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What can we learn about eating disorder mortality from eating disorder diagnoses at initial assessment? A Danish nationwide register follow-up study using record linkage, encompassing 45 years (1970-2014). Psychiatry Res 2021; 303:114091. [PMID: 34246009 DOI: 10.1016/j.psychres.2021.114091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 06/11/2021] [Accepted: 06/27/2021] [Indexed: 12/14/2022]
Abstract
Increased risk for premature mortality is well established for women and girls diagnosed with anorexia nervosa (AN), but less is known for other types of eating disorder (ED), and especially the mortality outcome for boys and men is under-studied. In this registry-based observational epidemiological study, we included all people appearing in the Danish Psychiatric Central Research Register with an eating disorder (ED) diagnosis in the time period from Jan 1,1970 to Dec 31, 2014 (N: 22,633). For each patient four controls without ED were selected, matched for age, sex and place of residence (N: 90486). In all 802 people with ED died over 255762.6 person-years of observation. Standardized mortality ratio (SMR) for all-cause mortality and suicide mortality was significantly increased for all ED-diagnoses in women. The SMRs for men were similar, but only reached significance for the diagnoses AN and unspecified ED. Mortality by natural causes and accidents was significantly increased in most ED-diagnoses in women. The unequal female-to-male ratio in this, and most other studies of ED-patients, suggests that boys and men with ED have unmet needs.
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Mortality in males as compared to females treated for an eating disorder: a large prospective controlled study. Eat Weight Disord 2021; 26:1627-1637. [PMID: 32789622 DOI: 10.1007/s40519-020-00960-1] [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: 11/27/2019] [Accepted: 07/10/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To report on the mortality of DSM-IV eating disorders and predictors of premature death in males compared to females after inpatient treatment. METHODS Crude mortality rate (CMR) and standardized mortality ratio (SMR) were computed for a large sample of males aged at treatment 16-61 years [N = 66 anorexia nervosa (AN), 52 bulimia nervosa (BN), 70 eating disorder not otherwise specified (ED-NOS)] and females aged 14-65 years (N = 2066 AN, 1880 BN, 1350 ED-NOS). In addition, a survival analysis and Cox regression analyses for identifying predictors of death were computed. RESULTS CMRs for males and females, respectively, were 15% and 5% in AN, 8% and 3% in BN, and 4% and 3% in ED-NOS. Compared to the general population, mortality was elevated in males with AN (SMR = 4.93) and in all female diagnostic groups (AN, BN, ED-NOS). No significant sex differences for SMR emerged in any diagnostic group. Compared to females with AN or BN, males with AN or BN showed a shorter survival time after onset (survival analysis). Being male, and having AN, increased the risk of premature death. CONCLUSION Mortality in inpatients with eating disorder is high, especially in AN. Males appear to have about the same outcome in terms of mortality as females with AN, BN, and ED-NOS. However, long-term survival was shorter in males with AN or BN compared to females. The need for intensive treatment in both males and females with an eating disorder remains an important issue. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Krukowska-Zaorska A, Kot K, Marek E, Dura W, Safranow K, Lipski M. Knowledge of Oral and Physical Manifestations of Anorexia Nervosa Among Polish Dentists: A Cross-Sectional Study. Front Psychiatry 2021; 12:751564. [PMID: 34777055 PMCID: PMC8578852 DOI: 10.3389/fpsyt.2021.751564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Anorexia nervosa is a psychosomatic disorder and is commonly associated with impaired oral health. Dentists can play a relevant role in the early diagnosis of anorexia nervosa. With the help of intra- and extraoral examinations and anamnesis, the dentist can detect characteristic signs and symptoms of this eating disorder. The purpose of this study was to determine the knowledge regarding the oral and physical manifestations of anorexia nervosa among general dental practitioners and specialist dentists of Poland. Material and Methods: A pretested online questionnaire consisting of a first part asking for the characteristics of the participant and a second part with 22 specific questions on their general knowledge of anorexia nervosa and knowledge of physical and oral manifestations of this eating disorder was used. Results: A total of 369 dentists completed the questionnaire. The Polish dentists in this study reported sufficient knowledge regarding anorexia nervosa. However, younger dentists and general dental practitioners had relatively lower knowledge scores than other groups. The dentists mainly had difficulties with the oral symptoms of anorexia nervosa. Conclusion: Despite Polish dentists having sufficient knowledge about anorexia nervosa in relation to the general symptoms of anorexia, there are deficits with regard to oral manifestations. Therefore, there is a need to increase continuing education in this field, which can improve early diagnosis of this disease by dental practitioners and referral to specialists for treatment.
