Eating disorders and IDDM. A problematic association.

IDDM and eating disorders are common conditions in young women. Whether a specific association exists between these two disorders remains controversial. Some studies have suggested an increased incidence of eating disorders in young women with IDDM, whereas others have not detected such an increase. These differences may be attributable, at least in part, to methodological issues in study design, measurement tools, and relatively small sample sizes. Whether the prevalence of eating disorders in IDDM is increased will be resolved only by larger studies that use standardized diagnostic interviews. We suspect that certain aspects of IDDM and its management may trigger the expression of an eating disorder in susceptible individuals. Required dietary restraint and weight gain related to diabetes management are the factors most likely to be implicated. Eating disorders are relatively common in young women with IDDM and may contribute to impaired metabolic control with hypoglycemia and DKA, and to long-term microvascular complications of diabetes. Omission or reduction of required insulin, an extremely common means of weight control in these young women, is likely an important factor in this regard. Further research is required to determine more precisely the relationship between IDDM and eating disorders, and the effects of eating disorders on metabolic control and chronic complications of IDDM.     

“It’s the Symptom of the Problem,Not the Problem itself”: A Qualitative Exploration of the Role of Pro-anorexia Websites in Users’ Disordered Eating

The growing trend in the use of the Internet and social media as a method of self-managing illness presents a critical opportunity to better understand the role of pro-anorexia (pro-ana) websites for eating disorders. Therefore, 155 pro-ana website messages regarding criticism that the site was responsible for developing anorexia were inductively thematically analysed. The analysis revealed five main themes: eating disorders are mental illnesses and websites do not cause mental illness, pro-ana websites and eating disorders are more than wanting to be thin (with sub-theme residents and visitors), eating disorders develop regardless of pro-ana websites, pro-ana sites do not cause eating disorders but they may trigger or encourage them (with sub-theme the problem is the user, not the site) and pro-ana sites provide support. Pro-ana websites and online communities present clinicians with complex treatment challenges. Collaborative, therapeutic consultations about pro-ana website use may help to establish how and when accessing them may hinder the treatment process.     

A focused overview of anorexia nervosa and bulimia: Part I—Etiological issues

The origin of eating disorders as a major mental illness may be explored by investigating several related concepts. Examination of biological, social, and psychological perspectives facilitates understanding of these disorders; neurobiological origin may be especially enlightening because of its exciting relevancy to new developments in the study and understanding of mental illness in general. This focus on the neurobiology of eating disorders may better explain the relationship between the eating disorders and the mood disorders, particularly major depression. Through the understanding of this relationship, new avenues of treatment possibilities are open, consistent with interventions and pharmacological developments in the treatment of major depression. In Part I, etiological theories of anorexia nervosa and bulimia will be defined and briefly explored. For the purposes of this article, the discussion of eating disorders will focus on the classification as specified in DSM-III-R (American Psychiatric Association, 1987) specifically limited to the categories of anorexia nervosa and bulimia nervosa.     

Eating disorders: antecedents, evolution and course.

Concepts of eating disorders have altered so that anorexia nervosa is now recognized as an important but uncommon syndrome within a spectrum of disordered eating. Behaviours used by dieters constitute the mild end of the eating disorder spectrum. Dieting in young women is for the most part a transient and benign activity without longer-term consequences. However, a group of dieters do progress to develop the symptoms and behaviour of eating disorders, so that dieting has been associated with an eight-fold rise in the risk of later eating disorder. Dieting or factors closely associated may account for most eating disorders in young women. Many antecedents of eating disorder appear to operate through increasing the risk of dieting rather than determining eating disorders specifically. Only the development of further neurotic and depressive symptoms characterizes dieters progressing to eating disorders. As the evidence implicating dieting in the origin of eating disorders becomes stronger so strategies for primary prevention become clearer.     

Commentary on Empirical Examinations of the Association Between Anxiety and Eating Disorders

A substantial body of research supports comorbidity between eating and anxiety disorders, and articles in this special section explore the nature of this association using several different research designs. This commentary reviews findings from these articles, focusing on inferences that may be drawn from each design. Collectively, articles support the need for future studies to examine whether eating and anxiety disorders share underlying mechanisms. If identified, such mechanisms could create opportunities for transdiagnostic interventions that ameliorate suffering from both eating and anxiety disorders.     

