• Adolescence and health

      Baker, Karen (2008)
    • 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.;
    • 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.
    • 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.
    • 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.
    • The clinical effectiveness and cost-effectiveness of a ‘stepping into day treatment’ approach versus inpatient treatment as usual for anorexia nervosa in adult specialist eating disorder services (DAISIES trial): a study protocol of a randomised controlled multi-centre open-label parallel group non-inferiority trial

      Arcelus, Jon (2022)
      Anorexia nervosa (AN) is a serious and disabling mental disorder with a high disease burden. In a proportion of cases, intensive hospital-based treatments, i.e. inpatient or day patient treatment, are required, with day patient treatment often being used as a ‘step-down’ treatment after a period of inpatient treatment. Demand for such treatment approaches has seen a sharp rise. Despite this, the relative merits of these approaches for patients, their families, and the NHS and wider society are relatively unknown. This paper describes the rationale for, and protocol of, a two-arm multi-centre open-label parallel group non-inferiority randomised controlled trial, evaluating the effectiveness and cost-effectiveness of these two intensive treatments for adults with severe AN: inpatient treatment as usual and a stepped care day patient approach (the combination of day patient treatment with the option of initial inpatient treatment for medical stabilisation). The main aim of this trial is to establish whether, in adults with severe AN, a stepped care day patient approach is non-inferior to inpatient treatment as usual in relation to improving body mass index (BMI) at 12 months post-randomisation.
    • Clinicians' perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings

      Arcelus, Jon (2022)
      BACKGROUND: Admissions to intensive treatment (i.e., inpatient [IP] and/or day patient [DP]) for individuals with severe anorexia nervosa (AN) are common. Growing literature indicates potential risks and benefits of each intensive treatment approach; however, existing research has focused on patient and carer perspectives of these treatments. Also, there is scant empirical evidence available for guiding the parameters of intensive treatments for AN. We therefore explored clinicians' perspectives and experience of supporting adults with severe AN in intensive settings. METHODS: We conducted twenty one semi-structured interviews with clinicians who deliver intensive treatments (i.e., IP and/or DP) for individuals with severe AN across four specialist Eating Disorder Services in the United Kingdom between May 2020 and June 2021. We asked clinicians about their views and experiences of supporting individuals with severe AN in intensive treatment settings and the challenges and opportunities associated with IP and DP treatment. Data were analysed using reflexive thematic analysis supported by NVivo software. RESULTS: Five broad and interrelated themes were identified: (1) Intensive Support; (2) The Severity of Patients' Illnesses; (3) Hope and Recovery; (4) Which Treatment When; (5) Limited Resources; and (6) Carer Burden. We identified various similarities between the two intensive treatment approaches, including the value of intensive and multidisciplinary support and carer involvement, and the challenge of managing complex and unique needs in resource-limited intensive settings. We also found differences in the relationship of treatment to patients' home environments, the necessity of patient motivation, and the management of risk. CONCLUSIONS: Both intensive treatment settings are valued by clinicians; however, there are unique challenges and opportunities for supporting individuals with severe AN within each. Our findings suggest DP treatment may be used as an alternative to IP treatment for individuals with severe AN. However, clear questions remain over which intensive treatment setting is best suited to which patient when and should be the focus of future research. Some people with anorexia nervosa will need intensive treatment (e.g., inpatient and day patient treatment) during the course of their illness. We interviewed twenty-one clinicians working in Specialist Eating Disorder Services to explore their views on supporting people with severe anorexia nervosa in inpatient and day patient services and about the perceived advantages and disadvantages of these. We analysed the transcripts of these interviews using thematic analysis. We identified similarities between the two intensive treatment approaches. These included the value of intensive and multidisciplinary support, the importance of carer involvement, and the challenge of managing patient’s complex and unique needs in services with limited resources. We also found differences between inpatient and day patient treatment. These included how treatment relates to patients’ home environments, the importance of patient motivation, and managing risk. Day patient treatment may be an alternative to inpatient treatment for people with severe anorexia nervosa. Future research should investigate which intensive treatment setting is best suited to which patient and when.
    • Detecting eating psychopathology in female athletes by asking about exercise: Use of the compulsive exercise test

      Arcelus, Jon (2017)
      The present study assessed the suitability of the Compulsive Exercise Test (athlete version; CET-A) for identifying female athletes with clinically significant features related to or comparable with eating psychopathology. Three hundred and sixty-one female athletes (including 12 with a clinically diagnosed eating disorder) completed the Eating Disorders Examination Questionnaire and the CET-A. Receiver operating curve analysis was employed to identify a cut-off value on the CET-A, which could indicate clinically significant features related to or comparable with eating psychopathology among female athletes. The analysis demonstrated that a CET-A score of 10 successfully discriminated female athletes with a current eating disorder. The results suggest that the CET-A may be a suitable tool for detecting eating psychopathology in female athletes. Additional longitudinal research is needed to evaluate the predictive value of the CET-A. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
    • 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)
    • 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)
    • Eating disorders and disordered eating in the LGBTQ population

