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Caldiroli A, Affaticati LM, Coloccini S, Manzo F, Scalia A, Capuzzi E, La Tegola D, Colmegna F, Dakanalis A, Signorelli MS, Buoli M, Clerici M. Clinical Factors Associated with Binge-Eating Episodes or Purging Behaviors in Patients Affected by Eating Disorders: A Cross-Sectional Study. J Pers Med 2024; 14:609. [PMID: 38929830 PMCID: PMC11205112 DOI: 10.3390/jpm14060609] [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: 02/19/2024] [Revised: 04/20/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
The aim of the present study was to investigate the potential associations between clinical/socio-demographic variables and the presence of purging/binge-eating episodes in eating disorders (EDs). Clinical/socio-demographic variables and psychometric scores were collected. Groups of patients were identified according to the presence or absence of purging or objective binge-eating episodes (OBEs) and compared through t-test and chi-square tests. Binary logistic regression analyses were run. A sample of 51 ED outpatients was recruited. Patients with purging behaviors had a longer duration of untreated illness (DUI) (t = 1.672; p = 0.019) and smoked a higher number of cigarettes/day (t = 1.061; p = 0.030) compared to their counterparts. A lower BMI was associated with purging (OR = 0.881; p = 0.035), and an older age at onset showed a trend towards statistical significance (OR = 1.153; p = 0.061). Patients with OBEs, compared to their counterparts, were older (t = 0.095; p < 0.001), more frequently presented a diagnosis of bulimia or binge-eating disorder (χ2 = 26.693; p < 0.001), a longer duration of illness (t = 2.162; p = 0.019), a higher number of hospitalizations (t = 1.301; p = 0.012), and more often received a prescription for pharmacological treatment (χ2 = 7.864; OR = 6.000; p = 0.005). A longer duration of the last pharmacological treatment was associated with OBE (OR = 1.569; p = 0.046). In contrast to purging, OBE was associated with a more complicated and severe presentation of ED. A lower BMI and a later age at onset, as well as long-lasting previous pharmacological treatments, may predict the presence of purging/binging. Further research is needed to thoroughly characterize ED features and corroborate our preliminary findings.
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Affiliation(s)
- Alice Caldiroli
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (D.L.T.); (F.C.); (A.D.); (M.C.)
| | - Letizia Maria Affaticati
- Department of Medicine and Surgery, University of Milan Bicocca, via Cadore 38, 20900 Monza, Italy; (L.M.A.); (F.M.); (A.S.)
| | - Sara Coloccini
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (S.C.); (M.S.S.)
| | - Francesca Manzo
- Department of Medicine and Surgery, University of Milan Bicocca, via Cadore 38, 20900 Monza, Italy; (L.M.A.); (F.M.); (A.S.)
| | - Alberto Scalia
- Department of Medicine and Surgery, University of Milan Bicocca, via Cadore 38, 20900 Monza, Italy; (L.M.A.); (F.M.); (A.S.)
| | - Enrico Capuzzi
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (D.L.T.); (F.C.); (A.D.); (M.C.)
| | - Davide La Tegola
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (D.L.T.); (F.C.); (A.D.); (M.C.)
| | - Fabrizia Colmegna
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (D.L.T.); (F.C.); (A.D.); (M.C.)
| | - Antonios Dakanalis
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (D.L.T.); (F.C.); (A.D.); (M.C.)
- Department of Medicine and Surgery, University of Milan Bicocca, via Cadore 38, 20900 Monza, Italy; (L.M.A.); (F.M.); (A.S.)
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, 95123 Catania, Italy; (S.C.); (M.S.S.)
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Massimo Clerici
- Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi 33, 20900 Monza, Italy; (E.C.); (D.L.T.); (F.C.); (A.D.); (M.C.)
- Department of Medicine and Surgery, University of Milan Bicocca, via Cadore 38, 20900 Monza, Italy; (L.M.A.); (F.M.); (A.S.)
