Eating Disorders最新文献

With an elevated prevalence of disordered eating in low-income settings, efforts to optimize the detection of eating disorders (EDs) in such settings are necessary. A significant barrier relates to the scarcity of training for clinicians not working in specialized ED settings. This manuscript assessed the impact of an ED screening tool and an ED assessment workshop upon the detection of EDs in publicly insured psychiatry settings. Leveraging a case series design to assess 165 consecutive adult patients in outpatient psychiatry settings, we indexed the prevalence of ED diagnoses rendered by psychiatrists when assessing patients (i) without prior knowledge of ED symptoms, (ii) after being made aware of patient scores from an ED screening measure, and (iii) after undergoing an ED assessment workshop, and being made aware of patient screening scores. While 27% of the sample reported clinically significant ED symptoms on the screening measure, ED diagnoses were only rendered in 2% of the sample when psychiatrists were not made aware of ED symptoms prior to assessment. In contrast, incorporating a screening tool altered the rates of ED diagnoses, with 18% of the sample receiving an ED diagnosis. Moreover, the combinatorial introduction of both the ED screening measure and an ED assessment workshop further altered diagnostic practice-with this resulting in ED diagnoses in 27% of the sample. The findings suggest that ED screening and training workshops can have significant impacts on diagnostic accuracy and, with little cost, can provide patients with diagnoses that would otherwise go undetected.

Objective: Family involvement (FI) in the treatment of eating disorders (EDs) is critical for children/adolescents, yet its role during residential treatment (RT) in adults is uncharted. PTSD may play a role in influencing FI but is also unexplored.

Method: We examined the role of FI in 2786 ED patients (89% F) admitted to RT with and without provisional PTSD. At discharge, staff rated the degree of FI as follows: 1) Not at all; 2) Slightly/somewhat; 3) Very much/extremely. Changes in ED, depression, anxiety, PTSD, and quality of life measures from admission to discharge were examined via multivariate analyses of covariance using degree of FI as an independent variable and age, gender, admission BMI, age of ED onset, and baseline symptom levels as covariates.

Results: Patients with the highest FI were the youngest, had the lowest BMIs and the oldest ages of ED onset. Rates of provisional PTSD were greatest in individuals with no FI and least in those with the highest FI. Those with no FI did significantly worse on all measures than those with higher levels of FI.

Conclusion: FI is an important component in ED treatment of adults in RT and is especially needed in patients with PTSD.

Peer support is where individuals with the same shared experience provide mutual support. Using a non-controlled repeated measure design, this study evaluates initial efficacy of one-to-one email peer support. Young people with an eating disorder were matched with a recovered volunteer befriender, for up to one year, providing 1-3 email contacts a week. All participants completed measures (self-esteem, self-efficacy, wellbeing) at start of service, two and four-month intervals for recipients (n = 92) and peer befrienders (n = 86) respectively, and at end of service. Recipients also completed measures of social connectedness, impact of eating disorder, and goal-based outcomes. Multilevel mixed-effects linear regression models indicated significant improvements across all outcomes for recipients by 4 months, apart from self-esteem, and improvements self-efficacy, eating disorder impact and goal-based outcomes maintained at end of service. Peer befrienders did not show changes in self-esteem or self-efficacy, but there was a small significant reduction in wellbeing. The study provides evidence for email peer support for young people with eating disorders and highlights the need for robust support for befriending roles.

Although eating disorders (EDs) affect individuals of all races and ethnicities, racially/ethnically minoritized individuals are less likely to receive ED treatment than White individuals. The present study aimed to compare ED treatment experiences in a sample of racially/ethnically minoritized individuals vs. White participants. As a secondary aim, we explored how acculturation and mental health stigma factors were associated with treatment experiences. We recruited 41 White and 27 racially/ethnically minoritized individuals with a history of EDs (with all racially/ethnically minoritized individuals having to be categorized into one group due to limited power to conduct analyses across groups). Participants completed an assessment of their treatment experiences, ratings of the helpfulness of each treatment, self-reported barriers to treatments, their level of acculturation, and their tolerance towards stigma. We found that racially/ethnically minoritized participants reported receiving a significantly lower total number of ED treatments than White participants. Second, racially/ethnically minoritized participants were significantly less likely to seek out inpatient and day treatment/partial hospitalization than White participants. Third, racially/ethnically minoritized rated nutritionists and residential treatment as significantly less helpful than White participants. Fourth, racially/ethnically minoritized participants identified the lack of cultural competence among providers as a significantly more substantial barrier to treatment than White participants. Finally, among racially/ethnically minoritized participants, higher immersion in dominant society correlated positively with perceived helpfulness of ED treatment. These insights can guide the development of targeted interventions aimed at mitigating treatment barriers and enhancing treatment outcomes for racially/ethnically minoritized individuals affected by EDs.

Posttraumatic stress disorder (PTSD) and eating disorders (EDs) frequently co-occur, with PTSD potentially worsening ED treatment outcomes. Integrated and concurrent interventions that treat both conditions together have been recommended, but no best practices exist. This case series of nine patients provides preliminary data on Written Exposure Therapy (WET), a brief, low-resource PTSD intervention, delivered concurrently with inpatient or day hospital ED treatment. Results showed reductions in PTSD symptoms, with most patients experiencing clinically significant improvements. Changes in ED symptoms varied, but no patients experienced deterioration. These findings suggest WET is a promising, efficient method for treating PTSD alongside ED treatment, supporting the need for clinical trials to assess its acceptability and efficacy for ED-PTSD.

