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Elwyn R, Williams M, Smith E, Smith S. Two identical twin pairs discordant for longstanding anorexia nervosa and OSFED: lived experience accounts of eating disorder and recovery processes. J Eat Disord 2024; 12:127. [PMID: 39223672 PMCID: PMC11367789 DOI: 10.1186/s40337-024-01078-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: 02/01/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Research into the risk of anorexia nervosa (AN) has examined twin pairs to further the understanding of the contributions of genetics, trait inheritance, and environmental factors to eating disorder (ED) development. Investigations of twin experiences of EDs have been biologically-based and have not considered the qualitative, phenomenological aspects of twin experiences. A gap in the literature exists regarding understanding of discordant twins with EDs. This research was developed in response, with the aim to deepen understanding of AN in discordant twins and to create novel ideas for further research and testing. The case studies presented in this article provide lived experience insights of two identical discordant twin pairs: one twin pair discordant for longstanding AN and one twin pair discordant for 'atypical' AN (the twin with AN has recovered). The perspectives and experiences of each co-twin (one with AN and one without) explore a number of factors that may have contributed to twin discordance in these cases, and how each twin has responded to the impact of AN in their lives. Through use of first-person accounts in case study presentation, this article centres social justice values of lived experience leadership and involvement in research. This article aims to extend current knowledge and understanding of EDs in discordant twins, particularly regarding risk for ED development, ED duration, diagnosis and treatment, and recovery processes.
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Affiliation(s)
- Rosiel Elwyn
- Neuroscience and Psychiatry, Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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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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Birgegård A, Abbaspour A, Borg S, Clinton D, Mantilla EF, Savva A, Termorshuizen JD, Bulik CM. Longitudinal experiences and impact of the COVID-19 pandemic among people with past or current eating disorders in Sweden. Eat Disord 2022; 30:602-617. [PMID: 34634228 DOI: 10.1080/10640266.2021.1985286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The study aimed to document the impact of the COVID-19 pandemic on the health and well-being of individuals with past and current eating disorders (ED) in Sweden. We re-contacted participants with a known lifetime history of ED from two previous Swedish studies. Participants completed an online survey about health and functioning at baseline early in the pandemic (Wave 1 ca May/June 2020; N= 982) and six months later (Wave 2 Dec/Jan 2020/21; N= 646). Three important patterns emerged: 1) higher current ED symptoms were associated with greater anxiety, worry, and pandemic-related ED symptom increase; 2) patterns were fairly stable across time, although a concerning percentage (23%) who were symptom-free at Wave 1 reported the re-emergence of symptoms at Wave 2; and 3) only a minority of participants (<50%) with a current ED were in treatment, and of those in treatment, many reported fewer treatment sessions and decreased quality of care. The COVID-19 pandemic appears to pose serious health challenges for individuals with an ED, whether currently symptomatic or in remission. We encourage health service providers and patient advocates to be alert to the needs of individuals with ED and to take active measures to ensure access to appropriate evidence-based care both during and following the pandemic.
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Affiliation(s)
- Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Afrouz Abbaspour
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stina Borg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Clinton
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emma Forsén Mantilla
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Androula Savva
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jet D Termorshuizen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Jérolon A, Perduca V, Delsedime N, Abbate-Daga G, Marzola E. Mediation models of anxiety and depression between temperament and drive for thinness and body dissatisfaction in anorexia nervosa. Eat Weight Disord 2022; 27:2569-2581. [PMID: 35460450 PMCID: PMC9556361 DOI: 10.1007/s40519-022-01397-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/25/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) is a life-threatening condition in which temperament, anxiety, depression, and core AN body-related psychopathology (drive for thinness, DT, and body dissatisfaction, BD) are intertwined. This relationship has not been to date disentangled; therefore, we performed a multiple mediation analysis aiming to quantify the effect of each component. METHODS An innovative multiple mediation statistical method has been applied to data from 184 inpatients with AN completing: Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Eating Disorders Inventory-2, State-Trait Anxiety Inventory, and Beck Depression Inventory. RESULTS All affective temperaments but the hyperthymic one were involved in the relationship with DT and BD. Only the anxious temperament had a significant unmediated direct effect on DT after the strictest correction for multiple comparisons, while the depressive temperament had a significant direct effect on DT at a less strict significance level. State anxiety was the strongest mediator of the link between affective temperament and core AN body-related psychopathology. Depression showed intermediate results while trait anxiety was not a significant mediator at all. CONCLUSION Affective temperaments had a relevant impact on body-related core components of AN; however, a clear direct effect could be identified only for the anxious and depressive temperaments. Also, state anxiety was the strongest mediator thus entailing interesting implications in clinical practice. LEVEL OF EVIDENCE V, cross-sectional study.
