Non-specific Eating Disorders Research Articles

Narrative Therapy Expressive Art Group Interventions for Adolescents with Eating Disorders in Residential Treatment

ABSTRACT Eating disorders continue to impact youth at staggering rates, with 13.2% of adolescents meeting DSM-5 criteria for an eating disorder by age 20. Integrating narrative therapy expressive art interventions with the healing power of group can meet the layered developmental needs of adolescents battling anorexia, bulimia, binge eating disorder, or nonspecific eating disorders. This conceptual manuscript pulls from literature on expressive arts, adolescent eating disorders, group counseling, and residential treatment considerations using a narrative therapy theoretical approach. Expressive art interventions appropriate for serving adolescents with eating disorders in a residential treatment setting are provided.

The network analysis in patients with anorexia nervosa treated with intensive enhanced cognitive behavior therapy: reflections on the research data

The network theory conceptualizes mental disorders as causally connected symptom systems rather than as effects of a superordinate and unknowable illness, otherwise called latent. Network analysis, a statistical technique designed to identify network structures among psychiatric symptoms from empirical data, has been widely used in eating disorders. Three of these studies have been conducted on patients with anorexia nervosa treated with intensive enhanced cognitive behavior therapy (CBT-E). The first study found that the network structures in adult and adolescent patients with anorexia nervosa are similar and share overvaluation of shape and weight as the core feature of anorexia nervosa psychopathology, supporting the cognitive behavioral theory. The second study found that intensive CBT-E reduces the psychopathology network connectivity over time in patients with anorexia nervosa, confirming the effectiveness of CBT-E in improving eating-disorder psychopathology. In contrast, the third study, including in the networks not only the clinical features of the eating disorder psychopathology but also those of the general psychopathology, found that the structure of the network of patients with anorexia nervosa remains unchanged mainly after intensive CBT-E. These findings stimulate a rethinking of the current viewing of the eating-disorder psychopathology and the potential reasons for the partial efficacy of actual therapeutic interventions for patients with anorexia nervosa, which seem not effective enough to break the bonds between specific and nonspecific eating disorder features.

Specific eating disorders – selected aspects of pathogenesis and risk factors

Although research into the aetiology and pathogenesis of eating disorders has been ongoing for many years, it has not yet been possible to identify all the factors responsible for their development. Current research does not focus on a single risk factor, but looks for correlations between them. This article presents selected aspects of the pathogenesis and risk factors of specific eating disorders. Family and individual factors, social and cultural factors, and biological factors are described. Particular attention has been paid to the aspect of parenting styles and behaviours exhibited, e.g. excessive punishment and emotional coldness. The coexistence of personality disorders with specific and non-specific eating disorders is also described. The social aspect highlights the development of social media and their impact on selfesteem, body dissatisfaction, and promotion of pathological thinness. Cultural factors include progressive “westernisation” and the rapid increase in the prevalence of eating disorders in the areas of the world where they did not previously exist. Among biological factors, publications on appetite neuromodulators, genetic factors, gut microbiota disorders, and the so-called brain-gut axis were analysed. Modern science is not as yet able to answer the question of which of the mentioned factors has the greatest impact on the development of eating disorders, however, ongoing research offers hope for effective treatment of these diseases in the future. Knowing the factors predisposing to their occurrence will allow early identification of risk groups and undertaking preventive and therapeutic actions, including psychotherapy and pharmacotherapy.

Irrational Beliefs and Their Role in Specific and Non-Specific Eating Disorder Symptomatology and Cognitive Reappraisal in Eating Disorders.

