A qualitative study on the multi-level process of resilience development for adults recovering from eating disorders

Abstract Background Resilience research to date has been criticised for its consideration of resilience as a personal trait instead of a process, and for identifying individual factors related to resilience with no consideration of the ecological context. The overall aim of the current study was to explore the multi-level process through which adults recovering from EDs develop resilience, from the perspectives of clients and clinicians. The objective of this research was to outline the stages involved in the process of developing resilience, which might help to inform families and services in how best to support adults with EDs during their recovery. Method Thirty participants (15 clients; 15 clinicians) took part in semi-structured interviews, and responded to questions relating to factors associated with resilience. Using an inductive approach, data were analysed using reflexive thematic analysis. Results The overarching theme which described the process of developing resilience was ‘Bouncing back to being me’, which involved three stages: ‘Who am I without my ED?’, ‘My eating disorder does not define me’, and ‘I no longer need my eating disorder’. Twenty sub-themes were identified as being involved in this resilience process, thirteen of which required multi-level involvement. Conclusion This qualitative study provided a multi-level resilience framework for adults recovering from eating disorders, that is based on the experiences of adults with eating disorders and their treating clinicians. This framework provided empirical evidence that resilience is an ecological process involving an interaction between internal and external factors occurring between adults with eating disorder and their most immediate environments (i.e. family and social). Plain English summary Anorexia nervosa, bulimia nervosa and binge-eating disorder demonstrate high rates of symptom persistence across time and poor prognosis for a significant proportion of individuals affected by these disorders, including health complications and increased risk of mortality. Many researchers have attempted to explore how to improve recovery outcomes for this population. Eating disorder experts have emphasised the need to focus not only on the weight indicators and eating behaviours that sustain the eating disorder during recovery, but also on the psychological well-being of the person recovering. One way to achieve this is to focus on resilience, which was identified as a fundamental aspect of eating disorder recovery in previous research. This study conceptualises resilience as a dynamic process that is influenced not only at a personal level but also through the environment in which the person lives. This study gathered data from adults with eating disorders and their treating clinicians, to devise a framework for resilience development for adults recovering from eating disorders. The paper discussed ways in which these findings and the framework identified can be easily implemented in clinical practice to facilitate a better understanding of eating disorder resilience and to enhance recovery outcomes.

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Association and Familial Coaggregation of Type 1 Diabetes and Eating Disorders: A Register-Based Cohort Study in Denmark and Sweden

10.2337/figshare.14040212 ◽

2021 ◽

Author(s):

Ashley E. Tate ◽

Shengxin Liu ◽

Ruyue Zhang ◽

Zeynep Yilmaz ◽

Janne T. Larsen ◽

...

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Eating Behaviors ◽

Diabetes Diagnosis ◽

Disordered Eating Behaviors ◽

Increased Risk ◽

Clinical Diagnoses

OBJECTIVE To ascertain the association and co-aggregation of eating disorders and childhood-onset type 1 diabetes in families. RESEARCH DESIGN AND METHODS Using population samples from national registers in Sweden (n= 2 517 277) and Demark (n= 1 825 920) we investigated the within-individual association between type 1 diabetes and EDs, and their familial co-aggregation among full siblings, half-siblings, full cousins, and half-cousins. Based on clinical diagnoses we classified eating disorders (EDs) into: any eating disorder (AED), anorexia nervosa and atypical anorexia nervosa (AN), and other eating disorder (OED). Associations were determined with hazard ratios (HR) with confidence intervals (CI) from Cox regressions. RESULTS <pre>Swedish and Danish individuals with a type 1 diabetes diagnosis had a greater risk of receiving an ED diagnosis (HR [95% CI] Sweden: AED 2.02 [1.80 – 2.27], AN 1.63 [1.36 – 1.96], OED 2.34 [2.07 – 2.63]; Denmark: AED 2.19 [1.84 – 2.61], AN 1.78 [1.36 – 2.33], OED 2.65 [2.20 – 3.21]). We also meta-analyzed the results: AED 2.07 [1.88 – 2.28], AN 1.68 [1.44 – 1.95], OED 2.44 [2.17 – 2.72]. There was an increased risk of receiving an ED diagnosis in full siblings in the Swedish cohort (AED 1.25 [1.07 – 1.46], AN 1.28 [1.04 – 1.57], OED 1.28 [1.07 – 1.52]), these results were non-significant in the Danish cohort.</pre> CONCLUSION Patients with 1 diabetes are at a higher risk of subsequent EDs; however, there is conflicting support for the relationship between having a sibling with type 1 diabetes and ED diagnosis. Diabetes healthcare teams should be vigilant for disordered eating behaviors in children and adolescents with type 1 diabetes.

