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Eating disorders: The big issue

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... La Organización Mundial de la Salud (OMS) incide en el hecho de que los TCA aparecen durante la adolescencia y que son más comunes entre las mujeres, ya que algunas de ellas centran la preocupación por su imagen en la pérdida de peso (6,7) . Aunque existe concordancia sobre que las mujeres jóvenes constituyen la mayoría de las personas con anorexia y bulimia nerviosa, se ha podido demostrar que otras patologías como el trastorno por atracón pueden darse y ser igual de comunes en ambos sexos (8) . Al mismo tiempo, se producen cada vez más en diferentes contextos socioculturales, debido en gran parte a la globalización de los medios, aunque continúa predominando su desarrollo en países occidentales y con ingresos más altos (9,10,11) . ...
... Asimismo, la morbilidad y gravedad de la anorexia y bulimia se caracteriza por complicaciones médicas que provocan gran parte de la tasa de mortalidad y por un descenso de entre diez a veinte años de la esperanza de vida, destacando también la alta tasa y riesgo de suicidio (27,28) . En concreto, la tasa de mortalidad es casi dos veces más alta para las personas con TCA que para la población general, siendo la mortalidad en la AN más alta que en otros TCA (8,28,29) . ...
... En consecuencia, teniendo en cuenta el género, aunque en este estudio no se obtienen diferencias estadísticamente significativas en los trastornos de conducta alimentarios, sí se alcanzan resultados ligeramente más elevados para el género femenino. Diferentes estudios concuerdan en que las mujeres jóvenes constituyen la mayoría de las personas que presentan anorexia y bulimia nerviosa (8,26) . Se debe considerar que, históricamente, el estudio de los TCA se ha centrado en las mujeres, por lo que la nosología de los trastornos alimentarios ha evolucionado a partir de estudios en los que se carece de una representatividad alta respecto a investigaciones que contemplen el género masculino. ...
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Fundamentos. Los Trastornos de la conducta alimentaria (TCA) se inician normalmente durante la pubertad y adolescencia, momento en el que se debe prestar atención a los factores que influyen en el desarrollo de la enfermedad. El objetivo de este trabajo es evaluar las actitudes hacia la alimentación y el riesgo de padecer TCA, teniendo en cuenta las variables personales y familiares en una población de estudiantes de educación secundaria. Métodos. Participaron un total de 790 estudiantes de educación secundaria obligatoria (ESO) matriculados/as en el curso 2019/2020 en institutos de la Comunidad Autónoma de Galicia de los cuales 410 eran varones y 380 mujeres (M=13,84; DT= 1,37). En este estudio descriptivo-transversal los TCA fueron valorados mediante el Eating Attitudes Test (EAT-26) de Garner, en la versión adaptada a sujetos españoles. Resultados. Atendiendo a las variables personales analizadas, no se han encontrado diferencias significativas de los trastornos de conducta alimentaria en el género de los adolescentes, pero sí en la edad, curso escolar y uso de redes sociales. Del mismo modo, los datos sí presentan diferencias significativas en los trastornos de conducta alimentaria según el nivel de estudios de las familias y su relación familiar. Conclusiones. Los resultados obtenidos en la investigación verifican una influencia de las variables personales y familiares sobre las actitudes asociadas a los TCA. Continuar ahondando en estas variables puede facilitar una mejor intervención, así como mejorar el diseño de estrategias preventivas.
... La Organización Mundial de la Salud (OMS) incide en el hecho de que los TCA aparecen durante la adolescencia y que son más comunes entre las mujeres, ya que algunas de ellas centran la preocupación por su imagen en la pérdida de peso (6,7) . Aunque existe concordancia sobre que las mujeres jóvenes constituyen la mayoría de las personas con anorexia y bulimia nerviosa, se ha podido demostrar que otras patologías como el trastorno por atracón pueden darse y ser igual de comunes en ambos sexos (8) . Al mismo tiempo, se producen cada vez más en diferentes contextos socioculturales, debido en gran parte a la globalización de los medios, aunque continúa predominando su desarrollo en países occidentales y con ingresos más altos (9,10,11) . ...
... Asimismo, la morbilidad y gravedad de la anorexia y bulimia se caracteriza por complicaciones médicas que provocan gran parte de la tasa de mortalidad y por un descenso de entre diez a veinte años de la esperanza de vida, destacando también la alta tasa y riesgo de suicidio (27,28) . En concreto, la tasa de mortalidad es casi dos veces más alta para las personas con TCA que para la población general, siendo la mortalidad en la AN más alta que en otros TCA (8,28,29) . ...
... En consecuencia, teniendo en cuenta el género, aunque en este estudio no se obtienen diferencias estadísticamente significativas en los trastornos de conducta alimentarios, sí se alcanzan resultados ligeramente más elevados para el género femenino. Diferentes estudios concuerdan en que las mujeres jóvenes constituyen la mayoría de las personas que presentan anorexia y bulimia nerviosa (8,26) . Se debe considerar que, históricamente, el estudio de los TCA se ha centrado en las mujeres, por lo que la nosología de los trastornos alimentarios ha evolucionado a partir de estudios en los que se carece de una representatividad alta respecto a investigaciones que contemplen el género masculino. ...
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Objective: Eating disorders (EDs) usually begin during puberty and adolescence, a time when attention should be paid to the factors that influence the development of the disease. The aim of this study was to assess attitudes towards eating and the risk of developing EDs, taking into account personal and family variables in a population of secondary school students. Methods: A total of 790 Compulsory Secondary School students enrolled in the 2019/2020 academic year in secondary schools in the Autonomous Community of Galicia participated, of whom 410 were male and 380 female (M=13.84; SD=1.37). In this descriptive-cross-sectional study, eating disorders were assessed using Garner's Eating Attitudes Test (EAT-26), adapted to Spanish subjects. The statistical treatment of the data was carried out by means of a multivariate analysis of variance (MANOVA), which took the form of frequency analysis and contingency tables. Results: With regard to the personal variables analysed, no significant differences in eating disorders were found across adolescents' gender (p>0.05), but there were significant differences in age (p<0.001), school year (p<0.001) and use of social networks (p<0.05). Similarly, the data do showed significant differences in eating disorders according to the level of studies of the families (p<0.01) and their family relationship (p<0.001). Conclusions: The results obtained in this research confirm an influence of personal and family variables in attitudes associated with EDs. Further investigation of these variables may facilitate better intervention, as well as improve the design of preventive strategies.
... Based on the prevalence estimates of EDs obtained in the framework of the European Study of the Epidemiology of Mental Disorders project [2,3], lifetime prevalence of AN, BN, BED, sub-threshold BED, and any binge eating (this entity included all cases of BN, BED and sub-threshold BED as well as cases of AN with binge eating) is 0.48%, 0.51%, 1.12%, 0.72%, and 2.15%, respectively. Prevalence across genders is uneven, with women having 8-10 times higher odds than men of developing an ED [4,5]. In a recent Italian study [6] regarding pathways to specialist care for EDs, the data also showed almost 90% of the patients were female. ...
... One in every six or seven young women having an ED or AN is very common. The peak onset of ED is 15-25 years, while the average duration of illness is about 6 years [4,5]. A recent Italian study showed that AN and BN patients had an age of onset around 18 years [7]. ...
... Many people with eating disorders have long impairments in social functioning and employment. Data show that one in four has no paid employment [5] When reviewing the literature, very few studies have been studying sociodemographic data of eating disorder subjects under specialized treatment. For instance, Arcelus and Button [8] studied clinical and sociodemographic characteristics of university students referred to an eating disorder unit, but only report few demographic characteristics such as that 93% of the patients were female, their mean age was 21 and that the majority (75%) was referred by their general practitioner. ...
Article
Introduction: Epidemiologic information on sociodemographic and clinical characteristics in eating disorders in Western European countries are scarce. Purpose: In this study, we report demographic and clinical characteristics of eating disorder (ED) patients undergoing treatment in five specialized ED centers in Flanders (Belgium). Method: Data from 642 ED patients were collected by means of a structured questionnaire. Results: Data show that 93.8% of patients are female, with an average age of 22.6 years. The largest subgroup in our sample suffers from anorexia nervosa, namely 52.8%. Bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS) account for 17.7%, 10.7% and 18.8% of the sample, respectively. Mean age of onset was 17 years. Mean duration of illness was 5.6 years, but 20.2% of patients had their illness for over 8 years. Anorexia nervosa patients of the restricting type (AN-R) have the shortest duration of illness. BED patients stood out because they were older on average, more often in a relationship and more often in ambulatory treatment. 70% of patients over 20 years old completed higher education, but one-third of this group was unemployed and/or disabled. Remarkably, ED patients grow more up in intact families compared to the general population. Conclusions: Epidemiology of ED patients in treatment in Flanders (Belgium) seems to resemble worldwide findings. The long duration of illness, the common evolution towards chronicity and the early work impairment underline the severe personal and societal impact of ED and call to the need for early detection and treatment of these patients. Level of evidence: Level V: cross-sectional descriptive study. Keywords: Anorexia nervosa; Binge eating disorder; Bulimia nervosa; Demographic characteristics; Eating disorders.
