Objective
To examine psychiatric and somatic correlates of DSM‐5 eating disorders (EDs)—anorexia nervosa (AN), bulimia nervosa (BN), and binge‐eating disorder (BED)—in a nationally representative ...sample of adults in the United States.
Method
A national sample of 36,309 adult participants in the national epidemiologic survey on alcohol and related conditions III (NESARC‐III) completed structured diagnostic interviews (AUDADIS‐5) to determine psychiatric disorders, including EDs, and reported 12‐month diagnosis of chronic somatic conditions. Prevalence of lifetime psychiatric disorders and somatic conditions were calculated across the AN, BN, and BED groups and a fourth group without specific ED; multiple logistic regression models compared the likelihood of psychiatric/somatic conditions with each specific ED relative to the no‐specific ED group.
Results
All three EDs were associated significantly with lifetime mood disorders, anxiety disorders, alcohol and drug use disorders, and personality disorders. In all three EDs, major depressive disorder was the most prevalent, followed by alcohol use disorder. AN was associated significantly with fibromyalgia, cancer, anemia, and osteoporosis, and BED with diabetes, hypertension, high cholesterol, and triglycerides. BN was not associated significantly with any somatic conditions.
Conclusions
This study examined lifetime psychiatric and somatic correlates of DSM‐5 AN, BN, and BED in a large representative sample of U.S. adults. Our findings on significant associations with other psychiatric disorders and with current chronic somatic conditions indicate the serious burdens of EDs. Our findings suggest important differences across specific EDs and indicate some similarities and differences to previous smaller studies based on earlier diagnostic criteria.
Historically, male presentations of eating disorders (EDs) have been perceived as rare and atypical – a perception that has resulted in the systematic underrepresentation of males in ED research. ...This underrepresentation has profoundly impacted clinical practice with male patients, in which i) stigmatization and treatment non-engagement are more likely, ii) a distinct array of medical complexities are faced, and iii) symptom presentations differ markedly from female presentations. Further, the marginalization of males from ED research has hindered the assessment and clinical management of these presentations. This critical review provides an overview of the history of male EDs and synthesizes current evidence relating to the unique characteristics of male presentations across the diagnostic spectrum of disordered eating. Further, the emerging body of evidence relating to muscularity-oriented eating is synthesized in relation to the existing nosological framework of EDs. The impact of marginalizing male ED patients is discussed, in light of findings from epidemiological studies suggesting that clinicians will be increasingly likely to see males with ED in their practices. It is suggested that changes to current conceptualizations of ED pathology that better accommodation male ED presentations are needed.
•Male EDs are systematically overlooked in ED research.•Male ED presentations differ significantly from female ED presentations.•Muscularity-oriented disordered eating has emerged as an ED phenotype in males.•Current ED classification schemes do not accommodate muscularity-oriented disordered eating.•The marginalization of male ED patients remains an ongoing concern.
Eating disorders (EDs) lead to multiple psychiatric and somatic complications and thus constitute a major public health concern.
The aim of this study was to give an exhaustive view of the studies ...reporting the prevalence of the different EDs or total EDs and to study their evolution.
A literature search following PRISMA Guidelines and limited to studies in English or French published between 2000 and 2018 was performed and relevant studies were included in this systematic review on the prevalence of EDs. The literature search revealed 94 studies with accurate ED diagnosis and 27 with broad ED diagnosis.
In 94 studies with accurate ED diagnosis, the weighted means (ranges) of lifetime ED were 8.4% (3.3–18.6%) for women and 2.2% (0.8–6.5%) for men. The weighted means (ranges) of 12-month ED prevalence were 2.2% (0.8–13.1%) for women and 0.7% (0.3–0.9%) for men. The weighted means (ranges) of point prevalence were 5.7% (0.9–13.5%) for women and 2.2% (0.2–7.3%) for men. According to continents, the weighted means (ranges) of point prevalence were 4.6% (2.0–13.5%) in America, 2.2% (0.2–13.1%) in Europe, and 3.5% (0.6–7.8%) in Asia.
In addition to the former, 27 other studies reported the prevalence of EDs as broad categories resulting in weighted means (ranges) of total point prevalence of any EDs of 19.4% (6.5–36.0%) for women and 13.8% (3.6–27.1%) for men.
Despite the complexity of integrating all ED prevalence data, the most recent studies confirm that EDs are highly prevalent worldwide, especially in women. Moreover, the weighted means of point ED prevalence increased over the study period from 3.5% for the 2000–2006 period to 7.8% for the 2013–2018 period. This highlights a real challenge for public health and healthcare providers.
To investigate, in a nationally representative sample of US adults, the prevalence of help-seeking in individuals with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) ...eating disorders (EDs) and to examine sex and ethnic/racial differences.
The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N=36,309) included respondents who met the criteria for specific lifetime DSM-5 EDs and answered questions regarding help-seeking for their ED symptoms (anorexia nervosa AN: n=275; bulimia nervosa BN: n=91; and binge-eating disorder BED: n=256).
The prevalence (standard error) estimates of ever seeking any help for AN, BN, and BED were 34.5% (2.80%), 62.6% (5.36%), and 49.0% (3.74%), respectively. Adjusting for sociodemographic characteristics, men and ethnic/racial minorities (non-Hispanic blacks and Hispanics) were statistically significantly less likely to ever seek help for BED than were women or non-Hispanic whites, respectively. Hispanics also were significantly less likely to seek help for AN relative to non-Hispanic whites.