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West CE, Hazzard VM, Loth KA, Larson N, Hooper L, Neumark-Sztainer D. The interplay between food insecurity and family factors in relation to disordered eating in adolescence. Appetite 2023; 189:106994. [PMID: 37544329 PMCID: PMC10617248 DOI: 10.1016/j.appet.2023.106994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
This study examined the association between food insecurity and both binge eating and unhealthy weight-control behaviors (UWCBs) and assessed whether such associations differ by factors within the family environment. Data were collected from a diverse sample of adolescents (Mage = 14.5 years; 54.1% female) and their parents/guardians (N = 2137 dyads) participating in EAT 2010 (Eating and Activity over Time). Food-insecure adolescents were more likely to report binge eating (prevalence ratio [PR] = 1.94; 95% confidence interval [CI]: 1.41-2.69) and UWCBs (PR = 1.34; 95% CI: 1.21-1.49) than food-secure adolescents. Family meal importance (p = .03) and family communication (p < .001) significantly moderated the association between food insecurity and UWCBs, such that the association was weaker at lower levels of these factors. Significant interactions with parental weight talk/concern (p < .001) and weight teasing (p = .04) indicated a weaker association between food insecurity and UWCBs in the presence of these factors. Findings indicate that the association between food insecurity and UWCBs among youth is less salient in the absence of family protective factors and in the presence of family risk factors for UWCBs, indicating the importance of targeting food insecurity itself, regardless of the presence of family risk or protective factors for UWCBs.
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Affiliation(s)
- Caroline E West
- Department of Psychological Sciences, Kent State University, Kent, OH, USA.
| | - Vivienne M Hazzard
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nicole Larson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Laura Hooper
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Van Buuren L, Fleming CAK, Hay P, Bussey K, Trompeter N, Lonergan A, Mitchison D. The prevalence and burden of avoidant/restrictive food intake disorder (ARFID) in a general adolescent population. J Eat Disord 2023; 11:104. [PMID: 37386518 PMCID: PMC10311698 DOI: 10.1186/s40337-023-00831-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/17/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Little is known about the prevalence and impairment associated with possible Avoidant/restrictive food intake disorder (ARFID) in community adolescent populations. We aimed to investigate the prevalence, health-related quality of life (HRQoL), and psychological distress associated with possible ARFID in a sample of adolescents from the general population in New South Wales, Australia. METHODS A representative sample of 5072 secondary school students aged between 11 and 19 years completed the online EveryBODY survey in 2017. The survey included demographic data, eating behaviours, psychological distress and both physical and psychosocial health-related quality of life. RESULTS The prevalence of possible ARFID was 1.98% (95% CI 1.63-2.41) and did not differ significantly across school years 7-12. The weight status of participants with possible ARFID did not differ significantly from those without possible ARFID. When measuring gender identity, the ratio of males to females with possible ARFID was 1:1.7. This was statistically significant, however, the effect size was very small. Psychological distress and HRQoL did not differ significantly between the possible ARFID and non-ARFID group. CONCLUSIONS The prevalence of possible ARFID was found to be similar to that of anorexia nervosa and binge eating disorder in the general adolescent population. Adolescents who identify as girls rather than boys may be more likely to develop ARFID, replication with new samples is required to confirm these findings. The impact of ARFID on HRQoL may be minimal in adolescence and become more significant in adulthood, further research using longitudinal design, healthy control groups and/or diagnostic interviews is required.
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Affiliation(s)
- Lara Van Buuren
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Catharine Anne Kerle Fleming
- School of Health Sciences, Western Sydney University, Sydney, Australia.
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Kay Bussey
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Nora Trompeter
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
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McClelland J, Robinson L, Potterton R, Mountford V, Schmidt U. Symptom trajectories into eating disorders: A systematic review of longitudinal, nonclinical studies in children/adolescents. Eur Psychiatry 2020; 63:e60. [PMID: 32450945 PMCID: PMC7355161 DOI: 10.1192/j.eurpsy.2020.55] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background. Eating disorders (EDs) are serious mental illnesses that can be life-threatening. Stage of illness models and early intervention strategies could be informed by a better understanding of symptomatology that precedes the onset of an ED. This review aims to explore which symptoms (both ED and other psychiatric disorder-related) exist prior to the onset of an ED and whether there any prospective associations between these symptomatologies. Methods. A systematic literature review was conducted in MEDLINE, Embase, and PsycINFO for large, longitudinal, prospective studies in nonclinical cohorts of children/adolescents that report symptoms prior to the onset of an ED. A quality assessment of included studies was conducted using the Newcastle-Ottawa Quality Assessment Scale. Results. A total of 22 studies were included, and over half were assessed to be of good quality. Studies identified the presence of a broad range of ED and other psychiatric disorder-related symptoms prior to ED onset. Possible prospective associations were identified, including early eating and feeding difficulties in childhood, to ED-related symptoms (e.g., dieting and body dissatisfaction) and other psychiatric disorder-related symptoms (e.g., anxiety and depression) in childhood/early adolescence, progressing to severe symptomatology (e.g., extreme weight control behaviors and self-harm) in mid-adolescence/emerging adulthood. Conclusion. The trajectory of symptoms identified to precede and possibly predict onset of an ED may inform early intervention strategies within the community. Suggestions for further research are provided to establish these findings and the clinical implications of these discussed, in order to inform how best to target prodromal stages of EDs.