Eating disorders in adolescents with type 1 diabetes. A closer look at a complicated condition

The cultural drive to be thin can lead to eating disorders in many women and girls. In adolescent females with diabetes, the increased focus on eating and the weight gain associated with good glycemic control likely increase their susceptibility to abnormal eating. It is clear that nonspecified and subthreshold eating disorders, and possibly bulimia and anorexia, are more common in this group of patients. Good nutritional counseling to help patients avoid weight gain and family counseling to improve communication between patients and their families may help decrease this risk. Intentional insulin omission is a frequent means of preventing weight gain or increasing weight loss in adolescent females with type 1 diabetes. Eating disorders should be suspected in patients with recurrent diabetic ketoacidosis or poor glycemic control that is resistant to attempts at improvement. Treatment includes decreasing dietary restraint, promoting healthy eating, and either psychiatric counseling or psychologic intervention, or both.     

Eating disorders. Highlights of nursing assessment and therapeutics

Nurses providing care for individuals with eating disorders should identify and test the effectiveness of various milieu factors and nursing therapeutics employed in the treatment of these often-debilitating disorders. Nurses offer presence, role modeling, surveillance, and emotional and physiologic support while guiding reluctant patients to explore and experiment with new behaviors. Nurses provide flexibility, empathy, and rational limit setting in response to the unique and shifting needs of each patient. This interpersonal dynamic is often extremely different from that experienced in the patient's family of origin and, thus, contributes to the essential "interpersonal conditions" that are necessary for the patient to engage meaningfully in treatment. The prevalence of eating disorders suggests that nurses are likely to encounter people with eating disorders in many settings. Nurses should be skilled at spotting disordered eating among an array of clinical presentations (e.g., amenorrhea, disturbed family relationships, athletic injuries) because people engaged in disordered eating are hesitant to volunteer such information. In addition to the shame associated with disordered eating is the stigma associated with psychiatric treatment. Seeking help from a nurse may be perceived as less stigmatizing than seeking care from a psychiatrist. Thus, nurses may serve as important points of entry for the hesitant patient. The initial contact is so essential in setting the stage for the continuation and denouement of therapy. Finally, nurses and patients with disordered eating share at least one commonality. Both groups are predominantly women. The prevailing culture has been implicated repeatedly as a major factor in contributing to the prevalence of disordered eating. Nurses experience the influences of paternalism in their professional practice and confront daily the pressures of socially constructed feminine ideals. These gender-sensitive ways of knowing, which nurses bring to the treatment relationship, should be further analyzed as substantive dimensions with treatment and preventive potential.     

Diagnosis and therapy of eating disorders

Even though there is no convincing evidence that eating disorders in general are on the rise, there has been an enormous increase in "treated" cases of patients with eating disorders. This review will cover important aspects of diagnosis and treatment of eating disorders. Psychotherapeutical and pharmacological treatment strategies in anorexia and bulimia nervosa will be discussed. For both eating disorders, psychotherapy is the treatment of choice. Drugs with a serotonergic function, e.g. serotonin-reuptake-inhibitors (SSRI), have demonstrated significant results in the treatment of bulimia nervosa and eating disorders with comorbid depression. In clinical practice "treatment packages" are offered because of the complexity of the disorders. The paper also deals with medical complications of eating disorders, motivational interviewing in anorexia nervosa and treatment with self-help manuals in bulimia nervosa.     

Could Your Patient Have an Eating Disorder?

Eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder, affect approximately 14 million people in the U.S., three‐fourths of whom are female. Contrary to popular belief, eating disorders affect people of all ages. Women's health nurses can play a vital role in identifying adolescents and women who may be suffering from an eating disorder and referring them for specialized treatment.     

Patients with eating disorders. A high-risk group for fractures

PURPOSE: To analyze fracture risk and bone mineral density in patients with eating disorders (anorexia nervosa, bulimia nervosa, and other eating disorders). DESIGN: Clinical overview. FINDINGS: Bone mineral density is decreased and fracture risk increased in patients with anorexia nervosa. In patients with bulimia nervosa, bone mineral is only marginally decreased and fracture risk marginally increased. In patients with other eating disorders (eating disorders not otherwise specified), bone mineral density is decreased and fracture risk increased. CONCLUSIONS: Fracture risk is increased in patients with eating disorders. An eating disorder should be suspected in severely underweight young individuals (primarily girls) presenting with fractures, especially low-energy fractures.     