Background: Research on which specific maladaptive cognitions characterize eating disorders (ED) is lacking. This study explores irrational beliefs (IBs) in ED patients and controls and the association between IBs and ED-specific and non-specific ED symptomatology and cognitive reappraisal. Methods: 79 ED outpatients with anorexia nervosa, bulimia nervosa, or other specified feeding or eating disorders and 95 controls completed the Attitudes and Beliefs Scale-2 (ABS-2) for IBs. ED outpatients also completed the Eating Disorder Inventory-3 (EDI-3) for ED-specific (EDI-3-ED Risk) and non-specific (EDI-3-General Psychological Maladjustment) symptomatology; General Health Questionnaire (GHQ) for general psychopathology; Emotion Regulation Questionnaire (ERQ) for cognitive reappraisal. Results: Multivariate analysis of variance with post hoc comparisons showed that ED outpatients exhibit greater ABS-2-Awfulizing, ABS-2-Negative Global Evaluations, and ABS-2-Low Frustration Tolerance than controls. No differences emerged between ED diagnoses. According to stepwise linear regression analyses, body mass index (BMI) and ABS-2-Awfulizing predicted greater EDI-3-ED Risk, while ABS-2-Negative Global Evaluations and GHQ predicted greater EDI-3-General Psychological Maladjustment and lower ERQ-Cognitive Reappraisal. Conclusion: Awfulizing and negative global evaluation contribute to better explaining ED-specific and non-specific ED symptoms and cognitive reappraisal. Therefore, including them, together with BMI and general psychopathology, when assessing ED patients and planning cognitive–behavioral treatment is warranted.

Przegląd niespecyficznych zaburzeń odżywiania

Przegląd niespecyficznych zaburzeń odżywiania

Реальное качество жизни vs завышенные представления о собственной изысканной внешности (продолжение)

The relevance. The article is devoted to the consideration of a question that would seem to be of a purely medical and philosophical nature, when a person, under aggressive influence and sophisticated pressure of the media, chooses a pattern of his eating behavior that differs markedly from the generally accepted behavior, called normal. Adhering to the chosen method of eating behavior, the consumer brings his body to a certain degree of weakening, mental torture and with a diagnosis of “Nervous orthorexia” turns into a patient of specialized rehabilitation clinics, becomes the ward of narrowly oriented doctors for the treatment of white brain. For any organism, the consequences of such a diagnosis are usually destructive. Objective. The authors of the article are trying to investigate the genesis of this little-studied problem and find any connection with the level and quality of life of Russians in recent years, with the quality of food consumed and with the general psychological state of society during its testing with an excessively long crisis. Methods. Diagnostic packages, testing of the functional state of patients according to Donini & Marsili , ORTO-15 and their clinical surveys are already as respondents. A large statistical sample of the online survey is represented by 612 respondents of different sexes and different age groups. To assess the standard of living and morbidity by Nervous orthorexia, statistical methods were used to measure the relationship of Spearman, Pearson, structural averages, etc. Results. Nervous orthorexia has been found to be characterized by the phenomenon of avoidant behavior that is included in the group of nonspecific eating disorders of the patient. Conclusion. The results of the retrospective period confirm the working hypothesis about the existence of a statistically significant relationship between the decline in the standard of living of urban population in the Northwestern Federal District and the incidence of Nervous orthorexia in its various manifestations.

Реальное качество жизни vs завышенные представления о собственной изысканной внешности

The relevance. The article is devoted to the consideration of a question that would seem to be of a purely medical and philosophical nature, when a person, under aggressive influence and sophisticated pressure of the media, chooses a pattern of his eating behavior that differs markedly from the generally accepted behavior, called normal. Adhering to the chosen method of eating behavior, the consumer brings his body to a certain degree of weakening, mental torture and with a diagnosis of “Nervous orthorexia” turns into a patient of specialized rehabilitation clinics, becomes the ward of doctors for the treatment of white brain. For any organism, the consequences of such a diagnosis are usually destructive. Objective. The authors of the article are trying to investigate the genesis of this little-studied problem and find any connection with the level and quality of life of Russians in recent years, with the quality of food consumed and with the general psychological state of society during its testing with an excessively long crisis. Methods. Diagnostic packages, testing of the functional state of patients according to Donini & Marsili , ORTO-15 and their clinical surveys are already as respondents. A large statistical sample of the online survey is represented by 612 respondents of different sexes and different age groups. To assess the standard of living and morbidity by Nervous orthorexia, statistical methods were used to measure the relationship of Spearman, Pearson, structural averages, etc. Results. Nervous orthorexia has been found to be characterized by the phenomenon of avoidant behavior that is included in the group of nonspecific eating disorders of the patient. Conclusion. The results of the retrospective period confirm the working hypothesis about the existence of a statistically significant relationship between the decline in the standard of living of urban population in the Northwestern Federal District and the incidence of Nervous orthorexia in its various manifestations.

