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Wall PL, Fassnacht DB, Fabry E, O'Shea AE, Houlihan C, Mulgrew K, Ali K. Understanding stigma in the context of help-seeking for eating disorders. J Eat Disord 2024; 12:126. [PMID: 39223635 PMCID: PMC11367835 DOI: 10.1186/s40337-024-01086-w] [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: 05/28/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Stigma is a complex construct and its association with help-seeking among those experiencing eating disorders is not well understood. Rates of help-seeking are low for those with eating disorder symptoms and, therefore, determining the role of stigma and shame in this relationship is needed to help inform effective awareness campaigns aimed at improving prognostic outcomes. The current study examined the associations between perceived stigma, self-stigma, shame, and help-seeking behaviour in a community sample of individuals with elevated eating disorder symptoms. METHODS Participants completed an online survey that included measures of stigma and shame as perceived barriers to help-seeking for individuals with eating disorders. Those with elevated eating disorder symptoms and high clinical impairment were included in the study (N = 333). RESULTS Using binary logistic regression models controlling for age and gender, results showed that perceived stigma, self-stigma, and shame predicted 64% of help-seeking behaviour (p = .005). The only significant unique predictor of formal help-seeking was "Being concerned that other people believe eating disorders are not real illnesses". No other stigma or shame items were found to significantly predict help-seeking. CONCLUSIONS The present findings suggest that while stigma plays an important role in help-seeking, it might not be the primary reason preventing individuals with eating disorders from accessing care. The field is encouraged to investigate these factors to promote help-seeking effectively.
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Affiliation(s)
- Prudence L Wall
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia
| | - Daniel B Fassnacht
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Esme Fabry
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Anne E O'Shea
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Catherine Houlihan
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia
| | - Kate Mulgrew
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia
| | - Kathina Ali
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia.
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.
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D’Adamo L, Grammer AC, Rackoff GN, Shah J, Firebaugh ML, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Rates and correlates of study enrolment and use of a chatbot aimed to promote mental health services use for eating disorders following online screening. EUROPEAN EATING DISORDERS REVIEW 2024; 32:748-757. [PMID: 38502605 PMCID: PMC11144085 DOI: 10.1002/erv.3082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE We developed a chatbot aimed to facilitate mental health services use for eating disorders (EDs) and offered the opportunity to enrol in a research study and use the chatbot to all adult respondents to a publicly available online ED screen who screened positive for clinical/subclinical EDs and reported not currently being in treatment. We examined the rates and correlates of enrolment in the study and uptake of the chatbot. METHOD Following screening, eligible respondents (≥18 years, screened positive for a clinical/subclinical ED, not in treatment for an ED) were shown the study opportunity. Chi-square tests and logistic regressions explored differences in demographics, ED symptoms, suicidality, weight, and probable ED diagnoses between those who enroled and engaged with the chatbot versus those who did not. RESULTS 6747 respondents were shown the opportunity (80.0% of all adult screens). 3.0% enroled, of whom 90.2% subsequently used the chatbot. Enrolment and chatbot uptake were more common among respondents aged ≥25 years old versus those aged 18-24 and less common among respondents who reported engaging in regular dietary restriction. CONCLUSIONS Overall enrolment was low, yet uptake was high among those that enroled and did not differ across most demographics and symptom presentations. Future directions include evaluating respondents' attitudes towards treatment-promoting tools and removing barriers to uptake.
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Affiliation(s)
- Laura D’Adamo
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Center for Weight, Eating, and Lifestyle Science (WELL Center) and Department of Psychological and Brain Sciences, Philadelphia, PA, USA
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Gavin N. Rackoff
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C. Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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3
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Liao Z, Birgegård A, Monell E, Borg S, Bulik CM, Mantilla EF. Maladaptive exercise in eating disorders: lifetime and current impact on mental health and treatment seeking. J Eat Disord 2024; 12:86. [PMID: 38915052 PMCID: PMC11194861 DOI: 10.1186/s40337-024-01048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Many patients with eating disorders report exercise as a central symptom of their illness-as a way to compensate for food intake, prevent weight-gain, and/or reduce negative affect. Previous findings show associations between maladaptive exercise and more severe eating disorder pathology, higher risk for relapse, other co-morbid symptoms, and worse treatment outcome. METHODS In this study, we included 8252 participants with eating disorders and investigated associations between maladaptive exercise (both lifetime and current) and ED pathology, illness duration, depression, anxiety, self-harm and suicidal ideation, and treatment seeking patterns in individuals with lifetime maladaptive exercise. Participants were included via the Swedish site of the large global study The Eating Disorders Genetics Initiative (EDGI) and completed measures of both lifetime and current symptomatology. RESULTS Results indicate that lifetime maladaptive exercise is associated with higher prevalence of lifetime depression and anxiety and with patients more often receiving treatment, although these results need to be investigated in future studies. Current maladaptive exercise was associated with more severe ED symptoms, and higher levels of depression, anxiety, obsessive-compulsive traits, and suicidal ideation. CONCLUSIONS Our findings point to the complexities of exercise as an eating disorder symptom and the need for clearly assessing and acknowledging this, as well as tailoring interventions to treat this symptom to achieve sustainable recovery.
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Affiliation(s)
- Zhenxin Liao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden.
| | - Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden
| | - Elin Monell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden
- Stockholm County Council, Stockholms Centrum för ätstörningar, Wollmar Yxkullsgatan 27, Stockholm, 118 50, Sweden
| | - Stina Borg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC, 27599-716, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-716, USA
| | - Emma Forsén Mantilla
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12a, Stockholm, 171 77, Sweden
- The Swedish School of Sport and Health Sciences, GIH, Lidingövägen 1, Box 5626, Stockholm, 114 86, Sweden
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Birgegård A, Isomaa R, Monell E, Bjureberg J. Validation of the eating pathology symptoms inventory (EPSI) in Swedish adolescents. J Eat Disord 2024; 12:68. [PMID: 38802891 PMCID: PMC11129359 DOI: 10.1186/s40337-024-01027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Eating disorders (ED) are associated with symptoms across body image, disordered eating, and exercise-related domains, and while predominantly affecting females, ED in males is also a significant concern. However, popular self-report methods insufficiently capture male presentations. This study aimed (1) to validate the first Swedish translation of the Eating Pathology Symptoms Inventory (EPSI), which was designed to overcome limitations in previous measures, and (2) compare genders gender-specific manifestations of eating pathology, depression, and anxiety in Swedish high-school students. METHODS Participants were 359 high-school students (47% males) aged 17.0 years (range 15-21). RESULTS Confirmatory factor analysis and correlation patterns showed support for the 8-factor structure and convergent validity, but poorer discriminant validity may suggest caution in interpreting single scales as evidence of ED pathology. Gender comparisons were broadly consistent with previous research. CONLUSIONS The Swedish EPSI may be used to asses ED symptoms, but caution is suggested in interpreting some scales in isolation as indicative of ED pathology.