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Comorbidity between types of eating disorder and general medical conditions

The British Journal of Psychiatry ◽

10.1192/bjp.2021.104 ◽

2021 ◽

pp. 1-8

Author(s):

Natalie C. Momen ◽

Oleguer Plana-Ripoll ◽

Cynthia M. Bulik ◽

John J. McGrath ◽

Laura M. Thornton ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Proportional Hazards ◽

Medical Condition ◽

Detailed Examination ◽

Cox Proportional Hazards ◽

Medical Conditions ◽

Relative Risks ◽

Hazard Ratios ◽

Increased Risk

Background Comorbidity with general medical conditions is common in individuals with eating disorders. Many previous studies do not evaluate types of eating disorder. Aims To provide relative and absolute risks of bidirectional associations between (a) anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified and (b) 12 general medical conditions. Method We included all people born in Denmark between 1977 and 2010. We collected information on eating disorders and considered the risk of subsequent medical conditions, using Cox proportional hazards regression. Absolute risks were calculated using competing risks survival analyses. We also considered risks for prior medical conditions and subsequent eating disorders. Results An increased risk was seen for almost all disorder pairs (69 of 70). Hazard ratios for those with a prior eating disorder receiving a subsequent diagnosis of a medical condition ranged from 0.94 (95% CI 0.57−1.55) to 2.05 (95% CI 1.86−2.27). For those with a prior medical condition, hazard ratios for later eating disorders ranged from 1.35 (95% CI 1.26–1.45) to 1.98 (95% CI 1.71–2.28). Absolute risks for most later disorders were increased for persons with prior disorders, compared with reference groups. Conclusions This is the largest and most detailed examination of eating disorder–medical condition comorbidity. The findings indicate that medical condition comorbidity is increased among those with eating disorders and vice versa. Although there was some variation in comorbidity observed across eating disorder types, magnitudes of relative risks did not differ greatly.

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Infecundity and Infertility

Oxford Research Encyclopedia of Global Public Health ◽

10.1093/acrefore/9780190632366.013.184 ◽

2019 ◽

Author(s):

Marie Thoma ◽

Carie Cox ◽

Jasmine Fledderjohann ◽

Rudolph Kantum Adageba

Keyword(s):

Public Health ◽

Reproductive Health ◽

Sexual And Reproductive Health ◽

Assisted Reproductive Technologies ◽

Significant Proportion ◽

Well Being ◽

Reproductive Technologies ◽

Reproductive Age ◽

Increased Risk ◽

Global Epidemiology

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Global Public Health. Please check back later for the full article. Infertility remains a neglected area in sexual and reproductive health, yet its consequences are staggering. Infertility is estimated to impact about 15% (estimates range from 48 million to 180 million) of couples of reproductive age worldwide. It is associated with adverse physical and mental health outcomes, financial distress, severe social stigma, increased risk of domestic abuse, and marital instability. While men and women are equally likely to be infertile, women often bear the societal burden of infertility, particularly in societies where a woman’s identity and social value is closely tied to her ability to bear children. Despite these consequences, disparities in access to infertility treatment between low- and high-income populations persist, given the high cost and limited geographic availability of diagnostic services and assisted reproductive technologies. In addition, a significant proportion of infertility arises from preventable factors, such as smoking, sexually transmitted infections, pregnancy-related infection or unsafe abortion, and environmental contaminants. Accordingly, programs that address the equitable prevention and treatment of infertility are not only in keeping with a reproductive rights perspective, but can also improve public health. However, progress on infertility as a global concern in the field of sexual and reproductive health and rights is stymied by challenges in understanding the global epidemiology of infertility, including its causes and determinants, barriers to accessing quality infertility care, and a lack of political will and attention to this issue. Tracking and measurement of infertility is highly complex, resulting in considerable ambiguity about its prevalence and stratification of reproduction globally. A renewed global focus on infertility epidemiology, risk factors, and access to and receipt of quality of care will support individuals in trying to reach their desired number and spacing of children and improve overall health and well-being.