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Affiliation(s)
- Allan Jérolon
- CNRS, MAP5 UMR 8145, Université de Paris, F-75006 Paris, France
| | | | - Nadia Delsedime
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
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Comparison of the Differences in State-Trait Anxiety Inventory Scores and Insomnia Histories between Monozygotic and Dizygotic Twins: A Cross-Sectional Study Using KoGES HTS Data. J Clin Med 2022; 11:jcm11144011. [PMID: 35887774 PMCID: PMC9318741 DOI: 10.3390/jcm11144011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 01/09/2023] Open
Abstract
The heritability of anxiety and its association with insomnia have been suggested. This study investigated the coincidence of anxiety and insomnia in monozygotic twins compared to dizygotic twins. The Korean Genome and Epidemiology Study 2005–2014 was used. The ≥20-year-old cohort population was composed of 1300 twin participants. A total of 980 monozygotic twins and 232 dizygotic twins were compared for the concordance for the history of insomnia in both twin pairs (coincidence of insomnia) and the difference in state of anxiety and trait of anxiety scores. The odds ratios (ORs) for the coincidence of insomnia in monozygotic twins compared to dizygotic twins were analyzed using multiple logistic regression analysis. The estimated values (EV) of the difference of state and trait of anxiety scores were analyzed using a linear regression model. The coincidence of insomnia was not high in monozygotic twins compared to dizygotic twins. The difference in the state of anxiety score was comparable between monozygotic twins and dizygotic twins. However, the difference in anxiety scores was higher in dizygotic twins than in monozygotic twins. The monozygotic twin group did not demonstrate higher coincidence of insomnia or the state of anxiety than the dizygotic twin group. However, the monozygotic twin group indicated higher coincidence of the trait of anxiety than the dizygotic twins. The current results implied the potential contribution of heritable factors for the trait of anxiety.
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Springall G, Cheung M, Sawyer SM, Yeo M. Impact of the coronavirus pandemic on anorexia nervosa and atypical anorexia nervosa presentations to an Australian tertiary paediatric hospital. J Paediatr Child Health 2022; 58:491-496. [PMID: 34570958 PMCID: PMC8661708 DOI: 10.1111/jpc.15755] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/28/2022]
Abstract
AIM The coronavirus (COVID-19) pandemic has led to increased concerns about adolescent mental health. This study aimed to determine the effect of the pandemic on adolescent eating disorders (EDs) by measuring changes in the number and severity of presentations to an Australian paediatric ED service that utilises a standardised approach to triage and assessment. METHODS A 4-year retrospective chart review (2017-2020) of all patients (n = 457) presenting to the Royal Children's Hospital Eating Disorder Service, Melbourne, was undertaken. The incidence of each diagnosis and measures of condition severity were extracted from the database and patient medical records. Clinical comments relating to the impact of COVID-19, on both ED behaviours and treatment, were also noted. RESULTS Annual presentations increased from a mean of 98.7 per annum from 2017 to 2019 to 161 in 2020 (63% increase). COVID-19 restrictions were reported to be a trigger for ED behaviours in 40.4% of adolescents diagnosed with anorexia nervosa in 2020. There was no significant difference in severity across years despite increased cases. CONCLUSIONS The dramatic increase in presentations has implications for primary health and paediatric care as well as specialist ED services. Increased support is needed for EDs during this time.
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Affiliation(s)
- Gabriella Springall
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Michael Cheung
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of CardiologyRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Susan M Sawyer
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of Adolescent MedicineRoyal Children's HospitalMelbourneVictoriaAustralia,Centre for Adolescent HealthRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Michele Yeo
- Department of Adolescent MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
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Reilly EE, Perry TR, Brown TA, Wierenga CE, Kaye WH. Intolerance of Uncertainty and Eating Disorder Symptoms Over the Course of Intensive Treatment. Behav Ther 2021; 52:698-708. [PMID: 33990243 DOI: 10.1016/j.beth.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 12/26/2022]
Abstract
There is a critical need to identify processes that may influence outcome in existing treatments for eating disorders (EDs). Intolerance of uncertainty (IU), which refers to excessive distress regarding uncertain situations, is a well-established feature of anxiety disorders. Emerging work suggests that IU decreases over the course of cognitive-behavioral treatments and may relate to better treatment outcomes. As some literature has suggested IU may functionally maintain ED symptoms, testing whether changes in IU over treatment relate to outcome may result in the identification of novel treatment targets. This study aimed to build upon past work documenting links between IU and ED symptoms by exploring changes in IU over treatment and links between early change in IU (1-month) and discharge symptoms. Participants (N = 274) receiving partial hospitalization treatment completed the Eating Pathology Symptoms Inventory and Intolerance of Uncertainty Scale at admission, 1-month post-admission, and discharge. Results suggested that IU significantly reduced from admission to discharge and that reductions in IU scores from admission to 1-month related to cognitive restraint, dietary restriction, and body image at discharge. However, this pattern did not hold for exercise, binge eating, or purging. Altogether, these results replicate past work supporting IU as a common feature across ED diagnoses and provide initial data suggesting that targeting IU early in treatment may enhance treatment outcomes.
