Eating Disorder Sufferers Research Articles

Potential of CPP-ACP and cranberry proantho-cyanidin chewing gum for remineralization of perimylolysis in eating disorders patients

Background: Eating disorder (ED) is characterized by abnormalities in the pattern, amount, and nature of food eaten. Recent studies confirm the high prevalence of ED worldwide, which has increased significantly from 3.5% to 7.8% in the last 18 years. One of the common symptoms of ED sufferers is intentional vomiting, which can lower the pH of the oral cavity and induce perimylolysis. A new challenge is finding an innovation to alleviate perimylolysis in ED patients regarding behavior and dental treatment. Material and Methods: The literature review was carried out in PUBMED, ResearchGate, and ScienceDirect with the keywords: CPP-ACP, proanthocyanidin, chewing gum, eating disorder. Conclusions: Chewing gum containing CPP-ACP and proanthocyanidins from cranberries has been shown to have remineralization potential to help relieve perimylolysis in ED patients from a behavioral and dental perspective.

Ninety Minutes of Freedom: An Interpretative Phenomenological Analysis of the Role that Sport Plays on an Athlete with an Eating Disorder

<i>Eating disorders (ED) are serious and potentially life-treating mental disorders that affect millions of individuals worldwide. Researchers have indicated that athletes who participate in sports are at a greater risk of developing an ED than members of the general population. Previous research has focused on investigating the prevalence and symptomatology of eating disorder sufferers. Limited qualitative research has sought to analyze the lived experiences of patients and especially athletes with an ED. Therefore, the purpose of this research is to provide a platform for an athlete who was clinically diagnosed with an ED to share their story and highlight how playing a sport affected their condition. Semi-structured interviews were conducted with one female athlete who participated in a non-weight-centered sport. Interpretative phenomenological analysis was used to understand the experiences of the athlete and investigate how participation in a competitive sport impacted their eating disorder. Four superordinate themes emerged from the data: family dysfunction, life transitions, control over emotions, and social support needs. The findings from this study were atypical in comparison to current research. Although participating in football exacerbated the symptoms of the participant’s eating disorder, it was not involved in the aetiology as previous research has indicated. Football provided the participant with an outlet to separate from the powerful stressors she faced. </i>

Classification of Twitter users with eating disorder engagement: Learning from the biographies

Individuals with an Eating Disorder (ED) are typically reluctant to seek help via traditional means (e.g., psychologists). However, recent evidence suggests that many individuals seek assistance via social media for weight and diet related concerns. Sophisticated approaches are needed to better distinguish those who may be in need of help for an ED from those who are simply commenting on ED in online social environments. In order to facilitate effective communication between individuals with or at-risk of an ED and healthcare professionals, this research exploits a deep learning model to differentiate the users with ED engagement (e.g., ED sufferers, healthcare professionals or communicators) over social media. For this purpose, a collection of Twitter data is compiled using Twitter application programming interface (API) on the Australian Research Data Commons (ARDC) Nectar research cloud. After collecting 1,400,000 Twitter biographies in total, a subset of 4000 biographies are annotated manually. This annotation enables the differentiation of users engaged with ED-focused language on social media into five categories: ED-user, healthcare professional, communicator, healthcare professional-communicator, and other. Based on these annotated categories, a predictive deep learning model based on bidirectional encoder representations from transformers (BERT) and long short-term memory (LSTM) is developed. The model achieves an F1 score of 98.19% and an accuracy of 98.37%. It demonstrates the viability of detecting the individuals with possible ED risk and distinguishes them from other categories using their biography data. We further conducted a network analysis for investigating the communication network between these categories. Our analysis shows that ED-users are more secretive and self-protective, whereas the healthcare professionals and communicators frequently interact with each other and a wide range of other people. To the best of our knowledge, our research is the first of its kind for identifying the different user categories engaged with ED-focused communications on social media.

The minority or the misunderstood? A young man's journey with anorexia nervosa.

