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Pedram P, Patten SB, Bulloch AGM, Williams JVA, Dimitropoulos G. Self-Reported Lifetime History of Eating Disorders and Mortality in the General Population: A Canadian Population Survey with Record Linkage. Nutrients 2021; 13:3333. [PMID: 34684334 PMCID: PMC8538567 DOI: 10.3390/nu13103333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 02/04/2023] Open
Abstract
Eating disorders (EDs) are often reported to have the highest mortality of any mental health disorder. However, this assertion is based on clinical samples, which may provide an inaccurate view of the actual risks in the population. Hence, in the current retrospective cohort study, mortality of self-reported lifetime history of EDs in the general population was explored. The data source was the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), linked to a national mortality database. The survey sample was representative of the Canadian household population (mean age = 43.95 years, 50.9% female). The survey inquired about the history of professionally diagnosed chronic conditions, including EDs. Subsequently, the survey dataset was linked to the national mortality dataset (for the date of death) up to 2017. Cox proportional hazards models were used to explore the effect of EDs on mortality. The unadjusted-hazard ratio (HR) for the lifetime history of an ED was 1.35 (95% CI 0.70-2.58). However, the age/sex-adjusted HR increased to 4.5 (95% CI 2.33-8.84), which was over two times higher than age/sex-adjusted HRs for other mental disorders (schizophrenia/psychosis, mood-disorders, and post-traumatic stress disorder). In conclusion, all-cause mortality of self-reported lifetime history of EDs in the household population was markedly elevated and considerably higher than that of other self-reported disorders. This finding replicates prior findings in a population-representative sample and provides a definitive quantification of increased risk of mortality in EDs, which was previously lacking. Furthermore, it highlights the seriousness of EDs and an urgent need for strategies that may help to improve long-term outcomes.
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Affiliation(s)
- Pardis Pedram
- Department of Psychiatry, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- Mathison Centre for Mental Health Research & Education, Foothills Medical Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (S.B.P.); (A.G.M.B.)
- Hotchkiss Brain Institute, University of Calgary Foothills, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Scott B. Patten
- Mathison Centre for Mental Health Research & Education, Foothills Medical Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (S.B.P.); (A.G.M.B.)
- Hotchkiss Brain Institute, University of Calgary Foothills, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- O’Brien Institute for Public Health, University of Calgary Foothills, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Cuthbertson & Fischer Chair in Pediatric Mental Health, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Andrew G. M. Bulloch
- Mathison Centre for Mental Health Research & Education, Foothills Medical Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (S.B.P.); (A.G.M.B.)
- Hotchkiss Brain Institute, University of Calgary Foothills, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- O’Brien Institute for Public Health, University of Calgary Foothills, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Jeanne V. A. Williams
- Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
| | - Gina Dimitropoulos
- Department of Psychiatry, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- Mathison Centre for Mental Health Research & Education, Foothills Medical Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada; (S.B.P.); (A.G.M.B.)
- Hotchkiss Brain Institute, University of Calgary Foothills, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- O’Brien Institute for Public Health, University of Calgary Foothills, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Faculty of Social Work, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
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202
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Dialectical Behaviour Therapy Improves Emotion Dysregulation Mainly in Binge Eating Disorder and Bulimia Nervosa: A Systematic Review and Meta-Analysis. J Pers Med 2021; 11:jpm11090931. [PMID: 34575707 PMCID: PMC8470932 DOI: 10.3390/jpm11090931] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
Emotion dysregulation is a transdiagnostic phenomenon in Eating Disorders (ED), and Dialectical Behaviour Therapy (DBT) (which was developed for reducing dysregulated emotions in personality disorders) has been employed in patients with ED. This systematic review and meta-analysis investigated whether the effect of DBT was stronger on emotion dysregulation, general psychopathology, and Body Mass Index (BMI) in participants with ED, when compared to a control group (active therapy and waitlist). Eleven studies were identified in a systematic search in accordance with PRISMA guidelines. Most studies included participants with Binge Eating Disorder (BED) (n = 8), some with Bulimia Nervosa (BN) (n = 3), and only one with Anorexia Nervosa (AN). The pooled effect of DBT indicated a greater improvement in Emotion Regulation (ER) (g = −0.69, p = 0.01), depressive symptoms (g = −0.33, p < 0.00001), ED psychopathology (MD = −0.90, p = 0.005), Objective Binge Episodes (OBE) (MD = −0.27, p = 0.003), and BMI (MD = −1.93, p = 0.01) compared to the control group. No improvement was detected in eating ER following DBT (p = 0.41). DBT demonstrated greater efficacy compared with the control group in improving emotion dysregulation, ED psychopathology, and BMI in ED. The limitations included the small number of studies and high variability.
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203
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Coelho JS, Suen J, Marshall S, Burns A, Geller J, Lam PY. Gender differences in symptom presentation and treatment outcome in children and youths with eating disorders. J Eat Disord 2021; 9:113. [PMID: 34526146 PMCID: PMC8441244 DOI: 10.1186/s40337-021-00468-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To address the gaps in the literature examining eating disorders among males and gender minority youths, a prospective study was designed to assess gender differences in eating disorder symptom presentation and outcomes. Muscularity concerns may be particularly relevant for male youths with eating disorders, and were included in assessment of eating disorder symptom presentation. METHODS All cisgender male youths who presented for specialized eating disorder treatment at one of two sites were invited to participate, along with a group of matched cisgender females, and all youths who did not identify with the sex assigned to them at birth. Youths completed measures of eating disorder symptoms, including muscularity concerns, and other psychiatric symptoms at baseline and end of treatment. RESULTS A total of 27 males, 28 females and 6 trans youths took part in the study. At baseline, Kruskal-Wallis tests demonstrated that trans youths reported higher scores than cisgender male and female youths on measures of eating pathology (Eating disorder examination-questionnaire (EDE-Q) and the body fat subscale of the male body attitudes scale (MBAS)). These analyses demonstrated that there were no differences between cisgender male and female youths on eating disorder symptoms at baseline. However, repeated measures ANOVA demonstrated that males had greater decreases in eating pathology at discharge than did females, based on self-reported scores on the EDE-Q, MBAS, and Body Change Inventory. CONCLUSIONS Gender differences in eating pathology appeared at baseline, with trans youths reporting higher levels of eating pathology than cisgender youths, though no differences between cisgender males and females emerged at baseline for eating disorder symptom presentation. Contrary to expectations, there were no gender differences in measures of muscularity concerns. Males demonstrated greater eating disorder symptom improvements than females, suggesting that male adolescents may have better treatment outcomes than females in some domains.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada. .,Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
| | - Janet Suen
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Sheila Marshall
- School of Social Work, University of British Columbia, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada.,Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Alex Burns
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.,Eating Disorders Program, St. Paul's Hospital, Vancouver, BC, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada.,Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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204
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Iwajomo T, Bondy SJ, de Oliveira C, Colton P, Trottier K, Kurdyak P. Excess mortality associated with eating disorders: population-based cohort study. Br J Psychiatry 2021; 219:487-493. [PMID: 33118892 DOI: 10.1192/bjp.2020.197] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Individuals with eating disorders have a high mortality risk. Few population-based studies have estimated this risk in eating disorders other than anorexia nervosa. AIMS To investigate all-cause mortality in a population-based cohort of individuals who received hospital-based care for an eating disorder (anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified) in Ontario, Canada. METHOD We conducted a retrospective cohort study of 19 041 individuals with an eating disorder from 1 January 1990 to 31 December 2013 using administrative healthcare data. The outcome of interest was death. Excess mortality was assessed using standardised mortality ratios (SMRs) and potential years of life lost (PYLL). Cox proportional hazards regression models were used to examine sociodemographic and medical comorbidities associated with greater mortality risk. RESULTS The cohort had 17 108 females (89.9%) and 1933 males (10.1%). The all-cause mortality for the entire cohort was five times higher than expected compared with the Ontario population (SMR = 5.06; 95% CI 4.82-5.30). SMRs were higher for males (SMR = 7.24; 95% CI 6.58-7.96) relative to females (SMR = 4.59; 95% CI 4.34-4.85) overall, and in all age groups in the cohort. For both genders, the cohort PYLL was more than six times higher than the expected PYLL in the Ontario population. CONCLUSIONS Patients with eating disorders diagnosed in hospital settings experience five to seven times higher mortality rates compared with the overall population. There is an urgent need to understand the mortality risk factors to improve health outcomes among individuals with eating disorders.
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Affiliation(s)
- Tomisin Iwajomo
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto; and ICES, Toronto, Ontario, Canada
| | - Susan J Bondy
- ICES, Toronto; and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto; and ICES, Toronto; and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario; Canada
| | - Patricia Colton
- University Health Network, Toronto; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Kathryn Trottier
- University Health Network, Toronto; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto; and ICES, Toronto; and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
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205
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Drakes DH, Fawcett EJ, Rose JP, Carter-Major JC, Fawcett JM. Comorbid obsessive-compulsive disorder in individuals with eating disorders: An epidemiological meta-analysis. J Psychiatr Res 2021; 141:176-191. [PMID: 34216946 DOI: 10.1016/j.jpsychires.2021.06.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/05/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
The present study aimed to provide a precise, meta-analytic estimate of the prevalence of obsessive-compulsive disorder (OCD) amongst those with a current primary eating disorder (ED) diagnosis, and to isolate its predictors. An online search of PubMed and PsycINFO was conducted with a Boolean search phrase incorporating keywords related to OCD, EDs, comorbidity, prevalence, and epidemiology, complemented by references coded from related review articles and contact with experts in the field. Articles were included if they (a) reported an observational study examining current ED diagnoses, (b) used a semi-structured or structured diagnostic interview for OCD and ED diagnosis, (c) applied DSM or ICD criteria, (d) included adolescent or adult samples (age > 12), (e) included patient or community samples, and (f) reported lifetime or current OCD comorbidity. From the 846 articles identified, 35 lifetime and 42 current estimates were calculated. OCD prevalence was extracted from each study for each ED diagnostic category, along with eleven additional potential moderators. Analyses revealed an aggregate lifetime OCD prevalence of 13.9% CI95% [10.4 to 18.1] and current OCD prevalence of 8.7% CI95% [5.8 to 11.8] across EDs. Moderator analyses revealed the prevalence of and risk for OCD in EDs to be greatest in anorexia nervosa binge-eating purging type (ANBP). Further, OCD is most prevalent amongst patient samples than samples recruited from the community.
