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Melisse B, van den Berg E, de Beurs E. Effectiveness of web-based guided self-help cognitive behavioral therapy-enhanced for binge-eating disorder: An implementation study. Int J Eat Disord 2024; 57:1379-1389. [PMID: 37876352 DOI: 10.1002/eat.24079] [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: 06/19/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Web-based guided self-help cognitive behavioral therapy-enhanced (CBT-E) is a 12-weeks, 12-sessions, digitalized version of part II of the self-help book Overcoming Binge Eating. This intervention is effective when offered under controlled circumstances in a randomized-controlled-trial. It is unknown how patients with binge-eating disorder (BED) respond to this intervention when offered in real-world clinical-settings. The aim of this study is to examine post-intervention effectiveness of guided self-help CBT-E for BED in real-world settings. METHOD The present study used a cohort-design examining the effectiveness of web-based guided self-help CBT-E according to an intention-to-treat (ITT) analysis. BED patients (n = 278) were assessed pre- and post-intervention. The primary outcome was reduction in binge-eating episodes. Other outcomes were full-recovery (EDE-Q score <2.77 and abstinence from binge-eating episodes), impaired psychosocial functioning, defined as secondary impairment, and general psychopathology post-intervention. RESULTS The number of binge-eating episodes reduced by an average of 16 binge-eating episodes per 4 weeks pre-intervention to five binge-eating episodes during the last 4 weeks of treatment. Abstinence from binge eating was reported by 30%, and 28% reported full recovery. Effect sizes (Cohen's d) were large (d ≥ 1.0) for all outcome measures. There were no differences in outcomes between the ITT and the completers sample. DISCUSSION Guided self-help CBT-E is associated with significant improvements. The effects of guided self-help CBT-E offered in a real-world-setting are comparable to self-help CBT-E offered in a randomized-controlled-trial. However, it should be noted that comparisons with randomized-controlled-trials requires caution. Longer-term follow-up data are necessary to measure persistence of treatment benefits. PUBLIC SIGNIFICANCE Offering CBT-E as a web-based guided self-help intervention has several benefits for patients with BED. Guided self-help CBT-E is associated with significant improvements on the short term when offered in real-world clinical settings.
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Affiliation(s)
- Bernou Melisse
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
- Section Clinical Psychology, Leiden University, Leiden, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Elske van den Berg
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
| | - Edwin de Beurs
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
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Nitsch A, Watters A, Manwaring J, Bauschka M, Hebert M, Mehler PS. Clinical features of adult patients with avoidant/restrictive food intake disorder presenting for medical stabilization: A descriptive study. Int J Eat Disord 2023; 56:978-990. [PMID: 36695305 DOI: 10.1002/eat.23897] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of this study is to describe the clinical features of adult patients with avoidant/restrictive food intake disorder (ARFID) to better understand the medical findings, psychological comorbidities, and laboratory abnormalities in this population. METHOD We completed a retrospective chart review of all adult patients with a diagnosis of ARFID, admitted for medical stabilization, between April 2016 and June 2021, to an inpatient hospital unit, which specializes in severe eating disorders. Information collected included anthropomorphic data, laboratory assessments, and medical history at time of admission. RESULTS One hundred and twenty-two adult patients with ARFID were identified as meeting inclusion criteria for the study. The most common ARFID presentation was "fear of adverse consequences." The majority were female (70%), with an average age of 32.7 ± 13.7 years and mean percent of ideal body weight (m%IBW) of 68.2 ± 10.9. The most common laboratory abnormalities were low serum prealbumin and vitamin D, hypokalemia, leukopenia, and elevated serum bicarbonate. The most common psychiatric diagnoses were anxiety and depressive disorders, and the most common medical diagnoses were disorders of gut-brain interaction (DGBI). DISCUSSION This is the largest study to the authors' knowledge of medical presentations in adult patients with ARFID. Our results reflect that the adult patient with ARFID may, in some aspects, present differently than pediatric and adolescent patients with ARFID, or from ARFID patients requiring less intensive care. This study highlights the need for further investigation of adult patients with ARFID. PUBLIC SIGNIFICANCE ARFID is a restrictive eating disorder first defined in 2013. This study explores the medical presentations of adult patients (>18 years old) with ARFID presenting for specialized eating disorder treatment and identifies unique features of the adult presentation for treatment, compared to pediatric and adolescent peers.
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Affiliation(s)
- Allison Nitsch
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashlie Watters
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jamie Manwaring
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
| | - Maryrose Bauschka
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
| | - Melanie Hebert
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
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Coopey E, Johnson G. "The male elephant in the room": a qualitative evidence synthesis exploring male experiences of eating disorders. J Eat Disord 2022; 10:131. [PMID: 36056450 PMCID: PMC9440558 DOI: 10.1186/s40337-022-00614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Men are believed to be underrepresented in eating disorder services; there are many reasons presented to account for this such as a lack of recognition and detection. Due to the physical and psychological complexity of an eating disorder it is important to understand this underrepresentation. This qualitative evidence synthesis aimed to explore the literature relating to men's experiences of an eating disorder, in order to synthesise the findings and offer a more coherent understanding. METHOD A systematic search of the literature was undertaken. Inclusion and exclusion criteria were applied to the findings resulting in 14 papers deemed suitable for inclusion. A Meta-Ethnographic approach to synthesising the data of the 89 participants was undertaken. RESULTS Four themes were identified: 'Societal Construction of the Perfect Male'; 'Striving to Maintain a Masculine Identity'; 'The Interconnectedness of Control and Self-Worth', and 'The Hidden Man'. There appeared to be an underlying concept relating to the conflict of being a man, with what is perceived to be a 'woman's illness' and how this challenged the men's experiences of masculinity. CONCLUSIONS Being a man with an eating disorder conflicted with societal norms, exacerbating their experience of having an eating disorder.. To resolve this, gendered norms need to shift, at societal level as well as considering how best to improve understanding and recognition of men with an eating disorder at the first point of help seeking.
