Validation of the Arabic version of the binge eating scale and correlates of binge eating disorder among a sample of the Lebanese population

Systematic review of the epidemiology of eating disorders in the Arab world

PURPOSE OF REVIEW

The Arab world is dealing with modernization and sociocultural changes both associated with eating disorders. The present review provides an update of 'Eating disorders in the Arab world: a literature review', which was published in 2020.

RECENT FINDINGS

There are 22 recent epidemiological studies on eating disorders in five different countries in the Arab world. A large-scale national mental health survey reported a 12-month eating disorder prevalence of 3.2% and an eating disorder lifetime prevalence of 6.1%. Binge-eating disorder was the most common eating disorder (12-month prevalence = 2.1%, lifetime prevalence = 2.6%), 1.6% was at high risk for binge-eating disorder. Overall, between 23.8 and 34.8% was at high risk for any eating disorder. Body-shape dissatisfaction, a high BMI and separated/widowed/single marital status were associated with eating disorder pathology.

SUMMARY

Although there is still a lack of studies compared to the western world, the number of epidemiological studies on eating disorders in the Arab world is growing and there is an increase in studies using appropriate assessment-tools and norms. It is recommended to offer specialized treatment and to implement preventive programs.

Association of Social Media Use Disorder and Orthorexia Nervosa Among Lebanese University Students: The Indirect Effect of Loneliness and Factor Structure of the Social Media Use Disorder Short Form and the Jong-Gierveld Loneliness Scales

The current study aims to examine the relationship between Social Media Use Disorder (SMUD) and Orthorexia Nervosa (ON), and evaluate the indirect effect of loneliness in this association. This cross-sectional study was carried out between July and September 2021. A total of 363 university students were recruited through convenience sampling through several universities in Lebanon's governorates. Data about information about the social media applications mostly used (Instagram, Facebook, Twitter, etc.), the number of times of entry to social media applications, the time spent on these applications, ON, loneliness and SMUD, were also collected. The Mplus v.7.2 software was used to estimate categorical confirmatory factor analyses (CFA) of the SMD and loneliness scales. The one-factorial model of the SMD scale fitted well according to χ2/df (69.71/27 = 2.58), TLI (.967), CFI (.956), and RMSEA values (.066; CI [.047-.085]; pclose = .079). The one-factorial model of the loneliness scale fitted well according to χ2/df (10.30/5 = 2.06) TLI (=0.97), CFI (=0.98), and RMSEA values (=0.054; CI [0.000-0.101]; pclose = 0.379). When entering the social media applications and time spent on these applications as independent variables in a first regression model, using Instagram (Beta = 2.73), using Tumblr (Beta = 3.22), spending 30-60 minutes per day on social media apps compared to less than 30 minutes (Beta = 2.33), higher physical activity index (Beta = 0.04) and loneliness (Beta = 0.67) were significantly associated with more ON. When entering the SMUD score as an independent variable in a second regression model, the results showed that higher SMUD (Beta = 0.50) was significantly associated with more ON. Also, loneliness played a partial indirect role in the association between SMUD and ON (by 16%). The current results can help mental health professionals better detect these potential psychological disorders and might help improve future treatment of issues related to ON and SMUD.

Validation and Psychometric Properties of the Chinese Version of the Binge Eating Scale in Young Adults

Background

Although structured clinical interviews are considered the gold standard for assessing binge eating disorder (BED), the self-administered Binge Eating Scale (BES) has been widely used as a screening tool for BED in clinical research. However, the psychometric properties of the BES among Chinese young adults remain unclear. This study aimed to examine the validity of a Chinese version of the BES with a large sample.

Methods

A total of 2182 young adult college students were tested using the Simplified Chinese version of BES (SCBES), the 7-Item Binge-Eating Disorder Screener (BEDS-7), the Zung Self-Rating Depression Scale (SDS), the Generalized Anxiety Disorder Scale (GAD-7), and the Dual-Modes of Self-Control Scale (DMSC). The frequency of objective binge-eating episodes was used as a measure of severity. Validity and reliability of the SCBES were assessed through multiple analyses, along with the item analysis.

Results

The data revealed that the SCBES demonstrated reasonable reliability and validity. The Cronbach's α value was 0.813, with a one-month test-retest reliability of 0.835. The exploratory factor analysis (EFA) extracted three first-order factors, which explained a total of 53.82% of the variance. The confirmatory factor analysis (CFA) confirmed the three-factor model (ie, Binge-eating behaviors, Lack of control, Negative affects related to overeating), with a good model fit. The SCBES also demonstrated excellent concurrent and criterion validity, significantly correlating with the BEDS-7 and frequency of objective binge-eating episodes (r=0.760-0.782, p<0.001). Gender, body mass index, depression, anxiety, impulsivity, and self-control were significantly associated with the total score of SCBES.

Conclusion

The SCBES demonstrated sound psychometric properties and exhibited good cross-cultural adaptability in Chinese young adults, with a novel three-factor model fitting the data best. This scale could serve as a useful screening tool for identifying the severity of binge eating behaviors among Chinese youths.

Depressive symptoms among a sample of Lebanese adolescents: Scale validation and correlates with disordered eating

BACKGROUND

Adolescence is a transitional phase that brings many psychological and physiological challenges that increase emotional vulnerability and threaten the adolescent's mental well-being. Indeed, mental illnesses, such as depression and eating disorders, show an alarming increase in prevalence after puberty. Adolescent depression is particularly concerning owing to the fact that it is a principal cause of disability among adolescents, an important risk factor for suicidality, and is associated with higher risks of present and subsequent morbidity. Our study aimed at (1) examining the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) and (2) evaluating the correlation between depression, eating disorders, stress, and other variables in a sample of Lebanese adolescents.

METHODS

This cross-sectional research enlisted 555 Lebanese teenagers (15-18 years) from all Lebanese governorates (May-June 2020). The confirmatory factor analysis of the PHQ-9 scale items was carried out using the SPSS AMOS program v.24. The relative chi-square, the root mean square error of approximation (RMSEA), Tucker Lewis Index (TLI) and the comparative fit index (CFI) were all utilized as goodness-of-fit indexes.

RESULTS

The median age of the participants was 16.66 ± 1.00 years, with 75.7% females. Among these 555 adolescents, 62.9% had mild-to-moderate depression and 14% reported moderately severe-to-severe depression, while only 23.1% were classified as not suffering from depression. Confirmatory factor analysis of the PHQ-9 scale was conducted using the one-factor structure that is described in the literature; the fit indices obtained were acceptable as follows: χ²/df= 136.26/27 =5.05, CFI=0.92, TLI=0.90 and RMSEA=0.085 [0.072-0.100]. However, the modification indices between items 6 and 9 were high; after correlating these two items, the fit indices improved more as follows: χ²/df= 105.59/26=4.06, CFI=0.94, TLI=0.92 and RMSEA=0.074 [0.060-0.089]. The multivariable analysis results showed that more stress (β=0.59), female sex (β=1.54), and more binge eating (β=0.16) were significantly associated with more depression.

