Gender Identity Disorder in Adolescence: A Review of the Literature

This article reviews the empirical literature on gender identity disorder in Adolescents: one of the most contested diagnoses in DSM. Fourteen studies were identified, a critique is provided and the surrounding controversies explored. This article suggests recommendations for future practice and research.     

A Qualitative Analysis of Job Burnout in Eating Disorder Treatment Providers

Although job burnout is common in mental health care settings, almost no research has examined burnout in eating disorder treatment providers. Using qualitative methodology, this study examined a) perceived contributors of burnout, b) efforts to manage burnout, and c) recommendations for avoiding burnout in a sample of professional eating disorder treatment providers. Recruited via professional organizations, 298 participants completed an online questionnaire designed by the authors. Qualitative responses were coded and grouped into themes. Results indicated that almost all participants worried about their patients' health, which frequently resulted in negative affect (e.g., anxiety, sadness). The most frequently cited contributors to burnout were common characteristics of eating pathology (e.g., chronicity, relapse, symptom severity); patient characteristics (e.g., personality conflict); work-related factors (e.g., time demands); and, financial issues (e.g., inadequate compensation). To avoid burnout, over 90% of participants engaged in self-care behaviors (e.g., exercise, social support). Early-career practitioners were encouraged to utilize supervision, create a work/life balance, engage in self-care, and limit caseloads. These results suggest that supervision and training of eating disorder treatment providers should include burnout management.     

Reports of Stress: A Comparison Between Eating Disordered and Non-Eating Disordered Adolescents

This study utilizes a unique method to examine reports of stressful life events provided by eating disordered and non-eating disordered adolescents. Subjects (all females) participated in a standardized procedure to obtain reports of stressful life events. The Life Events and Coping Inventory (LECI) was used to categorize reported stressors. Eating disorder subjects discussed more stressors than non-eating disorder subjects only when eating disorder events were included. Furthermore, eating disorder subjects reported more events that could not be classified within the LECI and were rated as non-normative. The findings point to the importance of qualitative rather than purely quantitative approaches to stressful life events assessment with adolescents.     

Personality Characteristics and Intention to Self-Harm: A Study of Eating Disordered Patients

The purpose of this study was to examine certain psychological and behavioral differences between anorexic (AN) and bulimic (BN) patients ( n = 78 and 75, respectively) who either had or had not reported an urge to self-harm. The debate concerning whether self-injurious behaviors are more appropriately viewed as obsessive-compulsive behaviors or more closely connected to impulse control disorders like alcohol and drug addiction gave rise to the questions examined in this study. We found no frequency differences between the two patient groups in intention to self-harm. We also found that obsessive-compulsive symptoms and addictive personality characteristics were greater in those with an urge to self-harm. These findings support the view that impulsivity and compulsivity are independent dimensions that can both co-exist in the same individual, and that both are more prominent in those with an intention to self-harm.     

A Cross-Cultural Study of Disordered Eating Attitudes Among Filipino and Caucasian Americans

The present study examines the symptom levels of eating disorders among Filipino and Caucasian college students residing in Hawaii. The study also examines what variables are associated with disordered eating. A self-report questionnaire that included measures of anger discomfort, self-dissatisfaction, body dissatisfaction, and symptoms of eating disorders was administered to Filipino and Caucasian college students. As predicted, females reported higher eating disorder symptom scores than males. However, Filipino males reported higher levels of disordered eating, dieting, and body dissatisfaction than Caucasian males. No association was found between disordered eating and anger discomfort among Filipinos. The results support previous findings of females reporting higher disordered eating attitudes than males, however, Filipino males reported higher disordered attitudes than Caucasian males. Anger discomfort was not associated with disordered eating among Filipinos, supporting past studies that suggest anger management may not be an appropriate treatment for disordered eating among some Asian groups.     

Depression as a Function of Eating Disorder Diagnostic Status and Gender

The purpose of the present study was to examine depressive symptoms as a function of eating disorder (ED) diagnostic status and gender. A demographic questionnaire, the Beck Depression Inventory-II (BDI-II; Beck, Steer & Brown, 1996 Beck, A. T., Steer, R. A. and Brown, G. K. 1996. Manual for the Beck Depression Inventory, 2nd, San Antonio, TX: The Psychological Corporation.  [Google Scholar]), and the Questionnaire for Eating Disorder Diagnoses (Q-EDD; Mintz, O'Halloran, Mulholland & Schneider, 1997 Mintz, L. B., O'Halloran, M. S, Mulholland, A. M. and Schneider, P. A. 1997. Questionnaire for Eating Disorder Diagnoses: Reliability and validity of operationalizing DSM–IV criteria into a self-report format: Correction. Journal of Counseling Psychology, 44: 63–79. [Crossref], [Web of Science ®] , [Google Scholar]) were administered to a nonclinical sample of college-aged men (n = 115) and women (n = 136). Contrast tests revealed significant differences in mean BDI-II scores as a function of Q-EDD diagnostic status. This effect did not differ as a function of gender and the pattern was the same for both cognitive and somatic-affective depressive symptoms. The nature of the comorbid relationship between ED and depressive symptoms appears markedly similar across both genders.     