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Affiliation(s)
- Emily Coopey
- Centre for Applied Psychology, School of Psychology, University of Birmingham, Birmingham, UK.
| | - George Johnson
- Centre for Applied Psychology, School of Psychology, University of Birmingham, Birmingham, UK
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Ralph AF, Brennan L, Byrne S, Caldwell B, Farmer J, Hart LM, Heruc GA, Maguire S, Piya MK, Quin J, Trobe SK, Wallis A, Williams-Tchen AJ, Hay P. Management of eating disorders for people with higher weight: clinical practice guideline. J Eat Disord 2022; 10:121. [PMID: 35978344 PMCID: PMC9386978 DOI: 10.1186/s40337-022-00622-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population. AIM The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations. METHODS The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience. RECOMMENDATIONS Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed. CONCLUSIONS This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.
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Affiliation(s)
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Wodonga, Australia
| | - Sue Byrne
- Department of Psychology, University of Western Australia, Perth, Australia
| | | | - Jo Farmer
- Lived Experience Advocate, Melbourne, Australia
| | - Laura M. Hart
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Gabriella A. Heruc
- Eating Disorders and Nutrition Research Group (ENRG), School of Medicine, Western Sydney University, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, Sydney, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Macarthur Clinical School, Sydney, Australia
- Camden and Campbelltown Hospitals, Sydney, Australia
| | - Julia Quin
- Lived Experience Advocate, Melbourne, Australia
| | - Sarah K. Trobe
- National Eating Disorders Collaboration, Sydney, Australia
| | - Andrew Wallis
- Sydney Children’s Hospitals Network, The Children’s Hospital Westmead, Sydney, Australia
| | | | - Phillipa Hay
- Eating Disorders and Body Image (EDBI), Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- South Western Sydney Local Health District, Sydney, Australia
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Coelho JS, Suen J, Marshall S, Zaid-Alkailani H, Geller J, Lam PY. Treatment experiences of male and female youths with eating disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1119-1133. [PMID: 35876265 DOI: 10.1111/bjc.12384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The current study was conducted to further understand the experiences of youths with an eating disorder with accessing services and receiving treatment. Participants' perceptions of the role of gender in eating disorder treatment was also assessed. DESIGN A prospective mixed methods design was used, with the current report focusing on qualitative interviews. METHODS Youths who were receiving services in a specialized paediatric eating disorder program completed a semi-structured interview in combination with a visual lifeline upon their discharge. A process of interpretative induction was employed to derive high-level concepts from the interviews. RESULTS A total of 28 youths (15 males and 13 females) completed an interview. Four high-level concepts were identified: (1) unwanted/non-collaborative support, (2) conflicting views, (3) dynamics in relationships (with sub-concepts relating to peers and health professionals), and (4) changing mindset. Although many participants viewed treatment as universal, a subset of participants noted that treatment was tailored towards females. CONCLUSIONS Youths shared several challenges that they encountered in their journey to accessing specialized eating disorders treatment, including disagreement with their parents/caregivers and health professionals about treatment plans. Interactions with peers and health professionals represented both a facilitator (e.g., feeling supported and inspired by peers) and a challenge (e.g., negative interactions with professionals). Some youths shared concerns about the female-centric nature of treatment. The results of this study highlight the importance of collaborative care for paediatric eating disorders, and consideration for gender inclusivity in eating disorders treatment.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Janet Suen
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada
| | - Sheila Marshall
- School of Social Work, University of British Columbia, Vancouver, BC, Canada
| | - Haya Zaid-Alkailani
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Provincial Adult Tertiary Eating Disorders Program, Saint Paul's Hospital, Vancouver, BC, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Babb C, Jones CRG, Fox JRE. Investigating Service Users' Perspectives of Eating Disorder Services: A Meta-Synthesis. Clin Psychol Psychother 2022; 29:1276-1296. [PMID: 35141970 PMCID: PMC9546143 DOI: 10.1002/cpp.2723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 12/05/2022]
Abstract
Objective Despite a number of qualitative studies published from the perspective of eating disorder (ED) service users, there has been no attempt to exclusively synthesize their views to gain a fuller understanding of their ED service experiences. It is important to understand this perspective, since previous research highlights the difficulties ED healthcare professionals report when working with this client group. Method A systematic search of the literature was conducted to identify qualitative studies focusing on experiences of ED services from the perspective of service users. Twenty‐two studies met the inclusion criteria and underwent a quality appraisal check using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. These were then synthesized using a meta‐synthesis approach. Results Four overarching themes were generated: “Treatment: Focus on physical vs. psychological symptoms”; “Service Environment: The role of control within services”; “Staff: Experiences with staff and the value of rapport”; and “Peer Influence: Camaraderie vs. comparison.” Service users expressed a desire for more psychological input to tackle underlying difficulties relating to their ED. A complex relationship with feelings of control was described, with some feeling over‐controlled by service providers, while others retrospectively recognized the need for control to be taken away. Staff values, knowledge and trust played a significant role in treatment and recovery. Peers with an ED were described to be a valuable source of understanding and empathy, but some found peer influence to perpetuate comparison and competitiveness. Discussion The results portray some of the conflicts and complexities that service users encounter in ED services. A running thread throughout is the perceived importance of adopting an individualized approach within these services.
