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Sim L, Fahrenkamp A, Geske JR, Lebow J, Thilges H, Peterson CB, Matthews A, Harbeck-Weber C. Screening for eating disorders in adolescents with chronic pain: the Eating Attitudes Test-16-Chronic Pain. J Eat Disord 2024; 12:56. [PMID: 38730431 PMCID: PMC11084020 DOI: 10.1186/s40337-024-01014-y] [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: 01/05/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Few measures have been validated to screen for eating disorders (ED) in youth with chronic pain. We conducted confirmatory (CFA) of two established factor structures of the Eating Attitudes Test-26 (EAT-26) in a sample of youth with chronic pain attending an intensive interdisciplinary pain treatment (IIPT) program and examined the validity of the best-fitting model in predicting ED diagnoses in this sample. METHODS Participants were 880 adolescents (M age = 16.1, SD = 2.1) consecutively admitted into an IIPT program who completed the EAT-26 upon admission. CFA was conducted and in the case of inadequate fit, EFA was planned to identify alternative models. Factors of the best-fitting model were included in a logistic regression analysis to predict ED diagnoses. RESULTS The TLIs (0.70; 0.90), RMSEAs (0.09; 0.07) and CFIs (0.73; 0.92) suggested poor fit of one model and adequate of the second model. Goodness of fit indices from EFA (TLI:0.85, RMSEA:0.06) did not outperform the fit of the second CFA. As such, the second model was retained with the exception of one factor. The items loaded onto a 16-item, five factor model: Fear of Getting Fat, Social Pressure to Gain Weight, Eating-Related Control, Eating-Related Guilt and Food Preoccupation. Based on chart review, 19.1% of the participants were diagnosed with an eating disorder. Logistic regression analyses indicated the new 16-item measure and Fear of Getting Fat, significantly predicted an ED diagnosis that did not include avoidant restrictive food intake disorder (ARFID) and Social Pressure to Gain Weight significantly predicted a diagnosis of ARFID. CONCLUSIONS An alternative 16-item, 5-factor structure of the EAT-26 should be considered in screening for EDs with youth with chronic pain.
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Affiliation(s)
- Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Amy Fahrenkamp
- Pain, Palliative Care, and Integrative Medicine Department, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Jennifer R Geske
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jocelyn Lebow
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Hope Thilges
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Abigail Matthews
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
| | - Cynthia Harbeck-Weber
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA
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Eating disorders in 11–17 year old schoolgirls: Prevalence, features of clinical manifestations, psychosomatic comorbidity. ACTA BIOMEDICA SCIENTIFICA 2023. [DOI: 10.29413/abs.2023-8.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background. Eating disorders are an urgent public health problem due to their high prevalence and mortality. The disease prognosis depends on timely diagnosis; however, these conditions are sure to be underestimated.The aim. To study the prevalence, features of clinical manifestations and psychosomatic comorbidity of eating disorder (ED) and subthreshold eating disorder (SED) in schoolgirls aged 11–17 years.Materials and methods. We examined 917 schoolgirls aged 11–17 years. The screening questionnaire including 11questions combined into three pools named “Thoughts about one’s own body” was used. The first pool (A) – assessed body dissatisfaction, the second one (B) – eating disorders, the third one (C) – food intake disorders. The answers were encoded as “1”, “2”, “3” (“false”, “rather true”, “true”). Schoolgirls who scored the maximum number of points (12) in the pool A were regarded as dissatisfied with their body and were further divided into two groups: the first group (ED) included girls who scored more than 10 points in the pool B; girls who scored less than 10 points were in the second group (SED), respectively. Body mass index (BMI) was determined by the weight-height coefficient correlated with centile tables. Psychosomatic comorbidity was assessed by the presence of recurrent headache and abdominal pain in the last six months.Results. The overall prevalence of eating disorders was 11.7 %, where ED made 2.1 %, SED – 9.6 %. All schoolgirls had abnormal eating behavior; however, those with SED used less aggressive weight-loss methods. BMI ˂ 5th percentile was observed in 10 % of girls with ED and 4.5 % – with SED. 60 % of girls with ED and 40.9 % with SED complained about frequent headaches; 30 % of girls with ED and 20.4 % with SED were suffering from frequent abdominal pain.Conclusion. In schoolgirls, subthreshold eating disorder is 4.6 times more common than threshold eating disorder. Characteristics of clinical manifestations are the absence of underweight for most schoolgirls and comorbidity with pain syndrome.