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Affiliation(s)
- Dalainey H Drakes
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
| | - Emily J Fawcett
- Student Wellness and Counselling Centre, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Julia P Rose
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | | | - Jonathan M Fawcett
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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206
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Paterna A, Alcaraz-Ibáñez M, Fuller-Tyszkiewicz M, Sicilia Á. Internalization of body shape ideals and body dissatisfaction: A systematic review and meta-analysis. Int J Eat Disord 2021; 54:1575-1600. [PMID: 34165215 DOI: 10.1002/eat.23568] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The present meta-analysis summarizes existing evidence on the relationship between the internalization of body shape ideals (IBSI) and body dissatisfaction. METHOD Pooled effect sizes (r) were computed using a random-effects model. The robustness of the results was examined using influence analyses. Potential predictors of effect heterogeneity were examined using subgroup analysis and univariable/multivariable meta-regressions. Publication bias was examined using the three-parameter selection model (3PSM). RESULTS A total of 141 effect-sizes from 78 studies (N = 39,491) were retrieved. Results revealed medium (r = .25; muscular/athletic-ideal internalization) to very large (r = .43, general attractiveness-ideal internalization; and r = .45, thin-ideal internalization) relationships, all these being largely similar in male and female individuals. DISCUSSION IBSI and body dissatisfaction were strongly linked: (a) in younger individuals (general attractiveness-ideal internalization); (b) when IBSI was operationalized in terms of endorsement rather than mere awareness of appearance ideals; (c) in studies of lower methodological quality (muscular/athletic-ideal internalization); and (d) when IBSI was assessed using instruments involving social comparisons. Given the largely cross-sectional nature of data included in this meta-analysis, further testing in prospective and experimental studies is needed to confirm hypotheses about causality of observed associations. Such findings would have impact for prevention and intervention studies.
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Affiliation(s)
- Adrian Paterna
- Department of Education, Health Research Center, University of Almería, Almería, Spain
| | - Manuel Alcaraz-Ibáñez
- Department of Education, Health Research Center, University of Almería, Almería, Spain
| | | | - Álvaro Sicilia
- Department of Education, Health Research Center, University of Almería, Almería, Spain
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207
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Mohamed S, Kramer RSS, Thornborrow T, Pollet TV, Tovée MJ, Cornelissen PL. 3D visualisation of psychometric estimates for the ideal male body. Body Image 2021; 38:295-305. [PMID: 34023808 DOI: 10.1016/j.bodyim.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
Psychological concerns are frequently indexed by psychometric questionnaires but the mental representations that they seek to quantify are difficult to visualise. We used a set of questionnaires designed to measure men's concept of their bodies including: the Drive for Muscularity Scale (DMS; McCreary & Sasse, 2000), the Perceived Sociocultural Pressures Scale (PSPS; Stice, Nemeroff, & Shaw, 1996a), the Body Appreciation Scale (BAS-2; Tylka & Wood-Barcalow, 2015), and the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3; Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004). We combined their use with an interactive 3D modelling programme to allow men to create computer-generated representations of their ideal bodies. We used a principal component analysis to extract those shape components of our participants' CGI ideal bodies that were predicted by the questionnaires and reconstructed the body shapes that these questionnaires were capturing. Moving from the lowest to the highest score on both the DMS and SATAQ corresponded with changes in muscularity, particularly muscle mass and definition. This approach allows us to demonstrate the actual body features that are being captured by a particular questionnaire.
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Affiliation(s)
- Sophie Mohamed
- Department of Clinical Health, Aberdeen Royal Infirmary, Foresterhill Rd, Cornhill Rd, Aberdeen AB25 2ZN, UK
| | - Robin S S Kramer
- School of Psychology, College of Social Science, University of Lincoln, Lincolnshire LN6 7TS, UK
| | - Tracey Thornborrow
- School of Psychology, College of Social Science, University of Lincoln, Lincolnshire LN6 7TS, UK
| | - Thomas V Pollet
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Martin J Tovée
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
| | - Piers L Cornelissen
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
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208
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Compte EJ, Cattle CJ, Lavender JM, Murray SB, Brown TA, Capriotti MR, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR, Nagata JM. Psychometric evaluation of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender gay men and cisgender lesbian women. Body Image 2021; 38:241-250. [PMID: 33962223 PMCID: PMC8635416 DOI: 10.1016/j.bodyim.2021.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 12/19/2022]
Abstract
Despite increasing empirical interest in muscle dysmorphia (MD), a dearth of research has assessed this construct in sexual minority populations. In particular, the psychometric properties of one of the most widely used measures of MD symptoms-the Muscle Dysmorphic Disorder Inventory (MDDI)-have not been evaluated in sexual minority populations despite emerging evidence suggesting differential risk for MD symptoms across sexual orientation groups. In this study, we assessed the psychometric properties of the MDDI in a sample of 715 cisgender gay men and 404 cisgender lesbian women ages 18-50 years who participated in a large-scale national longitudinal cohort study of sexual and gender minority adults. The factor structure of the MDDI was examined in each sample using a two-step, split-sample exploratory and confirmatory factor analytic approach. Exploratory factor analysis supported a three-factor structure in both samples, which were confirmed by confirmatory factor analysis. Moreover, results supported the internal consistency reliability and convergent validity of the MDDI subscales in both samples. Cumulatively, these findings suggest that the MDDI is an appropriate measure of MD symptoms among cisgender gay men and cisgender lesbian women.
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Affiliation(s)
- Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile; Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Metis Foundation, San Antonio, TX, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, CA, USA; San Diego State University Research Foundation, San Diego, CA, USA
| | - Matthew R Capriotti
- Department of Psychology, San José State University, San Jose, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Annesa Flentje
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
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209
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Richson BN, Johnson SN, Swanson TJ, Christensen KA, Forbush KT, Wildes JE. Predicting probable eating disorder case-status in men using the Clinical Impairment Assessment: Evidence for a gender-specific threshold. Eat Behav 2021; 42:101541. [PMID: 34332312 PMCID: PMC10044494 DOI: 10.1016/j.eatbeh.2021.101541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/28/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
The Clinical Impairment Assessment (CIA) is a widely used self-report measure of the psychosocial impairment associated with eating-disorder symptoms. Past studies recommended a global CIA score of 16 to identify clinically significant impairment associated with a probable eating disorder (ED). However, to date, research on the properties of the CIA has been conducted in majority-women samples. Preliminary research on gender differences in CIA scores suggested men with EDs report less impairment on the CIA relative to women with EDs. Thus, the purpose of this study was to test if a different impairment threshold is needed to identify cases of men with EDs. We hypothesized that a lower CIA threshold, relative to that identified in majority-women samples, would most accurately identify men with EDs. Participants (N = 162) were men from our university-based and general community-based ED participant registry who completed the CIA and Eating Disorder Diagnostic Scale. Both precision-recall and receiver operating characteristic curves assessed what CIA global score threshold most accurately identified men with EDs. Both analytic approaches indicated that a CIA global score of 13 best predicted ED case-status in men. Consistent with past research, men with a clinically significant ED appear to report lower impairment on the CIA. Results have implications for screening and assessing for substantial ED-related impairment in men. Additionally, past research using the CIA to identify men with EDs may have under-identified men with clinically significant symptoms.
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Affiliation(s)
| | - Sarah N Johnson
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | | | | | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, USA.
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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210
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Associations between weight/shape overvaluation, sociodemographic features and BMI: 10-year time trends. Eat Weight Disord 2021; 26:2001-2009. [PMID: 33098060 DOI: 10.1007/s40519-020-01046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate the prevalence of overvaluation across sociodemographic features and weight status over time. METHODS The data included sequential cross-sectional surveys with representative samples of the adolescent and adult (15 years or older) population in South Australia. Five surveys that assessed overvaluation were conducted in the years 2005 (n = 3047), 2008 (n = 3034), 2009 (n = 3007), 2015 (n = 3005) and 2016 (n = 3047). Overvaluation was assessed by structured interview based on the Eating Disorder Examination. To examine unique effects of demographic variables on the likelihood to report overvaluation, and also to examine whether this varied as a function of time, a multivariate binary logistic regression was computed. RESULTS Across survey years, participants who were more likely to endorse overvaluation were female (2005: OR 2.85, CI 2.04-3.99; 2008/9: OR 1.74, CI 1.50-2.01; 2015/6: OR 1.54, CI 1.34-1.76), had a BMI > 30 (2005: OR 3.93, CI 1.49-10.34; 2008/9: OR 2.22, CI 1.31-3.78; 2015/6: OR 2.09, CI 1.19-3.67), had left school (2015/6: OR 1.36, CI 1.14-1.63), and lived in the country (2015/6: OR 1.95, CI 1.69-2.24). Being in the oldest age group was protective against endorsing overvaluation in each survey year. There was also a main effect of survey year, with participants in the 2015/6 survey more likely to endorse overvaluation (p < 0.001). CONCLUSIONS Female, young and obese people were more likely to endorse overvaluation; however, the prevalence of overvaluation increased significantly in all sociodemographic and BMI groups in since 2005-2016. EVIDENCE-BASED MEDICINE Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.
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211
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Body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals. Eat Weight Disord 2021; 26:1915-1925. [PMID: 33063287 DOI: 10.1007/s40519-020-01040-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Internalized sociocultural standards of attractiveness are a risk factor repeatedly linked to eating disorders; however, many nonbinary individuals do not conform to these standards. PURPOSE This study investigated the body checking behaviors and eating disorder pathology among nonbinary individuals with androgynous appearance ideals. METHODS Participants (n = 194) completed an online survey assessing body checking behaviors, body appreciation, gender congruence, and eating disorder pathology RESULTS: Body checking predicted eating disorder pathology, and body image significantly improved the model. Gender congruence did not additional variance in predicting eating pathology CONCLUSION: Though gender congruence was not a significant predictor of eating pathology, content analysis revealed unique body behaviors specific to nonbinary individuals' gender identity and gender expression. Clinical implications include expanding perceptions of eating disorder presentation when working with nonbinary individuals with androgynous appearance ideals. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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212
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Perko VL, Forbush KT, Christensen KA, Richson BN, Chapa DAN, Bohrer BK, Griffiths S. Validation of the factor structure of the Eating Pathology Symptoms Inventory in an international sample of sexual minority men. Eat Behav 2021; 42:101511. [PMID: 34004456 PMCID: PMC10042082 DOI: 10.1016/j.eatbeh.2021.101511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/28/2021] [Accepted: 04/18/2021] [Indexed: 11/29/2022]
Abstract
Sexual minority individuals are at greater risk for the development of eating-disorder (ED) psychopathology. Despite the importance of understanding ED symptoms in sexual minority men, most ED measures were developed and validated in heterosexual, young adult, white women. The psychometric properties of ED measures in diverse populations remain largely unknown. The purpose of this study was to test: 1) whether the eight-factor structure of the Eating Pathology Symptoms Inventory (EPSI) replicated in sexual minority men and 2) group-level mean differences between gay and bisexual men on the eight EPSI scales. International participants (N = 722 sexual minority men from 20 countries) were recruited via the Grindr smartphone application. Confirmatory factor analysis (CFA) was completed using a weighted least square mean and variance adjusted estimator. Group differences in eating pathology between gay and bisexual men were tested using independent samples t-tests. The CFA model fit was good on all fit indices (CFI/TLI > 0.90, RMSEA < 0.06). Gay and bisexual men only differed on the EPSI Binge Eating scale. The results of this investigation suggest that the EPSI may be a useful tool for understanding eating pathology in this population. Using psychometrically sound assessment tools for sexual minority men is a vital piece of treatment planning and clinical decision making. The current study fills an important gap in the clinical and research literature by testing the validity and psychometric properties of a commonly used ED measure in sexual minority men.