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Affiliation(s)
- Charli Babb
- School of Psychology, Cardiff University, UK
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7
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Richardson C, Paslakis G. Men's experiences of eating disorder treatment: A qualitative systematic review of men-only studies. J Psychiatr Ment Health Nurs 2021; 28:237-250. [PMID: 32608115 DOI: 10.1111/jpm.12670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 01/12/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: There is a widespread perception that eating disorders are predominantly women´s illnesses. Most studies in the field of eating disorders include predominantly women. Current eating disorder programmes are tailored to meet women´s needs. At the same time, studies show that the rate of eating disorders among men is rising. Men tend to seek help for their eating disorder late in the course of their illness; even when they do seek treatment, they run risk of being undiagnosed by health professionals. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We assessed the current knowledge on how men think and feel about their eating disorders and explored how this may affect their help-seeking behaviours and how they go about managing their eating disorders. Men experience unique symptoms and issues that may translate into unique treatment needs. There is a call to re-evaluate the current status quo for men with eating disorders regarding access to and receiving treatment for their eating disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is becoming an increasing priority to effectively treat men with eating disorders. Men need to be recognized as stakeholders in eating disorder-associated health care delivery. Healthcare professionals should receive training about the nature of eating disorders in men. Eating disorder-specific treatments will require adaptations to mirror the needs of individuals rather than particular gender/sex entities. ABSTRACT: Objective Despite the widespread perception that eating disorders (EDs) are predominantly experienced by women and girls, the incidence rate among men has risen substantially in recent years. Men may face unique challenges accessing treatment, which can negatively affect prognosis. The present paper aimed to review men's thoughts and feelings about their ED, and their experiences of ED treatment. Method We conducted a systematic search for qualitative articles focusing on the treatment experiences of men with EDs. Results Nine studies met inclusion criteria. Key themes that emerged across the studies were as follows: (a) recognition of the ED, (b) help-seeking, (c) treatment characteristics and (d) patient characteristics. Given that EDs are widely regarded to exclusively affect women and girls, men were reluctant to recognize their EDs, faced minimization of their symptoms by health professionals and had difficulty finding treatments that were tailored to their unique needs and preferences as men. Conclusions The present findings may serve as reference points to design future ED-specific interventions that are more inclusive of men. Further studies are needed to explore the differential experiences of men across diagnostic categories and treatment types, as well as elucidate the potential role of men-only services.
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Affiliation(s)
- Candice Richardson
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Georgios Paslakis
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Thapliyal P, Conti J, Bandara RSL, Hay P. “It exists”: An exploratory study of treatment experiences in men with eating disorders. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1111/ap.12455] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Priyanka Thapliyal
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, New South Wales, Australia,
| | - Janet Conti
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, New South Wales, Australia,
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia,
| | - Ranidu S. L. Bandara
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia,
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, New South Wales, Australia,
- Camden and Campbelltown Hospitals (SWSLHD), Sydney, New South Wales, Australia,
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9
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Thapliyal P, Mitchison D, Mond J, Hay P. Gender and help-seeking for an eating disorder: findings from a general population sample. Eat Weight Disord 2020; 25:215-220. [PMID: 30066257 DOI: 10.1007/s40519-018-0555-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/24/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aimed to compare gender differences in eating disorder (ED) features and to examine the role of gender as a predictor of ED help-seeking controlling for other putative determinants, namely weight/shape overvaluation, age, BMI, and impairment in role functioning. METHODS Demographic, ED symptoms, and related data were collected during household interviews of individuals aged ≥ 15 years. One hundred and forty-eight participants (164 after data were weighted) with an ED syndrome were identified. RESULTS Compared to women, men with an ED were younger and had lower levels of purging and overvaluation. However, men and women with an ED had similar levels of functional impairment, binge eating and strict dieting. In univariate analyses, males in general, but not males with an ED, were significantly less likely than females to seek help for an ED. In multivariate analysis of people with an ED, only BMI was significantly associated with treatment-seeking. CONCLUSION Functional health impairment and common ED behaviours were similar for men and women with EDs. Gender may not be a primary reason to be more or less likely to seek help for an ED. Rather, other features, most notably, a higher BMI, appear to be stronger predictors of ED-specific help-seeking. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Priyanka Thapliyal
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Deborah Mitchison
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Jonathan Mond
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Centre for Rural Health, School of Health Sciences, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Kinnaird E, Norton C, Pimblett C, Stewart C, Tchanturia K. "There's nothing there for guys". Do men with eating disorders want treatment adaptations? A qualitative study. Eat Weight Disord 2019; 24:845-852. [PMID: 31471886 PMCID: PMC6751275 DOI: 10.1007/s40519-019-00770-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/12/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Men with eating disorders may experience unique issues compared to their female counterparts, and there is a growing interest in how these differences should be addressed in clinical practice. However, the views of male patients on potential treatment adaptations remain under-explored. The purpose of this study was to explore the experiences of men who have experienced treatment for eating disorders. METHODS Men who had experienced eating disorder treatment were recruited through UK National Health Service eating disorder services and online advertising. 14 participants took part in semi-structured interviews discussing their experiences of treatment, and their views on the need for adaptations. Interviews were analysed using thematic analysis. RESULTS Three main themes were identified from the analysis: a preference for person-centred, rather than gender-centred treatment, a feeling of being "the odd one out" as men in current treatment environments, and recommendations for treatment adaptations. CONCLUSIONS Participants described wanting to be treated as individuals and not defined by their gender. Whilst existing treatment approaches were mostly felt to achieve this individual focus, the actual treatment setting may inadvertently reinforce a perception of atypicality due to being men in a female-dominated environment. Adaptations may therefore be required to make the treatment environment more male friendly. Clinical recommendations are outlined. LEVEL OF EVIDENCE V. Qualitative study.