... In summary, the pandemic has shone a light on the acute needs of young people with EDs and on ED researchers' and clinicians' ingenuity in adapting and evaluating treatments designed to cope with rising demand, but solid research funding needs to follow, commensurate with the burden posed by these disorders (Schmidt et al., 2016). Governmental funding for ED research is starkly lower than for mental disorders of comparable prevalence or clinical impairment (Murray et al., 2017;Schmidt et al., 2016). ...
... In summary, the pandemic has shone a light on the acute needs of young people with EDs and on ED researchers' and clinicians' ingenuity in adapting and evaluating treatments designed to cope with rising demand, but solid research funding needs to follow, commensurate with the burden posed by these disorders (Schmidt et al., 2016). Governmental funding for ED research is starkly lower than for mental disorders of comparable prevalence or clinical impairment (Murray et al., 2017;Schmidt et al., 2016). In Australia, for example, research funding equates to approximately $1.10 per individual with an ED versus $32.62 and $67.36 per person with autism or schizophrenia, respectively (Murray et al., 2017). ...
... [15][16][17][18][19][20] Eating disorders have become more common in recent decades especially in combination with obesity. 21 The total prevalence of lifetime eating disorders among U.S. adults has been reported as almost 2% and emerging adults appear to be more at risk of disordered eating compared to older age groups. 22 A recent cross-sectional survey comprising a self-selected sample of emerging adults from different faculties of a Turkish university found that 10% of the sample was classed as being at high risk for having an eating disorder. ...
... 23 While young females account for the majority of individuals with anorexia and bulimia nervosa, males and females are almost equally at risk for having binge eating disorder. 21 It is not surprising that those who love food and/or who are addicted to food may use online platforms for food-related content. For instance, those who love food but do not want to suffer the negative consequences of excessive eating satisfy their needs by watching mukbang, which enables them to experience vicarious eating and satiation. ...
Article
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Objective: Accumulating empirical research has emphasized that a wide range of online activities-such as using social networking sites-can be performed in order to compensate unattained needs or to cope with negative affect and psychopathological symptoms. Although the correlates of problematic social networking use have been extensively investigated, less is known about problematic YouTube use (PYU), an umbrella term grouping a number of different activities (e.g., viewing of online video games, watching specific YouTube channels). Furthermore, nothing is known concerning increasingly popular and distinct YouTube-related activities such as mukbang watching (i.e., watching livestream "eating broadcasts" where someone eats various foods in front of the camera while interacting with viewers). The aim of the present study was to examine the mediating role of problematic mukbang watching (PMW) on the relationships between depression and loneliness with PYU. Methods: An online survey that comprised assessment tools for aforementioned variables was administered to 217 mukbang viewers (mean age=20.58 years, range 18-33 years). Results: Results indicated that PMW was positively related to loneliness and PYU. Depression was positively and directly associated with PYU but was not associated with PMW. Conclusion: Further research is required to better understand the psychological processes underlying problematic mukbang watching and its association with other mental health conditions (e.g., addictive disorders, eating disorders).
... Eating Disorders (EDs) represent a world-wide cause of psychiatric and physical morbidity and mortality. The overall incidence of EDs has been reported to have significantly increased over the last decade [1][2][3][4]. Moreover, the illness is affecting people at an increasingly younger age [3,4]. ...
... The overall incidence of EDs has been reported to have significantly increased over the last decade [1][2][3][4]. Moreover, the illness is affecting people at an increasingly younger age [3,4]. The prevalence of Anorexia Nervosa (AN) is estimated to be approximately 1% among women, with women being affected about 10 times more often than men [5]. ...
Article
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Literature reviews appear to indicate that Music Therapy (MT) may instil a sense of empowerment and generate feelings of renewed self-confidence, distracting subjects who follow this type of intervention from negative thoughts and, generally, helping patients suffering from Anorexia Nervosa (AN) to redevelop or rediscover their identity. The purpose of the study reported in this paper is to investigate whether MT proposed before an evening meal is capable of decreasing pre-meal anxiety in adolescents suffering from AN who follow the Day-hospital Treatment Programme at the San Bortolo Hospital of Vicenza (Italy). A total of 24 patients participated voluntarily in once-weekly sessions of group-based MT conducted by a qualified music therapist over a period of six months. Before evening meals on Monday, Tuesday and Wednesday, pre-meal anxiety was measured using a self-report scale, and the MT group session occurred every Wednesday before the evening meal was consumed. MT activities were both active and receptive. It has been found that with respect to Mondays and Tuesdays, pre-meal anxiety was significantly lower on Wednesdays following participation in the MT group. MT is evidently capable of reducing pre-meal anxiety and may be adopted as a supportive element in treatment plans relating to patients with AN in a day-hospital treatment programme.
... In summary, the pandemic has shone a light on the acute needs of young people with EDs and on ED researchers' and clinicians' ingenuity in adapting and evaluating treatments designed to cope with rising demand, but solid research funding needs to follow, commensurate with the burden posed by these disorders (Schmidt et al., 2016). Governmental funding for ED research is starkly lower than for mental disorders of comparable prevalence or clinical impairment (Murray et al., 2017;Schmidt et al., 2016). ...
... In summary, the pandemic has shone a light on the acute needs of young people with EDs and on ED researchers' and clinicians' ingenuity in adapting and evaluating treatments designed to cope with rising demand, but solid research funding needs to follow, commensurate with the burden posed by these disorders (Schmidt et al., 2016). Governmental funding for ED research is starkly lower than for mental disorders of comparable prevalence or clinical impairment (Murray et al., 2017;Schmidt et al., 2016). In Australia, for example, research funding equates to approximately $1.10 per individual with an ED versus $32.62 and $67.36 per person with autism or schizophrenia, respectively (Murray et al., 2017). ...
... 6 Recent literature suggests that fewer than half of individuals with anorexia nervosa or bulimia nervosa fully recover. 7 It is well-established that rates of SH in young people diagnosed with an ED are exceptionally high, 8 9 ranging between 25.4% and 55.2% 10 contrasting to 13.4% in the general population. 11 Koutek et al's study reported SH in 49% of their female participants with ED, and suicidal behaviour in 60%. ...
Article
Introduction: Self-harm is highly prevalent among young people with eating disorders. However, why a young person may develop and continue to experience both an eating disorder and self-harm is unclear. This study will investigate the frequency, intensity, duration, function, context and processes of self-harm among people aged 16-25 diagnosed with an eating disorder. It will explore participants' perspectives on the genesis and functions of both their self-harm and eating disorder, as well as their support needs. The study was designed with the input of members of a Young Persons' Advisory Group, who will be key to study delivery and dissemination. Methods and analysis: This exploratory study has a sequential mixed-methods explanatory design. Between 70 and 100 young people aged 16-25 with both an eating disorder diagnosis and self-harm thoughts and/or behaviours will be recruited from three NHS Eating Disorder outpatient services in England. Phase 1: a 14-day (six prompts per day) ecological momentary assessment (EMA) of participants' feelings, thoughts, motivations, behaviours and experiences of self-harm. Phase 2: 20-30 participants from phase 1 will be reapproached to take part in an in-depth qualitative interview on the psychological, emotional and social factors that underlie their self-harm and eating disorder as well as their support needs. EMA data from phase 1 will be analysed using descriptive and multilevel statistics. Qualitative interview data from phase 2 will be analysed using inductive and deductive thematic analysis. Results from both phases will be integrated using a mixed-methods matrix, with each participant's data from both phases compared alongside comparative analysis of the datasets as a whole. Ethics and dissemination: The study gained ethical approval from the NHS HRA West Midlands-Black Country Research Ethics Committee (number: 296032). We anticipate disseminating findings to clinical, academic and lived experience audiences, at academic conferences, through peer-reviewed articles, and through various public engagement activities (eg, infographics, podcasts).
... A range of potentially efficacious prevention (Stice et al., 2019), early intervention (Jacobi et al., 2012), and treatment (Linardon et al., 2017) programs designed to target ED symptoms and risk factors exist, yet barriers such as cost, geographical constraints, limited professional availability, and stigma continue to contribute to low rates of professional help seeking (Stice et al., 2017;Weissman & Rosselli, 2017). Since a delay in help seeking can lead to symptom escalation and, ultimately, the onset of a clinically significant ED (Schmidt et al., 2016), innovations to intervention delivery are urgently needed to increase access to and willingness to receive evidence-based care. ...
