuje systematycznych przeglądów naukowych, które analizowałyby jej skuteczność w zakresie zaburzeń obrazu ciała u osób chorujących na anoreksję lub zagrożonych jej wystąpieniem. Stanowi to barierę zarówno dla praktyków sięgających po rozwiązania terapeutyczne, jak i teoretyków badających mechanizmy interwencji terapeutycznych czy edukatorów działających na rzecz profilaktyki zdrowia. Celem niniejszych rozważań jest przegląd badań dotyczących wpływu różnego rodzaju interwencji opartych na metodach pracy z ciałem na obraz ciała osób z zaburzeniami odżywiania lub zagrożonych zaburzeniami odżywiania typu anoreksja. Metoda Badanie przeprowadzono zgodnie ze standardem PRISMA. Zeksplorowano elektroniczne bazy danych (ProQuest, PsychINFO, PubMed, ScienceDirect, Scopus, Web of Science) w poszukiwaniu randomizowanych badań kontrolnych (RCT). Łącznie przeanalizowano 425 pozycji, z czego 69 pełnotekstowych artykułów zostało poddanych krytycznej ocenie. Ostatecznie do przeglądu włączono 15 badań, które spełniły wszystkie kryteria włączenia. Wyniki Analizy wskazują, że programy oparte na metodach pracy z ciałem, w porównaniu z grupami kontrolnymi, były bardziej skuteczne w redukowaniu czynników ryzyka i promowaniu czynników ochronnych, a dodanie ich do podstawowej formy terapii może prowadzić do znaczącego zmniejszenia objawów zaburzeń odżywiania. Konkluzje W przyszłości istotne byłoby bezpośrednie porównanie wpływu konkretnych typów interwencji na czynniki ryzyka i czynniki chroniące.
... Treatment programs targeting AN are expensive, and they lead to an improvement in the patient's health, but not to a full remission (Schmidt et al., 2016;Westmoreland, Krantz, & Mehler, 2016). This is because most therapeutic methods are not highly effective (Bulik, Berkman, Brownley, Sedway, & Lohr, 2007), relapse and chronic relapse rates are high Keel, Dorer, Franko, Jackson, & Herzog, 2005), and many patients drop out of treatment (Fassino, Pierò, Tomba, & Abbate-Daga, 2009). ...
Aim Despite the growing significance of body-oriented therapy and the broad applicability of psychotherapeutic methods that focus on the body, there is a general scarcity of systematic reviews analyzing the effectiveness of this therapeutic approach in addressing body image problems in persons with anorexia or at risk of anorexia. The above constitutes a barrier for practitioners, theoreticians who investigate the mechanisms underpinning therapeutic interventions, as well as educators who implement health promotion programs. The aim of this article was to review research studies analyzing the effects of different body-oriented interventions on body image perception in persons suffering from or at risk of eating disorders such as anorexia. Methods The review was conducted according to the PRISMA guidelines. Digital databases (ProQuest, PsychINFO, PubMed, ScienceDirect, Scopus, Web of Science) were searched for randomized control trials (RCT). A total of 425 records, including 69 full-length research articles, were critically analyzed. Fifteen trials that met all inclusion criteria were ultimately included in the analysis. Results The review revealed that body-oriented therapeutic programs are more effective in reducing risk factors and reinforcing protective factors in comparison with the control groups, and that the inclusion of body-oriented therapy in standard therapeutic practice could substantially minimize the symptoms of eating disorders. Conclusions Further research is needed to directly compare the effects of different types of interventions on risk factors and protective factors.
... Risk of EDs is increasing in Asian countries and is often overlooked by healthcare professionals [14]. The continuum of EDs is characterized by severe disturbances in eating behavior and body image perception affecting the individual's health and body weight [15]. Of note, a co-occurrence of mental health problems is a common phenomenon throughout the continuum of EDs, including mood disorders (depression), anxiety disorders, and EXD [16][17][18]. ...
Background
Although numerous studies have examined associations between personality traits and eating disorders in females, few studies have been conducted on female exercisers. Given the high risk of disordered eating in female exercisers, this study investigated the associations between the Big Five personality traits and disordered eating in female exercisers, and further explored the potential mediators, namely exercise dependence symptoms, and obsessive–compulsive symptoms underlying this association.
Methods
A total of 295 female exercisers aged between 18 to 67 years ( M = 22.11, SD = 6.65) participated in this study.
Results
Negative and statistically significant correlations between conscientiousness ( r = − 0.17, p < 0.01), emotional stability ( r = − 0.27, p < 0.001) and agreeableness ( r = − 0.18, p < 0.01) and disordered eating were observed in our sample of female exercisers. The multiple mediation analyses revealed that exercise dependence symptoms and obsessive–compulsive symptoms mediate the relationship between conscientiousness ( β = 0.016, CI = [0.003, 0.031]), emotional stability ( β = -0.012, CI = [− 0.028, − 0.002]), and disordered eating in female exercisers, whereas obsessive–compulsive symptoms ( β = − 0.041, CI = [− 0.088, − 0.001]) but not exercise dependence symptoms are a mediator of the relationship between agreeableness and disordered eating.
Conclusions
Our findings can be used to improve the screening procedures for eating disorders in female exercisers as they contribute to a better understanding of the psychological mechanisms that underlie the associations between the Big Five personality traits and disordered eating.
... Eating disorders (ED) [1] have been understudied in the global health sector, despite being debilitating conditions with significant consequences, including increased mortality, reduced social functioning, and employment problems [2,3]. EDs are associated with long-term impairments, including psychosocial illnesses such as depression and anxiety [4], with substantially increasing prevalence rates among young adults [5]. ...