Subjective eating disorder (ED) recovery has important clinical relevance. However, studies have focused on the perspectives of cisgender heterosexual individuals, which is notable given that sexual and gender minority (SGM) people often describe feelings misrepresented by prevailing ED conceptualizations. We examined eating pathology and psychosocial functioning across subjective recovery stages in SGM individuals (N = 196). Analyses of variance tested differences between active ED (n = 106, 54.1%), partial recovery (n = 82, 41.8%), and full recovery (n = 8, 4.1%) groups. Groups differed in body dissatisfaction, binge eating, restricting, clinical impairment, autonomy, environmental mastery, and self-acceptance. Most differences were observed between the full recovery and active ED groups and the full recovery and partial recovery groups, such that subjectively higher levels of ED recovery were generally associated with lower transdiagnostic ED symptoms and better psychosocial functioning. Clinical profiles appear similar between SGM and cisgender heterosexual individuals across subjective ED recovery stages.

Studies exploring disordered eating among transgender and nonbinary populations have primarily focused on minority stressors with a dearth of research examining the role of gender identity pride on body appreciation and intuitive eating. To address this gap in the literature, the present study, comprised of 148 transgender and nonbinary adults (M_age = 24.68, SD = 6.64), tested the associations among gender identity pride, body appreciation, and intuitive eating, controlling for demographics and minority stress variables. The study also tested body appreciation as a mediator in the cross-sectional association between gender identity pride and intuitive eating. Regression models indicated that greater gender identity pride was significantly associated with greater body appreciation, but not intuitive eating. Greater body appreciation was a significant mediator in the positive association between gender identity pride and intuitive eating. Findings support the significant role and relevance of examining gender identity pride as related to body appreciation and intuitive eating. Future research may determine the causal impact of gender identity pride on body image and eating behaviors in transgender and nonbinary populations. Clinicians may consider the positive role of gender identity pride when addressing body image and eating behaviors with their transgender and nonbinary clients.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals report more experiences of healthcare discrimination and disordered eating behaviors (DEBs), and less trust in physicians than their cisgender and heterosexual counterparts. Although research supports a link between discrimination and DEBs among LGBTQ+ populations, few studies have specifically investigated healthcare discrimination and DEBs in this population. This study examined whether LGBTQ+ status moderated the relation between negative healthcare experiences and DEBs in undergraduates. Undergraduates (n = 322) from a Southeastern (United States) university completed measures of healthcare discrimination, trust in physicians, and DEBs. Analyses investigated whether LGBTQ+ status moderated the relation between healthcare discrimination and DEBs; trust in physicians and DEBs. LGBTQ+ individuals (35% of sample), reported less trust in physicians (p < .001), and more body dissatisfaction (p = .007) and shape/weight overvaluation (p = .008). Among all undergraduates, experiences of healthcare discrimination were associated with higher body dissatisfaction (p = .003) and shape/weight overvaluation (p = .008). Less trust in physicians was associated with greater shape/weight overvaluation (p = .005). LGBTQ+ status did not moderate either relation. It is important to reduce healthcare discrimination and foster patient-provider trust for all young adults. Future research should examine factors influencing patient-provider trust among LGBTQ+ individuals.

Transgender and gender diverse (TGD) young adults experience elevated risk for eating disorders (ED), partially due to cissexist discrimination and victimization; less is understood about how socioeconomic determinants contribute to their ED risk. Qualitative data collected from 66 TGD young adults (18-30 years old; 29% self-identified as transgender women, 29% as transgender men, 39% as nonbinary people, and 3% as another gender identity (e.g., māhū)) in eight asynchronous online focus groups explored how socioeconomic determinants in conjunction with other dimensions of identity and lived experience shape disordered eating behavior (DEB) and ED risk. Participants described how economic barriers-including poverty and dependency on others (e.g. parents for health insurance)-and challenges produced by insurance and healthcare systems impeded healthcare access to the detriment of their overall mental health and risk for ED. In addition, participants shared different ways they leveraged financial resources to cope with stress, sometimes in ways that impelled disordered eating behaviors. Finally, participants described how poverty, socioeconomic advantage and disadvantage, and classism compound other systems of oppression (e.g. racism, ableism, weight bias) to adversely impact their general health and ED risk.

Young cisgender sexual minority women (e.g. lesbian, queer) in the U.S. are at risk for disordered eating behaviors (DEB). Minority stress theory proposes sexual minority stressors (SMS; e.g. discrimination) related to marginalized statuses are culturally specific stressors that may explain engagement in these behaviors. However, little is known about daily SMS-DEB associations. We conducted a 14-day daily diary study of 321 U.S.-based sexual minority cisgender women ages 19-35 who were in a relationship with a woman. SMS were assessed using an 8-item daily measure of distal SMS (e.g. heard anti-LGBT talk, verbal harassment), and DEB with single items capturing dietary restraint, overeating, loss of control eating, and emotional eating. Multi-level models revealed on days when women experienced SMS, they were more likely to report dietary restraint and emotional eating, but not overeating or loss of control eating. Women who generally reported more frequent SMS were more likely to report all four DEB. There were no significant couple-level SMS-DEB associations. These findings expand our understanding of how SMS is associated with DEB in the daily lives of cisgender sexual minority women. Future studies are needed to explore the temporal sequencing of the associations. Findings may also help to inform the design of culturally tailored interventions aimed at reducing DEB among sexual minority women.