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Baker JH, Freestone D, Cai K, Silverstein S, Urban B, Steinberg D. Eating Disorder Clinical Presentation and Treatment Outcomes by Gender Identity Among Children, Adolescents, and Young Adults. J Adolesc Health 2024; 75:254-260. [PMID: 38310504 DOI: 10.1016/j.jadohealth.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 11/03/2023] [Accepted: 11/15/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Current eating disorder treatment approaches for youth were developed for use with cisgender girls, which limits the understanding of effectiveness for cisgender boys and transgender and gender expansive (TGE) youth. Here, we compare treatment outcomes for cisgender boys and TGE youth with cisgender girls receiving family-based treatment for an eating disorder. METHODS Patients were aged 6-24 and either active in treatment or discharged from September 1, 2020, to November 1, 2022 (N = 1,235). Patient exposure to treatment varied given individualized length of treatment. Outcomes include eating disorder symptoms, depression, anxiety, suicidality, caregiver burden, and parental confidence in supervising treatment. Treatment outcomes for cisgender boys and TGE youth were compared with cisgender girls. RESULTS Patients included n = 975 cisgender girls, n = 152 cisgender boys, and n = 108 TGE youth. Anorexia nervosa was the most common diagnosis. Cisgender boys reported significantly lower eating disorder (b = -2.7 [-4.1, -1.3]), anxiety (b = -1.6 [-2.2, -0.9]), and depression (b = -1.7 [-2.4, -0.9]) symptoms at admission compared with cisgender girls. TGE patients had significantly higher anxiety (b = 1.08 [0.28, 1.91]) and depression (b = 1.72 [0.78, 2.65]) symptoms compared with cisgender girls. Cisgender boys started with significantly lower suicidal ideation (b = -1.28 [-2.19, -0.43]) and TGE patients with significantly higher suicidal ideation (b = 1.63 [0.76, 2.51]) than cisgender girls. All symptoms improved during treatment and improved at similar rates over time in treatment regardless of gender identity. DISCUSSION Early evidence from this study supports the use of family-based treatment for cisgender boys and TGE youth with eating disorders. Further research is needed on the long-term outcomes of this approach for youth of all genders.
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Affiliation(s)
| | | | - Kelly Cai
- Equip Health, Inc., Carlsbad, California
| | | | - Bek Urban
- Equip Health, Inc., Carlsbad, California
| | - Dori Steinberg
- Equip Health, Inc., Carlsbad, California; Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, North Carolina
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Hagan KE, Johnson A, Venables K, Makara A, Haynos AF. Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students. Int J Eat Disord 2024; 57:924-936. [PMID: 38303677 PMCID: PMC11018494 DOI: 10.1002/eat.24152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Research on the natural course of symptoms of atypical anorexia nervosa (AN) relative to AN and bulimia nervosa (BN) is limited yet needed to inform nosology and improve understanding of atypical AN. This study aimed to 1) characterize trajectories of eating disorder and internalizing (anxiety, depression) symptoms in college students with and without a history of atypical AN, AN, and BN; and 2) compare sex and race/ethnicity distributions across groups. METHOD United States college students who participated in Spit for Science™, a prospective cohort study, were classified as having a history of atypical AN (n = 125), AN (n = 160), BN (n = 617), or as non-eating-disorder controls (NCs, n = 5876). Generalized and linear mixed-effects models assessed group differences in eating and internalizing symptom trajectories, and logistic regression compared groups on sex and race/ethnicity distributions. RESULTS Atypical AN participants demonstrated elevated eating disorder and internalizing symptoms compared to NCs during college, but less severe symptoms than AN and BN participants. Although all eating disorder groups showed signs of improvement in fasting and driven exercise, purging and depression remained elevated. Atypical AN participants showed increasing anxiety and stable binge-eating trajectories compared to AN and/or BN participants. The atypical AN group comprised significantly more people of color than the AN group. DISCUSSION Findings underscore that atypical AN is a severe psychiatric disorder. As atypical AN may present as less severe than AN and BN and disproportionately affects people of color, clinicians should be mindful of biases that could delay diagnosis and care. PUBLIC SIGNIFICANCE College students with histories of atypical AN, AN, and BN demonstrated improvements in fasting and driven exercise and stable purging and depression levels. Atypical AN students showed worsening anxiety and stable binge-eating trajectories compared to favorable changes among AN and BN students. A higher percentage of atypical AN (vs. AN) students were people of color. Findings may improve the detection of atypical AN in college students.
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Affiliation(s)
- Kelsey E. Hagan
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Women’s Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Adanya Johnson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kira Venables
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Amanda Makara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Ann F. Haynos
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
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Toigo S, Katzman DK, Vyver E, McFaull SR, Iynkkaran I, Thompson W. Eating disorder hospitalizations among children and youth in Canada from 2010 to 2022: a population-based surveillance study using administrative data. J Eat Disord 2024; 12:3. [PMID: 38167164 PMCID: PMC10763198 DOI: 10.1186/s40337-023-00957-y] [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: 10/31/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) are severe mental illnesses associated with significant morbidity and mortality. EDs are more prevalent among females and adolescents. Limited research has investigated Canadian trends of ED hospitalizations prior to the COVID-19 pandemic, however during the pandemic, rates of ED hospitalizations have increased. This study examined rates of ED hospitalizations among children and youth in Canada from 2010 to 2022, by sex, age, province/territory, length of stay, discharge disposition and ED diagnosis. METHODS Cases of ED hospitalizations among children and youth, ages 5 to 17 years, were identified using available ICD-10 codes in the Discharge Abstract Database from the 2010/11 to 2022/23 fiscal years. The EDs examined in this study were anorexia nervosa (F50.0), atypical anorexia nervosa (F50.1), bulimia nervosa (F50.2), other EDs (F50.3, F50.8) and unspecified EDs (F50.9). Both cases of total and first-time ED hospitalizations were examined. Descriptive statistics and trend analyses were performed. RESULTS Between 2010/11 and 2022/23, 18,740 children and youth were hospitalized for an ED, 65.9% of which were first-time hospitalizations. The most frequent diagnosis was anorexia nervosa (51.3%). Females had significantly higher rates of ED hospitalization compared to males (66.7/100,000 vs. 5.9/100,000). Youth had significantly higher rates compared to children. The average age of ED hospitalization was 14.7 years. Rates of ED hospitalizations were relatively stable pre-pandemic, however during the pandemic (2020-2021), rates increased. INTERPRETATION Rates of pediatric ED hospitalizations in Canada increased significantly during the pandemic, suggesting that there may have been limited access to alternative care for EDs or that ED cases became more severe and required hospitalization. This emphasizes the need for continued surveillance to monitor how rates of ED hospitalizations evolve post-pandemic.
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Affiliation(s)
- Stephanie Toigo
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada.
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ellie Vyver
- Section of Adolescent Medicine, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Steven R McFaull
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
| | - Ithayavani Iynkkaran
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
| | - Wendy Thompson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
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Chatwin H, Holde K, Yilmaz Z, Larsen JT, Albiñana C, Vilhjálmsson BJ, Mortensen PB, Thornton LM, Bulik CM, Petersen LV. Risk factors for anorexia nervosa: A population-based investigation of sex differences in polygenic risk and early life exposures. Int J Eat Disord 2023; 56:1703-1716. [PMID: 37232007 PMCID: PMC10524536 DOI: 10.1002/eat.23997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To examine sex differences in risk factors for anorexia nervosa (AN). METHOD This population-based study involved 44,743 individuals (6,239 AN cases including 5,818 females and 421 males, and 38,504 controls including 18,818 females and 19,686 males) born in Denmark between May 1981 and December 2009. Follow-up began on the individual's sixth birthday and ended at AN diagnosis, emigration, death, or December 31, 2016, whichever occurred first. Exposures included socioeconomic status (SES), pregnancy, birth, and early childhood factors based on data from Danish registers, and psychiatric and metabolic polygenic risk scores (PRS) based on genetic data. Hazard ratios were estimated using weighted Cox proportional hazards models stratified by sex (assigned at birth), with AN diagnosis as the outcome. RESULTS The effects of early life exposures and PRS on AN risk were comparable between females and males. Although we observed some differences in the magnitude and direction of effects, there were no significant interactions between sex and SES, pregnancy, birth, or early childhood exposures. The effects of most PRS on AN risk were highly similar between the sexes. We observed significant sex-specific effects of parental psychiatric history and body mass index PRS, though these effects did not survive corrections for multiple comparisons. CONCLUSIONS Risk factors for AN are comparable between females and males. Collaboration across countries with large registers is needed to further investigate sex-specific effects of genetic, biological, and environmental exposures on AN risk, including exposures in later childhood and adolescence as well as the additive effects of exposures. PUBLIC SIGNIFICANCE Sex differences in the prevalence and clinical presentation of AN warrant examination of sex-specific risk factors. This population-based study indicates that the effects of polygenic risk and early life exposures on AN risk are comparable between females and males. Collaboration between countries with large registers is needed to further investigate sex-specific AN risk factors and improve early identification of AN.