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Affiliation(s)
| | - Taylor R Perry
- Eating Disorders Center for Treatment and Research, University of California, San Diego
| | - Tiffany A Brown
- Eating Disorders Center for Treatment and Research, University of California, San Diego
| | - Christina E Wierenga
- Eating Disorders Center for Treatment and Research, University of California, San Diego
| | - Walter H Kaye
- Eating Disorders Center for Treatment and Research, University of California, San Diego
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Himmerich H, Kan C, Au K, Treasure J. Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences. Pharmacol Ther 2020; 217:107667. [PMID: 32858054 DOI: 10.1016/j.pharmthera.2020.107667] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 08/17/2020] [Indexed: 12/14/2022]
Abstract
The pharmacological treatment of patients with an eating disorder (ED) often includes medications to treat their ED, comorbid mental health problems, malnutrition and the physical health problems resulting from it. The currently approved pharmacological treatment options for EDs are limited to fluoxetine for bulimia nervosa (BN) and - in some countries - lisdexamfetamine for binge eating disorder (BED). Thus, there are no approved pharmacological options for anorexia nervosa (AN), even though study results for olanzapine and dronabinol are promising. Topiramate might be an additional future option for the treatment of BN and BED. Selective serotonin reuptake inhibitors (SSRI), mirtazapine and bupropion could be considered for the treatment of comorbid unipolar depression. However, AN and BN are contraindications for bupropion. For ED patients with a manic episode, we recommend olanzapine in AN and risperidone in BN and BED; whereas for bipolar depression, olanzapine (plus fluoxetine) seems appropriate in AN and lamotrigine in BN and BED. Acute anxiety or suicidality may warrant benzodiazepine treatment with lorazepam. Proton-pump inhibitors, gastroprokinetic drugs, laxatives and hormones can alleviate certain physical health problems caused by EDs. Therapeutic drug monitoring, pharmacogenomic testing, a more restrictive use of "pro re nata" (PRN) medication, an interdisciplinary treatment approach, shared decision making (SDM) and the formulation of common treatment goals by the patients, their family or carers and clinicians could improve treatment success and safety. Novel genetic, immunological, microbiome and brain imaging research as well as new pharmacological developments like the use of psychedelics, stimulants, novel monoaminergic drugs, hormone analogues and drugs which enhance the effects of psychotherapy may extend our therapeutic options in the near future.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK.
| | - Carol Kan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
| | - Katie Au
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
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Weissman RS, Bauer S, Thomas JJ. Access to evidence-based care for eating disorders during the COVID-19 crisis. Int J Eat Disord 2020; 53:369-376. [PMID: 32338400 PMCID: PMC7267278 DOI: 10.1002/eat.23279] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 01/02/2023]
Abstract
The COVID-19 pandemic has forced an abrupt change in the delivery of clinical services, including for individuals with an eating disorder. We present this Virtual Issue as a resource for the eating disorder community to showcase research published in the International Journal of Eating Disorders that provides information on effective strategies to help address the challenges arising from COVID-19-related disruptions. Articles included describe original research or systematic reviews on obstacles to health services use and strategies to improve access to care; technological tools to provide or enhance interventions; patients' and clinicians' attitudes or perspectives on using digital tools for clinical care; factors influencing therapeutic alliance; and ideas for improving reach and uptake of digital interventions. We hope that readers will find ways to observe and record their own experiences during this global crisis; the experiences of people at risk for developing or exhibiting an eating disorder; and the experiences of those who care for people with an eating disorder. These lived experiences will be invaluable in formulating hypotheses for future studies in service of advancing the understanding of eating disorders and improving interventions and policies for reducing the burden of suffering attributable to eating disorders.
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Affiliation(s)
- Ruth S. Weissman
- Department of PsychologyWesleyan UniversityMiddletownConnecticutUSA
| | - Stephanie Bauer
- Center for Psychotherapy ResearchUniversity Hospital HeidelbergHeidelbergGermany
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
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