CONCLUSION

This study supports the validity of the PHQ-9, which presents as a reliable tool for the evaluation of depression in future epidemiological studies of Lebanese adolescents. It also elucidates the high level of depression among this age group and its correlation with modifiable and unmodifiable factors.

The association between mental health and Bulimia Nervosa among a sample of Lebanese young adults: the indirect effect of difficulties in emotion regulation

BACKGROUND

Bulimia nervosa (BN) is defined as repeated episodes of binge eating, followed by compensatory behaviors such as self-induced vomiting. BN has been shown to be associated with many co-morbidities including depression and anxiety. BN has also been associated with stress, which was shown to trigger binge eating episodes in BN. Furthermore, difficulties in emotion regulation have been seen to play an important role in the psychopathology of eating disorders, including BN. Seeing that BN is the most prevalent eating disorder in Lebanon, which is linked to the stressful events the country has been through, the study aims to examine the indirect effect of emotional dysregulation on this relationship between mental health issues (stress, anxiety and depression) and bulimia nervosa among young adults. We hypothesize that difficulties in emotion regulation would have an indirect effect in the relationship between mental health and BN.

METHODS

This was a cross-sectional observational study, based on an online anonymous survey, which was carried out between September and December of 2020. Participants were all 18 years and above, recruited from all Lebanese governorates (n = 1175).

RESULTS

Difficulties in emotion regulation mediated the association between anxiety/stress/depression and bulimia. Higher mental health issues were significantly associated with more difficulties in emotion regulation; higher difficulties in emotion regulation were significantly associated with more bulimia. Finally, higher anxiety and higher stress, but not depression, were significantly and directly associated with higher bulimia.

CONCLUSION

Results of this study could be used by mental health professional to shed light on the difficulties in emotion regulation in patients with BN and try to use therapeutic strategies to help them better regulate their emotions.

The mediating effect of body appreciation between muscle dysmorphia and bulimia nervosa among Lebanese adolescents

BACKGROUND

Muscle dysmorphia (MD) is a common psychological disorder present in Lebanese adolescents. Several disorders can be present concomitantly with MD such as bulimia nervosa and exercise addiction. This study aims to explore the mediating effect of body appreciation between Muscle dysmorphia and bulimia nervosa, and to validate the exercise addiction inventory scale in Lebanese adolescents.

METHODS

This was a cross-sectional designed study, conducted between August-September 2022, and enrolling 403 adolescents currently residing in Lebanon (15 to 18 years old), from all Lebanese governorates (Beirut, Mount Lebanon, North, South, and Bekaa). Our sample was chosen using the snowball technique, a soft copy of the questionnaire was created using google forms software, and an online approach was conceived to proceed with the data collection.

RESULTS

The mean age of the participants was 16.63 ± 1.46 years with 57.3% females. The factor analysis for the Exercise Addiction Inventory suggested one factor, which explained 62.58% of the common variance. The confirmatory factor analysis revealed an adequate fit to the model with satisfactory Maximum Likelihood Chi-Square/Degrees of Freedom (χ²/df), SRMR, CFI, TLI, and AVE. The mediation analysis showed that the direct relation between bulimia and MD was not significant after eliminating the effect of body appreciation (r = .12, p < .001). However, body appreciation was significantly associated with bulimia nervosa (r=-1.06, p < .001) and MD (r=-.28, p < .001).

CONCLUSION

Body appreciation was found to be a mediator between muscle dysmorphia and bulimia nervosa and thus it is the main factor leading to both disorders. Therefore, body appreciation should be addressed in the evaluation and management of Muscle Dysmorphia.

The mediating role of anxiety and depression between problematic social media use and bulimia nervosa among Lebanese university students

Background

Bulimia nervosa (BN) is a disorder that is characterized by binge eating and inappropriate compensatory behavior to control weight. The aim of this study was to evaluate the mediating role of anxiety and depression between problematic social media use (PSMU) and BN among a sample of Lebanese university students.

Methods

This cross-sectional study was carried out between July and September 2021; a total of 363 university students was recruited through convenience sampling. The PROCESS SPSS Macro version 3.4, model four was used to test the indirect effect and calculate three pathways. Pathway A determined the regression coefficient for the effect of PSMU on mental health issues (depression/anxiety); Pathway B examined the association between mental health issues on BN, and Pathway C’ estimated the direct effect of PSMU on BN. Pathway AB was used to calculate the indirect effect of PSMU on BN via depression/anxiety.

Results

Results showed that depression and anxiety partially mediated the association between PSMU and BN. Higher levels of PSMU were associated with more depression and anxiety; higher depression and anxiety were associated with more BN. PSMU was directly and significantly associated with more BN. When entering anxiety (M1) then depression (M2) as consecutive mediators in a first model, the results showed that only depression mediated the association between PSMU and bulimia. When taking depression (M1) then anxiety (M2) as consecutive mediators in a second model, the results showed that the mediation PSMU → Depression → Anxiety → Bulimia was significant. Higher PSMU was significantly associated with more depression, which was significantly associated with more anxiety, which was significantly associated with more bulimia. Finally, higher PSMU was directly and significantly associated with more bulimia

Conclusion

The current paper highlights the relationship that social media use has on BN and other aspects of mental health such as anxiety and depression in Lebanon. Future studies should replicate the mediation analysis conducted in the current study while taking into account other eating disorders. Additional investigations of BN and its correlates must strive to improve the comprehension of these associations’ pathways through designs that allow to draw temporal frameworks, in order to efficiently treat this eating disorder and prevent its negative outcomes.

Bulimia nervosa, an eating disorder, is characterized by an impulsive consumption of food in a short period of time, followed by behaviors that compensate the eating such as vomiting or excessive exercise in order to avoid weight gain. Individuals with problematic social media use were found to have higher levels of bulimia symptoms. Symptoms of bulimia can also be associated with both depression and anxiety. The aim of the current study was to examine the mediating role of anxiety and depression between problematic social media use and bulimia nervosa. The results of our study found that problematic social media use was directly associated with more bulimia nervosa and also associated with higher depression and anxiety, both of which were associated with bulimia nervosa. Tackling associated disorders may help reduce symptoms of bulimia nervosa. Clinicians should carefully examine these associations while assessing and implementing treatment plans.