Despite findings that 1 in 4 eating disorder sufferers are male (Beat, 2017), they continue to be known as "female" disorders, an association which delays diagnosis in males and prevents them from seeking the help that they need to recover. The current paper aimed to challenge this misconception by enabling and supporting Ben, a young male diagnosed with Anorexia Nervosa aged 16, to share his experience of seeking and receiving treatment for the disorder. It achieved this by exploring how his disorder developed, his experience of a child and adolescent inpatient service and the events leading up to this, and his life post-discharge, all in collaboration with Ben himself and using his own words. The paper concludes with some implications for future practice, including that eating disorders should not be skewed towards any gender, treatment programmes need to ensure full inclusivity of males, and more gender sensitive information is required to raise awareness of this population and thus reduce the stigma and isolation they experience at present. It is hoped that these, along with the rest of the paper, will be accessible to and utilized by both professionals and non-professionals alike. ● Around one quarter of people diagnosed with an eating disorder are male, yet they continue to be known as "female" disorders. Because of this, young males are often missed by the system and as a result, receive treatment later than they should. They are currently underrepresented in services. ● This paper challenges the association above by supporting a young man who suffered with a type of eating disorder known as Anorexia Nervosa to share his journey from his personal perspective. It provides great insight into what it is like to be a male with an eating disorder, including how it felt to be the only male in an inpatient facility surrounded by females with the same disorder. ● The paper also provides important information for professionals working in the area. For example, eating disorders, including Anorexia Nervosa, should not be associated with one specific gender, and treatment programmes for young people with eating disorders should ensure they are appropriate for both females and males. As a society, we need to challenge the stigma which exists for males in admitting when they are struggling and asking for help, and we need to do everything we can to ensure that young men are picked up earlier in the system, in order to give them the best chance of recovery. ● It is hoped that Ben's story and the recommendations from it can go on to help other males who might be struggling.

Schema therapy for eating disorders with complexity and comorbidity

High levels of comorbidity and complexity amongst eating disorder sufferers is associated with reduced treatment effectiveness and higher dropout. There is an urgent need for research into transdiagnostic treatment models that address comorbidity, particularly rigid personality traits and disorders, alongside eating disorder pathology. Schema therapy may be ideally suited due to its growing evidence base both for eating disorders and the comorbidities that often interfere with outcomes with this population.

The economic cost of bulimia nervosa and binge eating disorder: a population-based study.

The most common eating disorders (EDs) are bulimia nervosa (BN) and binge eating disorder (BED), serious psychiatric illnesses that have devastating effects on the physical and psychological wellbeing of sufferers. EDs range in complexity and severity but can be life-threatening without appropriate treatment. Although it is well-known that quality of life impacts is high for ED sufferers, research regarding fiscal and related costs is severely limited. The aim of this study was to understand economic and other costs of EDs at the community level. Data were derived from 2017 household community representative structured interview of 2977 people aged ⩾ 15 years in South Australia. ED diagnoses, health systems, productivity, transaction, out-of-pocket expenses and other related costs of BN and BED were used to estimate the economic burden of EDs in South Australia. The annual total economic cost of EDs in 2018 was estimated at $84 billion for South Australia. This included $81 billion from the burden of disease as the result of years lived with disability (YLD) ($62 billion) and years of life lost ($19 billion). The health system costs, productivity and tax revenue loss to the Australian economy were estimated at $1 billion, $1.6 billion and $0.6 billion, respectively. The YLD average cost in 2018 in South Australia was $296 649 per person. This is two-thirds of the costs borne by individuals and the wider economy. Prevention and management initiatives for EDs need to take into account these costs when assessing their potential benefits.

Development and validation of the Premorbid Childhood Traits Questionnaire (PCT-Q) in eating disorders.

