Current approach to eating disorders: a clinical update

This article presents current diagnostic conceptualisations of eating disorders, including new disorders such as binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). This is followed by contemporary findings in the epidemiology of eating disorders, their broad sociodemographic distribution and the increases in community prevalence. Advances and the current status of evidence‐based treatment and outcomes for the main eating disorders, anorexia nervosa, bulimia nervosa and BED are discussed with focus on first‐line psychological therapies. Deficits in knowledge and directions for further research are highlighted, particularly with regard to treatments for BED and ARFID, how to improve treatment engagement and the management of osteopenia.     

Perfectionism and eating disorders: a review of the literature

In recent years, a large number of studies have examined perfectionism and eating disorders. Perfectionism is well known to occur in anorexia nervosa, but has only more recently been recognized as also associated with bulimia nervosa. However, to date there has been no synthesis or evaluation of these studies. The purpose of this article is to review the concept of perfectionism and its assessment, and to evaluate the research that has examined perfectionism and eating disorders. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Pathways to specialist care for eating disorders: An Italian multicentre study

Two hundred forty six patients with eating disorders (EDs) recruited from eight Italian specialized treatment centres were administered with the World Health Organization “Encounter Form,” a standardized schedule that makes it possible to characterize the clinical pathways that patients follow to reach specialized care. The median time from symptoms onset to specialized care was 114 weeks. Primary “points of access to care” were general practitioners (25%), psychiatrists (18%), and clinical nutritionists (17%), followed by various other carers. All patients received specific psychotherapy, whereas only 11% of them were given psychotropic drugs. EDs are characterized by complex care pathways, with low rates of direct access to specialized care. Although the role of general practitioners remains crucial, they tend to follow different clinical routes to refer ED patients. Educational programmes on EDs should be addressed to general practitioners and clinical nutritionists, in order to ease the transition of ED patients to a mental health care setting.     

Making eating disorders classification work in ICD‐11

The time has come again for the revision of the existing classifications systems and the creation of new versions, DSM‐V and ICD‐11. In September 2009, an initial call for comments and views regarding the development of the ICD‐11 was made to the Eating Disorders Section of the Royal College of Psychiatry. This Viewpoint summarises the main points collected from child and adolescents and eating disorder (ED) psychiatrists in response to this consultation, outlines some proposals for modification of the relevant section(s) of ICD‐11 and gives our views. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

A longitudinal study on the association between facets of mindfulness and eating disorder symptoms in individuals diagnosed with eating disorders

Mindfulness‐based treatments for eating disorders could be improved by understanding how facets of mindfulness predict eating disorder symptoms over time. We examined whether facets of mindfulness predict eating disorder symptoms over time and vice versa. Individuals with an eating disorder diagnosis (N = 124; 87.9% diagnosed with anorexia nervosa) and an undergraduate sample (N = 290) completed measures of mindfulness at baseline. The clinical sample also completed these measures 1 month later. Individuals in the clinical sample had lower acting with awareness and higher observing than individuals in the undergraduate sample (ps < 0.002). In the clinical sample, higher body dissatisfaction prospectively predicted lower acting with awareness (p = 0.02). Lower acting with awareness prospectively predicted higher drive for thinness (p < 0.01) and bulimic symptoms (p < 0.01). Acting with awareness shows potential as a process that can be altered to effect positive outcomes on drive for thinness and bulimic symptoms.     

A framework for conceptualising early intervention for eating disorders

Objective

This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders.

Method and Results

Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence-based approaches to early intervention for eating disorders and progress is being made in scaling these.

Conclusions

We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics.     