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Affiliation(s)
- Jessica McClelland
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lauren Robinson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rachel Potterton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Victoria Mountford
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Maudsley Health, Abu Dhabi, United Arab Emirates
| | - Ulrike Schmidt
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Ralph-Nearman C, Achee M, Lapidus R, Stewart JL, Filik R. A systematic and methodological review of attentional biases in eating disorders: Food, body, and perfectionism. Brain Behav 2019; 9:e01458. [PMID: 31696674 PMCID: PMC6908865 DOI: 10.1002/brb3.1458] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/05/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The current systematic and methodological review aimed to critically review existing literature utilizing implicit processing, or automatic approach- and/or avoidance-related attentional biases between eating disorder (ED) and nonclinical samples, which (a) highlights how psychophysiological methods advance knowledge of ED implicit bias; (b) explains how findings fit into transdiagnostic versus disorder-specific ED frameworks; and (c) suggests how research can address perfectionism-related ED biases. METHOD Three databases were systematically searched to identify studies: PubMed, Scopus, and PsychInfo electronic databases. Peer-reviewed studies of 18- to 39-year-olds with both clinical ED and healthy samples assessing visual attentional biases using pictorial and/or linguistic stimuli related to food, body, and/or perfectionism were included. RESULTS Forty-six studies were included. While behavioral results were often similar across ED diagnoses, studies incorporating psychophysiological measures often revealed disease-specific attentional biases. Specifically, women with bulimia nervosa (BN) tend to approach food and other body types, whereas women with anorexia nervosa (AN) tend to avoid food as well as overweight bodies. CONCLUSIONS Further integration of psychophysiological and behavioral methods may identify subtle processing variations in ED, which may guide prevention strategies and interventions, and provide important clinical implications. Few implicit bias studies include male participants, investigate binge-eating disorder, or evaluate perfectionism-relevant stimuli, despite the fact that perfectionism is implicated in models of ED.
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Affiliation(s)
- Christina Ralph-Nearman
- Laureate Institute for Brain Research, Tulsa, OK, USA.,School of Psychology, University of Nottingham, Nottingham, UK
| | - Margaret Achee
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | | | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, USA.,Department of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Ruth Filik
- School of Psychology, University of Nottingham, Nottingham, UK
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6
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Fergus KB, Copp HL, Tabler JL, Nagata JM. Eating disorders and disordered eating behaviors among women: Associations with sexual risk. Int J Eat Disord 2019; 52:1310-1315. [PMID: 31267548 PMCID: PMC9714254 DOI: 10.1002/eat.23132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the association between eating disorders or disordered eating behaviors and sexual risk in young women. METHOD We used prospective cohort data of young women ages 18-26 years from the National Longitudinal Study of Adolescent to Adult Health (N = 5,899). Exposures of interest (at 18-26 years) included a self-reported eating disorder diagnosis or disordered eating behaviors including fasting/skipping meals, vomiting, diet pills, or laxative/diuretic use to lose weight and binge eating. Sexual risk outcomes at 7-year follow-up included the number of new sexual partners, condom use, and sexually transmitted infections. RESULTS Having either an eating disorder or reporting any disordered eating behavior was associated with a greater number of new sexual partners (B = 1.09, 95% CI [0.18, 2.00]) and lower odds of condom use (odds ratio 0.70, 95% CI [0.53, 0.94] among a subsample of sexually active, unmarried women). DISCUSSION Young women with eating disorders or who engage in disordered eating behaviors are at higher risk for multiple new sexual partners and unprotected sex. Clinicians caring for young adults with eating disorders may consider screening for sexual risk behaviors.