Reproductive functions in eating disorders.

This article reviews current knowledge about the effects of anorexia nervosa, bulimia nervosa and partial syndromes on ovulation, menstruation, sexuality, fertility, pregnancy and fetal-infant health. Eating disorders may result in failure to ovulate, oligomenorrhea, amenorrhea, reduced sex drive, infertility, hyperemesis gravidarum, low maternal weight gain in pregnancy, small babies for gestational date, low birth weight infants, increased neonatal morbidity and problems in infant feeding. The available information suggests that clinicians should inquire about nutritional intake, a history of eating disorders and weight reducing behaviours as part of the routine assessment of patients with the disorders of reproductive function listed above. If an eating disorder is discovered before conception, the woman should be encouraged to delay pregnancy until the eating disorder is treated and effectively under control. If the woman is pregnant, early diagnosis and treatment are essential to reduce maternal and fetal complications. The infants of eating-disordered women should be carefully followed to ensure adequate nutritional intake. Problems in reproductive function related to eating disorders offer rich opportunities for multispecialty collaboration in primary and secondary prevention programmes directed toward both mother and infant.     

Boys with eating disorders.

Although commonly associated with girls and women, eating disorders do not discriminate. School nurses need to be aware that male students also can suffer from the serious health effects of anorexia nervosa, bulimia, anorexia athletica, and eating disorders not otherwise specified. Sports that focus on leanness and weight limits can add to a growing boy's risk of developing an eating disorder. Issues of body image and sexual development can complicate and can distort previously normal eating habits. Students may use powerful and dangerous drugs readily available via the Internet, including growth hormone, creatine, testosterone, and aminophylline, to build muscle and to eliminate fat, potentially causing serious health consequences. School nurses can partner with health and physical education teachers, coaches, school staff, parents, and students to identify and to support boys with eating disorders     

Traitement de la restriction cognitive : est-ce si simple ?

We define cognitive restraint as all eating behaviors, beliefs, interpretations and cognitions about food and how to eat, stemming from an intention to control one’s weight by mentally controlling eating behavior. We describe four levels of cognitive restraint: mild, moderate, severe and decompensated, which correspond to increasingly serious eating disorders. All levels are treatable. Cognitive restraint treatment consists of: 1) working on eating beliefs: the psychophysiology of eating and weight regulation are explained to the patient and dysfunctional beliefs about eating are identified and discussed. A behaviour contract is determined consisting of eating in accordance with eating sensations and emotions, and accepting the weight attained from eating in this way; 2) working on eating behaviors: meals and snacks are reorganized so that paying attention to eating sensations and emotions becomes possible. Systematic desensitization through successive tasks is the crucial component of treatment in order to reduce anxiety about weight, guilt about eating and dichotomous beliefs related to food. Mindful tasting, especially of demonized foods is also essential. This type of food is most often the subject of compulsive eating or bulimia. Cognitive restraint treatment is necessary, but not sufficient to treat eating disorders and weight problems. Emotional problems at the source of compulsive eating behaviours or bulimia also need to be addressed. Working on self-acceptance and self-affirmation is also necessary when the set-point differs significantly from the ideal weight. The treatment is not without pitfalls: paying attention to eating sensations becomes distorted when it becomes a way of controlling weight. Weight loss may also lead to a performance rationale, which is opposed to weight regulation. Cognitive restraint treatment allows the patient to develop a more peaceful relationship with food, and to participate in the management of eating disorders and weight problems.     

