Objective: At present there is no clear, cohesive, and comprehensive theoretical understanding of the role of core beliefs in the development of disordered eating. The present study aimed to develop and test a theoretical model outlining important processes and pathways from core beliefs to eating disorder (ED) behaviours. It also aimed to explore potential differences (or similarities) in contributions of four core belief dimensions to the development and maintenance of ED symptomatology.
Method: Data were collected from a sample of 800 non-clinical participants. Path analysis was conducted to test general and multi-dimensional models. Indirect effects were calculated for all possible pathways from ED core beliefs to dietary restraint, objective binge eating, and compensatory behaviours.
Results: The hypothesised model demonstrated poor to acceptable fit to the data. Modifications were made to the general model to improve fit, remove non-significant paths and add theoretically and statistically relevant paths. All indirect effects of possible pathways from core beliefs to ED behaviours were significant. A multi-dimensional version of the model was tested with four core belief dimensions. This model identified differences in pathways from each core belief dimension to ED symptoms.
Discussion: This study extends the current understanding of the role of core beliefs in the development and maintenance of disordered eating, by building upon previous theoretical models and empirical literature. We present a general core beliefs model of disordered eating, and preliminary findings regarding differences in the processes and pathways from four key core belief dimensions to ED behaviours.
Background: Pathological eating and addictive processes are linked to obesity. Food addiction (FA) involves hedonic eating of highly palatable foods, accompanied by addictive symptoms like craving, loss-of-control (LOC) eating, and withdrawal. The main objectives of this study were to assess FA prevalence and symptoms in bariatric surgery candidates, and its relationship with depression, dysregulated eating, and 1- year postoperative weight loss (WL).
Methods: Data from 69 bariatric surgery patients (74% female, 26% male, ) were analysed. Self-report measures including Yale Food Addiction Scale (YFAS) 2.0, Eating Disorder Examination-Questionnaire (EDE-Q), Repetitive Eating Questionnaire [Rep(eat)-Q] and Hospital Anxiety and Depression Scale (HADS) were administered pre-surgery and at 1-year follow-up.
Results: The mean preoperative YFAS symptom score was 2.2. (SD = 2.59). 16% of the sample met YFAS diagnostic criteria for FA. Top reported FA criteria were "substance taken in larger amount than intended" (33%), "persisted desire or repeated unsuccessful attempts to quit" (29%), and "use in physically hazardous situations" (23%). The YFAS symptom scores correlated significantly with the frequency of LOC binge eating, depression and repetitive eating scores, but showed no correlation with age or BMI. Preoperative YFAS symptom scores did not significantly predict % WL at 1-year follow-up.
Conclusions: Our findings align with previous research, indicating that preoperative FA symptoms is unrelated to preoperative BMI and total %WL, but linked to eating pathology, such as LOC binge eating and grazing, as well as depression in bariatric surgery candidates.
Objectives: To interview a series of individuals with bulimia nervosa of longstanding to establish their symptoms and examine the suggestion, using qualitative analysis, that the term "Severe and Enduring Bulimia Nervosa (SEED-BN)" might be appropriate and helpful.
Methods: 12 participants with Bulimia Nervosa, one male, were interviewed with the help of an interview guide. Interviews were recorded and transcribed. Transcripts were analysed using Thematic Analysis.
Results: Participants with Bulimia Nervosa described serious problems in many realms, especially social, psychological, family and relationships.
Conclusions: Bulimia nervosa of long duration is associated with many serious symptoms. It seems likely that recognition of long-standing bulimia nervosa as a severe and enduring eating disorder could encourage clinicians and families to pay attention to the wide variety of problems suffered by this group. Further research is required to examine this proposal.
Background: Māori (the Indigenous people of Aotearoa New Zealand) report higher rates of eating disorders than non-Māori, but access treatment at lower rates. Diagnostic terms lacking in cultural relevance likely contribute to Māori exclusion in eating disorder spaces. Developing terms in te reo Māori (the Māori language) presents an opportunity to challenge eating disorder stereotypes and increase cultural safety in the eating disorder workforce.
