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Sharpe SL. A living experience proposal for the co-occurring diagnosis of avoidant/restrictive food intake disorder and other eating disorders. J Eat Disord 2024; 12:110. [PMID: 39103970 PMCID: PMC11299394 DOI: 10.1186/s40337-024-01073-1] [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] [Received: 12/31/2023] [Accepted: 07/29/2024] [Indexed: 08/07/2024] Open
Abstract
The eating and feeding disorder section of the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR) is organized by a diagnostic algorithm that limits the contemporaneous assignment of multiple eating disorder diagnoses. Avoidant/restrictive food intake disorder (ARFID) is a disturbance in food intake typically associated with lack of interest in food, food avoidance based on sensory characteristics, and/or fear of aversive consequences from eating. According to the DSM-5-TR, an ARFID diagnosis cannot be made when weight or shape disturbances are present, and ARFID cannot be co-diagnosed with other eating disorders characterized by these disturbances. However, emerging evidence from both clinical and lived experience contexts suggests that the co-occurrence of ARFID with multiple other types of eating disorders may be problematically invisibilized by this trumping scheme. The diagnostic criteria for ARFID can contribute to inappropriate diagnosis or exclusion from diagnosis due to excessive ambiguity and disqualification based on body image disturbance and other eating disorder pathology, even if unrelated to the food restriction or avoidance. This harmfully limits the ability of diagnostic codes to accurately describe an individual's eating disorder symptomatology, impacting access to specialized and appropriate eating disorder care. Therefore, revision of the DSM-5-TR criteria for ARFID and removal of limitations on the diagnosis of ARFID concurrent to other full-syndrome eating disorders stands to improve identification, diagnosis, and support of the full spectrum of ARFID presentations.
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Affiliation(s)
- Sam L Sharpe
- Department of Social Transformation Studies, Kansas State University, 003 Leasure Hall 1128 N. Martin Luther King Jr. Dr, Manhattan, KS, 66506, USA.
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Monteleone AM, Carfagno M, Barone E, Cascino G, Pitocco A, Brandi C, Landolfi L, Toni C, Sampogna G, Fiorillo A. Attitudes and gaps in knowledge of the diagnosis, treatment, and psychopathology of eating disorders among different health professionals. J Eat Disord 2024; 12:89. [PMID: 38943186 PMCID: PMC11212406 DOI: 10.1186/s40337-024-01053-5] [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] [Received: 09/15/2023] [Accepted: 06/19/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Health professionals from different specialties in medical and psychological areas play an important role in diagnosis and treatment of eating disorders (EDs). This study aimed to identify gaps in knowledge about the diagnosis, etiology, and management of EDs and to assess health professionals' attitudes towards these illnesses. METHODS A new questionnaire was developed and validated. Residents and consultants working in disciplines involved in the management of EDs (namely, internal medicine, general practitioners, psychiatric area, psychological area, and surgical area) completed the questionnaire. Knowledge and attitudes were compared among the study groups through one-way ANCOVA and chi-square tests. RESULTS The final version of the questionnaire consisted of 54 items assessing the following areas: stigma, treatment, physical complications, diagnosis, and aetiopathogenesis of EDs. For all health professionals the area of most deficiency was the aetiopathogenesis, while the best one was the management of physical complications. All medical professionals showed less knowledge than psychiatrists in terms of etiology, diagnosis, and treatment of EDs. A lack of knowledge about evidence-based psychotherapies, general psychopathology, and family members' role in the management of EDs emerged among all health professionals. Stigma was found among non-mental health professionals who considered these patients to be different from others and responsible for their abnormal eating behaviors. CONCLUSIONS Clarifying the health professionals' specific gaps occurring in the knowledge of EDs and in the attitudes towards these individuals may inform educational programs to improve early detection and management of EDs.
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Affiliation(s)
- Alessio Maria Monteleone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples, 80138, Italy.