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Affiliation(s)
- Hannah Chatwin
- National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
| | - Katrine Holde
- National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
| | - Zeynep Yilmaz
- National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Janne Tidselbak Larsen
- National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Clara Albiñana
- National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
| | - Bjarni Jóhann Vilhjálmsson
- National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Liselotte Vogdrup Petersen
- National Centre for Register-Based Research (NCRR), Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
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Traut P, Halbeisen G, Braks K, Huber TJ, Paslakis G. Sociodemographic and clinical features of men and women with eating disorders: a diagnosis-matched, retrospective comparison among inpatients. Front Psychiatry 2023; 14:1192693. [PMID: 37484681 PMCID: PMC10359980 DOI: 10.3389/fpsyt.2023.1192693] [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: 03/23/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Eating disorders (EDs) are among the most severe mental disorders in women and men, often associated with high symptom burden and significant limitations in daily functioning, frequent comorbidities, chronic course of illness, and even high mortality rates. At the same time, differences between men and women with EDs remain poorly explored. Methods In this study, we compared 104 men to 104 diagnosis-matched women with EDs regarding sociodemographic and clinical features. Using latent class mixture modelling, we identified four distinct patient subgroups based on their sociodemographic features. Results Men with EDs had significantly higher odds than women to belong to a "single-childfree-working" class. Moreover, while there were few overall differences in ED-related symptoms and general psychopathology between men and women, single-childfree-working men with EDs presented with higher general psychopathology symptoms than men in the other classes. Discussion We discuss how considering sex and gender along with further sociodemographic differences in EDs may help to improve ED diagnosis and treatment.
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Affiliation(s)
- Philipp Traut
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Karsten Braks
- Centre for Eating Disorders, Klinik am Korso, Bad Oeynhausen, Germany
| | - Thomas J. Huber
- Centre for Eating Disorders, Klinik am Korso, Bad Oeynhausen, Germany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
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Kenny B, Bowe SJ, Taylor CB, Moodie M, Brown V, Hoban E, Williams J. Longitudinal relationships between sub-clinical depression, sub-clinical eating disorders and health-related quality of life in early adolescence. Int J Eat Disord 2023; 56:1114-1124. [PMID: 36896467 PMCID: PMC10946984 DOI: 10.1002/eat.23928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE A comprehensive understanding of the relationship between depressive symptoms and eating disorder (ED) symptoms requires consideration of additional variables that may influence this relationship. Health-related quality of life (HRQOL) has been associated with both depression and EDs; however, there is limited evidence to demonstrate how all three variables interact over time. This study sought to explore the bi-directional relationships between depressive symptoms, ED symptoms and HRQOL in a large community sample of young adolescents METHOD: Adolescents (N = 1393) aged between 11 and 14 years (M = 12.50, SD = 0.38) completed an online survey measuring depressive symptoms, ED symptoms and HRQOL. Two-level autoregressive cross-lagged models with three variables (i.e., depressive symptoms, HRQOL and ED) assessed across two time points (T1 and T2) were created to address the study aims. RESULTS HRQOL was found to predict depressive symptoms and depressive symptoms were found to predict ED symptoms. Components of HRQOL (i.e., social relationships and ability to cope) were found to share a differential relationship with depressive symptoms. Inability to cope predicted depressive symptoms and depressive symptoms predicted negative social relationships. EDs were found to predict reduced HRQOL and negative social relationships. DISCUSSION Findings suggest prevention and early intervention programs designed to address adolescent depression should focus on improving HRQOL. Future research should assess the relationship between HRQOL and individual ED symptoms (e.g., body-related ED symptoms, restrictive symptoms) as a means of exploring relationships that may have been masked by assessing ED symptoms using a total score. PUBLIC SIGNIFICANCE This study sought to explore how eating disorders, depressive symptoms, and health-related quality of life (HRQOL) relate over time in a sample of young adolescents. Findings indicate adolescents who self-reported lower levels of HRQOL, including a reduced ability to cope, are at risk of experiencing depressive symptoms. Adolescents should be provided with the tools to develop problem-focused coping strategies as a means of reducing depressive symptoms.
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Affiliation(s)
- Bridget Kenny
- School of Health and Social Development, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Steven J. Bowe
- Biostatistics Unit, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - C. Barr Taylor
- School of Medicine, Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCaliforniaUSA
- Center for m2HealthPalo Alto UniversityPalo AltoCaliforniaUSA
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Vicki Brown
- Deakin Health Economics, School of Health and Social Development, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Elizabeth Hoban
- School of Health and Social Development, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Joanne Williams
- School of Health and Social Development, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
- School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
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Yilmaz Z, Schaumberg K, Halvorsen M, Goodman EL, Brosof LC, Crowley JJ, Mathews CA, Mattheisen M, Breen G, Bulik CM, Micali N, Zerwas SC. Predicting eating disorder and anxiety symptoms using disorder-specific and transdiagnostic polygenic scores for anorexia nervosa and obsessive-compulsive disorder. Psychol Med 2023; 53:3021-3035. [PMID: 35243971 PMCID: PMC9440960 DOI: 10.1017/s0033291721005079] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Clinical, epidemiological, and genetic findings support an overlap between eating disorders, obsessive-compulsive disorder (OCD), and anxiety symptoms. However, little research has examined the role of genetics in the expression of underlying phenotypes. We investigated whether the anorexia nervosa (AN), OCD, or AN/OCD transdiagnostic polygenic scores (PGS) predict eating disorder, OCD, and anxiety symptoms in a large developmental cohort in a sex-specific manner. METHODS Using summary statistics from Psychiatric Genomics Consortium AN and OCD genome-wide association studies, we conducted an AN/OCD transdiagnostic genome-wide association meta-analysis. We then calculated AN, OCD, and AN/OCD PGS in participants from the Avon Longitudinal Study of Parents and Children to predict eating disorder, OCD, and anxiety symptoms, stratified by sex (combined N = 3212-5369 per phenotype). RESULTS The PGS prediction of eating disorder, OCD, and anxiety phenotypes differed between sexes, although effect sizes were small. AN and AN/OCD PGS played a more prominent role in predicting eating disorder and anxiety risk than OCD PGS, especially in girls. AN/OCD PGS provided a small boost over AN PGS in the prediction of some anxiety symptoms. All three PGS predicted higher compulsive exercise across different developmental timepoints [β = 0.03 (s.e. = 0.01) for AN and AN/OCD PGS at age 14; β = 0.05 (s.e. = 0.02) for OCD PGS at age 16] in girls. CONCLUSIONS Compulsive exercise may have a transdiagnostic genetic etiology, and AN genetic risk may play a role in the presence of anxiety symptoms. Converging with prior twin literature, our results also suggest that some of the contribution of genetic risk may be sex-specific.
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Affiliation(s)
- Zeynep Yilmaz
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katherine Schaumberg
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Matthew Halvorsen
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Erica L. Goodman
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
| | - Leigh C. Brosof
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - James J. Crowley
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Carol A. Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Manuel Mattheisen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, Aarhus, Denmark
- The Lundbeck Foundation Initiative of Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre, King's College London, London, UK
- National Institute for Health Research Biomedical Research Centre, South London and Maudsley National Health Service Trust, London, UK
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, HUG, Geneva, Switzerland
- Institute of Child Health, University College London, London, UK
- Department of Paediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, HUG, Geneva, Switzerland
| | - Stephanie C. Zerwas
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
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Shehata WM, Abdeldaim DE. Emotional eating in relation to psychological stress during COVID-19 pandemic: a cross-sectional study in faculty of medicine, Tanta University, Egypt. BMC Public Health 2023; 23:277. [PMID: 36750824 PMCID: PMC9904530 DOI: 10.1186/s12889-023-15177-x] [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: 07/13/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Stress, anxiety, and depression resulting from the COVID-19 pandemic as well as subsequent restrictive measures had a negative impact on eating behaviors. This study aimed to determine the emotional eating behaviors and the perceived stress level and to assess the relation between them among adults in the faculty of medicine during the late period of lockdown during the COVID-19 pandemic. METHODS This was a cross-sectional study among 580 persons from the faculty of medicine, at Tanta University, Egypt conducted over a period of one month during the last period of partial lockdown (October 2020). A self-administered structured questionnaire consisted of five parts used in the study (sociodemographic factors, COVID-19-related parameters, nutrition-related information during the pandemic, emotional eating scale, and perceived stress scale). RESULTS More than two-fifths of students, employees, and staff (45.2%, 45.5%, and 44.2%, respectively) stated that their weight increased as a result of the lockdown. 50.8% of students, 42.5% of employees, and 54.6% of staff were in the moderate emotional eating groups. Similarly, the majority of students, employees, and staff reported moderate levels of stress(84%, 80.8%, and 76.1% respectively). The total emotional eating score was positively correlated with the total perceived stress scores (r = 0.13, p = 0.001*). CONCLUSION COVID-19 pandemic, particularly during the period of lockdown, had a negative impact on individuals' psychological stress levels and levels of emotional eating behaviors.
