Eating disorders

Opinion statement  

Eating disorders

Eating disorders are an important cause of physical and psychosocial morbidity in adolescent girls and young adult women. They are much less frequent in men. Eating disorders are divided into three diagnostic categories: anorexia nervosa, bulimia nervosa, and the atypical eating disorders. However, the disorders have many features in common and patients frequently move between them, so for the purposes of this Seminar we have adopted a transdiagnostic perspective. The cause of eating disorders is complex and badly understood. There is a genetic predisposition, and certain specific environmental risk factors have been implicated. Research into treatment has focused on bulimia nervosa, and evidence-based management of this disorder is possible. A specific form of cognitive behaviour therapy is the most effective treatment, although few patients seem to receive it in practice. Treatment of anorexia nervosa and atypical eating disorders has received remarkably little research attention.     

Diversity in risk factors of osteoporosis

Osteoporosis is a typical of multifactorial diseases. There have been reported many risk factors contributing to the development of this involutional disease. One may think that all a physician has to do in the treatment of osteoporosis is administration of an effective drug regardless of the risk factors the patient has. However, this strategy is just like giving insulin to the patient with diabetes mellitus without controlling his/her diet. This chapter summarizes current knowledge on major risk factors for low bone mass to help the readers reduce the risk of further loss of bone mass in their patients.     

帕金森病伴骨质疏松患者相关因素分析研究

目的探讨老年帕金森病伴骨质疏松发生的相关危险因素。方法选取帕金森病患者996例,根据骨密度检查结果分为骨质疏松组282例,非骨质疏松组714例,分析帕金森病伴骨质疏松的发生与人文因素、血管危险因素和血清骨代谢特点的相关性。结果骨质疏松组年龄、女性、体质量指数明显高于非骨质疏松组,骨密度明显低于非骨质疏松组,差异有统计学意义(P0.01)。H-Y1～5级骨质疏松组维生素D水平明显低于非骨质疏松组[(21.2±4.4)μg/L vs (53.8±3.7)μg/L,(17.2±4.2)μg/L vs (49.1±5.6)μg/L,(14.1±5.1)μg/L vs (45.6±5.3)μg/L,(13.6±4.8)μg/L vs (40.9±5.2)μg/L,(12.4±4.2)μg/L vs (39.8±5.1)μg/L,P0.01]。H-Y3级、H-Y4级和H-Y5级骨质疏松组降钙素水平明显高于非骨质疏松组,骨钙素水平明显低于非骨质疏松组,差异有统计学意义(P0.01)。多因素logistic回归分析显示,年龄(OR=1.77,95%CI:1.19～2.23,P=0.000)、女性(OR=2.24,95%CI:1.20～2.53,P=0.000)、体质量指数(OR=2.19,95%CI:1.24～2.53,P=0.000)、维生素D(OR=2.25,95%CI:1.29～2.63,P=0.000)是帕金森病伴骨质疏松发生的独立危险因素。结论帕金森病患者应及时治疗、适量运动、加强营养、补充维生素D,以减少骨质疏松发生。     

Eating disorders as coping strategies: a critique

An association between eating disorder symptoms and stress has been observed in a number of studies in both laboratory and clinical settings. A popular conclusion has been that eating disorder symptoms may represent a coping strategy. However, since coping is a part of the stress process, it is possible that many authors have confounded this process (i.e. stress) with the outcome (i.e. eating disorder). Suggestions that eating disorders are coping strategies are discussed in terms of a precise definition of coping. Symptoms can only be considered as coping strategies if they are goal-directed and motivated by the wish to influence stress levels. Although it is suggested that eating disorders are unlikely to be coping strategies at their onset, they may acquire functional status by reinforcement, although this still does not mean that they are necessarily coping strategies. It is suggested that the view of eating disorders as coping may simply be a modern causal explanation of symptoms. The advantages and disadvantages of such a casual explanation for clinical practice are discussed. Copyright © 1998 John Wiley & Sons, Ltd and Eating Disorders Association.     

Perfectionism and learning experiences in dance class as risk factors for eating disorders in dancers

There is strong evidence that perfectionism is a risk factor for eating disorders. Women who engage in dance training have been reported to be at risk for eating disorders, and it has been hypothesised that expectancies about thinness and restricting food intake are formed partly as a result of exposure to thinness related learning (TRL) experiences in this environment, which may increase their risk. To clarify the relative contribution of perfectionism and learning in accounting for eating disorder symptoms in this group, 142 female ballet dancers completed an online survey. Through structural equation modelling it was found that the association between perfectionism and eating disorder symptoms was partially mediated by learning about thinness and restriction. The results suggest that eating disorder symptoms in dancers are significantly influenced by the interaction of perfectionism and learning, and future research should investigate the efficacy of prevention programs to target these risk factors in female dancers. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Stressful life events and depressive disorders as risk factors for acute coronary heart disease]

BACKGROUND: Several studies outlined the role of stressful life events in the pathogenesis of coronary heart disease. It has recently been emphasized the role of depression, both clinical and subclinical, in the course of myocardial infarction. The relationship between recent life events, major depression, depressive symptomatology and onset of acute coronary heart disease has been less considered. METHODS: Ninety-seven consecutive patients with first episode of coronary heart disease and 97 healthy subjects matched for sociodemographic variables were included. All patients were interviewed by Paykel's interview for recent life events, a semistructured interview for determining the psychiatric diagnosis of mood disorders, a semistructured interview for demoralization. Patients were assessed while on remission from the acute phase. The time period considered was the year preceding the first episode of coronary heart disease, and the year before interview for controls. RESULTS: Patients with acute coronary heart disease reported significantly more life events than control subjects (p < 0.001). All categories of events (except entrance events) were significantly more frequent. Thirty percent of patients were identified as suffering from a major depressive disorder; 9% of patients were suffering from minor depression, and 20% from demoralization. Even though there was an overlap between major depression and demoralization (12%), 17% of patients with major depression were not classified as demoralized and 7 % of patients with demoralization did not satisfy the criteria for major depression. Independently of mood disorders, patients have a higher (p < 0.001) mean number of life events than controls. With regard to life events, the same significant difference (p < 0.001) compared to controls applied to patients with and without mood disorders. CONCLUSIONS: Our findings emphasize the relationship between life events and acute coronary heart disease. These data, together with those regarding traditional cardiac risk factors, may have clinical and prognostic implications to be verified in longitudinal studies.     

Eating in eating disorders

The aim of this paper is to bring eating back into the centre of the eating disorder discourse. The ability to interrogate and understand the central processes of appetite has increased considerably since the discovery of leptin and the ability to observe brain function with scanning methodologies. This has led to substantial progress in understanding the biological causative and maintaining factors in eating disorders, opening up the possibility of translating the latest findings into new forms of treatment. The biological mechanisms underpinning symptoms evolution and course of illness will first be described, follows by a discussion on integrating the research evidence in fear and feeding into patient care. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Eating disorders as manifestations of developmental disorders: language and the capacity for abstract thinking in psychotherapy of eating disorders

The serious eating disorders are manifestations of personality disorders which are characterized by an inadequately developed ability to distinguish and understand emotional states and needs. This paper focus on the development of transitional objects and an inner language as prerequisites for the ability to use words and abstract symbols as soothing and controlling functions. The psychotherapy of patients with eating disorders, and psychosomatic disorders, should be founded on the understanding of their concrete mode of functioning. It is important to avoid misunderstanding and interpreting both the symptoms and the patients' concretistic language as metaphors and symbols of their emotions and needs, before the development of an internal, meaningful language. This is essential for a successful psychotherapeutic result. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association.