The eating disorders NOS diagnostic profile among college women

Help-seeking attitudes and behaviours among youth with eating disorders: a scoping review

BACKGROUND

Although early intervention is crucial in interrupting the development of eating disorders, little is currently known about help-seeking behaviours among individuals experiencing eating disorder symptoms. Given that eating disorders typically begin early in life, it is necessary to investigate the processes employed by children, adolescents, and emerging adults when seeking services for troubling symptoms. This is a growing concern as the COVID-19 pandemic has resulted in an increase in the number of individuals engaging in disordered eating behaviours. This scoping review explores the current state of the literature for evidence on how youth with eating disorder symptoms seek help, with the aim of better understanding how to identify and treat more individuals earlier.

METHODS

Using scoping review methodology, we searched seven databases for studies published from January 2000 to April 2021 that reported on help-seeking attitudes, behaviours, and healthcare utilization patterns for children and adolescents (< 18 years), emerging adults (18-25 years), and a mixture of these groups (< 25 years). Seven thousand, two hundred, and eighteen articles were identified for review. After duplicates were removed, three reviewers independently screened titles and abstracts and reviewed full-text articles. Findings related to help-seeking activity were extracted from the 62 articles that were ultimately included in this scoping review.

RESULTS

Study findings were summarized into help-seeking patterns (i.e., rates, types) as well as factors ranging from the individual level to society that influenced help-seeking behaviour. Many youth meeting eating disorder criteria were not seeking help. Notable barriers to help-seeking included poor mental health literacy, experiences with healthcare providers who failed to detect and lacked knowledge about eating disorders, minimal support from family and friends, and stigma surrounding eating disorders and help-seeking for mental health concerns.

CONCLUSIONS

The results of this scoping review can be used to inform early intervention and health promotion program development. Future research should focus on the help-seeking attitudes and activities among underrepresented groups with eating disorders (e.g., men, ethnic and gender minorities), the perspectives of family and other supporters in the help-seeking process for youth, and retrospective accounts from adults with lived experience of an eating disorder. Plain English summary Addressing and interrupting eating disorder-related thoughts and behaviours as soon as possible, with the help of a mental health professional, leads to better outcomes for youth struggling with an eating disorder. However, little is known about what prompts youth to talk about their weight, body, or eating concerns with someone-like their parent, friend, teacher, guidance counsellor, or primary care practitioner. This review explores the available published research on help-seeking patterns and preferences among youth with eating disorder concerns. Our team followed a standardized process to find 62 relevant articles for this paper. Of note, many young people who reported eating disorder concerns were not seeking help for themselves. Feeling supported by family and their primary care provider, understanding the signs of an eating disorder, and not feeling shame for reaching out for help reportedly led youth to speak up about their concerns. The findings have clinical implications for learning effective ways to help youth feel safe to speak freely about their eating disorder-related concerns, which enhances the chances of intervening early and catching symptoms before they worsen.

Discrepancies Between Explicit Feelings of Power and Implicit Power Motives Are Related to Anxiety in Women With Anorexia Nervosa

Background

Several studies identified low subjective feelings of power in women with anorexia nervosa (AN). However, little is known about implicit power motives and the discrepancy between explicit feelings of power and implicit power motives in AN.

Aim

The study investigated the discrepancy between explicit feelings of power and implicit power motives and its relationship to anxiety in patients with AN.

Method

Fifty-three outpatients and inpatients with AN and 48 participants without AN were compared regarding subjective feelings of power and anxiety. Explicit power [investigated with the Personal Sense of Power Scale (trait focus) and a visual analog scale (state focus)], implicit power motives [investigated with the Multi-Motive Grid (MMG)] and trait anxiety [measured with the State-Trait Anxiety Inventory (STAI)], were assessed.

Results

Explicit feelings of power (state and trait level) were lower in patients with AN compared to non-AN participants. No differences in implicit power motives were found when comparing the groups against each other. However, looking at the groups separately, women with AN had similar levels of implicit fear of losing power and hope for power, whereas woman without AN had significantly lower fear of losing power than hope for power. Focusing on discrepancies between powerful feelings and power motives, results were mixed, depending on the subscale of the MMG. Lastly, discrepancies between implicit power motives and explicit feelings of power were positively correlated with trait anxiety in AN patients.

Conclusion

These findings underline that individuals with AN display significantly lower explicit feelings of power, however, they show similar implicit power motives compared to individuals without AN. The discrepancy between explicit feelings of power and implicit power motives is related to anxiety in AN and may represent a vulnerability factor to illness maintenance.

