Abstract
We investigated whether brief non-judgmental focus on the details of one’s non-dominant hand might lead to changes in perception of its size, and if such a change would be related to central ...coherence, body dissatisfaction, or how much participants liked their hand. After two pilot experiments (N = 28 and N = 30 respectively: Appendix 1), a within-subject experiment (N = 82) was conducted. Subjects were mainly university students. They were asked to rate the size of their non-dominant hand and how much they liked it, and the size of an external object (a X-box controller) on a visual-analog scale before and after focusing on their details for 5 min, as well as the size of another object (a calculator) before and after a 5 min long distraction task. After completing the tasks, they were asked to respond to a brief questionnaire on body dissatisfaction. A s significant interaction between time and factors (non-dominant hand, X-box controller and calculator) emerged (
F
(2, 78) = 6.41,
p
= .003). Participants rated their hand as larger after focusing on its details compared to baseline, and this change was significantly larger than those reported for the X-box controller. No significant change in how they liked their hand was observed, and contrary to the pilot experiments, the perceived change in size of the hand was not related to body dissatisfaction. The significant change in reporting of the size of the hand after focusing on its details seems to be an interesting finding, worth further replications.
In an anonymous online study (N = 824), we investigated the frequency of use of appearance and performance-enhancing drugs and supplements (APEDS) in a sample of young men (15−30 years) in Sweden, ...along with their self-reported eating disorder (ED) symptoms, drive for muscularity and sexual orientation. A total of 129 participants (16.1%) reported regular use of supplements (at least once a week), including one individual using anabolic steroids (0.1%), while a lifetime use of APEDS was reported by 32.3%. The overlap between those using protein supplements and creatine was large (83.6%). Some symptoms of ED (e.g., dietary restraint, objective binge eating, self-induced vomiting, and excessive exercise) significantly predicted the use of APEDS. In addition, the use of APEDS was significantly predicted by the drive for muscularity. The prediction was stronger for the behavioral component of drive for muscularity (Exponential B = 8.50, B = 2.14, SE = 0.16, p < 0.001, Negelkerke R2 = 0.517) than for its attitudinal component (Exponential B = 1.52, B = 0.42, SE = 0.06, p < 0.001, Negelkerke R2 = 0.088). A significantly larger proportion of those identifying as heterosexual reported using APEDS (34.4%) compared to those identifying themselves as homosexual (25.0%), bisexual (19.2%) or other (23.7%). Overall, our results suggest that the use of APEDS might be more related to the drive for muscularity and sexual orientation than symptoms of ED.
Objective
Avoidant/restrictive food intake disorder (ARFID) was introduced as a new diagnosis in the DSM‐5. This systematic scoping review explores how ARFID as a diagnostic entity is conceptualized ...in the research literature and evaluates the diagnostic validity according to the Feighner criteria.
Method
A systematic scoping review of papers on ARFID in PubMed/MEDLINE and Web of Science was undertaken, following PRISMA and Joanna Briggs Institute guidelines.
Results
Fifty‐one original research publications, 23 reviews and commentaries, and 20 case reports were identified. The use of ARFID as a conceptual category varies significantly within this literature. At this time, the ARFID diagnosis does not fulfil the Feighner criteria for evaluating the validity of diagnostic constructs, the most urgent problem being the demarcation toward other disorders. A three‐dimensional model—lack of interest in food, selectivity based on sensory sensitivity, and fear of aversive consequences—is gaining support in the research literature.
Discussion
The introduction of the ARFID diagnosis has undoubtedly increased the recognition of a previously largely neglected group of patients. However, this article points to an inability of the current DSM‐5 diagnostic criteria to ensure optimal diagnostic validity, which risks making them less useful in clinical practice and in epidemiological research. To increase the conceptual validity of the ARFID construct, several possible alterations to the current diagnostic criteria are suggested, including a stronger emphasis of the three identified subdomains and further clarifying the boundaries of ARFID.
Resumen
Objetivo
El trastorno evitativo/restrictivo de la ingesta de alimentos (TERIA) (ARFID, en sus siglas en inglés), fue introducido como una nueva categoría diagnóstica en el DSM‐5. Esta revisión sistemática del alcance explora cómo es conceptualizado el ARFID en la literatura científica y evalúa la validez diagnóstica de acuerdo a los criterios de Feighner.
Método
Se realizó una revisión sistemática del alcance de ARFID en los artículos publicados en PubMed/MEDLINE y en Web of Science siguiendo los lineamientos PRISMA y del Instituto Joanna Briggs.