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Affiliation(s)
- Emma Kinnaird
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, SE5 8AZ, London, UK
| | | | | | - Catherine Stewart
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, SE5 8AZ, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, SE5 8AZ, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Illia State University, Tbilisi, Georgia.
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11
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Nutley S, Varma D, Chen X, Striley CW. Willingness of individuals with eating disorders to participate in health research. Int J Eat Disord 2019; 52:914-923. [PMID: 31063267 PMCID: PMC8136836 DOI: 10.1002/eat.23090] [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: 12/08/2018] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND/AIMS This study examines the association between eating disorders (EDs) and willingness to participate in health research studies among community members. MATERIALS & METHOD Data were collected from Health Street, a University of Florida community engagement initiative which aims to reduce disparities in healthcare and health research by direct engagement of community members. RESULTS Among 8,226 community members, 3.9% (n = 324) reported a lifetime ED. For all six types of health research studies queried, individuals with a lifetime ED reported a higher willingness to participate in health research compared to individuals without a history. After adjusting for selected covariates, individuals with ED were significantly more likely than individuals without ED to say they would be willing to volunteer for research studies that: ask questions about health (OR: 7.601, 95% CI: [1.874, 30.839]); require an overnight stay in a hospital (OR: 2.041, 95% CI: [1.442, 2.889]); and provide no remuneration (OR: 1.415, 95% CI: [1.022, 1.958]). Furthermore, when compared to individuals with anxiety or depression, individuals with ED reported increased interest in research participation and increased willingness to participate in most types of research studies assessed. After stratifying by gender and race, we observed few differences in willingness to participate in research among individuals with ED. DISCUSSION These findings contribute to our current understanding of participant recruitment and enrollment in ED health research. Underrepresented populations who often do not seek treatment for EDs endorsed a high willingness to participate. CONCLUSION Future studies will likely benefit from including community members in ED research.
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Affiliation(s)
- Sara Nutley
- Department of EpidemiologyUniversity of Florida Gainesville Florida
| | - Deepthi Varma
- Department of EpidemiologyUniversity of Florida Gainesville Florida
| | - Xinguang Chen
- Department of EpidemiologyUniversity of Florida Gainesville Florida
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12
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Coffino JA, Udo T, Grilo CM. Rates of Help-Seeking in US Adults With Lifetime DSM-5 Eating Disorders: Prevalence Across Diagnoses and Differences by Sex and Ethnicity/Race. Mayo Clin Proc 2019; 94:1415-1426. [PMID: 31324401 PMCID: PMC6706865 DOI: 10.1016/j.mayocp.2019.02.030] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate, in a nationally representative sample of US adults, the prevalence of help-seeking in individuals with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) eating disorders (EDs) and to examine sex and ethnic/racial differences. PATIENTS AND METHODS The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N=36,309) included respondents who met the criteria for specific lifetime DSM-5 EDs and answered questions regarding help-seeking for their ED symptoms (anorexia nervosa [AN]: n=275; bulimia nervosa [BN]: n=91; and binge-eating disorder [BED]: n=256). RESULTS The prevalence (standard error) estimates of ever seeking any help for AN, BN, and BED were 34.5% (2.80%), 62.6% (5.36%), and 49.0% (3.74%), respectively. Adjusting for sociodemographic characteristics, men and ethnic/racial minorities (non-Hispanic blacks and Hispanics) were statistically significantly less likely to ever seek help for BED than were women or non-Hispanic whites, respectively. Hispanics also were significantly less likely to seek help for AN relative to non-Hispanic whites. CONCLUSION This was the first study in a nationally representative sample of US adults to examine rates of help-seeking, including by sex and ethnic/racial differences, across DSM-5-defined EDs. These findings emphasize the need to develop strategies to encourage help-seeking among individuals with EDs, particularly among men and ethnic/racial minorities.