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Affiliation(s)
- Agnieszka Krukowska-Zaorska
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kot
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Ewa Marek
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Włodzimierz Dura
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Mariusz Lipski
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
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O'Connor P, Daly L, Higgins A. Partners' experiences of living with a person with an eating disorder: A grounded theory study. J Adv Nurs 2019; 75:1741-1750. [PMID: 31012143 DOI: 10.1111/jan.14032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 12/01/2022]
Abstract
AIM To explore the experiences of intimate partners of people with an eating disorder. DESIGN Qualitative grounded theory study. METHODS In-depth interviews were conducted with 18 partners of people with an eating disorder from 2013-2016. Data were analysed using the principles of classic grounded theory including, concurrent data collection and analysis, theoretical sampling, constant comparative analysis and memo writing. RESULTS Partners encounter disruptions to their lives when their significant other experiences an eating disorder. As a result, partners engage in a four-stage cyclical process involving: encountering a disruption; becoming an informed self; countering the disruption and reclaimed livability. By engaging in this process partners learn to support their significant other, remain committed to the relationship and recover their own lives. The process is drawn together and defined as the theory of 'Reconstructing Livability'. CONCLUSION The theory of 'Reconstructing Livability' provides a unique conceptualization of the experiences of partners who are living with a person with an eating disorder. It highlights the challenges faced by partners when supporting the recovery of their significant other and the intimate relationship, while reclaiming their own lives. IMPACT This study addresses the dearth of knowledge and understanding of partners' experiences. Partners engage in a process to enable them support recovery of their significant other and their own lives, but this is hindered by the challenges and unmet needs they experience. The theory provides a basis on which nurses can provide effective and timely supports to partners.
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Affiliation(s)
- Patricia O'Connor
- Department of Nursing and Midwifery, St. Patricks University Hospital, Trinity College Dublin, Ireland
| | - Louise Daly
- Department of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Agnes Higgins
- Department of Nursing and Midwifery, Trinity College Dublin, Ireland
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Strobel C, Quadflieg N, Voderholzer U, Naab S, Fichter MM. Short- and long-term outcome of males treated for anorexia nervosa: a review of the literature. Eat Weight Disord 2018; 23:541-552. [PMID: 30027397 DOI: 10.1007/s40519-018-0538-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To give an overview of existing studies on the short- and long-term outcome for males treated for anorexia nervosa and to compare the outcome between adolescents and adults as well as between males and females. METHODS A systematic literature search was conducted in PubMed, PsycINFO and PSYNDEX and complemented by a manual search of the references from all relevant studies. RESULTS Out of 1064 search results, 18 studies met our inclusion criteria. A combined total of 1129 males of varying age groups were followed 0.5-27 years post-treatment. For 1009 individuals, only vital status was ascertained. Length of follow-up and outcome definitions varied considerably. Limited data-especially in adults-prevented adequate age comparisons. In both adolescents and adults outcome and mortality differed widely across studies with no firm evidence for gender differences. Outcome in mixed samples of adolescents and adults was inconsistent. Studies rarely compared the genders statistically, and when they did, the results were nonsignificant. CONCLUSIONS Knowledge on the outcome of males treated for anorexia nervosa is scarce. Only few studies comprising insufficient numbers of males exist. Results based on these findings are inconclusive and in part contradicting. Further research is needed, including large sample sizes of reliably diagnosed males, adequate follow-up intervals, follow-up assessments with carefully defined outcome criteria, and comparisons to matched female patient samples. LEVEL OF EVIDENCE Level I, Systematic review.