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Affiliation(s)
- Victoria L Perko
- University of Kansas, Department of Psychology, Lawrence, KS 66045, USA
| | - Kelsie T Forbush
- University of Kansas, Department of Psychology, Lawrence, KS 66045, USA.
| | | | - Brianne N Richson
- University of Kansas, Department of Psychology, Lawrence, KS 66045, USA
| | | | - Brittany K Bohrer
- UC San Diego Health Eating Disorders Center for Treatment and Research, Department of Psychiatry, San Diego, CA 92121, USA
| | - Scott Griffiths
- University of Melbourne, Department of Psychology, Parkville, VIC 3010, Australia
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213
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Donahue JM, Simone M, Scharmer C, Anderson LM, Anderson D. Differential item functioning analysis for the Eating Disorder Examination Questionnaire among heterosexual and sexual minority men. Eat Weight Disord 2021; 26:2071-2076. [PMID: 33025524 PMCID: PMC8021598 DOI: 10.1007/s40519-020-01035-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Sexual minority (SM) men are at a higher risk for eating disorders and related issues, relative to heterosexual men. However, it is currently unknown whether commonly used measures of eating pathology are appropriate to use among diverse groups of men. Determining the unique functioning of existing assessments may help better and more accurately understand eating disorder pathology within this population. The present study examined differences in item endorsement between sexual orientation in the Eating Disorder Examination Questionnaire (EDE-Q) through differential item functioning (DIF). METHODS Heterosexual and SM men (N = 703) completed the EDE-Q and a demographic questionnaire. EDE-Q scores were examined for clinically significant DIF based on participants' self-reported sexual orientation (e.g., heterosexual men vs SM men). RESULTS SM men reported higher EDE-Q symptom composite scores than heterosexual men. DIF was observed for all EDE-Q items relative to the global score; however, only one item met clinical significance (EDE-Q #19; ∆R2 ≥ 0.13). CONCLUSION Results suggest that SM men experience greater levels of ED pathology than heterosexual men. While the EDE-Q is a commonly used measure of eating pathology, findings suggest that sexual orientation bias may impact many items on the EDE-Q. However, results from this study indicated that only one item introduces bias that has clinical implications. Additional research is needed to further explore and replicate this finding among more diverse samples of SM and heterosexual men. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Joseph M Donahue
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, USA.
| | - Melissa Simone
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Christina Scharmer
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, USA
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Drew Anderson
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, USA
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214
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Coelho JS, Suen J, Marshall S, Burns A, Lam PY, Geller J. Parental experiences with their child's eating disorder treatment journey. J Eat Disord 2021; 9:92. [PMID: 34315529 PMCID: PMC8314586 DOI: 10.1186/s40337-021-00449-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/18/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Parents are integral in the treatment of pediatric eating disorders. The current study was conducted to further understand the barriers and facilitators that parents experience in accessing specialized, tertiary level eating disorder treatment for children and adolescents. The goals of the study were to understand the processes leading to diagnosis and treatment, perceived barriers and facilitators to accessing care, and parents' experiences over the course of their child's eating disorder treatment. METHODS Ten parents whose children were admitted to a Canadian tertiary level specialized pediatric eating disorders program took part in an exit interview upon their child's completion of treatment in the program. In-depth semi-structured interviews were combined with a visual timeline. Interpretive induction was performed to generate high-level concepts that emerged from the interviews. RESULTS Five high-level concepts were identified: (1) delays in identifying eating disorder symptoms, (2) challenges in accessing eating disorder services, (3) the right treatment at the right time, (4) emotional impact on parents, and (5) parental expertise and involvement. CONCLUSIONS Several barriers were identified by parents that interfered with treatment, including system-related challenges when accessing specialized eating disorder treatment, concerns about a lack of appropriate mental health support for their child, and difficulties with transitioning between community and tertiary level care. Negative emotions, including guilt and self-blame, were common early in the treatment journey. Themes of parental involvement throughout treatment, and parents taking charge of their child's recovery, emerged across interviews. The results of this study suggest the importance of early identification of eating disorder symptoms, facilitating smoother transitions between levels of care (e.g., community services and hospital-based eating disorder care), and improving clinical decision-making to ensure children and adolescents with eating disorders receive the most appropriate treatment based on their clinical presentation.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H 3N1, Canada. .,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Janet Suen
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H 3N1, Canada
| | - Sheila Marshall
- School of Social Work, University of British Columbia, Vancouver, BC, Canada.,Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Alex Burns
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H 3N1, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Box 150, Vancouver, BC, V6H 3N1, Canada.,Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Eating Disorders Program, St. Paul's Hospital, Vancouver, BC, Canada
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215
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Ganson KT, Rodgers RF, Murray SB, Nagata JM. Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students. J Eat Disord 2021; 9:88. [PMID: 34289904 PMCID: PMC8293526 DOI: 10.1186/s40337-021-00443-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fasting is an unhealthy behavior that has been frequently used as part of weight loss attempts. To date, little research has been conducted to determine the prevalence and substance use and mental health correlates of fasting among college students. Therefore, the aim of this study was to estimate the prevalence and associations between any (≥ 1 time) and regular (≥ 13 times) occurrences of fasting in the past 4 weeks and substance use and mental health correlates among a large sample of college students from 2016 to 2020. METHODS Data from four academic survey years (2016-2020; N = 8255) of the national (USA) Healthy Minds Study were analyzed. Unadjusted prevalence of any and regular fasting by survey year and gender was estimated. Multiple logistic regression analyses were conducted to estimate the associations between any and regular fasting and the demographic (age, body mass index, race/ethnicity, sexual orientation, highest parental education), substance use (cigarette use, marijuana use, other illicit drug use, alcohol use), and mental health (depression, anxiety, eating disorder symptoms, suicidal ideation, non-suicidal self-injury) correlates. RESULTS Any fasting in the past 4 weeks was common among both men (14.77%) and women (18.12%) and significantly increased from 2016 (10.30%) to 2020 (19.81%) only among men. Regular fasting significantly increased among both men and women from 2016 (men: 1.46%; women: 1.79%) to 2020 (men: 3.53%; women: 6.19%). Among men and women, both any and regular fasting in the past 4 weeks were associated with higher odds of all mental health symptoms, including a positive depression, anxiety, and eating disorder screen, suicidal ideation, and non-suicidal self-injury. Among women, but not men, any and regular fasting in the past 4 weeks were associated with higher odds of marijuana use and other illicit drug use (e.g., cocaine, ecstasy). CONCLUSIONS The results from this study underscore both the high and increasing prevalence of fasting among a national sample of college students, as well as the substance use and mental health symptoms associated with this behavior. Healthcare professionals both on and off campus should consider screening for fasting behaviors among college students and provide appropriate intervention when needed.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, 550 16th Street, Box 0110, San Francisco, San Francisco, CA, 94158, USA.
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216
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Tambone R, Poggio G, Pyasik M, Burin D, Dal Monte O, Schintu S, Ciorli T, Lucà L, Semino MV, Doricchi F, Pia L. Changing your body changes your eating attitudes: embodiment of a slim virtual avatar induces avoidance of high-calorie food. Heliyon 2021; 7:e07515. [PMID: 34345726 PMCID: PMC8319483 DOI: 10.1016/j.heliyon.2021.e07515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/18/2021] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
The virtual-reality full-body illusion paradigm has been suggested to not only trigger the illusory ownership of the avatar's body but also the attitudinal and behavioral components stereotypically associated to that kind of virtual body. In the present study, we investigated whether this was true for stereotypes related to body size: body satisfaction and eating control behavior. Healthy participants underwent the full-body illusion paradigm with an avatar having either a larger or a slimmer body than their own, and were assessed for implicit attitudes towards body image and food calorie content at baseline and after each full-body illusion session. Results showed that the illusion emerged regardless of the avatar's body size, whereas the perceived dimension of the own body size changed according to the avatar's body size (i.e., participants felt to be slimmer after embodying their slim avatar and larger after embodying their large avatar). Crucially, we found that implicit attitudes towards food, but not those towards one's own body, were modulated by the size of the virtual body. Compared to baseline, ownership of a slimmer avatar increased the avoidance of high-calorie food, whereas ownership of a larger avatar did not induce changes. Our findings suggest that the illusory feeling of being slimmer drives also the food-related stereotypes associated with that body size, increasing the regulation of eating behaviors.
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Affiliation(s)
- Riccardo Tambone
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Turin, Italy
| | - Giulia Poggio
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Turin, Italy
| | - Maria Pyasik
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Turin, Italy.,NPSY-Lab. VR, Department of Human Sciences, University of Verona, Verona, Italy
| | - Dalila Burin
- Smart-Aging Research Center, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai, Japan
| | - Olga Dal Monte
- Department of Psychology, University of Turin, Turin, Italy.,Department of Psychology, Yale University, New Haven, CT, USA
| | - Selene Schintu
- Department of Psychology, George Washington University, Washington DC, DC, USA
| | - Tommaso Ciorli
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Turin, Italy
| | - Laura Lucà
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Turin, Italy
| | - Maria Vittoria Semino
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Turin, Italy
| | - Fabrizio Doricchi
- Department of Psychology, University of Rome "La Sapienza", Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Lorenzo Pia
- SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Turin, Italy.,NIT (Neuroscience Institute of Turin), Turin, Italy
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217
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The Association Between Autistic Traits and Disordered Eating is Moderated by Sex/Gender and Independent of Anxiety and Depression. J Autism Dev Disord 2021; 51:1866-1879. [PMID: 32852639 PMCID: PMC8124044 DOI: 10.1007/s10803-020-04669-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Previous studies have reported positive correlations between autistic traits and disordered eating, though it is unclear whether the association is moderated by sex/gender or whether it is independent of anxiety or depression. We present the findings of an online survey of 691 participants who completed the Autism Spectrum Quotient (AQ), Hospital Anxiety and Depression Scale (HADS), and Eating Attitudes Test-26 (EAT-26). Following a pre-registered analysis plan, we observed positive correlations between AQ and EAT-26 in males and females, with the association being significantly stronger in females. AQ also remained a significant predictor of EAT-26 when anxiety and depression were controlled for statistically. These findings may be relevant when considering therapeutic interventions in disordered eating populations that exhibit autistic traits.
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218
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Nattiv A, De Souza MJ, Koltun KJ, Misra M, Kussman A, Williams NI, Barrack MT, Kraus E, Joy E, Fredericson M. The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part 1: Definition and Scientific Basis. Clin J Sport Med 2021; 31:335-348. [PMID: 34091537 DOI: 10.1097/jsm.0000000000000946] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
ABSTRACT The Male Athlete Triad is a syndrome of 3 interrelated conditions most common in adolescent and young adult male endurance and weight-class athletes and includes the clinically relevant outcomes of (1) energy deficiency/low energy availability (EA) with or without disordered eating/eating disorders, (2) functional hypothalamic hypogonadism, and (3) osteoporosis or low bone mineral density with or without bone stress injury (BSI). The causal role of low EA in the modulation of reproductive function and skeletal health in the male athlete reinforces the notion that skeletal health and reproductive outcomes are the primary clinical concerns. At present, the specific intermediate subclinical outcomes are less clearly defined in male athletes than those in female athletes and are represented as subtle alterations in the hypothalamic-pituitary-gonadal axis and increased risk for BSI. The degree of energy deficiency/low EA associated with such alterations remains unclear. However, available data suggest a more severe energy deficiency/low EA state is needed to affect reproductive and skeletal health in the Male Athlete Triad than in the Female Athlete Triad. Additional research is needed to further clarify and quantify this association. The Female and Male Athlete Triad Coalition Consensus Statements include evidence statements developed after a roundtable of experts held in conjunction with the American College of Sports Medicine 64th Annual Meeting in Denver, Colorado, in 2017 and are in 2 parts-Part I: Definition and Scientific Basis and Part 2: The Male Athlete Triad: Diagnosis, Treatment, and Return-to-Play. In this first article, we discuss the scientific evidence to support the Male Athlete Triad model.