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Affiliation(s)
- Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Rasmus Isomaa
- Wellbeing Services County of Ostrobothnia, Vasa, Finland
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland
| | - Elin Monell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Colton E, Wilson KE, Chong TTJ, Verdejo-Garcia A. Dysfunctional decision-making in binge-eating disorder: A meta-analysis and systematic review. Neurosci Biobehav Rev 2023; 152:105250. [PMID: 37263530 DOI: 10.1016/j.neubiorev.2023.105250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/03/2023]
Abstract
Binge-Eating Disorder (BED) involves anticipatory craving and urges, subjective loss-of-control during binge-eating episodes, and post-feeding psychological distress and guilt. Evidence indicates neurocognitive dysfunctions contribute to BED onset, maintenance, and treatment response. However, an integrated understanding of how cognitive processes underpin BED symptomology is lacking. We utilised a multi-stage decision-making model defining ten cognitive processes underpinning Preference Formation, Choice Implementation, Feedback Processing, and Flexibility/Shifting, to comprehensively review research published since 2013. We used preregistered PICOS criteria to assess 1966 articles identified from PubMed, PsycInfo, and Scopus database searches. This yielded 50 studies reporting behavioural cognitive tasks outcomes, comparing individuals with BED to controls with normal and higher weight. Meta-analyses revealed a unique profile of cognitive dysfunctions that spanned all decision-making stages. Significant deficits were evident in Uncertainty Evaluation, Attentional Inhibition, Choice Consistency, and Cognitive Flexibility/Set-shifting. We propose a novel model of dysfunctional decision-making processes in BED and describe their role in binge-eating behaviour. We further highlight the potential for cognitive interventions to target these processes and address the significant treatment gap in BED.
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Affiliation(s)
- Emily Colton
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia.
| | - Kira-Elise Wilson
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
| | - Trevor T-J Chong
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
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Izquierdo AM, Nelson JD, Daza A, Gasbarro A, Hardin R, Marino J, Fischer S. Predictors of current suicidal ideation in a multi-diagnostic sample of individuals with eating disorders. J Eat Disord 2023; 11:94. [PMID: 37291663 DOI: 10.1186/s40337-023-00789-w] [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: 07/31/2022] [Accepted: 04/20/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Individuals with eating disorders (EDs) have high rates of suicidal ideation (SI) and attempts (SA). Fasting, body dissatisfaction, binge eating and purging have been associated with SI in non-clinical samples, individuals with anorexia nervosa or low-weight EDs, and a multi-diagnostic sample. However, few studies have examined how ED symptoms contribute to risk for SI in conjunction with other well-established risk factors, such as nonsuicidal self-injury (NSSI) and past SA. The aim of this study was to examine which ED symptoms contribute unique risk for current SI in a multi-diagnostic, clinical sample when statistically adjusting for gender, NSSI, past SA, and past SI. METHODS We conducted a chart review of 166 individuals who presented for ED treatment at an outpatient facility and signed informed consent. Initial intake interviews were coded for the presence versus absence of fasting, fear of weight gain, binge eating, purging, excessive exercise, restriction, body checking, self-weighing, and body dissatisfaction, as well as NSSI, past SA, past SI, and current SI. RESULTS A total of 26.5% of the sample endorsed current SI. In a logistic regression analysis, identifying as male (n = 17) or having a non-binary gender identity (n = 1), the presence of fasting, and past SI were all significantly associated with increased odds of current SI, whereas excessive exercise significantly decreased odds of current SI. Fasting was equally common across all diagnostic groups. CONCLUSIONS Future research should establish the temporal relationship between fasting and SI to better inform intervention.
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Affiliation(s)
- Alyssa M Izquierdo
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Jillian D Nelson
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alyssa Daza
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | | | | | | | - Sarah Fischer
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
- Potomac Behavioral Solutions, Arlington, VA, USA
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7
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Prevention and early intervention in eating disorders: findings from a rapid review. J Eat Disord 2023; 11:38. [PMID: 36899428 PMCID: PMC9999654 DOI: 10.1186/s40337-023-00758-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/19/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs. METHODS This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review. RESULTS In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist. CONCLUSIONS Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.
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Nelson JD, Martin LN, Izquierdo A, Kornienko O, Cuellar AE, Cheskin LJ, Fischer S. The role of discrimination and adverse childhood experiences in disordered eating. J Eat Disord 2023; 11:29. [PMID: 36850009 PMCID: PMC9969653 DOI: 10.1186/s40337-023-00753-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND In clinical research, there has been a call to move beyond individual psychosocial factors towards identifying cultural and social factors that inform mental health. Similar calls have been made in the eating disorders (ED) field underscoring the need to understand larger sociocultural influences on EDs. Discrimination is a social stressor that may influence mental health in similar ways to traumatic or adverse childhood experiences (ACEs). Given the high rates of EDs and discrimination among marginalized groups, it is vital to understand the role of discrimination and ACEs as predictors of ED symptoms in these populations. The aim of this study is to examine how perceived discrimination predicts ED pathology when statistically adjusting for gender, race, and ACEs. METHODS The diverse study sample consisted of 331 undergraduate students from a longitudinal cohort study (ages 18-24; 66% female; 35% White/non-Hispanic). Participants completed measures of everyday discrimination, ACEs, and ED pathology. RESULTS Following adjustment for multiple statistical comparisons, the frequency of daily discrimination predicted all ED symptoms above and beyond history of ACEs. In follow-up analyses, number of reasons for discrimination predicted cognitive restraint and purging. Differences in ED symptomatology were found based on the reason for discrimination, gender, and race. Specifically, those who experienced weight discrimination endorsed higher scores on all ED symptoms, and those experiencing gender discrimination endorsed higher body dissatisfaction, cognitive restraint, and restriction. People of color endorsed higher restriction, while female participants endorsed higher scores on all ED symptom with the exception of cognitive restraint. CONCLUSION Discrimination is a salient risk factor for ED symptoms even when accounting for individuals' history of ACEs. Future research should utilize an intersectional approach to examine how perceived discrimination affects ED pathology over time. (Word count: 234).
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Affiliation(s)
- Jillian D Nelson
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Laura N Martin
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alyssa Izquierdo
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Olga Kornienko
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Sarah Fischer
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
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Reas DL, Wisting L, Lindvall Dahlgren C. Co-occurrence of nonsuicidal self-injury and eating disorder pathology in adolescents. Int J Eat Disord 2023; 56:439-445. [PMID: 36524669 PMCID: PMC10107669 DOI: 10.1002/eat.23826] [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: 05/02/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Little is known about the co-occurrence of nonsuicidal self-injurious (NSSI) behaviors and eating disorder (ED) pathology in community samples of adolescents. METHODS A total of 1558 Norwegian upper secondary school students (Grades 11, 12, and 13) completed the Deliberate Self-Harm Inventory and a measure of ED pathology. RESULTS Adolescents (53.1% F, 46.9% M) were a mean age of 17.1 years. A higher level of ED pathology was reported (12.1 vs. 5.3, p < .001) among adolescents who had a history of NSSI. Significantly higher levels of ED pathology were found among females who reported hitting themselves until bruised, head banging, severe scratching, and burning with a lighter, but not cutting, or the other forms of self-injury. Of adolescents with a history of NSSI, 60% of females and 15% of males scored above a cutoff for ED pathology. Of adolescents scoring above a cutoff for ED pathology, 42.5% of females and 37.1% of males had engaged in lifetime NSSI. DISCUSSION Adolescents-in particular, females- with a history of NSSI reported significantly greater ED pathology. Notably, a higher proportion of males with ED pathology reported lifetime self-injury than vice versa, underscoring the importance of carefully screening for the presence of self-harm among males with ED pathology. PUBLIC SIGNIFICANCE STATEMENT Over 1500 upper secondary school students with an average age of 17 years completed an online survey assessing current ED pathology and lifetime NSSI. Adolescents, particularly females, with a history of self-harm reported significantly more ED pathology. Findings also indicated the need to carefully screen for self-harm among males with ED pathology. Parents, schools, and health professionals should be aware that self-harm and ED pathology commonly co-occur and warrant assessment.