Purpose
Maladaptive eating behaviors like food addiction (FA) are common among students, and orthorexia nervosa (ON) is being evaluated as a new condition among eating disorders (EDs). Moreover, dietary diversity (DD) is recognized as an important component of a healthy diet. Thus, the current study sought to examine the prevalence of ON and FA as well as the factors associated with ON, FA, and DD among university students in Bangladesh during the COVID-19 pandemic.
Methods
Four-thousand-and-seventy-six students were recruited and completed an online survey consisting of the Bratman Orthorexia test, the modified Yale Food Addiction Scale, and a questionnaire based on the Food and Agriculture Organizations’ guidelines. Inferential statistics, bivariate and multivariable linear regression were used for analyzing data.
Results
ON and FA were observed in 1.7% and 7.5% of participants, respectively, with 43.8% exhibiting Health Fanatic eating attitude. The mean DD score was 5.96 (SD = 1.56). Students with ON consumed more legumes, nuts, seeds, and vegetables including dark green leafy vegetables whereas students with FA consumed more organ meats and eggs. Students who were older-aged, married, formerly smoked, had fitness goals, and had guilty feelings about violating food rules were more likely to have ON, whereas those who were female, were married, actively smoked, and were overweight and obese were more likely to have FA.
Conclusions
The findings suggest that students from Bangladesh are at risk of FA, and less so for ON. These entities and low DD deserve more research attention in Bangladesh to increase awareness and ensure appropriate interventions.
... Eating disorders (EDs) are mental illnesses characterised by important disturbances of food behaviour, and body image [1], with significant physical and psychosocial associated impairments which result in increased morbidity and mortality. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has described the different forms of specified EDs [2]: anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) as referred as typical ED, while Other Specified Feeding or Eating Disorders (OSFED), including sub-syndromic or atypical forms of AN, BN and BED.A residual category of Unspecified Feeding or Eating Disorder has also been proposed. ...
Background
Eating disorders (ED) are a public health concern due to their increasing prevalence and severe associated comorbidities. The aim of this study was to identify mental health and health behaviours associated with each form of EDs.
Methods
A case–control study was performed: cases were patients with EDs managed for the first time in a specialized nutrition department and controls without EDs were matched on age and gender with cases. Participants of this study filled self-administered paper questionnaire (EDs group) or online questionnaire (non-ED group). Collected data explored socio-demographics, mental health including anxiety and depression, body image, life satisfaction, substances and internet use and presence of IBS (Irritable Bowel Syndrome).
Results
248 ED patients (broad categories: 66 Restrictive, 22 Bulimic and 160 Compulsive) and 208 non-ED subjects were included in this study. Mean age was 36.0 (SD 13.0) and 34.8 (SD 11.6) in ED and non-ED groups, respectively. Among patients and non-ED subjects, 86.7% and 83.6% were female, respectively. Body Shape Questionnaire mean score was between 103.8 (SD 46.1) and 125.0 (SD 36.2) for EDs and non-ED group, respectively ( p < 0.0001). ED patients had a higher risk of unsatisfactory friendly life, anxiety, depression and IBS than non-ED s (all p < 0.0001) Higher risk of anxiety, depression and IBS was found for the three categories of EDs. Higher risk of smoking was associated only with restrictive ED, while or assault history and alcohol abuse problems were associated only with bulimic ED. The risk of binge drinking was lower in all EDs categories than in non-ED.
Conclusion
This study highlights the common comorbidities shared by all EDs patients and also identifies some specific features related to ED categories. These results should contribute to the conception of future screening and prevention programs in at risk young population as well as holistic care pathways for ED patients.
Plain English summary
This case–control study evaluated mental health and health behaviours associated with the main categories of Eating Disorders (EDs). Cases were patients with EDs initiating care in a specialized nutrition department and controls without ED were matched on age and gender with cases. Self-administered paper questionnaires were filled by ED 248 patients (66 Restrictive, 22 Bulimic and 160 Compulsive) and online questionnaire by 241 non-ED controls. Body image satisfaction was significantly worse in ED patients than in controls. ( p < 0.0001). Dissatisfactory life, anxiety, depression and irritable bowel syndrome were more found in patients with all EDs categories than in non-ED ( p < 0.0001). Smoking risk was increased only in restrictive patients while and assault history and alcohol abuse was increased only in bulimic patients. These results highlight the global burden of ED and related comorbidities and provide useful information for future screening, prevention and care programs.
... Eating disorders (anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and other specified feeding and eating disorder-OSFED)) are common psychiatric disorders that affect ~ 1 in 10 individuals [1] and have a peak of onset in adolescence [2]. Despite their prevalence and onset at a crucial stage in development eating disorders remain far below other psychiatric disorders in relation to papers published [3] and research funding [3,4]. Eating disorders are also underrepresented at major psychiatric conferences and in major psychiatric journals. ...
... For instance, a higher risk of bone fractures and musculoskeletal injuries was found among individuals who engaged in excessive physical exercise [11] while being deprived of the change to do exercise has been associated with withdrawal symptoms (e.g., anxiety and depression), attention deficits and sleep problems in dependent exercisers [10,12]. With regard to ED, it is characterized by severe eating behavior and body image perception disturbances, which affect individual's body weight and health [13]. Previous investigations into the EXD-ED relationship have mainly focused on levels of comorbidity [14]. ...