A léböjtkúrák és az atípusos evészavarok lehetséges kapcsolata. Kvalitatív előtanulmány

There are two notable eating behaviors that are not far from having their own category as a mental disorder: the purging disorder, that is already among the DSM-5 non-specific eating disorders, and orthorexia nervosa, when a person is fixating too much on healthy foods. Our purpose is to describe how these can be observed in recreational juice cleanse camps, which are very popular today as an alternative health trend. The first author recorded her data during multisited ethnographic observations in two Hungarian juice cleanse camps. Based on the diary logs, notes and interviews collected, we will present the motives of eating anomalies that the participants had shown. The main motive of the camp is "detoxification". The lack of solid food, drastically low calorie intake and lots of physical activity will bring an inevitable change in the body, that is interpreted as toxins leaving the body. Participants have also included deliberate use of laxatives in their everyday routines, with which they associate positive connotations and are linked to the spiritual processes of "letting it go" and "renewal" in the spirit of a holistic approach. The use of symbols in the physiological processes was highly noticeable. Rapid weight loss due to diuresis, the desire for "clean" meals, and "self-rewarding" borrowed from the esoteric-self-help culture are also common motives. Due to the refeeding complications, so far two deaths have been reported by camp organizers. Both purging disorder and orthorexia nervosa can be well-identified in our observations. This shows that also in the non-clinical environment, there is an institutionalization of eating habits that are dangerous to the health. This "detox" is not only physiologically harmful, but it is not proved to provide long-term help in mental health either. As a solution, we advocate developing an appropriate health communication plan for misconceptions about healthy lifestyle and eating, and also a promotion of psychotherapeutic opportunities. Orv Hetil. 2018; 159(28): 1153-1157.

A systematic review of cost-effectiveness studies of prevention and treatment for eating disorders.

Eating disorders are serious mental disorders and are associated with substantial economic and social burden. The aim of this study is to undertake a systematic review of the cost-effectiveness studies of both preventive and treatment interventions for eating disorder. Electronic databases (including the Cochrane Controlled Trial Register, MEDLINE, PsycINFO, Academic Search Complete, Global Health, CINAHL complete, Health Business Elite, Econlit, Health Policy Reference Center and ERIC) were searched for published cost-effectiveness studies of eating disorder prevention and treatment including papers published up to January 2017. The quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. In all, 13 studies met the review inclusion criteria as full cost-effectiveness studies and 8 were published since 2011. The studies included three modelled and one trial-based study focused on prevention, two trial-based and one modelled study for anorexia nervosa treatment and three trial-based studies for bulimia nervosa treatment. The remaining studies targeted binge-eating disorder or non-specific eating disorder treatment. The average percent of CHEERS checklist items reported was 71% (standard deviation 21%). Eating disorder interventions were mainly cost-saving or more effective and more costly compared to comparators; however, some results did not reach statistical significance. In the two studies that achieved 100% CHEERS checklist, one study reported that a cognitive dissonance intervention might be cost-effective for prevention of anorexia nervosa and bulimia nervosa with a 90% participation rate and the second study supported lisdexamfetamine to be cost-effective in the treatment of binge-eating disorder. Insufficient evidence for long-term cost-effectiveness (e.g. over 2 years) was found. Cost-effectiveness studies in eating disorder appear to be increasing in number over the last 6 years. Findings were inconsistent and no firm conclusion can be drawn with regard to comparative value-for-money conclusions. However, some promising interventions were identified. Further research with improved methodology is required.

Nonspecific eating disorders - a subjective review.