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Affiliation(s)
- Aurelia Nattiv
- Division of Sports Medicine and Non-Operative Orthopaedics, Departments of Family Medicine and Orthopaedic Surgery, University of California Los Angeles, Los Angeles, California
| | - Mary Jane De Souza
- Department of Kinesiology, Penn State University, University Park, Pennsylvania
| | - Kristen J Koltun
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrea Kussman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | - Nancy I Williams
- Department of Kinesiology, Penn State University, University Park, Pennsylvania
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California; and
| | - Emily Kraus
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | | | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
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219
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Priesterroth L, Grammes J, Clauter M, Kubiak T. Diabetes technologies in people with type 1 diabetes mellitus and disordered eating: A systematic review on continuous subcutaneous insulin infusion, continuous glucose monitoring and automated insulin delivery. Diabet Med 2021; 38:e14581. [PMID: 33826771 DOI: 10.1111/dme.14581] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023]
Abstract
AIMS In this systematic review, we aimed (1) to identify and describe research investigating the use of advanced diabetes technologies (continuous subcutaneous insulin infusion, CSII; continuous glucose monitoring, CGM; automated insulin delivery, AID) in people with type 1 diabetes (T1DM) and disordered eating and (2) to discuss potential (dis)advantages of diabetes technology use in this population, derived from previous research. METHODS We conducted a systematic literature search in two electronic databases for English articles published between 2000 and 2020 addressing eating disorders and/or dysfunctional eating behaviours and diabetes technology use in children, adolescents and adults with T1DM (PROSPERO ID CRD42020160244). RESULTS Of 70 publications initially identified, 17 were included. Overall, evidence on the use of diabetes technologies in people with T1DM and disordered eating is scarce. The majority of the studies reports findings on CSII in people with T1DM and dysfunctional eating behaviours or eating disorders. Findings predominantly stem from observational data and are, in most cases, secondary findings of the respective studies. Providing the greatest flexibility in diabetes management, CSII may have benefits in disordered eating. CGM data may complement the diagnostic process of disordered eating with a physiological indicator of insulin restriction (i.e. time spent in hyperglycaemia). CONCLUSIONS Results on possible (dis)advantages of diabetes technology use in people with T1DM and disordered eating are based on observational data, small pilot trials and anecdotical evidence from case reports. Prospective data from larger samples are needed to reliably determine potential effects of diabetes technology on disordered eating in T1DM.
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Affiliation(s)
- Lilli Priesterroth
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Jennifer Grammes
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Mona Clauter
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
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220
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Taniguchi E. Role of parental confirmation in body dissatisfaction and body change behaviors among college men. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:520-528. [PMID: 31730753 DOI: 10.1080/07448481.2019.1684299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/02/2019] [Accepted: 10/20/2019] [Indexed: 06/10/2023]
Abstract
To examine how the components of confirmation (i.e., acceptance and challenge) from mother and father have an indirect effect on college men's body dissatisfaction through self-concept, and if body dissatisfaction, in turn, is related to body change behaviors. Participants: College men (N = 237) aged 18-25 from two large universities completed an online survey. Methods: Structural equation modeling was conducted to test hypothesized mediation model. Results: Maternal acceptance had negative indirect effects on body dissatisfaction through self-concept, and body dissatisfaction, in turn, was positively related to body change behaviors. Mother challenge emerged as a near-significant direct and positive predictor of muscularity enhancement behaviors. None of the paternal variables significantly contributed to the model. Conclusions: Mother acceptance may contribute to sons' positive view of self and their appearance, potentially reducing the likelihood of their engagement in body change behaviors. Intervention can target parent-child communication and enhancement of college men's self-concept.
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Affiliation(s)
- Emiko Taniguchi
- Department of Communicology, University of Hawaii at Manoa, Honolulu, Hawaii, USA
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221
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Ganson KT, Murray SB, Nagata JM. Last word: A call to develop specific medical treatment guidelines for adolescent males with eating disorders. Eat Disord 2021; 29:344-350. [PMID: 31414975 DOI: 10.1080/10640266.2019.1652474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Males with eating disorders are underdiagnosed and undertreated, which may be a result of inadequate guidance and training to assess and treat eating disorders for medical professionals. This may be particularly problematic for adolescent males given the focus of eating disorders research and treatment on adolescent females. Furthermore, there is a paucity of research to guide screening, medical treatment, and training of health professions in adolescent males with eating disorders. The development of eating disorders education and training for medical professionals are included in the 21st Century Cures Act, which further emphasizes the opportunity to develop treatment guidelines individualized to male patients. This last word calls for the development of specific medical treatment guidelines for adolescent males with eating disorders.
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Affiliation(s)
- Kyle T Ganson
- School of Social Work, Simmons University, Boston, MA, USA
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
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222
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Aouad P, Hay P, Foroughi N, Cosh SM, Mannan H. Associations Between Defence-Style, Eating Disorder Symptoms, and Quality of Life in Community Sample of Women: A Longitudinal Exploratory Study. Front Psychol 2021; 12:671652. [PMID: 34276493 PMCID: PMC8281956 DOI: 10.3389/fpsyg.2021.671652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/31/2021] [Indexed: 12/27/2022] Open
Abstract
Background and Aim: Eating Disorders (EDs) impact an estimated 15% of the global population and are linked to maladaptive defence-styles (coping strategies) and poorer mental health outcomes. Defence-styles have been grouped into immature, neurotic, and mature behaviours. Studies have yet to examine all three defence-styles in ED symptomatic individuals over an extended period of time. The current study aimed to investigate using converse analysis the relationships between defence-style and ED outcomes over a 5-years period. Methods: Participants (n = 216, mean age 33 years) were recruited through the Women's Eating and Health Literacy study, with the current study examining a 5-years period of two waves (year-4 and year-9). The current study tested associations over time between eating pathology (EDE-Q), psychological distress (K10), mental and physical health related quality of life (M/PHRQoL, SF-12), and defence-style (DSQ-40). Results: Mature, immature and neurotic defence-styles did not significantly change over 5 years. Over the same period, only PHRQoL significantly predicted mature defence-styles having positive effect. Both MHRQoL and PHRQoL significantly predicted immature defence-styles having positive and negative effects, respectively. Psychological distress, PHRQoL and weight concern significantly predicted neurotic defence-styles having positive effects except for psychological distress. PHRQoL, MHRQoL, restraint and eating concern significantly predicted overall eating pathology having positive effects except for PHRQoL and MHRQoL. Conversely, among the defence-style variables, over 5 years, both immature and neurotic defence-styles significantly predicted psychological distress having positive effects, immature and mature defence-styles significantly predicted MHRQoL having negative and positive effects, respectively, while only immature defence-styles significantly predicted overall eating pathology having positive effect. Conclusions: The results of the current study suggest that immaturity and neuroticism but not maturity were the defence-style variables predicting psychological distress over a 5-years period while conversely psychological distress predicted only neurotic defence styles. The findings of the current study may suggest that without intervention, mature, immature and neurotic defence-styles may largely remain immutable to significant shifts over time. Limitations in the current study included limited demographic representation. The current study is anticipated to generate considerations into treatments that could strengthen defence-styles in individuals with increased eating pathology.
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Affiliation(s)
- Phillip Aouad
- InsideOut Institute, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
- School of Psychology, University of New England, Armidale, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Nasim Foroughi
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Suzanne M. Cosh
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Haider Mannan
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
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Beccia AL, Baek J, Austin SB, Jesdale WM, Lapane KL. Eating-related pathology at the intersection of gender identity and expression, sexual orientation, and weight status: An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) of the Growing Up Today Study cohorts. Soc Sci Med 2021; 281:114092. [PMID: 34118689 PMCID: PMC8372301 DOI: 10.1016/j.socscimed.2021.114092] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/23/2021] [Accepted: 05/28/2021] [Indexed: 11/18/2022]
Abstract
The objective of this study was to investigate how gender identity, the overwhelmingly prioritized dimension of social identity/position in eating-related pathology research, intersects with gender expression, sexual orientation, and weight status to structure the social patterning of eating disorders and disordered eating behaviors among young people in the U.S. Data were drawn from the 2010/2011 Growing Up Today Study (GUTS; N = 11,090-13,307). We conducted an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) by nesting participants within social strata defined by intersecting gender identity, gender expression, sexual orientation, and weight status categories in a series of multilevel logistic models for four outcomes (past-year purging, overeating, and binge eating; lifetime eating disorder diagnosis). To illustrate the advantages of intersectional MAIHDA, we compared the results to those from unitary and conventional intersectional analyses. The intersectional MAIHDA revealed a complex social patterning of eating-related pathology characterized by heterogeneity and outcome-specificity. Several multiply marginalized strata (e.g., those including gender nonconforming, sexual minority, and/or larger-bodied girls/women) had disproportionately elevated prevalence, although all estimates were driven by additive effects. Notably, these patterns were obscured within the unitary and conventional intersectional analyses. Future epidemiologic research on eating-related pathology should continue to adopt an intersectional approach through the use of appropriate methodologies.
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Affiliation(s)
- Ariel L Beccia
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA; Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Jonggyu Baek
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - S Bryn Austin
- Division of Adolescent Adult Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
| | - William M Jesdale
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
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224
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Nagata JM, Compte EJ, Cattle CJ, Lavender JM, Brown TA, Murray SB, Flentje A, Capriotti MR, Lubensky ME, Obedin-Maliver J, Lunn MR. Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender sexual minority men and women. BMC Psychiatry 2021; 21:297. [PMID: 34103034 PMCID: PMC8186088 DOI: 10.1186/s12888-021-03302-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/24/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of elevated body image-related concerns among sexual minority populations, little is known about the degree of muscle dysmorphia (MD) symptoms among sexual minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to examine the nature and severity of MD symptoms in cisgender sexual minority men and women and provide community norms of the MDDI for these populations. METHODS Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people from the United States, were examined. Participants included cisgender gay men (N = 1090), cisgender bisexual plus (bisexual, pansexual, and/or polysexual) men (N = 100), cisgender lesbian women (N = 563), and cisgender bisexual plus women (N = 507). We calculated means, standard deviations (SD), and percentiles for the MDDI total and subscale scores for cisgender sexual minority men and women. We compared MDDI scores by sexual orientation using linear regression models, both unadjusted and adjusted for sociodemographics. RESULTS Overall, the sample was 85.2% White, 3.0% Asian or Pacific Islander, 2.0% Black, 0.5% Native American, 3.9% multiracial, and 6.6% Hispanic/Latino/a. The mean age was 38.6 (SD = 14.3) and 69.4% had a college degree or higher. Means (SD) for the MDDI total score were 27.4 (7.7) for cisgender gay men, 26.4 (6.4) for cisgender bisexual plus men, 24.3 (6.1) for cisgender lesbian women, and 24.6 (5.5) for cisgender bisexual plus women. There were no significant differences in MDDI scores between cisgender gay and bisexual plus men, or between cisgender lesbian women and bisexual plus women in unadjusted or adjusted models. CONCLUSIONS These normative data provide insights into the experience of MD symptoms among cisgender sexual minority men and women and can aid researchers and clinicians in the evaluation of MD symptoms and interpretation of MDDI scores in sexual minority populations.