Article
Despite their potential as a scalable, cost-effective intervention format, self-guided internet-based interventions for eating disorder (ED) symptoms continue to be associated with suboptimal rates of adherence and retention. Improving this may depend on the design of an internet intervention and its method of content delivery, with interactive programs expected to be more engaging than static, text-based programs. However, causal evidence for the added benefits of interactive functionality is lacking. We conducted a randomized controlled comparison of an internet-based intervention for ED symptoms with and without interactive functionality. Participants were randomized to a four-week interactive (n =148) or static (n =145) version of an internet-based, cognitive-behavioral program. The interactive version included diverse multimedia content delivery channels (video tutorials, graphics, written-text), a smartphone app allowing users to complete the required homework exercises digitally (quizzes, symptom tracking, self-assessments), and progress monitoring features. The static version delivered identical intervention content but only via written-text, and contained none of those interactive features. Dropout rates were high overall (58%), but were significantly-yet slightly-lower for the interactive (51%) compared to the static intervention (65%). There were no significant differences in adherence rates and symptom-level improvements between the two conditions. Adding basic interactive functionality to a digital intervention may help with study retention. However, present findings challenge prior speculations that interactive features are crucial for improving user engagement and symptom improvement.
... This also supports that there might be an addictive, relapsing process behind in this subgroup of obese patients, as many other addictions also start during adolescence and early adulthood (55,56). It is also true that eating pathologies tend to arise during this developmentally sensitive period (57). ...
Article
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The concept of food addiction (FA) has become central in recent years in understanding the psychological etiology of obesity. In this matched case-control study from Turkey, it was aimed to examine the prevalence of FA and related risk factors in four consecutive body mass index (BMI) categories. The case group consisted of pre-operative bariatric surgery patients with BMI over 35.0 kg/m ² ( n = 40) and the control group was composed of age- and gender- matching individuals from the other categories, namely obese ( n = 35), overweight ( n = 40), and normal weight ( n = 40). The Yale Food Addiction Scale (YFAS) and a standardized clinical interview using the DSM-5 substance use disorders criteria adopted for FA, the Eating Disorder Examination Questionnaire (EDEQ) and the Barratt Impulsivity Scale (BIS-11) were used as assessment instruments. It was found that FA was significantly associated with more serious eating pathologies, more frequent weight-cycling and earlier onset of dieting, higher impulsivity, and higher BMI. Motor and total impulsivity scores showed a positive albeit week correlation with the severity of FA but no significant correlation with BMI, indicating a relationship between impulsivity and weight gain in some but not all individuals. The severity of FA predicted the increase in BMI. Our findings suggest that FA is associated with weight gain in a group of individuals, plausibly through impulsive overeating. Emphasis on FA and its clinical implications such as addiction-based treatments may improve outcomes in obesity and facilitate health promotion.
... Both eating disorders and DEB involve considerable psychological impairment and distress, and are associated with a range of serious medical complications [36]. The mortality rate for people with eating disorders is also one of the highest among all psychiatric illnesses [3], with these difficulties considered to be a serious public health concern [42]. ...
Article
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Background Past research has established individual relationships between disordered eating behaviours (DEB) and both self-regulation difficulties and identity disturbance. However, no research has looked at the shared influence of these constructs on DEB nor at personality functioning in individuals with DEB. Methods In the present study, self-regulation was explored in terms of effortful control, impulsivity and emotion regulation while identity integration was measured in terms of impairments in self-functioning using a sample of 247 undergraduate students. Results Significant associations were found between all components of self-regulation and DEB, with the exception of impulsivity. Identity instability was also associated with self-regulation difficulties and DEB. Structural Equation Modelling analyses indicated that identity instability partially mediated the relationship between self-regulation and DEB. Lastly, disordered eating was associated with difficulties in personality functioning, with young women presenting with DEB reporting significantly greater difficulties in both self and interpersonal personality functioning. Conclusion Behavioural eating anomalies should be considered as epiphenomena secondary to a possible deeper issue that reflects difficulties related to identity integration and potential personality functioning. The clinical implications of these findings are discussed.
... Such disorders are chronic, difficult to recover from, prone to relapse and often have serious sequelae (Brownell and Walsh, 2017;Rodgers et al., 2018;Galmiche et al., 2019). Many studies confirmed that EDs make people more vulnerable to psychiatric illnesses such as anxiety and depression, as well as bodily diseases such as diabetes and obesity (Fairburn et al., 2000;Johnson et al., 2001;Schmidt et al., 2016). People with EDs experience a reduced quality of life compared with those suffering from other mental illnesses and physical health conditions (Jenkins et al., 2011a). ...
Article
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Social Networking Sites (SNSs) are common tools with which modern people share their lives and establish social relationships. However, some studies have found SNSs to be associated with eating disorders, although other have identified no connection between the two. To explore the interaction between SNSs and eating disorder behaviors, this study aimed to comprehensively synthesize previous studies using meta-analysis methods. Based on selection criteria, there were 87 effect sizes from 22 studies. After analysis using a three-level random-effects meta-analysis model, a positive correlation between the use of SNSs and irregular eating behaviors was found, r = 0.09 (95% CI: 0.06, 0.11; p < 0.001). In addition, by analyzing potential moderators, body mass index (r = −0.032; 95% CI: −0.058, −0.006; p = 0.019), survey methods, and sample sources was discovered could alter the relationship between SNSs and disordered eating behaviors. Specifically, there was a significantly larger association between SNSs results obtained by paper and pencil surveys and disordered eating behaviors (r = 0.114; 95% CI: 0.081, 0.147; p < 0.001) than that between SNSs results obtained by online surveys and disordered eating behaviors (r = −0.055; 95% CI: −0.102, −0.007; p < 0.01). University students showed a larger correlation between SNSs and disordered eating behavior than other samples (r = 0.089; 95% CI: 0.049, 0.129; p < 0.001). Overall, this meta-analysis confirms that the excessive use of SNSs is associated with an increased risks of disordered eating behaviors. It is hoped that this study can provide a reference for the management and intervention of dietary behaviors related to social networks in the future.
... While others note this increase may be driven by increasing cultural sensitivity in research; recognising biases in both lay and expert perceptions of the prototypical ED patient (i.e., female, thin, White, Western and middle-class prototype) and increasing attention on the prevalence and phenomenology of EDs in more diverse groups (Currin et al., 2007;Gordon et al., 2002;Gordon et al., 2006;Sonneville & Lipson, 2018;Striegel-Moore et al., 2003;Veillette et al., 2018). Not surprisingly, given their association with physical and psychological morbidity and mortality risk, EDs are recognized as a serious public health issue (Carta et al., 2014;Schmidt et al., 2016). This has generated a rich body of research in academic publications, including specialised journals such as the International Journal of Eating Disorders, European Eating Disorders Review, Eating Disorders, Journal of Eating Disorders, and Eating and Weight Disorders-over recent decades. ...
Article
Objective Employing bibliometric methods, the present study aimed to map out the general landscape of existing research on eating disorders (EDs) over the past decades. Method Using the Web of Science database, we retrieved 41,917 research articles related to EDs published from 1981 to 2020. After removing those without an abstract, a total of 37,446 articles were retained. The study outlined the distribution of scholarship by time, languages, regions, and countries, and identified major research lines by applying latent topic modelling. Results Results revealed a general increasing trend in the number of publications on EDs research, and researchers from Western countries dominated the production of related scholarship. The distribution of published scholarship varied significantly by languages, regions, and countries. Seven main research topics emerged from past research (i.e., animal studies of food intake, risk factors and at-risk groups for eating disorders, body image in eating disorders, studies of cognition and brain in eating disorders, symptomatology and comorbidity of eating disorders, body weight and nutrition status in eating disorders, and treatment of eating disorders), with different topics showing unique research trends across the years. Conclusions This bibliometric analysis presents the most complete up-to-date overview on published research on EDs. While there is an increasing trend for EDs research, the available research evidence is generally from Western countries; thus, it is suggested that cooperation on EDs research should be strengthened between Western countries and other countries in the future.
... Anorexia nervosa (AN) is a serious and complex psychiatric disorder characterized by self-directed severe weight loss, intense fear of weight gain, disturbed body image, and secondary medical problems associated with malnutrition involving a vast variety of biopsychosocial influencing risk and maintenance factors [1][2][3][4][5]. AN has the highest mortality rate [6,7] and health system costs [8,9] among all psychiatric disorders with a reported chance of full recovery still less than 50% [10][11][12][13][14]. Especially female adolescents between 15 and 19 years are affected by AN with a postulated decrease in the age of onset [7,[15][16][17][18]. ...
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This study evaluated the short-term outcome of a multimodal inpatient treatment concept for adolescents with anorexia nervosa (AN). In this prospective observational study, a cohort of 126 female adolescents with AN (age range: 11–17, mean age: 14.83) was longitudinally followed from admission to discharge (average duration of stay: 77 days). We used gold-standard clinical interviews and self-report data, as well as DSM-5 remission criteria, to evaluate the treatment outcome. From admission to discharge, body-mass-index (BMI) significantly improved by 2.6 kg/m2. Data from clinical interviews and self-reports yielded similar improvements in restraint eating and eating concerns (large effects). Lower effects were observed for variables assessing weight/shape concerns and drive for thinness. At discharge, 23.2% of patients showed full remission of AN, 31.3% partial remission, and 45.5% no remission according to DSM-5 criteria. Differences in remission groups were found regarding AN severity, age at admission, and use of antidepressant medication. Living with both parents, longer duration of inpatient treatment and the use of antipsychotic medication were significantly associated with higher BMI change. The findings provide evidence for the short-term effectiveness of our inpatient treatment concept. We recommend using DSM-5 based remission criteria to evaluate the treatment outcome to improve the comparability of studies.