The psychometric properties of Binge Eating Scale among overweight college students in Taiwan

BACKGROUND

The Binge Eating Scale (BES) is a widely used measuring tool to assess binge eating problems in Western countries. However, the psychometric properties of such scales among cross-cultural youth groups are insufficient, and the factor structure continues to be debated; therefore, further research is needed. The aim of this study was to examine the properties of BES among overweight college students in Taiwan.

METHODS

A cross-sectional design and convenience sampling were adopted to recruit 300 overweight students from five universities. A translated Traditional Chinese version of BES was used for the survey, and the validity of the scale was tested using the Confirmatory Factor Analysis (CFA) and Bulimic Investigatory Test, Edinburgh (BITE). The reliability was evaluated using internal consistency and test-retest reliability.

RESULTS

The CFA results showed a reasonable model fit. The first-order two-factor model was consistent with that of the original BES and significantly correlated with the criterion of BITE score. Cronbach's α value, representing internal consistency reliability, and the intraclass correlation coefficient of repeated measures made one month apart were both 0.83, indicating good reliability and stability. Significant correlations were observed between the BES score and sex and BMI; however, no correlation was observed between BES scores and age.

CONCLUSION

The BES presents sound psychometric properties, has good cross-cultural applicability, and can be used as a first-line screening tool by mental health professionals to identify the severity of binge eating behavior among overweight college students in Taiwan. It is recommended that participant diversity and obesity indicators be incorporated into the scale in the future to establish a universal psychometric tool.

Severity of Binge Eating Behavior among Overweight College Students in Taiwan and Associated Factors

BACKGROUND

Binge eating (BE) is considered a marker of obesity and overweight and a significant characteristic of feeding and eating disorders. Despite the high prevalence of obesity on college campuses, the issue of BE among college students in Taiwan has received little attention. The aim of this study was to investigate BE behavior among overweight college students in Taiwan and associated factors.

METHODS

This study utilized a cross-sectional survey. A total of 300 overweight college students were recruited through convenience sampling. Data were collected using a self-administered Binge Eating Scale (BES) and a body weight composition monitor (Model No. OMRON, HBF-126) and analyzed using descriptive statistics, correlation analysis, and regression analysis.

RESULTS

The average BES score was 10.67 (SD = 6.66, 0-34). With a BES score of 17 as the cut-off point, 17.3% (n = 52) of the participants were found to have moderate or severe BE behavior. Analysis of the demographic and psychosocial data using Spearman's rho rank correlation coefficient revealed that sex, body mass index (BMI), uncontrolled eating, weight loss diets, academic stress, peer competition, interpersonal distress, and unpleasant or major life events were significantly correlated with BE behavior and its probability (rs = -0.14-0.15, p < 0.05). Furthermore, logistic regression analysis indicated that the odds ratio of the BES scores of female participants and those who stated to have experienced uncontrolled eating, weight loss diets, peer competition, and interpersonal distress was 1.05-6.04 times those of male participants and those without such experiences (p < 0.05).

CONCLUSION

The study found that nearly one-fifth of participants presented moderate to severe levels of BE behaviors, and these were significantly correlated with sex and external environmental stress. This study suggests early intervention from campus psychological health personnel to provide proper therapy.

Prevalence and associated factors of binge eating disorder among Bahraini youth and young adults: a cross-sectional study in a self-selected convenience sample

BACKGROUND

Binge eating disorder (BED) is defined as recurrent ingestion of an unusually large amount of food in a discrete period of time. BED has the highest prevalence of all eating disorders. Studies have shown a strong relationship between BED and both physical and psychological factors such as obesity, depression and anxiety. This research aimed to report the prevalence and associated factors of BED among Bahrainis (aged 15-30 years).

METHODS

A total of 959 participants (aged 15-30 years) completed self-administered online questionnaires. BED was measured using the binge eating disorder Screener-7. The Patient Health Questionnaire-9 and General Anxiety Disorder-7 were used to measure depression and anxiety, respectively.

RESULTS

Out of all participants, 21.2% had binge eating symptoms. A higher BMI, a restricted diet, depression and anxiety were associated with more frequent binge eating symptoms. Out of all associated factors, depression had the strongest association with binge eating, (rp = 0.371, p < 0.0001). However, sociodemographic variables including age and other medical conditions were not significantly associated with BED symptoms.

CONCLUSION

In conclusion, the prevalence of BED symptoms was significantly high among the study participants. The results point out the crucial role of awareness of the interaction between obesity, depression and anxiety as potential risk factors for binge eating tendencies. Further research should examine their relationship with BED.

Impact of social comparison on perceived online academic futility: A perspective from parents

In response to the wide-ranging concern of online academic futility, the current study aimed to explore the independent variables and mediating variable from a novel perspective of parents during COVID-19. Based on the social comparison theory and the control-value theory of achievement emotions, social comparison and tutoring anxiety were incorporated into an integrated model as predictors and mediator, respectively. A total of 300 parents completed an online survey. The results of the structural equation modeling indicated that upward social comparison and downward social comparison were both positively related to tutoring anxiety, which in turn positively predicted perceived online academic futility. Notably, tutoring anxiety played a significant mediating role in the association between different social comparison and perceived online academic futility. These results highlight the consistent predictive effect of upward social comparison and downward social comparison on perceived online academic futility, shedding light on the roles of tutoring anxiety in explaining the relationship from parental perspectives.

Frequency of binge eating behavior in patients with borderline personality disorder and its relation to emotional regulation and impulsivity

PURPOSE

Eating disorders are common among patients with borderline personality disorder (BPD), contributing to their lack of treatment response and bad prognosis. In this context, it is helpful to examine the relevance of eating behavior and to understand whether borderline traits are higher in those individuals. In this study, a sample of patients with BPD screened to determine the frequency of binge eating (BE) behaviors and its relation to impulsivity and emotional dysregulation.

METHOD

Seventy participants aged 25.81 ± 6.34 years were recruited from Okasha Institute of psychiatry, Cairo, Egypt. Diagnosed by the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), assessed for impulsivity, emotion regulation using the Barratt Impulsiveness Scale and the Trait Meta Mood Scale (TMMS), respectively, and screened for BE behaviors by Binge Eating Scale.

RESULTS

All of the participants had medium emotional regulation propensity 82.63 ± 10.81 and showed variable degrees of impulsivity, mainly moderate 42 (60%). More than half of the participants had BE behavior 37 (~ 53%), with a significant negative correlation with clarity of feeling, total score of TMMS, and age. Similarly, on comparing the participant with binging versus no binging group, a significant relation between BE behavior, fear of abandonment (p value 0.02), clarity of feeling, and total score of TMMS was found. However, no significant relation between BE behavior & impulsivity demonstrated.