Some features of eating disorders (EDs) are often present in childhood before the onset of the ED. We developed a novel questionnaire to retrospectively capture such childhood traits. Focus groups were conducted at the University of California-San Diego, USA, and at the University of Turin, Italy. Three focus groups were conducted at each site, interviewing patients and parents to identify those traits that most commonly characterize childhood of patients with EDs. A preliminary version of the Premorbid Childhood Traits Questionnaire (PCT-Q) derived from these focus groups was then administered to 94 consecutive inpatients with an ED and to 286 healthy controls (HCs) at the Turin site. Also, 208 participants' parents were enrolled as well; in fact, the PCT-Q was developed with both a proband and an informant version. A 37-item final version of the PCT-Q was generated. Reliability analyses suggested acceptability for harm avoidance (HA), social phobia, alexithymia, interoceptive awareness (IA), and food obsessions. Inter-rater reliability ranged from fair to moderate. ED sufferers scored significantly higher than HCs on HA, social phobia, alexithymia, IA, and food obsessions. These findings support the possibility that premorbid traits contribute to a risk to develop an ED in some individuals. III: case-control analytic study.

Eating Disorder Patient Experiences of Volitional Stigma Within the Healthcare System and Views on Biogenetic Framing: A Qualitative Perspective

ObjectiveResearch has consistently indicated that fear of stigma is a pertinent factor when understanding the poor prevalence of treatment seeking among individuals with mental illness, particularly eating disorders (EDs). The purpose of this study was to investigate the treatment experiences of ED sufferers within an Australian context, in addition to exploring patient views on framing EDs as biogenetic conditions, given the increased understanding and presentation of EDs as biologically based conditions.MethodsSemi‐structured online data collection was conducted with 35 Australian women with a history of an ED (54.3% in treatment, 45.7% in “recovery” or “recovered”). The data were evaluated using a three‐phased coding system, allowing findings to emerge from significant themes inherent within the raw data (thematic analysis).ResultsTreatment was perceived as traumatic, punitive, blaming, lacking in understanding/education, and overemphasised the physical dimensions of the illness. The experience of volitional stigma in the healthcare system was frequent and expected, and for many sufferers had adverse effects. Biogenetic framing was perceived to be more likely to reduce (rather than exacerbate) stigma, particularly perceptions of volition and personal responsibility. Although reductions in blame and responsibility were welcomed, there was concern that biogenetic explanations could negatively impact recovery by endorsing genetic fatalism and encouraging self‐fulfilling prophecies via genetic essentialism.ConclusionsOverall, findings highlight that attention to volitional stigma within the health system is required (particularly education) and that aetiological framing (with caution and sensitivity) is perceived to be a feasible stigma reduction method by ED sufferers.

From eating identity to authentic selfhood: Identity transformation in eating disorder sufferers following psychotherapy

BackgroundThe following article illustrates the development of the identity configuration process of Chilean female patients with an eating disorder (ED) following successful psychotherapeutic treatment.MethodThis was a qualitative, descriptive study, which explored patients' subjective perspectives. In‐depth interviews were conducted with 20 female patients, and data were analysed according to procedures established by the Grounded Theory method.ResultsFour dimensions of identity were identified: (1) self‐image as idealised versus imperfect; (2) knowledge of one's inner world; (3) impulse control; and (4) life goals. Transcending these themes was the central notion of identity and a shift in this identity from someone who defines themselves by their eating disorder toward a more authentic and complex sense of self.ConclusionResults suggest that successful treatment facilitates the construction of an authentic identity, which includes developing a more realistic and complex understanding of themselves and their emotional and physical needs.

Family, Friends, and Romantic Partners of Eating Disorder Sufferers

Individuals who reported having a friend, family member, or romantic partner with current eating disorder symptoms ( n = 82) participated in this study. Participants documented the types of spiritual/religious coping strategies they used when coping with the stress of being close to an eating disorder sufferer. Following correlation analyses, we found a significant association between two types of negative spiritual/religious coping (spiritual discontent religious coping and punishing God/Higher Power reappraisal religious coping) and increased depression. In a regression analysis, only spiritual discontent religious coping remained significantly linked with depression. Clinicians who work with clients who are close to eating disorder sufferers can draw on these findings to inform therapeutic interventions.