1) Background: The common factors which potentially contribute to the development of eating disorders and exercise dependence during early adulthood are still relatively unclear. The present study aimed to examine the role of BMI, body image inflexibility, and generalized anxiety in these two behavioral problems in a sample of college students. 2) Methods: In total, 878 habitual exercisers (58.1% male with BMI = 22.12 ± 2.39; 41.9% female with BMI = 20.55 ± 2.21) with age of 20.09 ± 1.76 years participated in this study. The main outcomes of interest are exercise dependence symptoms, eating disorders symptoms, body image inflexibility, and symptoms of generalized anxiety (as measured by Exercise Dependence Scale-Revised, Eating Disorder Examination-Questionnaire-Short Form, Body Image Acceptance and Action Questionnaire, and Generalized Anxiety Disorder-7, respectively). Pearson correlation, path analysis, and model fit information were tested. 3) Results: After controlling for age, gender, and field of study, lower BMI was linked to more exercise dependence symptoms but this association was not statistically significant, while a greater BMI was significantly associated with a higher risk of developing eating disorders (β = −0.08, p < 0.001). Moreover, higher body image inflexibility significantly and positively contributed to severe exercise dependence (β = 0.26, p < 0.001) as well as abnormal eating attitudes and behaviors (β = 0.74, p < 0.001). Furthermore, generalized anxiety is a significant contributor to exercise dependence symptoms (β = 0.14, p < 0.001) but not eating disorders symptoms. 4) Conclusion: Based on our finding that body image inflexibility is a common risk factor for the development of exercise dependence and eating disorders, the prevention and treatment of these two disorders should involve the improvement of psychological flexibility. In addition, the individual with a higher BMI is more vulnerable to developing eating disorders, while those who have severer generalized anxiety symptoms should be given more attention when screening for exercise dependence.
... To our best knowledge, no studies have examined eating disorders (EDs) among left-behind female adolescents compared with those living with their parents, although EDs are characterized by severe disturbances in body weight and eating behavior (Schmidt et al., 2016). Other unfavorable family circumstances implying separation from parents, such as divorce, have been also linked to different aspects of children's eating behavior and their overweight (Yannakoulia et al., 2008). ...
Romanian emigration rates are among the highest in Europe. This cross-sectional study estimates the prevalence of full-threshold eating disorders (EDs) and other specified feeding or eating disorders (OSFEDs) among left-behind female adolescents (LBFA) compared with non-left-behind female adolescents (NLBFA) living with their parents in Romania. In addition, we investigated the associations between full-threshold EDs and OSFEDs with self-esteem, hopelessness, and thin-ideal internalization in both groups. The data was collected from 717 female adolescents (aged 14-18). Results showed no significant differences in prevalence of full-threshold EDs and OSFEDs between LBFA (n = 128) and NLBFA (n = 589). Multiple logistic regressions revealed that self-esteem and zBMI were significant predictors of OSFEDs in the LBFA group, while thin-ideal internalization and self-esteem predicted OSFEDs in the NLBFA group. There was no significant association between presumptive predictors and full-threshold EDs among LBFA. Findings suggest that parental emigration is not associated with an increased prevalence of full and subthreshold EDs among female adolescents.
... Anorexia nervosa (AN) is a severe and disabling eating disorder that carries a high disease burden for affected individuals, their loved ones, and society [55]. Treatment outcomes are poor: 20% of patients remain chronically ill and less than 50% reach full recovery [57]. ...
Background
A key feature of anorexia nervosa is body image disturbances and is often expressed by dysfunctional body-related behaviours such as body checking and body avoiding. These behaviours are thought to contribute to both the maintenance and relapse of AN, yet empirical evidence is scarce. One variable that may contribute to the need for engaging in these behaviours is intolerance of uncertainty. This study aims to investigate body checking and body avoiding and its relations with intolerance of uncertainty in women with anorexia nervosa (AN-ill; 70), women recovered from AN (AN-rec; 85) and control group (127).
Methods
Three questionnaires were completed, measuring eating pathology, intolerance of uncertainty and body checking and body avoiding. One-way ANOVAS were used to test group differences. Moderation analyses were used to investigate associations between variables.
Results
Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill followed by AN-rec and, lastly, the control group, confirming group differences. Intolerance of uncertainty was associated with body checking in the AN-rec group and the control group but not in the AN-ill group. The association between intolerance of uncertainty and body avoiding was reported in the AN-rec group and only marginally in the control group.
Conclusion
Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill, however still elevated in AN-rec, confirming the presence of body image disturbances, even after recovery. The unique associations between intolerance of uncertainty and body checking and body avoiding within the studied groups may represent different stages of the illness. In the AN-rec group, the relation between intolerance of uncertainty, body checking and body avoiding may be driven by trait anxiety. For AN-ill group, body checking and body avoiding may eventually have grown into habitual patterns, rather than a strategy to ameliorate anxiety and uncertainty.
Plain English summary
Women with anorexia nervosa often experience disturbances in their body image and are expressed in body-related behaviours such as body checking and body avoiding. These behaviours are thought to contribute to both the maintenance and relapse of anorexia nervosa. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and may contribute to the need for engaging in these behaviours. This study aims to investigate body checking and body avoiding and its relations with intolerance of uncertainty in women with anorexia nervosa (AN-ill; 70), women recovered from AN (AN-rec; 85) and control group (127). Three questionnaires were completed, measuring eating pathology, intolerance of uncertainty and body checking and body avoiding. Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill and still elevated in AN-rec, even after recovery. The associations between intolerance of uncertainty and body checking and body avoiding within the studied groups may represent different stages of the illness. In the AN-rec group, the relation between intolerance of uncertainty, body checking and body avoiding may be driven by trait anxiety. For AN-ill group, body checking and body avoiding may have grown into habitual patterns, rather than a strategy to ameliorate anxiety and uncertainty.