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Affiliation(s)
- Deborah Lynn Reas
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Line Wisting
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Camilla Lindvall Dahlgren
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Oslo New University College, Oslo, Norway
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Yu Z, Muehleman V. Eating Disorders and Metabolic Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2446. [PMID: 36767812 PMCID: PMC9916228 DOI: 10.3390/ijerph20032446] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Eating disorders are complex diseases with multifactorial causes. According to the Diagnostic and Statistical Manual of Mental Disorders text version (DSM-5-TR) and the WHO International Classification of Diseases and Related Health Problems (ICD-11), the major types of eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder. The prevalence of eating disorders is alarmingly increasing globally. Moreover, the COVID-19 pandemic has led to more development and worsening of eating disorders. Patients with eating disorders exhibit high rates of psychiatric comorbidities and medical comorbidities such as obesity, diabetes, and metabolic syndrome. This paper aims to review and discuss the comorbidities of eating disorders with those metabolic diseases. Eating disorder treatment typically includes a combination of some or all approaches such as psychotherapy, nutrition education, and medications. Early detection and intervention are important for the treatment of eating disorders.
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Affiliation(s)
- Zhiping Yu
- Department of Nutrition and Dietetics, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA
| | - Valerie Muehleman
- Department of Nutrition and Dietetics, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA
- Beaufort Jasper Hampton Comprehensive Health Services, Inc., P.O. Box 357, Ridgeland, SC 29926, USA
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11
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Romano KA, Lipson SK, Beccia AL, Quatromoni PA, Murgueitio J. Disparities in eating disorder symptoms and mental healthcare engagement prior to and following the onset of the COVID-19 pandemic: Findings from a national study of US college students. Int J Eat Disord 2023; 56:203-215. [PMID: 36479981 PMCID: PMC9851957 DOI: 10.1002/eat.23869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Early COVID-19 eating disorders (EDs) research used regionally restricted samples with little sociodemographic diversity. The present study aimed to address these research gaps by examining whether pandemic-related changes in ED symptoms and mental healthcare prevalence differed for historically marginalized groups within a national sample of US college students. METHOD Participants included 242,906 US college students (Mage = 23.45, SD = 7.04; MBMI = 25.28, SD = 5.91) who completed the repeated cross-sectional multi-institute Healthy Minds Study between January 2019 and May 2021. Moderated logistic regressions examined whether pandemic-related changes in individuals' likelihoods of exhibiting current probable ED, reporting lifetime ED diagnoses, and-among individuals with current probable ED-mental healthcare engagement differed for diverse gender, sexual, and racial/ethnic identity groups, and by body mass index (BMI) and financial stress. RESULTS There were increases of 5% and 12% in individuals' likelihoods of exhibiting current probable ED and symptomatic individuals' mental healthcare engagement, respectively, pre- to post-COVID-19 onset, but no pandemic-related changes in lifetime ED diagnosis prevalence. There were also important variations in these time-trends for different marginalized groups. For example, individuals identifying as genderqueer/gender nonconforming and lesbian exhibited increasing ED symptoms pre- to post-COVID-19 onset, and individuals with current probable ED and higher BMIs were increasingly likely to receive mental healthcare. Associations between financial stress, and the ED and mental healthcare outcomes did not change over time. DISCUSSION These findings provide insight into groups of US college students that experienced disproportionate ED burden during the pandemic at the population level, and directions for research and interventions that warrant consideration.
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Affiliation(s)
- Kelly A Romano
- Department of Psychology, Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Sarah K Lipson
- Boston University School of Public Health, Department of Health Law Policy and Management, Boston, Massachusetts, USA
| | - Ariel L Beccia
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Paula A Quatromoni
- Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA
| | - Jose Murgueitio
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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Dufour R, Novack K, Picard L, Chadi N, Booij L. The use of technology in the treatment of youth with eating disorders: A scoping review. J Eat Disord 2022; 10:182. [PMID: 36434657 PMCID: PMC9700893 DOI: 10.1186/s40337-022-00697-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Adolescence and young adulthood is a high-risk period for the development of eating disorders. In recent years, there has been an increase in use of technology-based interventions (TBIs) for the treatment of eating disorders. The objective of this study was to determine the types of technology used for eating disorder treatment in youth and their effectiveness. METHODS A scoping review was conducted according to PRISMA-ScR guidelines. Four databases were searched. Eligible articles included: (1) a TBI (2) participants with a mean age between 10- and 25-years and meeting DSM-IV or DSM-5 criteria for any eating disorder and (3) qualitative or quantitative designs. Quantitative and qualitative studies were assessed for quality. RESULTS The search identified 1621 articles. After screening of titles and abstracts, 130 articles were read in full and assessed for eligibility by two raters. Forty-nine (29 quantitative and 20 qualitative, observational, or mixed methods studies) met inclusion criteria. Quality ratings indicated that 78% of quantitative studies had a low risk of bias and 22% had a moderate risk. Technologies reviewed in our study included videoconference therapy, mobile applications, and online self-help. We considered interventions used both within sessions with clinicians as well as those used in between sessions by patients alone. Fifteen of 18 (83%) quantitative studies found that TBIs reduce eating disorder symptomatology, with nine of those reporting medium-to-large effect sizes. Qualitative data was of high quality and suggested that virtual interventions are acceptable in this population. CONCLUSIONS Although identified studies are of high quality, they are limited in number. More research is needed, particularly regarding videoconferencing and mobile applications. Nonetheless, TBIs show promise for the treatment of eating disorders in youth. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Rachel Dufour
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada
| | - Kaylee Novack
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Louis Picard
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chemin de La Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Nicholas Chadi
- Sainte-Justine Hospital Research Centre, Montreal, Canada. .,Division of Adolescent Medicine, Department of Pediatrics, Université de Montréal, Montreal, Canada. .,Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chemin de La Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Linda Booij
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
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13
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AlHadi AN, Almeharish A, Bilal L, Al-Habeeb A, Al-Subaie A, Naseem MT, Altwaijri YA. The prevalence and correlates of bulimia nervosa, binge-eating disorder, and anorexia nervosa: The Saudi National Mental Health Survey. Int J Eat Disord 2022; 55:1541-1552. [PMID: 35932093 DOI: 10.1002/eat.23790] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Limited studies have been conducted in the Kingdom of Saudi Arabia on eating disorders (EDs). This study presents national epidemiological survey data on the prevalence and correlates of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and their association with other mental health disorders, impairment in role functioning, and individual help-seeking behaviors in the Saudi National Mental Health Survey (SNMHS). METHOD A face-to-face survey was conducted in a nationally representative household sample of Saudi citizens aged 15-65 (n = 4004). The Composite International Diagnostic Interview (CIDI 3.0) was used to produce estimates of lifetime and 12-month prevalence and treatment of common DSM-IV mental disorders. RESULTS Twelve-month prevalence of any of the three EDs was 3.2%; the overall lifetime prevalence was 6.1%. Education and marital status were significantly associated with both 12-month and lifetime EDs prevalence. Significant mental health comorbidities associated with 12-month EDs were anxiety, mood, and impulse-control disorders, while lifetime EDs were significantly related to all disorders. A similar percentage of respondents that reported having ED-related treatment at some point in their lifetime utilized healthcare and nonhealthcare sector. There was a significant relationship between body mass index category, and lifetime BED and BN. DISCUSSION The 12-month prevalence of EDs in the Saudi population was higher than the EDs rates reported worldwide. These findings can help healthcare experts, and policymakers in the implementation of initiatives for raising awareness of EDs among the Saudi population, and the development of a country-wide plan for the prevention of EDs. PUBLIC SIGNIFICANCE STATEMENT The study presents data on the prevalence, correlates, and help-seeking behaviors of AN, BN, and BED, in the Saudi National Mental Health Survey (SNMHS). Obtaining information on this underrepresented region is essential due to the large differences in cross-national data in addition to cultural beliefs about mental illness and treatment seeking to exert an important influence on eating disorders. Such knowledge could provide a better understand of mechanisms underlying the development of eating disorders and thereby improve prediction, prevention, and treatment.