... They are associated with high levels of distress, personal and social impairment and reduced quality of life [1]. Adolescence and early adulthood is when eating disorders typically develop and early detection is key to improving outcomes and treatment efficacy [2,3]. Family therapy focused on anorexia nervosa (FT-AN) is the first line recommended treatment for adolescents internationally [4] and has been shown to be superior to individual approaches [5]. ...
Article
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Introduction Multi-family therapy (MFT) is a recommended treatment for adolescent anorexia nervosa internationally. Despite recent significant advances in single-family therapy, the evidence base for MFT remains relatively small. Several individual and family factors have been associated with poorer outcomes in single-family therapy, many of which may be addressed or ameliorated by MFT if delivered early in treatment. This trial aims to determine the feasibility and acceptability of adding a five-day multi-family therapy group to the early stages of family therapy for anorexia nervosa. Secondary objectives are to explore effect size changes in key individual and family factors across treatment. Methods This feasibility trial will use a randomised controlled design. Sixty adolescents (age 10–17 inclusive) with anorexia nervosa or atypical anorexia nervosa and their parents will be recruited from a community-based specialist eating disorder service in London, UK. Participants will be randomly allocated to receive six months of eating disorder focussed family therapy with a five-day MFT group (experimental group) or without (control group). Block randomisation will be conducted by the King’s Clinical Trials Unit and researchers will be blind to participants’ intervention allocation. Feasibility, acceptability and secondary outcomes measures will be collected at baseline, post-MFT, end of treatment, six-month and 12-month follow-up. Feasibility and acceptability will be assessed according to trial sign-up rates, retention, measure completion rates and satisfaction. Secondary outcomes include physical health improvements, changes in psychiatric symptoms, emotion regulation and reflective function capacity, expressed emotion, parental difficulties and therapeutic alliance. Descriptive data and exploration analysis of trends and effect sizes will be reported upon at trial completion. Discussion The five-day MFT program developed for this study is novel, brief and more accessible than previous MFT models. The inclusion of a data collection point during treatment and follow-up will allow for an investigation of trends during and after treatment. This will allow exploration and comparison of future potential mediators and moderators of MFT and FT-AN outcomes and how these may differ between treatments. Trial registration ISRCTN registry; ISRCTN93437752 , on 27 January 2021.
... Anorexia nervosa is a severe and disabling eating disorder that carries a high disease burden for affected individuals, their relatives and the society [100]. The seriousness of the disorder is reflected in long illness duration (over 20 years for more than half of the patients; [32]) and high mortality rates [3,31]. ...
Article
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Anorexia Nervosa is a severe and disabling mental disorder and a huge challenge to treat. Intense fears of e.g., food, eating, weight gain and social evaluation are core features of anorexia nervosa and obstacles during treatment. The perceived threats trigger avoidance and safety behaviors like highly restrictive eating, strict eating rules, vomiting and body checking, to minimize feared outcomes. The role of avoidance in anorexia nervosa is however hardly studied experimentally. In the present article, the focus is on a new transdiagnostic research agenda featuring both basic and clinical experimental research into avoidance as a most important mechanism maintaining the eating disorder. Avoidance learning and the generalization of learned avoidance behaviors are discussed, as well as safety behaviors and the need for inhibitory learning as a treatment target during exposure therapy.
... The peak age of onset for EDs is 15 to 25 years and the average duration of illness is approximately 6 years (7). Amongst critical developmental milestones in adolescence and young adulthood, the maximum risk period for the emergence of these disorders also spans the transition boundary from pediatric health services to adult health services (8). ...
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Background: There is a dearth of research that identifies pediatric to adult health care transition practices that yield positive outcomes for young people with eating disorders (EDs). Further, adolescent and caregiver perspectives are poorly understood and underrepresented in the literature. The purpose of this study, focused on the impending transition from pediatric to adult health services, was twofold: (a) to identify adolescent and caregiver perspectives of barriers and facilitators of a successful transition for adolescents with EDs; and (b) to understand adolescent and caregiver suggestions of interventions for a successful transition. Design/Method: We recruited five adolescents with EDs who were about to be transferred out of pediatric care as well as their caregivers. We conducted a qualitative study in accordance with the principles of interpretive description. Through conducting semi-structured, in-depth interviews with adolescents and caregivers, we investigated their knowledge about health system transitions and anticipated experiences. We identified participants' perceptions of barriers and facilitators regarding a successful transition, as well as their recommendations to improve the transfer of care. Results: Participants possessed a limited understanding of transition processes despite the fact that they were about to be transferred to adult care. From our analyses, the following themes were identified as barriers during the transition process: re-explaining information to adult healthcare providers, lack of professional support while waiting for uptake into the adult health system, and late timing of transition of care discussions. Both adolescents and caregivers expressed that involvement of parents and the pediatric healthcare team helped to facilitate a successful transfer of care. In addition, participants expressed that the implementation of a Transition Coordinator and Transition Passport would be helpful in facilitating a seamless transfer between systems of care. Discussion: These findings demonstrate a significant gap in the system and highlight the importance of developing interventions that facilitate a successful transition. The themes that emerged from this study can inform the development of interventions to facilitate a coordinated transition from pediatric to adult health services for adolescents with EDs.
... Whilst a fixed definition of recovery is contested by those with lived experiences of eating disorders and scholars (Eli 2016; LaMarre and Rice 2021), according to clinical definitions, fewer than half of patients with either anorexia nervosa or bulimia nervosa fully recover (Schmidt et al. 2016). Individuals with eating disorders have significantly elevated mortality rates. ...
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Anorexia nervosa is a paradoxical disorder, regarded across disciplines as a body project and yet also an illness of disembodied subjectivity. This overlooks the role that material environments—including objects and spaces—play in producing embodied experiences of anorexia both within and outside treatment. To address this gap, this paper draws together two ethnographic studies of anorexia to explore the shared themes unearthed by research participants’ engagements with objects that move across boundaries between treatment spaces and everyday lives. Demonstrating how the anorexic body is at once both phenomenologically lived and socio-medically constituted, we argue that an attention to materiality is crucial to understanding lived experiences. A materialist account of anorexia extends the literature on treatment resistance in eating disorders and offers a reconceptualisation of ‘the body in treatment’, showing how objects and spaces shape, maintain, and even ‘trigger’ anorexia. Therefore, against the background of the high rates of relapse in eating disorders, this analysis calls for consideration of how interventions can better take account of eating disordered embodiment as shaped by material environments.
... The onset of eating disorders most often occurs during adolescence and early adulthood [1][2][3][4]. Biological, social and psychological risk factors have been identified for the development of these serious mental illnesses which are associated with limited quality of life, psychiatric comorbidity, chronicity, increased mortality risk, and high relapse rates [5][6][7][8][9]. Despite the severe psychological and physical impairment associated with eating disorders, only a minority of individuals seek and receive professional help [10]. ...
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Background: Growing evidence supports the effectiveness of Internet-based prevention programs for eating disorders, but the adjunctive benefit of synchronous peer support has yet to be investigated. In the current study, a randomised controlled trial was conducted to evaluate the effectiveness of an indicated Internet-based prevention program (ProYouth OZ) with and without peer-to-peer support in reducing disordered eating behaviours and attitudes. Method: Fifty young adults (18-25 years) with eating disorder symptoms were randomised to one of three study conditions: (1) ProYouth OZ (without peer-to-peer support), (2) ProYouth OZ Peers (with peer-to-peer support), and (3) a waitlist control group. Outcomes were assessed at three different time points. Eating disorder symptoms (primary outcome) were measured with the Eating Disorder Examination Questionnaire. Results: Of 415 screened participants, 73 (17.6%) were eligible and 213 (51.3%) excluded due to severe eating disorder symptoms. Fifteen participants (30%) completed the post-intervention survey. Of the two intervention groups, 20.6% failed to access any component of the program. Of 17 ProYouth OZ Peers participants, 58.8% attended at least one chat session, 20% attended 2-5 sessions, and 11.8% attended all six sessions. Due to limited outcome data, it was not possible to statistically examine between-group differences in outcomes. Visual inspection of individual profiles revealed that both ProYouth OZ Peers participants who completed the post-intervention survey showed a decrease in disordered eating compared with only one of the six completers in ProYouth OZ. Conclusion: Findings highlight the challenges of trialling Internet-based eating disorder prevention programs in the community. The study identified a large group of emerging adults with eating disorders who were interested in an Internet-based program, suggesting a high level of unmet need. Future research on synchronous peer-to-peer support in Internet-based prevention for eating disorders is warranted. Further studies are required to identify optimal strategies for reaching this population (e.g., online vs. offline) and evaluating the effectiveness of a range of strategies for promoting engagement. Finally, there is an urgent need to develop innovative widely accessible interventions for individuals who experience clinically relevant eating disorder symptomatology but may not be ready or able to seek professional face-to-face treatment. Trial registration: ACTRN12615001250527, Registered 16 November 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615001250527.