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Affiliation(s)
- Walaa M. Shehata
- grid.412258.80000 0000 9477 7793Assistant professor of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Doaa E. Abdeldaim
- grid.412258.80000 0000 9477 7793Assistant professor of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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Giacomini G, Elhadidy HSMA, Paladini G, Onorati R, Sciurpa E, Gianino MM, Borraccino A. Eating Disorders in Hospitalized School-Aged Children and Adolescents during the COVID-19 Pandemic: A Cross-Sectional Study of Discharge Records in Developmental Ages in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192012988. [PMID: 36293569 PMCID: PMC9602016 DOI: 10.3390/ijerph192012988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 05/08/2023]
Abstract
Eating disorders (EDs) are characterized by behavioral and cognitive aspects that result in a significant impairment of an individual's well-being. COVID-19 pandemic consequences negatively impacted healthcare services and people's mental health. Particularly, in developmental ages, difficulties in coping with the situation could have had an impact on eating behaviors. Therefore, the aim of this study was to assess EDs' hospitalization trend before, during and after the pandemic peak to evaluate whether it has been influenced. A retrospective cross-sectional study was conducted on the hospital discharge forms of patients from 5 to 19 years old in Piedmont, which is a region in northern Italy. Overall, hospitalization, age, and gender-specific rates due to EDs that occurred in 2020 and 2021 were compared to those that occurred in 2018-2019. Since 2020, there has been a 55% reduction in overall hospitalizations, while the total proportion of EDs admissions has doubled from 2020 to 2021 (from 13.9‱ to 22.2‱). Significant hospitalization rate increases were observed both in 15-19 and in 10-14 females' age groups in 2021. Non-significant increases were observed in all males' age groups. The increase in hospitalizations for EDs should be further investigated, as it might be the tip of an iceberg not yet acknowledged.
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Affiliation(s)
- Gianmarco Giacomini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | | | - Giovanni Paladini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Roberta Onorati
- Regional Public Health Observatory, Epidemiology Unit, Local Health Board TO3, Piedmont Region, 10195 Grugliasco, Italy
| | - Elena Sciurpa
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
- Correspondence:
| | - Alberto Borraccino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
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Bryant E, Spielman K, Le A, Marks P, Touyz S, Maguire S, Brennan L, Bryant E, Byrne S, Caldwell B, Calvert S, Carroll B, Castle D, Caterson I, Chelius B, Chiem L, Clarke S, Conti J, Crouch L, Dammery G, Dzajkovski N, Fardouly J, Feneley J, Foroughi N, Fuller-Tyszkiewicz M, Fursland A, Gonzalez-Arce V, Gouldthorp B, Griffin K, Griffiths S, Hambleton A, Hannigan A, Hart M, Hart S, Hay P, Hickie I, Kay-Lambkin F, King R, Kohn M, Koreshe E, Krug I, Le A, Linardon J, Long R, Long A, Madden S, Maguire S, Maloney D, Marks P, McLean S, Meddick T, Miskovic-Wheatley J, Mitchison D, O’Kearney R, Paterson R, Paxton S, Pehlivan M, Pepin G, Phillipou A, Piccone J, Pinkus R, Raykos B, Rhodes P, Rieger E, Rodan S, Rockett K, Russell J, Russell H, Salter F, Sawyer S, Shelton B, Singh U, Smith S, Smith E, Spielman K, Squire S, Thomson J, Tiggemann M, Touyz S, Utpala R, Vartanian L, Wallis A, Ward W, Wells S, Wertheim E, Wilksch S, Williams M, Touyz S, Maguire S. Screening, assessment and diagnosis in the eating disorders: findings from a rapid review. J Eat Disord 2022; 10:78. [PMID: 35672777 PMCID: PMC9175461 DOI: 10.1186/s40337-022-00597-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/21/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems. METHODS This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for studies published between 2009 and mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review. RESULTS Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males. CONCLUSIONS A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many. Limited screening in healthcare settings and low rates of eating disorder training in the healthcare professions are just some of the barriers to help-seeking which may contribute to delayed intervention and diagnosis in the eating disorders. This has significant impacts, prolonging treatment when it is finally received, and increasing healthcare costs for both the individual and the healthcare system. The current review is part of a larger Rapid Review series conducted to inform the development of Australia's National Eating Disorders Research and Translation Strategy 2021-2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe, often to guide policy-making and address urgent health concerns. The Rapid Review synthesises the current evidence-base and identifies gaps in eating disorder research and care, in order to guide decision making and address urgent health concerns. This paper gives a critical overview of the scientific literature relating to the current state of screening, assessment, and diagnosis of eating disorders within Western healthcare systems that may inform health policy and research in an Australian context. It covers screening initiatives in both general and high-risk populations; personal, clinician and healthcare system challenges relating to help-seeking; and obstacles to accurate and timely clinical diagnosis across the eating disorders.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Karen Spielman
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, New South Wales Health, Sydney, Australia
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Cura-Esquivel I, Ramos-Álvarez J, Delgado E, Regalado-Ceballos A. Prevalence of food addiction using the Yale-C scale in Mexican children with overweight and obesity. PeerJ 2022; 10:e13500. [PMID: 35637710 PMCID: PMC9147313 DOI: 10.7717/peerj.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/05/2022] [Indexed: 01/17/2023] Open
Abstract
Background The prevalence of excess weight and obesity in children has increased significantly worldwide. The concept of food addiction (FA) has been associated with eating-related problems and obesity. Studies on this topic have primarily examined adult samples and little is known about addictive-like eating among Mexican children and adolescents. Methods We conducted this study to examinate the prevalence of FA in a group of 291 overweight and obese children and adolescents using YFAS scale for children (YFAS-C) in Mexico. Results According to the YFAS-C approximately 14.4% of participants met for FA diagnosis. Forty-two (14.4%) received a FA diagnosis: 14 children and 28 adolescents. The number of FA symptoms in participants who received an FA diagnosis (M = 4.35, SD = 1.07) compared to participants with no FA diagnosis (M = 1.70, SD = 1.53) was significantly higher (p ≤ 0.001). There were no statistically significant gender differences and the proportion of subjects with an FA diagnosis did not differ by age between children and adolescents. FA is a focus of interest in attempting to explain certain behaviors that may contribute to the development of obesity and explain the failure of the weight loose programs in children.
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Affiliation(s)
- Idalia Cura-Esquivel
- Department of Pediatrics, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Juan Ramos-Álvarez
- Department of Pediatrics, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Edna Delgado
- Department of Pediatrics, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Airam Regalado-Ceballos
- School of Medicine and University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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12
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Papini NM, Jung M, Cook A, Lopez NV, Ptomey LT, Herrmann SD, Kang M. Psychometric properties of the 26-item eating attitudes test (EAT-26): an application of rasch analysis. J Eat Disord 2022; 10:62. [PMID: 35509106 PMCID: PMC9069796 DOI: 10.1186/s40337-022-00580-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The 26-item Eating Attitudes Test (EAT-26) is a commonly used tool to assess eating disorder risk. The purpose of this study was to examine the psychometric properties of the EAT-26 with a combined sample: (1) of adults with overweight and obesity enrolled in a behavioral weight loss program and (2) general adult sample (n = 469; age = 36.17 ± 17.83 years; female = 72.5%; white = 66.3%; obese BMI category = 58%). METHODS Rasch modeling was used to assess model-data fit, create an item-person map to evaluate relative distribution items and persons, item difficulty, and person's eating disorder (ED) risk level of the EAT-26. Differential item functioning (DIF) and rating scale functioning of the EAT-26 were also evaluated using Rasch analysis. RESULTS A total of 7 misfit items were removed from the final analysis due to unacceptable Infit and Outfit mean square residual values. The item-person map showed that the items were biased toward participants with moderate to high levels of ED risk and did not cover those who had low risk for having an ED (< - 1 logits). The DIF analyses results showed that none of the items functioned differently across sex, but 5 items were flagged based on obesity status. The six-category Likert-type rating scale did not function well indicating a different response format may be needed. CONCLUSION Several concerns were identified with the psychometric evaluation of the EAT-26 that may question its utility in assessing ED risk in individuals at low risk for ED, within samples of people who have overweight and obesity seeking weight loss treatment. The 26-item Eating Attitudes Test is a self-rated measure of eating attitudes that measures symptoms and concerns of eating disorders (ED). Very little is known about how this instrument performs differently based on individual factors like body mass index (BMI) and sex (male/female). We used an advanced measurement theory (i.e., Rasch analysis) to determine if the EAT-26 is an adequate measure to detect disordered eating in men and women of different BMIs. Results indicated that the EAT-26 was biased toward participants with moderate to high levels of disordered eating risk and did not adequately detect individuals at low risk for disordered eating. The EAT-26 did not function differently based on sex (male/female). However, five questions did function differently based on obesity status (those without obesity/ those with obesity). Finally, we observed the six-category rating scale did not function appropriately and that a new response format may be warranted. In sum, there were several issues (e.g., poor rating scale and different item functioning) with the EAT-26 and future work should develop screening tools that detect low risk of disordered eating as well as function well in adults with overweight and obesity.