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Affiliation(s)
- Ahmad N AlHadi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amani Almeharish
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Lisa Bilal
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
| | - Abdulhameed Al-Habeeb
- National Center for Mental Health Promotion, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdullah Al-Subaie
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia.,Department of Psychiatry, Edrak Medical Center, Riyadh, Saudi Arabia
| | - Mohammad Talal Naseem
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
| | - Yasmin A Altwaijri
- SABIC Psychological Health Research & Applications Chair (SPHRAC), College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Research Department, King Salman Center for Disability Research, Riyadh, Saudi Arabia
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14
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Grammer AC, Shah J, Laboe AA, McGinnis CG, Balantekin KN, Graham AK, Smolar L, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Predictors of treatment seeking and uptake among respondents to a widely disseminated online eating disorders screen in the United States. Int J Eat Disord 2022; 55:1252-1258. [PMID: 35719123 PMCID: PMC9444923 DOI: 10.1002/eat.23760] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 06/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore predictors of treatment seeking and uptake among individuals following an online eating disorders (EDs) screen in the U.S. disseminated by the National Eating Disorders Association. METHOD Respondents who screened at risk or positive for a probable ED from 04/2019 to 05/2021 (N = 263,530) were eligible to complete a 2-month follow-up survey that assessed treatment seeking and uptake after being offered referral options following screening. Analyses were conducted using chi-square tests or logistic regressions. RESULTS Sixty thousand thirty-four respondents (22.8%) opted-in to the follow-up survey, of whom 2276 (3.8%) completed it. Of the final analytic sample (n = 1922), 35.7% of respondents reported seeking and 22.4% reported receiving treatment. Treatment seeking and uptake were more common among respondents who were female, White, or >24 years of age; uptake was more common among respondents who were non-Hispanic or higher income. Elevated shape/weight concerns were significantly, albeit modestly, associated with reduced likelihood to receive treatment. DISCUSSION Demographic differences in treatment seeking and uptake highlight the need to optimize ED screening tools/feedback to meet the needs of underserved groups and to address stereotypes and structural barriers that may interfere. Research is also needed to identify barriers to uptake among those with elevated shape/weight concerns. PUBLIC SIGNIFICANCE Relatively low rates of treatment seeking and uptake were observed, particularly among underserved groups, 2 months following a widely disseminated online eating disorders screen. Optimization of online eating disorder screening tools and delivery of feedback and referral information may be needed to increase health care utilization.
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Affiliation(s)
- Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Agatha A. Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Claire G. McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine N. Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York, New York, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for mHealth, Palo Alto University, Palo Alto, California, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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15
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Malova E, Dunleavy V. Men have eating disorders too: an analysis of online narratives posted by men with eating disorders on YouTube. Eat Disord 2022; 30:437-452. [PMID: 34402402 DOI: 10.1080/10640266.2021.1930338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Eating Disorders (ED) among men are still surrounded by stigma and gender stereotypes, with a common misconception that ED are an exclusively female condition. This study employed a gender-sensitive approach to uncover males' critical needs for effective treatment and recovery. We qualitatively analyzed a sample of twenty-five videos posted on YouTube by men with ED, presenting personal stories of recovery and recovery in-progress. Through thematic analysis of the narratives, we identified three common factors increasing disordered eating behaviors in men: 1) bullying, 2) drive for muscularity, and 3) self-regulation. In addition, we found three major themes related to barriers preventing men from help-seeking: 1) shame and stigma, 2) lack of knowledge and information, and 3) low level of perceived doctor-patient communication. The findings of this study can contribute to the conceptualization of future interventions and recovery programs designed to prevent and treat ED in men.
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Affiliation(s)
- Ekaterina Malova
- Department of Communication Studies, University of Miami, Coral Gables, Florida, USA
| | - Victoria Dunleavy
- Department of Communication Studies, University of Miami, Coral Gables, Florida, USA
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16
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Freizinger M, Recto M, Jhe G, Lin J. Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap. CHILDREN 2022; 9:children9060837. [PMID: 35740774 PMCID: PMC9221982 DOI: 10.3390/children9060837] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Atypical anorexia nervosa (AAN) is a restrictive eating disorder (ED) that describes individuals who may be normal weighted or overweight; many have a premorbid history of obesity. Pediatric care providers are trained to identify and provide best practices for youth with pediatric obesity; however, most pediatric care providers are not trained to assess and treat restrictive EDs which typically present in youth aged 10 and 14 years. Although individuals with AAN may appear to be within a ‘healthy weight’, many experience malnutrition, psychological symptoms, and severe physiological complications after weight loss. These individuals are presenting to pediatric services at an increasing rate and exhibit acute medical instability along with severe ED psychopathology. One complicating factor is youth with AAN may take longer to be identified by pediatric providers and may be reluctant to engage in treatment. Delayed treatment for AAN, along with all EDs often results in poorer treatment outcomes. A greater understanding of this complex illness is essential to inform medical decisions, such as labs, vitals, hospital admissions, and psychological therapy. Currently, there are no standardized guidelines for treating AAN in youths. This review is designed to present evidence-based treatment to inform and guide best treatment practices.
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Affiliation(s)
- Melissa Freizinger
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| | - Michelle Recto
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Grace Jhe
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Jessica Lin
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
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17
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Feldhege J, Bilic S, Ali K, Fassnacht DB, Moessner M, Farrer LM, Griffiths KM, Bauer S. Knowledge and Myths about Eating Disorders in a German Adolescent Sample: A Preliminary Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116861. [PMID: 35682445 PMCID: PMC9180431 DOI: 10.3390/ijerph19116861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 12/04/2022]
Abstract
Eating disorder mental health literacy (ED-MHL) refers to knowledge about the symptoms, causes, and treatment of eating disorders (EDs) and is an important factor in people’s attitudes towards individuals with EDs and help-seeking for EDs. Associations between ED-MHL, stigma, ED symptomatology, and gender were investigated in a sample of N = 194 German high school students. Knowledge and myths about EDs were assessed with 18 factual statements about EDs and agreement/disagreement with common myths about ED. Students also completed the Universal Stigma Scale (USS), the Weight Concerns Scale (WCS), and demographic items. Students judged M = 8.39 (SD = 3.40) statements correctly, while the average agreement with all ED myths was low (M = 0.19, SD = 0.14). Greater ED-MHL was associated with lower stigmatization of EDs. Male participants were less knowledgeable and more likely to agree with the ED myths. Participants displayed moderate ED-MHL; however, certain aspects such as ED risk factors or symptoms of specific disorders such as anorexia nervosa and bulimia nervosa were less well known. These results can inform the design of future MHL interventions for adolescents.