| | - Marco Carfagno
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples, 80138, Italy
| | - Eugenia Barone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples, 80138, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Armando Pitocco
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples, 80138, Italy
| | - Carlotta Brandi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples, 80138, Italy
| | - Lorenzo Landolfi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples, 80138, Italy
| | - Claudia Toni
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples, 80138, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples, 80138, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples, 80138, Italy
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Lawson ML, Hisle-Gorman E, Susi A, Dorr M, Nylund CM, Chokshi B. Impact of the COVID-19 pandemic on care for anorexia and bulimia nervosa in US military-connected adolescents and young adults. Int J Eat Disord 2024; 57:376-387. [PMID: 38069451 DOI: 10.1002/eat.24105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This study examined the impact of the COVID-19 pandemic on healthcare engagement for anorexia nervosa (AN) and bulimia nervosa (BN) in a large, geographically diverse population. METHOD This repeated monthly, cross-sectional study queried Military Health System records of individuals aged 10-21 before and during the pandemic (February 2019-January 2022). ICD-10 codes identified encounters for AN and BN. Monthly rates of care were modeled as the number of unique individuals with an ICD-10-identified eating disorder-related encounter per month divided by the enrolled population. Poisson regression analysis evaluated rates of care stratified by eating disorder, clinical setting, and sex. RESULTS In a population of 1.76 million adolescents and young adults, 1629 individuals with AN or BN received care during the pre-pandemic period; 3256 received care during the pandemic. The monthly rate of care for females with AN during the pandemic increased in inpatient settings (adjusted relative risk [aRR]: 1.31 [1.16-1.49]) and outpatient settings (aRR: 1.42 [1.37-1.47]); monthly care rates in males with AN increased in the outpatient setting (aRR: 1.46 [1.28-1.67]). Females with BN had increased engagement in outpatient settings (aRR: 1.09 [1.03-1.16]); BN care for males showed no significant monthly changes during the pandemic period in either healthcare setting. DISCUSSION With increased rates of AN and BN disorder-related care during the pandemic, screening for eating disorder symptomatology may allow for timely diagnosis and intervention in periods of heightened stress. Pandemic-related increases in healthcare engagement may strain limited resources, emphasizing a need to expand accessibility of clinical expertise. PUBLIC SIGNIFICANCE This study indicates that monthly rates of healthcare engagement during the COVID-19 pandemic for AN and BN varied based on clinical setting and sex in an adolescent and young adult population. The increased number of individuals seeking eating disorder-related care, especially outpatient care, attributed to heightened stressors necessitates accessible professionals with eating disorder clinical expertise.
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Affiliation(s)
- Michelle L Lawson
- Department of Pediatrics, Division of Adolescent Medicine, Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas, USA
| | - Elizabeth Hisle-Gorman
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Apryl Susi
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Madeline Dorr
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Cade M Nylund
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Binny Chokshi
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Downey AE, Odette M, Sanders AE, Kuykendall M, Saunders E, Nagata JM, Forsberg S, Buckelew SM, Garber AK. What medical providers need to elevate outpatient care for adolescents and young adults with binge-eating disorder: A novel protocol. Int J Eat Disord 2024; 57:294-302. [PMID: 38130097 DOI: 10.1002/eat.24110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Binge-eating disorder (BED) in adolescents and young adults is underrecognized and understudied and no standardized guidelines exist for medical providers caring for this population. To highlight the lack of extant evidence, we examine the demographic characteristics of youth with BED in an academic eating disorders (EDs) program and primary care clinic and describe the needs of their medical care providers. METHOD A retrospective chart review was conducted for patients who met criteria for BED from July 2021 to June 2022. We surveyed their medical providers to understand their needs in caring for this population. A multidisciplinary team with expertise in the care of youth with EDs amalgamated current evidence in caring for youth with BED into a protocolized care schema designed for implementation in the outpatient medical setting. RESULTS Eighteen youth with BED were reviewed, 14 identified as female, 3 as male, and 1 as "Other." Average age was 15.4 (2.7) years old, and mean body mass index was 35.90 (8.25). 33.3% (6) patients identified as White/Caucasian, followed by 22.2% (4) Hispanic/Latinx. Eleven of 18 were privately insured. The most common medical recommendations were for regular meals and snacks and for individual psychotherapy. Medical providers desired more education about identification and management of youth with BED. CONCLUSIONS To address the lack of medical care guidelines for youth with BED, recommendations in this Forum include: increased education for medical providers, standardized medical monitoring, an emphasis on psychotherapy, and a weight-inclusive orientation. PUBLIC SIGNIFICANCE Adolescents and young adults with BED are underrecognized and undertreated. Little is known about the characteristics of these patients and the medical care these patients receive within academic EDs program. For the first time, preliminary recommendations for medical care are provided.
