Journal of Eating Disorders最新文献

Introduction: This Rapid Review (RR) aimed to assess the current literature over the past decade to determine the prevailing evidence regarding compulsory treatment* in eating disorders (ED). It is hoped that the review will help inform a consensus opinion as to whether this course of action confers significant clinical benefit, and importantly, to whom it should apply. The review also explores alternative options to involuntary care.

Methods: Four indexing databases (OVID; ProQuest; Web of Science; PubMed/MedLine) were searched using variations of the following keywords: "coercive/detained/involuntary/least restrictive care" "treatment refusal" "incarcerated/forced/compulsory admission" "moral/ethic/legal/mental health act" "eating disorder". Research was restricted to articles published between 2013 and 2023 and included grey literature.

Results: Of 9911 articles retrieved, 34 were included for final analyses, exploring ethical, legal, and physical and mental health outcomes of compulsory treatment. Studies comprised review papers, cohort studies, cross sectional research, case series reports, ethnography, commentary papers and grey literature. The majority of studies focused on individuals with anorexia nervosa (AN). Only two papers considered compulsory treatment in individuals with other eating disorders (EDs) Findings largely align with previous reviews suggesting compulsory treatment saves lives but comes at a therapeutic and personal cost. It remains unknown as to who may benefit from compulsory treatment. The decision to invoke compulsory treatment remains with the clinician and is a responsibility that is likely to be faced by most in their care of individuals with EDs.

Conclusions: Significant gaps remain in the published literature and a clear road map for a clinician-informed decision on the submission of a compulsory treatment for a person with ED does not yet exist. Further, there is little evidence as to who is most likely to benefit from compulsory treatment. There is consensus that efforts should be concentrated on reducing instances of compulsory treatment and minimising coercion through the development of open, transparent and trusting relationships between individuals and their treating clinician. Co-produced research and the development of clinical guidelines guided by the voices of individuals with lived experience are needed to ensure minimisation of potential harm.

Objective: This systematic review examines the literature regarding perceived clinician stigma and treatment experiences of adult patients with eating disorders, emphasising lived experience perspectives.

Method: A systematic search was conducted across MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials [CENTRAL] to identify studies published from 1 January 2000 until 24 March 2024 that explored patient experiences of clinician attitudes and behaviours in eating disorder treatment. Eligible studies included those reporting on perceived clinician stigma and impacts on treatment outcomes.

Results: There were 11 studies that met the eligibility criteria. The studies encompassed various diagnoses, locations, and healthcare settings, reflecting a broad spectrum of experiences and contexts within treatment of eating disorders. Four key themes emerged across the studies: treatment engagement, where perceived clinician stigma led to reduced patient involvement; therapeutic alliances, with stigma compromising relationships between patients and healthcare providers; barriers to treatment and care, where stigma heightened obstacles to accessing support; and weight stigma.

Discussion: Despite the overall scarcity of evidence, these qualitative studies provide evidence of impacts of perceived clinician stigma on patient experiences in eating disorder treatment. These findings provide an initial understanding of negative effects of clinician attitudes such as dismissiveness and invalidation, which may hinder treatment adherence and therapeutic outcomes. Beyond addressing stigma, future research should explore how clinician behaviours can foster positive treatment experiences, such as patients feeling heard, respected, and understood. Clinicians' reflective practices should focus on improving therapeutic alliances and fostering more inclusive, patient-centred care. Future studies should prioritise mixed-methods approaches to investigate how clinician stigma and positive care experiences influence treatment engagement, recovery trajectories, and long-term outcomes.

Background: Although many people have concerns about their body image, weight, and eating behaviors these issues are not usually discussed in a productive manner with medical providers. Thus, we examined nursing and medical students' willingness to discuss patients' weight, body image, and eating disorders and reasons why they may do so.

Method: One hundred and eighty-three nursing and medical students (M_age = 25.06, SD = 5.43) participated in this study. Participants completed open-ended questions pertaining to their willingness to discuss body image, eating, and weight-related issues with future patients. We further queried students' perspective on body mass index (BMI) as a measure of weight status and sought to determine if participants' own weight, weight concerns, appearance evaluation, body appreciation, and experiences of stigma were associated with their willingness to discuss weight-related issues with prospective patients.

