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Dunlop R, Simonds LM, John M. Self-disclosure by adolescents in therapy for eating difficulties: A Q-Methodology study. Clin Child Psychol Psychiatry 2024; 29:90-102. [PMID: 37879067 PMCID: PMC10748442 DOI: 10.1177/13591045231209648] [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] [Indexed: 10/27/2023]
Abstract
Facilitating client self-disclosure is essential to therapeutic effectiveness. Given the long-term consequences of eating difficulties for adolescents, there is a need for more research on self-disclosure in this group. This study investigated factors likely to influence adolescents' decisions to self-disclose during psychological therapy for eating difficulties using Q-methodology. Participants (n = 28), recruited through child and adolescent mental health services in the UK, completed a task that involved sorting 47 statements to represent their viewpoint on self-disclosure. The 28 completed sorts were subjected to a by-participant factor analysis in order to identify distinct viewpoints in the sample. Three distinct factors were extracted. One factor emphasised the importance of therapist self-disclosure on decisions to disclose. In contrast, another factor placed more emphasis on the influence of eating disorder identity and readiness to change on disclosure decisions. The third factor placed emphasis on the quality of the therapeutic relationship and readiness to change as having most influence. Given the absence of a unifying factor representing what influences the decision to disclose, clinicians should ensure they explore with young people what might influence their decision to disclose.
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Affiliation(s)
- Rhiannon Dunlop
- Department of Psychological Interventions, University of Surrey, UK
- Solent East CAMHS Eating Disorder Service, Solent NHS Trust, UK
| | - Laura M Simonds
- Department of Psychological Interventions, University of Surrey, UK
| | - Mary John
- Department of Psychological Interventions, University of Surrey, UK
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2
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Prevention and early intervention in eating disorders: findings from a rapid review. J Eat Disord 2023; 11:38. [PMID: 36899428 PMCID: PMC9999654 DOI: 10.1186/s40337-023-00758-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/19/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs. METHODS This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review. RESULTS In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist. CONCLUSIONS Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.
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3
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McAulay C, Mond J, Outhred T, Malhi GS, Touyz S. Eating disorder features in bipolar disorder: clinical implications. J Ment Health 2023; 32:43-53. [PMID: 33573438 DOI: 10.1080/09638237.2021.1875401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with elevated rates of eating disorders (EDs), but the nature and impact of specific ED features are unclear. AIMS This study sought to identify which ED features are common in BD, and whether these relate to quality of life (QoL) impairment and body mass index (BMI). METHOD A clinical sample of 73 adults with BD completed self-report measures of health, ED features, emotion regulation ability, impulsivity, and QoL. RESULTS Binge eating (45%), excessive dietary restriction (39%), overvaluation of weight/shape (51%), purging (16%) and driven exercise (27%) were common, and associated with a poorer clinical picture, including poorer QoL and poorer emotion regulation. Furthermore, regular binge eating episodes explained a significant proportion of variance in QoL impairment after controlling for other significant predictors. The best predictors of BMI were number of medical conditions, impulsivity and positive beliefs about binge eating. CONCLUSIONS ED features that may not meet criteria for a fully diagnosable ED - particularly overvaluation of weight/shape and binge eating - warrant greater attention, as they may still significantly worsen QoL. Future research should focus on modifying existing psychological interventions to better target ED features among individuals with BD and thereby improve clinical outcomes.