... These necessary steps, however, require a clear agenda and corresponding funding, which we formulated for Europe in 2016. 7 In the UK, a report by the All-Party Parliamentary Group on Eating Disorders called for action to break the vicious cycle of stigma and underfunding of research into eating disorders. Colleagues from Australia and the UK have also highlighted the need for a joined-up research agenda on eating disorders, to match increasing service demand among young people during the pandemic, with appropriately funded innovative clinical research. ...
... An inexpensive, easily disseminated intervention might reduce ED onset among those at highest risk. (Schmidt et al., 2016) In a random student sample, 30% have eating disorder symptoms or weight concerns. (Bruch, 1974 ...
... Eating disorders (EDs) are highly distinctive psychiatric disorders characterized by severe and persistent disturbance in eating behaviors (American Psychiatric Association, 2013). EDs are associated with a wide variety of psychiatric and physical problems, and present high rates of persistence and recurrence, predominantly among adolescent and young adult women of Western societies (Ágh et al., 2016;Schmidt et al., 2016). Given the detrimental clinical and social impact of EDs, it is crucial to identify the factors that may contribute to their development and maintenance. ...
Article
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Objective Research has supported a link between insecure attachment and eating disorders (EDs); however, little is known about how this influence is exerted in young female EDs patients. This study tested, for the first time, a multiple mediational model, wherein the four Fairburn’s transdiagnostic mechanisms mediated the relationship between attachment to the mother and ED symptoms.MethodsA total of 101 female young EDs patients aged 15–24 were administered the Inventory of Parent and Peer Attachment, Eating Disorder Inventory-3 and Eating Attitudes Test-26 to assess attachment, the four transdiagnostic maintaining mechanisms and ED symptoms, respectively.ResultsComparison analyses showed that there were no significant differences between the diagnostic groups in terms of attachment and the transdiagnostic variables. Multiple mediational analyses indicated that low self-esteem and clinical perfectionism were significant mediators between insecure attachment to the mother and ED symptoms, while controlling for depressive symptoms.Conclusion These findings suggest that the distal risk influence of insecure attachment to the mother in the development of ED symptoms might be explained by low self-esteem and high clinical perfectionism, controlling for depressive symptoms. Further investigation into the efficacy of cognitive-behavioral treatments targeting insecure attachment representations for young EDs patients is recommended.
... Eating disorders (EDs) are highly prevalent, disabling, and potentially fatal psychiatric illnesses characterized by abnormal eating and weight disturbances [1,2]. They are etiologically complex and multifactorial in nature, often leading to severe psychological and somatic complications [3][4][5][6], marked functional impairments [7][8][9], and poor quality of life and overall prognosis [10][11][12]. ...
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Eating disorders (EDs) are serious, life-threatening psychiatric conditions associated with physical and psychosocial impairments, as well as high morbidity and mortality. Given the chronic refractory nature of EDs and the paucity of evidence-based treatments, there is a pressing need to identify novel approaches for this population. The noncompetitive N-methyl-D-aspartate receptor (NMDAr) antagonist, ketamine, has recently been approved for treatment-resistant depression, which exhibits rapid and robust antidepressant effects, particularly among clinical non-responders. It is now being investigated for several new indications, including obsessive-compulsive, post-traumatic , and substance use disorder; and shows transdiagnostic potential for EDs. As such, the aim of this review is to examine contemporary findings on the treatment of EDs with ketamine, whether used as a primary, adjunctive, or combination pharmacotherapy. Avenues for future research are also discussed. Overall, results are encouraging and point to therapeutic value, yet are limited to case series and reports principally on anorexia nervosa. Further empirical work is thus needed to explore and establish ketamine efficacy for EDs, and to inform targeted treatment strategies.
... Anorexia nervosa (AN) is a severe eating disorder marked by emotional distress, psychosocial impairment, and physical morbidity (Schmidt et al., 2016). As current treatment options are limited in their effectiveness (Berends, Boonstra, & van Elburg, 2018;Murray, Quintana, Loeb, Griffiths, & Le Grange, 2019), learning more about the factors that are associated with treatment outcome of AN may facilitate intervention development. ...
Article
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Objective: Satisfaction with normative life domains has been proposed as an important factor in the persistence of anorexia nervosa (AN). Initial evidence from a cross-sectional study indicated that individuals with AN reported lower satisfaction with normative life domains than individuals without an eating disorder. As an important next step in understanding causal relations, the present study used a longitudinal design to examine whether an improvement in AN symptoms is paralleled by an increase in satisfaction with normative life domains from baseline to follow-up and whether relatively low satisfaction with normative life domains at baseline is related to less improvement in AN symptoms. Methods: During baseline and at 1-year follow-up, adolescents with AN (N = 69) completed the Brief Multidimensional Students' Life Satisfaction Scale to measure satisfaction with normative life domains (e.g., friendships, school experience). Furthermore, eating disorder symptoms and BMI were measured. Results: Improvement in eating disorder symptoms, but not in BMI, was paralleled by an increase in satisfaction with normative life domains. Relatively low satisfaction with normative life domains at baseline was not prospectively related to less improvement in eating disorder symptoms or BMI at follow-up. Discussion: Our findings provide initial evidence that satisfaction with normative life domains is a malleable factor which fluctuates with symptom severity in AN. The results of this exploratory study point to the relevance of examining whether targeting satisfactory engagement with specific life domains optimizes treatment effectiveness. Public significance: We explored whether an improvement in anorexia nervosa symptoms from start of treatment to 1-year follow-up would be paralleled by an increase in satisfaction with normative life domains. Improvement in eating disorder symptoms (but not BMI) was indeed related to a concurrent increase in satisfaction with normative life domains. These preliminary results point to the promising possibility that targeting satisfactory engagement with specific life domains may potentially enhance treatment effectiveness.
... Eating disorders (EDs) are highly prevalent, disabling, and potentially fatal psychiatric illnesses characterized by abnormal eating and weight disturbances [1,2]. They are etiologically complex and multifactorial in nature, often leading to severe psychological and somatic complications [3][4][5][6], marked functional impairment [7][8][9], and poor quality of life and overall prognosis [10][11][12]. ...
Article
Full-text available
Eating disorders (EDs) are serious, life-threatening psychiatric conditions associated with physical and psychosocial impairment, as well as high morbidity and mortality. Given the chronic refractory nature of EDs and the paucity of evidence-based treatments, there is a pressing need to identify novel approaches for this population. The noncompetitive N-methyl-D-aspartate receptor (NMDAr) antagonist, ketamine, has recently been approved for treatment-resistant depression, exerting rapid and robust antidepressant effects. It is now being investigated for several new indications, including obsessive–compulsive, post-traumatic, and substance use disorder, and shows transdiagnostic potential for EDs, particularly among clinical nonresponders. Hence, the aim of this review is to examine contemporary findings on the treatment of EDs with ketamine, whether used as a primary, adjunctive, or combination psychopharmacotherapy. Avenues for future research are also discussed. Overall, results are encouraging and point to therapeutic value; however, are limited to case series and reports on anorexia nervosa. Further empirical research is thus needed to explore ketamine efficacy across ED subgroups, establish safety profiles and optimize dosing, and develop theory-driven, targeted treatment strategies at the individual patient level.
... As mentioned above, the prevalence of BED in many regions is unknown 15 . Lacking data and awareness regarding epidemiology of BED and the burden of disease in people with BED is problematic for many reasons 218 , not least because eating disorder research in general is grossly under-funded, partly due to the neglect of the effect of eating disorders on the individual and society 15,218,219 . ...
Article
Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018–2020 is estimated to be 0.6–1.8% in adult women and 0.3–0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first-line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence-based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics. Binge eating disorder is an eating disorder that is characterized by loss of control of eating behaviour and episodes of eating very large amounts of food. This Primer discusses the epidemiology, mechanisms, diagnosis and treatment of binge eating disorder.
... Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition characterized by anomalies in two domains: social interactions and communication, and restricted/repetitive patterns of behaviors (American Psychiatric Association [APA], 2013). Cognitive-behavioral processes (e.g., central coherence, set shifting) associated with autism have further been linked with eating disorders (EDs) (Huke et al., 2013): life-threatening psychiatric conditions that affect psychological, physical and social well-being (American Psychiatric Association [APA], 2013; Schmidt et al., 2016). As such, research has established several commonalities in underlying cognitive and neural phenotypes in autism and anorexia nervosa (AN) (characterized by restrictive food intake, disproportionate fear of weight gain and weight and shape concerns; American Psychiatric Association [APA], 2013; Westwood and Tchanturia, 2017). ...