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Affiliation(s)
- Kirkpatrick B. Fergus
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Hillary L. Copp
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Jennifer L. Tabler
- Department of Criminal Justice and Sociology, University of Wyoming, Laramie, Wyoming
| | - Jason M. Nagata
- Department of Pediatrics, University of California-San Francisco, San Francisco, CA
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Jankauskiene R, Baceviciene M, Pajaujiene S, Badau D. Are Adolescent Body Image Concerns Associated with Health-Compromising Physical Activity Behaviours? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071225. [PMID: 30959823 PMCID: PMC6480370 DOI: 10.3390/ijerph16071225] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/18/2019] [Accepted: 04/03/2019] [Indexed: 12/13/2022]
Abstract
The present study aimed to assess the-prevalence of health-compromising eating and physical activity behaviours, and to test their associations with physical activity, internalisation of sociocultural attitudes towards appearance, and body image in a sample of adolescents of both genders. A total sample of 736 adolescents (437 or 59.4% were girls) participated in the study. The participants ranged in age from 16 to 19 years (x = 17.2, SD = 0.6). The sample completed a questionnaire measuring body mass index, the risk of eating disorders, body image, internalisation of sociocultural ideals of appearance, health-compromising eating behaviours (HCEB), and health-compromising weight control related to physical activity behaviours (HCPAB). Logistic regressions were used to assess the associations between the study variables and predictors of HCEB and HCPAB. The results of the study showed a relatively high prevalence of HCEB with a significantly higher prevalence in girls and participants with a higher BMI. The study also demonstrated that the prevalence of adolescent HCPAB was higher than HCEB. The internalisation of sociocultural attitudes towards appearance and body image concerns were higher in the HCEB and HCPAB groups. Female gender (OR = 1.88; 95% PI = 1.10–3.18), HCPAB (OR = 1.19; 95% PI = 1.10–1.28), a preoccupation with being overweight (OR = 3.43; 95% PI = 2.52–4.66), and body weight evaluation as too high (OR = 2.40; 95% PI = 1.57–3.68) were significant predictors of HCEB. More frequent physical activity (OR = 3.02; 95% PI = 1.76–5.17), HCEB (OR = 1.22; 95% PI = 1.11–1.32), and perceived pressures to conform to popular beauty ideals (OR = 1.51; 95% PI = 1.12–2.03) predicted higher HCPAB. HCPAB is an important variable associated with adolescents’ body image, physical activity, and weight control. The results of the present study are important for health promotion and education programs addressing adolescents’ healthy lifestyle, weight control, and body image concerns.
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Affiliation(s)
- Rasa Jankauskiene
- Institute of Sport Science and Innovation, Lithuanian Sports University, Sporto 6, 44221 Kaunas, Lithuania.
| | - Migle Baceviciene
- Department of Health, Physical and Social Education, Lithuanian Sports University, Sporto 6, 44221 Kaunas, Lithuania.
| | - Simona Pajaujiene
- Department of Coaching Science, Lithuanian Sports University, Sporto 6, 44221 Kaunas, Lithuania.
| | - Dana Badau
- Department of Human Movement Sciences, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540139 Targu Mures, Romania.
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Silva SUD, Barufaldi LA, Andrade SSCDA, Santos MAS, Claro RM. Nutritional status, body image, and their association with extreme weight control behaviors among Brazilian adolescents, National Adolescent Student Health Survey 2015. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180011. [PMID: 30517462 DOI: 10.1590/1980-549720180011.supl.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/08/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION This study aimed to analyze the association between nutritional status, body image perception, and extreme weight control behaviors among adolescents. METHODS This is an analytical cross-sectional study conducted in Brazil based on the National Adolescent Student Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE) of 2015, with adolescents aged 13 to 17 years. Nutritional status and body image perception were the independent variables. The two dependent variables were vomiting or laxative use and use of medicines and other formulas for weight control in the 30 days prior to data collection. We used Poisson regression models for association, with demographic variables for control. RESULTS 7.4% of adolescents (95%CI 6.7 - 8.2) reported vomiting or using laxatives, with no difference between genders. The prevalence of use of medicines and formulas was higher among boys (7.8%; 95%CI 6.6 - 8.9). The association between nutritional status and extreme behaviors was not significant. However, the prevalence of vomiting or laxative use for adolescents who considered themselves very fat was 2.3 (95%CI 1.1 - 4.7) times higher for boys and 5.3 (95%CI 3.3 - 8.6) times higher for girls, while the use of medicines and formulas was 4.0 (95%CI 2.3 - 7.1) times higher for girls who considered themselves very fat. CONCLUSION Body image perception seems to have a greater influence on extreme behaviors than nutritional status. Strategies involving health services and schools have great potential to impact the self-esteem and health of students positively.