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Affiliation(s)
- Claire McAulay
- Clinical Psychology Unit, University of Sydney, Sydney, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia
| | - Tim Outhred
- Academic Department of Psychiatry, Northern Sydney Local Health District, Sydney, Australia.,Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia
| | - Gin S Malhi
- Academic Department of Psychiatry, Northern Sydney Local Health District, Sydney, Australia.,Department of Psychiatry, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia
| | - Stephen Touyz
- Clinical Psychology Unit, University of Sydney, Sydney, Australia
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4
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Sahlan RN, Serier KN, Smith JE. Using Exploratory Structural Equation Modeling (ESEM) To Examine the Factor Structure and Measurement Invariance of the Farsi Version of the Children's Eating Attitudes Test (F-ChEAT) among Iranian Preadolescents Across Gender and Age. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01466-w. [PMID: 36459345 DOI: 10.1007/s10578-022-01466-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/05/2022]
Abstract
Despite considerable examination of the Children's Eating Attitudes Test (ChEAT) in Western societies, there is no study about the ChEAT in Iran. The purpose of the current study was to translate and examine the factor structure and measurement invariance of the Farsi version of the ChEAT (F-ChEAT) among Iranian preadolescents. Iranian preadolescents (N = 717) completed the F-ChEAT and demographic information. Exploratory structural equation modeling (ESEM) was used to examine the factor structure and measurement invariance across gender and age. A 5-factor, 15-item ESEM model showed an excellent fit of the data. Tests of measurement invariance suggested that scores on the latent means could be meaningfully compared across gender and age. Girls had higher latent means on the Food Preoccupation and Caloric Awareness and Control factors, and older preadolescents had higher latent means on all the F-ChEAT factors, except for the Dieting factor. Findings suggest that a 5-factor, 15-item ESEM model of the F-ChEAT was a useful assessment tool to understand disordered eating symptoms in Iranian preadolescents.
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Affiliation(s)
- Reza N Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Kelsey N Serier
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jane Ellen Smith
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA.
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5
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Feldhege J, Bilic S, Ali K, Fassnacht DB, Moessner M, Farrer LM, Griffiths KM, Bauer S. Knowledge and Myths about Eating Disorders in a German Adolescent Sample: A Preliminary Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116861. [PMID: 35682445 PMCID: PMC9180431 DOI: 10.3390/ijerph19116861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 12/04/2022]
Abstract
Eating disorder mental health literacy (ED-MHL) refers to knowledge about the symptoms, causes, and treatment of eating disorders (EDs) and is an important factor in people’s attitudes towards individuals with EDs and help-seeking for EDs. Associations between ED-MHL, stigma, ED symptomatology, and gender were investigated in a sample of N = 194 German high school students. Knowledge and myths about EDs were assessed with 18 factual statements about EDs and agreement/disagreement with common myths about ED. Students also completed the Universal Stigma Scale (USS), the Weight Concerns Scale (WCS), and demographic items. Students judged M = 8.39 (SD = 3.40) statements correctly, while the average agreement with all ED myths was low (M = 0.19, SD = 0.14). Greater ED-MHL was associated with lower stigmatization of EDs. Male participants were less knowledgeable and more likely to agree with the ED myths. Participants displayed moderate ED-MHL; however, certain aspects such as ED risk factors or symptoms of specific disorders such as anorexia nervosa and bulimia nervosa were less well known. These results can inform the design of future MHL interventions for adolescents.
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Affiliation(s)
- Johannes Feldhege
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
- Correspondence:
| | - Sally Bilic
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
| | - Kathina Ali
- College of Education, Psychology and Social Work, Flinders University, Adelaide 5042, Australia; (K.A.); (D.B.F.)
- Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide 5042, Australia
- Research School of Psychology, Australian National University, Canberra 2601, Australia;
| | - Daniel B. Fassnacht
- College of Education, Psychology and Social Work, Flinders University, Adelaide 5042, Australia; (K.A.); (D.B.F.)
- Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide 5042, Australia
- Research School of Psychology, Australian National University, Canberra 2601, Australia;
| | - Markus Moessner
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
| | - Louise M. Farrer
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia;
| | - Kathleen M. Griffiths
- Research School of Psychology, Australian National University, Canberra 2601, Australia;
- College of Health & Medicine, Australian National University, Canberra 2601, Australia
| | - Stephanie Bauer
- Center for Psychotherapy Research, Heidelberg University Hospital, 69115 Heidelberg, Germany; (S.B.); (M.M.); (S.B.)