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Affiliation(s)
- Johannes Feldhege
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
- Correspondence:
| | - Sally Bilic
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
| | - Kathina Ali
- College of Education, Psychology and Social Work, Flinders University, Adelaide 5042, Australia; (K.A.); (D.B.F.)
- Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide 5042, Australia
- Research School of Psychology, Australian National University, Canberra 2601, Australia;
| | - Daniel B. Fassnacht
- College of Education, Psychology and Social Work, Flinders University, Adelaide 5042, Australia; (K.A.); (D.B.F.)
- Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide 5042, Australia
- Research School of Psychology, Australian National University, Canberra 2601, Australia;
| | - Markus Moessner
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
| | - Louise M. Farrer
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia;
| | - Kathleen M. Griffiths
- Research School of Psychology, Australian National University, Canberra 2601, Australia;
- College of Health & Medicine, Australian National University, Canberra 2601, Australia
| | - Stephanie Bauer
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
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18
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Romano KA, Lipson SK, Beccia AL, Quatromoni PA, Gordon AR, Murgueitio J. Changes in the prevalence and sociodemographic correlates of eating disorder symptoms from 2013 to 2020 among a large national sample of U.S. young adults: A repeated cross-sectional study. Int J Eat Disord 2022; 55:776-789. [PMID: 35338504 PMCID: PMC9204707 DOI: 10.1002/eat.23709] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The present study aimed to: (1) identify recent temporal changes in the prevalence of different cognitive and behavioral eating disorder (ED) symptoms, current probable EDs, lifetime ED diagnoses, and mental healthcare use among college students across the United States; (2) determine whether established disparities in ED prevalence and receiving mental healthcare have widened or narrowed over time for marginalized groups within this population. METHOD Participants included a large national sample of U.S. college students (N = 286,720) who completed the repeated cross-sectional Healthy Minds Study from 2013 to 2020. Descriptive statistics and polynomial regressions quantified time-trends in participants' ED symptoms and past 12-month mental healthcare. Moderated regressions examined temporal changes in ED symptoms and mental healthcare based on sociodemographic characteristics. RESULTS Individuals' engagement in different cognitive and behavioral ED symptoms, and likelihoods of exhibiting current probable EDs, reporting lifetime ED diagnoses, and (for individuals with current probable EDs) receiving therapy or counseling in the past 12-months exhibited nonlinear increases from 2013 to 2020. Further, the prevalence of current and lifetime ED symptoms and (for symptomatic individuals) past 12-month mental healthcare differed over time for individuals with different BMIs and gender, sexual, and racial/ethnic identities (but not ages). In particular, individuals with higher BMIs and those who identified as male, bisexual, and gay, lesbian, or queer exhibited increasing ED pathology over time. DISCUSSION These findings provide important information on groups of U.S. college students that have experienced increasing burden of ED symptoms and may help guide ED prevention, treatment, and research priorities. PUBLIC SIGNIFICANCE Recent temporal changes in the prevalence of eating disorder (ED) symptoms and mental healthcare were examined in a national sample of U.S. young adults. Non-linear increases in ED symptoms and mental healthcare were identified among U.S. young adults overall from 2013 to 2020. U.S. young adults with higher BMIs, males, bisexual, and gay, lesbian, or queer individuals exhibited increasing ED burden over time.
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Affiliation(s)
- Kelly A. Romano
- The Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia, USA
| | - Sarah K. Lipson
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Ariel L. Beccia
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Paula A. Quatromoni
- Department of Health Sciences, Boston University, Boston, Massachusetts, USA
| | - Allegra R. Gordon
- Department of Community Health Science, Boston University School of Public Health, Boston, Massachusetts, USA,Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Jose Murgueitio
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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19
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Hamilton A, Mitchison D, Basten C, Byrne S, Goldstein M, Hay P, Heruc G, Thornton C, Touyz S. Understanding treatment delay: Perceived barriers preventing treatment-seeking for eating disorders. Aust N Z J Psychiatry 2022; 56:248-259. [PMID: 34250844 DOI: 10.1177/00048674211020102] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Only a small proportion of individuals with an eating disorder will receive targeted treatment for their illness. The aim of this study was to examine the length of delay to treatment-seeking and determine the barriers preventing earlier access and utilisation of eating disorder treatment for each diagnostic group - anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding or eating disorder. METHOD Participants were recruited as part of the TrEAT multi-phase consortium study. One hundred and nineteen Australians (13-60 years; 96.9% female) with eating disorders currently accessing outpatient treatment for their illness completed an online survey comprised of self-report measures of eating disorder severity, treatment delay and perceived barriers to treatment-seeking. The treating clinician for each participant also provided additional information (e.g. body mass index and diagnosis). RESULTS Overall, the average length of delay between onset of eating disorder symptoms and treatment-seeking was 5.28 years. Controlling for age, latency to treatment-seeking was significantly longer for individuals with bulimia nervosa and binge eating disorder compared to anorexia nervosa. However, when perceived barriers to treatment-seeking were investigated, there were no significant differences between the diagnostic groups in regard to the perceived barriers they experienced. Stigma was rated as the most impactful barrier for each diagnostic group. CONCLUSION Findings suggest that individuals with eating disorders face substantial delays in accessing appropriate treatment and that latency to treatment-seeking is often magnified for counter-stereotypical eating disorder presentations. Further research is required to investigate other factors contributing to this delay.
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Affiliation(s)
- Amber Hamilton
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia.,Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia.,Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | | | - Susan Byrne
- School of Psychology, University of Western Australia, Perth, WA, Australia.,The Swan Centre, Perth, WA, Australia
| | - Mandy Goldstein
- Department of Psychology, Macquarie University, Sydney, NSW, Australia.,Mandy Goldstein Psychology, Sydney, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia.,Wesley Hospital Eating Disorder Day Program, Sydney, NSW, Australia.,Camden and Campbelltown Hospital, SWSLHD, Campbelltown, NSW, Australia
| | - Gabriella Heruc
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia.,Appetite for Change, Sydney, NSW, Australia
| | - Christopher Thornton
- Department of Psychology, Macquarie University, Sydney, NSW, Australia.,The Redleaf Practice, Sydney, NSW, Australia
| | - Stephen Touyz
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
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20
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Zhou X, Bambling M, Edirippulige S. A mixed-method systematic review of text-based telehealth interventions in eating disorder management. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-03-2021-0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose
Eating disorders (EDs) is a major health condition affecting 9% of the global population and 10% of those with EDs lost their lives as a result. Text-based telehealth interventions (TTIs) seem to provide a low-cost and convenient treatment option; however, the evidence is scarce. This study aimed to synthesize evidence relating to the use of TTIs for the management of EDs.