Identification and Treatment of Eating Disorders in the Primary Care Setting

Eating disorders, which are associated with a host of adverse medical morbidities, negative psychological sequelae, and considerable reductions in quality of life, should be diagnosed and treated promptly. However, primary care physicians may find it uniquely challenging to detect eating disorders in their early stages, before obvious physical problems arise and while psychological symptoms are subtle. Although psychological symptoms may dominate the presentation, the physician is an integral member of the treatment team and is in a unique role to diagnose and treat eating disorders. This clinical review surveys the eating disorders literature, identified by searching MEDLINE and PubMed for articles published from January 1, 1983, to September 30, 2009, using the following keywords: anorexia nervosa, bulimia nervosa, eating disorders, eating disorders NOS, binge eating, binge eating disorder, and night eating syndrome. This review also focuses on practical issues faced by primary care physicians in the management of these conditions and other issues central to the care of these complex patients with medical and psychiatric comorbid conditions.AN = anorexia nervosa; BED = binge-eating disorder; BN = bulimia nervosa; CBT = cognitive behavior therapy; DSM = Diagnostic and Statistical Manual of Mental Disorders; EDNOS = eating disorder not otherwise specified; NES = night-eating syndromeHealth service utilization among adults with eating disorders is high, and hospitalization expenses are on the rise.¹ Among adults with eating disorders, at least half had their disorder first diagnosed by their primary care physicians.^2,3 Although primary care physicians are in a unique role to diagnose and treat eating disorders, reviews of medical education frequently show a lack of adequate training in their identification and treatment, and hence health care professionals may only detect an eating disorder once substantial medical and psychological consequences have developed.^3,4 This review discusses the main eating disorders seen in primary care, including anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), night-eating syndrome (NES), and eating disorder not otherwise specified (EDNOS), detailing the signs and symptoms of each of these eating disorders, screening tests to detect them, and pharmacological and psychosocial approaches to their treatment (Open in a separate window     

Childhood trauma as a predictor of eating psychopathology and its mediating variables in patients with eating disorders

Aim. The aims of this study were to determine whether specific forms of childhood trauma predict eating psychopathologies and to investigate the mediating effects of the psychological symptoms of depression and obsessive‐compulsion between childhood trauma and eating psychopathologies in patients with eating disorders. Background. The highest probability of poor treatment outcomes in patients with eating disorders has been observed in those who experienced childhood trauma. Therefore, researchers are now examining whether childhood trauma should be considered a risk factor for eating psychopathology, but childhood traumatic experiences as predictors of eating psychopathology and their mediating variables has not been investigated sufficiently with this clinical population. Design. Survey. Methods. The subjects were 73 Korean patients with eating disorders. The Childhood Trauma Questionnaire, Eating Disorder Inventory‐2, Beck Depression Inventory and Maudsley Obsessional‐Compulsive Inventory were used to assess self‐reported childhood trauma in five domains (emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect), eating psychopathology, depression and obsessive‐compulsion. Stepwise multiple regression analyses were used to explore whether these childhood traumatic experiences predict eating psychopathology and mediation analyses were conducted according to Baron and Kenny’s guidelines. Results. Emotional abuse, physical neglect and sexual abuse were found to be significant predictors of eating psychopathology. We also found that depression fully mediated the association between some forms of childhood trauma and eating psychopathology, while obsessive‐compulsion did not mediate this association. Conclusions. Future interventions for patients with eating disorders should focus on assessing the possibility of childhood trauma, especially in those patients with poor treatment outcomes. In addition, whether or not traumatised individuals exhibit depression is a more important predictor of eating psychopathology than the traumatic experience itself. Relevance to clinical practice. Early intervention for childhood trauma and depression might contribute to preventing eating disorders in traumatised individuals.     

Eating disorders,fertility, and pregnancy: relationships and complications

Women are becoming heavier with each generation although the ideal female image emphasizes slimness. This focus results in the development of eating disorders in a significant number of women. The most common eating disorders are anorexia nervosa and bulimia nervosa. Eating disorder behaviors during pregnancy are associated with complications such as preterm delivery, low birthweight, intrauterine growth restriction, Caesarean birth, and low Apgar scores. Increasing the understanding of eating disorders assists health care professionals to accurately assess and intervene to improve a woman's nutritional status, monitor eating behaviors that may negatively affect a woman's health and fertility, and promote positive outcomes during pregnancy.     

Body Image,Eating Attitudes and Breastfeeding Intention: Implications for Mental Health and Maternal Child Nurses

Body image dissatisfaction and disordered eating are often overlooked as personal factors that may affect pregnancy, postpartum, and infant feeding method. The current study compared body image, eating attitudes, and breastfeeding intention of first-time breastfeeding mothers to first-time non-breastfeeding mothers. A two-group, comparative design was used to analyze data for first-time mothers recruited through a large pediatric practice with multiple offices. Although there was no significant difference in body image scores between the groups, the literature suggests that body image dissatisfaction can affect the transition to motherhood and lead to more serious mental health issues. Prevention of psychiatric disorders such as eating disorders can be addressed early with information regarding body dissatisfaction and disordered eating. Findings from this study have implications for mental health and maternal child health providers.     