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Affiliation(s)
- Natalie M Papini
- Department of Health Sciences, Northern Arizona University, 1100 S. Beaver St., Flagstaff, AZ, 86001, USA.
| | - Myungjin Jung
- Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, MS, USA
| | - Amanda Cook
- Volunteer Behavioral Health Care System, Murfreesboro, TN, USA
| | - Nanette V Lopez
- Department of Health Sciences, Northern Arizona University, 1100 S. Beaver St., Flagstaff, AZ, 86001, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Minsoo Kang
- Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, MS, USA
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13
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Caqueo-Urízar A, Urzúa A, Flores J, Acevedo D, Lorca JH, Casanova J. Relationship between eating disorders and internalized problems in chilean adolescents. J Eat Disord 2021; 9:118. [PMID: 34565472 PMCID: PMC8474780 DOI: 10.1186/s40337-021-00474-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/07/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Eating disorders (ED) are associated with internalized problems (INTP), such as depression and anxiety. Evidence shows that ED and INTP are associated with comorbidities. The relationship between these variables has not been the focus of studies on young people from Northern Chile. Children and adolescents are considered as an at-risk group, since they have been found to experience greater vulnerability to psychological problems than other age groups within the population and given the scarcity of studies in Chile, it is necessary to study the relationship between these variables. METHODS This study analyzed the relationship between ED and INTP in Chilean high school students aged 12 to 18 years using Pearson's correlation. This is a non-experimental and transactional correlational study. We included 2277 students belonging to the public, government-subsidized, and private educational establishments in Northern Chile. The Child and Adolescent Evaluation System [Sistema de Evaluación de Niños y Adolescentes (SENA)] was used to detect a range of INTP, as well as ED. The Brief Self-Control Scale was used in this study. RESULTS A strong and direct correlation of the eating disorder variable with depression and anxiety was found. Additionally, significant differences were observed with sex, highlighting females with a higher presence of INTP and ED. CONCLUSIONS There is a need to establish strategies in the school setting for detecting frequent symptomatology in adolescents with INTP and ED to achieve a timely and accessible intervention. Since the symptomatology of ED is more prevalent in adolescents, this research evaluated relationships between ED and INTP in young people from Northern Chile. This research is relevant because the evidence on this topic in Chile is scarce and the relationships found could be the first research on the subject and serve to design an intervention plan at the school level in the medium and long terms. It is a non-experimental and transactional correlational study because all variables were measured at a single moment, and it sought to establish relationships between variables without assuming causality. The sample of secondary school students consisted of 2277 students, belonging to the public, subsidized, and private schools. Strong relationships were observed between INTP and ED, the strongest correlations being with the variables depression and anxiety. In addition, female participants presented greater problems in ED and INTP.
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Affiliation(s)
- Alejandra Caqueo-Urízar
- Instituto de Alta Investigación, Universidad de Tarapacá, Calle Antofagasta n°1520, Arica, 1000000, Chile.
| | - Alfonso Urzúa
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Jerome Flores
- Escuela de Psicología Y Filosofía, Universidad de Tarapacá & Centro Justicia Educacional CJE, Santiago, Chile
| | - Daniel Acevedo
- Escuela de Psicología Y Filosofía, Universidad de Tarapacá & Centro Justicia Educacional CJE, Santiago, Chile
| | - Jessica Herrera Lorca
- Escuela de Psicología Y Filosofía, Universidad de Tarapacá & Centro Justicia Educacional CJE, Santiago, Chile
| | - Jenifer Casanova
- Escuela de Psicología Y Filosofía, Universidad de Tarapacá & Centro Justicia Educacional CJE, Santiago, Chile
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14
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Coelho JS, Suen J, Marshall S, Burns A, Geller J, Lam PY. Gender differences in symptom presentation and treatment outcome in children and youths with eating disorders. J Eat Disord 2021; 9:113. [PMID: 34526146 PMCID: PMC8441244 DOI: 10.1186/s40337-021-00468-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To address the gaps in the literature examining eating disorders among males and gender minority youths, a prospective study was designed to assess gender differences in eating disorder symptom presentation and outcomes. Muscularity concerns may be particularly relevant for male youths with eating disorders, and were included in assessment of eating disorder symptom presentation. METHODS All cisgender male youths who presented for specialized eating disorder treatment at one of two sites were invited to participate, along with a group of matched cisgender females, and all youths who did not identify with the sex assigned to them at birth. Youths completed measures of eating disorder symptoms, including muscularity concerns, and other psychiatric symptoms at baseline and end of treatment. RESULTS A total of 27 males, 28 females and 6 trans youths took part in the study. At baseline, Kruskal-Wallis tests demonstrated that trans youths reported higher scores than cisgender male and female youths on measures of eating pathology (Eating disorder examination-questionnaire (EDE-Q) and the body fat subscale of the male body attitudes scale (MBAS)). These analyses demonstrated that there were no differences between cisgender male and female youths on eating disorder symptoms at baseline. However, repeated measures ANOVA demonstrated that males had greater decreases in eating pathology at discharge than did females, based on self-reported scores on the EDE-Q, MBAS, and Body Change Inventory. CONCLUSIONS Gender differences in eating pathology appeared at baseline, with trans youths reporting higher levels of eating pathology than cisgender youths, though no differences between cisgender males and females emerged at baseline for eating disorder symptom presentation. Contrary to expectations, there were no gender differences in measures of muscularity concerns. Males demonstrated greater eating disorder symptom improvements than females, suggesting that male adolescents may have better treatment outcomes than females in some domains.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada. .,Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
| | - Janet Suen
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Sheila Marshall
- School of Social Work, University of British Columbia, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada.,Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Alex Burns
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.,Eating Disorders Program, St. Paul's Hospital, Vancouver, BC, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada.,Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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15
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Purkiewicz A, Kamelska-Sadowska AM, Ciborska J, Mikulska J, Pietrzak-Fiećko R. Risk Factors for Eating Disorders and Perception of Body in Young Adults Associated with Sex. Nutrients 2021; 13:nu13082819. [PMID: 34444979 PMCID: PMC8401797 DOI: 10.3390/nu13082819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 02/06/2023] Open
Abstract
(1) Background: The integrated approach to the prevention and treatment of eating disorders (EDs) requires knowledge and can be used only when specific risk factors are known. The aim of this study was to examine the differences in food choices and eating behavior between males and females; (2) Methods: This study comprised 148 females and 27 males aged from 18 to 26-years-old (MEAN ± SD = 21.4 ± 1.86 years old). Information about EDs was obtained from four different measures: the body mass index (BMI), the eating disorder screen for primary care (ESP), a standardized and validated questionnaire called “My Eating Habits” and the food frequency questionnaire with 10 answers (FFQ-10); (3) Results: The risk for developing eating disorders was detected in nearly 67% of respondents. It was also shown that EDs were more common in females and how body weight affected the way individuals feel about themselves. Females showed more unhealthy eating habits, which contributed to dietary restrictions and emotional overeating, as they were also afraid of gaining weight. The frequency of eating meat and drinking alcohol was higher in males, whereas eating legume seeds was less frequent in females. (4) Conclusions: This study opens a new field, which will help health care professionals recognize the problems with eating disorders and treat them based on different sex characteristics.
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Affiliation(s)
- Aleksandra Purkiewicz
- Department of Commodity Sciences and Food Research, Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Plac Cieszyński 1, 10-719 Olsztyn, Poland; (A.P.); (R.P.-F.)
| | - Anna Malwina Kamelska-Sadowska
- Department of Rehabilitation and Orthopedics, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
- Clinic of Rehabilitation, Provincial Specialist Children’s Hospital in Olsztyn, 10-719 Olsztyn, Poland
- Correspondence:
| | - Joanna Ciborska
- Department of Human Nutrition, Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Słoneczna 45 F, 10-719 Olsztyn, Poland;
| | - Julia Mikulska
- Cosmetology, Trichology, Dietetics Julia Mikulska, 11-500 Giżycko, Poland;
| | - Renata Pietrzak-Fiećko
- Department of Commodity Sciences and Food Research, Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Plac Cieszyński 1, 10-719 Olsztyn, Poland; (A.P.); (R.P.-F.)