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6
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Fatt SJ, Mitchison D, Bussey K, Mond J. Methods used to assess insight in individuals with eating disorders: a scoping review. J Ment Health 2022:1-12. [PMID: 35543348 DOI: 10.1080/09638237.2022.2069696] [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: 03/30/2021] [Revised: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
Insight can be impaired in individuals with an eating disorder and the nature of this impairment can vary. Although this topic has been the focus of several studies and reviews, methodologies used to assess insight have received less attention. A scoping review was conducted using a systematic search of articles before January 2021 to elucidate the methodologies used to assess insight in those with an eating disorder, with discussion of strengths and limitations. A total of 3089 studies were screened, and 24 quantitative studies which assessed at least one aspect of insight in individuals with an eating disorder were included in the review. Methods of assessing insight included coding of clinical notes, low scores on measures of self-report symptoms, direct assessment of insight, vignette, and self-report single-item questions. Insight into disordered eating symptoms was most frequently assessed. Most research used samples who were female, white, diagnosed with anorexia nervosa, and were seeking or receiving treatment. In designing future research and interventions, optimal methods used to assess insight should consider the research/clinical question, available resources, and the targeted demographic. Further, descriptions of which aspects of insight are being assessed should be considered in the interpretation of both current and future findings.
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Affiliation(s)
- Scott J Fatt
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Kay Bussey
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia
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7
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Abstract
PURPOSE Early detection of eating disorders (EDs) could improve their prognosis, decrease morbidity and mortality, and prevent the risk of evolution towards a chronic form and somatic, psychiatric and psychosocial complications. The objective of this review was to examine the current scientific data concerning the early detection of EDs, which is one of the facets of secondary prevention. METHOD A scoping literature review was carried out following the PRISMA-ScR criteria, including all articles on ED detection published up to 2021 on PUBMED and PSYCINFO. RESULTS 43 articles were included. Anorexia nervosa and bulimia nervosa were the most widely studied disorders. The articles focused on professionals from the medical field (GPs, psychiatrists, gynaecologists, gastroenterologists and residents), from the paramedical field, from education and sport, and from the general population. The assessments conducted with the professionals receiving interventions aiming to improve detection demonstrated their efficacy. Interventions for ED detection in the general population and at school seemed less efficacious. CONCLUSION The results highlighted some lines of action to be implemented. They pointed towards improving initial and continuing education for professional carers; e-learning could be an interesting solution for continuing education. Improving training with specific instructors, school personnel and sports professionals is also one of the solutions for a better detection of EDs. Specific recommendations could be published for fitness centre professionals to help them to deal with clients suspected of having an ED. Among secondary school students and in the general population, a better dissemination of mental health literacy and the development of mental health first aid programs could help improve early detection. LEVEL OF EVIDENCE Level I: Evidence obtained from systematic reviews.
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8
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Trompeter N, Bussey K, Forbes MK, Mond J, Hay P, Basten C, Goldstein M, Thornton C, Heruc G, Byrne S, Griffiths S, Lonergan A, Touyz S, Mitchison D. Differences between Australian adolescents with eating disorder symptoms who are in treatment or not in treatment for an eating disorder. Early Interv Psychiatry 2021; 15:882-888. [PMID: 32881352 DOI: 10.1111/eip.13027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/23/2020] [Accepted: 08/02/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Mental health problems frequently occur during adolescence, however, few adolescents seek treatment for these problems, especially for eating disorders. The current study aimed to quantify how adolescents in a clinical sample (ie, those receiving treatment for an eating disorder), differ in terms of psychological factors (eating disorder symptoms and psychological distress), compared to adolescents with eating pathology in a community sample (ie, those not receiving treatment). METHOD Data were used from a community sample of adolescents with eating disorder pathology who have not sought treatment (n = 1011) and a clinical sample of adolescents presenting at eating disorder services for treatment (n = 153). Participants reported demographics and completed questionnaires assessing weight/shape concerns, disordered eating and psychological distress. RESULTS Adolescents with a lower BMI, more frequent purging and higher weight/shape concerns were more common in the clinical sample, while those engaging in more frequent driven exercise were less common in the clinical sample. The samples did not differ in severity of psychological distress. CONCLUSIONS The findings highlight the need for increasing mental health literacy about the role of BMI and driven exercise in eating disorder symptom presentation to increase early detection of these disorders among adolescents.