Design/methodology/approach
Five databases were searched published between January 2020 and May 2019. The authors used keywords relating to telehealth and EDs. The authors used Joanna Briggs Institute's (JBI's) critical appraisal instrument to assess the methodology quality of included studies.
Findings
Fifteen studies were included in this mix-method systematic review and assessed for methodology quality. Email, web-based texting, text-messaging and online chat room were used as mode for deliver healthcare for patients with EDs. In the treatment phase, all studies (nine studies; n = 860 participants) showed effectiveness (for RCTs) and usefulness (for non-RCT studies). In the aftercare phase (six studies; n = 364 participants), the results regarding the effectiveness of TTIs were mixed. Two studies showed effectiveness whilst four studies did not find statistically significant change of ED outcomes.
Research limitations/implications
The qualities of these studies varied; firstly, 66% (n = 10) of the studies were non-randomized studies (e.g. single-arm trial, case report) with small samples. Moreover, one-fourth (n = 4) of the studies did not use validated instruments or indicate the instrument. Also, half (n = 7) of the studies used TTIs as adjunct to face-to-face treatment or bigger online treatment, it is hard to make conclusion that the changes were due to TTIs' effect. In addition, follow-up rate is not satisfactory, thus results should be interpreted cautiously.
Practical implications
TTIs seem to be promising for management of EDs, particularly in the treatment phase. This provides an important treatment option for health practitioners and people with EDs as an alternative or in adjunct with face-to-face services.
Originality/value
This is the first review to synthesis the use of TTIs for ED management.
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21
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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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22
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Johnson SN, Forbush KT, Swanson TJ, Christensen KA. An empirical evaluation of the diagnostic threshold between full-threshold and sub-threshold bulimia nervosa. Eat Behav 2021; 42:101540. [PMID: 34315120 PMCID: PMC10044451 DOI: 10.1016/j.eatbeh.2021.101540] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/27/2022]
Abstract
Previous research has failed to find differences in eating disorder and general psychopathology and impairment between people with sub- and full-threshold bulimia nervosa (BN). The purpose of the current study was to test the validity of the distinction between sub- and full-threshold BN and to determine the frequency of objective binge episodes and inappropriate compensatory behaviors that would best distinguish between sub- and full-BN. Community-recruited adults (83.5% female) with current sub-threshold (n = 105) or full-threshold BN (n = 99) completed assessments of eating-disorder psychopathology, clinical impairment, internalizing problems, and drug and alcohol misuse. Receiver operating characteristic curve analysis was used to evaluate whether eating-disorder psychopathology, clinical impairment, internalizing problems, and drug and alcohol misuse could empirically discriminate between sub- and full-threshold BN. The frequency of binge episodes and inappropriate compensatory behaviors (AUC = 0.94) was "highly accurate" in discriminating between sub- and full-threshold BN; however, only objective binge episodes was a significant predictor of BN status. Internalizing symptoms (AUC = 0.71) were "moderately accurate" at distinguishing between sub- and full-BN. Neither clinical impairment (AUC = 0.60) nor drug (AUC = 0.56) or alcohol misuse (AUC = 0.52) discriminated between groups. Results suggested that 11 episodes of binge eating and 17 episodes of inappropriate compensatory behaviors optimally distinguished between sub- and full-BN. Overall, results provided mixed support for the distinction between sub- and full-threshold BN. Future research to clarify the most meaningful way to discriminate between sub- and full-threshold is warranted to improve the criterion-related validity of the diagnostic system.
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23
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Ma R, Zhang M, Oakman JM, Wang J, Zhu S, Zhao C, Hu Z, Buchanan NT. Eating disorders treatment experiences and social support: Perspectives from service seekers in mainland China. Int J Eat Disord 2021; 54:1537-1548. [PMID: 34101214 DOI: 10.1002/eat.23565] [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: 11/25/2020] [Revised: 05/29/2021] [Accepted: 05/29/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study explored treatment experiences and social support among individuals with eating disorders (EDs) in mainland China. METHOD Subscribers of a Chinese online social media platform (WeChat) focused on EDs were invited to complete a screening questionnaire that included the Eating Disorder Diagnostic Scale for the DSM-5. Of the 116 questionnaire responses, 31 met inclusion criteria for follow-up interviews. Individuals who never sought treatment were not eligible for follow-up interviews, but provided brief explanations about why they did not seek treatment. All eligible participants (n = 31) completed a semi-structured interview about their experiences with ED treatment and social support. Qualitative data from the interviews and survey responses regarding not seeking treatment were subjected to inductive data-driven thematic analysis with deductive coding to illuminate treatment and social support experiences or reasons for not seeking treatment. RESULTS Themes emerged from interviews revealed positive inpatient treatment experiences for anorexia nervosa, but negative outpatient treatment experiences, unaffordable care, and ineffective psychopharmacological treatments. Parents, friends, and partners were sources of social support, but participants largely felt misunderstood or blamed by these same entities. Shame, not recognizing ED as an illness, and financial constraints were listed as the primary reasons for not seeking treatment. DISCUSSION The importance of hearing patients' perspectives, improving ED literacy in China, increasing knowledge of culturally specific manifestations of EDs, and developing culturally responsive services and dissemination of treatment resources are emphasized.
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Affiliation(s)
- Ruofan Ma
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Manning Zhang
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Jonathan M Oakman
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jiping Wang
- School of Biomedical Engineering, Sun Yat-sen University, Guangzhou, China
| | - Siqi Zhu
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chendi Zhao
- School of Sociology, Beijing Normal University, Beijing, China.,School of Sociology, University of Oklahoma, Norman, Oklahoma, USA
| | - Zhiyuan Hu
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - NiCole T Buchanan
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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24
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Emotion Dysregulation within the CBT-E Model of Eating Disorders: A Narrative Review. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10225-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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25
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Fitzsimmons-Craft EE, Balantekin KN, Graham AK, DePietro B, Laing O, Firebaugh ML, Smolar L, Park D, Mysko C, Funk B, Taylor CB, Wilfley DE. Preliminary data on help-seeking intentions and behaviors of individuals completing a widely available online screen for eating disorders in the United States. Int J Eat Disord 2020; 53:1556-1562. [PMID: 32542896 PMCID: PMC7978480 DOI: 10.1002/eat.23327] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Scaling an online screen that provides referrals may be key in closing the treatment gap for eating disorders (EDs), but we need to understand respondents' help-seeking intentions and behaviors after receiving screen results. This study reported on these constructs among respondents to the National Eating Disorders Association online screen who screened positive or at high risk for an ED. METHOD Respondents completed the screen over 18 months (February 9, 2018-August 28, 2019). Those screening positive or at high risk for an ED (n = 343,072) had the option to provide data on help-seeking intentions (after screen completion) and behaviors (2-month follow-up). RESULTS Of eligible respondents, 4.8% (n = 16,396) provided data on help-seeking intentions, with only 33.7% of those reporting they would seek help. Only 7.6% of eligible respondents opted in to the 2-month follow-up, with 10.6% of those completing it (n = 2,765). Overall, 8.9% of respondents to the follow-up reported being in treatment when they took the screen, 15.5% subsequently initiated treatment, and 75.5% did not initiate/were not already in treatment. DISCUSSION Preliminary results suggest that among the small minority who provided data, only one-third expressed help-seeking intentions and 16% initiated treatment. Online screening should consider ways to increase respondents' motivation for and follow-through with care.