Using bodily postures in the treatment of anorexia nervosa: Effects of power posing on interoception and affective states

OBJECTIVE

Power posing involves the adoption of an expansive bodily posture. This study examined whether power posing could benefit individuals with anorexia nervosa (AN) and women with normal weight in regards to interoceptive ability and affective states.

METHOD

Participants included 50 inpatients and outpatients with AN as well as 51 normal-weight women. Interoceptive accuracy (IAcc), measured by the heartbeat tracking task and interoceptive sensibility (IS), measured by confidence ratings, were assessed at baseline, after a single power posing session and after 1 week of daily training. Also, the short-term effects of power posing on subjective feelings of dominance, pleasantness, and arousal were investigated.

RESULTS

Both groups increased in their IAcc after one power posing session. Also, there was a significant main effect of time on feelings of dominance and pleasantness in the short-term. Women with AN displayed lower levels of IS, dominance, and pleasantness as well as higher levels of arousal than women without AN.

DISCUSSION

These findings suggest that power posing has the potential to increase IAcc, subjective feelings of power and pleasant affect in the short-term. Further research should investigate which mechanisms foster the effectiveness of this intervention to tailor it to the needs of women with AN.

Estimating the economic value of counselling services using the contingent valuation method

This study aimed to justify the use of the contingent valuation method to elicit the willingness to pay (WTP) for counselling services and to analyse the socio-demographic and psychological factors that influence WTP (through an increase in insurance premiums) for counselling services in South Korea. Regarding WTP for counselling services, the researchers asked 561 participants double-bounded dichotomous choice questions, which is one of the major estimation methods. Two survival analysis models were set up with their corresponding variables to investigate the factors affecting the WTP for an increase in insurance premiums to cover counselling services. The results indicate that a person in South Korea who makes KRW 2,500,000 (USD 2223.21) per month and pays KRW 66,625 (USD 59.25) per month in insurance premiums is willing to pay a roughly 1% premium to receive additional counselling services. The first regression analysis model for WTP showed that pocket money and counselling experience had significant positive effects while gender had a significant negative effect. The second model included four additional psychological factors and the significant effects of gender and counselling experience that had been found in the first model disappeared while only pocket money showed a significant effect on WTP.

Anxiety as a Moderator of the Relationship Between Body Image and Restrained Eating

PURPOSE

To examine three indicators of psychopathology (stress, anxiety, and depression) as potential moderators of the relationship between body image dissatisfaction (BID) and restrained, emotional, and external eating, while controlling for family-related variables (i.e., household income, living situation, and psychopathology in the family) and individual variables (i.e., body mass index, physical activity, and major life events).

DESIGN AND METHODS

A descriptive, correlational cross-sectional design was used. A sample of 894 female undergraduates aged between 18 and 25 completed a self-reported questionnaire.

FINDINGS

Moderation analyses indicated that anxiety significantly moderated the relationship between BID and restrained eating, whereas depression and stress did not.

PRACTICE IMPLICATIONS

Findings may be used in the development and implementation of education and prevention programs for disordered eating in college campuses. The usefulness of these findings for nursing practice is discussed.

Crisis on campus: Eating disorder intervention from a developmental-ecological perspective

OBJECTIVE

The purpose of this article is to review a crisis intervention using the developmental-ecological protocol (Collins and Collins, 2005) with a college student presenting with symptomatology of an active eating disorder.

PARTICIPANTS

Participants included University Wellness Center employees responding to the crisis.

METHODS

Methods include an informal review of the crisis intervention response and application of the ABCDE developmental-ecological crisis model.

RESULTS

Results reported include insight into crisis intervention when university counseling and health center is not available as resources.

CONCLUSIONS

ABCDE Developmental-ecological model recommendations for university faculty and staff are included.

Breaking the Silence: Disordered Eating and Big Five Traits in College Men

Men remain largely underrepresented in the eating disorder literature and few studies have investigated risk factors for disordered eating among men. The current study examined associations between Big Five personality traits and eating disorder symptoms in a sample of college men (N = 144). Participants completed the Eating Disorder Diagnostic Scale and Ten Item Personality Inventory online. Results suggested that openness was positively associated with purging-type behaviors and that emotional stability was positively related to symptoms of anorexia nervosa and global eating pathology. Findings highlight the prevalence of eating disorder symptoms among college men and suggest that these symptoms are associated with a different constellation of personality traits than is typically reported among women. Implications for targeted prevention and intervention programs and future research are discussed.