Recognizing alcohol and drug abuse in patients with eating disorders

Eating disorders and alcohol/drug abuse are frequently comorbid. Eating-disordered patients are already at an increased risk for morbidity and mortality, so alcohol and drug use pose additional dangers for these patients. Restricting anorexics, binge eaters, and bulimics appear to be distinct subgroups within the eating-disordered population, with binge eaters and bulimics more prone to alcohol and drug use. Personality traits such as impulsivity have been linked to both bulimia nervosa and substance abuse. Many researchers have proposed that an addictive personality is an underlying trait that predisposes individuals to both eating disorders and alcohol abuse. Interviewing is generally the most useful tool in diagnosing alcohol and substance abuse disorders in individuals with eating disorders. It is essential for the physician to be non-judgmental when assessing for substance abuse disorders in this population. We discuss interviewing techniques, screening instruments, physical examination, and biological tests that can be used in evaluating patients with comorbid eating disorders and substance abuse. More studies are needed to understand psychobiological mechanisms of this comorbidity, and to develop treatments for individuals with comorbid eating disorders and substance misuse.     

Eating behavior, eating disorders and obesity

Over the last 50 years, the nutritional and socioeconomic conditions have dramatically changed in all industrialized countries. As a consequence, there has been a sharp rise in the prevalence of obesity. Simultaneously, social and cultural pressures to maintain a thin body shape have significantly increased. This untoward situation is largely responsible for the steady increase of eating disorders, especially bulimia nervosa and binge-eating disorder, which are common disorders among normal or overweight individuals. Although the criteria for bulimia nervosa were first described in the DSM-III in 1980 (APA, 1980), recent studies have demonstrated that only about 12% of these patients are detected by their GP's. One reason for this low rate of detection may be due to the tendency of patients to conceal their illness from others. It is also possible, however, that general practitioners lack sufficient knowledge about bulimia nervosa, preventing proper identification. To help improve this situation, diagnostic guidelines and therapeutic options were summarized. Binge-eating disorder (BED), which is classified as an "eating disorder not otherwise specified" in the DSM-IV (APA, 1994), has been described as the most relevant eating disorder for overweight individuals. It has been estimated that approximately 20-30% of overweight persons seeking help at weight loss programs are classified as binge eaters. Initial results from these studies suggest that binge eaters may require a modified psychotherapeutic approach which focuses on normalizing disordered eating patterns before attempting weight loss. In addition to the importance of screening for eating disorder behaviors, overweight patients should be assessed for other comorbid conditions, such as depression and anxiety. Further, body image disturbances should be assessed during the evaluation. In the event that comorbid disorders are present, it is recommended that specific psychotherapeutic interventions which target these problems be integrated into the overall weight reduction program.     

Cognitive behavioral therapy for eating disorders

Eating disorders include anorexia nervosa and bulimia nervosa. The former is characterized by failure to maintain a minimum normal body weight, while the latter is typified by recurrent binge eating followed by inappropriate compensating behavior, which may include self-inducing vomiting; abuse of laxatives, diuretics or other medications; fasting; and over-exercise. Because eating disorders are difficult to detect in the early stages and patients frequently try to hide their condition and avoid seeking medical help, medical treatment is sometimes sought only once a patient's condition poses an immediate threat to his/her health, or even life. Some patients suffer from chronic and treatment-refractory disorders. Cognitive behavioral therapy, administered through partially-structured guidance and education, has been shown to treat eating disorders effectively by correcting associated maladaptive and distorted cognitions and behaviors. A review of articles published in the domestic and international literature over the past five years show that cognitive behavioral therapy is more effective in treating eating disorders than other traditional approaches. Therefore, we chose to focus this study on the cognitive behavioral therapy model. Nurses can employ cognitive behavioral therapy to help eating disordered patients address and overcome the core beliefs that underpin their disorder (e.g., compulsive concern about body weight or figure) and recover health.