To review the literature examining the effectiveness and efficacy of a cognitive behavioural therapy (CBT) for eating disorders delivered in ten sessions for those who are not underweight (CBT-T). A systematic search of the literature (MEDLINE, EMBASE, PsycINFO, Scopus and ProQuest) was conducted to identify relevant publications to date at the time of March 2022 (re-run in May 2023). Intervention studies of any study design that investigated CBT-T offering outcome data at least pre- to post- intervention for eating disorder and related outcomes were included. Results were reported for treatment attrition, abstinence, remission, eating disorder psychopathology, disordered eating behaviours, psychosocial impairment, depression and anxiety and synthesised using a narrative synthesis framework. The Effective Public Health Practice Project (EPHPP) quality assessment tool (Thomas et al., 2004) was used to assess the quality of included studies. Outcomes for 555 people who received CBT-T across eight studies (one randomised control trial and seven non-randomised studies) were synthesised. Support was found for the effectiveness and efficacy of CBT-T for a range of non-underweight eating disorders, with respect to eating disorder psychopathology, disordered eating behaviours, psychosocial impairment, abstinence and remission. CBT-T also led to improvements for depression and anxiety symptoms. CBT-T appears to improve eating disorder and co-morbid outcomes for people with non-underweight eating disorders within ten sessions, with comparable results to standard-length CBT for eating disorders (CBT-ED). Although results for CBT-T are promising, there were concerns with the quality of the studies. Future research is required to strengthen the evidence base with larger, higher-quality studies which compare CBT-T directly with recommended psychological treatments, such as standard-length CBT-ED.
Eating disorders, characterized by abnormal eating behaviors, are among a wide variety of psychiatric conditions that mainly affect children and adolescents. These disorders have a multifactorial origin and can be associated with restrictive diets, negative feelings, harmful family relationships, and post-traumatic stress. Thus, this study’s objective was to evaluate the association between indicators of eating disorders and family and school contexts in Brazilian adolescents who previously experienced sexual abuse and examine the findings based on sex. National School Health Survey data were utilized. Among 102,301 students between 11 and 19 years of age, 4124 reported having experienced sexual abuse and were included in this study. Self-report questionnaires were used to assess participants’ health status and the presence of risk behaviors, which were examined through multivariate analysis using a Poisson regression model. The results indicated positive relationships between self-induced vomiting, laxative misuse, and other purgative methods and infrequent meals with family, hunger, and the presence of violence in students’ daily lives, regardless of sex (p < 0.05). In addition, body dissatisfaction and negative feelings about one’s body were associated with having been bullied or teased by schoolmates for both sexes (p < 0.05). Distant relationships with parents were associated with purgative methods and body dissatisfaction among female students (p < 0.05). In conclusion, body dissatisfaction, negative feelings about one’s body, laxative misuse, self-induced vomiting, and purgative methods were found to be associated with factors in family and school contexts such as hunger, infrequent meals with family, family violence, distant relationships with parents, and bullying at school in adolescents who have previously experienced sexual abuse.
Recently, Davey et al. (2023) outlined several recommendations for future care, policy and research for patients with eating disorders which is primarily focused on the UK health care system. Our commentary aims at contributing several aspects from other European countries and emphasises the need for stronger European collaboration, joint initiatives and a strategic plan to foster clinical and research concepts in the eating disorder field, especially in a time of multiple (global) crises and restricted resources.
Therapists report significant countertransference reactions when treating clients with eating disorders (EDs). Countertransference may be pronounced among therapists with eating disorder lived experience (EDLE). Minimal research examines how therapists with EDLE negotiate their experiences while treating ED clients. Informed by the person-of-the-therapist philosophy, this study sought to understand how therapists use and manage their EDLE when working with ED clients. Using constructivist grounded theory methodology, semistructured interviews (Mtime = 89 min) were conducted with 22 therapists with EDLE. Results revealed that therapists engaged in two interconnected systems. The Central System helps therapists transform their lived experiences into clinical guidance. The Checks and Balances System allows therapists to find a balance between connecting with the client and allowing for differences in experiences to emerge. Lastly, three personal processes existing outside of these systems were found to impact therapists' use of self. Findings provide novel ways that therapists can use their EDLE.
Previous research has shown that patients with anorexia nervosa (AN) show an attentional bias to food. However, due to different conceptualizations of attentional bias and the use of various paradigms, results are inconclusive and more precise insights into the exact nature of this attentional bias are needed. Therefore, an eye-tracking paradigm with food (low and high caloric) and non-food (objects) pictures was used to investigate biases in AN patients (n = 25) compared to healthy controls (n = 22). Several indices of visual attention were examined, both during free (initial orientation, fixation frequency, fixation time) and explicitly instructed (engagement, disengagement) viewing. Our results during the free viewing phase indicated that AN patients (as compared to healthy matched controls) looked less frequently and spent less time fixating on food stimuli, compared to the comparison group. No differences between both groups (n = 47) in initial orientation could be observed. Interestingly, during the instructed viewing phase, no differences between the patient and the comparison group were observed in engagement or disengagement to food stimuli. These results suggest an (initial) attentional avoidance of food in AN patients when closely investigating spontaneous attentional processes, while this could not be observed during gaze behaviour when receiving clear instructions. Hence, future research should look into how attentional bias during spontaneous gaze patterns could serve as a potential marker of AN, and how targeting this bias could be applied in treatment interventions.