Results: Coding of qualitative data indicated that nursing and medical students were "sometimes" willing to discuss prospective patients' weight, body image, and eating disorders, especially if a health concern was evident. Nursing students seemed somewhat more willing to discuss weight issues than medical students and willingness to discuss one of these issues (e.g., body image) was positively associated with willingness discuss the others. Plans for future discussions of body image and weight were marginally associated with personal experiences of weight stigma. The majority of participants indicated that BMI was not a valid measure of health.

Conclusions: Taken together, findings suggest that future providers' conversations with patients about these sensitive topics are less likely to be associated with their own experiences and more with the relevance of these topics to specific patients.

Background: Evidence on how persons with and in remission from an eating disorder experience their oral health is limited. Dental treatment in Sweden today is often postponed until medical rehabilitation has been completed, but this carries risks. For the patient, the risk is severely impaired oral health and additional suffering, and for both society and the patient, higher costs than might have been necessary.

Methods: Ten female informants aged 21-51 years (mean age = 36.7, standard deviation 12.7) in remission from an eating disorder with a median duration of 12.5 (range 4-25) years of illness, were questioned in semi-structured interviews about their perceptions of oral health. All participants had been referred to a specialist dental clinic and needed oral rehabilitation. 10% of the patients had been diagnosed with anorexia nervosa and 90% with bulimia nervosa. All had been in remission from the eating disorder for at least one year. Transcripts of the interviews were analyzed with thematic analysis using an inductive approach.

Results: One overarching theme emerged from the analysis: dental damage persisted as a visible, lingering scar during remission of the eating disorder, reminiscent of the disease and its consequences. The three major themes identified were (1) Physical impact, (2) Psychological impact, and (3) Impact on daily living. The first major theme included erosive tooth wear and impaired oral function and aesthetics. Interviewees described the second as feelings of stigma, guilt, shame, anxiety, and worry, in particular concerning self-inflicted dental damage through self-induced vomiting. The last major theme covered avoidance strategies such as limiting smiling and laughing and minimizing social situations such as eating with others, pursuing a wanted career, and meeting a partner.

Conclusions: The participants in this study expressed a profound negative impact on daily life and a two-fold burden of stigma of having suffered from both an eating disorder and poor oral health.

Objective: Eating disorders (EDs) comprise a range of illnesses characterised by disordered eating, distressing thoughts, and changes in weight. EDs in the perinatal period are a growing concern. Maternity staff receive little training in this area and often report feeling ill-equipped to recognise or respond to presentations of ED during this time. The study aimed to develop and evaluate an online educational module for clinicians and support workers to improve knowledge of EDs in the perinatal period.

Method: Education modules were developed using a co-design process with consumer advocates, peer support workers, clinicians, and experts. Consumer perspectives, evidence-based videos, activities, and text relating to screening, management, monitoring and referral of perinatal individuals with EDs were included in the module. Quantitative and qualitative data from pre- and post- surveys were used to evaluate changes in knowledge and confidence before and after completing the module, and to assess staff satisfaction, usability, and obtain feedback for improvement.

Results: Use of the online education module significantly increased staff knowledge of EDs in the perinatal period. Participants also felt more confident in discussing the topic with patients, screening, supporting, and referring a person with ED in the perinatal period. Participants also reported the module was engaging and easy-to-use.

Conclusions: Findings indicate that the ED online education module is an engaging and easy-to-use tool for improving the knowledge and skills of the healthcare workforce, thereby improving patient care and health outcomes. The development of additional online resources for clinicians would be beneficial for increasing staff capability and improving patient services.

Background: Emotional eating is a prevalent maladaptive coping mechanism among college students, which is associated with mental health and sleep concerns. Though previous studies have established a link between sleep quality, depression and emotional eating, most of these have been in Western populations. In addition, few existing studies have taken physical activities into account, and the underlying mechanisms between these four variables remain to be further studied. Therefore, our study investigated the mediating role of depression and the moderating role of physical activity levels in the relationship between sleep quality and emotional eating among Chinese college students. Our study can help to understand the characteristics of this population and provide guidance on the intervention pathways for emotional eating.