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Affiliation(s)
- Christine Strobel
- Schön Klinik Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), 83209, Prien, Germany
| | - Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU), Nussbaumstraße 7, 80336, Munich, Germany
| | - Ulrich Voderholzer
- Schön Klinik Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), 83209, Prien, Germany
| | - Silke Naab
- Schön Klinik Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), 83209, Prien, Germany
| | - Manfred M Fichter
- Schön Klinik Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), 83209, Prien, Germany. .,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU), Nussbaumstraße 7, 80336, Munich, Germany.
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Waller G, Schmidt U, Treasure J, Murray K, Aleyna J, Emanuelli F, Crockett J, Yeomans M. Problems across care pathways in specialist adult eating disorder services. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.107.018325] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodDespite considerable knowledge of outcomes for patients who complete treatment for eating disorders, less is known about earlier stages in the treatment journey. This study aimed to map the efficiency of the anticipated patient journey along care pathways. Referrals to specialist eating disorder services (n=1887) were tracked through the process of referral, assessment, treatment and discharge.ResultsThe patient mortality rate was low. However, there were serious problems of attrition throughout the care pathways. of the original referrals where a meaningful conclusion could be reached, in approximately 35% the person was never seen, only half entered treatment and only a quarter reached the end of treatment.Clinical ImplicationsThis study demonstrates considerable inefficiency of resource utilisation. Suggestions are made for reducing this inefficiency, to allow more patients the opportunity of evidence-based care.
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Weissman RS. Fifty volumes of scholarship on eating disorders. Int J Eat Disord 2017; 50:3-8. [PMID: 28025874 DOI: 10.1002/eat.22653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 11/08/2022]
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Rance N, Moller NP, Clarke V. ‘Eating disorders are not about food, they’re about life’: Client perspectives on anorexia nervosa treatment. J Health Psychol 2015; 22:582-594. [PMID: 26446375 DOI: 10.1177/1359105315609088] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Risk of suicide among female adolescents with eating disorders: a longitudinal population-based study. Eat Weight Disord 2015; 20:295-300. [PMID: 25596926 DOI: 10.1007/s40519-015-0176-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Suicide is a major cause of death among individuals with eating disorders. This study examined risk of suicide among females with eating disorders based on population-based military data. METHODS Data on diagnoses of eating disorders from the pre-induction screening for psychopathology and diagnoses assigned during military service were merged with data on later suicide from the nationwide Israeli Death Registry. We identified 1,356 females with eating disorders and compared their risk of suicide to a population-based control group of females without eating disorders over a mean follow-up period of 8.5 ± 5.34 years. RESULTS Females with eating disorders had a higher rate of suicide (0.22 %, n = 3) compared to females without eating disorders (0.03 %, n = 166). Having a moderate-severe eating disorder was associated with increased risk of suicide (RR = 12.50, 95 % CI = 3.86-38.09), whereas none of the females diagnosed as having a mild eating disorder died by suicide. CONCLUSIONS Females with moderate-severe eating disorders are at risk of suicide and should be monitored for suicidal intent.
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Nielsen S, Mitchell AJ. Comment on "Re-examining premature mortality in anorexia nervosa: A meta-analysis redux" by Keshaviah et al. [Comprehensive Psychiatry 55 (2014) 1773-1784]. Compr Psychiatry 2015; 61:131-2. [PMID: 26091893 DOI: 10.1016/j.comppsych.2015.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Keshaviah A, Edkins K, Hastings ER, Krishna M, Franko DL, Herzog DB, Thomas JJ, Murray HB, Eddy KT. Re-examining premature mortality in anorexia nervosa: a meta-analysis redux. Compr Psychiatry 2014; 55:1773-84. [PMID: 25214371 DOI: 10.1016/j.comppsych.2014.07.017] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022] Open
Abstract
Anorexia nervosa (AN) is reported to have the highest premature mortality of any psychiatric disorder, but recent meta-analyses may have inflated estimates. We sought to re-estimate mortality after methodological corrections and to identify predictors of mortality. We included 41 cohorts from 40 peer-reviewed studies published between 1966 and 2010. Methods included double data extraction, log-linear regression with an over-dispersed Poisson model, and all-cause and suicide-specific standardized mortality ratios (SMRs), with 95% Poisson confidence intervals. Participants with AN were 5.2 [3.7-7.5] times more likely to die prematurely from any cause, and 18.1 [11.5-28.7] times more likely to die by suicide than 15-34 year old females in the general population. Our estimates were 10% and 49% lower, respectively, than previously reported SMRs. Risk of premature mortality was highest in studies with older participants, although confounding by treatment was present. Gender, ascertainment, and diagnostic criteria also impacted risk.