Background:
Eating Disorders (EDs) are among the deadliest of the mental disorders and carry a sizeable public health burden, however their research and treatment is consistently underfunded, contributing to protracted illness and ongoing paucity of treatment innovation.
Methods:
We compare absolute levels and growth rates of Australian mental health research funding by illness group for the years 2009-2021, with a specific focus on eating disorders analysed at the portfolio level.
Findings:
Actual and adjusted data obtained from Australia's three national medical research funding bodies (NHMRC, ARC and MRFF) shows eating disorders receive a disproportionately low allocation of mental health research funding despite having amongst the highest mortality rates. Forty-one category one research grants totalling $AUD28.1 million were funded for eating disorders over the period. When adjusted for inflation, this equates to $2.05 per affected individual, compared with $19.56 for depression, $32.11 for autism, and $176.19 for schizophrenia. Half of all research funded for eating disorders was 'basic' research (e.g., illness underpinning), with little investment in the development of innovative treatment models, novel therapeutics or translation, well reflected by recovery rates of less than 50% in individuals with Anorexia Nervosa.
Interpretation:
Significant discrepancy remains between research funding dollars and disease burden associated with the mental health disorders. The extent to which eating disorders are underfunded may in part be attributable to inaccuracies in epidemiological and burden of disease data.
Funding:
This work was in-part funded by the Australian Government Department of Health and the National Eating Disorder Research & Translation Strategy. The funder was not directly involved in informing the development of the current study.
Objectives
This 2023 update of the WFSBP guidelines for the pharmacological treatment of eating disorders (EDs) reflects the latest diagnostic and psychopharmacological progress and the improved WFSBP recommendations for the assessment of the level of evidence (LoE) and the grade of recommendation (GoR).
Methods
The WFSBP Task Force EDs reviewed the relevant literature and provided a timely grading of the LoE and the GoR.
Results
In anorexia nervosa (AN), only a limited recommendation (LoE: A; GoR: 2) for olanzapine can be given, because the available evidence is restricted to weight gain, and its effect on psychopathology is less clear. In bulimia nervosa (BN), the current literature prompts a recommendation for fluoxetine (LoE: A; GoR: 1) or topiramate (LoE: A; GoR: 1). In binge-eating disorder (BED), lisdexamfetamine (LDX; LoE: A; GoR: 1) or topiramate (LoE: A; GoR: 1) can be recommended. There is only sparse evidence for the drug treatment of avoidant restrictive food intake disorder (ARFID), pica, and rumination disorder (RD).
Conclusion
In BN, fluoxetine, and topiramate, and in BED, LDX and topiramate can be recommended. Despite the published evidence, olanzapine and topiramate have not received marketing authorisation for use in EDs from any medicine regulatory agency.
This study presents an initial effort to develop disordered eating pathology (DEP) prevention program with an emphasis on maternal involvement. Disordered eating pathology representing a range of behaviors and attitudes, from negative body image to full-blown eating disorder. It appears mainly in adolescent females and related to psychological and familial factors, including maternal modeling of thinness. A sample of 118 Israeli girls (11-12) was divided into three groups: participants in the program in parallel with their mothers, participants without their mothers, and control. Participants completed self-report questionnaires. Groups were tested three times: pre-intervention, post-intervention, and follow-up. For those girls who participated in parallel with their mothers, higher self-esteem was associated with fewer pathological diet behaviors. Findings deepen understanding of the risk factors involved in the development of DEP. The main study contribution is the important role mothers play in preventing DEP among their daughters.
Purpose
This instant study explores the relationship between weight-based teasing and depressive symptoms in Indian college students. It further investigates the moderating effect of gratitude on depressive symptoms occurring due to weight-based teasing.
Design/methodology/approach
The study is theoretically based on Fredrickson's broaden-and-built theory (2001). PROCESS macro in IBM SPSS v21 was used to analyze the effect of gratitude in moderation of weight-based teasing and depressive symptoms. The study used correlation and regression analysis to assess the relationship between weight-based teasing and depressive symptoms.
Findings
The study has confirmed that weight-based teasing results in the development of depressive symptoms in Indian college students. The study has also revealed that gratitude casts a significant moderating effect on depression due to weight-based teasing, i.e. a reduction in regression weight of weight-based teasing.
Originality/value
This study is the first of its kind in India and will significantly add to the national literature on teasing and depression. Further, the study will help stakeholders like educators and policymakers to formulate psychological programs based on positive psychology 2.0 and gratitude to combat the rising issue of body shaming in India.
This paper aims to provide an overview of FREED, including how and why it was developed, why early intervention is essential in supporting people struggling with eating difficulties and, lastly, explaining how FREED works clinically.
Commonly developing in adolescence and following a chronic course, eating disorders are life-threatening psychological disorders and typically very difficult to treat despite the body of research exploring treatment options. Due to the high levels of severity and the enduring nature of eating disorders, schema therapy has been proposed as a more effective treatment than cognitive behaviour therapy. To assess the effectiveness of schema therapy in adults with eating disorders, the present systematic review was designed in accordance with PRISMA guidelines. A structured search of electronic databases and grey literature was conducted, and the Mixed Methods Assessment Tool was used to assess the quality of each article. Four articles including 151 participants were found which demonstrated that schema therapy is effective at reducing eating disorder symptoms and behaviour and general psychopathology. Despite the limitations of this study, including the scarcity of research available and varying methodologies used, the present systematic review found evidence supporting the use of schema therapy in patients with eating disorders, particularly those experiencing severe and enduring forms.