The aim of this paper was to characterise nonspecific eating disorders (other than anorexia nervosa and bulimia nervosa). The Medline database was searched for articles on nonspecific eating disorders. The following disorders were described: binge eating disorder (BED), pica, rumination disorder, avoidant/restrictive food intake disorder, night eating syndrome (NES), sleep-related eating disorder (SRED), bigorexia, orthorexia, focusing on diagnosis, symptoms, assessment, comorbidities, clinical implications and treatment. All of the included disorders may have dangerous consequences, both somatic and psychological. They are often comorbid with other psychiatric disorders. Approximately a few percent of general population can be diagnosed with each disorder, from 0.5-4.7% (SRED) to about 7% (orthorexia). With the growing literature on the subject and changes in DSM-5, clinicians recognise and treat those disorders more often. More studies have to be conducted in order to differentiate disorders and treat or prevent them appropriately.

¿Son las alteraciones neuropsicológicas de los trastornos de la conducta alimentaria endofenotipos de la enfermedad? Revisión y estado actual del tema

INTRODUCTION. Recent studies have shown that alterations to the executive cognitive functions may be endophenotypes of eating disorders. AIM. To perform a critical review of the literature on neuropsychological alterations in patients with eating disorders and their first-degree relatives. DEVELOPMENT. We review the papers written in English and in Spanish indexed in Medline and PsycINFO over the last 10 years. We included abstracts of papers that have still not been published and search terms were crossed. Excluding some isolated clinical cases, we obtained 41 studies on patients with anorexia nervosa (n = 17), bulimia nervosa (n = 5), both (n = 13) or a non-specific eating disorder (n = 6). CONCLUSIONS. The studies reviewed display important limitations due to their heterogeneous methodology and small samples, which give rise to contradictory results. Most of them were conducted on anorexia nervosa. Cognitive rigidity seems to be more frequent in patients with anorexia and their relatives, and alterations in decision-making or central coherence is more often found in bulimia nervosa. There is evidence suggesting that the neuropsychological alterations found in eating disorders are endophenotypes of the disease.

Psychological Balance in High Level Athletes: Gender-Based Differences and Sport-Specific Patterns

ObjectivesFew epidemiological studies have focused on the psychological health of high level athletes. This study aimed to identify the principal psychological problems encountered within French high level athletes, and the variations in their prevalence based on sex and the sport practiced.MethodsMultivariate analyses were conducted on nationwide data obtained from the athletes' yearly psychological evaluations.ResultsA representative sample of 13% of the French athlete population was obtained. 17% of athletes have at least one ongoing or recent disorder, generalized anxiety disorder (GAD) being the most prevalent (6%), followed by non-specific eating disorders (4.2%). Overall, 20.2% of women had at least one psychopathology, against 15.1% in men. This female predominance applied to anxiety and eating disorders, depression, sleep problems and self-harming behaviors. The highest rates of GAD appeared in aesthetic sports (16.7% vs. 6.8% in other sports for men and 38.9% vs. 10.3% for women); the lowest prevalence was found in high risk sports athletes (3.0% vs. 3.5%). Eating disorders are most common among women in racing sports (14% vs. 9%), but for men were found mostly in combat sports (7% vs. 4.8%).DiscussionThis study highlights important differences in psychopathology between male and female athletes, demonstrating that the many sex-based differences reported in the general population apply to elite athletes. While the prevalence of psychological problems is no higher than in the general population, the variations in psychopathology in different sports suggest that specific constraints could influence the development of some disorders.

High frequency of non-specific eating disorders in obese persons

Determine frequency of Eating Disorders and Non-Specific Eating Disorders and pathological behaviour in obese patients. The study includes fifty-four obese patients (BMI > or = 30) consecutively attended at the Nutrition Section of the University Hospital of Vigo. Aged 37.5 +/- 11.1. Range 18-58, 45 female and 9 male. 15 adult normal-weight subjects (11 female, 4 male), aged 35,3 +/- 9,2 años. Frequency of Eating Disorders was determined by a lifestyle clinical interview and the following questionnaires: Eating Attitudes Test 26 (EAT26), Bulimic Investigatory Test Edimburgh (BITE) and Questionnaire Eating Weight Patterns Revised (QEWP-R). Twelve out of 54 (20.6%) patients showed Pathological Behavior, while 5 (4.1%) and 3 (2.5%) had Non- Specific Eating Disorders and Classic Eating Disorders respectively, whereas in the control group non subjects showed psychological anomalies. When we divided obese patients by the degree of obesity, differences in the frequencies of the Eating Disorders was no observed. In our obese patients, Pathological Behavior was the most frequent finding followed for Non-Specific Eating Disorders and Classic Eating Disorders.