Methods: A convenience sampling method was employed to select eligible participants for investigation. The General Information Questionnaire, the Pittsburgh Sleep Quality Index Scale, the Patient Health Questionnaire, the Dutch Eating Behavior Scale, and the International Physical Activity Questionnaire were employed to measure the general condition, sleep quality, depression, emotional eating, and physical activity. A total of 813 college students (M_age = 19.14, SD = 1.12, range = 17 ~ 25 years old, 71.1% females) completed the survey. The moderated mediation analysis was carried out using the SPSS PROCESS macro.

Results: After controlling for sex, age, and body mass index (BMI), sleep quality positively predicted emotional eating. Depression primarily mediated the association between them. Besides, physical activity levels moderated the relationship between sleep quality and emotional eating via depression. Depression significantly predicted emotional eating among students with low levels of physical activity; however, it was not significant among students with moderate or high levels of physical activity.

Conclusions: The role of depression mediates the link between sleep quality and emotional eating. Regular exercise can ease the symptoms of emotional eating through depression. This implies the importance of offering more sleep hygiene education and physical activity in university settings.

Background: Many individuals perceive Anorexia Nervosa (AN) as a part of their personal identity. Externalisation of the problem is a practice that is often taken up within NICE recommended treatments for AN. Dominant understandings of externalisation are that this practice involves making the "problem" a separate entity, external to the individual. It is an attitude taken by the client and family, stimulated by the therapist to build engagement with treatment and supportive relationships around the individual. However, there is a paucity of research exploring the therapeutic effects of this approach. This research aims to address this gap by exploring the role of externalisation in treatment for AN to elicit an understanding of how this practice is experienced including how it can help and hinder recovery.

Methods: Thirteen adults with a current and/or past diagnosis of AN participated in semi-structured interviews. This qualitative study used a reflexive thematic analysis.

Analysis: Participants described their experience of externalisation as a journey which is depicted by four main themes. 'Separating the AN from the self' reflects the tensions inherent in learning to distinguish between one's perceived sense of "self" and "the AN". 'Making sense of the AN' describes the experience of language forms used to separate the AN from the individual's identity. 'Feeling seen, or unseen as a person beyond the AN' illustrates the helpful and harmful effects of externalising practices on relationships. 'Navigating a complex relationship with the AN' depicts the effects of one-, versus two-way externalisation on the individual's relationship to AN.

Conclusions: The notion of separating one's internal dialogue from one's concept of self may initially be rejected by the individual experiencing AN. However, as the individual develops trust in the therapist and becomes socialised to common forms of externalising language, they may begin to realise two sides within them, a perceived "healthy self" and "the anorexia voice". However, social-cultural discourses around eating contribute to ambiguity during the differentiation between these two voices, thus elucidating the effects of an absence of problem deconstruction alongside externalisation within ED-focussed treatments. Externalising practices were most helpful when led by the individual using their own experience-near language and least helpful when they did not permit the individual to feel seen as a person beyond the AN. Therapists, treatment teams and family members should be cognisant of the emotional effects of language used to externalise AN. Importantly, they should ensure that externalisation is practiced within the spirit of narrative therapy from which it originates.

Background: Emerging adulthood is a transitory period in which disordered eating (DE) manifests; collecting data on the prevalence of DE among this population as well as demographic and behavioral correlates are important public health goals.

Methods: Data from an annual survey of undergraduate students at a large state university from 2019 to 2022 were analyzed, allowing researchers to compare prevalence and correlates before and after the onset of the COVID-19 pandemic using two brief screeners: the SCOFF and Eating Disorder Screener for Primary Care (ESP). We hypothesized that rates of DE would be greater after the onset of COVID-19 as compared to before. We also hypothesized that those identifying as women, reporting higher alcohol or drug use, and contemplating suicide would have greater odds of reporting symptoms consistent with DE.

Results: DE was significantly lower in pre-pandemic years compared to pandemic years: ESP pre = 38.01%(n = 704), pandemic = 48.79%(n = 645), p < 0.001; SCOFF pre = 22.82%(n = 422), pandemic = 31.46%(n = 414), p < 0.001. Logistic regressions showed women and students who contemplated suicide reported significantly greater DE, regardless of screener or time period. Inconsistent relationships were found between DE and current substance use.

Conclusion: These findings may inform targeted interventions for those most vulnerable to disordered eating.