Development, psychometric properties and preliminary clinical validation of a brief, session-by-session measure of eating disorder cognitions and behaviors: The ED-15.

In the treatment research literature on other psychological disorders, there is a move towards session-by-session symptom measurement. The necessary measures need to be brief, focused on core features since the last session, and readily available to clinicians. There is no measure in the eating disorders that meets those criteria. This research reports the development and validation of such a self-report questionnaire. The authors generated and refined a brief set of attitudinal and behavioral items. The resulting questionnaire (the ED-15) and an existing measure (Eating Disorders Examination-Questionnaire; EDE-Q) were completed by a large nonclinical adult sample (N = 531), a group of self-reported eating disorder sufferers (N = 63), and a group of women (N = 33) diagnosed with bulimia nervosa or atypical bulimia nervosa and undertaking cognitive-behavioral therapy. Factor analysis identified two scales (Weight and Shape Concerns; Eating Concerns), with strong internal consistency and test-retest reliability. Correlations with the EDE-Q (r = 0.889) indicates that the ED-15 and EDE-Q measure near-identical constructs. The ED-15 differentiated self-reported eating-disordered and nonclinical groups to the same degree as the longer EDE-Q. Session-by-session analysis of the CBT treatment group demonstrated that the different ED-15 scales changed in different patterns across therapy. The ED-15 is not proposed as an alternative to existing measures, but as a complementary tool, used to measure session-by-session change for clinical and research purposes. Future research will track changes in ED-15 scores across therapy, to determine the importance of very early response to therapy and sudden changes.

Perceived discrimination and favourable regard toward underweight, normal weight and obese eating disorder sufferers: implications for obesity and eating disorder population health campaigns.

BackgroundObesity stigma has been shown to increase binge eating, whilst positive regard for eating disorders (EDs) may increase dietary restriction which can also lead to binge eating and weight gain. In the context of increasing prevalence of both obesity and EDs exploring community attitudes towards these illnesses may uncover new variables worthy of consideration in population health campaigns. The aim of the study was to explore community perceived stigma and conversely favourable regard toward eating disorder (ED) sufferers of varying weight status, and understand how the attitudes of obese individuals may differ from those of non-obese individuals. Data for this purpose were derived from interviews with individuals participating in a general population health survey. Vignettes of an underweight female with Anorexia Nervosa (AN), a normal weight male with an atypical eating disorder (NWED) and an obese female with Binge Eating Disorder (BED) were presented to three randomly selected sub-samples of n = 983, 1033 and 1030 respectively. Questions followed that assessed participants’ attitudes towards and beliefs about the person described in the vignette and their eating behaviours.ResultsSixty-six per cent of participants who responded to the obese BED vignette believed that there would be discrimination against the person described (primarily because of her weight). Corresponding figures were for the AN and NWED vignettes were 48% and 35%, respectively. A positive regard for weight-loss or body-image-enhancing ED behaviours was reported ‘occasionally’ or more often by 8.8% of respondents to the AN vignette and by 27.5% of respondents to the NWED vignette. Positive regard for ED behaviours was significantly more likely in obese participants (AN: 15%; NWED: 43%).ConclusionThe findings support integrated ED and obesity prevention programs that address weight stigma and the social desirability of ED behaviours in vulnerable individuals.

Somatotype: a more sophisticated approach to body image work with eating disorder sufferers

This study sought to identify existing and desired somatotypes among eating disorder patients and controls based on the somatotype theoretical model, using a novel three-dimensional (3D) scanning approach. Sixty-three female adult volunteers comprising 31 eating disorder patients and 32 controls underwent digital photography and 3D body scanning as part of a larger body image study. Participants' existing somatotype was evaluated from the 3D scans. Each individual interacted with her 2D image using specialist software to generate ideal body shape area, which was mapped onto 3D body segments to construct a ‘virtual ideal physique’, which was then rated for somatotype. Existing somatotype differed between groups, with controls and bulimia nervosa patients having greater endomorphy and lesser ectomorphy than anorexia nervosa (AN) patients and those with eating disorders not otherwise specified. Desired physiques differed by group but reflected similar direction of change, with all groups wishing to be significantly more slender. AN patients sought the most linear physique compared with other groups, while controls sought the greatest change from existing physique. The somatotype schema is an effective method for assessing existing physique and aspirational changes in eating disordered patients, providing a new perspective on the ‘thin ideal’ for patients and clinicians.