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Affiliation(s)
- Jaime A Coffino
- Department of Psychology, University at Albany, State University of New York, Albany, NY; Department of Psychiatry, Yale School of Medicine, New Haven, CT.
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Recio-Barbero M, Fuertes-Soriano S, Cabezas-Garduño J, López-Atanes M, Peña-Rotella A, Sáenz-Herrero M. Delayed Diagnosis of an Eating Disorder in a Male Patient With Superior Mesenteric Artery Syndrome: Results From a Case Study. Front Psychiatry 2019; 10:731. [PMID: 31681041 PMCID: PMC6803474 DOI: 10.3389/fpsyt.2019.00731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Eating disorders (EDs) are serious and life-threatening mental diseases characterized by abnormal or altered eating habits. The prevalence is variable, being influenced by diverse sociocultural factors. Historically, the prevalence of EDs has been higher in women (90%), although the incidence of these disorders in men appears to be increasing. In daily medical practice, when considering the presentation of other medical complications associated to the development of an ED, few is known about its real prevalence in men. Among them, some severe gastrointestinal complications that are rarely presented, such as the superior mesenteric artery syndrome (SMAS), can produce life-threatening results. Despite that, very few cases of men presenting this pathology are reported in literature. Case Presentation: A 38-year-old man without a history of psychiatric disease was admitted to the emergency department with nausea, abdominal pain, and severe malnutrition (body mass index 15.7 kg/m2). He was diagnosed with SMAS and was studied by multiple specialists on suspicion of a probable organic origin of his thinning. The suspected diagnosis of ED was rejected for months by some professionals, as well as by the patient and his family, until it was finally diagnosed with unspecified feeding and eating disorder (USFED). Conclusion: This case represents an example of diagnostic challenge where a delayed diagnosis of an ED in a male patient was made probably due to gender bias in clinical research and practice. In the literature, numerous reports were described in women diagnosed with SMAS with a previous diagnosis of an ED; however, few cases were found in men. In this clinical case, the patient suffered a significant diagnostic delay, probably due to the lack of diagnostic suspicion given by the differences in the prevalence and clinical presentation of EDs in women and men.
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Affiliation(s)
- María Recio-Barbero
- Department of Psychiatry, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Department of Neurosciences, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Sara Fuertes-Soriano
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Janire Cabezas-Garduño
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Mayte López-Atanes
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Alvar Peña-Rotella
- Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
| | - Margarita Sáenz-Herrero
- Department of Psychiatry, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Department of Neurosciences, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain.,Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health Service, Barakaldo, Spain
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14
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Grillot CL, Keel PK. Barriers to seeking treatment for eating disorders: The role of self-recognition in understanding gender disparities in who seeks help. Int J Eat Disord 2018; 51:1285-1289. [PMID: 30488569 DOI: 10.1002/eat.22965] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Previous research suggests that men with eating disorders are less likely to seek treatment than are women. Given stereotypes linked to eating disorders, men may be less likely to recognize when they have an eating disorder, which could act as a barrier to treatment-seeking. METHOD The current study examined differences in self-recognition and treatment-seeking behavior by gender, controlling for other covariates, in participants with probable DSM-5 eating disorders drawn from a larger community-based sample. RESULTS Being female and self-recognition were both associated with increased likelihood of treatment-seeking while accounting for other potential covariates, including race/ethnicity, age, BMI, and comorbid disorders. DISCUSSION Results indicate that self-recognition is a barrier to seeking treatment for both genders and does not account for help-seeking differences between women and men. Findings have implications for interventions to address barriers to treatment-seeking for eating disorders.
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Affiliation(s)
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
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Thapliyal P, Hay P, Conti J. Role of gender in the treatment experiences of people with an eating disorder: a metasynthesis. J Eat Disord 2018; 6:18. [PMID: 30123504 PMCID: PMC6088416 DOI: 10.1186/s40337-018-0207-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/11/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Traditionally perceived as a disorder of women, Eating Disorders (EDs) are known to have impacts on people irrespective of their gender. This study is designed to synthesise the available qualitative research studies to more broadly understand the diverse experiences of ED and their treatment, specifically in relationship to issues of gender. METHODS The methodology involved a systematic search and quality appraisal of the literature published after 1980 using terms that aimed to represent the primary concepts of "role of gender" and "treatment experiences" and "eating disorders". Nine qualitative studies met the inclusion criteria. Meta-themes were inductively generated through a synthesis of data across themes from the relevant included papers. RESULTS Analysis of data was constructed around three meta-themes, each with subthemes. The first meta-theme "Out of sight, out of mind" depicted the experience of gender issues that were marginalised in treatment. More specifically for transgender people, when gender issues were ignored by treatment providers, this frequently led to non-disclosure of their gender identity. Furthermore, men were less likely to be assessed for an eating disorder and within this context; diagnosis of an ED and referral to specialist treatment was frequently hindered. The second meta-theme "Lack of literacy among health care providers" focused on issues related to misdiagnosis of EDs, and the question of whether this was related to a lack of health literacy amongst health professionals. The final theme "Pathways into treatment that address stigma and other barriers" highlighted the need for the development of future treatment interventions address the complex social reality of the experiencing person, including questions of gender. CONCLUSION Gender issues impact upon the ED experience and require broader consideration in the development and evaluation of ED treatment interventions, including the further development of gender-informed interventions. TRIAL REGISTRATION Protocol registered on PROSPERO 2017 CRD42017082616.