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Affiliation(s)
- Simoni Urbano da Silva
- Departamento de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Laura Augusta Barufaldi
- Divisão de Pesquisa Populacional, Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) - Rio de Janeiro (RJ), Brasil
| | | | - Maria Aline Siqueira Santos
- Departamento de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Rafael Moreira Claro
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
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Fogarty S, Elmir R, Hay P, Schmied V. The experience of women with an eating disorder in the perinatal period: a meta-ethnographic study. BMC Pregnancy Childbirth 2018; 18:121. [PMID: 29720107 PMCID: PMC5932857 DOI: 10.1186/s12884-018-1762-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy is a time of enormous body transformation. For those with an eating disorder during pregnancy this time of transformation can be distressing and damaging to both the mother and the child. In this meta-ethnographic study, we aimed to examine the experiences of women with an Eating Disorder in the perinatal period; that is during pregnancy and two years following birth. METHOD A meta-ethnographic framework was used in this review. After a systematic online search of the literature using the keywords such as pregnancy, eating disorders, anorexia, bulimia, binge eating disorder, perinatal, postnatal and post-partum, 11 papers, involving 94 women, were included in the review. RESULTS A qualitative synthesis of the papers identified 2 key themes. The key theme that emerged during pregnancy was: navigating a 'new' eating disorder. The key that emerged in the perinatal period was return to the 'old' eating disorder. CONCLUSION Following a tumultuous pregnancy experience, many described returning to their pre-pregnancy eating behaviors and thoughts. These experiences highlight the emotional difficulty experienced having an eating disorder whilst pregnant but they also point to opportunities for intervention and a continued acceptance of body image changes. More research is needed on the experiences of targeted treatment interventions specific for pregnant and postpartum women with an eating disorder and the effectiveness of putative treatment interventions during this period.
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Affiliation(s)
- Sarah Fogarty
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Rakime Elmir
- Affiliate Ingham Institute for Applied Medical Research, Centre for Applied Nursing Research (CANR), Liverpool, NSW 2170 Australia
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Phillipa Hay
- School of Medicine and Centre for Health Research, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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10
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Haynes A, Kersbergen I, Sutin A, Daly M, Robinson E. A systematic review of the relationship between weight status perceptions and weight loss attempts, strategies, behaviours and outcomes. Obes Rev 2018; 19:347-363. [PMID: 29266851 PMCID: PMC5814847 DOI: 10.1111/obr.12634] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 01/25/2023]
Abstract
It is commonly assumed that a person identifying that they are 'overweight' is an important prerequisite to successful weight management. However, there has been no systematic evaluation of evidence supporting this proposition. The aim of the present research was to systematically review evidence on the relationship between perceived overweight and (i) weight loss attempts, (ii) weight control strategies (healthy and unhealthy), (iii) weight-related behaviours (physical activity and eating habits), (iv) disordered eating and (v) weight change. We synthesized evidence from 78 eligible studies and evaluated evidence linking perceived overweight with outcome variables separately according to the gender, age and objective weight status of study participants. Results indicated that perceived overweight was associated with an increased likelihood of attempting weight loss and with healthy and unhealthy weight control strategies in some participant groups. However, perceived overweight was not reliably associated with physical activity or healthy eating and was associated with greater disordered eating in some groups. Rather than being associated with improved weight management, there was consistent evidence that perceived overweight was predictive of increased weight gain over time. Individuals who perceive their weight status as overweight are more likely to report attempting weight loss but over time gain more weight.
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Affiliation(s)
- A Haynes
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - I Kersbergen
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - A Sutin
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - M Daly
- Behavioural Science Centre, Stirling Management School, University of Stirling, Stirling, UK.,UCD Geary Institute, University College Dublin, Dublin, Ireland
| | - E Robinson
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Minnick AM, Cachelin FM, Durvasula R. Personality Disorders and Psychological Functioning Among Latina Women with Eating Disorders. Behav Med 2017; 43:200-207. [PMID: 28767016 PMCID: PMC6105924 DOI: 10.1080/08964289.2016.1276429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little is known about personality disorders (PD) and comorbidities among Latinas with eating disorders (ED). The dysregulation and chronicity of PDs can complicate and augment the symptomatology of EDs. This set of analyses provides a preliminary examination of PD and psychopathology in a sample of Latina women with ED. Participants (N = 34) were administered the Structured Clinical Interview for the Diagnostic and Statistical Manual, Eating Disorders Examination, and Millon Clinical Multiaxial Inventory-III to assess personality pathology, and questionnaires (Beck Depression Inventory-II and Brief Symptom Inventory) to assess psychological functioning. Results indicated the most common clinically significant trait in the sample was depressive personality (50% of the sample had a score of 75 or higher on this trait). For Bulimia Nervosa (BN) and Binge Eating Disorder (BED), avoidant (41%) and depressive (65%) personalities, respectively, were the most common clinically significant traits. Anxiety disorders were the most common psychiatric diagnoses, and 52.9% of the sample reported both clinically significant PD traits and other major psychopathology. There were no significant differences between the BED and BN groups on prevalence of PD traits and psychopathology. This pilot study highlights the need for further examination of PD and psychopathology in Latinas with ED. Unlike previous research with White women, we found no differences on PD and psychopathology between BED and BN, and the most prevalent PDs among Latinas were different than White women. Personality and psychological functioning should be assessed in all patients with ED, with ongoing research focused on identifying patterns in understudied groups such as Latinas, a practice that may improve treatment for this underserved population.