Why self‐critical patients present with more severe eating disorder pathology: The mediating role of shame

Gilbert (Compassion: Conceptualisations, Research, and Use in Psychotherapy. London: Routledge, 2005) theorized that self-critical individuals have more severe psychopathology due in part to their elevated feelings of shame. We sought to test this model in a sample of eating disorder sufferers. Seventy-four patients admitted to a specialized day or inpatient eating disorders treatment programme completed the Forms of Self-Criticism and Self-Reassurance Scale, Rosenberg Self-Esteem Inventory, Experience of Shame Scale, Beck Depression Inventory, Positive and Negative Affect Schedule, and Eating Disorder Examination Questionnaire. We tested our mediational model with Preacher and Hayes' (Behavior Research Methods, 40, 879, 2008) bootstrapping approach entering self-criticism as a predictor, self-esteem as a covariate, and shame, negative affect, positive affect, and depressive symptoms as simultaneous mediators. Applying a 95% confidence interval, the total indirect effect of self-criticism on eating disorder pathology was significantly different from zero suggesting that its influence occurred through the proposed set of mediators. Specific indirect effects revealed that shame was the only mediator to contribute significantly to the model. Results support the theory that among eating disorder patients, higher self-criticism is associated with elevated eating disorder pathology through feelings of shame. Interventions that target the shame of self-critical patients might therefore facilitate their recovery.

Is migraine a risk factor for the occurrence of eating disorders? Prevalence and biochemical evidences

The eating disorders (ED), anorexia nervosa (AN) and bulimia nervosa (BN), are severe psychiatric and somatic conditions occurring mainly in young woman. Although the aetiology is largely unknown, same evidences suggest that biological and psychological factors play a relevant role in the pathogenesis, along with monoamine, indole and same hypothalamic hormonal dysfunctions. Migraine is characterized by similar metabolic and psychological anomalies suggesting that a possible relationship exists between the two pathological conditions. To understand the possible relationship between migraine and ED, we have investigated the prevalence of migraine and the other primary headaches in a large group of AN and BN patients. In addition, we have studied the role of tyrosine metabolism in the same group of AN and BN young woman sufferers. In particular, we measured plasma levels of elusive amines: tyramine (Tyr) and octopamine (Oct) and catecholamines: noradrenalin (NE), dopamine (DA). The results of this study show that the prevalence of migraine in the woman affected by ED is very high (<75%). The levels of Tyr and DA were higher and levels of NE were lower in the ED patients in respect to the control subjects. These biochemical findings suggest that abnormalities of limbic and hypothalamic circuitries play a role in the pathogenesis of ED. The very high prevalence of migraine in our group of ED sufferers and the biochemical profile of migraine, similar to that of ED patients shown in this study, suggest that migraine may constitute a risk factor for the occurrence of ED in young females. This hypothesis is supported by the onset of migraine attacks that initiated, in the majority of the patients, before the occurrence of ED symptoms.

What are the top five essential features of a high quality eating disorder service? A comparison of the views of US and UK eating disorder sufferers, carers and health professionals.

The aim of the present study was to identify what are the main features of a high quality eating disorders service and to triangulate the views of patients, carers and health professionals in a cross-national (USA, UK) survey. Data from an internet survey were subjected to content analysis and common themes were identified. All six stakeholder groups (US and UK patients, carers and health professionals) included the professional qualities of staff amongst their top five quality features. Personal qualities of staff, support for carers and psychological interventions were mentioned by four of the six groups, Support for service users and nutritional assistance was mentioned by three groups. Availability/access and Rapid access to care were mentioned by UK Carers and UK health care personnel. Medical assistance was only mentioned by US health care professionals and flexible care only by UK sufferers. This study suggests many similarities and some differences between different stakeholders from two countries with different health care systems in their views on quality of care.