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Affiliation(s)
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Bianca DePietro
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Olivia Laing
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York, New York, USA
| | - Dan Park
- National Eating Disorders Association, New York, New York, USA
| | - Claire Mysko
- National Eating Disorders Association, New York, New York, USA
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lüneburg, Germany
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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26
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Abstract
CONTEXT Eating disorders (EDs) in male athletes are potentially debilitating disorders with significant medical, psychological, and athletic performance consequences. EVIDENCE ACQUISITION Searches were performed across PubMed, EBSCOhost, and PSYCinfo from 1990 to 2019. Keywords searched were eating disorder, male, athlete, anorexia nervosa, bulimia nervosa, muscularity, muscle dysmorphia, and sports. Search results included articles written in the English language and encompassed reviews, empirical studies, and theoretical articles. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS EDs among male athletes may lead to serious negative outcomes, including increased susceptibility to injury, inconsistent performance, problematic recovery, muscle deficiencies, impairment of optimal athletic functioning, and medical, social, and emotional problems. Male athletes with EDs may be more difficult to identify and diagnose for a variety of reasons related to differential presentation of symptoms, secretiveness or shame around behaviors, and sex-related stigma. CONCLUSION Professionals working closely with athletes are uniquely positioned to identify and screen those who may require further evaluation and treatment.
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Affiliation(s)
- Madison Eichstadt
- West Virginia University School of Medicine, Morgantown, West Virginia
| | - Jessica Luzier
- West Virginia University School of Medicine-Charleston Division.,Department of Behavioral Medicine and Psychiatry, West Virginia University
| | - Daniel Cho
- Department of Behavioral Medicine and Psychiatry, West Virginia University.,Charleston Area Medical Center, Charleston, West Virginia
| | - Chantel Weisenmuller
- West Virginia University School of Medicine-Charleston Division.,Department of Behavioral Medicine and Psychiatry, West Virginia University
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27
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Linardon J, Shatte A, Tepper H, Fuller-Tyszkiewicz M. A survey study of attitudes toward, and preferences for, e-therapy interventions for eating disorder psychopathology. Int J Eat Disord 2020; 53:907-916. [PMID: 32239725 DOI: 10.1002/eat.23268] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE E-therapy shows promise as a solution to the barriers that stand in the way of people receiving eating disorder (ED) treatment. Despite the potential for e-therapy to reduce the well-known treatment gap, little is known about public views and perspectives on this mode of intervention delivery. This study explored attitudes toward, and preferences for, e-therapy among individuals spanning the spectrum of eating pathology. METHOD Survey data assessing e-therapy attitudes and preferences were analyzed from 713 participants recruited from the public. Participants were categorized into one of five subgroups based on the type of self-reported ED symptoms and severity/risk level, ranging from high risk to a probable threshold or subthreshold ED. RESULTS Attitudes toward e-therapies appeared to be relatively positive; participants largely supported health care insurance coverage of costs for e-therapies, and were optimistic about the wide-ranging benefits of e-therapy. Although three-quarters of participants expressed a preference for face-to-face therapy, a significant percentage of participants (∼50%) reported an intention to use an e-therapy program for current or future eating problems, with intention ratings highest (70%) among those with probable bulimia nervosa (BN). Variables associated with an e-therapy preference were not currently receiving psychotherapy, more positive e-therapy attitudes, and greater stigma associated with professional help-seeking. Variables associated with e-therapy intentions were more positive e-therapy attitudes and a probable BN classification. CONCLUSIONS Present findings have important implications for increasing online intervention acceptance, engagement, and help-seeking among those at different stages of illness.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Adrian Shatte
- School of Science, Engineering and Information Technology, Federation University, Victoria, Melbourne, Australia
| | - Hannah Tepper
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
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28
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Ali K, Fassnacht DB, Farrer L, Rieger E, Feldhege J, Moessner M, Griffiths KM, Bauer S. What prevents young adults from seeking help? Barriers toward help-seeking for eating disorder symptomatology. Int J Eat Disord 2020; 53:894-906. [PMID: 32239776 DOI: 10.1002/eat.23266] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate help-seeking attitudes, intentions, and behaviors, and to systematically explore perceived barriers to help-seeking for eating, weight, or shape concerns among young adults. Differences in perceived barriers as a function of type of eating disorder symptomatology were also examined. METHOD Data were collected using an online survey among individuals (aged 18-25 years) in Australia. Overall, 291 young adults with varying levels of eating disorder symptoms completed measures of disordered eating, weight or shape concerns, help-seeking barriers, attitudes, intentions, and behaviors. According to their self-reported symptoms, participants were classified into four subgroups (i.e., anorexia nervosa [AN] symptoms, bulimia nervosa [BN] symptoms, binge-eating disorder [BED] symptoms, and other eating disorder symptoms). RESULTS Despite the belief that help-seeking is useful, only a minority of participants with elevated symptoms, namely those with AN, BN, and BED symptoms, believed they needed help. Across the sample, the most frequently cited barriers to seeking help for eating disorder symptoms were: concern for others, self-sufficiency, fear of losing control, denial and failure to perceive the severity of the illness, and stigma and shame. DISCUSSION The findings highlight the need to educate young adults about the severity of eating disorders and the importance of seeking help, and to increase the awareness of help-seeking barriers among those designing public health interventions as well as clinicians. Our findings suggest that help-seeking barriers may differ depending on the type of eating disorder symptomology.
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Affiliation(s)
- Kathina Ali
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.,Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia.,College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Daniel B Fassnacht
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.,College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Elizabeth Rieger
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Johannes Feldhege
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Kathleen M Griffiths
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
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29
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Thapliyal P, Mitchison D, Mond J, Hay P. Gender and help-seeking for an eating disorder: findings from a general population sample. Eat Weight Disord 2020; 25:215-220. [PMID: 30066257 DOI: 10.1007/s40519-018-0555-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/24/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aimed to compare gender differences in eating disorder (ED) features and to examine the role of gender as a predictor of ED help-seeking controlling for other putative determinants, namely weight/shape overvaluation, age, BMI, and impairment in role functioning. METHODS Demographic, ED symptoms, and related data were collected during household interviews of individuals aged ≥ 15 years. One hundred and forty-eight participants (164 after data were weighted) with an ED syndrome were identified. RESULTS Compared to women, men with an ED were younger and had lower levels of purging and overvaluation. However, men and women with an ED had similar levels of functional impairment, binge eating and strict dieting. In univariate analyses, males in general, but not males with an ED, were significantly less likely than females to seek help for an ED. In multivariate analysis of people with an ED, only BMI was significantly associated with treatment-seeking. CONCLUSION Functional health impairment and common ED behaviours were similar for men and women with EDs. Gender may not be a primary reason to be more or less likely to seek help for an ED. Rather, other features, most notably, a higher BMI, appear to be stronger predictors of ED-specific help-seeking. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Priyanka Thapliyal
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Deborah Mitchison
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Jonathan Mond
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Centre for Rural Health, School of Health Sciences, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW, Australia
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30
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Hay P, Ghabrial B, Mannan H, Conti J, Gonzalez-Chica D, Stocks N, Heriseanu A, Touyz S. General practitioner and mental healthcare use in a community sample of people with diagnostic threshold symptoms of bulimia nervosa, binge-eating disorder, and other eating disorders. Int J Eat Disord 2020; 53:61-68. [PMID: 31591750 DOI: 10.1002/eat.23174] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/07/2019] [Accepted: 09/07/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Lengthy delays in receiving treatment have been reported for people with bulimia nervosa (BN) and binge-eating disorder (BED). This study aimed to investigate healthcare use and predictors of mental health specialist healthcare use in a community sample of individuals with diagnostic threshold symptoms of BN, BED-Broad, or another eating disorder (Other ED). METHOD In 2017, 2,977 individuals aged ≥15 years were interviewed in a general population survey. Participants were asked questions relating to sociodemographic, ED symptoms, other clinical features, and healthcare use data. Assessment of ED symptoms was based on diagnostic questions derived from the eating disorder examination. RESULTS Thirty-six participants with symptoms of BN, 33 participants with BED-Broad, and 369 with an Other ED were identified. Fewer people with symptoms of BN/BED-Broad (23%) or an Other ED (6%) had treatment from a mental health specialist than from a general practitioner (GP; 80%, 71.6%). Healthcare use differed significantly across type of ED only for treatment from a mental health specialist. In multivariate analyses, being asked about a person's mental health by a GP was the best explanatory variable for receiving treatment from a mental health specialist. DISCUSSION A large treatment gap exists in healthcare for people with EDs. Inquiry about an individual's mental health by a GP was associated with higher rates of treatment from mental health specialists. However, a similar diet/eating inquiry did not have this association. Future research should consider the use of this patient and practitioner consultation in targeting improved detection of EDs.