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Mental Health Links With Eating Disorder Risk and Weight Related Concerns in First Semester College Students

Current Developments in Nutrition ◽

10.1093/cdn/nzab035_107 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 199-199

Author(s):

Zhiping Yu ◽

Paul Fuglestad ◽

Madisen Reasonover

Keyword(s):

Mental Health ◽

College Students ◽

Eating Disorders ◽

Eating Disorder ◽

Psychological Distress ◽

Food Addiction ◽

Well Being ◽

Eating Disorder Risk ◽

First Semester ◽

Disorder Risk

Abstract Objectives Both mental health and eating disorders are increasing health concerns for college students. This study aimed to examine associative links between psychological distress, eating disorder risk, food addiction, and weight related concerns among first semester college students. Methods Freshman students 18 years or older in all majors in a southeastern university were invited to take an online survey. The measures included demographic characteristics, psychological behaviors and eating disorder risks. Pearson's correlation analysis was used to assess associations. Results Ninety-two students (79.3% female, 61.5% white) completed the survey. Psychological distress significantly correlated with higher eating disorder risk (stress r = 0.28, anxiety r = 0.28, depression r = 0.42; P's < 0.01), higher food addiction symptom count (stress r = 0.30, anxiety r = 0.34, depression r = 0.44; P's < 0.01), and lower weight related quality of life (stress r = −0.27, anxiety r = −0.38, depression r = −0.52; P's < 0.01). Greater anxiety also significantly correlated with lower self-reported dream weights (r = −0.23, P < 0.05) and happy weights (r = −0.23, P < 0.05). Conclusions The findings suggest that the management of psychological well-being of college students is important for prevention and treatment of eating disorders and weight issues in this population. Funding Sources Brooks College of Health, University of North Florida.

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LA CLINICA DEI DISTURBI DEL COMPORTAMENTO ALIMENTARE: L’INTERVENTO PSICOLOGICO°

Istituto Lombardo - Accademia di Scienze e Lettere - Incontri di Studio ◽

10.4081/incontri.2020.632 ◽

2020 ◽

Author(s):

Enrico Molinari

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Collaborative Work ◽

Well Being ◽

Fundamental Question ◽

Restrictive Eating ◽

Political Experience ◽

Personal Experiences ◽

Unpleasant Emotion

Eating disorders represent a field of investigation and intervention of considerable interest for psychology. This is an extraordinarily complex area. When working with these patients, it is crucial to consider a multifactorial etiopathogenetic framework. As anyone who has ever worked with eating disorder will know, the words “challenge” and “body image” have a particularly important role, both in research and clinical practice. appearance. Of all other Eating Disorders, Anorexia Nervosa (AN) will be presented today. Its prevalence ranges between 0,28% and 1%, with a high mortality rate and its onset is related to the presence of a multiplicity of genetic, neurobiological and psychosocial interrelated factors. One fundamental question is: what are the objectives to achieve for each specific individual who show AN symptoms? Treatment should be directed towards as many areas as possible in order to increase the chances of success and ensure the patient’s greater psychophysical well-being. A collaborative work between nutritionists, physicians, psychologists, psychiatrists, patients themselves and their families, could turn the cure into an aesthetic, ethical and political experience. The narration of their own personal experiences is an essential moment in the treatment of patients with eating disorders. Keeping in mind that the restrictive eating behavior, which is typical in AN, seems aimed at avoiding unpleasant emotion and that the real expert of the disorder is always the patient himself, it is essential to build a relationship that promotes change.

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Eating Disorder Risk Among Patients Presenting to a Specialty Concussion Clinic

Neurology ◽

10.1212/01.wnl.0000719952.81181.73 ◽

2020 ◽

Vol 95 (20 Supplement 1) ◽

pp. S9.2-S10

Author(s):

Natalie Alexandra Gavi ◽

Rachel Pearson ◽

Kevin Bickart ◽

Meeryo Choe ◽

Talin Babikian ◽

...