Esophageal Crohnʼs Disease, Depression, and Eating Disorder: A Clinical Conundrum

Purpose: Involvement of the esophagus occurs in only 0.2% of Crohn's disease cases. Isolated Crohn's disease of the esophagus is exceedingly rare with only a handful of cases reported in the literature. This is a case of Crohn's disease with only esophageal involvement, but with the diagnosis made challenging in the setting of severe depression and possible eating disorder. Methods: A 29 year old female with a history of depression and possible eating disorder presented to a tertiary referral medical center for further evaluation of weight loss in the context of esophageal strictures. She had a long history of depression as well as previous diagnosis of nonspecific eating disorder with past hospitalization in an inpatient eating disorder unit. She initially presented with symptoms of dysphagia and 12 kg weight loss to an outside institution where upper endoscopy was notable for diffuse inflammation mucosal edema, multiple pseudopolyps, diffuse scarring, esophageal ulcer and strictures. Initial concerns included caustic ingestion but the patient and her spouse repeatedly denied any such history. Colonoscopy with terminal ileum exam was negative. Despite multiple endoscopic dilatations, she remained symptomatic and presented to our institution for further evaluation. Repeat upper endoscopy was notable for findings limited to the esophagus which included superficial ulcerations, multiple inflammatory pseudopolyps, and a stricture in the distal esophagus. Multiple biopsies were obtained and notable for findings of a non-necrotizing epithelioid granuloma and deep mucosal inflammation. Small bowel interrogation with MR Enterography was negative. Evaluation by Psychiatry was notable for findings consistent with depression but equivocal for an eating disorder. Initial therapy for Crohn's disease was started with oral budesonide gel. Following ten weeks of therapy, she remained symptomatic. Results: Although plans were made to escalate therapy, this was postponed as the patient was hospitalized in an inpatient psychiatric unit due to worsening depression. Conclusion: Crohn's disease with esophageal involvement is rare and exceedingly so when it is isolated to the esophagus. Psychiatric disorders are significant comorbidities and are common in the community. This is a case of Crohn's disease limited to the esophagus, in which the diagnosis and management were complicated by significant psychiatric comorbidities. This emphasizes the importance of clinical vigilance as well as impact of psychiatric comorbidities on medical care.

Comparison of Family Therapy and Family Group Psychoeducation in Adolescents with Anorexia Nervosa

To compare the effects of 4 months of 2 family-oriented treatments, family therapy and family psychoeducation, on female adolescents with newly diagnosed restrictive eating disorders. Twenty-five female adolescents requiring hospitalization were randomized into either family therapy or family group psychoeducation. Outcome measures included medical (body weight) and psychosocial (specific and nonspecific eating disorder psychopathology) variables at baseline and after 4 months of treatments every 2 weeks. A significant time effect was found in both treatment groups for the restoration of body weight (percentage of ideal body weight, P < 0.00001). The group averages ranged from 75% to 77% ideal body weight before treatment to 91% to 96% after it. A time effect was also seen on the Family Assessment Measure (P < 0.018), in that the patients of both groups acknowledged more family psychopathology at the end of treatment. No significant group differences were found on any of the self-report measures of specific and nonspecific eating disorder pathology. Weight restoration was achieved following the 4-month period of treatment in both the family therapy and family psychoeducation groups, but no significant change was reported in psychological functioning by either adolescents or parents. Family group psychoeducation, the less expensive form of treatment, is an equally effective method of providing family-oriented treatment to newly diagnosed, medically compromised anorexia nervosa patients and their families.