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Affiliation(s)
- Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, Australia.,Campbelltown Hospital, SWSLHD, Campbelltown, Australia
| | - Brittany Ghabrial
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Janet Conti
- School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andreea Heriseanu
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, and the InsideOut Institute, University of Sydney, Camperdown, New South Wales, Australia
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31
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Perko VL, Forbush KT, Siew CSQ, Tregarthen JP. Application of network analysis to investigate sex differences in interactive systems of eating-disorder psychopathology. Int J Eat Disord 2019; 52:1343-1352. [PMID: 31608479 DOI: 10.1002/eat.23170] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Although men comprise 25% of persons with eating disorders (EDs), most research has focused on understanding EDs in women. The theoretical framework underlying common ED treatment has not been rigorously tested in men. The purpose of this study was to compare the interconnectivity among ED symptoms in men versus women. METHOD Participants (N = 1,348; 50% men) were individuals with anorexia nervosa, bulimia nervosa, binge-eating disorder, or other specified feeding or eating disorder who were users of Recovery Record, a smartphone app for monitoring ED symptoms. Participants were matched on age and duration of illness. Network analysis was used to create networks of symptoms for both sexes. Strength centrality, network stability, and bootstrapped centrality differences were tested. The network comparison test (NCT) was used to identify sex differences between networks. Key players analysis was used to compare fragmentation of each network. RESULTS For both sexes, items related to binge eating and restricting emerged as highest in strength centrality. The NCT identified significant differences global strength (p = .03) but not network invariance (p = .06) suggesting that although the structure of the networks was not statistically different, the strength of the connections within the network was greater for women. Key players analysis indicated that both networks were similarly disrupted when important nodes within the network were removed. DISCUSSION Findings suggested that there are more similarities than differences in networks of EDs in men and women. Results have important clinical implications by supporting theoretical underpinnings of cognitive-behavioral models of EDs in both men and women.
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Affiliation(s)
- Victoria L Perko
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Cynthia S Q Siew
- Department of Psychology, National University of Singapore, Singapore
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32
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Brodrick B, McAdams C. Insight May Limit Identification of Eating Disorders. Biol Psychiatry 2019; 85:e55-e56. [PMID: 30579532 DOI: 10.1016/j.biopsych.2018.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Brooks Brodrick
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.
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33
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Schoen E, Clougher K, Wiese J. Developing an Eating Disorder Peer Advocate Program on Campus: A Report on the Eating Disorder Awareness and Advocacy Program (EDAAP). JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2019. [DOI: 10.1080/87568225.2019.1592730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Eva Schoen
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | - Joanna Wiese
- Eating Disorder Center, Children’s Mercy Kansas, Overland Park, KS, USA
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34
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Grillot CL, Keel PK. Barriers to seeking treatment for eating disorders: The role of self-recognition in understanding gender disparities in who seeks help. Int J Eat Disord 2018; 51:1285-1289. [PMID: 30488569 DOI: 10.1002/eat.22965] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Previous research suggests that men with eating disorders are less likely to seek treatment than are women. Given stereotypes linked to eating disorders, men may be less likely to recognize when they have an eating disorder, which could act as a barrier to treatment-seeking. METHOD The current study examined differences in self-recognition and treatment-seeking behavior by gender, controlling for other covariates, in participants with probable DSM-5 eating disorders drawn from a larger community-based sample. RESULTS Being female and self-recognition were both associated with increased likelihood of treatment-seeking while accounting for other potential covariates, including race/ethnicity, age, BMI, and comorbid disorders. DISCUSSION Results indicate that self-recognition is a barrier to seeking treatment for both genders and does not account for help-seeking differences between women and men. Findings have implications for interventions to address barriers to treatment-seeking for eating disorders.
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Affiliation(s)
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
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35
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Forbush KT, Chen PY, Hagan KE, Chapa DAN, Gould SR, Eaton NR, Krueger RF. A new approach to eating-disorder classification: Using empirical methods to delineate diagnostic dimensions and inform care. Int J Eat Disord 2018; 51:710-721. [PMID: 30132954 DOI: 10.1002/eat.22891] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/10/2018] [Accepted: 05/14/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Despite changes to the diagnostic criteria for eating disorders (EDs) in the DSM-5, the current diagnostic system for EDs has limited ability to inform treatment planning and predict outcomes. Our objective was to test the clinical utility of a novel dimensional approach to understanding the structure of ED psychopathology. METHOD Participants (N = 243; 82.2% women) were community-recruited adults with a DSM-5 ED assessed at baseline, 6-month, and 1-year follow-up. Hierarchical factor analysis was used to identify a joint hierarchical-dimensional structure of eating, mood, and anxiety symptoms. Exploratory structural equation modeling was used to test the ability of the dimensional model to predict outcomes. RESULTS At the top of the hierarchy, we identified a broad Internalizing factor that reflected diffuse symptoms of eating, mood, and anxiety disorders. Internalizing branched into three subfactors: distress, fear-avoidance (fears of certain stimuli and behaviors to neutralize fears, including ED behaviors designed to reduce fear of weight gain), and body dissatisfaction, which was nested within distress. The lowest level of the hierarchy was characterized by 15 factors. The hierarchical model predicted 60.1% of the variance in outcomes at 6-month follow-up, whereas all DSM eating, mood, and anxiety disorders combined predicted 35.8% of the variance in outcomes. DISCUSSION A dimensional approach to understanding and diagnosing EDs improved the ability to prospectively predict clinical course above-and-beyond the traditional categorical (DSM-based) approach. Our findings have implications for endeavors to improve the prediction of ED prognosis and course, and to develop more effective trans-diagnostic treatments.
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Affiliation(s)
- Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Po-Yi Chen
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Kelsey E Hagan
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | | | - Sara R Gould
- Division of Pediatrics, Children's Mercy-Kansas City Kansas City, Kansas
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
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