Objective:
To investigate associations between reported eating disorder (ED) diagnosis and substance use disorder (SUD) diagnosis, substance misuse, and illicit drug use among US college students.
Method:
Data consisting of n = 414,299 students' responses to the National College Health Assessment survey conducted by the American College Health Association between fall 2015 and spring 2019 were utilized for this study. Unadjusted and adjusted odds ratios were used to determine the association of reported ED diagnosis with reported SUD diagnosis, misuse of cigarettes, e-cigarettes, alcohol, marijuana, cocaine/methamphetamine, sedatives, hallucinogens, opiates, inhalants, MDMA, and other club drugs, as well as illicit use of prescription pain killers, prescription sedatives, and prescription stimulants. A sensitivity analysis investigating associations between reported anorexia nervosa (AN), bulimia nervosa (BN), and each substance use outcome was also conducted.
Results:
Among all in our analytic cohort, 7.15% reported receiving an ED diagnosis or being treated for an ED in the last 12 months. Students with ED indications were significantly more likely to report each of the substance use outcomes investigated in this study, including SUD diagnosis (aOR: 7.43; 95% CI: 6.98, 7.92; p < .0001), opiate misuse (aOR: 8.35; 95% CI: 7.38, 9.45; p < .0001), and misuse of other club drugs (aOR: 10.37; 95% CI: 9.10, 11.81; p < .0001) than peers without reported EDs. Both AN and BN were associated with an increased likelihood of SUD diagnosis.
Discussion:
These findings demonstrate strong associations between EDs and the most extensive list of substance use outcomes explored in the context of college setting ED research to date.
Objective:
This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders.
Method and results:
Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence-based approaches to early intervention for eating disorders and progress is being made in scaling these.
Conclusions:
We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics.
Objectives:
Eating disorders (ED) are associated with significant morbidity and mortality rates and are most common in young people aged between 15 and 19 years. Large representative surveys on disordered eating in youth are lacking. The main aims were to estimate the prevalence of disordered eating in a representative sample of 11-19 year olds in Northern Ireland and investigate the associations between probable eating disorder and a range of risk factors.
Designs and methods:
A large nationally representative household survey was conducted, and the bivariate and multivariate associations between demographic, familial, economic and psychological risk factors and probable eating disorder were assessed.
Results:
A total of 16.2% (n = 211) of the sample met the SCOFF screening criteria for disordered eating. Probable eating disorder was associated with being female (OR = 2.44), having a parent with mental health problems (OR = 1.68), suffering from certain psychological problems, such as mood or anxiety disorder (OR = 2.55), social media disorder (OR = 2.95), being the victim of physical bullying (OR = 1.71) and having smoked (OR = 2.46).
Conclusions:
This study provides the first prevalence estimates of probable eating disorder among youth in Northern Ireland. Furthermore, the study identifies unique risk factors for probable eating disorder among this representative sample.
Anorexia nervosa (AN) is a complex disorder of unknown etiology. It is characterized by dietary restriction and severe malnutrition, as well as by many psychological disturbances. The awareness of AN has risen in the last decades among scientists of different disciplines. It is undeniable that ΑΝ has the highest mortality rate of all mental disorders. There is no doubt that ΑΝ has the highest mortality rate of all mental disorders. In the treatment of this disorder, nutritional recovery and weight restoration are premature goals. It seems that nutritional status influences both the effectiveness of an intervention’s programs and the general health of this population, and it is often the result of interrelated factors. Experts should consider that while weight restoration is a critical part of AN treatment, changes in body composition, energy, and nutrient needs during weight recovery as well as weight maintenance should also be taken into consideration. This chapter attempts to describe suggested biomarkers related to energy requirements as a means of selecting the most appropriate and reliable methods of nutritional assessment.
Discussions about eating disorders are becoming more and more common in the medical field (Schmidt et al. 2016; Cohrdes et al. 2019). One such disorder is anorexia nervosa, which results in anorexia (Eating Disorders, National Institute of Mental Health, 2015). Here, psychological disorders are linked to slight genetic changes that guide the eating behavior of the affected people in such a way that their will to lose weight plays the central role in their daily lives (Watson et al. 2019). These people have a constant desire for an even thinner figure and therefore continually reduce their food intake. In Germany, about 1.1% of women—more than 90% of older girls and young women—and 0.3% of men are affected by this form of anorexia. This behavior pattern of people is associated with a high risk of chronic course and offers serious medical problems. These include, among others, metabolic disorders, low blood pressure, heart rhythm disorders and constant fatigue (Donghwi et al. 2017; Mitchell and Peterson 2020). Anorexia also leads to a drastic shrinking of the cerebral cortex (King et al. 2015). However, a complete restoration of the layer thickness could be observed in successful therapy. Anorexia athletica is a sports-related eating disorder.
Social Work addresses the social dimension of the person, which must be taken into account to promote a comprehensive approach to eating disorders. Under this consideration, we have tried to synthesise and analyze the available evidence of the role of Social Work and social intervention in eating disorders through an international systematic review. The systematic review followed the PRISMA standards, and a narrative synthesis analysis was generated. We searched the databases Web of Science, Scopus, PubMed y Cochchrane. 501 references were found, and a total of 19 articles that met the quality indicators were analyzed, in which the following categories related to eating disorders were found: types of interventions and Social Work in eating disorders, sociodemographic aspects to be considered, clinical particularities to be contemplated, attention to the family system and the support network, ethical aspects, and barriers and needs of the disease to be covered. The need for Social Work to delve into the particularities and consequences of eating disorders to make a social diagnosis and address the social dimension is highlighted. To date, the discipline has little specific literature on the subject, which is a professional challenge to be met.