CONCLUSION

A substantial number of patients with BPD suffering from BE, showing relation between binging, emotion dysregulation, and fear of abandonment.

LEVEL OF EVIDENCE

III, evidence obtained from well-designed cohort or case-control analytic studies.

Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women

OBJECTIVES

The objective of our study was to evaluate the association between the transition to menopause, body dissatisfaction, and abnormal eating habits (restrained eating, binge eating, and orthorexia nervosa) in a sample of middle-aged Lebanese women.

METHODS

A cross-sectional study conducted between July 2019 and January 2020 enrolled 1001 women aged 40 years and above from all Lebanese governorates. Data were collected by face-to-face interviews with all participants. The Body dissatisfaction subscale of the Eating Disorder Inventory‑second version was used to assess body dissatisfaction, whereas the Binge Eating Scale, Dutch Restrained Eating Scale, ORTO-15, Dusseldorf Orthorexia Scale (DOS), and Teruel Orthorexia Scale (TOS) were used to assess eating disorders (binge eating, restrained eating and orthorexia nervosa respectively. Multivariable analysis of covariance (MANCOVA) was used to compare multiple measures among the three menopausal phases, after adjustment over potential confounding variables (age, monthly income, body mass index, marital status, education level, and body dissatisfaction).

RESULTS

Postmenopause was significantly associated with more orthorexia nervosa tendencies (lower ORTO-15 scores) than premenopause (β = - 1.87; p = 0.022). Perimenopause was associated with more binge eating (β = 1.56; p = 0.031), and less orthorexia nervosa (as measured by the DOS) than premenopause, with this association tending to significance (β  = - 1.10; p = 0.051). Furthermore, higher body dissatisfaction was significantly associated with higher restrained eating (β = 0.02; p < 0.001), binge eating (β = 0.48; p < 0.001), and orthorexia nervosa as measured by ORTO-15 (β = - 0.17; p < 0.001) and TOS (β = 0.08; p = 0.002), but not DOS.

CONCLUSION

Our study showed that menopausal stages are associated with some disordered eating behaviors (binge eating and orthorexia nervosa) among middle-aged women. Those results may serve as a first step towards spreading awareness among women within this age group regarding eating attitudes. Moreover, healthcare professionals should screen for the presence of disordered eating during those women's routine visits to the clinics.

Disordered eating behaviour in adolescents with type 1 diabetes on continuous subcutaneous insulin infusion; relation to body image, depression and glycemic control

BACKGROUND

Disordered eating behaviour (DEB) represents a significant morbidity among people with type-1 diabetes (T1D). Continuous-subcutaneous insulin infusion (CSII) improves glycemic control and psychological wellbeing in those with T1D. However, its relation to DEB remains obscure.

OBJECTIVES

To compare DEB among adolescents with T1D on CSII versus basal-bolus regimen and correlate it with body image, HbA1C and depression.

METHODS

Sixty adolescents with T1D (30 on CSII and 30 on basal-bolus regimen), aged 12-17 years were studied focusing on diabetes-duration, insulin therapy, exercise, socioeconomic standard, hypoglycemic attacks/week and family history of psychiatric illness. Anthropometric measures, HbA1C, binge eating scale (BES), body image tool, patient health questionnaire-9 (PHQ9) and the Mini-KID depression scale were assessed.

RESULTS

Among the studied adolescents with T1D, six had DEB (10%), 14 had poor body-image perception (23.3%), 42 had moderate body-image perception (70%) and 22 had depression (36.7%). Adolescents with T1D on CSII had significantly lower BES (p = 0.022), Mini-KID depression (p = 0.001) and PHQ9 (p = 0.02) than those on basal-bolus regimen. BES was positively correlated to depression (p < 0.001), HbA1C (p = 0.013) and diabetes-duration (p = 0.009) and negatively correlated to body-image (p = 0.003).

CONCLUSION

DEB is a prevalent comorbidity among adolescents with T1D, with higher frequency in those on basal-bolus regimen than CSII.

Effects of night eating and binge eating disorders on general health in university students in Lebanon

BACKGROUND

Eating disorders (EDs) have an important impact on both physical and mental wellbeing, especially in a young population. There is a lack in research about EDs in the Middle East, and especially in Lebanon, where the co-occurring obesity is a widespread health problem.

AIM

Our study aims to assess the relation between night eating syndrome (NES) with binge eating disease (BED) and obesity (BMI) on one hand, and between NES and general health on the other hand, in university students.

MATERIALS AND METHODS

An observational cross-sectional study was conducted on 460 university students in Lebanon. Data collection was carried out using an online questionnaire. Socio-demographic and general health characteristics, BMI, Arabic validated General Health Questionnaire (GHQ-12), Arabic validated Binge Eating Scale (BES) and the Night Eating Diagnostic Questionnaire (NEDQ). Statistical analysis was accomplished on SPSS.

RESULTS

Participants having highest income showed highest NEDQ score. Females and participants with a history of eating disorders were more likely to have BED. A significant correlation was also found between having an ED history and negative impact on general health. BMI was correlated with both NEDQ and BES. Having NES was associated with also having BED. Furthermore, those with NES showed higher scores regarding GHQ-12.

CONCLUSION

Relatively high prevalence of NES and BED was noted in university students in Lebanon. This was correlated to a household income, general health, and BMI. The repercussion on both physical and mental morbidities highlights the importance for stepping up of the Lebanese organizational system to perform periodic screening.

Does Stockholm Syndrome Exist in Lebanon? Results of a Cross-Sectional Study Considering the Factors Associated With Violence Against Women in a Lebanese Representative Sample

The aim of this study is to validate the Stockholm syndrome scale (SSS) in Arabic, assess the correlation of the Stockholm syndrome in women who are victims of domestic violence, and evaluate the factors that enhance the level of violation among a representative sample of the Lebanese population. This is a cross-sectional study conducted on Lebanese women between September and December 2018. Participants enrolled in this study were from all of Lebanon's governorates and selected using an equitable representative sample. Being divorced (β = 9.83); with low educational level (β = 5.47); having a partner that takes substance (β = 16.17); addicted to alcohol (β = 8.21); addicted to gambling (β = 11.91); have a history of threats, violence, assaults, and crimes (β = 17.83); higher stressful life experiences (β = 0.75); and higher SSS score (β = 0.04) were significantly associated with higher partner physical and nonphysical abuse scale. For the validation of the SSS, five items (items 3, 20, 30, 38, and 40) were removed because none over-correlated with each other (r >.9), had a low load on the factors (<.3), or a weak commonality (<.3). SSS items converged on a seven-factor solution with Eigenvalues greater than 1, accounting for a total of 66.59% of the variance (α = .970). Our study revealed a positive association between the Stockholm syndrome and the violence against women and evaluated many factors that increase this association. Divorced women, with low educational level, having a partner addicted to alcohol, to illegal substance or to gambling, having a history of threats, violence, assaults, and crimes were more prone to experience physical and nonphysical abuse.