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16
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Gordon AR, Austin SB, Schultz J, Guss CE, Calzo JP, Wang ML. Gender Expression, Peer Victimization, and Disordered Weight-Control Behaviors Among U.S. High School Students. J Adolesc Health 2021; 68:1148-1154. [PMID: 33071166 PMCID: PMC8756556 DOI: 10.1016/j.jadohealth.2020.08.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/31/2020] [Accepted: 08/28/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study is to examine the association between gender expression, peer victimization, and disordered weight-control behaviors (DWCBs) in four population-based samples of U.S. high school students. METHODS Analyses include data from 5,488 U.S. high school students from the 2013 Youth Risk Behavior Surveys in four jurisdictions (Broward County, FL; Chicago, IL; Los Angeles, CA; San Diego, CA). Participants were 56% Hispanic/Latino, 21% black/African American, and 14% white. Two items asked about perceived gender expression; responses were classified into three groups: highly gender conforming (e.g., very masculine boys), moderately gender conforming, gender nonconforming (e.g., feminine boys). Sex-stratified multivariable logistic regression models were used to examine the association between gender expression, peer victimization, and DWCBs in previous month (fasting, using diet pills/liquids/powders, and purging [vomiting or using laxatives]), controlling for potential confounders. RESULTS Overall, 12% of respondents reported fasting, 6% reported diet pill use, and 5% reported purging, with significantly higher prevalence among gender nonconforming than among gender conforming male students (p < .001). In adjusted models, gender nonconforming male students had greater odds of fasting (odds ratio [95% confidence interval]: 3.0 [2.0-4.7]), diet pill use (6.1 [3.7-9.9]), and purging (7.2 [3.6-14.8]), relative to moderately conforming males. No significant associations were found among female students. Adding peer victimization to models modestly attenuated the association between gender nonconformity and DWCBs for male students. CONCLUSIONS In probability samples of U.S. high school students, we observed marked differences by gender expression in DWCBs among male students but not among female students. Gender expression-related stigma should be addressed within clinical and school-based interventions to prevent DWCBs.
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Affiliation(s)
- Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jordan Schultz
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Carly E Guss
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jerel P Calzo
- Division of Health Promotion & Behavioral Science, San Diego State University Graduate School of Public Health, San Diego, California; Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | - Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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17
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Franceschini A, Fattore L. Gender-specific approach in psychiatric diseases: Because sex matters. Eur J Pharmacol 2021; 896:173895. [PMID: 33508283 DOI: 10.1016/j.ejphar.2021.173895] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/29/2020] [Accepted: 01/19/2021] [Indexed: 12/20/2022]
Abstract
In both animals and human beings, males and females differ in their genetic background and hormonally driven behaviour and show sex-related differences in brain activity and response to internal and external stimuli. Gender-specific medicine has been a neglected dimension of medicine for long time, and only in the last three decades it is receiving the due scientific and clinical attention. Research has recently begun to identify factors that could provide a neurobiological basis for gender-based differences in health and disease and to point to gonadal hormones as important determinants of male-female differences. Animal studies have been of great help in understanding factors contributing to sex-dependent differences and sex hormones action. Here we review and discuss evidence provided by clinical and animal studies in the last two decades showing gender (in humans) and sex (in animals) differences in selected psychiatric disorders, namely eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder), schizophrenia, mood disorders (anxiety, depression, obsessive-compulsive disorder) and neurodevelopmental disorders (autism spectrum disorders, attention-deficit/hyperactivity disorder).
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Affiliation(s)
- Anna Franceschini
- Addictive Behaviors Department, Local Health Authority, Trento, Italy
| | - Liana Fattore
- Institute of Neuroscience-Cagliari, National Research Council, Italy.
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18
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Dueñas HR, Seah C, Johnson JS, Huckins LM. Implicit bias of encoded variables: frameworks for addressing structured bias in EHR-GWAS data. Hum Mol Genet 2020; 29:R33-R41. [PMID: 32879975 PMCID: PMC7530523 DOI: 10.1093/hmg/ddaa192] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/20/2022] Open
Abstract
The 'discovery' stage of genome-wide association studies required amassing large, homogeneous cohorts. In order to attain clinically useful insights, we must now consider the presentation of disease within our clinics and, by extension, within our medical records. Large-scale use of electronic health record (EHR) data can help to understand phenotypes in a scalable manner, incorporating lifelong and whole-phenome context. However, extending analyses to incorporate EHR and biobank-based analyses will require careful consideration of phenotype definition. Judgements and clinical decisions that occur 'outside' the system inevitably contain some degree of bias and become encoded in EHR data. Any algorithmic approach to phenotypic characterization that assumes non-biased variables will generate compounded biased conclusions. Here, we discuss and illustrate potential biases inherent within EHR analyses, how these may be compounded across time and suggest frameworks for large-scale phenotypic analysis to minimize and uncover encoded bias.
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Affiliation(s)
- Hillary R Dueñas
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Carina Seah
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jessica S Johnson
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Laura M Huckins
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Mental Illness Research, Education and Clinical Centers, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY 10468, USA
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Horváth Z, Román N, Elekes Z, Griffiths MD, Demetrovics Z, Urbán R. Alcohol consumption and risk for feeding and eating disorders in adolescence: The mediating role of drinking motives. Addict Behav 2020; 107:106431. [PMID: 32289746 DOI: 10.1016/j.addbeh.2020.106431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/09/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND A complex and bidirectional association has been assumed between feeding and eating disorders (FEDs) and alcohol consumption. Previous research has demonstrated that alcohol use among individuals with different forms of FEDs is more frequently motivated by two subtypes of internal drinking motives: coping and enhancement motives. Namely, these individuals might use alcohol primarily to regulate internal states, such as to mitigate negative emotions or enhance positive emotions. OBJECTIVES The present study investigated the mediating role of internal drinking motives on the association between risk for FEDs and alcohol consumption over the effects of relevant covariates, such as depressive symptoms or body mass index (BMI). METHODS Hungarian data of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 2015 were used. The final sample included responses from 5457 adolescents (50% males; mean age: 16.62 years). Validated self-report psychometric instruments assessed the level of alcohol use, depressive symptoms and risk for FEDs, and drinking motives. RESULTS Risk for FEDs presented a significant positive relationship with internal drinking motives and alcohol use. In the mediation analysis, a significant indirect effect was identified between risk for FEDs and alcohol use via internal drinking motives among females. CONCLUSIONS Results demonstrated that risk for FEDs was positively associated with internal drinking motives and alcohol use. An indirect effect of risk for FEDs on alcohol consumption via internal drinking motives was discriminated over the impact of depressive symptoms. However, the latter relationship was only found among females which may highlight the gender differences in the relationship between risk for FEDs and alcohol use.
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20
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Lucas C, Brady J, Olympia RP. School Nurses on the Front Lines of Healthcare: Recognizing "BONES" and Knowing When to Pick Up the Phone: Eating Disorders Among Students in the School Setting. NASN Sch Nurse 2020; 37:83-88. [PMID: 32731791 DOI: 10.1177/1942602x20942531] [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: 11/15/2022]
Abstract
Through a case presentation, this article describes the assessment and management of a student presenting with a history of disordered eating and weight loss. As medical concerns are brought to the attention of the school nurse, it is important for the school nurse to be aware of common signs and symptoms seen in students with undiagnosed or established eating disorders, as well as possible medical complications associated with untreated or poorly controlled eating disorders. Possible signs and symptoms associated with eating disorders that require outpatient referral or emergent management is delineated in this article, and school nurses are provided with a helpful mnemonic called "BONES" to aid in the recognition of eating disorders in the school setting.
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Affiliation(s)
- Christy Lucas
- Penn State University College of Medicine, Hershey, PA
| | - Jodi Brady
- Penn State University College of Medicine, Hershey, PA
| | - Robert P Olympia
- Professor, Departments of Emergency Medicine and Pediatrics, Penn State College of Medicine, Attending Pediatric Emergency Medicine physician, Penn State Hershey Medical Center, Hershey, PA
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Jaworski M, Panczyk M, Śliwczyński A, Brzozowska M, Janaszek K, Małkowski P, Gotlib J. Eating Disorders in Males: An 8-Year Population-Based Observational Study. Am J Mens Health 2020; 13:1557988319860970. [PMID: 31268395 PMCID: PMC6610443 DOI: 10.1177/1557988319860970] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of the study was the realistic evaluation of the prevalence of
eating disorders (ED) among Polish men who sought treatment through the National
Health Fund (NFZ) in the years 2010–2017. According to ICD-10, four types of ED
were analyzed: anorexia nervosa—AN (F50.0), atypical anorexia nervosa (F50.1),
bulimia nervosa—BN (F50.2), and atypical bulimia nervosa (F50.3). The NFZ database was used. The ED groups were defined according to ICD-10 codes.
Demographic data were collected from the web page of Statistics Poland (GUS).
The annual prevalence of EDs was estimated, and the age groups were categorized
into nine groups. For the incidence of EDs in male patients in the years
2010–2017, relative risk (RR) with 95% confidence interval (95% CI) was
calculated. The frequency trend of AN in males remains relatively stable. AN occurred mainly
in young men (between 11 and 30 years). It was noted that AN affected
approximately 100 men in each year of observation, while atypical anorexia
nervosa affected about 40 men. In 2017, the RR for EDs in young males was 0.041
(95% CI [0.033, 0.051]). Bulimia was relatively rare (about 35 males each
year). The incidence of EDs in males is a relatively constant phenomenon. The real
number of male patients with EDs may be higher. The current conceptualizations
of ED pathology should be modified and better adapted to men. Clinical
guidelines for specialists working with males with EDs should be developed.