This was the first study in a nationally representative sample of US adults to examine rates of help-seeking, including by sex and ethnic/racial differences, across DSM-5-defined EDs. These findings emphasize the need to develop strategies to encourage help-seeking among individuals with EDs, particularly among men and ethnic/racial minorities.
Background
Eating disorders are severe psychiatric disorders with a complex etiology involving transactions among sociocultural, psychological, and biological influences. Most research and reviews, ...however, focus on only one level of analysis. To address this gap, we provide a qualitative review and summary using an integrative biopsychosocial approach.
Methods
We selected variables for which there were available data using integrative methodologies (e.g., twin studies, gene‐environment interactions) and/or data at the biological and behavioral level (e.g., neuroimaging). Factors that met these inclusion criteria were idealization of thinness, negative emotionality, perfectionism, negative urgency, inhibitory control, cognitive inflexibility, serotonin, dopamine, ovarian hormones. Literature searches were conducted using PubMed. Variables were classified as risk factors or correlates of eating disorder diagnoses and disordered eating symptoms using Kraemer et al.'s (1997) criteria.
Findings
Sociocultural idealization of thinness variables (media exposure, pressures for thinness, thin‐ideal internalization, thinness expectancies) and personality traits (negative emotionality, perfectionism, negative urgency) attained ‘risk status’ for eating disorders and/or disordered eating symptoms. Other factors were identified as correlates of eating pathology or were not classified given limited data. Effect sizes for risk factors and correlates were generally small‐to‐moderate in magnitude.
Conclusions
Multiple biopsychosocial influences are implicated in eating disorders and/or disordered eating symptoms and several can now be considered established risk factors. Data suggest that psychological and environmental factors interact with and influence the expression of genetic risk to cause eating pathology. Additional studies that examine risk variables across multiple levels of analysis and that consider specific transactional processes amongst variables are needed to further elucidate the intersection of sociocultural, psychological, and biological influences on eating disorders.
Eating disorders involve irregularities in eating behavior that may cause gastrointestinal (GI) symptoms. Consequently, many patients with eating disorders seek gastroenterological healthcare at some ...point in their illness, with many seeking this care even before they seek treatment for and/or diagnosed with their eating disorder. As such, the gastroenterology provider is in a unique position to identify, manage, and facilitate treatment for an eating disorder early in the course of the illness. Although assessing eating disorders is already a difficult task, the identification of eating disorders in patients with GI disease represents an even greater challenge. In particular, common GI symptoms, such as nausea, vomiting, and bloating, may disguise an eating disorder because these symptoms are often viewed as a sufficient impetus for dietary restriction and subsequent weight loss. In addition, the focus on identifying an organic etiology for the GI symptoms can distract providers from considering an eating disorder. During this prolonged diagnostic evaluation, the eating disorder can progress in severity and become more difficult to treat. Unfortunately, a misconception that hinders eating disorder detection is the notion that the rate or method of weight loss is associated with an eating disorder. Regardless of whether weight loss is slow or rapid, purposeful or accidental, eating disorder behaviors and thought patterns may be present. Unidentified eating disorders are not only dangerous in their own right but also can interfere with effective management of GI disease and its symptoms. As such, it is imperative for the GI provider to remain well versed in the identification of these diseases.
Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even ...mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The objective is to allow the physician to efficiently sort out the wide variety of conditions, categorize them for therapy, and where necessary refer to specialists in the field.
Risk factors across the eating disorders Hilbert, Anja; Pike, Kathleen M; Goldschmidt, Andrea B ...
Psychiatry research,
12/2014, Volume:
220, Issue:
1
Journal Article
Peer reviewed
Open access
Abstract This study sought to examine risk and onset patterns in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Women with AN ( n= 71), BN ( n= 66), BED ( n= 160) and ...non-psychiatric controls ( n= 323) were compared retrospectively on risk factors, symptom onset, and diagnostic migration. Eating disorder groups reported greater risk exposure than non-psychiatric controls. AN and BED differed on premorbid personality/behavioral problems, childhood obesity, and family overeating. Risk factors for BN were shared with AN and BED. Dieting was the most common onset symptom in AN, whereas binge eating was most common in BN and BED. Migration between AN and BED was rare, but more frequent between AN and BN and between BN and BED. AN and BED have distinct risk factors and onset patterns, while BN shares similar risk factors and onset patterns with both AN and BED. Results should inform future classification schemes and prevention programs.
Body Image in Eating Disorders explores issues relating to the prevention, clinical diagnosis, and psychological treatment of distortions of body image in eating disorders. It presents a ...multifactorial model of indicators for diagnosis and treatment, considering psychological, sociocultural, and family indicators. Based on original empirical research with women and girls suffering from eating disorders, the book draws attention to limitations and dilemmas related to psychological diagnosis and treatment of people with eating disorders including anorexia readiness syndrome, bulimia, and bigorexia. The book proposes an integrative psychodynamic approach to the diagnosis and treatment of body image disorders and presents case studies illustrating examples of application of integration of psychodynamic therapy and psychodrama in psychological treatment of young people suffering from eating disorders. It considers risk factors including abnormal body image for the development of eating disorders and argues that psychological diagnosis of the body image is an important factor in determining the right direction of psychological treatment for people with eating disorders. Drawing on theoretical foundations and evidence-based clinical practice, the book will be of great interest to researchers, academics, and students in the fields of clinical and applied psychology, mental health, and specialists in eating disorders.
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