• Food refusal in prison

      Larkin, Emmet P. (1991)
      The prevalence of mental disorder amongst prisoners refusing food was studied by examining the prison records of a remand prison and a dispersal prison. Food refusal occurred predominantly in the remand prison. Less than one per cent of the annual remand population engaged in this behaviour. The results indicate that prisoners refusing food do so as a form of protest and that the prevalence of mental disorder among such prisoners is high. The majority respond to observation and counselling. Important indicators of psychosis are: (i) the inability of the prisoner to divulge reasons for his behaviour; and (ii) the refusal by the prisoner of both food and fluids. In such cases transfer to hospital for treatment may be urgently required.
    • Are acute inpatient mental health wards an appropriate treatment setting for people with anorexia nervosa?

      Wright, Nicola (2003)
      Many people with anorexia nervosa end up as inpatients in acute units because there is a dearth of specialist provision. Nicola Wright and Sara Owen consider the role of specialist services in supporting mainstream units and examine how nurses in acute settings can develop their expertise.
    • An exploratory investigation of the experiences of partners living with people who have bulimia nervosa

      Huke, Katherine (2006)
      Objective: This study aimed to explore partners' experiences of living as a couple with someone with bulimia nervosa. Method: Transcripts of eight exploratory interviews with partners were analysed using Interpretative Phenomenological Analysis. Results: Five superordinate themes emerged: (1) Living with the secrecy and deception; (2) Struggling to understand and find reasons; (3) Discovering your powerlessness; (4) ‘It's like growing to live with it’; (5) Experiencing strengths and strains in the relationship. Discussion: Living with someone with bulimia presents many challenges for partners. They struggle to understand what is happening, can find the secrecy difficult to live with, and are often left feeling powerless. However, partners also look to find ways of accepting and living with the bulimia. It is suggested that partners could be offered opportunities to access support, and that their perspectives could be a useful resource for therapeutic interventions. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.
    • Effect of a specialist disorders service on the knowledge and attitudes of local health professionals

      Rogers, David (2007)
      This study investigated the effect of a specialist eating disorders service on the attitudes and knowledge of local healthcare professionals. A questionnaire was sent to fully qualified psychiatrists, postgraduate trainees in psychiatry and general (internal) medicine, general practitioners (family physicians) and dietitians in two comparable cities: Leicester (which had a specialist eating disorders service) and Nottingham (which did not). Psychiatrists in training in Leicester had a greater knowledge of eating disorders than those in Nottingham. There was greater satisfaction with services in Leicester but no difference in attitudes. The presence of a local eating disorders service enhances postgraduate training and increases knowledge.
    • Adolescence and health

      Baker, Karen (2008)
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    • Treating young people with eating disorders: Transition from child mental health to specialist adult eating disorder services

      Bouman, Walter P. (2008)
      Background: The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) of young people with eating disorders may pose a number of difficulties, including an inconsistent referral process and age boundaries. Methods: We compared young adults referred to a specialist Adult Eating Disorders Service (AEDS) who had previous involvement with CAMHS for the treatment of their eating disorder with those who did not. Information regarding the socio-demographic characteristics and eating disorders symptomatology of patients assessed by an AEDS over a 4-year period was collected. Results: Patients who had previous involvement with CAMHS (particularly the ones treated as in-patients) presented with a lower self-esteem and more maturity fears (MF) than those without previous involvement. Conclusions: This study discusses the implication of these results in transitional arrangements between CAMHS and Adult services. It also highlights the need for heightened awareness of particular issues of self-esteem and maturation in these patients moving between services. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.
    • Negative affect mediates effects of psychological stress on disordered eating in young Chinese women