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Affiliation(s)
- Mariusz Jaworski
- 1 Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Mariusz Panczyk
- 1 Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Andrzej Śliwczyński
- 2 Department of Analysis and Strategy, The National Health Fund, Warsaw, Poland
| | - Melania Brzozowska
- 2 Department of Analysis and Strategy, The National Health Fund, Warsaw, Poland
| | - Katarzyna Janaszek
- 2 Department of Analysis and Strategy, The National Health Fund, Warsaw, Poland
| | - Piotr Małkowski
- 3 Department of Surgical and Transplant Nursing and Extracorporeal Treatment, Medical University of Warsaw, Poland
| | - Joanna Gotlib
- 1 Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Poland
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Risk factors and temporal patterns of disordered eating differ in adolescent boys and girls: Testing gender-specific appearance anxiety models. Dev Psychopathol 2020; 33:856-867. [DOI: 10.1017/s0954579420000188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAdolescent dieting and disordered eating (DE) are risks for clinical eating disorders. In this five-wave longitudinal study, we tested gender-specific models linking early risk factors to temporal patterns of DE, considering appearance anxiety as a mediator. Participants were 384 Australian students (age 10 to 13; 45% boys) who reported their purging and skipping meals, experience with appearance-related teasing, media pressure, and appearance anxiety. Parents reported pubertal maturation and height/weight was measured. Gender differences in temporal patterns of DE were found and predictive models were tested using latent-variable growth curve and path models. Boys’ DE was generally stable over time; girls showed stability in purging but an average increase in skipping meals. Peer teasing, media pressure, and pubertal maturation were associated with more elevated initial DE in girls, and pubertal maturation was associated with a steeper increase in DE. For boys, body mass index had a direct positive association with DE. Appearance anxiety was associated with more DE, but there was only one significant indirect effect via anxiety, which was for boys’ pubertal maturation. Findings support the dominant role of social interactions and messages, as well as pubertal maturation, for girls’ DE and the prominence of physical risk factors for explaining boys’ DE.
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Abstract
Eating disorders (EDs) are a group of prevalent psychiatric illnesses with an onset in early to late adolescence-a time of significant neural development, physical and psychologic growth, and self-exploration. The etiology and neurobiology of EDs are not well understood, but EDs are recognized as brain-based illnesses with serious acute and long-term consequences if undertreated or ignored. Two EDs, anorexia nervosa (AN) and bulimia nervosa (BN), have historically been the primary EDs of focus. The DSM-5 updated diagnostic criteria for these disorders added two more: binge-eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). EDs severely impact males as well as females across the weight spectrum. Comorbidity is high; mortality rates for AN and BN are the highest in psychiatric conditions and higher than many medical conditions. Several treatment options are available to treat an ED ranging from inpatient hospitalization to outpatient services and different psychotherapy options. This chapter reviews the diagnostic criteria, clinical presentation, and treatment for these disorders. Where available, sex differences and developmental considerations will be noted. For all EDs, early recognition and swift treatment are necessary to avoid a chronic course.
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Al-Salom P, Boylan K. Borderline Personality Disorder and Disordered Eating Behaviour: The Mediating Role of Rejection Sensitivity. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2019; 28:72-81. [PMID: 31447905 PMCID: PMC6691797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 06/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the relationship between disordered eating behaviour and Borderline Personality Disorder (BPD) in a clinical population of adolescent girls. We hypothesized that BPD and disordered eating would be strongly associated and that this association would be partially mediated by rejection sensitivity. METHOD Participants were 73 female patients aged 11-18 presenting for mental health treatment at an outpatient psychiatry clinic in a large metropolitan hospital. Measures used in this study include the Diagnostic Interview for Borderline Personality Disorder-Revised, Borderline Personality Questionnaire and The Short Screen for Eating Disorders. RESULTS Youth with BPD had significantly more disordered eating behaviour compared to controls. Of the nine facets of BPD, eight were highly correlated with disordered eating, suggesting important shared variance between the constructs of BPD and disordered eating. This study also demonstrated that rejection sensitivity significantly mediated the relationship between BPD symptoms and disordered eating. CONCLUSIONS This paper provides a novel association between a diagnosis of BPD in adolescents and disordered eating and the mediation effect of rejection sensitivity. These findings suggest that disordered eating should be screened in BPD samples and interventions targeting rejection sensitivity may be of clinical use.
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Yokokura M, Terada T, Bunai T, Nakaizumi K, Kato Y, Yoshikawa E, Futatsubashi M, Suzuki K, Yamasue H, Ouchi Y. Alterations in serotonin transporter and body image-related cognition in anorexia nervosa. NEUROIMAGE-CLINICAL 2019; 23:101928. [PMID: 31491815 PMCID: PMC6627582 DOI: 10.1016/j.nicl.2019.101928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/17/2019] [Accepted: 07/01/2019] [Indexed: 01/09/2023]
Abstract
The serotonin system has been implicated in the pathophysiology of anorexia nervosa (AN). A recent report proposed that body image distortion (BID), a core symptom of AN, may relate to abnormalities of the serotonin system, especially the serotonin transporter (5HTT). Positron emission tomography (PET) studies of underweight patients with active AN reported alterations in serotonin receptors, but not 5HTT. Here, we aimed to disclose the clinicopathophysiology of AN by focusing on 5HTT and cognitive functions, including BID, in groups with active AN. Twenty-two underweight female patients with AN (12 restricting-type AN (ANR); 10 binge-eating/purging-type AN (ANBP)) and 20 age-matched healthy female subjects underwent PET with a 5HTT radioligand [11C]DASB. The binding potential (BPND) of [11C]DASB was estimated semiquantitatively, and clinical data from Raven's colored progressive matrices for general intelligence, the Stroop test for focused attention, the Iowa gambling task for decision making and a dot-probe task designed for BID were compared with the levels of BPND in different groups. [11C]DASB BPND was significantly decreased in the medial parietal cortex in patients with AN and in the dorsal raphe in patients with ANR compared with healthy subjects (p < .05 corrected). Patients with ANR showed a significantly negative correlation between [11C]DASB BPND in the dorsal raphe and performance on the dot-probe task (p < .05 corrected). While reduced 5HTT in the medial parietal cortex (the somatosensory association area) is pathophysiologically important in AN in general, additional 5HTT reduction in the dorsal raphe as seen in ANR is implicated for the clinicopathophysiological relevance. 5HTT decreased in the parietal cortex in patients with AN. 5HTT decreased in the parietal cortex in patients with ANBP. 5HTT decreased in the parietal cortex and the dorsal raphe in patients with ANR. Patients with AN were poor at responding to the test for body image distortion (BID). 5HTT in the dorsal raphe was associated with cognitive performance of BID.
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Affiliation(s)
- Masamichi Yokokura
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsuhiro Terada
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyasu Bunai
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kyoko Nakaizumi
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuhiko Kato
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Etsuji Yoshikawa
- Central Research Laboratory, Hamamatsu Photonics K.K., Hamamatsu, Japan
| | - Masami Futatsubashi
- Hamamatsu PET Imaging Center, Hamamatsu Medical Photonics Foundation, Hamamatsu, Japan
| | - Katsuaki Suzuki
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hidenori Yamasue
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuomi Ouchi
- Department of Biofunctional Imaging, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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Quattlebaum M, Burke NL, Neyland MKH, Leu W, Schvey NA, Pine A, Morettini A, LeMay-Russell S, Wilfley DE, Stephens M, Sbrocco T, Yanovski JA, Jorgensen S, Olsen C, Klein D, Quinlan J, Tanofsky-Kraff M. Sex differences in eating related behaviors and psychopathology among adolescent military dependents at risk for adult obesity and eating disorders. Eat Behav 2019; 33:73-77. [PMID: 31005683 PMCID: PMC6535360 DOI: 10.1016/j.eatbeh.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 01/14/2023]
Abstract
Stressors unique to military families may place dependents of military service members of both sexes at high-risk for disordered-eating. Yet, there are no data examining sex-related differences in eating pathology and distress among this population. Therefore, we examined disordered-eating attitudes and associated psychosocial characteristics in adolescent military dependents at high-risk for both eating disorders and adult obesity (i.e., BMI ≥ 85th percentile and elevated anxiety symptoms and/or loss-of-control eating). One-hundred-twenty-five (55.2% female) adolescent (12-17 y) military dependents were studied prior to entry in an eating disorder and obesity prevention trial. Youth were administered the Eating Disorder Examination interview to determine disordered-eating attitudes, and completed questionnaires to assess self-esteem, social functioning, and depression. Girls and boys did not differ in BMIz (p = .66) or race/ethnicity (p = .997/p = .55). Adjusting for relevant covariates, girls and boys did not differ significantly with regard to disordered-eating global scores (p = .38), self-esteem (p = .23), or social functioning (p = .19). By contrast, girls reported significantly more symptoms of depression (p = .001). Adolescent male and female dependents at high-risk for eating disorders and adult obesity reported comparable levels of eating-related and psychosocial stress. Data are needed to elucidate how adolescent military dependents respond to intervention and whether sex moderates outcome.