College women eating disorder diagnostic profile and DSM-5

A consistent diagnostic profile describing college women with eating disorders has been well established in the college health and mental health literature. This diagnostic framework traditionally has been associated with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Eating Disorders Not Otherwise Specified category. In this article, the authors discuss implications of the recently revised Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition eating disorder diagnostic categories for the existing college women eating disorder profile.

The prevalence of binge eating disorder in a sample of college students in the north of Portugal

Binge eating disorder (BED) has important associated comorbidities and has been recently considered as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition. This study investigates the prevalence of BED in a sample of college students using a two-stage design. Between October 2008 and July 2009, 805 students attending a public college campus completed the Questionnaire on Eating and Weight Patterns - Revised to screen for possible cases. Eighty-five students meeting key criteria for BED were invited for a second stage interview using the Eating Disorder Examination. At stage 1, 9.6% of the subjects reported binge eating episodes. At stage 2, a prevalence rate of 0.5% for BED was found, and 1% if the criterion for large amount of food was excluded.

Patterns of compensatory behaviors and disordered eating in college students

Abstract.

OBJECTIVE

The current study investigated rates of endorsement of eating-related compensatory behaviors within a college sample.

PARTICIPANTS

This sample included male and female students (N = 1,158).

METHODS

PARTICIPANTS completed the Eating Disorder Examination Questionnaire (EDE-Q). The study defined 3 groups of students: those who did not endorse purging behaviors, those who endorsed only exercise, and those who endorsed laxative use or vomiting. Rates of related eating disorder risk variables were compared across the 3 groups.

RESULTS

Almost half of college students reported utilizing exercise as a compensatory strategy over the past 28 days. Those reporting compensatory exercise did not differ from other community and college samples on EDE-Q subscales.

CONCLUSIONS

Findings suggest that college students report significant rates of compensatory exercise, and those who report exercise as their only compensatory behavior also report relatively low levels of eating disorder risk.

Compensatory weight control behaviors of women in emerging adulthood: associations between childhood abuse experiences and adult relationship avoidance

OBJECTIVE

To examine correlates of compensatory weight control behaviors among women in transition between adolescence and adulthood.

PARTICIPANTS

The authors recruited a sample of undergraduate women (N = 759) at a large northwestern university during the 2009-2010 academic year.

METHODS

Logistic regression was used to assess relations among childhood abuse, psychosocial functioning, adult dating relationship factors, and women's endorsement of compensatory weight control behaviors.

RESULTS

The final model reliably distinguished between participants who endorsed versus denied use of compensatory behaviors (χ(2)[5, N = 747] = 36.37, p < .001), with global psychosocial functioning and relationship avoidance accounting for the most variance.

CONCLUSIONS

These findings illustrate the importance of considering childhood abuse histories and adult relationships while assessing young women's compensatory weight control behaviors.

Repeated traumatic experiences in eating disorders and their association with eating symptoms

OBJECTIVE

This study aimed to analyze the association between traumatic experiences (TEs) and eating symptoms and their severity in a healthy group (HG) of students and an eating disorder group (EDG).

METHOD

The HG (N=150) comprised first- and secondyear undergraduate psychology students, the EDG (N=150) day hospital patients. EDG patients were evaluated consecutively when they entered the Day Hospital Eating Disorder Unit. Information on TEs was collected via an ad hoc questionnaire, a semi-structured interview and the first part of The Dissociation Questionnaire (Part I). The Bulimic Investigatory Test Edinburgh was used to evaluate eating symptoms and their severity.

RESULTS

Emotional abuse was the most frequent TE in both groups. In the EDG, TEs occurred more in patients with purging behavior (anorexia nervosa of the binge-eating/purging type, AN-P; and bulimia nervosa of the purging type, BN-P) than in those with AN-R (anorexia nervosa of the restricting type). In patients with purging behavior, TEs often begin in childhood and are repeated. When the severity of eating symptoms in patients with EDs who had suffered repeated TEs was compared with those who had suffered an isolated TE, a tendency towards greater severity of eating symptoms associated with TE repetition was observed.

CONCLUSIONS

The results obtained with respect to the presence and type of TEs in EDs concurred with those of other studies. However, unlike other studies, we found high percentages of childhood TEs in ED subtypes with purging behavior. In these ED subtypes, TEs tended to be more repeated than in ED subtypes with restrictive behavior. Further studies are required to draw conclusions on the effect of the different TEs and their repetition on eating symptoms and their severity.