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Affiliation(s)
- Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia.,Camden and Campbelltown Hospital, SWSLHD, Campbelltown, Australia
| | - Christopher Basten
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Mandy Goldstein
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,Mandy Goldstein Psychology, Private Practice, Sydney, Australia
| | - Christopher Thornton
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,The Redleaf Practice, Private Practice, Sydney, Australia
| | - Gabriella Heruc
- School of Medicine, Western Sydney University, Sydney, Australia.,Appetite for Change, Private Practice, Sydney, Australia
| | - Susan Byrne
- School of Psychological Sciences, University of Western Australia, Perth, Australia.,The Swan Centre, Private Practice, Perth, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Stephen Touyz
- School of Psychology and Inside Out Institute, University of Sydney, Sydney, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
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9
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Fatt SJ, Mond J, Bussey K, Griffiths S, Murray SB, Lonergan A, Hay P, Pike K, Trompeter N, Mitchison D. Seeing yourself clearly: Self-identification of a body image problem in adolescents with an eating disorder. Early Interv Psychiatry 2021; 15:577-584. [PMID: 32426938 DOI: 10.1111/eip.12987] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/15/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
AIM Many adolescents who meet diagnostic criteria for an eating disorder do not self-identify as having a problem and may consequently be less likely to seek help. Extant research investigating self-identification has been limited to specific populations (ie, girls meeting criteria for bulimic-type eating disorders). This study investigated how self-identification varied across sex, eating disorder diagnoses, and the presence of extreme eating behaviours, and how self-identification was related to help-seeking in adolescents. METHODS Participants included 1002 Australian school students (75.5% female, Mage = 15.14 years, SD = 1.40) who met DSM-5 diagnostic criteria for an eating disorder. An online survey assessed self-identification of having a body image problem, as well as sex, eating disorder diagnosis, extreme eating behaviours, help-seeking for a body image problem, and other potential correlates of self-identification (demographics, psychological distress, social function, weight and shape concerns). RESULTS Approximately, 2 in 3 adolescents with an eating disorder self-identified as having a body image problem. Girls who met criteria for a major eating disorder diagnosis, and those engaging in extreme eating behaviours, were more likely to self-identify. When adjusting for covariates, only sex remained significantly associated with self-identification. Adolescents who self-identified were 2.71 times more likely to seek help for a body image problem, adjusting for covariates. CONCLUSIONS Public health strategies ought to promote awareness regarding the different ways that body image problems might manifest among both girls and boys, as well as the potential gravity of such problems. Awareness among parents, teachers and primary care providers should also be considered.
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Affiliation(s)
- Scott J Fatt
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kathleen Pike
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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10
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Mond J, Gorrell S. "Excessive exercise" in eating disorders research: problems of definition and perspective. Eat Weight Disord 2021; 26:1017-1020. [PMID: 33389704 PMCID: PMC8068596 DOI: 10.1007/s40519-020-01075-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia.,School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
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11
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Sahlan RN, Saunders JF, Mond JM, Fitzsimmons-Craft EE. Eating disorder symptoms among adolescent boys and girls in Iran. Int J Eat Disord 2021; 54:19-23. [PMID: 33270255 PMCID: PMC8006449 DOI: 10.1002/eat.23420] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Few studies of eating disorder (ED) symptoms among young people in Iran have been conducted. This cross-sectional study examined ED symptoms, assessed by the Eating Disorder Examination Questionnaire (EDE-Q). METHOD Adolescent boys (n = 498) and girls (n = 607) aged 12-19 years, recruited from schools in four different regions of Iran, completed a survey that included the EDE-Q. ED symptoms, namely, EDE-Q global scores and the occurrence of specific ED behaviors, were compared between boys and girls. RESULTS Girls had higher global scores and were more likely to report regular extreme dietary restriction than boys (16.6 vs. 12.0%). The effect sizes for these differences were small. The regular occurrence of other behaviors (girls vs. boys-binge eating: 21.1 vs. 18.8%; self-induced vomiting: 3.3 vs. 5.4%; laxative misuse: 6.1 vs. 7.6%; excessive exercise: 5.3 vs. 4.4%) did not significantly differ by gender. Twelve percent of boys and 12.9% of girls met criteria for an operational definition of "probable ED case." CONCLUSION ED symptoms appear to be relatively common among Iranian adolescent boys and girls. Programs designed to reduce the occurrence and adverse impact of these symptoms may therefore be increasingly important.