Methodology: Guided by a Māori worldview and the practice of wānanga (to meet, discuss, and think deeply about a topic), we present a Māori language glossary for eating disorders. The glossary is informed by expertise in te reo Māori, mātauranga Māori (the body of Māori knowledge), and eating disorders, and combines terms already in use with newly developed terms.
Results: We propose an umbrella term for eating disorders (ngā māuiui kai), as well as terms for anorexia nervosa (māuiui whakatiki), bulimia nervosa (pukuruaki), binge eating disorder (māuiui kaihoro), and avoidant restrictive food intake disorder (karo kai, with three subtypes of low interest [arokore kai], sensory-based avoidance [āmaimai rongo kai], and concern about the consequences of eating [wehi-ā-kai]). We also propose terms for related concepts of body image difficulties (māuiui whakawā ata), perfectionism (māuiui kōtihitihi) and emotion dysregulation (kare-a-roto kōtitititi).
Conclusion: This glossary is available for use by anyone looking for terms that come from a mana-enhancing (empowering, respectful, and strengths-based) Māori worldview. The kupu (words, terms) in this glossary are offered as possibilities for use, rather than as definitive or correct, in the hopes they will promote discussion about stigma, indigeneity, and language in the eating disorders field.
Background: Notwithstanding the documented short- and long-term weight loss and remission of physical and mental diseases following bariatric surgery, a significant proportion of patients fail to respond (fully) to treatment in terms of physical and mental health improvement. Mounting evidence links food-specific impulsivity, prefrontal cortex (PFC) hypoactivity and disrupted hormone secretion in bariatric surgery candidates to poorer post-surgical health outcomes. Neuromodulatory treatments like transcranial direct current stimulation (tDCS) uniquely target these neurobehavioral impairments. We present a pilot study protocol offering tDCS combined with an inhibitory control training and a structured psychosocial intervention to patients after bariatric surgery.
Methods: A total of N = 20 patients are randomized to 6 sessions of verum or sham tDCS over the PFC, combined with an individualized food-specific inhibitory control training and a structured psychosocial intervention within 18 months after bariatric surgery (t0). Beyond acceptability, feasibility and satisfaction of the intervention, effects of verum versus sham tDCS on food-specific impulsivity and on secondary outcomes quality of life, general impulsivity and psychopathology, food-related cravings, eating disorder psychopathology, weight trajectory and endocrine markers are assessed 4 weeks (t1) and 3 months after the intervention (t2).
Discussion: Results will provide information on the potential of combining tDCS with an inhibitory control training and a structured psychosocial intervention to enhance physical and mental outcomes after bariatric surgery. The present study may guide the development of future research with regard to tDCS as a brain-based intervention and of future post-surgical clinical programs, paving the way for randomized-controlled trials in larger samples.
Trial registration: The trial was prospectively registered on July 8, 2024, under the registration number DRKS00034620 in the German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00034620 ).
Background: Eating disorders (EDs) are increasingly prevalent in men, but men remain underrepresented across many ED-specific treatment settings. Based on the idea that persistent stereotypes, prejudice and discrimination, i.e., stigma against men with EDs, could impede help-seeking behaviors, the present study investigated whether stigma-related perceptions in men are associated with reduced help-seeking intentions for a broad range of disordered eating symptoms.
Methods: N = 132 adult men participated in a cross-sectional online survey and completed questionnaires on ED psychopathology, muscle dysmorphia, orthorexic eating, stigma-related perceptions of EDs in men, and help-seeking intentions.
Results: Moderator analyses showed that higher stigma-related perceptions were associated with reduced help-seeking intentions in response to increased ED symptom severity. However, this was only the case for traditionally "feminized" ED symptoms (related to thin-body ideals), but not for help-seeking with regard to muscularity-oriented, orthorexic, or avoidant/restrictive disordered eating.
Conclusions: Stigma may reduce help-seeking intentions with regard to "feminized" ED symptoms. The present findings suggest that perceptions of EDs as "women's diseases" were associated with reduced help-seeking in men. Stigma towards men with EDs could thus be a possible barrier to help-seeking in men, highlighting the relevance of stigma-reducing interventions in clinical and community settings.