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Affiliation(s)
- Jason M. Nagata
- grid.266102.10000 0001 2297 6811Department of Pediatrics, University of California, San Francisco, Box 0110, 550 16th Street, 4th Floor, San Francisco, CA 94158 USA
| | - Emilio J. Compte
- grid.440617.00000 0001 2162 5606Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile ,Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Chloe J. Cattle
- grid.266102.10000 0001 2297 6811Department of Pediatrics, University of California, San Francisco, Box 0110, 550 16th Street, 4th Floor, San Francisco, CA 94158 USA
| | - Jason M. Lavender
- grid.265436.00000 0001 0421 5525Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD USA ,The Metis Foundation, San Antonio, TX USA
| | - Tiffany A. Brown
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, San Diego, CA USA ,grid.263081.e0000 0001 0790 1491San Diego State University Research Foundation, San Diego, CA USA
| | - Stuart B. Murray
- grid.42505.360000 0001 2156 6853Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA USA
| | - Annesa Flentje
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA USA ,grid.168010.e0000000419368956The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
| | - Matthew R. Capriotti
- grid.168010.e0000000419368956The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA ,grid.186587.50000 0001 0722 3678Department of Psychology, San José State University, San Jose, CA USA
| | - Micah E. Lubensky
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, University of California, San Francisco, San Francisco, CA USA ,grid.168010.e0000000419368956The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
| | - Juno Obedin-Maliver
- grid.168010.e0000000419368956The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA
| | - Mitchell R. Lunn
- grid.168010.e0000000419368956The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA ,grid.168010.e0000000419368956Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA USA
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225
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Fatt SJ, Mond J, Bussey K, Griffiths S, Murray SB, Lonergan A, Hay P, Pike K, Trompeter N, Mitchison D. Seeing yourself clearly: Self-identification of a body image problem in adolescents with an eating disorder. Early Interv Psychiatry 2021; 15:577-584. [PMID: 32426938 DOI: 10.1111/eip.12987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/15/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
AIM Many adolescents who meet diagnostic criteria for an eating disorder do not self-identify as having a problem and may consequently be less likely to seek help. Extant research investigating self-identification has been limited to specific populations (ie, girls meeting criteria for bulimic-type eating disorders). This study investigated how self-identification varied across sex, eating disorder diagnoses, and the presence of extreme eating behaviours, and how self-identification was related to help-seeking in adolescents. METHODS Participants included 1002 Australian school students (75.5% female, Mage = 15.14 years, SD = 1.40) who met DSM-5 diagnostic criteria for an eating disorder. An online survey assessed self-identification of having a body image problem, as well as sex, eating disorder diagnosis, extreme eating behaviours, help-seeking for a body image problem, and other potential correlates of self-identification (demographics, psychological distress, social function, weight and shape concerns). RESULTS Approximately, 2 in 3 adolescents with an eating disorder self-identified as having a body image problem. Girls who met criteria for a major eating disorder diagnosis, and those engaging in extreme eating behaviours, were more likely to self-identify. When adjusting for covariates, only sex remained significantly associated with self-identification. Adolescents who self-identified were 2.71 times more likely to seek help for a body image problem, adjusting for covariates. CONCLUSIONS Public health strategies ought to promote awareness regarding the different ways that body image problems might manifest among both girls and boys, as well as the potential gravity of such problems. Awareness among parents, teachers and primary care providers should also be considered.
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Affiliation(s)
- Scott J Fatt
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kathleen Pike
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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226
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Examining associations among weight stigma, weight bias internalization, body dissatisfaction, and eating disorder symptoms: Does weight status matter? Body Image 2021; 37:38-49. [PMID: 33556915 PMCID: PMC8187267 DOI: 10.1016/j.bodyim.2021.01.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
The present study aimed to expand weight stigma theoretical models by accounting for central tenets of prominent eating disorder (ED) theories and increasing the generalizability of existing models for individuals across the weight spectrum. College students (Sample 1: N = 1228; Sample 2: N = 1368) completed online surveys assessing stigma and ED symptoms. In each sample, separately, multi-group path analyses tested whether body mass index (BMI) classification (underweight/average weight, overweight, obese) moderated a model wherein weight stigma experiences were sequentially associated with weight bias internalization, body dissatisfaction, and five ED symptoms: binge eating, purging, restricting, excessive exercise, muscle building behaviors. Results supported the assessed model overall and for individuals in each BMI class, separately. Although patterns of associations differed for individuals with different BMIs, these variations were limited. The present findings suggest that the adverse impact of weight stigma on distinct ED symptoms is not limited to individuals with elevated BMIs and that these associations are generally explained by the same mechanisms. Weight stigma interventions that focus on decreasing weight bias internalization and body dissatisfaction are recommended for individuals across the weight spectrum. Further examination of associations between weight stigma and multiple ED symptoms, beyond disinhibited eating, is supported.
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227
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Silén Y, Sipilä PN, Raevuori A, Mustelin L, Marttunen M, Kaprio J, Keski-Rahkonen A. Detection, treatment, and course of eating disorders in Finland: A population-based study of adolescent and young adult females and males. EUROPEAN EATING DISORDERS REVIEW 2021; 29:720-732. [PMID: 34008267 PMCID: PMC8349843 DOI: 10.1002/erv.2838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/22/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022]
Abstract
Objective: We assessed the detection, treatment and outcomes of DSM-5 eating disorders in a nationwide community setting. Method: The FinnTwin12 cohort comprises twins born in 1983–1987 in Finland (n = 5,600), with follow-up starting at age 12. We outline treatment and outcomes of the 127 females and 15 males diagnosed with a lifetime DSM-5 eating disorder in interviews conducted for a subsample (n = 1,347) in their early 20s. Results: Only 45 (32%) of those diagnosed with eating disorder in the interviews had their condition detected in healthcare, and even fewer received treatment (30% of females, 13% of males). Anorexia nervosa (AN), bulimia nervosa, and atypical AN were detected and treated more often than other eating disorders. Five years after disease onset, 41% of those diagnosed had recovered. There were no statistically significant differences in the course of different eating disorders (log-rank p = 0.66) but the outcome was more favourable among males (log-rank p = 0.008). The likelihood of 5-year recovery did not differ between those who had and who had not received treatment (41.1% vs. 40.5%, log-rank p = 0.66). Conclusion: Although eating disorders are common and symptoms are persistent for many, they remain under-diagnosed and under-treated. In real-world settings, effectiveness of provided treatments may be limited.
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Affiliation(s)
- Yasmina Silén
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pyry N Sipilä
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Linda Mustelin
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Mauri Marttunen
- Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Kaprio
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Anna Keski-Rahkonen
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
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228
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Pollina-Pocallet M, Artigues-Barberà E, Tort-Nasarre G, Sol J, Azlor L, Foguet-Boreu Q, Ortega-Bravo M. Self-Perception and Self-Acceptance Are Related to Unhealthy Weight Control Behaviors in Catalan Adolescents: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4976. [PMID: 34067159 PMCID: PMC8125803 DOI: 10.3390/ijerph18094976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 11/28/2022]
Abstract
Adolescence is associated with a higher vulnerability that may result in a high dissatisfaction, the practice of unhealthy weight-control behaviors (UWCB) and, eventually, the onset of body image-related mental disorders. These factors are strongly associated with the social context, so it is important to characterize them in local or regional studies. To assess the relationship between body image and UWCB presence, a cross-sectional study was performed among 2496 schooled adolescents from Lleida (Spain) between 2017 and 2019. Their perceived and desired images were evaluated and compared with the real image in order to obtain the body distortion and the body dissatisfaction and relate them with UWCB. The studied individuals perceived themselves thinner than they actually were, with no differences between males and females. However, differences were found regarding body dissatisfaction, showing that females desired to be thinner, while males desired a more corpulent body image. Furthermore, one out of ten individuals reported UWCB, with higher prevalence among females. UWCB was associated with a desire to be thinner and with distorted body images. It is essential to work on self-perception and self-acceptance in early adolescence from an interdisciplinary perspective at educational, social and health levels to promote health in adolescence.
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Affiliation(s)
- Mercè Pollina-Pocallet
- Bellpuig Primary Care Center, Gerència Territorial Lleida, Catalan Health Institute (ICS), Diputació, 5, 25250 Bellpuig, Lleida, Spain;
| | - Eva Artigues-Barberà
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, Carrer de Montserrat Roig, 25198 Lleida, Spain; (E.A.-B.); (G.T.-N.)
- Catalan Health Institute (ICS), Primary Care Lleida, Rambla Ferran, 44, 25007 Lleida, Spain;
- Research Support Unit Lleida, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Rambla Ferran, 44, 25007 Lleida, Spain;
- Research Group in Therapies in Primary Care (GRETAPS), Rambla Ferran, 44, 25007 Lleida, Spain
| | - Glòria Tort-Nasarre
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, Carrer de Montserrat Roig, 25198 Lleida, Spain; (E.A.-B.); (G.T.-N.)