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Affiliation(s)
- Reza N. Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Jessica F. Saunders
- Department of Psychological Science, Georgia College and State University, Milledgeville, GA, USA
| | - Jonathan M. Mond
- Center of Rural Health, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia,School of Medicine, Western Sydney University, Campbelltown, Australia
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12
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Ali K, Fassnacht DB, Farrer L, Rieger E, Feldhege J, Moessner M, Griffiths KM, Bauer S. What prevents young adults from seeking help? Barriers toward help-seeking for eating disorder symptomatology. Int J Eat Disord 2020; 53:894-906. [PMID: 32239776 DOI: 10.1002/eat.23266] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate help-seeking attitudes, intentions, and behaviors, and to systematically explore perceived barriers to help-seeking for eating, weight, or shape concerns among young adults. Differences in perceived barriers as a function of type of eating disorder symptomatology were also examined. METHOD Data were collected using an online survey among individuals (aged 18-25 years) in Australia. Overall, 291 young adults with varying levels of eating disorder symptoms completed measures of disordered eating, weight or shape concerns, help-seeking barriers, attitudes, intentions, and behaviors. According to their self-reported symptoms, participants were classified into four subgroups (i.e., anorexia nervosa [AN] symptoms, bulimia nervosa [BN] symptoms, binge-eating disorder [BED] symptoms, and other eating disorder symptoms). RESULTS Despite the belief that help-seeking is useful, only a minority of participants with elevated symptoms, namely those with AN, BN, and BED symptoms, believed they needed help. Across the sample, the most frequently cited barriers to seeking help for eating disorder symptoms were: concern for others, self-sufficiency, fear of losing control, denial and failure to perceive the severity of the illness, and stigma and shame. DISCUSSION The findings highlight the need to educate young adults about the severity of eating disorders and the importance of seeking help, and to increase the awareness of help-seeking barriers among those designing public health interventions as well as clinicians. Our findings suggest that help-seeking barriers may differ depending on the type of eating disorder symptomology.
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Affiliation(s)
- Kathina Ali
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.,Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia.,College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Daniel B Fassnacht
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.,College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Elizabeth Rieger
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Johannes Feldhege
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Kathleen M Griffiths
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
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13
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Bullivant B, Rhydderch S, Griffiths S, Mitchison D, Mond JM. Eating disorders "mental health literacy": a scoping review. J Ment Health 2020; 29:336-349. [PMID: 32041463 DOI: 10.1080/09638237.2020.1713996] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: While it is apparent that much has been learned about "mental health literacy" (MHL) relating to certain mental health problems, such as depression, in recent years, what has been learned about MHL relating to eating disorders (ED-MHL) is unclear.Aims: A scoping review was conducted to inform the current state of knowledge in this field.Methods: A systematic search of relevant literature published between 1997 and 2017 was followed by a narrative synthesis of the findings.Results: The number of eligible studies increased from 32 in 1997-2001 to 98 in 2012-2017 (total = 264). Most studies originated from North America or Europe, recruited individuals with EDs receiving treatment or college students and included both female and male or only female participants. The majority of studies examined MHL relating to anorexia nervosa or bulimia nervosa and examined attitudes which facilitate recognition and appropriate help-seeking and knowledge and beliefs about professional help available.Conclusion: Interest in ED-MHL is increasing and there is now a considerable body of research addressing some aspects of ED-MHL in a range of study populations. Notable gaps in the literature exist, including a paucity of information about ED-MHL relating to EDs other than anorexia nervosa and bulimia nervosa, ED behaviour in males and the use of self-help interventions. We hope the findings will provide an incentive to further research in these and other aspects of ED-MHL.