Resultados
se identificaron 51 publicaciones de investigación originales, 23 revisiones y comentarios, y 20 reportes de caso. El uso de ARFID como categoría conceptual varía significativamente dentro de esta literatura. En la actualidad, el diagnóstico de ARFID no reúne los criterios de Feighner para evaluar la validez del constructo diagnóstico, siendo el problema más urgente la delimitación con otros trastornos. Un modelo tridimensional –falta de interés en la comida, selectividad basada en la sensibilidad sensorial y miedo a las consecuencias aversivas – está ganando apoyo en la literatura científica.
Discusión
La introducción del diagnóstico de ARFID indudablemente ha incrementado el reconocimiento de un grupo grande de pacientes previamente ignorado. Sin embargo, esta revisión señala la incapacidad de los criterios actuales del DSM‐5 para asegurar una validez diagnóstica óptima, lo cual pone en riesgo su utilidad tanto en la práctica clínica como en la investigación epidemiológica. Se sugieren varias modificaciones posibles a los criterios diagnósticos actuales, con el fin de aumentar la validez conceptual del constructo ARFID, incluyendo un mayor énfasis en los tres subdominios identificados así como una mayor clarificación de los límites de ARFID.
Optimal use of assessment instruments for the detection and diagnosis of eating disorders (ED) depends on the availability of normative data. The aim of this work was to, for the first time, collect ...norms for both the Eating Disorder Examination Questionnaire (EDE-Q) and the newly developed Clinical Impairment Assessment (CIA) Scale from a general population of young women in Sweden, as well as from a clinical population of ED patients in Sweden. Participants were composed of both a randomized sample from the general population of women aged 18–30 years (N = 760) as well as from a clinical population aged 18–66 years (N = 2383). Data for the clinical population was extracted from the Stepwise database. Mean scores, standard deviations and percentile ranks for the global for the EDE-Q (as well as its subscales) and the CIA are presented. Prevalence figures of key eating disorder behaviors are also reported. Comparisons are made between the results in the present study with other existing normative studies on the EDE-Q and the CIA. The present study contributes to improving the accuracy of the interpretation of scores of the widely used self-report measure of ED, the EDE-Q, and the CIA, both of which play important roles in for diagnosis, prevention and intervention of ED.
The Cultural Formulation Interview (CFI) in the DSM-5 is a person-centered instrument for systematically appraising the impact of sociocultural factors in psychiatric assessment. The CFI has been ...shown to be feasible, acceptable, and useful in various clinical contexts. However, to this date there is only one published report describing the use of the CFI with patients with eating disorders.
To explore the potential benefits and challenges of utilizing the CFI in the assessment of eating disorders.
As an addendum to an ongoing qualitative study about barriers to treatment for eating disorders for individuals with a migration background in Sweden, we utilized the CFI in the assessment of adult patients (n=8) in specialist eating disorder treatment. Interview data were analyzed employing a thematic analysis framework. Participants provided feedback using a standard form for evaluation of the CFI.
Certain CFI questions proved especially meaningful in this context. In response to the CFI question about patient explanatory models, previously unrecognized ideas about causation emerged. These included perfectionism-a known risk factor for eating disorders-based on immigrant parents' career expectations and experiences of strict family control over life choices. In response to the CFI questions on cultural identity and its impact, the participants provided rich descriptions including important themes such as religion, racism, and ambiguities associated with being a second-generation immigrant. The final CFI question, eliciting concern about the patient-clinician relationship, revealed numerous examples of prejudice and unfamiliarity with migrant groups among healthcare providers.
The CFI can be useful in the assessment of patients with eating disorders and should be further explored as a standard tool in specialist eating disorder services.
Self-admission to psychiatric inpatient treatment is an innovative approach to healthcare rationing, based on reallocation of existing resources rather than on increased funding. In self-admission, ...patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. Previous findings on patients with severe eating disorders indicate that self-admission reduces participants' need for inpatient treatment, but that it does not alone lead to symptom remission.
The aim of this study was to evaluate if, from a service provider perspective, the resource reallocation associated with self-admission is justified. The analysis makes use of data from a cohort study evaluating the one-year outcomes of self-admission at the Stockholm Centre for Eating Disorders.
Participants in the program reduced their need for regular specialist inpatient treatment by 67%. Thereby, hospital beds were made available for non-participants due to the removal of a yearly average of 13.2 high-utilizers from the regular waiting list. A sensitivity analysis showed that this "win-win situation" occurred within the entire 95% confidence interval of the inpatient treatment utilization reduction.
For healthcare systems relying on rationing by waiting list, self-admission has the potential to reduce the need for hospitalization for patients with longstanding eating disorders, while also offering benefits in the form of increased available resources for other patients requiring hospitalization.