Identifying Early Indicators in Bipolar Disorder: A Qualitative Study

The identification of early markers has become a focus for early intervention in bipolar disorder. Using a retrospective, qualitative methodology, the present study compares the early experiences of participants with bipolar disorder to those with unipolar depression up until their first diagnosed episode. The study focuses on differences in early home and school environments as well as putative differences in personality characteristics between the two groups. Finally we a compare and contrast prodromal symptoms in these two populations. Thirty-nine participants, 20 diagnosed with unipolar depression and 19 diagnosed with bipolar disorder, took part in the study. A semi-structured interview was developed to elicit information about participants’ experiences prior to their first episode. Participants with bipolar disorder reported disruptive home environments, driven personality features, greater emotion dysregulation and adverse experiences during the school years, whereas participants with depression tended to describe more supportive home environments, and more compliant and introvert personality traits. Retrospective data collection and no corroborative evidence from other family members. No distinction was made between bipolar I and bipolar II disorder nor between melancholic and non-melancholic depression in the sample. Finally the study spanned over a 12-month period which does not allow for the possibility of diagnostic reassignment of some of the bipolar participants to the unipolar condition. These findings indicate that there may be benefits in combining both proximal and distal indicators in identifying a bipolar disorder phenotype which, in turn, may be relevant to the development of early intervention programs for young people with bipolar disorder.     

Identifying Critical Competencies for Psychotherapeutic Practice With Eating Disordered Clients: A Delphi Study

Mental health professionals lack systematic criteria against which to assess their competence to provide psychotherapy to eating disordered clients. In this Delphi study, a multidisciplinary panel of professionals with expertise in eating disorders treatment reached a consensus on essential eating disorders psychotherapy competencies, which included both literature-derived and participant-generated items. Competency domains included specialized knowledge and skills, professional responsibility, and therapist characteristics. An empirically derived, operational definition of minimum competence in psychotherapy for eating disorders was obtained. The essential competencies have utility for practitioners, novice and experienced, who wish to assess and enhance their ethical practice in psychotherapy for eating disorders.     

Emotional Eating and Eating Disorder Psychopathology

The study examined to what extent emotional eating, restrained eating, and bulimic tendencies are found together in naturally occurring groups, and whether these groups differ in terms of the psychological characteristics relevant to eating disorders. One hundred twenty-seven normal-weight women filled in The Dutch Eating Behavior Questionnaire, The Eating Attitudes Test, The Eating Disorder Inventory, and five measures of psychological well-being. Cluster analysis revealed three dieter subgroups (Normal Dieters, Emotional Dieters, and Bulimic Dieters) and one nondieter group. The results showed that only some restrained eaters were emotional eaters and that only some emotional eaters had bulimic tendencies. In addition, emotional and bulimic dieters differed from nondieters more strikingly in terms of eating disorder psychopathology and low psychological well-being than normal dieters did. The results suggest that emotional eating is not responsible for overeating only but may, in concert with chronic dieting, also relate to the general psychopathology found to underlie eating disorders.     

Eating Disorders: A Disorder of In and Out

The coexistence of a traumatic past and the development of an eating disorder is corroborated by clinicians and researchers. This article will discuss the author's concept of "the disorder of in and out" which is believed to describe the resulting core pathology: the individual does not know what to take into their lives and what to keep out of it, which is believed to be expressed metaphorically via symptoms. Treatment approaches will be explicated utilizing this perspective. Symptom choice, trauma, attachment and dissociation theories will be discussed with respect to the concept of a disorder of in and out.     

Eating Disorder and Schizophrenia

Abstract: Five cases with eating disorders (one case with anorexia nervosa alone, 4 cases with anorexia nervosa and bulimia nervosa) complicated with schizophrenia and 3 cases of bulimia nervosa complicated with schizophrenia were reported. The eating disorders and schizophrenia were diagnosed according to the diagnostic criteria of DSM-III-R. As to the type of schizophrenia, 4 patients were of an undifferentiated type and 4 cases were of a disorganized type. Regarding the prepsychotic personality, 6 of the 8 cases showed schizothyme personality traits. All the patients showed depressive symptoms which are relatively common in eating disorders. In all the patients, significant social or school life difflculties persisted and a resumption of premorbid functioning was not seen. The possibility of an afflnity between anorexia nervosa and schizophrenia was discussed.     

A Qualitative Study of Binge Eating and Obesity From an Addiction Perspective

The purpose of this study was to explore how obese women with and without binge eating disorder (BED) experience overeating in relation to the DSM-5 symptoms of addiction. Findings from this study demonstrate that food addiction can occur in obese individuals with and without BED. It is important that health care professionals identify individuals who may require a specific treatment approach that incorporates techniques used in the treatment of addictions.     