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Affiliation(s)
- Bianca Bullivant
- Faculty of Medicine, Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia.,Department of Psychology, Macquarie University, Sydney, Australia
| | - Suzie Rhydderch
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Deborah Mitchison
- Department of Psychology, Macquarie University, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Jonathan M Mond
- Department of Psychology, Macquarie University, Sydney, Australia.,Centre for Rural Health, University of Tasmania, Launceston, Australia
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14
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Thapliyal P, Mitchison D, Mond J, Hay P. Gender and help-seeking for an eating disorder: findings from a general population sample. Eat Weight Disord 2020; 25:215-220. [PMID: 30066257 DOI: 10.1007/s40519-018-0555-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/24/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aimed to compare gender differences in eating disorder (ED) features and to examine the role of gender as a predictor of ED help-seeking controlling for other putative determinants, namely weight/shape overvaluation, age, BMI, and impairment in role functioning. METHODS Demographic, ED symptoms, and related data were collected during household interviews of individuals aged ≥ 15 years. One hundred and forty-eight participants (164 after data were weighted) with an ED syndrome were identified. RESULTS Compared to women, men with an ED were younger and had lower levels of purging and overvaluation. However, men and women with an ED had similar levels of functional impairment, binge eating and strict dieting. In univariate analyses, males in general, but not males with an ED, were significantly less likely than females to seek help for an ED. In multivariate analysis of people with an ED, only BMI was significantly associated with treatment-seeking. CONCLUSION Functional health impairment and common ED behaviours were similar for men and women with EDs. Gender may not be a primary reason to be more or less likely to seek help for an ED. Rather, other features, most notably, a higher BMI, appear to be stronger predictors of ED-specific help-seeking. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Priyanka Thapliyal
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Deborah Mitchison
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Jonathan Mond
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Centre for Rural Health, School of Health Sciences, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW, Australia
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15
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Seiffge-Krenke I. Essstörungen: Entwicklungspsychologische und entwicklungspsychopathologische Perspektive. KINDHEIT UND ENTWICKLUNG 2019. [DOI: 10.1026/0942-5403/a000291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Zusammenfassung. Der vorliegende Beitrag betrachtet Essstörungen unter entwicklungspsychologischer und entwicklungspsychopathologischer Perspektive. Körperbildstörungen, gestörtes Essverhalten und der Einfluss beider Eltern werden in den Kontext der normalen Mädchenentwicklung gestellt und insbesondere der Einfluss der Freundinnen und der neuen Medien herausgearbeitet. Bereits bei nicht essgestörten Jugendlichen fallen extremes Diätieren und ängstliche Körperkontrolle, aber auch elterliche problematische Kommunikationsstile und die oft schädlichen Interaktionen mit Gleichaltrigen auf. Die Grenze zu pathologischen Phänomenen ist entsprechend schwer zu ziehen. Hinzukommen hohe Komorbiditäten zwischen verschiedenen Essstörungen und mit internalisierenden und externalisierenden psychischen Störungen. Zeitgeschichtliche Phänomene wie die „holy anorexia“ der vergangenen Jahrhunderte und die gegenwärtig beobachtbare Zunahme an Essstörungen bei Jungen und der Wunsch, das Geschlecht zu verändern (Transgender) werden ebenso betrachtet wie kulturelle Einflüsse („Is fat beautiful?“). In diesem Zusammenhang wird auch der Frage nachgegangen, ob Essstörungen zugenommen haben und welchen Beitrag die neuen Medien dabei möglicherweise haben.