... EDs are serious psychological illnesses, and their typical prodrome (symptoms that indicate the future onset of a disorder that are also a feature of the disorder) of body dissatisfaction and dietary restriction 2 emerges throughout adolescence. 3 Clinical EDs are associated with significant under or overweight and physical complications, 4 poor quality of life, social adversity, 5 and significant care needs. 6 Contemporary models of EDs suggest that the ways individuals respond to risks and rewards may be perpetuating factors for EDs. ...
Article
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Objective: Differences in decision-making under conditions of risk have been observed cross-sectionally in clinical groups of people with eating disorders but have never been studied longitudinally or in large cohorts. We investigated whether responses on the Cambridge Gambling Task (CGT), measured in the Millennium Cohort Study in childhood, would predict prodromal eating pathology in adolescence. Method: Regression models were built to explore relationships between CGT variables at age 11 years and prodromal eating pathology (body dissatisfaction, intention to lose weight, dietary restriction, significant under/overweight, and excessive exercise) at 14 years. Results: In 11,303 boys and girls, those with better quality decision-making were 34% less likely to show an intention to lose weight (b = -0.40, odds ratio [OR] = 0.66, p < 0.05) and 34% less likely to be overweight (b = -0.41, relative risk ratio [RRR] = 0.66, p < 0.05). Those with higher risk-taking were 58% more likely to report dietary restriction (b = 0.45, OR = 1.58, p < 0.05) and 46% more likely to report excessive exercise (b = 0.38, OR = 1.46, p < 0.05). In the complete-cases sample, higher risk-adjustment scores were associated with a 47% increased risk of underweight (b = 0.39, RRR = 1.47, p < 0.05), and better quality of decision-making was associated with a 46% lower risk of overweight (b = -0.60, RRR = 0.54, p < 0.05). Conclusion: Disadvantageous decision-making in childhood may predict prodromal eating pathology in adolescence and might represent a prevention target.
Article
Objective Little research has investigated variables affecting the relationship between weight- or shape-related bullying (WSB) and specific forms of disordered eating in adolescence. This study aimed to examine the relationship between WSB and eating disorder behaviors in Australian adolescents, and whether this relationship was moderated by body image attitudes. Method Data were used from the first wave of the EveryBODY study, a survey of body image concerns and eating disorders in a large representative sample of Australian adolescents (N = 573), aged 11–19 years. Participants completed an online survey with measures of WSB frequency, body image attitudes (drives for thinness, leanness, and muscularity), and disordered eating behaviors. Results Results indicated that frequency of WSB was positively associated with purging and muscularity-oriented behavior (MOB), but not dietary restriction, binge eating, or compulsive exercise. The relationship between WSB and MOB was moderated by drive for muscularity, such that victimization frequency was positively associated with MOB for those with high, but not low, desire to attain a muscular physique. Discussion Findings indicate that WSB is positively associated with purging and MOB but not other eating disorder behaviors, and that drive for muscularity moderates its effect on some behaviors. Understanding these relationships will be important in implementing tailored interventions for adolescents based on screening for victimization experiences and specific body image attitudes.
Article
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Binge eating is increasingly prevalent among adolescents and young adults and can have a lasting harmful impact on mental and physical health. Mechanistic insights suggest that aberrant reward-learning and biased cognitive processing may be involved in the aetiology of binge eating. We therefore investigated whether recently developed approaches to catalyse brief interventions by putatively updating maladaptive memory could also boost the effects of cognitive bias modification training on binge eating behaviour. A non-treatment-seeking sample of 90 binge eating young adults were evenly randomised to undergo either selective food response inhibition training, or sham training following binge memory reactivation. A third group received training without binge memory reactivation. Laboratory measures of reactivity and biased responses to food cues were assessed pre-post intervention and bingeing behaviour and disordered eating assessed up to 9 months post-intervention. The protocol was pre-registered at https://osf.io/82c4r/. We found limited evidence of premorbid biased processing in lab-assessed measures of cognitive biases to self-selected images of typical binge foods. Accordingly, there was little evidence of CBM reducing these biases and this was not boosted by prior ‘reactivation’ of binge food reward memories. No group differences were observed on long-term bingeing behaviour, caloric consumption or disordered eating symptomatology. These findings align with recent studies showing limited impact of selective inhibition training on binge eating and do not permit conclusions regarding the utility of retrieval-dependent memory ‘update’ mechanisms as a treatment catalyst for response inhibition training.
Article
A substantial proportion of adults with eating disorders are parents. Studies suggest these parents may experience a range of parenting challenges, and their children may be at an increased risk for the development of eating disorders themselves. With parenting practices being one potential environmental mechanism for the intergenerational transmission of eating disorders, we systematically searched Scopus, Web of Science, PubMed, MEDLINE, PsychINFO, and PsychArticles for controlled studies in which parenting attitudes, behaviours, and parent-child interactions were examined for parents with and without probable eating disorders. 26,512 abstracts were screened, and 167 full-text manuscripts were retrieved, with 33 studies meeting the review inclusion criteria. Studies suggest that parents with eating disorders experience higher levels of parenting stress than control parents, and may on average be more intrusive, less sensitive, and provide less structuring/facilitation in non-feeding interactions with their children. These parents also appear, on average, to experience increased concern about their children's weight, and parent-child mealtime interactions may be problematic and characterised by high levels of conflict. Suggestions for future research are made with a view to enhancing understandings of the intergenerational transmission of eating disorders, which may lead to the identification of intervention targets for parents with eating disorders and their children.
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National Eating Disorders Association conducts a NEDAwareness week every year, during which it publishes content on social media and news aimed to raise awareness of eating disorders. Measuring the impact of these actions is vital for maximizing the effectiveness of such interventions. This study is an effort to empirically measure the change in behavior of users who engage with NEDAwareness content, and compare the detected changes between campaigns in two different years. We analyze a total of 35,895 tweets generated during two campaigns of NEDAwareness campaigns in 2019 and 2020. In order to assess the reach of each campaign, we consider the users participating in the campaigns and their number of followers, as well as retweeting engagement. We use the Linguistic Inquiry and Word Count (LIWC) text modeling and causal impact analysis in order to gauge the change in self-expression of users who have interacted with the NEDAwareness content, compared to a baseline group of users. We further enrich our understanding of the users by extracting gender information from their display names. We find that, despite large media corporations (such as MTV and Teen Vogue) participating in the campaign, it is governmental and nonprofit accounts who are among the accounts that attract the most retweets. Whereas the most influential accounts were well-connected in 2019, the 2020 campaign saw little retweeting between such accounts, negatively impacting the reach of the material. Both campaigns engaged women at around 40% and men 17%, supporting previous research showing women to be more likely to share their experiences with eating disorders. Further, women were more likely to mention other health topics within the 15 days of the intervention, including pregnancy and abortion, as well as depression and anxiety, and to discuss the developing COVID pandemic in 2020. Despite the positive message of the campaign, we find that the users who have engaged with this content were more likely to mention the linguistic categories concerning anxiety and risk. Thus, we illustrate the complex, gender-specific effects of NEDAwareness online health intervention campaign on the continued self-expression of its audience and provide actionable insights for potential improvement of such public health efforts.
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Purpose The aim of our study was validating Eating Disorder Inventory (EDI) among pregnant women, who are vulnerable to eating disorders (EDs). Methods In 2012–2013, 1146 women (aged 18–47 years) completed a questionnaire including EDI during the first 3 days after delivery. We checked factorial validity of three diagnostic subscales of EDI with confirmative factor analysis and internal validity by Cronbach’s alpha and item-total correlation. We also tested discriminative validity by comparing average of the three subscale of EDI in case of ED and non-ED groups. Results When applying the EDI to pregnant women, it seems necessary to exclude five items on three diagnostic subscales: on the Drive for Thinness subscale, 4 items remain (out of 7); on the Bulimia subscale, 6 items remain (out of 7); the Body Dissatisfaction subscale decreases from 9 to 8 items. Cronbach’s alpha and item-total correlation values meet the requirements defined by Garner et al. The internal consistency of the EDI has proved to be appropriate, indicating that it is a reliable screening tool. Conclusions Thinking, attitudes, and behaviors connected to eating, along with the relation to altering body weight change during pregnancy. Vomiting usually accompanies pregnancy; body weight gain within wide limits is also regarded as normal during pregnancy. These behaviors and changes are not feasible to use for measuring ED symptoms. These aspects cannot be neglected when screening eating disorders in pregnant women. Level of evidence Level IV evidence obtained from multiple time series with or without an intervention.