- Health Education Research Group (GREpS), Faculty of Nursing and Physiotherapy, University of Lleida, Carrer de Montserrat Roig, 25198 Lleida, Spain
- Calaf Primary Care Center, Gerència Territorial Catalunya Central, Catalan Health Institute (ICS), Cta. Llarga 19, 08280 Calaf, Barcelona, Spain
| | - Joaquim Sol
- Catalan Health Institute (ICS), Primary Care Lleida, Rambla Ferran, 44, 25007 Lleida, Spain;
- Research Support Unit Lleida, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Rambla Ferran, 44, 25007 Lleida, Spain;
- Metabolic Physiopathology Group, Department of Experimental Medicine, University of Lleida-IRBLleida, Avinguda Alcalde Rovira Roure, 80, 25198 Lleida, Spain
| | - Laura Azlor
- Research Support Unit Lleida, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Rambla Ferran, 44, 25007 Lleida, Spain;
| | - Quintí Foguet-Boreu
- Central Research Unit, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain;
- Department of Psychiatry, Vic University Hospital, Francesc Pla el Vigatà, 1, 08500 Vic (Barcelona), Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic (Barcelona), Catalonia, Spain
| | - Marta Ortega-Bravo
- Catalan Health Institute (ICS), Primary Care Lleida, Rambla Ferran, 44, 25007 Lleida, Spain;
- Research Support Unit Lleida, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Rambla Ferran, 44, 25007 Lleida, Spain;
- Research Group in Therapies in Primary Care (GRETAPS), Rambla Ferran, 44, 25007 Lleida, Spain
- Faculty of Medicine, University of Lleida, Carrer de Montserrat Roig, 225198 Lleida, Spain
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229
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Mond J, Gorrell S. "Excessive exercise" in eating disorders research: problems of definition and perspective. Eat Weight Disord 2021; 26:1017-1020. [PMID: 33389704 PMCID: PMC8068596 DOI: 10.1007/s40519-020-01075-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia.,School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
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230
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Gewirtz O'Brien JR, Sim L, Narr C, Mattke A, Billings M, Jacobson RM, Lebow J. Addressing Disparities in Adolescent Eating Disorders: A Case Report of Family-Based Treatment in Primary Care. J Pediatr Health Care 2021; 35:320-326. [PMID: 33516619 DOI: 10.1016/j.pedhc.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
Eating disorders typically have a protracted course, marked by significant morbidity. Male adolescents and adolescents of color are at risk of delayed care. Primary care providers are well-positioned to identify eating disorders early and initiate treatment. This case report describes an adaptation of Family-Based Treatment delivered by a primary care provider to an Asian-American male adolescent from an immigrant family with restrictive anorexia nervosa. The adolescent achieved full-weight restoration and remission of his anorexia through treatment in primary care. Embedding eating disorder treatment within primary care could improve detection, engagement, and retention in treatment among young people from diverse backgrounds.
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231
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Reichenberger J, Schnepper R, Arend A, Richard A, Voderholzer U, Naab S, Blechert J. Emotional eating across different eating disorders and the role of body mass, restriction, and binge eating. Int J Eat Disord 2021; 54:773-784. [PMID: 33656204 PMCID: PMC8252459 DOI: 10.1002/eat.23477] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Different subtypes of eating disorders (ED) show dysfunctional eating behaviors such as overeating and/or restriction in response to emotions. Yet, systematic comparisons of all major EDs on emotional eating patterns are lacking. Furthermore, emotional eating correlates with body mass index (BMI), which also differs between EDs and thus confounds this comparison. METHOD Interview-diagnosed female ED patients (n = 204) with restrictive (AN-R) or binge-purge anorexia nervosa (AN-BP), bulimia nervosa (BN), or binge-eating disorder (BED) completed a questionnaire assessing "negative emotional eating" (sadness, anger, anxiety) and "happiness eating." ED groups were compared to BMI-matched healthy controls (HCs; n = 172 ranging from underweight to obesity) to exclude BMI as a confound. RESULTS Within HCs, higher BMI was associated with higher negative emotional eating and lower happiness eating. AN-R reported the lowest degree of negative emotional eating relative to other EDs and BMI-matched HCs, and the highest degree of happiness eating relative to other EDs. The BN and BED groups showed higher negative emotional eating compared to BMI-matched HCs. Patients with AN-BP occupied an intermediate position between AN-R and BN/BED and reported less happiness eating compared to BMI-matched HCs. DISCUSSION Negative emotional and happiness eating patterns differ across EDs. BMI-independent emotional eating patterns distinguish ED subgroups and might be related to the occurrence of binge eating versus restriction. Hence, different types of emotional eating can represent fruitful targets for tailored psychotherapeutic interventions. While BN and BED might be treated with similar approaches, AN-BP and AN-R would need specific treatment modules.
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Affiliation(s)
- Julia Reichenberger
- Department of Psychology, Centre for Cognitive NeuroscienceParis‐Lodron‐University of SalzburgSalzburgAustria
| | - Rebekka Schnepper
- Department of Psychology, Centre for Cognitive NeuroscienceParis‐Lodron‐University of SalzburgSalzburgAustria
| | - Ann‐Kathrin Arend
- Department of Psychology, Centre for Cognitive NeuroscienceParis‐Lodron‐University of SalzburgSalzburgAustria
| | | | - Ulrich Voderholzer
- Schoen Clinic RoseneckPrien am ChiemseeGermany
- Department of Psychiatry and PsychotherapyUniversity Hospital of the LMU MunichMunichGermany
- Department of Psychiatry and PsychotherapyUniversity Hospital FreiburgFreiburgGermany
| | - Silke Naab
- Schoen Clinic RoseneckPrien am ChiemseeGermany
| | - Jens Blechert
- Department of Psychology, Centre for Cognitive NeuroscienceParis‐Lodron‐University of SalzburgSalzburgAustria
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232
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Convertino AD, Brady JP, Grunewald W, Blashill AJ. Intimate partner violence and muscularity-building behavior in latino sexual minority men. Eat Disord 2021; 29:245-259. [PMID: 33734948 DOI: 10.1080/10640266.2021.1891371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Intimate partner violence (IPV) has been associated with increased prevalence of eating disorders. In men, disordered eating is often related to the muscularized ideal. Sexual minority men (SMM; e.g., gay, bisexual, etc.) are at higher risk for eating disorders and Latino SMM may be at particularly high risk; however, IPV and eating pathology has yet to be examined in this population. Therefore, the aim of this study is to elucidate the association between IPV and muscularity-related dissatisfaction and muscularity-oriented behavior in Latino SMM. Participants were 81 Latino SMM. Thirty participants (37% of the sample) met the cutoff score for experiencing IPV in the past month. In bivariate analyses, IPV was associated with muscularity-oriented behavior, but not muscularity-related dissatisfaction. In multivariable analyses, IPV was negatively associated with muscularity-related dissatisfaction with a small effect size and positively associated with muscularity-oriented behavior with a large effect size. It may be that SMM engage in muscle building behavior to increase self-esteem, regulate affect, or better physically protect themselves from their abusive partner. Future research should investigate motivation for muscle building behavior in individuals experiencing IPV.
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Affiliation(s)
- Alexandra D Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - John P Brady
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - William Grunewald
- Department of Psychology, San Diego State University, College of Sciences, San Diego, California, USA
| | - Aaron J Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA.,Department of Psychology, San Diego State University, College of Sciences, San Diego, California, USA
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233
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Frederick D, Gillespie BJ, Lever J, Berardi V, Garcia JR. Sexual Practices and Satisfaction among Gay and Heterosexual Men in Romantic Relationships: A Comparison Using Coarsened Exact Matching in a U.S. National Sample. JOURNAL OF SEX RESEARCH 2021; 58:545-559. [PMID: 33428466 DOI: 10.1080/00224499.2020.1861424] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Gay men are underrepresented in research on sexual satisfaction. We examined sexual satisfaction and over 50 sexual practices in an online U.S. national survey of men in relationships. Coarsened exact matching created comparable samples of heterosexual (n = 3527) and gay (n = 452) men on six demographic factors, including relationship length. Results identified many similarities between the groups, including sexual frequency, orgasm frequency, duration of sex, and sexual satisfaction. The majority of heterosexual and gay men expressed physical or emotional affection during their last sexual encounter, reporting that they or their partner said "I love you" (66%; 57%) and engaged in deep kissing (69%; 75%) or gentle kissing (82%; 72%). Heterosexual men were less likely than gay men to usually-always receive (27%; 61%) or give (37%; 68%) oral sex when intimate in the past month; were less likely to view pornography with their partner (35%; 61%); but were more likely to give their partner massages in the past year to improve their sex lives (71%; 58%). Number of sexual communication behaviors was a strong predictor of sexual satisfaction, particularly for gay men (β =.36). These findings enhance our understanding of heterosexual and gay men's sexual lives.
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Affiliation(s)
- David Frederick
- Crean College of Health and Behavioral Sciences, Chapman University
| | | | - Janet Lever
- Department of Sociology, California State University
| | - Vincent Berardi
- Crean College of Health and Behavioral Sciences, Chapman University
| | - Justin R Garcia
- The Kinsey Institute for Research in Sex, Gender, and Reproduction and Department of Gender Studies, Indiana University
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234
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Reilly EE, Bohrer B, Sullivan D, Essayli JH, Farrell NR, Brown TA, Gorrell S, Anderson LM, Cooper M, C Schreyer C, Olesnycky O, Peros O, Schaumberg K. Registered report: Initial development and validation of the eating disorders safety behavior scale. Int J Eat Disord 2021; 54:660-667. [PMID: 33638564 PMCID: PMC8044048 DOI: 10.1002/eat.23479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/07/2022]
Abstract
Anxiety and eating disorders (EDs) often co-occur, prompting calls to explore anxiety-related maintenance processes in ED samples. Safety behaviors, which function to prevent a feared outcome from occurring or to reduce anxiety associated with a feared stimulus, are observed across anxiety disorders and, along with overt avoidance behaviors, are an important target in treatment. Data suggest that individuals with EDs also engage in safety behaviors. However, no existing assessments provide a comprehensive measure of eating-disorder-specific overt avoidance and safety behaviors. The goal of this Stage 1 Registered Report is to develop a comprehensive self-report measure of ED-specific safety behaviors. In Study 1, we will recruit 50 women with EDs to complete the scale and provide feedback on the response scale. Feedback from these participants will be used to refine the measure. In Study 2, we will evaluate the psychometric properties of the measure in a large sample of women with EDs (n dependent on the size of measurement) and a community sample without current or a history of ED symptoms. We will explore the measure factor structure, known-groups validity by comparing scores from women with EDs to healthy controls, internal consistency, and convergent and divergent validity with other psychological instruments.
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Affiliation(s)
- Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Brittany Bohrer
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Daniel Sullivan
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Jamal H Essayli
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Saint Paul, Minnesota, USA
| | - Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Olenka Olesnycky
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Olivia Peros
- Department of Psychology, Hofstra University, Hempstead, New York, USA
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235
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Coelho JS, Norris ML, Tsai SCE, Wu YJ, Lam PY. Health professionals' familiarity and experience with providing clinical care for pediatric avoidant/restrictive food intake disorder. Int J Eat Disord 2021; 54:587-594. [PMID: 33300613 DOI: 10.1002/eat.23438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The current study explored the experience and familiarity of pediatric health professionals with avoidant/restrictive food intake disorder (ARFID), and assessed the application of diagnostic criteria in a series of clinical vignettes. METHOD Pediatric health professionals were invited to complete an online survey. Data from 93 health professionals from medical and allied health roles who completed the survey were analyzed. RESULTS Respondents providing care for pediatric feeding/eating disorders were more likely to report familiarity with ARFID than those not typically providing care for feeding/eating disorders. Clinicians who had provided care for pediatric ARFID reported more confidence in clinical management of ARFID than did those who had not yet provided care for ARFID, though there were overall relatively low levels of confidence in providing care for ARFID. Respondents to the clinical vignettes were more likely to confer a diagnosis of ARFID when there were symptoms of both psychosocial impairment and weight loss than when there was psychosocial impairment alone. DISCUSSION The results suggest variability in current application of diagnostic criteria for ARFID, low confidence in clinical management of ARFID, and ambiguity in clinicians' judgments regarding whether psychosocial impairment is sufficient to meet a diagnosis of ARFID.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark L Norris
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen C E Tsai
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuwei J Wu
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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236
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Thapliyal P, Conti J, Bandara RSL, Hay P. “It exists”: An exploratory study of treatment experiences in men with eating disorders. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1111/ap.12455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Priyanka Thapliyal
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, New South Wales, Australia,
| | - Janet Conti
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, New South Wales, Australia,
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia,
| | - Ranidu S. L. Bandara
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia,
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, New South Wales, Australia,
- Camden and Campbelltown Hospitals (SWSLHD), Sydney, New South Wales, Australia,
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237
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Psychological Risk Factors for the Development of Restrictive and Bulimic Eating Behaviors: A Polish and Vietnamese Comparison. Nutrients 2021; 13:nu13030910. [PMID: 33799636 PMCID: PMC8001869 DOI: 10.3390/nu13030910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 12/14/2022] Open
Abstract
The aim of this paper is to identify psychological factors which are culture specific or common predictors for restrictive and bulimic behaviors towards eating for young women raised in different cultures. The study included 661 young women from Poland (n = 233) and Vietnam (n = 428). Subjects filled-in the Eating Disorders Inventory (EDI-3) and the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS), and body measurements were collected to calculate anthropometric indices. Women form Vietnam were less satisfied with their appearance than were their Polish peers, but Vietnamese showed a lower level of preoccupation with being overweight and fear of obesity. Intercultural differences indicate that Vietnamese women show greater intensities for psychological variables, connected with restrictive and bulimic eating behaviors, verified in the research model: low self-esteem, personal alienation, interpersonal insecurity, interpersonal alienation, emotional dysregulation, interoceptive deficits, perfectionism and asceticism, and anxiety.