A Demographic and Symptom Descriptive Study of Callers to the National Association of Anorexia Nervosa and Associated Disorders: Linking Research and Advocacy

Phone support hotlines are an invaluable service to many eating disorder sufferers and their loved ones, and can also provide important data for eating disorder research. In the present study, the demographic and symptom information of nearly 800 volunteer callers to a free national eating disorder support and referral hotline was analyzed. Findings indicate that eating disorder sufferers who are referenced through hotline resources tend to be older, come from more varied socioeconomic backgrounds, and have more atypical symptoms than what is generally described in existing sources. Results are discussed in light of future directions for hotline research.

Migraine prevalence in eating disorders and pathophysiological correlations

The eating disorders (ED): anorexia nervosa (AN) and Bulimia nervosa (BN) are severe psychiatric and somatic conditions occurring mainly in young woman. Although the etiology is largely unknown, same evidences suggest that biological and psychological factors play a relevant role in the pathogenesis, along with monoamine, indole and same hypothalamic hormonal dysfunctions. Migraine is characterized by similar metabolic and psychological anomalies suggesting that a possible relationship exists between the two pathological conditions. In order to understand the possible relationship between migraine and ED, we have investigated the prevalence of migraine and the other primary headaches in a large group of AN and BN patients. In addition, we have studied the role of tyrosine metabolism in the same group of AN and BN young woman sufferers. In particular, we measured plasma levels of elusive amines: tyramine (Tyr) and octopamine (Oct) and catecholamines: noradrenalin (NE), dopamine (DA). The results of this study show that the prevalence of migraine in the woman affected be EA is very high (>75%). The levels of Tyr and DA were higher and levels of NE were lower in the ED patients with respect to the control subject. These biochemical findings suggest that abnormalities of limbic and hypothalamic circuitries play a role in the pathogenesis of ED. The very high prevalence of migraine in our group of ED sufferers and the biochemical profile of migraine, similar to that ED patients have shown in this study, suggest that migraine may constitute a risk factor for the occurrence of ED in the young females. This hypothesis is supported by the onset of migraine attacks that initiated, in the majority of the patients, before the occurrence of ED symptoms.

Study of tyrosine metabolism in eating disorders. Possible correlation with migraine

In order to understand the possible role of tyrosine metabolism and in particular that of elusive amines in the pathogenesis of eating disorders (ED), we measured the plasma levels of dopamine, noradrenaline, tyramine (Tyr) and octopamine (Oct) in a large group of anorexic and bulimic patients. In comparison to the control group, the levels of nordrenaline were significantly lower and those of dopamine and Tyr higher in the ED patients. The plasma levels of Oct were in the same range in both subject groups. However when comparing the bulimic vs. the anorexic group, the Oct levels were significantly lower in the anorexic group, whereas those of Tyr were significantly higher in the bulimic patients, suggesting that different activation in the metabolism of elusive amines may underlie the shift from the anorexic into the bulimic state. These biochemical findings raise the possibility that abnormalities of the limbic and hypothalamic circuitries play a role in the pathogenesis of ED. In addition, the very high prevalence of migraine (>75%) in our group of ED sufferers, and the biochemical profile(s) reported in migraine, which appear similar to that found in ED patients, suggest that migraine constitutes a risk factor for the occurrence of ED in young females.

Eating disorders in South Africa: an inter-ethnic comparison of admission data.

1found no specific clinical features that were unique to the black patients compared with white female sufferers. We explored possible differences in admission psychometric data among hospitalised black and white eating disorder (anorexia nervosa, bulimia nervosa) sufferers and found preliminary evidence for similarity of admission psychometric data for eating disorder sufferers, irrespective of race, in South Africa. Future research may not warrant racial categorisation of data, specifically for research purposes into eating disorders in South Africa.