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Affiliation(s)
- Mary Quattlebaum
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Natasha L. Burke
- Psychology Department, Fordham University, 441 E. Fordham Road, Bronx, NY 10458, USA
| | - M. K. Higgins Neyland
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - William Leu
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Natasha A. Schvey
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - Abigail Pine
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Alexandria Morettini
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Sarah LeMay-Russell
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - Denise E. Wilfley
- Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Mark Stephens
- Pennsylvania State University, Old Main, State College, PA 16801, USA
| | - Tracy Sbrocco
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - Sarah Jorgensen
- Fort Belvoir Community Hospital (FBCH), 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA
| | - Cara Olsen
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - David Klein
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA,Fort Belvoir Community Hospital (FBCH), 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA
| | - Jeffrey Quinlan
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Marian Tanofsky-Kraff
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA.
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Timko CA, DeFilipp L, Dakanalis A. Sex Differences in Adolescent Anorexia and Bulimia Nervosa: Beyond the Signs and Symptoms. Curr Psychiatry Rep 2019; 21:1. [PMID: 30637488 PMCID: PMC6559358 DOI: 10.1007/s11920-019-0988-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW We review research related to sex differences in eating disorders (EDs) in adolescents. Prior work has explored clinical differences; thus, we examine literature in areas identified as playing an etiological or maintenance role in EDs including: genetics, hormones, neurocognitive inefficiencies, and reward circuitry. RECENT FINDINGS Sex steroids appear to a play role in the unmasking of genetic risk for development of EDs and puberty may be a heightened period of risk for females. While neurocognitive differences have been well studied in adults with ED, research with adolescents has been less conclusive. Recent work suggests that neural circuitry involved in reward and punishment may play role in development and maintenance of EDs in females. Males are underrepresented in these areas of research. Given known sex differences in healthy adolescents, it is likely there are sex differences in the putative biological etiology/maintenance of EDs. Males should be included in future research.
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Affiliation(s)
- C Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Child and Adolescent Psychiatry and Behavioral Science, Robert's Center for Pediatric Research, 2716 South Street, 8-212, Philadelphia, PA, 19146, USA.
| | - Levi DeFilipp
- Department of Child and Adolescent Psychiatry and Behavioral Science, Robert's Center for Pediatric Research, 2716 South Street, 8-212, Philadelphia, PA, 19146, USA
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Cadore 48, 20900, Monza, Italy
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Recio-Barbero M, Fuertes-Soriano S, Cabezas-Garduño J, López-Atanes M, Peña-Rotella A, Sáenz-Herrero M. Delayed Diagnosis of an Eating Disorder in a Male Patient With Superior Mesenteric Artery Syndrome: Results From a Case Study. Front Psychiatry 2019; 10:731. [PMID: 31681041 PMCID: PMC6803474 DOI: 10.3389/fpsyt.2019.00731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Eating disorders (EDs) are serious and life-threatening mental diseases characterized by abnormal or altered eating habits. The prevalence is variable, being influenced by diverse sociocultural factors. Historically, the prevalence of EDs has been higher in women (90%), although the incidence of these disorders in men appears to be increasing. In daily medical practice, when considering the presentation of other medical complications associated to the development of an ED, few is known about its real prevalence in men. Among them, some severe gastrointestinal complications that are rarely presented, such as the superior mesenteric artery syndrome (SMAS), can produce life-threatening results. Despite that, very few cases of men presenting this pathology are reported in literature. Case Presentation: A 38-year-old man without a history of psychiatric disease was admitted to the emergency department with nausea, abdominal pain, and severe malnutrition (body mass index 15.7 kg/m2). He was diagnosed with SMAS and was studied by multiple specialists on suspicion of a probable organic origin of his thinning. The suspected diagnosis of ED was rejected for months by some professionals, as well as by the patient and his family, until it was finally diagnosed with unspecified feeding and eating disorder (USFED). Conclusion: This case represents an example of diagnostic challenge where a delayed diagnosis of an ED in a male patient was made probably due to gender bias in clinical research and practice. In the literature, numerous reports were described in women diagnosed with SMAS with a previous diagnosis of an ED; however, few cases were found in men. In this clinical case, the patient suffered a significant diagnostic delay, probably due to the lack of diagnostic suspicion given by the differences in the prevalence and clinical presentation of EDs in women and men.
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Affiliation(s)
- María Recio-Barbero
- Department of Psychiatry, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Department of Neurosciences, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Sara Fuertes-Soriano
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Janire Cabezas-Garduño
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Mayte López-Atanes
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Alvar Peña-Rotella
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Margarita Sáenz-Herrero
- Department of Psychiatry, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Department of Neurosciences, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain.,Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
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Coelho JS, Lee T, Karnabi P, Burns A, Marshall S, Geller J, Lam PY. Eating disorders in biological males: clinical presentation and consideration of sex differences in a pediatric sample. J Eat Disord 2018; 6:40. [PMID: 30534377 PMCID: PMC6260897 DOI: 10.1186/s40337-018-0226-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The growing body of research on eating disorders among male adolescents reveals some sex differences in clinical presentation. The current study set out to replicate and extend recent research on the clinical and medical characteristics of male youth with eating disorders, and examine sex differences between biological males and females in a tertiary pediatric eating disorder treatment setting. METHODS A retrospective chart review was conducted with all biological males who were admitted to the Eating Disorders Programs at British Columbia Children's Hospital (2003-2015) or the Looking Glass Residence (2011-2015). Clinical data, including demographics, percentage of median body mass index (% mBMI), and psychiatric diagnoses, were recorded along with medical data (i.e., vital signs, basic biochemistry investigations, and bone mineral density). A comparison group of females with eating disorders who received treatment at British Columbia Children's Hospital in the inpatient or outpatient streams (2010-2015) were included, to examine sex differences with males who were admitted during the same period. RESULTS A total of 71 male youth were included in the chart review. Males had significant medical complications, with 26.5% of the sample presenting with a heart rate of less than 50 beats per minute and 31.4% presenting with a bone mineral density z-score for the lumbar spine ≤ - 1. Sex differences between the subset of males who were treated between 2010 and 2015 (n = 41) and the females (n = 251) were examined. Females were more likely than were males to have a diagnosis of anorexia nervosa or bulimia nervosa, and to be underweight (< 95% mBMI) at admission. Males were younger than females, but no differences emerged in the duration of the eating disorder symptoms. No sex differences emerged relating to medical instability (e.g., bradycardia). CONCLUSIONS A large proportion of male children and youth with eating disorders are medically compromised at admission. Males were younger than females, and were less likely than females to have a diagnosis of anorexia nervosa or bulimia nervosa. Males who were underweight at admission had also lost a lower percentage of body weight in comparison to females. The current study replicates previous sex differences reported in pediatric samples.
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Affiliation(s)
- Jennifer S. Coelho
- Provincial Specialized Eating Disorders Program for Children & Adolescents, British Columbia Children’s Hospital, Box 178, 4500 Oak St., Vancouver, BC V6H 3N1 Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Tiffany Lee
- Provincial Specialized Eating Disorders Program for Children & Adolescents, British Columbia Children’s Hospital, Box 178, 4500 Oak St., Vancouver, BC V6H 3N1 Canada
| | - Priscilla Karnabi
- Provincial Specialized Eating Disorders Program for Children & Adolescents, British Columbia Children’s Hospital, Box 178, 4500 Oak St., Vancouver, BC V6H 3N1 Canada
| | - Alex Burns
- Provincial Specialized Eating Disorders Program for Children & Adolescents, British Columbia Children’s Hospital, Box 178, 4500 Oak St., Vancouver, BC V6H 3N1 Canada
| | - Sheila Marshall
- School of Social Work, University of British Columbia, Vancouver, BC Canada
- Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
- Eating Disorders Program, St. Paul’s Hospital, Vancouver, BC Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children & Adolescents, British Columbia Children’s Hospital, Box 178, 4500 Oak St., Vancouver, BC V6H 3N1 Canada
- Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
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Thapliyal P, Hay P, Conti J. Role of gender in the treatment experiences of people with an eating disorder: a metasynthesis. J Eat Disord 2018; 6:18. [PMID: 30123504 PMCID: PMC6088416 DOI: 10.1186/s40337-018-0207-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/11/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Traditionally perceived as a disorder of women, Eating Disorders (EDs) are known to have impacts on people irrespective of their gender. This study is designed to synthesise the available qualitative research studies to more broadly understand the diverse experiences of ED and their treatment, specifically in relationship to issues of gender. METHODS The methodology involved a systematic search and quality appraisal of the literature published after 1980 using terms that aimed to represent the primary concepts of "role of gender" and "treatment experiences" and "eating disorders". Nine qualitative studies met the inclusion criteria. Meta-themes were inductively generated through a synthesis of data across themes from the relevant included papers. RESULTS Analysis of data was constructed around three meta-themes, each with subthemes. The first meta-theme "Out of sight, out of mind" depicted the experience of gender issues that were marginalised in treatment. More specifically for transgender people, when gender issues were ignored by treatment providers, this frequently led to non-disclosure of their gender identity. Furthermore, men were less likely to be assessed for an eating disorder and within this context; diagnosis of an ED and referral to specialist treatment was frequently hindered. The second meta-theme "Lack of literacy among health care providers" focused on issues related to misdiagnosis of EDs, and the question of whether this was related to a lack of health literacy amongst health professionals. The final theme "Pathways into treatment that address stigma and other barriers" highlighted the need for the development of future treatment interventions address the complex social reality of the experiencing person, including questions of gender. CONCLUSION Gender issues impact upon the ED experience and require broader consideration in the development and evaluation of ED treatment interventions, including the further development of gender-informed interventions. TRIAL REGISTRATION Protocol registered on PROSPERO 2017 CRD42017082616.