Thesis
La régulation épigénétique de la méthylation de la lysine 27 de l'histone H3 (H3K27) a été récemment mise en évidence comme une étape clé de la polarisation en macrophages alternatifs de type M2, essentiels pour la réparation cardiaque après un infarctus du myocarde (IDM).Nous avons émis l'hypothèse que l’enzyme épigénétique EZH2, responsable de la méthylation de H3K27, pourrait agir comme un point de contrôle épigénétique au cours de ce processus. Nous démontrons pour la première fois une localisation cytoplasmique ectopique et potentiellement inactive de l'enzyme épigénétique EZH2, lors de la différenciation des monocytes en macrophages M2 in vitro ainsi que dans les macrophages M2 in vivo au cours d'une inflammation cardiaque post-IDM. De plus, nous montrons que l'inhibition pharmacologique d'EZH2, avec le GSK-343, résout la méthylation de H3K27 au niveau du promoteur des gènes bivalents, améliorant ainsi leur expression pour promouvoir les fonctions de réparation des monocytes humains. Conformément à cet effet protecteur, le traitement avec le GSK-343 accélère la résolution inflammatoire cardiaque empêchant l'expansion de la zone lésée et le dysfonctionnement cardiaque post-IDM in vivo.En conclusion, notre étude révèle que la modulation épigénétique des cellules immunitaires infiltrant le coeur peut être prometteuse pour limiter le remodelage cardiaque indésirable post-IDM.
Article
Music therapy (MT) has been used to support people with a variety of eating disorders (EDs), but it is unclear whether there is sufficient and robust evidence from controlled experimental studies. In this article, we report the results of a systematic review that summarises the evidence from published controlled studies where MT has been used to treat people diagnosed with any type of ED. Our results demonstrate that robust evidence concerning the effectiveness of MT for the treatment of EDs is severely lacking. Nonetheless, the evidence described in this paper warrants further investigation especially given that new treatment strategies for EDs are urgently needed. To this end, we offer a set of recommendations for future high-quality experimental studies that can inform the development of effective MT interventions and support for people with EDs.
Article
Background: Eating disorders (EDs) are prevalent in adolescents and young adults, leading to various psychiatric and physical complications that affect the quality of life and even mortality. Objectives: The present study aimed to investigate the mediating role of self-efficacy and self-esteem in the relationship of perfectionism and negative reactivity with EDs. Methods: This descriptive study was performed on 302 students selected from the University of Tehran during 2018 - 2019. The data collection tools were the ED Examination-Questionnaire Short form, Self-esteem Scale, Weight Efficacy Lifestyle Questionnaire‑Short Form, ED Inventory-Perfectionism Scale, and Perth Emotional Reactivity Scale. Pearson’s correlation coefficient and structural equation modeling were used to analyze the data. Results: The results showed that EDs had significant positive correlations with perfectionism (r = 0.4, P = 0.01) and general negative reactivity (r = 0.53, P = 0.01). On the other hand, these disorders had a significant negative correlation with self-esteem (r = -0.48, P = 0.01) and self-efficacy (r = 0.53, P=0.01). Self-esteem had a negative significant relationship with perfectionism (r = -0.12, P = 0.05) and negative reactivity (r = -0.68, P = 0.01). Moreover, self-efficacy had a negative significant relationship with perfectionism (r = -0.28, P = 0.01) and negative reactivity (r = -0.5, P = 0.01). The findings of path analysis showed that self-esteem and self-efficacy played mediating roles in the relationship of negative reactivity and perfectionism with EDs. Negative reactivity directly affected eating pathology (t = 1.27, ß = 0.13) but is not significant. Conclusions: Our findings showed that self-esteem and self-efficacy are protective factors against the negative effects of perfectionism and negative reactivity. Therefore, self-esteem and self-efficacy can be considered as parts of prevention and treatment programs for EDs.
Preprint
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Background: Growing evidence supports the effectiveness of Internet-based prevention programs for eating disorders. Peer-to-peer support has also been identified as a potentially useful component of these programs, but the adjunctive benefit of synchronous peer support has yet to be investigated. ProYouth OZ is an Internet-based prevention program for eating disorders consisting of psychoeducation, a supportive monitoring and feedback system, and synchronous peer support. The current study aimed to undertake an indicated prevention randomised controlled trial to evaluate the effectiveness of ProYouth OZ with and without peer-to-peer support in reducing disordered eating behaviours and attitudes relative to a waitlist control group. Method: In total, 50 young adults (18 to 25 years) with eating disorder symptoms were randomised to one of the three study conditions: (1) ProYouth OZ with peer-to-peer support, (2) ProYouth OZ without peer-to-peer support, and (3) a waitlist control group. Primary and secondary outcomes were assessed at three different time points. Results: Fifteen (30%) of the 50 randomised participants completed the post-intervention assessment. Due to limited outcome data, it was not possible to statistically examine between-group differences on the primary and secondary outcomes from pre- to post-intervention. However, trends in the available data suggested that peer support may be promising and warrants further investigation. Conclusion: Findings highlight the challenges of trialling Internet-based eating disorder prevention programs in the community, including the difficulty in recruiting emerging adults, maintaining program adherence and reducing attrition. Although not eligible for the current trial, the study identified a large group of emerging adults with eating disorders who were interested in an Internet-based program, suggesting a high level of unmet need. Future research on the topic of synchronous peer-to-peer support in Internet-based prevention for eating disorders is warranted. Further studies are required to identify optimal strategies for reaching this population (e.g., online vs offline) and evaluating the effectiveness of a range of strategies for promoting engagement. Finally, there is an urgent need to develop innovative widely accessible interventions for individuals who experience clinically relevant eating disorder symptomatology and choose to access help online but may not be ready or able to seek professional face-to-face treatment. Trial registration: ACTRN12615001250527, Registered 16 November 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615001250527
Article
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Anorexia nervosa (AN) is a disabling, costly and potentially deadly illness. Treatment failure and relapse are common after completing treatment, and a substantial proportion of patients develop severe and enduring AN. The time from AN debut to the treatment initiation is normally unreasonably long. Over the past 20 years there has been empirical support for the efficacy of several treatments for AN. Moreover, outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients. Early intervention improves outcomes and should be a priority for all patients. Outpatient treatment is usually the best format for early intervention, and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable. Inpatient care is more disruptive, more costly, and usually has a longer waiting list than does outpatient care. The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult. The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN. The scientific essentials for outpatient treatment are described, including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated. The following aspects are discussed: early intervention, outpatient treatment of AN, including outpatient psychotherapy for severe and extreme AN, how to determine when outpatient treatment is safe, and when transfer to inpatient healthcare is indicated. Emerging treatments, ethical issues and outstanding research questions are also addressed.
Article
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Purpose This study aims at clarifying the links between sexual violence and disordered eating (DE). Methods In a sample of 12,638 victims of self-reported sexual violence, we analyzed the situation of 546 victims that declared having developed DE. We assessed the characteristics of the assault (age, type of aggression) and the medical consequences (PTSD, depression, suicide attempts, anxiety disorders, etc.). Results DE prevalence was 4.3% in the victim sample. The age of the first assault in DE victims was significantly lower than that of the whole population (12 years vs 16 years for median; p < 0.001). A much higher prevalence of sexual assault consequences was present in victims developing DE with odd ratios (OR) for: self-mutilation (OR = 11.5 [8.29–15.95], p < 0.001); depression (OR = 5.7 [4.81–6.86], p < 0.001); self-medication (OR = 5.3 [3.86–7.19], p < 0.001); suicide attempts (OR = 4.5 [3.59–5.67], p < 0.001); post-traumatic stress disorder (OR = 3.8 [2.99–4.78], p < 0.001); anxiety troubles (OR = 5.2 [4.11–6.47], p < 0.001); alcoholism (OR = 4.0 [2.81–5.58], p < 0.001). Conclusion This study confirms the link between DE and sexual violence, especially in childhood, leading to severe psychological consequences. In this context, DE should be envisaged as a coping strategy accompanying emotional dysregulation due to traumatic events, and be treated as such. Level of evidence Level IV: Evidence obtained from multiple time series analysis such as case studies.
Article
Résumé Les troubles du Comportement Alimentaire (TCA) restrictifs à début précoce constituent un ensemble hétérogène de troubles du comportement alimentaire regroupant d’une part l’anorexie mentale à début pré-pubère et d’autre part les ARFID – Avoidant Restrictive Food Intake Disorders. Par leur survenue à une période critique du développement, les TCA restrictifs de l’enfant entraînent des altérations de la santé physique avec, selon leur durée d’évolution, un impact sur la croissance, la puberté, la minéralisation osseuse, le développement cérébral, ainsi que des altérations du fonctionnement cognitif et psychosocial. Malgré une prévalence élevée, le repérage et la prise en charge des troubles du comportement alimentaire sont souvent retardés. Une meilleure connaissance des troubles, un repérage précoce et une prise en charge pluridisciplinaire à la fois médicale, somatique et pédopsychiatrique, nutritionnelle et psycho-éducative sont nécessaires afin d’améliorer le pronostic et de limiter les impacts physique et psychologique sur le fonctionnement des enfants.