Adapted group-based dialectical behaviour therapy for binge eating in a practicing clinic: clinical outcomes and attrition

Research evidence has been accumulating for the efficacy of dialectical behaviour therapy (DBT) for binge eating. However, support for its effectiveness and transportability beyond efficacy trials is lacking. The current study evaluated the feasibility of group-based DBT for binge eating within the context of an operating community clinic. Women ages 24-49 (M = 39.60, SD = 9.53) with either subthreshold and full-threshold binge eating disorder or bulimia nervosa formed the group and comprised the sample (n = 5 treatment completers). Positive outcomes included significant improvement in both binge eating and secondary outcomes with the Eating Disorder Inventory subscales of Bulimia, Ineffectiveness, Perfectionism and Interpersonal Distrust. Attrition was elevated compared with previous efficacy trials, suggesting the need for increased attention to how to improve retention within routine practice settings. Given our limited sample size, these findings are viewed as promising but preliminary.

Moderators of the relationship between body image dissatisfaction and disordered eating

Various affective and personality variables may impact the relationship between body dissatisfaction and disordered eating symptomatology. The current study was a post-hoc analysis examining potential moderators (depression, anxiety, and impulsivity) of this relationship in college women. Four-hundred and seventy-two (472) enrolled college women between the ages of 18 and 55 participated in this study. Moderation analyses indicated that anxiety, depression, and dieting significantly moderated the relationship between body dissatisfaction and disordered eating, whereas impulsivity did not. Findings can be used to generate hypotheses for education and prevention programs on college campuses.

Correlates of weight concern and control in a Hispanic college student sample

This study examined the relationships between weight concern and control and theoretically and empirically relevant correlates in a Hispanic college student sample. Participants were 163 Hispanic college students who completed measures assessing demographics, willingness to put health at risk to lose weight, unhealthy weight loss methods, acculturation, body weight and fitness happiness and importance, and sociocultural attitudes toward appearance. Body mass index was also assessed. Females internalized sociocultural attitudes toward appearance more and found personal attractiveness more important than males, while males were less happy with their personal attractiveness. Internalization of sociocultural attitudes toward appearance and BMI predicted the degree to which individuals were willing to put their health at risk to lose weight. The previous factors, as well as the importance of body weight and fitness and being female, were significant predictors of number of unhealthy weight loss methods employed to lose weight. These data indicate that within a Hispanic college student population, weight concern and control issues are relevant considerations for future studies and the development and assessment of weight loss interventions.

Parents as protective factors in eating problems of college women

This study examined how parents can protect their college-aged daughters from disordered eating. Specifically, the influence of the following variables on disordered eating was investigated: parental emotional availability and acceptance, parents' critical messages about weight and shape, acceptance of sociocultural attitudes about appearance, self-esteem, and early menarche. Participants included a random sample of 211 female undergraduates who completed an Internet questionnaire. Using multiple regression, messages heard from mothers and fathers were found to contribute to disordered eating, and sociocultural attitudes acted as a mediator for the effects of mothers' and fathers' messages on disordered eating. Implications are discussed.

The influence of reported trauma and adverse events on eating disturbance in young adults

OBJECTIVE

Early experiences of trauma or adverse events may be associated with eating disturbance later in life, but evidence is scarce. This study examined whether reported history of adverse life events predicted eating disturbance upon college entry and prospective changes over the first semester of college.

METHOD

First semester college students (n = 249) reported trauma/adverse event histories and completed disordered eating questions (with two factors, restriction and binging/purging) at the beginning and end of their first semester.

RESULTS

At college entry, trauma type, frequency, and overall trauma severity were related to restricted eating, and trauma type and severity was related to binging/purging. Prospective increases in reported restricted eating were predicted by trauma type. Prospective increases in binging/purging were associated with trauma type and total trauma severity.

CONCLUSION

These data suggest that reports of past trauma and adverse events cross-sectionally predict reported disordered eating at college entry as well as prospective increases in disordered eating over the first semester of college. Research and clinical implications for these findings are discussed.

Characteristics of the female athlete triad in collegiate cross-country runners

The Female Athlete Triad is a life-threatening syndrome defined by disordered eating, amenorrhea, and osteoporosis.

OBJECTIVE AND PARTICIPANTS

The author's purpose in this study was to examine female cross-country runners' (N=300) calcium consumption, along with the prevalence of 2 components of the triad: disordered eating and menstrual dysfunction.

METHODS

The author used measures including the Orientation to Exercise Questionnaire, Calcium Rapid Assessment Method, and questions related to height, weight, exercise time, perceptions of eating disorders, and menstrual status. Previous or current eating disorders were reported by 19.4% of the women, 23.0% had irregular menstrual cycles, and 29.1% had inadequate calcium intake.