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Staller K, Abber SR, Burton Murray H. The intersection between eating disorders and gastrointestinal disorders: a narrative review and practical guide. Lancet Gastroenterol Hepatol 2023; 8:565-578. [PMID: 36868254 DOI: 10.1016/s2468-1253(22)00351-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 03/04/2023]
Abstract
Eating disorders include a spectrum of disordered thinking patterns and behaviours around eating. There is increasing recognition of the bi-directional relationship between eating disorders and gastrointestinal disease. Gastrointestinal symptoms and structural issues might arise from eating disorders, and gastrointestinal disease might be a risk factor for eating disorder development. Cross-sectional research suggests that individuals with eating disorders are disproportionately represented among people seeking care for gastrointestinal symptoms, with avoidant-restrictive food intake disorder in particular garnering attention for high rates among individuals with functional gastrointestinal disorders. This Review aims to describe the research to date on the relationship between gastrointestinal disorders and eating disorders, highlight research gaps, and provide brief, practical guidance for the gastroenterology provider in detecting, potentially preventing, and treating gastrointestinal symptoms in eating disorders.
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Affiliation(s)
- Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Sophie R Abber
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Helen Burton Murray
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Burton Murray H, Calabrese S. Identification and Management of Eating Disorders (including ARFID) in GI Patients. Gastroenterol Clin North Am 2022; 51:765-783. [PMID: 36375995 DOI: 10.1016/j.gtc.2022.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Eating disorders are characterized by cognitions (eg, fear of gastrointestinal symptoms around eating, overvaluation of body shape/weight) and behaviors (eg, dietary restriction, binge eating) associated with medical (eg, weight loss), and/or psychosocial impairments (eg, high distress around eating). With growing evidence for bidirectional relationships between eating disorders and gastrointestinal disorders, gastroenterology providers' awareness of historical, concurrent, and potential risk for eating disorders is imperative. In this conceptual review, we highlight risk and maintenance pathways in the eating disorder-gastrointestinal disorder intersection, delineate different types of eating disorders, and provide recommendations for the gastroenterology provider in assessing and preventing eating disorder symptoms..
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Affiliation(s)
- Helen Burton Murray
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Samantha Calabrese
- Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Boerner KE, Coelho JS, Syal F, Bajaj D, Finner N, Dhariwal AK. Pediatric Avoidant-Restrictive Food Intake Disorder and gastrointestinal-related Somatic Symptom Disorders: Overlap in clinical presentation. Clin Child Psychol Psychiatry 2022; 27:385-398. [PMID: 34779259 PMCID: PMC9047093 DOI: 10.1177/13591045211048170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Certain presentations of Avoidant/Restrictive Food Intake Disorder (ARFID) and Somatic Symptom and Related Disorders (SSRDs) have conceptual overlap, namely, distress and impairment related to a physical symptom. This study compared characteristics of pediatric patients diagnosed with ARFID to those with gastrointestinal (GI)-related SSRD. A 5-year retrospective chart review at a tertiary care pediatric hospital comparing assessment data of patients with a diagnosis of ARFID (n = 62; 69% girls, Mage = 14.08 years) or a GI-related SSRD (n = 37; 68% girls, Mage = 14.25 years). Patients diagnosed with ARFID had a significantly lower percentage of median BMI than those with GI-related SSRD. Patients diagnosed with ARFID were most often assessed in the Eating Disorders Program, whereas patients diagnosed with an SSRD were most often assessed by Consultation-Liaison Psychiatry. Groups did not differ on demographics, psychiatric diagnoses, illness duration, or pre-assessment services/medications. GI symptoms were common across groups. Patients diagnosed with an SSRD had more co-occurring medical diagnoses. A subset (16%) of patients reported symptoms consistent with both diagnoses. Overlap is observed in the clinical presentation of pediatric patients diagnosed with ARFID or GI-related SSRD. Some group differences emerged, including anthropometric measurements and co-occurring medical conditions. Findings may inform diagnostic classification and treatment approach.
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Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, 12358BC Children's Hospital Research Institute and University of British Columbia, Vancouver, BC, Canada
| | - Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada.,Department of Psychiatry, 8166University of British Columbia, Vancouver, BC, Canada
| | - Fiza Syal
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada
| | - Deepika Bajaj
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada
| | - Natalie Finner
- Division of Adolescent Medicine, 27338Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Amrit K Dhariwal
- Department of Psychiatry, 8166University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, 37210BC Children's Hospital, Vancouver, BC, Canada
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Quadflieg N. Gastrointestinal symptoms from an epidemiological perspective. Int J Eat Disord 2021; 54:913-914. [PMID: 34028845 DOI: 10.1002/eat.23562] [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: 05/10/2021] [Revised: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 11/07/2022]
Abstract
Four manuscripts on gastro-intestinal problems or disorders of gut-brain interaction are discussed from an epidemiological perspective. A literature review with strict inclusion criteria pointed out the dearth of evidence-based knowledge on gastrointestinal symptoms following treatment for anorexia nervosa. An epidemiological follow-up study showing the relevance of childhood abdominal pain for fasting to control weight in adolescence is used to emphasize the need to refine our approach to risk factor research in eating disorders. Two additional studies highlight the high prevalence of gastro-intestinal problems in eating disorders underscoring a need for improved consideration of these symptoms in clinical practice and eating disorder research.
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Affiliation(s)
- Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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