Seeing yourself clearly: Self-identification of a body image problem in adolescents with an eating disorder

Staying isolated indoors means that nobody sees me": ontological (in)security and living with significant appearance concerns before, during, and 'since' COVID-19

PURPOSE

Though a worldwide period of uncertainty (COVID-19) has 'ended', there exists a legacy of maladaptive experiences among people with significant appearance concerns (SAC) that requires care and attention.

METHODS

Using Giddens' concept of ontological security, we explored how people experienced their SAC before, during and "since" COVID-19. Qualitative surveys allowed us to capture diverse perspectives from individuals transnationally, analysed with deductive reflexive thematic analysis using ontological security as our theoretical foundation.

RESULTS

Themes named "More Mirror(ed) Time" and "Locked Out, Shut Down, and Shut Out" gave a contextual grounding for the embodied experiences of this group through times of social restrictions, and the theme "Redefining Relevance" explored the continued legacy of COVID-19 - and continued global uncertainties such as economic hardship and warfare - that impact the wellbeing of people with SAC.

CONCLUSIONS

People with SAC are still 'locked out' from essential healthcare support as those providing healthcare are overworked, under-resourced and rely on efficient interactive methods such as tele-health that may be triggers for people with SAC. Care providers may consider expanding appearance concerns verbiage, look to involve trusted others in the care-seeking process, and utilize modalities beyond digital health to support people with SAC.

The Unmet Treatment Need for Eating Disorders: What Has Changed in More Than 10 Years? An Updated Systematic Review and Meta-Analysis

OBJECTIVE

A minority of individuals with eating disorders seek help from health professionals qualified to provide eating disorder care. This review assessed the proportion of individuals with eating disorders who had sought help or received treatment, as an update to an earlier review conducted more than a decade ago.

METHOD

Three databases were searched for studies that: (1) included a community sample of help-seekers and non-help seekers, (2) used a standardized eating disorder screening instrument, and (3) assessed the percentage of participants who had sought help specifically for eating disorder concerns.

RESULTS

Of 972 articles, 21 studies met inclusion criteria, representing 37,423 participants. The pooled proportion reporting help-seeking from any source (e.g., helpline, support groups, chat rooms as well as health professionals) was 30% and the pooled proportion reporting formal treatment seeking from health professionals (e.g., psychologist) specifically for eating disorder concerns was 32%. However, there was evidence of publication bias across studies.

DISCUSSION

These rates suggest little to no improvement in the unmet need for treatment since the last review with studies continuing to focus on white adult women. Help-seeking rates among other populations remain unclear and there is an urgent need to understand reasons for overall low help-seeking rates. Clear definitions and measures of help-seeking with appropriate distinctions between sources of help are needed to improve our understanding of help-seeking pathways and identify solutions to facilitate help-seeking. Better visibility of health professionals qualified to provide safe and effective eating disorder care could help reduce the substantial treatment gap.

The effect of appearance and functionality concerns, and weight status, on negative body image mental health literacy in women

Few studies have investigated community knowledge and beliefs about negative body image. Yet, low rates of recognition and help-seeking for body image concerns have been reported. Given the prevalence of body image problems and associated mental health risks in women, the current online study investigated negative body image mental health literacy in 260 women aged 18 to 64 years recruited via Prolific. The mental health literacy paradigm was employed in a 2 × 2 experimental design in which the effect of a target's domain of body image concern (appearance versus body functionality) and weight status ("normal weight" versus "overweight") was assessed on problem recognition, beliefs, and help-seeking recommendations. Overall, low symptom recognition was observed, and ratings for beliefs and help-seeking suggested low levels of stigma. However, significantly greater sympathy and lifestyle support recommendations were observed in the overweight compared to normal weight condition, and a domain × weight interaction suggested significantly fewer negative emotional reactions in the appearance overweight condition compared to appearance normal weight, and functionality overweight, conditions. The findings suggest a need for education about body image independent of weight status in women. Future research would benefit from examining diverse samples, broader functionality concerns, and stigma.

Towards an understanding of help-seeking behaviour for disordered eating: Refinement of a barriers to help-seeking measure

AIM

Early intervention in eating disorders (EDs) is hampered by a lack of validated measures of barriers to treatment seeking. The present study examined the factor structure of the Perceived Barriers to Psychological Treatment scale (PBPT) and a combination of PBPT and Barriers to Seeking Help for ED items (BATSH-ED) with respect to treatment-seeking for an ED.