      Guo, Boliang; Yang, Min (2012)
      Background: The bi-relationships between psychological stress, negative affect and disordered eating has been well studied in western culture, while tri-relationship among them, i.e. how some of those factors influence these bi-relationships, has rarely been studied. However, there has been little related study in the different Chinese culture. This study was conducted to investigate the bi-relationships and tri-relationship between psychological stress, negative affect, and disordered eating attitudes and behaviors in young Chinese women. Methodology: A total of 245 young Chinese policewomen employed to carry out health and safety checks at the 2010 Shanghai World Expo were recruited in this study. The Chinese version of the Perceived Stress Scale (PSS-10), Beck Depression Inventory Revised (BDI-II), Beck Anxiety Inventory (BAI), and Eating Attitude Test (EAT-26) were administered to all participants. Principal Findings: The total scores of PSS-10, BDI-II and BAI were all highly correlated with that of EAT-26. The PSS-10 score significantly correlated with both BDI-II and BAI scores. There was no statistically significant direct effect from perceived stress to disordered eating (-0.012, 95%CI: -.038~0.006, p = 0.357), however, the indirect effects from PSS-10 via affect factors were statistically significant, e.g. the estimated mediation effects from PSS to EAT-26 via depression and anxiety were 0.036 (95%CI: 0.022~0.044, p<0.001) and 0.015 (95%CI: 0.005~0.023, p<0.01), respectively. Conclusions: Perceived stress and negative affects of depression and anxiety were demonstrated to be strongly associated with disordered eating. Negative affect mediated the relationship between perceived stress and disordered eating. The findings suggest that effective interventions and preventative programmes for disordered eating should pay more attention to depression and anxiety among the young Chinese female population. © 2012 Chen et al.
    • Adolescents with a diagnosis of anorexia nervosa: Parents' experience of recognition and deciding to seek help

      Thomson, Samuel; Marriott, Michael; Law, Hou; McLaughlin, Jo (2014)
      Background: Adolescents with anorexia nervosa rarely present themselves as having a problem and are usually reliant on parents to recognise the problem and facilitate help-seeking. This study aimed to investigate parents' experiences of recognising that their child had an eating problem and deciding to seek help.; Methods: A qualitative study with interpretative phenomenological analysis applied to semi-structured interviews with eight parents of adolescents with a diagnosis of anorexia nervosa.; Results: Parents commonly attributed early signs of anorexia nervosa to normal adolescent development and they expected weight loss to be short-lived. As parents' suspicions grew, close monitoring exposing their child's secretive attempts to lose weight and the use of internet searches aided parental recognition of the problem. They avoided using the term anorexia as it made the problem seem 'real'. Following serial unsuccessful attempts to effect change, parental fear for their child's life triggered a desire for professional help.; Conclusions: Parents require early advice and support to confirm their suspicions that their child might have anorexia nervosa. Since parents commonly approach the internet for guidance, improving awareness of useful and accurate websites could reduce delays in help-seeking.;
    • The use of interpersonal psychotherapy for non-suicidal self-injury and eating disorders

      Bouman, Walter P. (2014)
      Interpersonal psychotherapy (IPT) is an effective treatment for depressive disorder. Over the last two decades, IPT has been modified to treat different mental health problems, including eating disorders. When working with patients presenting with eating disorder psychopathology, the eating disorder behaviour is used as a marker of "abnormality" that is linked lo the person's interpersonal difficulty. Non-suicidal self-injury behaviour (NSSI) within the eating disorder individual can be treated in the same way as the eating disorder behaviour. Within IPT, the therapist firstly aims to identify the interpersonal focus associated with the unhealthy behaviour, in order to work through this focus to reduce the behaviour. This chapter describes the modified version of IPT for eating disorders. It also makes suggestions how IPT may be used in a population of patients with eating disorders and NSSI, by including NSSI in addition to eating disorder behaviour as a marker of distress. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: chapter)
    • Olfaction in eating disorders and abnormal eating behavior: a systematic review

      Arcelus, Jon (2015)
      The study provides a systematic review that explores the current literature on olfactory capacity in abnormal eating behavior. The objective is to present a basis for discussion on whether research in olfaction in eating disorders may offer additional insight with regard to the complex etiopathology of eating disorders (ED) and abnormal eating behaviors. Electronic databases (Medline, PsycINFO, PubMed, Science Direct, and Web of Science) were searched using the components in relation to olfaction and combining them with the components related to abnormal eating behavior. Out of 1352 articles, titles were first excluded by title (n = 64) and then by abstract and fulltext resulting in a final selection of 14 articles (820 patients and 385 control participants) for this review. The highest number of existing literature on olfaction in ED were carried out with AN patients (78.6%) followed by BN patients (35.7%) and obese individuals (14.3%). Most studies were only conducted on females. The general findings support that olfaction is altered in AN and in obesity and indicates toward there being little to no difference in olfactory capacity between BN patients and the general population. Due to the limited number of studies and heterogeneity this review stresses on the importance of more research on olfaction and abnormal eating behavior.
    • Body image dissatisfaction and eating-related psychopathology in trans individuals: A matched control study

