Eating disorders in the 21st century: identification, management, and prevention in obstetrics and gynecology

Psychological Meanings of Eating Disorders and Their Association With Symptoms, Motivation Toward Treatment, and Clinical Evolution Among Outpatients

Unlike patients suffering from egodystonic disorders, people with eating disorders sometimes attribute positive meanings to their symptoms, and this attribution process contributes to the maintenance of the disorder. This study aims at exploring psychological meanings of eating disorders and their associations with symptoms, motivation toward treatment, and clinical evolution. Eighty-one adults with an eating disorder (anorexia nervosa, n = 46 and bulimia nervosa, n = 35) treated in a day-hospital program were asked, each week over an 8-week period, to identify the psychological meanings they ascribed to their eating disorder. Avoidance was the most frequently identified meaning, followed by mental strength, security, death, confidence, identity, care, and communication. Avoidance was more frequently mentioned by participants with bulimia than in cases of anorexia. Security and mental strength were associated with less motivation toward treatment. Death was associated with more depressive and anxious symptoms. An exploratory factor analysis showed that these meanings formed three main dimensions: Avoidance, Intrapsychic, and Relational. Findings suggest that psychological meanings associated with eating disorders can be assessed and used as a clinical tool to increase treatment acceptability and effectiveness.

Eating Attitudes, Weight Control Behaviors, Body Image Satisfaction and Depression Level Among Indian Medical and Nursing Undergraduate Students

This was a cross sectional descriptive study carried out among Medical and Nursing students to assess the presence of eating disorders. Data was collected using self administered 'Sick, Control, One, Fat, Food' (SCOFF) and 'Eating Attitudes Test (EAT-26)' questionnaires. It was found that 34.1% and 10.4% of the participants were at high risk to suffer from eating disorders on SCOFF and EAT-26 scales. Further, age, gender and education found to have significant association on SCOFF and EAT-26 scores (p < 0.05). Thus, the findings suggest the need for effective interventions to prevent depression and eating disorders among the future health professionals.

Assessment of the menstrual cycle, eating disorders and self-esteem of Polish adolescents

INTRODUCTION

Eating disorders are an important factor in menstrual cycle disorders in girls. Moreover, low self-esteem among adolescent girls may be a risk factor for eating disorders. The aim of the study was to assess the menstrual cycle, eating habits and self-esteem of Polish adolescents.

METHODS

The study was conducted from January 2014 to March 2015 and included 623 girls, aged 15-19, from randomly selected junior high schools in Silesia, Poland, in which their menstrual cycle, risk of eating disorders and self-esteem were evaluated. A five-part questionnaire was used to assess basic demographic data, lifestyle and physical activity, gynecological history, as well as Rosenberg Self-Esteem Scale (SES) and Eating Attitude Test (EAT-26).

RESULTS

Irregular menstrual cycles were observed in 236 (37.88%) girls; 5.20% presented secondary amenorrhea. Based on the EAT-26 test, 101 (16.21%) girls were indicated being at risk for an eating disorder. Low self-esteem was observed in 340 (54.57%) study girls on the base of SES.

DISCUSSION

Girls with irregular menses had higher scores on the EAT-26 test in subscales: EAT-overall score, EAT-diet and EAT-bulimia, while lower scores on the SES. In our study, we did not observe a significant relationship between exercise intensity, body mass, BMI and menstrual cycle regularity. Low self-esteem among adolescent girls may be a risk factor for eating disorders which could interrupt the menstrual cycle.

The influence of eating disorders on mothers' sensitivity and adaptation during feeding: a longitudinal observational study

BACKGROUND

Parents with past and current eating disorders (ED) have been shown to report troubles nourishing their infants. This could increase the risk of infant feeding problems linked to maternal anxiety and depression. It is not clear how mothers' eating difficulties before pregnancy and at the time of birth can affect infant's feeding. We aimed to specify the impact of eating disorders on mothers' adaptation and sensitivity to their offspring during feeding, by comparing a population of mothers with eating disorders and controls.

METHODS

Twenty-eight women agreed to participate in interviews and filmed mother-baby interactions. Pregnant women consulting at an obstetric unit for care follow-up were screened and tested for symptoms of eating disorders with the EDE-Q Questionnaire (Eating Disorders Examination Questionnaire) and the EDE Interview (Eating Disorders Examination Interview). Infant functional troubles and mothers' sensitivity were investigated through the Symptom Check List. Reciprocal adaptation during feeding with their new-borns was filmed and analysed with the Chatoor Infant Feeding Scale. Before pregnancy, two women suffered from anorexia, three suffered from bulimia, three had binge eating symptoms and two were diagnosed with EDNOS (Eating Disorders Not Otherwise Specified).

RESULTS

Mothers suffering from ED tended to show more difficult interactive patterns in terms of dyadic reciprocity when feeding their babies compared with mothers with no symptoms of eating disorders. In the interviews, other than the behavioural data gathered, ED mothers expressed feeling more dissatisfaction and uneasiness during feeding.

CONCLUSIONS

Pregnancy seems to be an useful period for interviewing women on eating disorders, allowing for the design and implementation of prevention programmes based on mothers' narratives and infant/mother observations and treatment.

Failure to feed patients with anorexia nervosa and other perils and perplexities in the medical care of eating disorder patients

A 28 year old woman with anorexia nervosa was sent to an emergency room by her gastroenterologist for weakness and nausea following placement of a percutaneous endoscopic gastrostomy (PEG) tube, with a plan for admission to the hospital. She spent 2 days in the emergency room without receiving any nutrition, and was discharged home after being told that her laboratory tests and x-rays were normal. The following day, her gastroenterologist reviewed the x-rays and determined that she had a bowel obstruction, at which point she was admitted to the hospital, weighing 2 kg less than on her initial visit. A 26 year old woman with anorexia nervosa was prematurely discharged from a residential facility with a Dobhoff feeding tube in her small intestine. She developed dizziness and weakness and was admitted to the hospital, but did not receive any feeding during the 6 days she was there, despite documented blood sugars in the 30s. Apparently an early order for tube feeding was cancelled, for unclear reasons. Two days after discharge, she again developed weakness and returned to the emergency room with a letter from her physician stating that she required medical supervision for the initiation of feeding. However, she was discharged from the emergency room within hours, only to be re-admitted to the hospital the next day.

Eating disorders in the obstetric and gynecologic patient population

The eating disorders anorexia nervosa and bulimia nervosa and eating disorders not otherwise specified disproportionately affect women, have profound effects on the overall well-being of women and their children, and can have mortality rates as high as those found with major depression. These disorders may present to obstetrician-gynecologists (ob-gyns) clinically as menstrual dysfunction, low bone density, sexual dysfunction, miscarriage, preterm delivery, or low birth weight in offspring. Ninety percent of eating disorders develop before the age of 25 in otherwise healthy young women, a group that characteristically seeks the majority of their health care from ob-gyns. For all of these reasons, ob-gyns must have a greater awareness of these disorders and a lower index of suspicion for screening their patients than they currently do. Otherwise, they may miss life-threatening illness, treat characteristic amenorrhea inappropriately, or inadvertently intervene to help these women conceive, contributing to maternal and fetal risks. As providers of both primary and specialty care for women, ob-gyns have the opportunity to play a vital role in prevention and diagnosis of eating disorders and in the multidisciplinary management required to effectively manage these disorders.