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Affiliation(s)
- Alyssa M. Minnick
- University of North Carolina at Charlotte, Health Psychology Ph.D. Program
| | - Fary M. Cachelin
- University of North Carolina at Charlotte, Health Psychology Ph.D. Program
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van Passel B, Danner U, Dingemans A, van Furth E, Sternheim L, van Elburg A, van Minnen A, van den Hout M, Hendriks GJ, Cath D. Cognitive remediation therapy (CRT) as a treatment enhancer of eating disorders and obsessive compulsive disorders: study protocol for a randomized controlled trial. BMC Psychiatry 2016; 16:393. [PMID: 27832747 PMCID: PMC5105298 DOI: 10.1186/s12888-016-1109-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) and Obsessive Compulsive Disorder (OCD) are among the most incapacitating and costly of mental disorders. Cognitive Behaviour Therapy (CBT), medication, and combination regimens, to which in AN personalised guidance on weight control is added, are moderately successful, leaving room for more effective treatment algorithms. An underlying deficit which the two disorders share is cognitive inflexibility, a trait that is likely to impede treatment engagement and reduce patients' ability to benefit from treatment. Cognitive remediation therapy (CRT) is an easy-to-use intervention aimed at reducing cognitive inflexibility and thereby enhancing treatment outcome, which we aim to test in a controled study. METHODS In a randomized-controlled multicenter clinical trial 64 adult patients with AN and 64 with OCD are randomized to 10 bi-weekly sessions with either CRT or a control condition, after which Treatment As Usual (TAU) is started. All patients are evaluated during single-blind assessments at baseline, post-CRT/control intervention, and after 6 months. Indices of treatment effect are disorder-specific symptom severity, quality of life, and cost-effectivity. Also, moderators and mediators of treatment effects will be studied. DISCUSSION To our knowledge, this is the first randomized controlled trial using an control condition evaluating the efficacy and effectiveness of CRT as a treatment enhancer preceding TAU for AN, and the first study to investigate CRT in OCD, moreover taking cost-effectiveness of CRT in AN and OCD into account. TRIAL REGISTRATION The Netherlands Trial Register NTR3865 . Registered 20 february 2013.
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Affiliation(s)
- Boris van Passel
- Pro Persona, Centre for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care, Pastoor van Laakstraat 48, Lent, Nijmegen, 6663 CB The Netherlands
- Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR The Netherlands
| | - Unna Danner
- Altrecht Eating Disorders Rintveld, Oude Arnhemseweg 260, Zeist, 3705 BK The Netherlands
| | - Alexandra Dingemans
- Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, Leiden, 2333 ZZ The Netherlands
| | - Eric van Furth
- Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, Leiden, 2333 ZZ The Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Einthovenweg 20, Leiden, 2333 ZC The Netherlands
| | - Lot Sternheim
- Altrecht Eating Disorders Rintveld, Oude Arnhemseweg 260, Zeist, 3705 BK The Netherlands
- Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS The Netherlands
| | - Annemarie van Elburg
- Altrecht Eating Disorders Rintveld, Oude Arnhemseweg 260, Zeist, 3705 BK The Netherlands
- Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS The Netherlands
| | - Agnes van Minnen
- Pro Persona, Centre for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care, Pastoor van Laakstraat 48, Lent, Nijmegen, 6663 CB The Netherlands
- Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR The Netherlands
| | - Marcel van den Hout
- Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS The Netherlands
| | - Gert-Jan Hendriks
- Pro Persona, Centre for Anxiety Disorders Overwaal, Institution for Integrated Mental Health Care, Pastoor van Laakstraat 48, Lent, Nijmegen, 6663 CB The Netherlands
- Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR The Netherlands
| | - Daniëlle Cath
- Altrecht Academic Anxiety Centre, Nieuwe Houtenseweg 12, Utrecht, 3524 SH The Netherlands
- Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS The Netherlands
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Sonneville KR, Thurston IB, Milliren CE, Gooding HC, Richmond TK. Weight misperception among young adults with overweight/obesity associated with disordered eating behaviors. Int J Eat Disord 2016; 49:937-946. [PMID: 27218865 PMCID: PMC5064910 DOI: 10.1002/eat.22565] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the cross-sectional association between weight misperception among young adults with overweight/obesity and disordered eating behaviors. METHOD In a subsample of young adults with overweight or obesity participating in Wave III (2001-2002) of The National Longitudinal Study of Adolescent to Adult Health (n = 5,184), we examined the cross-sectional association between weight under-perception (i.e., perceiving oneself to be at a healthy body weight or underweight) and disordered eating (fasting/meal skipping for weight control, purging/pills for weight control, overeating/loss of control eating, and use of performance-enhancing products/substances). RESULTS About 20% of young adult females under-perceived their weight compared to 48% of males. Individuals who misperceived their weight as healthy were significantly less likely to report fasting/meal