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16
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Sparti C, Santomauro D, Cruwys T, Burgess P, Harris M. Disordered eating among Australian adolescents: Prevalence, functioning, and help received. Int J Eat Disord 2019; 52:246-254. [PMID: 30734332 DOI: 10.1002/eat.23032] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To estimate the prevalence of disordered eating (DE) among Australian adolescents and examine associations with clinical mental health problems, problems with functioning, and help received. METHOD We analyzed data from the Young Minds Matter survey (n = 2,298, 13-17 years). We derived an index of DE severity with four levels: (1) no DE; (2) subclinical DE; (3) suspected eating disorder; and (4) lifetime eating disorder diagnosis. RESULTS In 2013-2014, 31.6% (95%CI 35.5-39.9) of Australian adolescents experienced DE, comprising 25.7% (95%CI 23.9-37.6) with subclinical DE, 11.0% (95%CI 9.7-12.6) with a suspected eating disorder, and 0.9% (95%CI 0.6-1.3) with a lifetime eating disorder diagnosis. DE was more common among girls (41.4%, 95%CI 37.9-44.4) than boys (34.0%, 95%CI 31.1-37.0; p = .002). Adolescents with DE, compared to those without, were more likely to experience clinical mental health problems and problems with functioning. Most adolescents with DE reported help-seeking in the past year, commonly self-help; around 40% used school-based, primary care or specialist services (i.e., formal services). In multivariate analyses, the use of more specialized and intensive services was associated with more severe DE, greater problems with functioning, female gender, and 12-month mental disorder or subthreshold mental disorder symptoms. DISCUSSION The implementation of mental health promotion and prevention efforts for DE, and screening for DE in school and primary care settings, may facilitate detection and appropriate help-seeking among adolescents with DE.
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Affiliation(s)
- Claudia Sparti
- School of Public Health, The University of Queensland, Brisbane, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Damian Santomauro
- School of Public Health, The University of Queensland, Brisbane, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Australia.,Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, Washington
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Philip Burgess
- School of Public Health, The University of Queensland, Brisbane, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Meredith Harris
- School of Public Health, The University of Queensland, Brisbane, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Australia
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17
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Feldhege J, Moessner M, Stieler C, van Stipelen J, Bauer S. Wissen und Einstellungen zu Essstörungen bei Jugendlichen mit türkischem Migrationshintergrund. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0327-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Grillot CL, Keel PK. Barriers to seeking treatment for eating disorders: The role of self-recognition in understanding gender disparities in who seeks help. Int J Eat Disord 2018; 51:1285-1289. [PMID: 30488569 DOI: 10.1002/eat.22965] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Previous research suggests that men with eating disorders are less likely to seek treatment than are women. Given stereotypes linked to eating disorders, men may be less likely to recognize when they have an eating disorder, which could act as a barrier to treatment-seeking. METHOD The current study examined differences in self-recognition and treatment-seeking behavior by gender, controlling for other covariates, in participants with probable DSM-5 eating disorders drawn from a larger community-based sample. RESULTS Being female and self-recognition were both associated with increased likelihood of treatment-seeking while accounting for other potential covariates, including race/ethnicity, age, BMI, and comorbid disorders. DISCUSSION Results indicate that self-recognition is a barrier to seeking treatment for both genders and does not account for help-seeking differences between women and men. Findings have implications for interventions to address barriers to treatment-seeking for eating disorders.
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Affiliation(s)
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
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19
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Slewa-Younan S, Yaser A, Guajardo MGU, Mannan H, Smith CA, Mond JM. The mental health and help-seeking behaviour of resettled Afghan refugees in Australia. Int J Ment Health Syst 2017; 11:49. [PMID: 28855961 PMCID: PMC5571658 DOI: 10.1186/s13033-017-0157-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/20/2017] [Indexed: 02/02/2023] Open
Abstract
Background Psychological trauma, in particular, posttraumatic stress disorder (PTSD) and depression, are highly prevalent among resettled refugees. However, little is known regarding the mental health status and associated help-seeking behaviour of resettled Afghan refugees in Australia. Methods A sample of 150 resettled Afghan refugees (74 males; mean age 32.8 years, SD = 12.2) living in Adelaide, South Australia were recruited. Self-reported measures of PTSD, depression, exposure to traumatic events, functional impairment, self-recognition of PTSD symptomatology and help-seeking behaviours were completed. Multivariate analysis of variables associated with help-seeking was conducted. Results Forty-four percent of participants met criteria for clinically significant PTSD symptoms and all but one participant reported being exposed to 1 or more traumatic and/or conflict related events, such as ‘losing your property and wealth’. Moreover, 14.7% of participants had symptoms suggestive of clinically significant depression. General practitioners were the most common source of help in relation to mental health problems, with very few participants (4.6%) seeking help from specialist trauma and torture mental health services. Self-recognition of having a PTSD related mental health problem and functional impairment levels were both found to be independent predictors of help-seeking (p ≤ .05). Conclusions The findings provide further evidence for high rates of PTSD symptomatology and low uptake of mental care among resettled refugees. Poor self-recognition of the presence and/or adverse impact of PTSD symptoms may need to be targeted in mental health promotion programs designed to improve “mental health literacy” and thereby promote early and appropriate help-seeking where this is needed.