Background
New DSM-5 diagnostic criteria for eating disorders were published in 2013. Adolescent cohort studies in the Australian community indicate that the point prevalence of DSM-5 eating disorders may be as high as 15% in females and 3% in males. The goal of the current study was to determine the 3-month prevalence of DSM-5 disorders in a representative sample of Australian older adolescents and adults. A secondary aim was to explore the demographic correlates of these disorders, specifically, age, gender, income, and educational attainment and presence of obesity.
Methods
We conducted and merged sequential cross-sectional population survey data of adults (aged over 15 years) collected in 2008 and in 2009 (n = 6041). Demographic information and the occurrence of regular (at least weekly over the past 3 months) objective and subjective binge eating, extreme dietary restriction, purging behaviors, and overvaluation of weight and/or shape, were assessed.
Results
The 3-month prevalence of anorexia nervosa and bulimia nervosa were both under 1% whereas the prevalence of binge eating disorder (BED) and sub-threshold BED were 5.6-6.9%. The prevalence of BED including overvaluation of weight/shape was 3%. Other specified and unspecified eating disorders including purging disorder were less common, under 1% to 1.4%. While people with eating disorders were generally younger than others, the mean age was in the fourth decade for anorexia nervosa and bulimia nervosa and in the fourth or fifth decade for all other disorders. Most people with eating disorders had similar household incomes and educational attainments to the general population. People with bulimia nervosa, BED and sub-threshold bulimia nervosa were more likely to be obese than people without an eating disorder.
Conclusions
The findings support the expanded demographic distribution of eating disorders. There is a relatively high prevalence of BED compared to anorexia nervosa and bulimia nervosa. As it is in BED, obesity is a very common co-morbidity in bulimia nervosa.
Background
Cross-national population data from the WHO World Mental Health surveys are used to compare role attainments and role impairments associated with binge-eating disorder (BED) and bulimia nervosa (BN).
Methods
Community surveys assessed 23 000 adults across 12 countries for BED, BN and ten other DSM-IV mental disorders using the WHO Composite International Diagnostic Interview. Age-of-onset was assessed retrospectively. Ten physical disorders were assessed using standard conditions checklists. Analyses examined reciprocal time-lagged associations of eating disorders (EDs) with education, associations of early-onset (i.e., prior to completing education) EDs with subsequent adult role attainments and cross-sectional associations of current EDs with days of role impairment.
Results
BED and BN predicted significantly increased education (females). Student status predicted increased risk of subsequent BED and BN (females). Early-onset BED predicted reduced odds of current (at time of interview) marriage (females) and reduced odds of current employment (males). Early-onset BN predicted increased odds of current work disability (females and males). Current BED and BN were both associated with significantly increased days of role impairment (females and males). Significant BED and BN effects on adult role attainments and impairments were explained by controls for comorbid disorders.
Conclusions
Effects of BED on role attainments and impairments are comparable with those of BN. The most plausible interpretation of the fact that these associations are explained by comorbid disorders is that causal effects of EDs are mediated through secondary disorders. Controlled treatment effectiveness studies are needed to trace out long-term effects of BED–BN on secondary disorders.
Objective:
To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide.
Methods:
Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH) Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial) and subjective (distress, embarrassment) burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided.
Results:
Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+). Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings.
Conclusions:
The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers.
Background:
The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people.
Aims:
To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country.
Methods:
The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010.
Results:
The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US.
Discussion:
This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges.
Recommendations:
Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.
Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes; however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of ‘thinness’ and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.
Anorexia nervosa is an important cause of physical and psychosocial morbidity. Recent years have brought advances in understanding of the underlying psychobiology that contributes to illness onset and maintenance. Genetic factors influence risk, psychosocial and interpersonal factors can trigger onset, and changes in neural networks can sustain the illness. Substantial advances in treatment, particularly for adolescent patients with anorexia nervosa, point to the benefits of specialised family-based interventions. Adults with anorexia nervosa too have a realistic chance of achieving recovery or at least substantial improvement, but no specific approach has shown clear superiority, suggesting a combination of re-nourishment and anorexia nervosa-specific psychotherapy is most effective. To successfully fight this enigmatic illness, we have to enhance understanding of the underlying biological and psychosocial mechanisms, improve strategies for prevention and early intervention, and better target our treatments through improved understanding of specific disease mechanisms.
Mental and brain disorders represent the greatest health burden to Europe—not only for directly affected individuals, but also for their caregivers and the wider society. They incur substantial economic costs through direct (and indirect) health-care and welfare spending, and via productivity losses, all of which substantially affect European development. Funding for research to mitigate these effects lags far behind the cost of mental and brain disorders to society. Here, we describe a comprehensive, coordinated mental health research agenda for Europe and worldwide. This agenda was based on systematic reviews of published work and consensus decision making by multidisciplinary scientific experts and affected stakeholders (more than 1000 in total): individuals with mental health problems and their families, health-care workers, policy makers, and funders. We generated six priorities that will, over the next 5–10 years, help to close the biggest gaps in mental health research in Europe, and in turn overcome the substantial challenges caused by mental disorders.