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Affiliation(s)
- Priyanka Thapliyal
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Sydney, NSW Australia
| | - Janet Conti
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW Australia
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Abstract
OBJECTIVES Despite traditional views of eating disorders as a female illness, there is a growing body of evidence that the incidence rate of eating disorders in men is rising. Research suggests that these men may experience unique symptoms and difficulties, however, it is unclear how these unique needs may impact treatment. The aim of this study was to explore clinicians' views on whether men have gender-specific treatment needs, and how far these needs require treatment adaptations. DESIGN Qualitative interview study using framework analysis to explore the experiences of clinicians working with men with eating disorders. SETTING Outpatient National Health Service eating disorder service in London. PARTICIPANTS Ten clinicians from a variety of clinical backgrounds participated in the study. RESULTS The following three themes emerged: male-specific issues identified by clinicians, treatment approaches used for this population and the importance of creating a male-friendly environment. Male-specific issues identified by participants included an increased focus on muscularity and difficulty expressing or discussing emotion. Clinicians also suggested that men may be more likely to adopt a performance-based approach to. This was linked by clinicians to the impact of cultural perceptions of masculinity on their patients. Clinicians in this study felt that these individual needs could be met by adapting existing approaches within a supportive, male-friendly environment. However, there was not consensus over specific adaptations, including identifying risk, the need for male-only groups, or whether male patients needed access to male clinicians. CONCLUSIONS Although men do present with specific treatment needs, these can typically be met within the framework of typical treatment approaches by experienced clinicians in an environment sensitive to the presence of men in an otherwise female-dominated space. However, there are a lack of explicit guidelines for this process, and areas such as male-only treatment spaces require further research.
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Affiliation(s)
- Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Caroline Norton
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Arts and Sciences, Ilia State University, Tbilisi, Georgia
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17
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Thapliyal P, Mitchison D, Miller C, Bowden J, Alejandro González-Chica D, Stocks N, Touyz S, Hay P. Comparison of mental health treatment status and use of antidepressants in men and women with eating disorders. Eat Disord 2018; 26:248-262. [PMID: 29161184 DOI: 10.1080/10640266.2017.1383788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Mental health treatment status and antidepressant use were investigated among men and women with an eating disorder (ED) who were interviewed in a general population survey of 3005 adults (aged ≥15 years). Compared to women, men with an ED were significantly less likely to receive treatment for a mental health problem or to be currently using an antidepressant. On multivariate analyses, female gender, lower mental health-related quality of life, and lower weight/shape overvaluation were significant predictors of receiving treatment and antidepressant use. Treatment was less likely in men and in people with higher ED cognitions.
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Affiliation(s)
- Priyanka Thapliyal
- a Translational Health Research Institute (THRI), School of Medicine , Western Sydney University , Sydney , Australia
| | - Deborah Mitchison
- b Centre for Emotional Health, Department of Psychology , Macquarie University, Sydney, Australia, and School of Medicine, Western Sydney University , Sydney , Australia
| | - Caroline Miller
- c School of Public Health , The University of Adelaide , Adelaide , Australia
| | - Jacqueline Bowden
- d Population Health Research Group , South Australian Health and Medical Research Institute (SAHMRI) , Adelaide , Australia
| | - David Alejandro González-Chica
- e Discipline of General Practice, Adelaide Medical School, NHMRCCentre of Research Excellence to Reduce Inequality in Heart Disease , The University of Adelaide , Adelaide , Australia
| | - Nigel Stocks
- e Discipline of General Practice, Adelaide Medical School, NHMRCCentre of Research Excellence to Reduce Inequality in Heart Disease , The University of Adelaide , Adelaide , Australia
| | - Stephen Touyz
- f School of Psychology, Faculty of Science , the University of Sydney , Camperdown , Australia
| | - Phillipa Hay
- a Translational Health Research Institute (THRI), School of Medicine , Western Sydney University , Sydney , Australia
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18
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Holmes S, Drake S, Odgers K, Wilson J. Feminist approaches to Anorexia Nervosa: a qualitative study of a treatment group. J Eat Disord 2017; 5:36. [PMID: 29158897 PMCID: PMC5682639 DOI: 10.1186/s40337-017-0166-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/17/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are now often approached as biopsychosocial problems. But it has been suggested by scholars interested in sociocultural factors that all is not equal within this biospsychosocial framework, with the 'social' aspects of the equation relegated to secondary factors within ED treatment contexts. Although sociocultural influences are well-established as risk factors for EDs, the exploration of whether or how such perspectives are useful in treatment has been little explored. In responding to this context, this article seeks to discuss and evaluate a 10 week closed group intervention based on feminist approaches to EDs at a residential eating disorder clinic in the East of England. METHODS The data was collected via one-to-one qualitative interviews and then analysed using thematic discourse analysis. RESULTS The participants suggested that the groups were helpful in enabling them to situate their problem within a broader cultural and group context, that they could operate as a form of 'protection' from ideologies regarding femininity, and that a focus on the societal contexts for EDs could potentially reduce feelings of self-blame. At the same time, the research pointed to the complexities of participants considering societal rather than individualised explanations for their problems, whilst it also confronted the implications of ambivalent responses toward feminism. CONCLUSIONS Highly visible sociocultural factors in EDs - such as gender - may often be overlooked in ED clinical contexts. Although based on limited data, this research raises questions about the marginalisation of sociocultural factors in treatment, and the benefits and challenges including the latter may involve.