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Affiliation(s)
- Amanda E Downey
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Michelle Odette
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Austin E Sanders
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Mikayla Kuykendall
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Elizabeth Saunders
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Sara M Buckelew
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Andrea K Garber
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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Molinaro ML, Shen K, Agarwal G, Inglis G, Vanstone M. Family physicians' moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care. Br J Gen Pract 2024; 74:e41-e48. [PMID: 37957021 PMCID: PMC10664150 DOI: 10.3399/bjgp.2023.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/10/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Family physicians (GPs) working with patients experiencing social inequities have witnessed patients' healthcare needs proliferate. Alongside increased workload demands fostered within current remuneration structures, this has generated concerning reports of family physician attrition and possible experiences of moral distress. AIM To explore stories of moral distress shared by family physicians caring for patients experiencing health needs related to social inequities. DESIGN AND SETTING A critical narrative inquiry, informed by the analytic lens of moral distress, conducted in Ontario, Canada. METHOD Twenty family physicians were recruited through purposive and snowball sampling via word of mouth and email mailing lists relevant to addictions and mental health care. Physicians participated in two narrative interviews and had the opportunity to review the interview transcripts. RESULTS Family physicians' accounts of moral distress were linked to policies governing physician remuneration, scope of practice, and the availability of social welfare programmes. These structural elements left physicians unable to get patients much needed support and resources. CONCLUSION This study provides evidence that physicians experience moral distress when unable to offer crucial resources to improve the health of patients with complex social needs resulting from structural features of the Canadian health and social welfare system. Further research is needed to critically interrogate how health and social welfare systems around the world can be reformed to improve the health of patients and increase family physicians' professional quality of life, potentially improving retention.
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Affiliation(s)
- Monica L Molinaro
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Katrina Shen
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gabrielle Inglis
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Chaves E, Jeffrey DT, Williams DR. Disordered Eating and Eating Disorders in Pediatric Obesity: Assessment and Next Steps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6638. [PMID: 37681777 PMCID: PMC10487955 DOI: 10.3390/ijerph20176638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Abstract
While the exact prevalence of disordered eating in youth who are overweight and have obesity has not been determined, studies show that the odds of a young adult (18-24 years) with obesity engaging in disordered eating behaviors is 2.45 times more likely to occur than in young adults with Body Mass Indexes (BMI) in the normative range. The purpose of this review is to highlight the role that disordered eating and eating disorders may play in pediatric obesity and the importance of screening for these conditions. The ability to identify and assess disordered eating alters the course of treatment. Without an understanding of the intersection of obesity and disordered eating, medical providers may continue treatment-as-usual. Doing so may inadvertently contribute to internalized weight bias in patients with obesity and exacerbate their disordered eating symptoms and behaviors. In addition, understanding the spectrum of disordered eating in pediatric patients with obesity allows providers to tailor treatments, discuss food and physical activity differently, and know when to refer patients to eating-disorder-specific providers for continued treatment.
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Affiliation(s)
- Eileen Chaves
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
- Center of Healthy Weight and Nutrition, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - D. Thomas Jeffrey
- Psychology Department, The Ohio State University, Columbus, OH 43210, USA;
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Giacomini G, Elhadidy HSMA, Paladini G, Onorati R, Sciurpa E, Gianino MM, Borraccino A. Eating Disorders in Hospitalized School-Aged Children and Adolescents during the COVID-19 Pandemic: A Cross-Sectional Study of Discharge Records in Developmental Ages in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192012988. [PMID: 36293569 PMCID: PMC9602016 DOI: 10.3390/ijerph192012988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 05/08/2023]
Abstract
Eating disorders (EDs) are characterized by behavioral and cognitive aspects that result in a significant impairment of an individual's well-being. COVID-19 pandemic consequences negatively impacted healthcare services and people's mental health. Particularly, in developmental ages, difficulties in coping with the situation could have had an impact on eating behaviors. Therefore, the aim of this study was to assess EDs' hospitalization trend before, during and after the pandemic peak to evaluate whether it has been influenced. A retrospective cross-sectional study was conducted on the hospital discharge forms of patients from 5 to 19 years old in Piedmont, which is a region in northern Italy. Overall, hospitalization, age, and gender-specific rates due to EDs that occurred in 2020 and 2021 were compared to those that occurred in 2018-2019. Since 2020, there has been a 55% reduction in overall hospitalizations, while the total proportion of EDs admissions has doubled from 2020 to 2021 (from 13.9‱ to 22.2‱). Significant hospitalization rate increases were observed both in 15-19 and in 10-14 females' age groups in 2021. Non-significant increases were observed in all males' age groups. The increase in hospitalizations for EDs should be further investigated, as it might be the tip of an iceberg not yet acknowledged.
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Affiliation(s)
- Gianmarco Giacomini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | | | - Giovanni Paladini
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Roberta Onorati
- Regional Public Health Observatory, Epidemiology Unit, Local Health Board TO3, Piedmont Region, 10195 Grugliasco, Italy
| | - Elena Sciurpa
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
- Correspondence:
| | - Alberto Borraccino
- Department of Public Health Sciences and Pediatrics, Università di Torino, 10126 Torino, Italy
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