Binge eating behavior in a sample of Lebanese Adolescents: Correlates and Binge Eating Scale validation

BACKGROUND

Binge eating disorder is a common eating disorder among the adolescent population. The available literature in the Middle East in general, and Lebanon specifically, is relatively scarce and/or outdated. The objectives of this study were to (1) validate the Binge Eating Scale (BES) for use in Lebanese adolescents, and (2) assess correlates of binge eating behavior among this population.

METHODS

A cross-sectional study conducted between May and June 2020, enrolling 555 adolescents between the ages of 15-18 years old from all Lebanese governorates. The Binge Eating Scale was used to screen for the presence/absence of binge eating.

RESULTS

A confirmatory factor analysis revealed that the one-factorial model fits the data best. The results of a linear regression, taking the binge eating score as the dependent variable, showed that higher body dissatisfaction, more alcohol use disorder, higher depression, vomiting to lose weight and starving to lose weight were significantly associated with more binge eating. Higher self-esteem was significantly associated with less binge eating.

CONCLUSION

The Arabic Version of the BES scale seems to be a reliable tool to be used in Lebanese adolescents for the assessment of binge eating. More body dissatisfaction, lower self-esteem, increased depressive symptoms were associated with more binge eating. We hope this tool will be a reliable one to be used in epidemiological studies and research about eating behaviors/disorders. The results showed that higher body dissatisfaction, higher depression, vomiting to lose weight and starving to lose weight were significantly associated with more binge eating. Our study also showed that the Binge Eating Scale is an adapted and validated tool to be used among Lebanese adolescents for the assessment of binge eating. We hope that the study results will help clinicians in the screening and management of Binge Eating behaviors among Lebanese adolescents.

Validation of the Arabic version of the Eating Attitude Test in Lebanon: a population study

OBJECTIVES

To validate an Arabic version of the Eating Attitude Test (EAT-26) and identify factors (such as depression, stress, anxiety and body dissatisfaction) that might be associated with disordered eating among a sample of the Lebanese population.

DESIGN

Cross-sectional study.

SETTING

All Lebanese governorates.

PARTICIPANTS

A total of 811 participants randomly selected participated in this 5-month study (January-May 2018).

RESULTS

The EAT-26 scale items converged over a solution of six factors that had an eigenvalue over 1, explaining a total of 60·07 % of the variance (Cronbach's α = 0·895). The prevalence of disordered eating attitudes was 23·8 %. Higher EAT-26 scores (disordered eating attitudes) were significantly associated with higher depression (β = 0·325), higher emotional eating (β = 0·083), daily weighing (β = 3·430), higher physical activity (β = 0·05), starving to reduce weight (β = 4·94) and feeling pressure from TV/magazine to lose weight (β = 3·95).

CONCLUSIONS

The Arabic version of EAT-26 can be a useful instrument for screening and assessing disordered eating attitudes in clinical practice and research. Some factors seem to be associated with more disordered eating attitudes among participants for whom psychological counseling may be needed. Yet, our findings are considered preliminary, and further studies are warranted to confirm them.

Orthorexia nervosa and disordered eating attitudes among Lebanese adults: Assessing psychometric proprieties of the ORTO-R in a population-based sample

BACKGROUND

Previous research demonstrated a relationship between ON and disordered eating symptoms (eating concern, restraint, cognitive preoccupations about body shape and weight) and disordered eating attitudes (DEA). Since screening for orthorexia nervosa is now part of clinical practice, the measurement instruments to be used must be clinically significant, reliable, valid and sensitive to our target population. The main objective of the present study was to confirm the factor structure of the Arabic version of the ORTO-R using a first sample of Lebanese adults and confirm those results on another sample. The secondary objective was to assess sex differences in terms of ON and DEA, as well as to examine whether symptoms of ON were related to DEA in Lebanese adults.

METHODS

A total of 783 Lebanese adults was selected to participate in this cross-sectional study (January-May 2018) using a proportionate random sample from all Lebanese governorates.

RESULTS

The mean age of the total sample was 27.78 ± 11.60 years (Min. 18 -Max. 84) (33.5% females) and their mean BMI was 24.36 ± 5.31 kg/m2. All items of the ORTO-R were extracted during the factor analysis and yielded a two-factor solution with Eigenvalues > 1 (variance explained  =  50.07%; KMO = 0.570; Bartlett's sphericity test p<0.001; αCronbach = 0.755). This factor structure was confirmed by a confirmatory factor analysis; the Maximum Likelihood Chi-Square  =  26.894 and Degrees of Freedom  =  8, which gave a χ2/df  =  3.36. The Tucker Lewis Index (TLI) value was 0.914, whereas the standardized root mean square residual (SRMR) value was 0.032. The root mean square error of approximation (RMSEA) value was 0.077 [95% CI 0.046-0.111] (pclose = 0.07) and comparative fit index (CFI) value was 0.967 respectively, indicating a good fit of the model. There was also no measurement invariance between genders. Female gender was significantly associated with lower ORTO-R scores (more orthorexia nervosa) compared to males (B = -0.65; p = 0.026, 95% CI -1.22- -0.08; ɳ2 = 0.006). However, no significant difference was found between genders in terms of EAT-26 scores (B = 0.23; p = 0.813, 95% CI -1.66-2.12; ɳ2 = 0.0001). Higher ORTO-R scores (lower/ less pathological ON tendencies and behaviors) were significantly related to higher EAT-26 total scores (higher levels of DEA) as well as higher dieting, bulimia and oral control scores in both females (from a weak to a moderate positive correlation) and males (a weak positive correlation).

CONCLUSION

This cross-sectional population-based study confirmed the factor structure of the Arabic version of the ORTO-R, demonstrated an association between ON and DEA and revealed more ON among females compared to males.

Differences in the Associations between Body Dissatisfaction and Eating Outcomes by Gender? A Lebanese Population Study

BACKGROUND

The objective of this study was to evaluate the impact of the interaction between body dissatisfaction and gender on eating disorders (restrained eating, binge eating, orthorexia nervosa, and emotional eating) among a sample of Lebanese adults.

METHODS

This cross-sectional study, conducted between January and May 2018, enrolled 811 participants selected randomly from all Lebanese Mohafazat. The mean age of the participants was 27.6±11.8 years. The majority were females (66.5%), had a high level of education (73.2%), and low income (77.9%). This study used the following scales: body dissatisfaction subscale of the Eating Disorder Inventory-second version, binge eating scale, Dutch restrained eating scale, orthorexia nervosa scale (ORTHO-15 scale), emotional eating scale, perceived stress scale, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale.