      Bouman, Walter P.; Richards, Christina; Arcelus, Jon (2015)
      High levels of body dissatisfaction have already been reported in the trans population; however, the root of this dissatisfaction, and its association with eating disordered behaviours, has not been studied in-depth. This study aims to assess eating disorder risk by comparing 200 trans people, 200 people with eating disorders and 200 control participants' scores on three subscales of the Eating Disorders Inventory-2 (EDI-2) and to further explore dissatisfaction in the trans participants using the Hamburg Body Drawing Scale (HBDS). The results showed that overall participants with eating disorders scored higher than trans or control groups on all EDI-2 measures, but that trans individuals had greater body dissatisfaction than control participants and, importantly, trans males had comparable body dissatisfaction scores to eating disordered males. Drive for thinness was greater in females (cis and trans) compared with males. In relation to HBDS body dissatisfaction, both trans males and trans females reported greatest dissatisfaction not only for gender-identifying body parts but also for body shape and weight. Overall, trans males may be at particular risk for eating disordered psychopathology and other body image-related behaviours.; Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    • Eating disorders

      Arcelus, Jon (2016)
      Eating disorders are prevalent across all sports but especially those where weight and/or body shape has a direct impact on performance. These are aesthetic sports (e.g. gymnastics), endurance sports (e.g. distance running), weight category sports (e.g. judo), and antigravity sports (e.g. high jumping). Eating disorders negatively impact on athletes' health and performance. The sports environment contains additional risk factors for those vulnerable to eating disorders. The risks can be managed by adopting appropriate nutritional and coaching practices. Although early identification of disorders can be difficult there are considerable benefits from prompt identification, assessment, and treatment. The sports coach can have an important role in the identification and management of eating disorders. Recovery and rehabilitation require collaboration between the athlete, his/her support team, and the treating clinical team. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: chapter)
    • The Compulsive Exercise Test: Confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders

      Arcelus, Jon (2016)
      BACKGROUND: This study aimed to determine the psychometric properties of the Compulsive Exercise Test (CET) among an adult sample of patients with eating disorders.
    • Dimensions of compulsive exercise across eating disorder diagnostic subtypes and the validation of the Spanish version of the Compulsive Exercise Test

      Arcelus, Jon (2016)
      Objectives: Compulsive exercise in eating disorders has been traditionally considered as a behavior that serves the purpose of weight/shape control. More recently, it has been postulated that there may be other factors that drive the compulsive need to exercise. This has led to the development of the Compulsive Exercise Test (CET); a self-reported questionnaire that aims to explore the cognitive-behavioral underpinnings of compulsive exercise from a multi-faceted perspective. The objectives of this study were threefold: (1) to validate the Spanish version of the CET; (2) to compare eating disorder diagnostic subtypes and a healthy control group in terms of the factors that drive compulsive exercise as defined by the CET; (3) to explore how the dimensions evaluated in the CET are associated with eating disorder symptoms and general psychopathology. Methods: The CET was administered to a total of 157 patients with an eating disorder [40 anorexia nervosa, 56 bulimia nervosa (BN), and 61 eating disorder not-otherwisespecified (EDNOS)] and 128 healthy weight/eating controls. Patients were assessed via a semi-structured interview to reach a DSM-IV-TR diagnosis. Additionally, all participants completed the Symptom Checklist-90-Revised (SCL-90R) and the Eating Disorders Inventory-2 (EDI-2). Results: Confirmatory factor analysis demonstrated adequate goodness-of-fit to the original five-factor model of the CET. BN and EDNOS patients scored higher in the avoidance and rule-driven behavior, weight control, and total CET scales in comparison to the healthy controls, and higher across all scales apart from the exercise rigidity scale compared to the anorexia nervosa patients. Mean scores of the anorexia nervosa patients did not differ to those of the control participants, except for the mood improvement scale where the anorexia nervosa patients obtained a lower mean score. Mean scores between the BN and EDNOS patients were equivalent. The CET scales avoidance and rule-driven behavior, weight of control and total CET scores were positively correlated with the clinical assessment measures of the SCL-90R and EDI-2. Conclusion: Compulsive exercise is a multidimensional construct and the factors driving compulsive exercise differ according to the eating disorder diagnostic subtype. This should be taken into account when addressing compulsive exercise during the treatment of eating disorders. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: journal abstract)
    • Validity of exercise measures in adults with anorexia nervosa: The EDE, compulsive exercise test and other self-report scales