ClinicalTrials.gov ID: NCT02937259 (retrospectively registered 10/15/2016).
► Psychometric properties of the BSQ-8C were investigated. ► The BSQ-8C is a short version of the Body Shape Questionnaire. ► Norms from the general population were collected to improve ...interpretation. ► Test–retest reliability, internal consistency and convergent validity were high.
There is a need for brief, sensitive, and reliable instruments for contextual assessment of body dissatisfaction. Suitable selection and optimal use of psychological assessment instruments requires appropriate psychometric as well as normative data. Two studies were conducted to investigate the psychometric properties and collect general population norms for a short, eight item version of the Body Shape Questionnaire (BSQ-8C). In the first study, a sample of undergraduate students (N=182) was recruited to investigate the psychometric properties of the BSQ-8C, while in the second study a sample from the general population of Swedish women aged 18–30 years (N=747) was used to collect norms. The test–retest reliability, internal consistency, and convergent validity for BSQ-8C were high. Given the questionnaire's briefness and good psychometric properties, particularly when used in conjunction with norms, the BSQ-8C is considered a valuable instrument for measuring body shape dissatisfaction among young adult women.
Eating disorders (ED) are severe psychiatric conditions, characterized by decreased quality of life and high mortality. However, only a minority of patients with ED seek care and very few receive ...treatment. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to increase access to evidence-based treatments.
The aims of the present study were to (1) develop and evaluate the usability of an Internet-delivered guided self-help treatment based on Enhanced Cognitive Behavioral Therapy (ICBT-E) for patients with full or subthreshold bulimia nervosa (BN) or binge eating disorder (BED) with a user centered design process, and (2) to evaluate its feasibility and preliminary outcome in a clinical environment.
The study was undertaken in two stages. In Stage I, a user-centered design approach was applied with iterative phases of prototype development and evaluation. Participants were eight clinicians and 30 individuals with current or previous history of ED. In Stage II, 41 patients with full or subthreshold BN or BED were recruited to a single-group open trial to evaluate the feasibility and preliminary outcome of ICBT-E. Primary outcome variables were diagnostic status and self-rated ED symptoms.
The user-centered design process was instrumental in the development of the ICBT-E, by contributing to improvements of the program and to the content being adapted to the needs and preferences of end-users. The overall usability of the program was found to be good. ICBT-E targets key maintaining factors in ED by introducing healthy eating patterns and addressing over-evaluation of weight and shape. The results indicate that ICBT-E, delivered in a clinical setting, is a feasible and promising treatment for full or subthreshold BN or BED, with a high level of acceptability observed and treatment completion of 73.2 %. Participation in ICBT-E was associated with significant symptom reductions in core ED symptomology, functional impairment as well as depressive symptoms, and the results were maintained at the 3-month follow-up.
ICBT-E was developed with end-users' preferences in mind, in accordance with the identified recommendations, and the program was perceived as usable by end-users. The study demonstrated the potential of ICBT-E, which marks a step forward in the effort to make powerful, empirically supported psychological interventions targeting ED more widely available and accessible.
•Eating disorders are severe disorders but only a minority seek and receive care.•Digital interventions have the potential to increase access to care.•Internet-delivered cognitive behavioral therapy (ICBT-E) was developed.•A user-centered design process was undertaken, contributing to improvements of ICBT-E.•The feasibility and preliminary outcome of ICBT-E was evaluated with promising resuts.
A link between perfectionism and disordered eating has been documented in previous studies. The purpose of the current study was to expand our knowledge of the specific role of perfectionism in ...disordered eating by examining perfectionism as a mediator or a moderator in the relation between body dissatisfaction and disordered eating (assessed using the EAT-26 and its subscales, and the Binge Scale). We sampled a large ethnically diverse sample of university women (N=520) using two measures of perfectionism: the Eating Disorder Inventory Perfectionism subscale (EDI-P) and the Multidimensional Perfectionism Scale (H-MPS). In general, socially prescribed and self-oriented perfectionism, but not other-oriented perfectionism, were correlated with disordered eating attitudes and behaviors, except binge eating. Furthermore, perfectionism was found to partially mediate and moderate the relation between body dissatisfaction and disordered eating, however the strength of these associations differed depending on both the particular measure of perfectionism (EDI-P versus H-MPS) and the specific dimension of perfectionism (self-oriented, socially prescribed, other-oriented) used in the analyses. The findings are discussed in relation to the need for more informed and theoretically sound models of the development and maintenance of disordered eating.
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