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238
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O'gorman B, Sheffield J, Clarke R, Griffiths S. “Guys don't talk about their bodies”: A qualitative investigation of male body dissatisfaction and sociocultural influences in a sample of 40 Australian males. CLIN PSYCHOL-UK 2021. [DOI: 10.1111/cp.12198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Beth O'gorman
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia,
| | - Jeanie Sheffield
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia,
| | - Ruby Clarke
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia,
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia,
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239
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Gorrell S, Le Grange D, Blalock DV, Mehler PS, Johnson C, Manwaring J, Duffy A, Huston E, McClanahan S, Rienecke RD. Gender identity, race/ethnicity and eating pathology in a treatment-seeking community sample. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2021; 31:77-89. [PMID: 36703863 PMCID: PMC9876537 DOI: 10.1016/j.jbct.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Despite the wide-reaching impact of eating disorders (EDs), less is known about eating pathology among individuals across racial/ethnic groups whose gender identity differs from the binary categorization. Examining ED pathology both across binary and minority-gender groups, and relative to racial/ethnic identification is necessary to inform screening and culturally-sensitive intervention efforts. This study investigated patterns of ED symptomology among youth and adults (N = 13658) who telephoned treatment centers in the United States when seeking clinical support for ED symptoms. Analyses examined data from participants who completed a semi-structured clinical interview. Results indicated that Anorexia nervosa was the most common diagnosis in each gender category and for a majority of race/ethnic groups; Black individuals had elevated rates of binge eating disorder. Compared to females, males were less likely to endorse all ED symptoms (ps < .001); gender minority status was also associated with decreased report of a majority of ED symptoms. Asian and Black individuals were less likely than Whites to endorse most ED symptoms. When compared to Whites, Hispanic/Latinx and Bi/Multi-racial participants did not demonstrate significant differences in presentation across a majority of ED symptoms. Overall findings suggest individuals with female gender and White race may seek treatment from an ED treatment facility with greater frequency than other demographic groups. Noted exceptions include Hispanic/Latinx and Bi/Multi-racial individuals, for whom ED pathology may be represented comparably to Whites. While findings confirm traditional patterns in gender and racial/ethnic representation in EDs, current study findings also underscore that EDs are not culture bound.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA (Emeritus)
| | - Dan V. Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Philip S. Mehler
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA,ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA,University of Colorado School of Medicine, Denver, CO, USA
| | - Craig Johnson
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA
| | - Jamie Manwaring
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA
| | - Emma Huston
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Renee D. Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
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240
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Schaefer LM, Rodgers RF, Thompson JK, Griffiths S. A test of the tripartite influence model of disordered eating among men. Body Image 2021; 36:172-179. [PMID: 33307310 PMCID: PMC7987734 DOI: 10.1016/j.bodyim.2020.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
Studies of the Tripartite Influence Model conducted with female samples suggest that thinness-oriented pressures, internalization, and appearance comparisons may be risk factors for disordered eating. However, limited work has investigated this model among men utilizing measures specifically designed to assess both muscularity- and thinness-oriented processes, which characterize male body image concerns. To address this gap, the current study examined the Tripartite Influence Model of disordered eating among men using a battery of such measures. A convenience sample of 265 male undergraduates completed validated, self-report measures of disordered eating, muscularity- and thinness-oriented appearance pressures, internalization, and appearance comparisons. Path analyses supported a slightly modified version of the Tripartite Influence Model, indicating direct and indirect paths from sociocultural pressures to disordered eating via internalization and appearance comparisons. These results provide support for a version of the Tripartite Influence Model among men. Specifically, muscularity- and thinness-oriented pressures appear to be related to disordered eating among college men via indirect pathways involving thin internalization, muscular internalization, and appearance comparisons. Future work is needed, however, to examine whether the model would generalize to muscularity-oriented disordered eating.
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241
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Dondzilo L, Mills C, Rodgers RF. Attentional engagement, appearance comparisons, and rumination as predictors of body dissatisfaction: Evaluation of a serial mediation model in men. Body Image 2021; 36:180-184. [PMID: 33338781 DOI: 10.1016/j.bodyim.2020.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/14/2020] [Accepted: 11/15/2020] [Indexed: 02/01/2023]
Abstract
Elevated body dissatisfaction is underpinned by an attentional bias towards images portraying appearance ideals. However, very little is known about the specific attentional mechanisms and mediating factors involved in this relationship in the context of male body dissatisfaction. The present study sought to replicate and extend on previous research among women showing that the relationship between attentional engagement bias and body dissatisfaction is sequentially mediated by appearance comparisons and rumination. Seventy undergraduate males completed an attentional task capable of independently assessing biased attentional engagement with images of muscular and non-muscular bodies followed by self-report measures of appearance comparisons, eating disorder-specific rumination, and body dissatisfaction. Results revealed that a heightened tendency to engage in appearance comparisons was associated with increased attentional engagement with muscular bodies, relative to non-muscular bodies. Moreover, a serial mediation analysis revealed that increased attentional engagement with muscular bodies was associated with appearance comparisons, which in turn were associated with eating disorder-specific rumination and, consequently, body dissatisfaction. The current findings replicate among men the serial mediation model of body dissatisfaction previously described among women and implicate heightened attentional engagement with idealized images as a potential pathway to body dissatisfaction in men.
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Affiliation(s)
- Laura Dondzilo
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia.
| | - Caitlin Mills
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, United States; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
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242
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Almeida M, Brown TA, Campos PF, Amaral ACS, de Carvalho PHB. Dissonance-based eating disorder prevention delivered in-person after an online training: A randomized controlled trial for Brazilian men with body dissatisfaction. Int J Eat Disord 2021; 54:293-304. [PMID: 33275811 DOI: 10.1002/eat.23423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Few prevention programs have been developed and empirically evaluated to address eating disorder (ED) and muscle dysmorphia (MD) symptoms in men. Furthermore, new strategies for the broad implementation of available programs are needed. We investigated the acceptability and efficacy of a dissonance-based (DB) intervention for Brazilian undergraduate men with body dissatisfaction to target risk and protective factors for ED and MD symptoms (the Body Project: More Than Muscles) after an online training for facilitators. METHOD Participants were randomized to a two-session DB-intervention (n = 89) or assessment-only control (AOC) (n = 91), and completed validated measures assessing ED and MD risk and protective factors pre-intervention, post-intervention, and at 4- and 24-week follow-up post-intervention. RESULTS Acceptability ratings were highly favorable. Regarding efficacy, the DB condition demonstrated significantly greater decreases in ED and MD risk factors compared to AOC from pre-intervention to 4-week (p-values <.05, between-condition Cohen's d = 0.35-1.10) and 24-week follow-up (p-values <.05, between-condition Cohen's d = 0.33-0.78). Results at post-intervention were not significant, with the exception that body appreciation showed significantly greater improvements in the DB condition (post-intervention: p < .01, between-condition Cohen's d = 0.40; 4-week: p < .001, between-condition Cohen's d = 0.80; and 24-week follow-up: p < .001, between-condition Cohen's d = 0.58). DISCUSSION Results support the acceptability and efficacy of a DB-intervention delivered in-person after an online training for facilitators up to 24-week follow-up in Brazilian men.
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Affiliation(s)
- Maurício Almeida
- NICTA, Body Image and Eating Disorder Research Group, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Tiffany A Brown
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,San Diego State University Research Foundation, San Diego, California, USA
| | - Priscila Figueiredo Campos
- NICTA, Body Image and Eating Disorder Research Group, Federal University of Juiz de Fora, Governador Valadares, Brazil
| | - Ana Carolina Soares Amaral
- Federal Institute of Education, Science and Technology of Southeast of Minas Gerais - Campus Barbacena, Barbacena, Brazil
| | - Pedro Henrique Berbert de Carvalho
- NICTA, Body Image and Eating Disorder Research Group, Federal University of Juiz de Fora, Governador Valadares, Brazil.,AMBULIM, Eating Disorders Program, Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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243
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Gonzales M, Blashill AJ. Ethnic/racial and gender differences in body image disorders among a diverse sample of sexual minority U.S. adults. Body Image 2021; 36:64-73. [PMID: 33171428 PMCID: PMC7987714 DOI: 10.1016/j.bodyim.2020.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022]
Abstract
This study assessed the occurrence of probable eating disorders (EDs), ED symptoms, probable body dysmorphic disorder (BDD), BDD symptoms, drive for muscularity, and appearance and performance enhancement drug (APED) misuse, in an ethnically/racially diverse sample of 962 cisgender sexual minority (SM) individuals in the United States, aged 18-30 years old. The overall occurrence of probable ED, probable BDD, and APED misuse in the current sample was 32.7 %, 50.9 %, and 30.6 %, respectively. With respect to ethnicity/race, Hispanic SMs reported the highest rates of EDs, BDD, APED misuse, and drive for muscularity, and may therefore be particularly at risk for developing body image disorders (BIDs). With respect to gender, SM men reported significantly greater drive for muscularity and APED misuse compared to SM women, while SM women reported significantly higher occurrence of probable ED and ED symptoms. The occurrence of EDs, BDD, and APED misuse were higher among SMs in this sample compared to previous rates found among heterosexual samples, suggesting that SMs, regardless of gender and ethnicity/race, are vulnerable to experiencing BIDs and APED misuse. Future research is needed to identify the mechanisms that place SMs at (increased) risk for BIDs, which will aid prevention/intervention development.
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Affiliation(s)
- Manuel Gonzales
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego CA 92182-4611, United States.
| | - Aaron J Blashill
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, United States; Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego CA 92182-4611, United States.