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Affiliation(s)
- Shameran Slewa-Younan
- Mental Health, School of Medicine, Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith South DC, Sydney, NSW Australia.,Centre for Mental Health, Melbourne, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anisa Yaser
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia
| | - Maria Gabriela Uribe Guajardo
- Mental Health, School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Caroline A Smith
- National Institute of Complementary Medicine, Western Sydney University, Sydney, Australia
| | - Jonathan M Mond
- Centre for Rural Health, University of Tasmania, Hobart, Australia.,School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
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20
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Anderson R, Gratwick-Sarll K, Bentley C, Harrison C, Mond J. Adolescents’ perception of the severity of binge eating disorder: a population-based study. J Ment Health 2015; 25:16-22. [DOI: 10.3109/09638237.2015.1057329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Harrison C, Mond J, Bentley C, Gratwick-Sarll K, Rieger E, Rodgers B. Loss of control eating with and without the undue influence of weight or shape on self-evaluation: evidence from an adolescent population. J Eat Disord 2014; 2:31. [PMID: 25364505 PMCID: PMC4215020 DOI: 10.1186/s40337-014-0031-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/12/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The overvaluation of weight and/or shape ("overvaluation"), a diagnostic criterion for anorexia nervosa and bulimia nervosa, is increasingly supported for inclusion in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) criteria of binge eating disorder (BED). However, current evidence has been largely confined to adult populations. The current study aims to examine the status of overvaluation among adolescents with loss of control (LOC) eating recruited from a large, population-based sample. METHOD Subgroups of female adolescents - LOC eating with overvaluation (n = 30); LOC eating without overvaluation (n = 58); obese no LOC eating ("obese control") (n = 36); and "normal-weight control" (normal-weight, no LOC eating) (n = 439) - recruited from secondary schools within the Australian Capital Territory (ACT) were compared on measures of eating disorder psychopathology, general psychological distress and quality of life. RESULTS Participants in the LOC eating with overvaluation subgroup reported significantly higher levels of eating disorder psychopathology than all other groups, while levels did not differ between participants in the LOC eating without overvaluation and obese control subgroups. On measures of distress and quality of life there were no significant differences between LOC eating with and without overvaluation subgroups. Both reported significantly greater distress and quality of life impairment than normal-weight controls. LOC eating with overvaluation participants had significantly higher levels of distress and quality of life impairment than obese controls, whereas scores on these measures did not differ between LOC eating without overvaluation and obese control subgroups. CONCLUSION The results suggest that the presence of overvaluation among adolescents with LOC eating indicates a more severe disorder in terms of eating disorder psychopathology, however may not indicate distress and disability as clearly as it does among adults with BED.
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Affiliation(s)
- Carmel Harrison
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Jonathan Mond
- Research School of Psychology, Australian National University, Canberra, Australia ; Department of Psychology, Macquarie University, Sydney, Australia
| | - Caroline Bentley
- Research School of Psychology, Australian National University, Canberra, Australia
| | | | - Elizabeth Rieger
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Bryan Rodgers
- Australian Demographic and Social Research Institute, Australian National University, Canberra, Australia
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