RESULTS

Body dissatisfaction was positively correlated to restrained eating (r=0.293, P<0.001), emotional eating (r=0.073, P=0.042) and binge eating (r=0.250, P<0.001). The interaction between body dissatisfaction and gender was significantly associated with more restrained eating (Beta=0.01, P<0.001) and orthorexia nervosa (Beta=-0.09, P<0.001), but not with emotional (Beta=-0.43, P=0.103) and binge eating (Beta=-0.08, P=0.358). When stratifying the analysis by gender, the results revealed that higher body dissatisfaction was significantly associated with more restrained eating in both genders, but particularly among women. Body dissatisfaction was significantly associated with higher emotional eating in men only and with higher orthorexia nervosa tendencies and behaviors in females only.

CONCLUSION

The interaction between body dissatisfaction and gender was significantly associated with orthorexia nervosa and restrained eating but not with binge or emotional eating. Higher body dissatisfaction was significantly associated with higher restrained eating, more pronounced in women, while it was significantly associated with higher orthorexia tendencies (lower ORTO-15 scores) in women only. Body dissatisfaction was associated with emotional eating in men only.

Emotional eating among Lebanese adults: scale validation, prevalence and correlates

OBJECTIVES

The present study aimed at developing an Arabic version of the Emotional Eating Scale (EES) and examining its reliability and validity among a sample of the Lebanese population. The secondary objective was to evaluate the correlation between emotional eating and body dissatisfaction along with depression and/or self-esteem among a representative sample of the Lebanese population.

METHODS

This cross-sectional study was conducted between January and May 2018. The sample was drawn proportionately from all Lebanese Mohafazat.

RESULTS

All items could be extracted from the list, except items 17 and 19. The EES items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 67.06% of the variance (KMO = 0.939; Bartlett's test of sphericity p < 0.001; α_Cronbach = 0.952). A higher body dissatisfaction was significantly associated with higher emotional eating (β = 0.31) and lower self-esteem (β =  - 0.054); however, no significant association was found with depression. Self-esteem and depression were not found to be significantly associated with emotional eating. When introducing depression and self-esteem as mediator factors for body dissatisfaction and emotional eating, body dissatisfaction did not remain significantly associated with emotional eating.

CONCLUSION

In this study, the Emotional Eating Scale was validated in Arabic among the Lebanese adult population, making this scale usable in further Lebanese research. Moreover, our results showed that body dissatisfaction was positively correlated with emotional eating and self-esteem, but not with depression. A positive association between body dissatisfaction and emotional eating was also demonstrated. This research offers new perspectives for the evaluation of emotional eating among the Lebanese adult population.

LEVEL OF EVIDENCE

Level V Cross-sectional descriptive study.

Emotion regulation among Lebanese adults: Validation of the Emotion Regulation Questionnaire and association with attachment styles

PURPOSE

Validate the Emotion Regulation Questionnaire (ERQ) and evaluate factors associated with emotion regulation among Lebanese adults.

METHODS

A proportionate random sample of 811 participants was chosen from all Lebanese governorates in this cross-sectional study.

FINDINGS

The principal component analysis of the ERQ items yielded two factors (α_Cronbach  = 0.764 and 0.658 for the Cognitive Reappraisal and Expressive Suppression facets, respectively). Higher secure attachment style was linked to higher cognitive reappraisal and expressive suppression. Higher anxious attachment style and anxiety were associated with lower cognitive reappraisal.

PRACTICAL IMPLICATIONS

The Arabic version of the ERQ is a suitable tool for the assessment of emotion regulation tendencies in clinical practice and research. The study came up with results similar to the ones given by many international studies.

Binge eating, orthorexia nervosa, restrained eating, and quality of life: a population study in Lebanon

OBJECTIVES

To assess the implication of disordered eating behaviors (DEBs) on the quality of life (QOL) of a sample of the Lebanese population, after adjustment over sociodemographic characteristics of those participants. Secondary objective aimed to assess the role of body dissatisfaction (BD) in the association of DEBs and QOL.

METHODS

This cross-sectional study was done between January and May 2018 and enrolled 811 participants from the community. A proportionate random sample technique was used to select the sample from all Lebanese Mohafazat. The World Health Organization Quality-of-life (WHOQOL)-BREF was used to assess the QOL and it includes four domains: physical health, psychological health, social relations, and environment.

RESULTS

Body dissatisfaction was found to be a major confounding factor contributing to psychological and environmental HQOL impairments in patient with restrained eating. Nevertheless, orthorexia nervosa was associated with QOL impairments in its physical and environmental domains, regardless of body dissatisfaction that was shown to be a major contributor for QOL impairments. Similarly, ON was directly correlated with QOL of life impairment in its physical and environmental domains, independently of all other risk factors.

CONCLUSION

When adding body dissatisfaction as a confounding variable, restrained eating and orthorexia nervosa remained significantly associated with quality-of-life impairments.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Factors associated with violence against women in a representative sample of the Lebanese population: results of a cross-sectional study

To evaluate the prevalence of violence against women (VAW) and assess factors associated with VAW among a representative sample of the Lebanese population. This cross-sectional study was carried out between September and December 2018. Participants from all Lebanese governorates were enrolled in this study using a proportionate random sample. The percentages of women who were exposed to physical and non-physical abuse were 37.1% and 49.4% respectively. Factors associated with physical abuse were being divorced, having a partner addicted to substances and alcohol, or with a history of threats, violence, assaults, and crimes, higher stressful life experiences, and abuse reported from childhood (physical, sexual, or psychological). Non-physical abuse was associated with abuse reported from childhood (physical, sexual, or psychological), higher stressful life experiences, and the fact that the partner is addicted to substances and alcohol, or has a history of threats. Our results suggest that being divorced, illiterate, and unemployed, having an addicted partner, and having experienced child abuse are all factors that are associated with more violence against women.

Selfie addiction: The impact of personality traits? A cross-sectional study among the Lebanese population

OBJECTIVES

To examine the relationship between personality traits (Neuroticism, Openness, Consciousness, Agreeableness, and Extraversion) and selfie addiction among Lebanese adults.

DESIGN/METHODS

A cross-sectional study, carried out between August 2017 and April 2018, enrolled 1206 community-dwelling participants.