Background: Even though robust evidence suggests the high prevalence of eating disorders (EDs) in China, EDs in China are characterized by low diagnosis rates, delayed treatment-seeking, and ineffective treatments. Given that listening to patients' perspectives and lived experiences is crucial to improving our understanding of EDs in the Chinese context, an investigation of the perceived causes of EDs in Chinese individuals with EDs represents a key step in improving the prevention and treatment of EDs in China.
Aims: To explore the perceived causes of EDs based on data from a sample of Chinese social media users with self-reported EDs, with a particular focus on the Zhihu platform.
Methods: We extracted and analyzed data through content analysis. Eight specific causes that could be classified into two groups were coded, including individual factors (e.g., "body image and eating") and sociocultural factors (e.g., "media and cultural ideals").
Results: A total of 2079 entries regarding self-reported EDs were retained for content analysis (14.7% were anorexia nervosa, 37.6% were bulimia nervosa, and 47.7% were binge-eating disorder). More than 90% of users with self-reported EDs claimed causes belonging to individual factors, while 35-51% of users claimed sociocultural factors. "Body image and eating" (68-87%) and "psychological and emotional problems" (65-67%) were the most commonly claimed specific causes, while "traumatic life events" (13-14%), "genetics and biology" (7-13%), and "sports and health" (9-12%) were the least claimed. Chi-square independent tests showed that users with different self-reported EDs disproportionately claimed certain causes.
Conclusions: Using large-scale social media data, findings provide a deeper understanding of the perceived causes of EDs in the Chinese context from individuals with self-reported EDs and highlight the variations in perceived causes across different self-reported ED types.
Background: To date, over 1.3 billion videos with the hashtag #bodyneutrality have been viewed on TikTok. Despite this, little existing literature has unpacked how body neutrality is conceptualised on TikTok. We examined how TikTok creators construct meaning and generate discourse surrounding #bodyneutrality.
Methods: Extending on previous works in the body neutrality space, we conducted a hybrid content/thematic analysis of TikTok videos in three different languages (English, Spanish, and Italian). Initially, 300 videos displaying "#bodyneutrality" were identified on TikTok. The first 178 TikTok videos were analysed, following the principles of data saturation and feasibility.
Results: We developed three themes: (1) The normalisation of diverse bodies, (2) The rejection of appearance as fundamentally important, and (3) Body neutrality is (better than) body positivity.
Conclusions: In line with conceptualisations of body neutrality in existing literature, some content emphasised the importance of devaluing physical appearance. Building on existing definitions, most creators also framed body neutrality as speaking to the fundamental humanness of owning a body and attempted to normalise various body shapes/sizes. Conversely, some content employed #bodyneutrality to promote or examine body positivity principles or to condemn appearance-based stigmatisation. Our study is one of the first to examine how body neutrality is understood and employed by people in the real world.
Background: Eating disorders (EDs) are serious psychiatric disorders that may cause great suffering and reduced quality of life. Severe EDs often lead to somatic complications and have a high mortality rate. The most seriously ill patients need hospitalisation, with a need for highly trained nurses.
Methods: The aim of the study was to investigate challenges when nursing adults with a severe ED, and how to succeed in establishing a therapeutic relationship. A qualitative design was chosen, and individual qualitative interviews conducted with twelve nurses. The analytic method was Braun and Clarke's thematic analysis.
Results: Six main themes were developed: entering the patient's world of experience (with the subthemes: understanding the patient's anxiety, understanding the patient's rigidity and need for control and understanding the patient's ambivalence), providing somatic nursing, building relationships, 'holding the line' (with the subtheme: demanding and rewarding), manoeuvring between rules and frameworks and providing good nursing care during coercive treatment.
Conclusion: Nursing patients with a severe ED is demanding, requiring somatic as well as psychiatric expertise. The nurse must understand the patient's anxiety, rigidity and need for control, and ambivalence. Nursing patients with a severe ED requires clarity, and steadiness and the nurses must cope with resistance. To succeed, teamwork and support from colleagues are needed.
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