To review the recent literature about the epidemiology, course, and outcome of eating disorders in accordance with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The residual category 'eating disorder not otherwise specified' (EDNOS) was the most common DSM-IV eating disorder diagnosis in both clinical and community samples. Several studies have confirmed that the DSM-5 criteria for eating disorders effectively reduce the proportion of EDNOS diagnoses. The lifetime prevalence of DSM-5 anorexia nervosa among women might be up to 4%, and of bulimia nervosa 2%. In a cross-national survey, the average lifetime prevalence of binge eating disorder (BED) was 2%. Both anorexia nervosa and bulimia nervosa are associated with increased mortality. Data on long-term outcome, including mortality, are limited for BED. Follow-up studies of BED are scarce; remission rates in randomized controlled trials ranged from 19 to 65% across studies. On a community level, 5-year recovery rates for DSM-5 anorexia nervosa and bulimia nervosa are 69 and 55%, respectively; little is known about the course and outcome of BED in the community.
Applying the DSM-5 criteria effectively reduces the frequency of the residual diagnosis EDNOS, by lowering the threshold for anorexia nervosa and bulimia nervosa, and adding BED as a specified eating disorder. Course and outcome studies of both anorexia nervosa and bulimia nervosa show that no significant differences exist between DSM-5 and DSM-IV definitions.
Background:
Little population-based data exist outside the United States on the epidemiology of binge eating disorder (BED). Cross-national BED data are presented here and compared with bulimia nervosa (BN) data in the World Health Organization (WHO) World Mental Health Surveys.
Methods:
Community surveys with 24,124 respondents (ages 18+) across 14 mostly upper-middle and high-income countries assessed lifetime and 12-month DSM-IV mental disorders with the WHO Composite International Diagnostic Interview. Physical disorders were assessed with a chronic conditions checklist.
Results:
Country-specific lifetime prevalence estimates are consistently (median; interquartile range) higher for BED (1.4%; .8-1.9%) than BN (.8%; .4-1.0%). Median age of onset is in the late teens to early 20s for both disorders but slightly younger for BN. Persistence is slightly higher for BN (6.5 years; 2.2-15.4) than BED (4.3 years; 1.0-11.7). Lifetime risk of both disorders is elevated for women and recent cohorts. Retrospective reports suggest that comorbid DSM-IV disorders predict subsequent onset of BN somewhat more strongly than BED and that BN predicts subsequent comorbid disorders somewhat more strongly than does BED. Significant comorbidities with physical conditions are due almost entirely to BN and to a somewhat lesser degree BED predicting subsequent onset of these conditions. Role impairments are similar for BN and BED. Fewer than half of lifetime BN or BED cases receive treatment.
Conclusions:
Binge eating disorder represents a public health problem at least equal to BN. Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.
The aim of the study was to examine how carers cope practically and emotionally with caring for individuals with anorexia nervosa who require intensive hospital care.
This study explores objective burden (time spent with caregiving and number of tasks), subjective burden (psychological distress), and social support in a sample of parents (n = 224) and partners (n = 28) from a consecutive series of patients (n = 178) admitted to inpatient units within the United Kingdom.
Most time was spent providing emotional support and less with practical tasks. Time spent with caregiving was associated with carer distress and was fully mediated by carer burden. This was ameliorated by social support. Partners received minimal support from others, and we found similar levels of burden and distress for mothers and partners.
The data indicate that professional and social support alleviates carer distress and may be of particular value for partners who are more isolated than parents. The data also suggest that time spent with practical support may be of more value than emotional support. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013;)
Gender differences in perceptions of the severity and prevalence of anorexia nervosa (AN) and bulimia nervosa (BN) were examined in young men (n=113) and women (n=289) recruited from a regional university campus in north-east Australia.
Participants viewed vignettes of fictional (female) sufferers of AN and BN and responded to the same series of questions in relation to each vignette.
For both vignettes, a substantial minority of male, but not female, participants indicated that they would be a little or not at all sympathetic to someone with the problem described, that the problem described would be a little or not at all difficult to treat, and that having the problem described would be moderately or a little distressing. Men were also more likely than women to consider BN to be primarily a problem of 'lack of will-power/self-control'. Perceptions of the prevalence of AN (modal response = 'very few women/10% or less') and BN ('10% to 30%') did not differ by gender and both male and female participants considered AN to be more severe and less common than BN.
The findings suggest that there may be a need to target the attitudes and beliefs of young men in particular in the prevention and early intervention initiatives for eating disorders.
To measure the cooccurrence of obesity and eating disorder (ED) behaviors in the South Australian population and assess the change in level from 1995 to 2005.
Two independent cross-sectional single stage interview based population surveys were conducted a decade apart. Self-reported height, weight, ED behaviors, and sociodemographics were assessed. Changes between the two time points were analyzed.
From 1995 to 2005 the population prevalence of comorbid obesity and ED behaviors increased from 1 to 3.5%. Comorbid obesity and ED behaviors increased more (prevalence odds ratio (POR) = 4.5; 95% confidence interval (CI) = 95% CI = [2.8, 7.4]; p < .001) than either obesity (POR = 1.6; 95% CI = [1.3, 2.0]; p < .001) or ED behaviors (POR = 3.1; 95% CI = [2.3, 4.1]; p < .001) alone.
Comorbid obesity and ED behaviors are an increasing problem in our society. Prevention and treatments efforts for obesity and EDs must consider and address this increasing comorbidity.
Regent's University London
- Eberhard-Karls Universität
- Tübingen
- Germany
- Sz Kg
Eberhard-Karls
Universität, Tübingen, Germany (KG, SZ); Regent's University
London, London, UK (AH); Groningen University, Groningen,
Netherlands (HWH);
- J Treasure
- S Zipfel
- N Micali
Treasure J, Zipfel S, Micali N, et al. Anorexia nervosa. Nat Rev Dis Primers
2015; 1: 15074.