Ethnicity,Ethnic Identity,Self-Esteem,and At-Risk Eating Disordered Behavior Differences of Urban Adolescent Females

The purpose of this study was two-fold: to determine the relationship between ethnic identity and self-esteem as dimensions of one's self-concept; and to determine if differences exist among one's ethnicity, ethnic identity, and/or self-esteem when examining at-risk eating disordered behaviors. A total of 893 urban adolescent females completed three behavioral subscales: the Eating Disorder Inventory, Rosenberg's Self-Esteem Scale, and Phinney's Multigroup Ethnic Identity Measure. As hypothesized, ethnic identity was significantly associated with self-esteem to form one's self-concept. When compared to Mexican American and White females, only Black females who were in the higher ethnic identity and self-esteem categories had significantly lower at-risk eating disordered scores. Our findings suggest eating disorder status in Mexican American and White females may not be associated as much with ethnic identity as with other acculturation and self-concept factors. Further, this study demonstrated ethnicity, self-esteem, and ethnic identity play significant roles in eating disorder risks.     

Diverging Eating Psychopathology in Transgendered Eating Disorder Patients: A Report of Two Cases

This report documents two transgendered biological males who met criteria for an eating disorder, who interchangeably reported periods of endorsing masculine and feminine gender identities, allowing an exploration of how their preferred gender orientation impacted their eating disorder psychopathology. This report suggests that the divergence of body image psychopathology amongst men may be impacted by gender role orientation, which is consistent with a developing body of research.     

Perceived and Individual Ideals of Gender in Swedish Adolescents with and without an Eating Disorder

This study examines the reliability and validity of the Self Loathing Subscale (SLSS) of the Exercise Orientation Questionnaire (EOQ) as a screening tool for possible eating disorders. We administered the SLSS and two other eating disorder screening instruments to 160 college students. Results indicate that the SLSS shows high internal consistency, concurrent validity, and convergent validity. Since the SLSS is based on questions about exercise and is not easily identifiable as a screening tool for eating disorders, the scale may be particularly useful in identifying possible pathology among individuals who may try to suppress or deny obvious symptoms of eating disorders.     

The Self of Adolescents with Autism Spectrum Disorder or Attention Deficit Hyperactivity Disorder: A Qualitative Study

Journal of Autism and Developmental Disorders - Self-development is a central developmental issue in adolescence, there are few studies describing the experiences related to the self in adolescents...     

Teasing and Disordered Eating Behaviors in Spanish Adolescents

The purpose of this study is to investigate the associations between peer teasing and body dissatisfaction (BD), emotional symptoms, drive for thinness (DT), and abnormal eating behaviors, as well as to analyze the mediating role of gender and body mass index (BMI) in such disorders. We screened 57,997 school children between 13 and 16 years of age. Scores in weight-related teasing and competency-related teasing were higher among girls, as well as overweight or obese individuals. Weight-teasing correlated more strongly with abnormal eating attitudes and behaviors, whereas competency-teasing correlated with emotional symptoms. Multiple linear regression analysis showed that weight-teasing is significantly and independently associated with BD, especially in boys. Multivariate analysis revealed a significant association between weight-teasing and abnormal eating in girls, although its predictive value was very low (Exp(B) = 1.009). Mediation analysis and Path analysis showed the mediating role of DT in this association. Interventions on teasing do not seem to be a priority in eating disorder prevention programs.     

Men,Muscles, and Eating Disorders: an Overview of Traditional and Muscularity-Oriented Disordered Eating

Purpose of Review

There is growing recognition that eating disorder (ED) symptoms, particularly those of a muscularity-oriented nature, are more common in men than previously understood. The purpose of the current review is to describe contemporary directions and implications of research on traditional and muscularity-oriented ED symptoms among males.

Recent Findings

Evidence indicates that ED symptoms occur in a substantial minority of men. Importantly, recent research has focused on muscularity-oriented body image and disordered eating in males, demonstrating the prevalence, correlates, and consequences of maladaptive muscularity-oriented attitudes and behaviors. A growing number of assessments are available to measure these constructs in males, and preliminary treatment considerations have begun to be addressed in the literature.

Summary

Research on male EDs and body image is increasingly focusing on muscularity-oriented manifestations. Continued empirical work will be critical to improve our understanding of the onset, maintenance, and treatment of muscularity-oriented disordered eating in males.

     

Therapy-Related Assessment of Self-Harming Behaviors in Eating Disordered Patients: A Case Illustration

Understanding an individual's self-harming behaviors should be the basis for selecting person-specific therapeutic interventions. For that purpose, the assessment is aimed at identifying the self-harming behaviors and related symptoms as well as analyzing the external (situational) and internal (cognitive and emotional) conditions that contribute directly to the instigation of the self-harming behaviors. In this article, we demonstrate the use of a new assessment procedure that may guide the selection of therapeutic interventions. Data collection and processing are illustrated by an individual case study of an eating-disordered patient showing different types of self-harming behavior such as vomiting, alcohol abuse, cutting, and suicide attempts.