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244
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Smith AJ, Farstad SM, von Ranson KM. Self-reported eating disorder psychopathology prevalence in community-based female and male Albertans: Gender and age group comparisons. Int J Eat Disord 2021; 54:438-444. [PMID: 33296105 DOI: 10.1002/eat.23434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We describe and compare eating disorder (ED) psychopathology prevalence in Canadian females and males across five age groups. METHOD This secondary data analysis study used the Eating Disorder Examination Questionnaire (EDE-Q) to assess ED psychopathology in 1,316 Alberta community-based female and male participants, aged 15 to 71. RESULTS Overall, 15.3% of female and 8.2% of male participants reported clinically-significant ED disturbances. Female participants reported greater global ED psychopathology than male participants, except older men and women aged 65-71, who reported similar, relatively low levels of global ED psychopathology. Women aged 65-71 endorsed less global ED psychopathology than younger females. More females than males reported regular binge eating and self-induced vomiting, whereas other ED behaviors were endorsed at similar rates. DISCUSSION This large-scale study, the first involving a Canadian sample, contributes to a small literature on ED psychopathology in community-based samples. The finding that 15% of female and 8% of male Albertans aged 15 to 71 endorsed clinically-significant ED disturbances is concerning; however, women aged 65-71 reported lower ED psychopathology than younger females. Gender and age differences were observed in global ED psychopathology. Routine ED screening of non-clinical adolescents and adults is warranted to permit prevention and early intervention.
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Affiliation(s)
- Alyssa J Smith
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Sarah M Farstad
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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245
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Romano KA, Lipson SK. Dietary restraint patterns and eating disorder help-seeking. Eat Weight Disord 2021; 26:159-168. [PMID: 31853888 DOI: 10.1007/s40519-019-00833-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/10/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Determine whether gender differences exist in associations among central barriers to and facilitators of eating disorder (ED) help-seeking-ED stigma, negative affect, perceived ED treatment need-as a function of individuals' probability of classification within empirically derived groups characterized by different dietary restraint patterns. METHOD As part of the cross-sectional, multi-institute Healthy Bodies Study, women (n = 2215) and men (n = 986) attending three colleges and universities in 2015 completed measures of ED symptoms, affect, and ED help-seeking in an online survey. Structural equation mixture modeling was used to (1) classify women and men, separately, into distinct classes characterized by unique dietary restraint patterns and (2) test associations among the three ED help-seeking barriers and facilitators within each class. RESULTS Five dietary restraint symptoms (food amount limiting attempts, fasting, food avoidance, following food/diet rules, desiring an empty stomach) clustered within four classes among women and three classes among men, which were characterized by qualitative and quantitative similarities and differences. Further, opposite patterns were generally found in associations among the ED help-seeking barriers and facilitators for women versus men as a function of the way dietary restraint symptoms clustered within each class. For example, bivariate associations between worse ED stigma and negative affect relative to greater perceived ED treatment need were both significant only among women in their lowest restraint severity class, whereas these associations were both significant among men in their highest severity class. DISCUSSION These findings can help to increase the reach of ED intervention efforts, including increasing ED help-seeking rates. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Kelly A Romano
- The Virginia Consortium Program in Clinical Psychology, 555 Park Avenue, Norfolk, VA, 23504, USA.
- Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, USA.
| | - Sarah K Lipson
- Department of Health Law Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
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246
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Lewis-Smith H, Garbett KM, Chaudhry A, Uglik-Marucha N, Vitoratou S, Dhillon M, Shroff H, Diedrichs PC. Adaptation and validation of the Eating Disorder Examination-Questionnaire in English among urban Indian adolescents. Int J Eat Disord 2021; 54:187-202. [PMID: 33305881 DOI: 10.1002/eat.23431] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Eating pathology is a salient issue in India, with clinical features reported among adults and adolescents. However, there are currently no validated measures of disordered eating in the Indian context. The present study therefore aimed to validate a culturally appropriate English language version of the Eating Disorder Examination Questionnaire (EDE-Q), a widely used measure, among adolescents in India. METHOD We adapted and examined the factor structure, reliability, and construct validity of the EDE-Q among an urban sample of 1,413 Indian adolescents (mean age = 13 years; 45% girls). RESULTS In contrast to the original four-factor model, exploratory factor analysis identified a two-factor solution for girls and boys, which was verified by confirmatory factor analysis; a "Preoccupation and Control" subscale and a "Weight and Shape Concerns" subscale. The total scale comprised 15 items for girls and 18 items for boys. Test-retest reliability and internal consistency were satisfactory for the girls' and boys' scales (Cronbach's α = .91 for both) and their comprising subscales (αs ≥ .80). Concurrent validity was established through medium-high significant correlations with measures of body image and internalization of appearance ideals. Combining items common to both versions of the scale led to a psychometrically acceptable model which was largely invariant across both genders, thus facilitating gendered comparison. DISCUSSION Findings indicate the reliability and validity of the EDE-Q among English-speaking urban Indian adolescents. This will facilitate further research examining the prevalence and nature of eating pathology among adolescents in India.
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Affiliation(s)
- Helena Lewis-Smith
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Kirsty M Garbett
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | | | | | | | - Megha Dhillon
- Lady Shri Ram College, University of Delhi, New Delhi, India
| | - Hemal Shroff
- Tata Institute of Social Sciences, Mumbai, India
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247
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Diagnostic Agreement between Physicians and a Consultation-Liaison Psychiatry Team at a General Hospital: An Exploratory Study across 20 Years of Referrals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020749. [PMID: 33477280 PMCID: PMC7830763 DOI: 10.3390/ijerph18020749] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022]
Abstract
Consultation-liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000-2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen's kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.
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248
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Gallagher KA, Sonneville KR, Hazzard VM, Carson TL, Needham BL. Evaluating gender bias in an eating disorder risk assessment questionnaire for athletes. Eat Disord 2021; 29:29-41. [PMID: 31079562 DOI: 10.1080/10640266.2019.1613846] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Due to stigma, eating disorders are under-researched, underdiagnosed and undertreated among men. This is particularly pertinent among athletes, as athletic goals are a major risk factor for disordered eating in men. This gender stereotype may be reinforced by eating disorder risk assessment tools that better reflect female symptoms. We examine an eating disorder risk assessment questionnaire in a population of athletes to assess both (1) gender bias in individual items and (2) gender differences on a cognitive and behavioral subscale, identified through a factor analysis. Controlling for eating disorder risk, we found that female gender significantly predicted high risk scores on four items; male gender significantly predicted high risk scores on four other items. We also found that women were more likely to score above the median on a cognitive subscale than men with the same level of eating disorder risk, while men were more likely to score above the median on a behavioral subscale. These results may be applied practically to allow eating disorder risk assessment tools to better capture eating disorder risk independent of gender. These methods may be applied to other questionnaires and other social identities, to expand the scope of eating disorder research and treatment.
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Affiliation(s)
| | | | | | - Traci L Carson
- School of Public Health, University of Michigan , Ann Arbor, MI, USA
| | - Belinda L Needham
- School of Public Health, University of Michigan , Ann Arbor, MI, USA
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249
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Nagata JM, Ganson KT, Cunningham ML, Mitchison D, Lavender JM, Blashill AJ, Gooding HC, Murray SB. Associations between legal performance-enhancing substance use and future cardiovascular disease risk factors in young adults: A prospective cohort study. PLoS One 2020; 15:e0244018. [PMID: 33320903 PMCID: PMC7737961 DOI: 10.1371/journal.pone.0244018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Legal performance-enhancing substances (PES), such as creatine, are commonly used by adolescents and young adults. As PES are mostly unregulated by the US Food and Drug Administration, there has been limited empirical attention devoted to examining their long-term safety and health outcomes. Preliminary studies have demonstrated associations between PES use and severe medical events, including hospitalizations and death. PES could be linked to cardiovascular disease (CVD), the most common cause of mortality in the US, by altering the myocardium, vasculature, or metabolism. The objective of this study was to examine prospective associations between the use of legal PES in young adulthood and CVD risk factors at seven-year follow-up. MATERIALS AND METHODS Nationally representative longitudinal cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves III (2001-2002) and IV (2008), were analyzed. Regression models determined the prospective association between the use of legal PES (e.g. creatine monohydrate) and CVD risk factors (e.g. body mass index, diabetes, hypertension, hyperlipidemia), adjusting for relevant covariates. RESULTS Among the diverse sample of 11,996 male and female participants, no significant differences by PES use in body mass index, diabetes, hypertension, or hyperlipidemia were noted at Wave III. In unadjusted comparisons, legal PES users (versus non-users) were more likely to be White, be male, be college educated, drink alcohol, and engage in weightlifting, exercise, individual sports, team sports, and other strength training. There were no significant prospective associations between legal PES use at Wave III and body mass index, hemoglobin A1c, systolic and diastolic blood pressure, and cholesterol (total, HDL, LDL, triglycerides) deciles at seven-year follow-up (Wave IV), adjusting for demographics, health behaviors, and Wave III CVD risk factors. Similarly, there were no significant prospective associations between legal PES use and diabetes, hypertension, or hyperlipidemia based on objective measures or self-reported medications and diagnoses, adjusting for demographics, health behaviors, and Wave III CVD risk. CONCLUSIONS We do not find evidence for a prospective association between legal PES use and CVD risk factors in young adults over seven years of follow-up, including BMI, diabetes, hypertension, or hyperlipidemia. It should be noted that legal PES use was operationalized dichotomously and as one broad category, which did not account for frequency, amount, or duration of use. Given the lack of regulation and clinical trials data, observational studies can provide much needed data to inform the safety and long-term health associations of legal PES use and, in turn, inform clinical guidance and policy.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Metis Foundation, San Antonio, Texas, United States of America
| | - Aaron J. Blashill
- Department of Psychology, San Diego State University, San Diego, California, United States of America
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, California, United States of America
- San Diego Joint Doctoral Program in Clinical Psychology, University of California, San Diego, California, United States of America
| | - Holly C. Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Stuart B. Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, California, United States of America
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250
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Springmann ML, Svaldi J, Kiegelmann M. Theoretical and Methodological Considerations for Research on Eating Disorders and Gender. Front Psychol 2020; 11:586196. [PMID: 33281684 PMCID: PMC7705215 DOI: 10.3389/fpsyg.2020.586196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/29/2020] [Indexed: 11/13/2022] Open
Abstract
Gender is a relevant factor in the etiology of eating disorders (ED) as evidenced by gender-specific components of disordered eating and by the high risk of ED among transgender individuals, in addition to other factors. However, research on connections between ED and gender identity are limited. Researchers who produce explanatory models, content themselves with faulting the sociocultural ideal of slimness for women, but they fail to grasp the connection between culture, gender and the body and they fall short of integrating this perspective into existing psychological knowledge about ED. Psychological research informed by feminist theory has begun to bridge this gap, but this growing area of research needs to be further developed and should include an understanding of ED in persons with all gender identities. This article expands the discussion of gender and ED, by grounding ED in an understanding of gender itself and by discussing methodological implications of this understanding.
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Affiliation(s)
| | - Jennifer Svaldi
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Mechthild Kiegelmann
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
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