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Affiliation(s)
- Su Holmes
- Department of FTM, University of East Anglia, Norwich, NR4 7TJ UK
| | - Sarah Drake
- School of HSC, University of East Anglia, Norwich, NR4 7TJ UK
| | - Kelsey Odgers
- Norfolk and Suffolk Foundation Trust, 80 St Stephens Road, Norwich, NR1 3RE UK
| | - Jon Wilson
- Norfolk and Suffolk Foundation Trust, 80 St Stephens Road, Norwich, NR1 3RE UK
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19
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Forrest LN, Smith AR, Swanson SA. Characteristics of seeking treatment among U.S. adolescents with eating disorders. Int J Eat Disord 2017; 50:826-833. [PMID: 28323350 DOI: 10.1002/eat.22702] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/20/2017] [Accepted: 02/26/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The majority of persons with eating disorders (EDs) do not seek ED treatment, yet little is known about treatment-seeking barriers or facilitators. The aim of the study is to describe the characteristics associated with seeking ED treatment among U.S. adolescents with EDs. METHOD Data from a nationally representative cross-sectional study of U.S. adolescents ages 13-18 years were used for these analyses. Specifically, adolescents who met criteria for lifetime EDs (N = 281) were included. Sociodemographic information, characteristics of EDs, psychiatric comorbidities, and other mental health service use were assessed via interview. RESULTS Only 20% of adolescents sought ED treatment. Females were 2.2 (95% CI 0.8, 6.4) times more likely to seek treatment than males (19.9% vs. 8.9%). Adolescents who met criteria for anorexia nervosa or bulimia nervosa were 2.4 (95% CI 0.9, 6.3) and 1.9 (95% CI 1.0, 3.8) times more likely to seek treatment than adolescents who met criteria for binge-eating disorder (27.5% and 22.3% vs. 11.6%). Specific ED behaviors (restriction and purging), ED-related impairment, and any mental health service use were also associated with adolescent treatment seeking. DISCUSSION Adolescent treatment seeking was infrequent overall, with individuals with counter-stereotypic ED presentations least likely to have sought treatment. Adolescent treatment seeking could be promoted through increasing awareness among the public and healthcare professionals that EDs affect a heterogeneous group of people. More generally, research involving both treatment-seeking and non-treatment-seeking individuals holds great potential to refine the field's knowledge of ED etiology, prevalence, treatment, and prevention.
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Affiliation(s)
| | - April R Smith
- Department of Psychology, Miami University, Oxford, Ohio
| | - Sonja A Swanson
- Erasmus MC, Rotterdam, The Netherlands.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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20
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Thapliyal P, Mitchison D, Hay P. Insights into the Experiences of Treatment for An Eating Disorder in Men: A Qualitative Study of Autobiographies. Behav Sci (Basel) 2017. [PMID: 28621727 PMCID: PMC5485468 DOI: 10.3390/bs7020038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Eating disorders are increasingly recognized as a problem for men but help-seeking is low and little is known about their treatment experiences. This paper sought to determine the treatment experiences of men who have suffered from an eating disorder using autobiographical data. Inclusion criteria were autobiographies of men who had experienced an eating disorder and sought any form of treatment for this, written in the English language, published between 1995 and 2015, and available for purchase in 2016. The search resulted in six books that were thematically analyzed. Analysis of data resulted in two broad themes (1. Positive experiences; 2. Negative experiences) with sub-themes. With regards to the first theme, factors such as concern of staff members, therapist’s expertise (in treating eating disorders in men), and a collaborative treatment approach were considered favorable for treatment. In contrast to the first theme, apathy of staff members, the authors’ own negative preconceptions, treatment providers being perceived as prioritizing financial concerns, perceived as incompetent and judgmental behavior of therapist(s), and time limitations of sessions were considered unfavorable treatment experiences. In this study, the perceived success of treatment depended on therapist’s features and the form of treatment provided. Further research examining these is indicated.
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Affiliation(s)
- Priyanka Thapliyal
- Translational Health Research Institute, School of Medicine, Western Sydney University, Building 3.G.P9, Locked Bag 1797, Penrith NSW 2751, Australia; p.hay@ westernsydney.edu.au.