Article
This is the first study to directly examine gender differences in comorbid gambling and eating disorders. We investigated gender differences in current gambling behaviors, gambling severity, gambling-related cognitive distortions, and psychiatric comorbidities in dual-diagnosed participants. Gambling and eating disorders, as well as other psychiatric comorbidities, were assessed using semi-structured diagnostic interviews of 349 treatment-seeking gamblers at a university hospital in São Paulo, Brazil. Forty-three participants (15 men and 28 women) met criteria for concurrent gambling and eating disorders. Women in the larger sample were more likely to have an eating disorder (8.0%) than men (4.3%), X2 = (1, N = 342) = 11.28, p = .001. This subsample (n = 43) also completed self-report measures of gambling behaviours, gambling severity, and cognitive distortions related to gambling. No gender differences were found in any gambling variables, including age of onset, past month gambling behaviors, gambling severity, and cognitive distortions. However, several gender differences were found in their current psychiatric comorbidities. Men were more likely to report alcohol use disorder and compulsive sexual behaviors than women. If replicated, the greater psychopathology observed in men with this dual diagnosis may suggest that gender-specific approaches are warranted in treatment. The present study may help guide future research investigating the comorbidity patterns and gender differences in those experiencing both gambling and eating disorders.
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Background: A long duration of untreated illness (DUI) is an unfavorable prognostic factor in anorexia nervosa (AN) and is associated with chronic illness progression. Although previous preventive measures aimed at reducing DUI and thus improving short- and long-term treatment outcomes have been partially successful, a better understanding of the factors involved in the sensitive phase prior to treatment initiation is needed. To date, there is no validated instrument available to assess these factors specifically for patients with AN. The FABIANA-project (Facilitators and barriers in anorexia nervosa treatment initiation) aims at identifying predictors of the DUI in order to target preventive measures better in the future. As part of this project, the FABIANA-checklist was developed, based on a multi-informant perspective and a multimodal bottom-up approach. The present study focusses on the process of item generation, item selection and psychometric validation of the checklist. Methods: Based upon a previous qualitative study, an initial set of 73 items was generated for the most frequently mentioned facilitators and barriers of treatment initiation in AN. After a process of consensual rating and cognitive pre-testing, the resulting 25-item version of the FABIANA-checklist was provided to a sample of female patients (N = 75), aged ≥ 14 years with AN that underwent their first psychotherapeutic treatment in the last 12 months. After item analysis, dimensionality of the final version of the FABIANA-checklist was tested by Principal Component Analysis (PCA). We evaluated construct validity assuming correlations with related constructs, such as perceived social support (F-SozU), support in the health care system (PACIC-5A), illness perception and coping (BIPQ). Results: We included 54 adult and 21 adolescent patients with AN, aged on average 21.4 years. Average BMI was 15.5 kg/m², age of onset was 19.2 years and average DUI was 2.25 years. After item analysis, 7 items were excluded. The PCA of the 18-item-FABIANA-checklist yielded six components explaining 62.64% of the total variance. Overall internal consistency was acceptable (Cronbach's α = .76) and construct validity was satisfactory for 14 out of 18 items. Two consistent components emerged: "primary care perceived as supportive and competent" (23.33%) and "emotional and practical support from relatives" (9.98%). With regard to the other components, the heterogeneity of the items led to unsatisfactory internal consistency, single item loading and in part ambiguous interpretability. Conclusions: The FABIANA-checklist is a valid instrument to assess factors involved in the process of treatment initiation of patients with AN. Psychometrics and dimensionality testing suggests that experienced emotional and practical support from the primary health care system and close relatives are main components. The results indicate that a differentiated assessment at item level is appropriate. In order to quantify the relative importance of the factors and to derive recommendations on early-intervention approaches, the predictive effect of the FABIANA-items on the DUI will be determined in a subsequent study which will further include the perspective of relatives and primary caregivers. Trial registration Clinical Trials.gov Identifier: NCT03713541: https://clinicaltrials.gov/ct2/show/NCT03713541 .
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Background Both eating disorders and excessive internet use represent significant health issues for contemporary adolescents. Yet, the link between them has seldom been investigated. We aim to study this association through their common underlying psychological factors: internalising problems and externalising problems. Methods A representative sample of 7,083 adolescents (M age = 13.48 years; SD age = 1.32; 50.3% girls) from Slovakia was obtained from the Health Behaviour in School-aged Children (HBSC) project in 2018. Study variables included the Excessive Internet Use Scale (EIU) and the Strength and Difficulties Questionnaire (SDQ). Eating disorders symptoms (EDS) were assessed by SCOFF and selected items from the Eating Disorder Screen for Primary Care (ESP). Data were analysed separately for boys and girls with Structural Equation Modelling. Results There was a partial correlation between EDS and EIU ( r = 0.36 for boys and r = 0.29 for girls) after controlling for the internalising and externalising of problems. Internalising and externalising problems were positively associated with EDS, while EIU was only associated with externalising problems. The results were comparable for both genders. Conclusion The study provides evidence that, during adolescence, EDS and EIU are related and have a tendency to occur together. Also, they are related even when controlled for their shared underlying psychological factors, namely the emotional and attentional/behavioural difficulties.
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Objective: Cross-sectional research provides robust evidence that individuals with anorexia nervosa (AN) report higher punishment sensitivity (PS) than individuals without an eating disorder (ED). High PS might interfere with treatment motivation and the ability to learn from experience. The current study took a longitudinal approach to test predictions that follow from the proposed relevance of PS as a factor in the persistence of AN symptoms. More specifically we tested (1) if higher PS at the start of treatment was related to less improvement in ED symptoms after one year, and (2) if a decrease in ED symptoms was associated with a concurrent decrease in PS. Method: Participants were 69 adolescents with a diagnosis of AN at the start of treatment of whom 62 participated again one year later. ED symptom severity and PS were assessed at both time points. Results: Findings showed that (1) higher PS at the start of treatment was related to less improvement in ED symptoms, and (2) an improvement in ED symptoms was related to a decrease in PS. Discussion: These findings are consistent with the proposed relevance of PS in the persistence of AN and suggest that it might be beneficial to address high PS in treatment. Public significance: Consistent with the view that punishment sensitivity (PS) is related to the persistence of anorexia nervosa, high PS at the start of treatment was related to less improvement in eating disorder symptoms in patients with anorexia nervosa. Furthermore, an improvement in eating disorder symptoms was associated with a concurrent decrease in PS, suggesting that PS can be subject to change and may be a relevant target for treatment.
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Psychiatric disorders like eating disorders (EDs) might be underpinned by differences in decision making. However, little previous research has investigated this potential relationship using longitudinal data. This study aimed to understand how components of decision making (delay aversion, risk adjustment, risk taking, quality of decision making and deliberation time) measured by the Cambridge Gambling Task in the United Kingdom’s Millennium Cohort Study (MCS; n = 11,303; female = 50.17%) at age 11 might explain clusters/types of ED prodrome involving body dissatisfaction, intention to lose weight, dietary restraint, excessive exercise and significant under/overweight measured in the MCS at age 14. Latent class analysis revealed two groups within the cohort: a non-prodromal eating pathology group, who were more likely to be of “average” weight, according to the UK90, with minimal disordered attitudes and behaviors in relation to eating and weight; and a second group with prodromal eating pathology, who had more body dissatisfaction, a desire to lose weight, were using dietary restriction and exercise to influence weight and were more likely to be “overweight” according to the UK90. Logistic regression showed that, after adjustment for confounding, higher risk-taking scores were associated with a 60% greater probability of being in the prodromal eating pathology group ( b = 0.47, OR = 1.60, p < 0.01), and higher scores on quality of decision making were associated with a 30% lower probability of being in the prodromal eating pathology group ( b = −0.34, OR = 0.70, p < 0.05). Helping young people to engage in moderate risk taking and improving decision making might reduce the later presence of ED prodromes.
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Purpose This study aims at clarifying the links between sexual violence and eating disorders (EDs). Methods In a sample of 12638 victims of sexual violence, we analyzed the situation of 546 victims that declared having developed ED. We assessed the characteristics of the assault (age, type of aggression) and the medical consequences (PTSD, depression, suicide attempts, anxiety disorders …). Results ED prevalence was 4.3% in the victim sample. The age of the first assault in ED victims was significantly lower than that of the whole population (12y vs 16 y for median; p<0.001). A much higher prevalence of sexual assault consequences was present in victims developing ED with odd ratios (OR) for: self-mutilation (OR = 11.5 [8.29-15.95], p<0.001); depression (OR=5.7 [4.81-6.86], p<0.001); self-medication (OR = 5.3 [3.86-7.19], p<0.001); suicide attempts (OR =4.5 [3.59-5.67], p<0.001); Post-traumatic stress disorder (OR = 3.8 [2.99-4.78], p<0.001) ; anxiety troubles (OR = 5.2 [4.11-6.47], p<0.001); alcoholism (OR =4.0 [2.81-5.58], p<0.001). Conclusion This study confirms the link between ED and sexual violence, especially in childhood, leading to severe psychological consequences. In this context, ED should be envisaged as a coping strategy accompanying emotional dysregulation due to traumatic events, and be treated as such.
Article
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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.
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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.
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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.
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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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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;)
Article
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.
Article
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.