skipping (Females: OR: 0.25, 95% CI: 0.14-0.43; Males: OR: 0.31, 95% CI: 0.20-0.48) and vomiting or taking diet pills/laxatives/diuretics (Females: OR: 0.10, 95% CI: 0.04-0.25; Males: OR: 0.10, 95% CI: 0.04-0.25) for weight control. Among females, those who misperceived their weight status as healthy were also less likely to report overeating or loss of control eating (OR: 0.41, 95% CI: 0.24-0.71). Greater use of performance-enhancing products/substances was seen among males who under-perceived their weight as healthy (OR: 2.06, 95% CI: 1.57-2.72) and among both females (OR: 2.29, 95% CI: 1.40-20.0) and males (OR: 2.27, 95% CI: 1.13-4.55) who perceived themselves to be underweight. DISCUSSION Weight under-perception among young adults with overweight/obesity may convey some benefit related to disordered eating behaviors, but could be a risk factor for the use of performance-enhancing products/substances. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord ; 49:937-946).
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Affiliation(s)
- Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Michigan.
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Idia B Thurston
- Department of Psychology, University of Memphis, Memphis, Tennessee
| | - Carly E Milliren
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Holly C Gooding
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tracy K Richmond
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Gordon AR, Austin SB, Krieger N, White Hughto JM, Reisner SL. "I have to constantly prove to myself, to people, that I fit the bill": Perspectives on weight and shape control behaviors among low-income, ethnically diverse young transgender women. Soc Sci Med 2016; 165:141-149. [PMID: 27518756 PMCID: PMC5241136 DOI: 10.1016/j.socscimed.2016.07.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022]
Abstract
The impact of societal femininity ideals on disordered eating behaviors in non-transgender women has been well described, but scant research has explored these processes among transgender women. The present study explored weight and shape control behaviors among low-income, ethnically diverse young transgender women at high risk for HIV or living with HIV in a Northeastern metropolitan area. Semi-structured in-depth interviews were conducted with 21 participants (ages 18-31 years; mean annual income <$10,000; ethnic identity: Multiracial [n = 8], Black [n = 4], Latina [n = 4], White [n = 4], Asian [n = 1]). Interviews were transcribed and double-coded using a template organizing method, guided by ecosocial theory and a gender affirmation framework. Of 21 participants, 16 reported engaging in past-year disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use. Study participants described using a variety of strategies to address body image concerns in the context of gender-related and other discriminatory experiences, which shaped participants' access to social and material resources as well as stress and coping behaviors. Disordered weight and shape control behaviors were discussed in relation to four emergent themes: (1) gender socialization and the development of femininity ideals, (2) experiences of stigma and discrimination, (3) biological processes, and (4) multi-level sources of strength and resilience. This formative study provides insight into disordered eating and weight and shape control behaviors among at-risk transgender women, illuminating avenues for future research, treatment, and public health intervention.
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Affiliation(s)
- Allegra R Gordon
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Nancy Krieger
- Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jaclyn M White Hughto
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Punzi EH. Excessive behaviors in clinical practice--A state of the art article. Int J Qual Stud Health Well-being 2016; 11:30055. [PMID: 26880343 PMCID: PMC4754017 DOI: 10.3402/qhw.v11.30055] [Citation(s) in RCA: 4] [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] [Accepted: 12/04/2015] [Indexed: 11/17/2022] Open
Abstract
This paper concerns difficulties with excessive food intake, sexual activities, romantic relationships, gambling, Internet use, shopping, and exercise—behaviors that might cause considerable suffering. Excessive behaviors are seen as expressions of underlying difficulties that often co-occur with other psychological difficulties, and behaviors may accompany or replace each other. Moreover, they might pass unnoticed in clinical practice. Given the complexity of excessive behaviors, integrated and individualized treatment has been recommended. This paper presents an overview of the terminology concerning excessive behaviors, and the impact of naming is acknowledged. Thereafter, methods for identification and assessment, as well as treatment needs are discussed. Because identification, assessment, and treatment occur in an interaction between client and practitioner, this paper presents a discussion of the need to empower practitioners to identify and assess excessive behaviors and provide an integrated treatment. Moreover, the need to support practitioners’ capacity to handle and tolerate the overwhelming suffering and the negative consequences connected to excessive behaviors is discussed. Qualitative studies are suggested in order to understand the meaning of excessive behaviors, treatment needs, and the interaction between client and practitioner.
