Eating disorders across two cultures: does the expression of psychological control vary?

Moving towards specificity: A systematic review of cue features associated with reward and punishment in anorexia nervosa

Models of anorexia nervosa (AN) posit that symptoms are maintained through deficient reward and enhanced punishment processing. However, theoretical and empirical inconsistencies highlight the need for a more nuanced conceptualization of this literature. Our goal was to comprehensively review the research on reward and punishment responding in AN from a cue-specific lens to determine which stimuli evoke or discourage reward and punishment responses in this population, and, ultimately, what properties these rewarding and punishing cues might share. A systematic review interrogating reward and punishment responses to specific cues yielded articles (n = 92) that examined responses to disorder relevant (e.g., food) and irrelevant (e.g., money) stimuli across self-report, behavioral, and biological indices. Overall, in most studies individuals with AN exhibited aversive responses to cues signaling higher body weights, social contexts, and monetary losses, and appetitive responses to cues for weight loss behaviors and thinness. Findings were more mixed on responses to palatable food and monetary gains. Results highlight that reward and punishment responding in AN are context specific and may be affected by varied stimulus qualities (e.g., predictability, controllability, delay, effort). Increasing specificity in future research on reward and punishment mechanisms in AN will better inform development of precisely-targeted interventions.

Management of Bulimia Nervosa

Bulimia nervosa is a crippling and chronic disorder, with individuals experiencing repeated binge-purge episodes. It is not widely understood by society. The use of the Roy adaptation model for the management of bulimia nervosa is examined in this article. Nursing models are utilized to provide a structure for planning and implementation of patient management. The Roy adaptation model focuses on the importance of individuals as able to adapt well to their changing surrounding environments. This model can be useful in managing patients with bulimia nervosa.

A comparison of eating disorder patients in India and Australia

BACKGROUND

Eating disorders (EDs) are an emerging concern in India. There are few studies comparing clinical samples in western and nonwestern settings.

AIM

The aim was to compare females aged 16-26 years being treated for an ED in India (outpatients n = 30) and Australia (outpatients n = 30, inpatients n = 30).

MATERIALS AND METHODS

Samples were matched by age and body mass index, and had similar diagnostic profiles. Demographic information and history of eating and exercise problems were assessed. All patients completed the quality-of-life for EDs (QOL EDs) questionnaire.

RESULTS

Indians felt they overate and binge ate more often than Australians; frequencies of food restriction, vomiting, and laxative use were similar. Indians were less aware of ED feelings, such as, "fear of losing control over food or eating" and "being preoccupied with food, eating or their body." Indians felt eating and exercise had less impact on their relationships and social life but more impact on their medical health. No differences were found in the global quality-of-life, body weight, eating behaviors, psychological feelings, and exercise subscores for the three groups.

CONCLUSION

Indian and Australian patients are similar but may differ in preoccupation and control of their ED-related feelings.

Assessment of anorexia nervosa: an overview of universal issues and contextual challenges

AIM

Anorexia Nervosa (AN) is a complex and clinically challenging syndrome. Intended for specialist audiences, this narrative review aims to summarise the available literature related to assessment in the adult patient context, synthesising both research evidence and clinical consensus guidelines.

METHOD

We provide a review of the available literature on specialist assessment of AN focusing on common trajectories into assessment, obstacles accessing assessment, common presenting issues and barriers to the assessment process, the necessary scope of assessment, and tools and techniques. It describes the further step of synthesising assessment information in ways that can inform resultant care plans.

RESULTS

In addition to assessment of core behaviours and diagnostic skills, considerations for the expert assessor include the functions of primary care, systemic and personal barriers, knowledge of current assessment tools and research pertaining to comorbid pathology in AN, assessing severity of illness, role of family at assessment, as well as medical, nutritional and compulsory elements of assessment.

CONCLUSION

Comprehensive assessment of AN in the current healthcare context still remains largely the remit of the specialist ED clinician. Assessment should remain an on-going process, paying particular attention to available empirical evidence, thereby reducing the gap between research and practice.

Body image disturbance in young North European and East Asian women with and without eating disorders in Australia and in Singapore

OBJECTIVE

To investigate body image disturbance in young women with and without an eating disorder (ED) across two different ethnic groups in Australia and Singapore.

METHOD

The relationship of body image disturbance to cultural orientation and socio-cultural factors was analysed in 154 women with and without an ED. Participants were from the following backgrounds: North European Australian, East Asian Australian, Singaporean Chinese (SC) and North European expatriates in Singapore.

RESULTS

Irrespective of cultural group, women with an ED had similar body dissatisfaction. Among those without an ED, SC women reported greater body dissatisfaction than all other cultural groups. Finally, within each cultural group, ED participants reported significantly higher body dissatisfaction than their non-ED counterparts with the exception of SC women where there was no difference.

DISCUSSION

Socio-cultural factors other than body image may play more important roles in SC women's ED psychopathology.