RESULTS

Those athletes perceiving a previous/current eating disorder scored higher on the Orientation to Exercise questionnaire than did those who did not perceive such.

CONCLUSION

The author recommends educational efforts for the prevention of components of the Female Athlete Triad.

Disordered Eating: Young Women's Search for Control and Connection

PROBLEM

Approximately 5% of American women suffer from eating disorders and scores more exhibit signs of disordered eating. The purpose of this study was to gain an understanding of disordered eating in adolescence.

METHODS

Grounded theory method was employed. In-depth interviews were conducted with 15 college women to explore their experiences with disordered eating.

FINDINGS

Choosing disordered eating behaviors as a method of control occurred when the young women lacked connected and close relationships with others. Conversely, when meaningful relationships were present in their lives, the dysfunction abated.

CONCLUSIONS

Psychosocial and dietary assessments are necessary to identify youngsters without connected relationships and/or predispositions to disordered eating.

Predicting bulimic symptoms: an interactive model of self-efficacy, perfectionism, and perceived weight status

An interactive model of perfectionism, perceived weight status, and self-efficacy was tested on 406 women to predict the bulimic symptoms of binge eating and inappropriate compensatory behaviors separately. This longitudinal study assessed hypothesized vulnerabilities of high perfectionism and low self-efficacy and the stressor of feeling overweight at Time 1 and then gathered weekly assessments of binge eating, vomiting, laxative use, fasting, and diet pill use for 11 weeks. As predicted, results showed that perfectionism, weight perception, and self-efficacy interacted to prospectively predict binge eating. In particular, women high in perfectionism who felt they were overweight and who had low self-efficacy reported the most number of weeks of binge eating. This interactive model did not predict inappropriate compensatory behaviors. Future directions and clinical implications are discussed.

Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders

OBJECTIVE

The study examined treatment seeking for eating disorders in Mexican American and European American women.

METHOD

One hundred forty-five women with eating disorders (76 Mexican American, 69 European American) were diagnosed using the Structured Clinical Interview for DSM-IV-TR (SCID-IV) and Eating Disorder Examination (EDE).

RESULTS

Only 28% of the sample reported having sought treatment for their eating problems and only 17% had received treatment. Both groups were equally likely to believe they have significant eating problems and to want help. However, Mexican Americans were less likely to have sought treatment and, having sought help, were less likely to have been diagnosed or treated. European Americans were more likely to have utilized psychotherapists, psychiatrists, and psychotropic medications, whereas Mexican Americans largely had sought help from general practitioners for weight concern. The two groups endorsed similar barriers to treatment seeking.

CONCLUSION

Results support clinical impressions that eating disorders largely go undetected and untreated. Nonspecialists may be likely to fail to detect eating disorders.

Correlations among Symptoms of Depression and Problematic Eating Patterns in Intercollegiate Athletes

Using self-report questionnaires, depressive symptoms as measured by the Beck Depression Inventory–II and problematic eating patterns as measured by the Eating Disorders Inventory were not significantly correlated for 57 (39 women) Division I varsity intercollegiate athletes.

Eating dysfunctions in college women: the roles of depression and attachment to fathers

The authors examined the roles of depression and attachment to fathers in college women's eating dysfunctions. Three-hundred six undergraduate women completed (1) a diagnostic measure of eating dysfunctions that categorized them as asymptomatic, symptomatic but not eating disordered, or eating disordered; (2) 3 dimensional measures of attachment to fathers; and (3) a dimensional measure of depression. Depression was directly related to severity of participants' eating dysfunction; the eating-disordered group had scores consistent with clinical depression. After controlling for depression, 3 facets of attachment to fathers significantly differentiated the 3 groups.

Eating and exercise disorders in young college men

The authors used the computerized Eating and Exercise Examination to investigate eating, weight, shape, and exercise behaviors in a convenience sample of 93 male college students. One fifth of the men worried about their weight and shape, followed rules about eating, and limited their food intake. Between 9% and 12% were unhappy with their body shape, felt fat, and seriously wanted to lose weight. Exercise was important for the self-esteem of 48% of the students. Thirty-four percent were distressed when they could not exercise as much as they wanted, 27% followed rules about exercising, and 14% worried about the amount of exercise they were doing. The respondents met clinical diagnoses for objective binge eating (3%), self-induced vomiting (3%), bulimia nervosa (2%), and exercise disorders (8%). Although 9% reported disordered eating, none had sought treatment. Health professionals should be aware that eating and exercise disorders may be present in college men and that screening may help in the early identification of these problems.