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Affiliation(s)
- Aparna Keshaviah
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine Edkins
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth R Hastings
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; The Amundsen Group, Burlington, MA, USA
| | - Meera Krishna
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Northeastern University, Boston, MA, USA
| | - David B Herzog
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Helen B Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Welch E, Ghaderi A. Mortality in anorexia nervosa – a look back at and beyond one of the most cited papers in the field. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/21662630.2014.968177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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13
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Hoang U, Goldacre M, James A. Mortality following hospital discharge with a diagnosis of eating disorder: national record linkage study, England, 2001-2009. Int J Eat Disord 2014; 47:507-15. [PMID: 24599787 DOI: 10.1002/eat.22249] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 12/16/2013] [Accepted: 12/26/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To calculate mortality of people with eating disorders (ED) in England, relative to that of people of the same age and sex, between 2001 and 2009. We were specifically interested in mortality amongst adolescents and young adults (15-24 years), and older adults (25-44 years). METHOD We analyzed a NHS Hospital Episode Statistics (HES) dataset for all England, linked to death registrations, to calculate age- and sex-specific discharge rates for people with a diagnosis of ED and their subsequent mortality by one year after discharge. RESULTS The standardized mortality ratio (SMR) for adolescents and young adults with a diagnosis of ED was 7.8 (95% confidence interval: 4.4-11.2). This compares with an SMR for people of the same age with schizophrenia of 10.2 (8.3-12.2), with bipolar disorder of 3.6 (1.1-6.1, and with depression of 4.5 (3.6-5.3). Of the ED, the SMR for anorexia nervosa (AN) in people aged 15-24 was 11.5 (6.0-17.0), for bulimia nervosa (BN) was 4.1 (0-8.7), and eating disorders not otherwise specified (ED NOS) was 1.4 (0-4.0). For older adults aged 25-44 years, the SMR for ED was 10.7 (7.7-13.6). Specifically, for AN was 14.0 (9.2-18.8), for BN was 7.7 (3.5-11.9), and ED NOS was 4.7 (1.4-8.0), for schizophrenia was 7.3 (6.6-7.9), for bipolar disorder was 4.3 (3.5-5.1) and for depression was 4.9 (4.6-5.3). No deaths were recorded below 15 years of age. DISCUSSION This study confirms the high SMR associated with ED, notably with anorexia and bulimia.
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Affiliation(s)
- Uy Hoang
- Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford, OX3 7LF, United Kingdom
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Pászthy B, Törzsök-Sonnevend M. [Pathogenesis of anorexia nervosa. Neurobiological risk factors and possible endophenotypes]. Orv Hetil 2014; 155:124-31. [PMID: 24440724 DOI: 10.1556/oh.2014.29812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Anorexia nervosa is a serious, chronical state of illness which often starts in childhood or adolescence and has serious consequences on the quality of life. This review focuses on the heterogenity of the disease with emphasis on special diagnostic implications in case of childhood onset. Research findings of the last decade showed that genetic and neurobiological vulnerabilities are at least as potent risk factors as psychological, family constellations and sociocultural preferences. The heritability of eating disorders levels those of diseases predominantly influenced by biological factors. The authors give a summary of the most investigated neurobiologic and neurocognitive factors which could be the fundaments of a biological vulnerablilty. To date, no common risk factor could be identified, but some existing adversities can clearly be related to distinct subgroups with the disorder. The concept of endo- and subphenotypes leads to more specific and more efficient methods of therapy in other somatic and psychiatric diseases.