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Affiliation(s)
- Elisabeth H Punzi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden;
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de Souza Cavalcanti AMT, de Arruda IKG, Moreno de Lima EAC, Neto WB, Meirelles Monteiro EML, de Lima LS, da Silva Diniz A. Characterization of eating behavior disorders in school-aged children and adolescents: a population-based study. Int J Adolesc Med Health 2016; 29:/j/ijamh.2017.29.issue-3/ijamh-2015-0087/ijamh-2015-0087.xml. [PMID: 26812858 DOI: 10.1515/ijamh-2015-0087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/19/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Cross-sectional study to assess the characteristics of the risk behaviors for eating disorders (EDs) in school children between 10 and 14 years of age in the city of Recife, Pernambuco, Brazil. METHODS 1405 school-aged children were assessed, using the Eating Behaviours and Body Image Test (EBBIT) to screen for EDs. The normality of the continuing variables was tested using the Kolmogorov-Smirnov test with Lilliefors correction. They were described as medians and interquartile intervals (25 and 75th percentiles). RESULTS The criteria that represented a condition of anorexia and/or bulimia nervosa were considered as strong indicators of risk for EDs in school-aged children who indicated the following behaviors with scores superior to the 75th percentile on the scales: "compulsive eating" 3.0% (CI95% 2.2-4.0); "dissatisfaction with body image/restrictive eating" 1.3% (CI95% 0.8-2.0); children scoring superior to the 30th percentile, "compulsive eating" + "dissatisfaction with body image/restrictive eating", 0.6% (CI95% 0.3-1.2); and superior to the 50th percentile; "compensatory behavior for hyperphagia" 6.7% (CI95% 5.4-8.1). In addition, greater vulnerability of the female gender was perceived, as well as an increase in the preliminary risk factors of EDs, such as advanced age, dissatisfaction with the body image linked to restrictive behaviors and the compulsive establishment of an eating pattern. CONCLUSION This study shows the dimension of the problem in this ecological context and the urgent need for intervention programs, developed among different sectors, from the perspective of the adolescents' empowerment to prevent and minimize the vulnerability factors of the eating disorders.
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Thomas M, Lovell A. Anxiety and compulsion patterns in the maintenance of bingeing/purging behaviours by individuals with bulimia nervosa. J Psychiatr Ment Health Nurs 2015; 22:20-9. [PMID: 25214066 DOI: 10.1111/jpm.12167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 11/28/2022]
Abstract
Bulimia nervosa, if not treated or if treated unsuccessfully, can develop into a severe and enduring eating disorder. Analysis of self-management of Seed-BN indicates that individuals frequently experience significant negative mental health issues and a complex relationship with medication management. Two discrete patterns of coping strategies to prevent deterioration in distressing symptoms were in evidence, controlled vomiting, which was related to the management of anxiety, and uncontrolled vomiting due to more dominant self-management of compulsive acts. The implications for nursing revolve around accurate assessment of vomiting and subsequent engagement by the individual with their coping strategies in relation to perceived deterioration in distressing symptoms. This paper reports on the results of a study into the self-reported coping strategies employed by a small sample (n = 12) of individuals diagnosed with bulimia nervosa purging sub-type, severe and enduring eating disorder (Seed-BN), referred to an outpatient clinic for psychotherapy. Data collection focused on the vomiting activities of participants through analysis of their self-management from diary extracts, which recorded vomiting patterns. Participants all experienced significant mental health issues, had complex histories of BN over a prolonged period, difficulties maintaining relationships, and many had an additional history of substance misuse including dependence on prescription drugs. The study findings indicated two different self-management strategies, anxiety containment and compulsion maintenance. There was a clear association between anxiety and controlled weekly vomiting patterns compared with compulsion and daily vomiting patterns. The implications for nursing practice relate to the potential for assessment of differences in vomiting patterns to indicate self-management status and subsequent interventions focusing on either anxiety or compulsive patterns.
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Affiliation(s)
- M Thomas
- Department of Mental Health & Learning Disabilities, Faculty of Health & Social Care, University of Chester, Chester, UK
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