RESULTS

Female gender (ORa = 2.79) and higher neuroticism (adjusted odds ratio [ORa] = 1.01) were significantly associated with moderate vs low selfie-taking. Higher openness (ORa = 0.96) was significantly associated with low selfie-taking. Female gender (ORa = 3.42) was significantly associated with intense vs low selfie-taking, whereas higher age (ORa = 0.93) and higher conscientiousness (ORa = 0.99) were significantly associated with lower intense selfie-taking.

PRACTICE IMPLICATIONS

This relationship can serve as a basis for other studies to better understand this new phenomenon and, later, to draw attention to a "selfie" practice that can deviate from the norm.

Social media use disorder and alexithymia: Any association between the two? Results of a cross-sectional study among Lebanese adults

PURPOSE

To learn more about the association between social media use disorder and alexithymia among Lebanese people.

DESIGN/METHODS

Four hundred fifty-six residents participated in this cross-sectional study which was carried out between January and December 2018.

FINDINGS

The results showed that 107 (23.7%) participants were classified as having social media use disorder. Higher social media use disorder score (β = .52), higher perceived stress (β = .35), and higher depression (β = .12) were significantly associated with more alexithymia.

PRACTICE IMPLICATIONS

Our results have shown that social media use disorder and being depressed and stressed were associated with higher levels of alexithymia. Psychologists/health practitioners can benefit from these findings in their future prevention and intervention plans. People who negatively utilize social media platforms can then be offered with appropriate counseling and coping mechanisms.

Factors associated with depression among the Lebanese population: Results of a cross-sectional study

OBJECTIVE

The aim of this study was to assess factors associated with depression in a representative sample of the Lebanese population.

DESIGN/METHODS

A cross-sectional study, conducted between November 2017 and March 2018, enrolled 789 participants. Depression was measured using the Arabic version of the Hamilton Depression Scale.

RESULTS

The participants' mean age was 30.30 ± 12.52 years (54.8% males). More than half of the participants had depressive symptoms (59.7%). Anxiety (β = .457), alcohol dependence (β = .290), suicidal ideation (β = 1.427), high socioeconomic status (β = 1.910), being widowed (β = 4.564), and physical work fatigue (β = .090) were significantly associated with higher depression. Higher social emotional awareness was significantly associated with lower depression (β = -.176).

PRACTICE IMPLICATIONS

This study sheds light on high levels of psychological distress and depression among the Lebanese general population and suggests potential preventative strategies.

Prevalence and Predictors of Emotional Eating among Healthy Young Saudi Women during the COVID-19 Pandemic

Emotional eating (EE) is prevalent among women and is associated with obesity. The coronavirus 2019 (COVID-19) pandemic and mandatory quarantine increased the risk of mental symptoms and, inferentially, emotional eating (EE). We investigated the EE prevalence and predictors during this pandemic. Overall, 638 women, ages 18-39, completed an online survey incorporating the Emotional Eating Scale, Perceived Stress Scale, Generalized Anxiety Disorder-7 Scale, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index, and Global Physical Activity Questionnaire. We asked about nutrition and collected data on weight, height, and pandemic responses. Most respondents (47.2%) reported low EE; 40.4% were "moderate" and 12.4% "high" emotional eaters; 42.8% reported depression, 27% anxiety, 71% moderate stress, and 12.5% severe stress. The main EE indicators/predictors were fat intake (β = 0.192, p = 0.004), number of meals (β = 0.187, p < 0.001), sugar consumption (β = 0.150, p < 0.001), body mass index (β = 0.149, p < 0.001), stress (β = 0.143, p = 0.004), energy intake (β = 0.134, p = 0.04), and fast food intake frequency (β = 0.111, p < 0.01). EE score correlated negatively with increased family income (β = -0.081, p = 0.049). Higher stress correlated with worse sleep, less sleep, and less physical activity. Emotional eating is common among young Saudi women during the pandemic. We recommend healthy food choices and increased physical activity to improve sleep and mitigate stress.

Construction of the Lebanese Anxiety Scale (LAS-10): a new scale to assess anxiety in adult patients

Objective: The study objectives were (1) to create a new 10-item scale, the 'Lebanese Anxiety Scale' (LAS-10), inspired by the diagnostic criteria of DSM-5, and the HAM-A and STAI scales and (2) to evaluate the performance of this new scale on a sample of Lebanese individuals.Methods: This cross-sectional study enrolled 1332 community dwelling participants between November 2017 and March 2018.Results: In sample 1, the participants' mean age was 28.08 years (63.9% females). The LAS items converged over a solution of two factors that had an Eigenvalue over 1, explaining a total of 51.97% of the variance (α_Cronbach=0.857). The optimal cut-off between healthy controls and anxious patients was 13.50 according to the ROC curve. The sensitivity and specificity were good at this cut-off (77.5% and 70.8%, respectively). The area under the curve was high: 0.811 [0.778-0.845]; p < .001. The positive predicted value of the LAS-10 score in sample 1 was 26.9%, whereas the negative predicted value was 95.2%.Conclusion: The results of the present study show that the LAS-10 is a tool that can be used in clinical practice and research to screen for anxiety.KEY POINTSThe positive predicted value of the LAS-10 score was 26.9%.Its negative predicted value was 95.2%.People with scores above 13.5 be referred to a health care professional for further assessment.The LAS-10 is a tool can be used in clinical practice and research to screen for anxiety.Future studies are needed to validate the LAS-10 in other countries.

Factors associated with anxiety among the Lebanese population: the role of alexithymia, self-esteem, alcohol use disorders, emotional intelligence and stress and burnout

Objective: To assess factors associated with anxiety among a sample of the Lebanese population.Methods: A cross-sectional, conducted between November 2017 and March 2018, enrolled 789 participants. Anxiety was measured using the Hamilton Anxiety Scale. A cluster analysis was then performed with the identified factor scores to identify the different profiles of the participants.Results: A cluster analysis based on the three factors derived three mutually exclusive clusters, which form 29.62%, 34.54%, and 35.84% of all participants, respectively. The first cluster represented people in distress (low emotional intelligence, high depersonalisation, alcohol use disorder, burnout, stress, alexithymia and low self-esteem); the second one represented people with wellbeing (High emotional intelligence, low depersonalisation, low alcohol use disorder, low burnout, low stress, low alexithymia and high self-esteem), whereas cluster 3 represented people in between. Higher age (Beta  =  0.065) was significantly associated with higher anxiety, whereas being in cluster 2 (people with wellbeing) (Beta = -12.37) and cluster 3 (people in between) (Beta = -5.426) were significantly associated with lower anxiety compared to being in cluster 1 (people in distress).Conclusions: The findings of this study are overall consistent with those of epidemiologic community-based surveys and may help inform structural models of classification and prediction of anxiety disorders (ADs).