Keyword(s):

Eating Disorder ◽

Significant Proportion ◽

Group Differences ◽

Registered Dietitian ◽

Positive Screen ◽

Concussion Management ◽

Increased Risk ◽

Injury Mechanisms ◽

Patient Health ◽

Time Since Injury

ObjectiveIn this pilot study, we aim to assess the prevalence of eating disorder (ED) risk in patients presenting to a multi-disciplinary concussion clinic.BackgroundAnxiety and depression are commonly seen after concussion. However, other post-concussive psychiatric disorders, including EDs, have not been as extensively studied. Athletes represent a population at higher risk for concussion; they also have increased risk of EDs, partly due to emphasis placed on body composition for athletic performance.Design/MethodsConsecutive new patients evaluated in a multi-disciplinary concussion clinic received questionnaires: the SCOFF ED Screening Tool, Patient Health Questionnaire (PHQ-9 or PHQ-A for adolescents), and Generalized Anxiety Disorder 7 (GAD-7). Patients 12–52 years old referred for concussion were included. A positive screen for ED behavior was defined as answering ‘yes’ to = 1 question on the SCOFF and/or reported poor appetite, weight loss, or overeating on the PHQ. Independent Samples Mann-Whitney U Tests were used to assess group differences in demographic and questionnaire data.ResultsTwenty-two patients (55% female, mean age 20.2 ± 10.4 years) completed questionnaires. Time from injury ranged from 3 days to >1 year. Injury mechanisms included sport (n = 16), fall (n = 4), struck (n = 1), and other (n = 1). Ten (45% total, 80% female) had positive ED screens. Significant associations were found between positive screens and total PHQ-9 (p = 0.017), GAD-7 scores (p = 0.025), and time since injury (p = 0.036), but not for age. Findings were no longer significant after controlling for gender.ConclusionsA significant proportion of females who present to a concussion clinic may be at risk of EDs. Because ED behaviors may affect concussion management and recovery, routine screening for ED in concussion clinics should be considered. Those with positive screens would benefit from a referral to a registered dietitian for additional evaluation. Further research is needed to verify the prevalence and characterize the effect of subclinical and clinical EDs in this population.

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Investigating the Use of CD-Rom CBT for Bulimia Nervosa and Binge Eating Disorder in an NHS Adult Outpatient Eating Disorders Service

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465810000688 ◽

2011 ◽

Vol 39 (4) ◽

pp. 443-456 ◽

Cited By ~ 9

Author(s):

Lisa Graham ◽

Mark Walton

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Bulimia Nervosa ◽

Binge Eating ◽

Binge Eating Disorder ◽

Well Being ◽

Dropout Rates ◽

Initial Assessment ◽

Computer Assisted ◽

Cd Rom

Background: Many patients who experience bulimia nervosa (BN) and binge eating disorder (BED) find it hard to access evidence-based treatments. Rates of failure to enter outpatient services following initial assessment are high, as are dropout rates from specialist outpatient eating disorders services. Aims: To offer CD-Rom CBT, a cognitive-behavioural multi-media supported self-help treatment, in a locality-based outpatient NHS Eating Disorders Service to patients who have binge eating disorder and bulimia nervosa. Method: Patients referred to a catchment-based NHS outpatient eating disorders service who were assessed and had an eating disorder with a binge-eating component were offered CD-Rom based CBT (Overcoming Bulimia) whilst on the waiting list for individual CBT. Results: Forty patients completed the 8 sessions and attended the evaluation appointment (13 had BN, 27 had BED). For both groups, there were significant improvements in well-being and functioning, as well as significant reductions in problems and risk. There was also a significant reduction on the “Bulimic Subscale” of the EDI. These results were comparable with the original study findings (Schmidt, Treasure and Williams, 2001). Dropouts from the CD-Rom reflected rates common to other EDS treatments suggesting that CD-Rom did not directly impact upon service dropout rates. Conclusions: Computer assisted CBT for Eating Disorders offers a promising, feasible and acceptable first step for patients who have bulimia nervosa or binge eating disorder and access treatment from specialist eating disorders services.