      Arcelus, Jon (2016)
      OBJECTIVE: Compulsive exercise is a prominent feature for the majority of patients with Anorexia Nervosa (AN), but there is a dearth of research evaluating assessment instruments. This study assessed the concurrent validity of the exercise items of the Eating Disorder Examination (EDE) and Eating Disorder Examination-Questionnaire (EDE-Q), with the Compulsive Exercise Test (CET) and other self-report exercise measures in patients with AN. We also aimed to perform validation of the CET in an adult clinical sample. METHODS: The sample consisted of 78 adults with AN, recruited for the randomized controlled trial "Taking a LEAP forward in the treatment of anorexia nervosa." At baseline, participants completed the EDE, EDE-Q, CET, Reasons for Exercise Inventory (REI), Commitment to Exercise Scale (CES) and Exercise Beliefs Questionnaire (EBQ). Correlational and regression analyses were performed. RESULTS: EDE exercise days and exercise time per day were positively correlated with each other and with all CET subscales (except Lack of exercise enjoyment), CES mean, EBQ total and REI total. Exercise time per day was associated with a higher EDE global score. The CET demonstrated good concurrent validity with the CES, the REI and the EBQ. Of the self-reports, the CET explained the greatest variance in eating disorder psychopathology and demonstrated good to excellent reliability in this sample. DISCUSSION: The EDE and EDE-Q demonstrated good concurrent validity with the CET. Further research is required to evaluate the CET's factor structure in a large clinical sample. However, the CET has demonstrated strong clinical utility in adult patients with AN. (c) 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016).
    • Evaluation of a motivation and psycho-educational guided self-help intervention for people with eating disorders (MOPED)

      Arcelus, Jon (2016)
      High dropout rates and poor levels of engagement are well documented for patients with eating disorders. Utilising motivational techniques and providing psycho-education have been suggested as ways to reduce treatment disengagement. This study aimed to evaluate the effect of a newly developed motivational and psycho-educational (MOPED) guided self-help intervention for people with eating disorders on engagement and retention in therapy. Patients who received MOPED pre-treatment ( n = 79) were compared with a diagnosis-matched group of patients receiving treatment as usual (TAU; n = 79). The study found that patients receiving MOPED had a higher engagement rate than those within the TAU group. Specifically, patients in the anorexic spectrum were found to present with both higher rates of engagement and completion of therapy when issued with MOPED in comparison with TAU. Self-help packages using motivational style could be a valuable and cost-effective intervention for patients with eating disorders. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • Body dissatisfaction and disordered eating in trans people: A systematic review of the literature

      Jones, Bethany A.; Murjan, Sarah; Arcelus, Jon (2016)
      Body dissatisfaction plays a prominent role in gender dysphoria. In some individuals body dissatisfaction appears to manifest disordered eating in order to suppress bodily features of natal gender and accentuate features of gender identity. To date, there has been no systematic review of the literature pertaining to body dissatisfaction and disordered eating in trans individuals. Such a review may highlight important implications for clinicians working with trans people. Therefore, the aim was to critically and systematically review the available literature examining body dissatisfaction or disordered eating in a trans population, and also the literature pertaining to how body dissatisfaction and disordered eating are related in trans people. This review found three studies that explored disordered eating in trans people, five studies that explored body image and disordered eating in trans people, and 18 studies that explored body image in trans people. The findings from this review suggest that body dissatisfaction is core to the distress trans people experience and that this dissatisfaction may also put some individuals at risk of developing disordered eating. Additionally, the findings appear to suggest that gender dysphoria treatment is successful at increasing body satisfaction and improving body image. The clinical implications are discussed. Copyright © 2015 © 2015 Taylor & Francis.