Validation of the AUDIT scale and factors associated with alcohol use disorder in adolescents: results of a National Lebanese Study

BACKGROUND

This study objective was to evaluate the prevalence of alcohol use disorder (AUD) and related factors (smoking, internet addiction, social anxiety, child abuse, and bullying) among a representative sample of Lebanese adolescents, and to validate and confirm psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT).

METHODS

A cross-sectional study, conducted between January and May 2019, enrolled 1810 adolescents aged between 14 and 17 from schools of all Lebanese districts. From the total number of schools, a proportionate number was selected in each district. AUD was defined as a high AUDIT score (≥8; score range 0-40). A principal component analysis technique to confirm the validity of the construct of the AUDIT scale score was done and a confirmatory analysis to assess the structure of the instrument was conducted. Spearman correlation was used for linear correlation between continuous variables. The Mann-Whitney test was used to compare the means of two groups, while the Kruskal-Wallis test was used to compare three groups or more. A stepwise linear regression was conducted, taking the AUDIT total score as the dependent variable and taking child abuse (psychological, sexual, physical and verbal), cigarette and waterpipe smoking dependence, bullying, social phobia, and internet addiction as independent variables.

RESULTS

The mean AUDIT score was 6.46 ± 8.44 and high risk of AUD was found in 507 (28.0%) adolescents [95% CI 0.259-0.301]. One factor solution of the AUDIT scale was found after running the factor analysis (αCronbach = 0.978). Higher AUDIT scores were significantly associated with higher cigarette (Beta = 0.527; p < 0.001) and waterpipe (Beta = 0.299; p < 0.001) dependence, higher childhood sexual abuse (Beta = 0.656; p < 0.001) and neglect (Beta = 0.126; p < 0.001), higher bullying victimization (Beta = 0.236; p < 0.001).

CONCLUSION

Alcohol use disorder among Lebanese adolescents seems to be associated with several factors, such as cigarette and waterpipe dependence, parents' divorce, higher internet addiction, bullying victimization, and childhood sexual abuse and neglect. Parents and healthcare professionals could use this data for early interventions.

Attachment style and addictions (alcohol, cigarette, waterpipe and internet) among Lebanese adolescents: a national study

Background

The prevalence in the Lebanese general population of cigarette and waterpipe smoking, alcohol drinking and internet use seems to be increasing lately. So far, no study was done relating the above to attachment styles in Lebanese adolescents. Consequently, the objective of our study was to assess the relationship between attachment styles (secure, preoccupied, fearful, and dismissing) and addictions (cigarettes, water pipes, alcohol, and internet) among this population.

Methods

It is a cross-sectional study that took place between January and May 2019. Two thousand questionnaires were distributed out of which 1810 (90.5%) were completed and collected back. A proportionate random sample of schools from all Lebanese Mohafazat was used as recruitment method.

Results

A secure attachment style was significantly associated with lower addiction to alcohol, cigarette, and waterpipe, whereas insecure attachment styles (preoccupied, dismissing and fearful) were significantly associated with higher addiction to cigarette, waterpipe, alcohol, and internet.

Conclusion

Lebanese adolescents with insecure attachment had higher rates of addiction to cigarette, waterpipe, alcohol, and internet. They should be closely monitored in order to reduce the risk of future substance use disorder and/or behavioral addiction development.

Impact of the interaction between alexithymia and the adult attachment styles in participants with alcohol use disorder

The current study aims to investigate the effect of the interaction between adult attachment styles and alexithymia among participants with alcohol use disorder (AUD). This study is cross-sectional, conducted between November 2017 and March 2018, which enrolled 789 community-dwelling participants. The interaction between alexithymia and secure relationship tended to significance (p = 0.057). Higher interaction between alexithymia and a fearful relationship style (β = 0.04) were significantly associated with higher AUD. The interaction model revealed the importance of stratifying the results according to presence/absence of alexithymia. Being a female and having a secure relationship style were significantly associated with lower AUD in both groups. Being divorced was significantly associated with higher AUD in both groups. Increasing age (β = -1.48), secondary (β = -4.65), and university level of education (β = -6.46) were significantly associated with lower AUD in the non-alexithymic group. Intermediate monthly income (β = 2.69) and being widowed (β = 8.24) were significantly associated with higher AUD in the non-alexithymic group. High monthly income (β = 3.46) was significantly associated with higher AUD in the alexithymic group. The results of this study showed that the consideration of the combination between attachment styles and alexithymia is of significance in the diagnosis and therapy of alcohol use disorders.

Factors associated with alcohol use disorder: the role of depression, anxiety, stress, alexithymia and work fatigue- a population study in Lebanon

Background

International research showed that common mental disorders such as depression, anxiety, social anxiety, stress, alexithymia and having insecure attachment styles are risk factors for alcohol use disorder (AUD). Our objective was to study the factors associated withAUD in a sample of the Lebanese population.

Methods

During the period lasting from November 2017 to March 2018, a sample of 789 Lebanese participants agreed to contribute to a cross-sectional study (53.23% males). Alcohol use disorder was assessed using the Alcohol Use Disorder Identification Test (AUDIT).

Results

A high risk of AUD was associated with higher alexithymia (ORa = 1.030; CI 1.009–1.051), depression (ORa = 1.076; CI 1.050–1.103) and suicidal ideation (ORa = 1.253; CI 1.026–1.531) in a significant manner. In opposition, a higher number of kids (ORa = 0.863; CI 0.752–0.991), being a female (ORa = 0.460; CI 0.305–0.694) and higher emotional management (ORa = 0.962; CI 0.937–0.988) were significantly associated with lower AUD risk.

A cluster analysis derived three mutually exclusive clusters. Cluster 1 formed 45.4% of the sample and assembled people with psychological difficulties (work fatigue and high stress, high emotional work fatigue and low emotional intelligence, low self-esteem, high social phobia, high alexithymia); Cluster 2 formed 34.4% of the sample and assembled people with high wellbeing (low suicidal ideation, low emotional work fatigue, depression and anxiety, high emotional intelligence, high self-esteem and low social phobia); whereas cluster 3 formed 20.2% of the sample and represented people with mental dysfunction (high anxiety and depression, high suicidal ideation, low self-esteem and high social phobia, low emotional intelligence, high emotional work fatigue). People with psychological difficulties (cluster 1) (Beta = 5.547; CI 4.430–6.663), and people in distress (cluster 3) (Beta = 7.455; CI 5.945–8.965) were associated with higher AUDIT scores than those with high wellbeing (cluster 2).

Conclusion

AUD seems to be influenced by several factors among the Lebanese population, including alexithymia, stress, anxiety and work fatigue. Healthcare professionals should spread awareness to reduce the prevalence of these factors.

Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.