Updates in the treatment of eating disorders in 2019: a year in review in Eating Disorders: The Journal of Treatment & Prevention

A new conceptual model for anorexia nervosa: A role for connective tissue?

The etiology of anorexia nervosa (AN) remains to be fully elucidated, and current theories also fail to account for the direct effect of starvation on the health of the organs and tissues, specifically the connective tissue present in most organs of the body. Individuals with hereditary disorders of connective tissue manifest with clinical symptoms that overlap with AN, as the abnormal connective tissue also contributes to many of the other extra-articular manifestations of these hereditary disorders. This article hypothesizes that a similar pathophysiology may also contribute to the clinical presentation of AN. Therefore, a better understanding is needed to elucidate: (1) the relationship between abnormal connective tissue and AN, (2) the impact of starvation toward the development of abnormal connective tissue and how this manifests clinically, (3) the etiology of autonomic nervous system changes contributing to the dysautonomia in AN, and (4) how the sensory signals sent from potentially abnormal connective tissue to the central nervous system impact interoception in AN. A conceptual model incorporating abnormal connective tissue is provided. PUBLIC SIGNIFICANCE: The etiology of AN remains poorly understood and current theories fail to account for the direct impact of starvation on the health of the organs and tissues of the body. There is significant clinical overlap between AN and hereditary connective tissue disorders. This paper attempts to provide a new conceptual model for AN in which abnormal connective tissue contributes to the underlying pathogenesis.

My mother, sisters, and I: Investigating the role of female family members in body dissatisfaction and disordered eating behaviours among young Middle-Eastern women

The global rise in body dissatisfaction and disordered eating concerns is apparent; however, limited research in Middle-Eastern populations gives an incomplete understanding of these concerns. The present study recruited 377 young women aged 18 to 25 years from the Middle-East for an online survey to determine how female family members may contribute to body dissatisfaction and disordered eating behaviours. Guided by the Tripartite Influence Model, we investigated the relationships between appearance pressures and fat talk, from mothers and sister(s), in predicting body dissatisfaction, and in turn, disordered eating symptomatology (restriction and bulimia), as mediated by appearance comparisons and internalisation of the thin-ideal. Overall, greater appearance pressures and fat talk from mothers and sister(s) were associated with body dissatisfaction and disordered eating symptomatology. Greater reported closeness in mother-daughter relationships, but not sister relationships, was associated with less perceived appearance pressure and fat talk by mothers, and lower appearance comparisons, body dissatisfaction and bulimia symptomatology. Finally, participants perceived greater appearance pressure from their mothers than their sister(s), but there was no difference in their perceived levels of fat talk. Findings demonstrate the applicability of a subsection of the Tripartite Influence Model in a non-Western and understudied population, namely in young Middle-Eastern women.

Holistic nursing care for people diagnosed with an eating disorder: A qualitative study based on patients and nursing professionals' experience

PURPOSE

To analyze eating disorder patients and nursing professionals' views and experience of the relationship-based care established.

DESIGN AND METHODS

A qualitative study that employs an interpretative phenomenological analysis. Nineteen patients and 19 nurses participated in the research through interviews and narrations.

FINDINGS

Nurses' help is both unexpected and relevant during the patients' recovery process. They provide care not focusing just on nutritional aspects, other factors such as mutual help, the psychological, emotional, social, and personal aspects are highlighted.

PRACTICE IMPLICATIONS

This study provides a deep understanding of the relationship-based care established that makes it possible to expand knowledge and to individualize the care provided.

Exercise Satiation: A novel theoretical conceptualization for problematic exercise observed in eating disorders

Exercise Satiation is a novel theoretical conceptualization for problematic exercise often observed in eating disorders. Problematic exercise is present across the spectrum of eating disorder presentations and is a cardinal symptom of eating disorders that has been difficult to treat historically. Conceptualizing exercise in the context of Reward Satiation similar to other biological drives such as eating could provide new insights into the etiology, maintenance, and treatment of problematic exercise in eating disorders. Through this understanding, we may be able to provide and increase adherence to interventions that target these mechanisms and as such, reduce impairment associated with problematic exercise for those with eating disorders. Using the Research Domain Criteria (RDoC) framework, we propose and discuss potential research avenues to explore Exercise Satiation in the context of eating disorders.