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Affiliation(s)
- Bea Pászthy
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika, Gyermek- és Ifjúságpszichiátriai Osztály Budapest Bókay J. u. 53. 1086
| | - Mária Törzsök-Sonnevend
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Gyermekgyógyászati Klinika, Gyermek- és Ifjúságpszichiátriai Osztály Budapest Bókay J. u. 53. 1086
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ED management of patients with eating disorders. Am J Emerg Med 2013; 31:859-65. [PMID: 23623238 DOI: 10.1016/j.ajem.2013.02.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Eating disorders are one of the "great masqueraders" of the twenty-first century. Seemingly healthy young men and women with underlying eating disorders present to emergency departments with a myriad of complaints that are not unique to patients with eating disorders. The challenge for the Emergency Medicine physician is in recognizing that these complaints result from an eating disorder and then understanding the unique pathophysiologic changes inherent to these disorders that should shape management in the emergency department. OBJECTIVE In this article, we will review, from the perspective of the Emergency Medicine physician, how to recognize patients with anorexia and bulimia nervosa, the medical complications and psychiatric comorbidities, and their appropriate management. CONCLUSIONS Anorexia and bulimia nervosa are complex psychiatric disorders with significant medical complications. Recognizing patients with eating disorders in the ED is difficult, but failure to recognize these disorders, or failure to manage their symptoms with an understanding of their unique underlying pathophysiology and psychopathology, can be detrimental to the patient. Screening tools, such as the SCOFF questionnaire, are available for use by the EM physician. Once identified, the medical complications described in this article can help the EM physician tailor management of the patient to their underlying pathophysiology and effectuate a successful therapeutic intervention.
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Abstract
This study explores the personal experience of pro-ana bloggers, members of an online community for people with eating disorders. Using Erving Goffman's work on stigma, this study explores the motivations, benefits, and drawbacks of blogging about a stigmatized mental illness, as taken from the bloggers' own perceptive. We conducted 33 interviews with bloggers from seven different countries via phone, Skype, and e-mail. Participants were motivated to blog because they found social support, a way to cope with a stigmatized illness, and means of self-expression. Participants described blogging as a cathartic experience and perceived the social support they received from other members of the pro-ana community as a benefit. The fear that the eating disorder will be revealed if the blog is exposed and the concern that the blog encourages disordered eating were the perceived negative consequences of maintaining such a blog. Thus, blogging about anorexia serves to both alleviate and trigger anxiety about living with this stigmatized illness. Recommendations for future research are made.
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Affiliation(s)
- Daphna Yeshua-Katz
- Department of Telecommunications, Indiana University, Bloomington, IN 47405, USA. ,
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Warren CS, Schafer KJ, Crowley ME, Olivardia R. A qualitative analysis of job burnout in eating disorder treatment providers. Eat Disord 2012; 20:175-95. [PMID: 22519896 DOI: 10.1080/10640266.2012.668476] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although job burnout is common in mental health care settings, almost no research has examined burnout in eating disorder treatment providers. Using qualitative methodology, this study examined a) perceived contributors of burnout, b) efforts to manage burnout, and c) recommendations for avoiding burnout in a sample of professional eating disorder treatment providers. Recruited via professional organizations, 298 participants completed an online questionnaire designed by the authors. Qualitative responses were coded and grouped into themes. Results indicated that almost all participants worried about their patients' health, which frequently resulted in negative affect (e.g., anxiety, sadness). The most frequently cited contributors to burnout were common characteristics of eating pathology (e.g., chronicity, relapse, symptom severity); patient characteristics (e.g., personality conflict); work-related factors (e.g., time demands); and, financial issues (e.g., inadequate compensation). To avoid burnout, over 90% of participants engaged in self-care behaviors (e.g., exercise, social support). Early-career practitioners were encouraged to utilize supervision, create a work/life balance, engage in self-care, and limit caseloads. These results suggest that supervision and training of eating disorder treatment providers should include burnout management.