Leptin—a parameter for body fat measurement in patients with eating disorders

Plasma levels of leptin correlate with the body mass index and even more with percentage body fat. Determinations of leptin levels might thus offer an alternative to easily assess fat mass in patients with eating disorders. Twenty-five females with the DSM-IV diagnosis of anorexia nervosa (n=12, mean BMI 13·8) and bulimia nervosa (n=13, mean BMI 21·7), respectively, were examined upon referral for inpatient treatment. Methods for the measurement of body fat were BMI and plasma leptin level; dual-energy X-ray absorptiometry (DXA) was used as a reference method. Leptin levels showed a highly significant correlation to body fat measured by DXA (r=0·95, p<0·001). In the group of anorexia patients the correlation of leptin levels with DXA (r=0·91, p<0·001) was significantly higher than with BMI (r=0·62, p<0·05). Measurement of leptin levels in AN patients is a promising approach for determining percentage body fat, especially at admission for inpatient treatment, prior to refeeding. © 1998 John Wiley & Sons, Ltd and Eating Disorders Association.     

The history of eating disorders in Norway

The history of eating disorders in Norway is described in four phases: (1) early case histories of eating disorder symptoms in the late 19th century Norwegian medical literature, (2) the pioneers of the post‐World War 2 decades, (3) the 1980s when eating disorders became visible to the public and a focus of interest among professionals, and (4) the consolidation of professional networks and the emergence of a national policy for treatment. In contrast to many other countries, the official Norwegian policy is to improve clinical competence and knowledge about eating disorders at all levels of health care rather than establishing special clinics. Beside arguing for such a policy, we suggest that discussing the balance between general and specialist services is an important future issue. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association.     

Clinical management of females seeking fertility treatment and of pregnant females with eating disorders

The presence of eating disorders (EDs) might have a significant impact upon pregnancy, birth, and the offspring's well‐being. Thus, several specific aspects are to be considered by medical professionals when females with EDs either become pregnant or intend to undergo fertility treatment. Clinical management algorithms for gynaecologists and fertility specialists are missing. Here, based on currently available evidence on the topic, specific clinical recommendations are presented. Treatment by a mental health professional may be necessary for pregnant females suffering from acute EDs or prior to fertility treatment. Because the regulation of the menstrual cycle is known to be induced in the course of ED‐specific treatment due to weight gain and eating behaviour stabilization, the necessity and drawbacks of fertility treatments in females with EDs are discussed.     

Self‐Discrepancy and Eating Disorder Symptoms Across Eating Disorder Diagnostic Groups

This study examined self‐discrepancy, a construct of theoretical relevance to eating disorder (ED) psychopathology, across different types of EDs. Individuals with anorexia nervosa (AN; n = 112), bulimia nervosa (BN; n = 72), and binge eating disorder (BED; n = 199) completed semi‐structured interviews assessing specific types of self‐discrepancies. Results revealed that actual:ideal (A:I) discrepancy was positively associated with AN, actual:ought (A:O) discrepancy was positively associated with BN and BED, and self‐discrepancies did not differentiate BN from BED. Across diagnoses, A:O discrepancy was positively associated with severity of purging, binge eating, and global ED psychopathology. Further, there were significant interactions between diagnosis and A:O discrepancy for global ED psychopathology and between diagnosis and A:I discrepancy for binge eating and driven exercise. These results support the importance of self‐discrepancy as a potential causal and maintenance variable in EDs that differentiates among different types of EDs and symptom severity. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

The prevalence of eating disorders and weight‐control methods among young women: a Hungarian representative study

The aim of this study is to analyse data concerning 15–24‐year‐old Hungarian women to estimate the prevalence of anorexia nervosa, bulimia nervosa and subclinical eating disorders. A cross‐sectional representative survey was conducted among 3615 young women using a self‐report questionnaire. The point prevalence of anorexia nervosa was 0.03%, of bulimia nervosa 0.41%, of subclinical anorexia nervosa 1.09% and of subclinical bulimia nervosa 1.48%. Our results show that 6.3% of the sample were ‘dieting’ daily, 7% exercised daily, 2.7% reported binge eating, and use of laxatives, diet pills and self‐induced vomiting at least twice a week was reported by 0.7%, 0.9% and 0.2%, respectively. This study was the first to be conducted on a nationally representative sample of young women in Hungary. The data are also analysed within a cross‐cultural perspective, comparing data from other Central–Eastern European and western countries. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.