METHOD

Participants were 456 female university students aged 17-25 reporting a wide range of disordered eating severity. Confirmatory factor analyses were conducted with the whole sample followed by correlational and regression analyses with a high-risk sample to assess validity of the selected questionnaire items.

RESULTS

Four models were tested. First, we replicated the original PBPT 8-factor structure in our sample with comparable fit indices. Second, the addition of six ED items comprising a Denial and Ambivalence subscale improved model fit. Third and fourth, when only significant subscales predicting treatment seeking were retained, with removal of items with weak loadings, a 15-item six-factor solution provided a best fit. A range of psychosocial measures had relationships in the expected directions with the questionnaire subscales. In addition to disordered eating, the denial subscale was uniquely associated with treatment seeking.

CONCLUSIONS

While the present study contributes to refining the assessment of barriers to help-seeking, future studies should consider co-design with lived experience to further improve the model fit of the questionnaire and improve predictiveness of help-seeking.

The Relationship Between Exercise Intention and Exercise Behavior of Junior School Students: An Analysis of Chain Mediating Effect

Objective

This study explores the relationship between exercise intention and exercise behavior and constructs a chain mediating model through the mediating effect of implementation intention and self-identity.

Method

Through the stratified cluster sampling method, 1,573 junior school students (with an average age of 13.71 ± 0.891 years) were evaluated by the exercise intention scale, the implementation intention scale, the self-identity scale, and the physical exercise grade scale. For data analysis, the common method deviation test, Pearson correlation analysis, and Model 6 in the SPSS macro program compiled by Hayes for the chain mediating test were conducted.

Results

(1) There is a marked correlation between positive exercise intention and exercise behavior (r = 0.345, p < 0.01), and exercise intention has a significant effect on the direct path of exercise behavior (β = 0.162, t = 12.355, p < 0.01). (2) Exercise intention can positively predict implementation intention (β = 0.219, t = 10.006, p < 0.01) and self-identity (β = 0.160, t = 16.159, p < 0.01); implementation intention can significantly and positively predict exercise behavior (β = 0.230, t = 12.742, p < 0.01),and self-identity can significantly and positively predict exercise behavior (β = 0.273, t = 7.911, p < 0.01). (3) Implementation intention and self-identity play a significant mediating role between exercise intention and exercise behavior. The mediating effect consists of three indirect effects: exercise intention → implementation intention → exercise behavior (the mediating effect value is 0.050), exercise intention → self-identity → exercise behavior (the mediating effect value is 0.044), and exercise intention →implementation intention → self-identity → exercise behavior (the mediating effect value is 0.017).

Conclusion

(1) Exercise intention can significantly and positively predict exercise behavior. (2) Implementation intention and self-identity exert a significant mediating effect between exercise intention and exercise behavior, including the separate mediating effect of implementation intention and self-identity, as well as the chain mediating effect of implementation intention and self-identity.

Methods used to assess insight in individuals with eating disorders: a scoping review

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.

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.

Early detection of eating disorders: a scoping review

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.

A Brief Assessment of Body Image Perception: Norm Values and Factorial Structure of the Short Version of the FKB-20

The Body Image Questionnaire-20 (FKB-20) is one of the most applied self-report measures in the context of body image assessment in German-speaking regions. A version of the FKB-20 capturing an ideal concept of body image is also available. A special property of the scale is its high sensitivity for individuals suffering from anorexia nervosa. The present research provided a short version of this scale (for both variants) and examined its validity in a representative sample (N = 2,347) of the German population. We utilized factor analysis methods to identify the optimal short scale of the measure, finding excellent model fit and reliability for a two-factor model (FKB-6) for both real and ideal body image. Both versions of the FKB-6 can be considered invariant across sex and age groups. Good reliability indices were shown for both versions of the FKB-6. The reliability indices were similar to those mentioned in previous studies. Our study also revealed, that large discrepancies between the real and an ideal body image are correlated with somatic and body dysmorphic symptoms. Finally, we provided norm values for comparisons of individual scores with the general population. The FKB-6 is a valid and a reliable measure that economizes assessments by clinicians and researchers.