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Affiliation(s)
- Priyanka Thapliyal
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW Australia
| | - Janet Conti
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW Australia
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Heimann PM, Konrad K, Vloet TD. [Anorexia nervosa in males]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 46:478-487. [PMID: 29651909 DOI: 10.1024/1422-4917/a000579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Anorexia nervosa in males Abstract. Anorexia nervosa (AN) is a rare disorder in boys and men with limited data and studies available. The recent update of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) will in all likelihood lead to an increase in the prevalence of AN in boys and men. This study aims to give an overview of the existing data in regards to gender differences in epidemiology, etiology, and symptoms of AN. We aim to highlight the differences in AN between the sexes, from a clinical point of view, and underline the need for further research on AN in boys.
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Affiliation(s)
- Pola Maria Heimann
- 1 Universitätsklinikum, Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, RWTH Aachen
| | - Kerstin Konrad
- 2 Lehr- und Forschungsgebiet für klinische Neuropsychologie des Kindes und Jugendalters, Universitätsklinikum der RWTH Aachen
| | - Timo D Vloet
- 3 Universitätsklinikum, Zentrum für psychische Gesundheit (ZEP), Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Würzburg
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Boys, Biceps, and Bradycardia: The Hidden Dangers of Muscularity-Oriented Disordered Eating. J Adolesc Health 2018; 62:352-355. [PMID: 29241987 DOI: 10.1016/j.jadohealth.2017.09.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 11/21/2022]
Abstract
The recognition of eating disorders (EDs) in males represents an ongoing challenge for physicians. This challenge is particularly complex in the case of EDs that are oriented toward muscularity, as opposed to thinness, which current diagnostic criteria do not accommodate. Nevertheless, EDs in males, and muscularity-oriented disordered eating (MODE) in particular, are increasingly prevalent and are likely to be encountered in clinical practice. We report the case of a 16-year-old male who presented with medical instability, requiring hospitalization, in the context of MODE. Importantly, this patient did not meet formal diagnostic criteria for a specific ED, and behavioral symptoms were deemed goal oriented in the context of high school wrestling pursuits. This case highlights the challenges of identifying MODE and the medical risks associated therein. Pediatricians are encouraged to screen for MODE in adolescent males reporting body image concerns.
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Valente S, Di Girolamo G, Forlani M, Biondini A, Scudellari P, De Ronchi D, Atti AR. Sex-specific issues in eating disorders: a clinical and psychopathological investigation. Eat Weight Disord 2017; 22:707-715. [PMID: 28853004 DOI: 10.1007/s40519-017-0432-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/14/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To highlight the characteristics of eating disorders (ED) in males, with particular attention to sex-related clinical features and psychiatric co-morbidities. METHOD Out of 280 persons, referred to our outpatients ED clinic between January 2011 and June 2014, 267 with complete information were included in this retrospective observational study. RESULTS The men/women ratio was one to five (male 16.5% vs female 83.5%) with an increasing proportion of male patients over the years. The most frequent ED in males was binge eating disorder, whereas in females anorexia nervosa and bulimia nervosa prevailed. Excessive exercising and fasting were the most common compensation behaviours in males; while self-induced vomiting and laxative-diuretic abuse were more typical in females. Among women, the most represented psychiatric co-morbidities were mood and somatoform disorders, whereas among men, anxiety and psychosis spectrum disorders were the most frequent ones. Borderline and histrionic personality disorders were prevalent in female ED, while narcissistic and antisocial personality disorders prevailed in males. DISCUSSION ED in men is a growing phenomenon. Male ED, compared to female ED, show differences in clinical presentation, symptoms and co-morbidities. Despite the use of clinical and psychometric evaluating tools targeting female patients, sex differences do exist and additional studies are required to investigate male specific issues in ED. Level of Evidence Level V, cross-sectional descriptive study.
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Affiliation(s)
- Stefano Valente
- Department of Biomedical and NeuroMotor Sciences-Psychiatry, University of Bologna, Viale Pepoli n 5, Bologna, Italy.
| | - Giulia Di Girolamo
- Department of Biomedical and NeuroMotor Sciences-Psychiatry, University of Bologna, Viale Pepoli n 5, Bologna, Italy
| | - Martina Forlani
- Department of Biomedical and NeuroMotor Sciences-Psychiatry, University of Bologna, Viale Pepoli n 5, Bologna, Italy
| | - Anna Biondini
- Department of Biomedical and NeuroMotor Sciences-Psychiatry, University of Bologna, Viale Pepoli n 5, Bologna, Italy
| | - Paolo Scudellari
- Department of Biomedical and NeuroMotor Sciences-Psychiatry, University of Bologna, Viale Pepoli n 5, Bologna, Italy
| | - Diana De Ronchi
- Department of Biomedical and NeuroMotor Sciences-Psychiatry, University of Bologna, Viale Pepoli n 5, Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and NeuroMotor Sciences-Psychiatry, University of Bologna, Viale Pepoli n 5, Bologna, Italy
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Can food addiction replace binge eating assessment in obesity clinics? EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2017. [DOI: 10.1016/j.ejmhg.2016.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Täljemark J, Råstam M, Lichtenstein P, Anckarsäter H, Kerekes N. The coexistence of psychiatric and gastrointestinal problems in children with restrictive eating in a nationwide Swedish twin study. J Eat Disord 2017; 5:25. [PMID: 28835820 PMCID: PMC5563893 DOI: 10.1186/s40337-017-0154-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/18/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Restrictive eating problems are rare in children but overrepresented in those with neurodevelopmental problems. Comorbidities decrease wellbeing in affected individuals but research in the area is relatively scarce. This study describes phenotypes, regarding psychiatric and gastrointestinal comorbidities, in children with restrictive eating problems. METHODS A parental telephone interview was conducted in 9- or 12-year old twins (n = 19,130) in the Child and Adolescent Twin Study in Sweden. Cases of restrictive eating problems and comorbid problems were established using the Autism, Tics-AD/HD and other Comorbidities inventory, parental reports of comorbidity as well as data from a national patient register. In restrictive eating problem cases, presence of psychiatric and gastrointestinal comorbidity was mapped individually in probands and their co-twin. Two-tailed Mann-Whitney U tests were used to test differences in the mean number of coexisting disorders between boys and girls. Odds ratios were used to compare prevalence figures between individuals with or without restrictive eating problems, and Fisher exact test was used to establish significance. RESULTS Prevalence of restrictive eating problems was 0.6% (concordant in 15% monozygotic and 3% of dizygotic twins). The presence of restrictive eating problems drastically increased odds of all psychiatric problems, especially autism spectrum disorder in both sexes (odds ratio = 11.9 in boys, odds ratio = 10.1 in girls), obsessive-compulsive disorder in boys (odds ratio = 11.6) and oppositional defiant disorder in girls (odds ratio = 9.22). Comorbid gastrointestinal problems, such as lactose intolerance (odds ratio = 4.43) and constipation (odds ratio = 2.91), were the most frequent in girls. Boy co-twins to a proband with restrictive eating problems generally had more psychiatric problems than girl co-twins and more girl co-twins had neither somatic nor any psychiatric problems at all. CONCLUSIONS In children with restrictive eating problems odds of all coexisting psychiatric problems and gastrointestinal problems are significantly increased. The study shows the importance of considering comorbidities in clinical assessment of children with restrictive eating problems.
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Affiliation(s)
- Jakob Täljemark
- Lund University, Medical Faculty, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Baravägen 1, S-221 85 Lund, Sweden
| | - Maria Råstam
- Lund University, Medical Faculty, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Baravägen 1, S-221 85 Lund, Sweden.,Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Anckarsäter
- CELAM (Centre for Ethics, Law and Mental Health), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Nóra Kerekes
- Department of Health Sciences, University West, Trollhättan, Sweden
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