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Building 3.G.P9, Locked Bag 1797, Penrith NSW 2751, Australia; p.hay@ westernsydney.edu.au
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21
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Cibralic S, Conti JE. “I'm More Acknowledged”: A Qualitative Exploration of Men's Positioning of their Body Image, Eating, and Exercise Concerns. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2017. [DOI: 10.1080/10720537.2017.1304298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sara Cibralic
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Janet E. Conti
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
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Boon E, Zainal KA, Touyz SW. Perceptions of eating disorder diagnoses and body image issues in four male cases in Singapore. J Eat Disord 2017; 5:33. [PMID: 29075493 PMCID: PMC5649072 DOI: 10.1186/s40337-017-0159-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/08/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite the increasing number of patients presenting for treatment, little is still known about male eating disorders cases. The current study presents four male eating disorder cases presented to our specialized treatment facility in Singapore. CASE PRESENTATION Cases 1, 2 and 3 are homosexual males in their twenties and thirties who presented with anorexia nervosa and bulimia nervosa. Case 4 is a heterosexual male in his twenties diagnosed with binge eating disorder. All four cases expressed body image dissatisfaction, fat phobia and fear of weight gain. Additionally, all of them sought treatment because of comorbid psychiatric conditions or parental wishes. Premorbid obesity and homosexual orientation may be potential risk factors for males in developing eating disorders. CONCLUSIONS These findings suggest that more exploration needs to be done for males diagnosed with eating disorders, particularly in the Asian society. A deeper understanding into factors associated with symptom presentation and treatment-seeking behaviors would greatly assist in informing the direction and focus of treatment in the region.
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Affiliation(s)
- Evelyn Boon
- Department of Psychiatry, Singapore General Hospital, 226 Outram Road, Singapore, 169039 Singapore
| | - Kelly Ann Zainal
- Department of Psychiatry, Singapore General Hospital, 226 Outram Road, Singapore, 169039 Singapore
| | - Stephen W Touyz
- School of Psychology, University of Sydney, Sydney, Australia
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23
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Eating disorders in men aged midlife and beyond. Maturitas 2015; 81:248-55. [DOI: 10.1016/j.maturitas.2015.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 11/20/2022]
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Hay P, Girosi F, Mond J. Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Disord 2015; 3:19. [PMID: 25914826 PMCID: PMC4408592 DOI: 10.1186/s40337-015-0056-0] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 04/02/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND New DSM-5 diagnostic criteria for eating disorders were published in 2013. Adolescent cohort studies in the Australian community indicate that the point prevalence of DSM-5 eating disorders may be as high as 15% in females and 3% in males. The goal of the current study was to determine the 3-month prevalence of DSM-5 disorders in a representative sample of Australian older adolescents and adults. A secondary aim was to explore the demographic correlates of these disorders, specifically, age, gender, income, and educational attainment and presence of obesity. METHODS We conducted and merged sequential cross-sectional population survey data of adults (aged over 15 years) collected in 2008 and in 2009 (n = 6041). Demographic information and the occurrence of regular (at least weekly over the past 3 months) objective and subjective binge eating, extreme dietary restriction, purging behaviors, and overvaluation of weight and/or shape, were assessed. RESULTS The 3-month prevalence of anorexia nervosa and bulimia nervosa were both under 1% whereas the prevalence of binge eating disorder (BED) and sub-threshold BED were 5.6-6.9%. The prevalence of BED including overvaluation of weight/shape was 3%. Other specified and unspecified eating disorders including purging disorder were less common, under 1% to 1.4%. While people with eating disorders were generally younger than others, the mean age was in the fourth decade for anorexia nervosa and bulimia nervosa and in the fourth or fifth decade for all other disorders. Most people with eating disorders had similar household incomes and educational attainments to the general population. People with bulimia nervosa, BED and sub-threshold bulimia nervosa were more likely to be obese than people without an eating disorder. CONCLUSIONS The findings support the expanded demographic distribution of eating disorders. There is a relatively high prevalence of BED compared to anorexia nervosa and bulimia nervosa. As it is in BED, obesity is a very common co-morbidity in bulimia nervosa.
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Affiliation(s)
- Phillipa Hay
- Centre for Health Research, School of Medicine, University of Western Sydney, Sydney, New South Wales Australia ; School of Medicine, James Cook University, Townsville, Queensland Australia
| | - Federico Girosi
- Centre for Health Research, School of Medicine, University of Western Sydney, Sydney, New South Wales Australia
| | - Jonathan Mond
- Department of Psychology, Macquarie University, Sydney, Australia, and School of Medicine, University of Western Sydney, Sydney, New South Wales Australia
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Mitchison D, Mond J. Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: a narrative review. J Eat Disord 2015; 3:20. [PMID: 27408719 PMCID: PMC4940910 DOI: 10.1186/s40337-015-0058-y] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/04/2015] [Indexed: 11/10/2022] Open
Abstract
Challenges to epidemiological studies of eating and related body image disturbance disorders in males include, in addition to low base rates and the predominance of residual diagnostic categories, the female-centric nature of current classification schemes and the consequent lack of appropriate assessment instruments. In this narrative review, we summarise epidemiological data regarding the prevalence and correlates of eating disorders, related body image disturbance disorders, and eating disorder features in males. Attention is focused on disorders most likely to be observed among males, such as muscle dysmorphia and muscularity-oriented excessive exercise. It is argued that, given the multiple challenges involved in research of this kind, a focus on features is more likely to advance the field than a focus on diagnoses. In terms of correlates, we focus on impairment and help-seeking, since these issues are most relevant in informing public health burden, service provision, and related issues. We end with some thoughts about current gaps in the knowledge base and directions for future research that we consider to be most promising.
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Affiliation(s)
- Deborah Mitchison
- School of Medicine, University of Western Sydney, Sydney, Australia ; Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- School of Medicine, University of Western Sydney, Sydney, Australia ; Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, Australia ; Research School of Psychology, Australian National University, Sydney, Australia
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