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Affiliation(s)
- Cortney S Warren
- Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Parkway, Las Vegas, NV 89154, USA.
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Preti A, Rocchi MBL, Sisti D, Camboni MV, Miotto P. A comprehensive meta-analysis of the risk of suicide in eating disorders. Acta Psychiatr Scand 2011; 124:6-17. [PMID: 21092024 DOI: 10.1111/j.1600-0447.2010.01641.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Past meta-analyses on suicide in eating disorders included few available studies. METHOD PubMed/Medline search for papers including sample n ≥40 and follow-up ≥5 years: 40 studies on anorexia nervosa (AN), 16 studies on bulimia nervosa (BN), and three studies on binge eating disorder (BED) were included. RESULTS Of 16,342 patients with AN, 245 suicides occurred over a mean follow-up of 11.1 years (suicide rate=0.124 per 100 person-years). Standardized mortality ratio (SMR) was 31.0 (Poisson 95% CI=21.0-44.0); a clear decrease in suicide risk over time was observed in recent decades. Of 1768 patients with BN, four suicides occurred over a mean follow-up of 7.5 years (suicide rate=0.030 per 100 person-years): SMR was 7.5 (1.6-11.6). No suicide occurred among 246 patients with BED (mean follow-up=5.3 years). CONCLUSION AN and BN share many risk factors for suicide: the factors causing lower suicide rates per person-year in BN compared to AN should be investigated.
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Affiliation(s)
- A Preti
- Centro Medico Genneruxi, Via Costantinopoli 42, Cagliari, Italy.
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Warren CS, Crowley ME, Olivardia R, Schoen A. Treating patients with eating disorders: an examination of treatment providers' experiences. Eat Disord 2009; 17:27-45. [PMID: 19105059 DOI: 10.1080/10640260802570098] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Patients with eating disorders bring unique challenges to treatment providers. The purpose of this study was to explore treatment providers' experiences working with patients with eating disorders. Specifically, we investigated 1) the frequency and management of commentary about the treatment providers' appearance from patients, 2) personal changes in affect, vigilance around appearance, and eating behaviors in treatment providers, and 3) feedback and suggestions about effectively working with these patients. Using quantitative and qualitative methods, 43 professional eating disorder treatment providers attending the Multiservice Eating Disorder Association (MEDA) annual conference completed a questionnaire created for this study. Results suggest that most treatment providers experienced direct and indirect commentary about their appearance from patients and experienced notable changes in their view of food, eating behaviors, and vigilance of their own and others' appearance while working with these patients. Recommendations and suggestions from treatment providers about effectively treating these patients and managing personal changes are explored.
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Affiliation(s)
- Cortney S Warren
- Department of Psychology, University of Nevada, Las Vegas, Nevada 89154, USA.
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Papadopoulos FC, Ekbom A, Brandt L, Ekselius L. Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry 2009; 194:10-7. [PMID: 19118319 DOI: 10.1192/bjp.bp.108.054742] [Citation(s) in RCA: 267] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Anorexia nervosa is a mental disorder with high mortality. AIMS To estimate standardised mortality ratios (SMRs) and to investigate potential prognostic factors. METHOD Six thousand and nine women who had in-patient treatment for anorexia nervosa were followed-up retrospectively using Swedish registers. RESULTS The overall SMR for anorexia nervosa was 6.2 (95% CI 5.5-7.0). Anorexia nervosa, psychoactive substance use and suicide had the highest SMR. The SMR was significantly increased for almost all natural and unnatural causes of death. The SMR 20 years or more after the first hospitalisation remained significantly high. Lower mortality was found during the last two decades. Younger age and longer hospital stay at first hospitalisation was associated with better outcome, and psychiatric and somatic comorbidity worsened the outcome. CONCLUSIONS Anorexia nervosa is characterised by high lifetime mortality from both natural and unnatural causes. Assessment and treatment of psychiatric comorbidity, especially alcohol misuse, may be a pathway to better long-term outcome.
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