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Association and Familial Coaggregation of Type 1 Diabetes and Eating Disorders: A Register-Based Cohort Study in Denmark and Sweden

10.2337/figshare.14040212.v1 ◽

2021 ◽

Author(s):

Ashley E. Tate ◽

Shengxin Liu ◽

Ruyue Zhang ◽

Zeynep Yilmaz ◽

Janne T. Larsen ◽

...

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Eating Behaviors ◽

Diabetes Diagnosis ◽

Disordered Eating Behaviors ◽

Increased Risk ◽

Clinical Diagnoses

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A longitudinal study of eating behaviours in childhood and later eating disorder behaviours and diagnoses

The British Journal of Psychiatry ◽

10.1192/bjp.2019.174 ◽

2019 ◽

Vol 216 (2) ◽

pp. 113-119 ◽

Cited By ~ 8

Author(s):

Moritz Herle ◽

Bianca De Stavola ◽

Christopher Hübel ◽

Mohamed Abdulkadir ◽

Diana Santos Ferreira ◽

...

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Longitudinal Study ◽

Binge Eating ◽

Binge Eating Disorder ◽

Latent Class ◽

Risk Difference ◽

Eating Behaviours ◽

Increased Risk

BackgroundEating behaviours in childhood are considered as risk factors for eating disorder behaviours and diagnoses in adolescence. However, few longitudinal studies have examined this association.AimsWe investigated associations between childhood eating behaviours during the first ten years of life and eating disorder behaviours (binge eating, purging, fasting and excessive exercise) and diagnoses (anorexia nervosa, binge eating disorder, purging disorder and bulimia nervosa) at 16 years.MethodData on 4760 participants from the Avon Longitudinal Study of Parents and Children were included. Longitudinal trajectories of parent-rated childhood eating behaviours (8 time points, 1.3–9 years) were derived by latent class growth analyses. Eating disorder diagnoses were derived from self-reported, parent-reported and objectively measured anthropometric data at age 16 years. We estimated associations between childhood eating behaviours and eating disorder behaviours and diagnoses, using multivariable logistic regression models.ResultsChildhood overeating was associated with increased risk of adolescent binge eating (risk difference, 7%; 95% CI 2 to 12) and binge eating disorder (risk difference, 1%; 95% CI 0.2 to 3). Persistent undereating was associated with higher anorexia nervosa risk in adolescent girls only (risk difference, 6%; 95% CI, 0 to 12). Persistent fussy eating was associated with greater anorexia nervosa risk (risk difference, 2%; 95% CI 0 to 4).ConclusionsOur results suggest continuities of eating behaviours into eating disorders from early life to adolescence. It remains to be determined whether childhood eating behaviours are an early manifestation of a specific phenotype or whether the mechanisms underlying this continuity are more complex. Findings have the potential to inform preventative strategies for eating disorders.

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The Role of the Gut Microbiome, Immunity, and Neuroinflammation in the Pathophysiology of Eating Disorders

Nutrients ◽

10.3390/nu13020500 ◽

2021 ◽

Vol 13 (2) ◽

pp. 500

Author(s):

Michael J. Butler ◽

Alexis A. Perrini ◽

Lisa A. Eckel

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Immune System ◽

Binge Eating ◽

Gut Microbiome ◽

Diet Composition ◽

Caloric Intake ◽

Psychiatric Illnesses ◽

Increased Risk

There is a growing recognition that both the gut microbiome and the immune system are involved in a number of psychiatric illnesses, including eating disorders. This should come as no surprise, given the important roles of diet composition, eating patterns, and daily caloric intake in modulating both biological systems. Here, we review the evidence that alterations in the gut microbiome and immune system may serve not only to maintain and exacerbate dysregulated eating behavior, characterized by caloric restriction in anorexia nervosa and binge eating in bulimia nervosa and binge eating disorder, but may also serve as biomarkers of increased risk for developing an eating disorder. We focus on studies examining gut dysbiosis, peripheral inflammation, and neuroinflammation in each of these eating disorders, and explore the available data from preclinical rodent models of anorexia and binge-like eating that may be useful in providing a better understanding of the biological mechanisms underlying eating disorders. Such knowledge is critical to developing novel, highly effective treatments for these often intractable and unremitting eating disorders.

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