      Arcelus, Jon; Bouman, Walter P. (2017)
      An overall increased prevalence of eating disorders psychopathology has been reported among the LGBTQ population, particularly among gay men. For some transgender people transitioning post puberty, pressure to conform to a social gender role with the body of their assigned gender may precipitate body dissatisfaction and eating disorders as a consequence. For gay men in particular, trying to conform to specific roles, and the effect of the media, may also affect body dissatisfaction. In addition, concurrent mental health problems such as anxiety and depression may make the LGBTQ population more vulnerable to developing eating disorders. Helpful interventions for eating disorders in the LGBTQ population include addressing the maintaining factors of the eating disorder through therapy; improving interpersonal skills; and considering specific themes for this population, such as coming out, fears of rejection, and personal/societal acceptance.
    • Eating disorders in athletes: Detection, diagnosis, and treatment

      Arcelus, Jon (2017)
      Sportsmen/women and dancers possess a distinct combination of physical and psychological attributes that can contribute toward their success within their sporting and dance context. This includes qualities such as physical and psychological resilience, an unyielding commitment to exercise, the continuous pursuit of excellence, and the ability to withstand intense physical exertion. However, because close attention to diet and weight control is very important in some sports and dance modalities, athletes are also at a significantly increased risk of developing an eating disorder. This chapter presents an overview of the current evidence on the presentation, prevalence, risk factors, and treatment strategies for eating disorders among athletes. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: chapter)
    • Eating symptomatology and general psychopathology in patients with anorexia nervosa from China, UK and Spain: A cross-cultural study examining the role of social attitudes

      Arcelus, Jon (2017)
      Cultural studies exploring differences in the manifestation of anorexia nervosa (AN) have primarily focus on Western and non-Western cultures. However, no study so far has considered the role that social attitudes (i.e. Collectivist vs. Individualist cultural values) have in the clinical manifestations of eating disorders, including AN patients. With this in mind, the aim of this study is to compare eating and general psychopathology in a large sample of individuals diagnosed with AN from China, Spain, and United Kingdom (UK), in order to study the differences according to belonging to Western or non-Western country, or the country's Individualist Index (IDV). The total sample comprised on 544 adults with a diagnosis of AN recruited from People s Republic of China (n = 72), UK (n = 117), and Spain (n = 355). Assessment measures included the Eating Disorders Inventory and the Symptom Checklist-90-Revised. Our results show significant differences in most of the eating and psychopathological indices between the three countries. Patients from Western societies (Spain and UK) share more similarities regarding psychopathological expression of AN than the non-Western country (China). While Western countries show higher levels of body dissatisfaction, somatization and overall psychopathology, Chinese patients tend to deny or minimize depression, anxiety and other psychopathological symptoms. Besides, the IDV shows cultural differences in the interpersonal sensitivity scale, being AN patients from UK (the more individualistic society) who presented with higher levels of interpersonal sensitivity (i.e. discomfort during interpersonal interactions and more negative expectations concerning interpersonal behavior). In conclusion, our findings suggest that psychopathological expression of AN is better explained by Western/Eastern influence than by individualist/collectivist values. Although the diagnosis for the eating disorder may be the same, differences in the psychopathology comorbid to the eating disorders may suggest the need for treatments to be modified according to the culture.
    • 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.
    • Evaluating a motivational and psycho-educational self-help intervention for athletes with mild eating disorder symptoms: A mixed methods feasibility study

      Arcelus, Jon (2022)
      OBJECTIVEThe primary aim was to assess the feasibility of undertaking a study evaluating the novel Motivational and Psycho-Educational Self-Help Programme for Athletes with Mild Eating Disorder Symptoms (MOPED-A). A mixed-methods approach was adopted to explore the feasibility of recruiting and retaining participants, and to evaluate the acceptability of measures, procedures and the intervention. A secondary aim was to explore the potential efficacy of MOPED-A in reducing athletes' eating disorder symptoms.METHODThirty-five athletes were recruited. Participation involved completing MOPED-A over a 6-week period and completing self-report measures at baseline (T1), post-intervention (T2) and 4-week follow-up (T3). A subsample (n = 15) completed an interview at T2.RESULTSRetention was good throughout the study (n = 28; 80%). Quantitative and qualitative feedback suggested the format, delivery, content and dosage of MOPED-A were acceptable. Athletes valued that the intervention was tailored to them, and this facilitated both participation and completion. Over a third of participants reported disclosing their eating difficulties and deciding to seek further support. Large reductions in eating disorder symptoms were detected at T2 and sustained at T3.CONCLUSIONSThe MOPED-A intervention can be feasibly implemented, is acceptable to participants, and demonstrates potential for reducing symptoms in athletes. A larger, controlled trial is warranted.
    • 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)
    • 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.
    • Exploring barriers to South Asian help-seeking for eating disorders

      Arcelus, Jon (2017)
      Purpose - Referrals to specialist eating disorder (ED) services from the South Asian (SA) community are under-represented, despite research suggesting that disordered eating attitudes and behaviours of SA people are similar to the population in general. The purpose of this paper is to identify the reasons for this and sought to inform ways to encourage help-seeking. Design/methodology/approach - A qualitative methodology was used to investigate barriers to help-seeking for EDs among the SA community. A key informant focus group was conducted with clinicians working within the local specialist ED service (participants n=16, 12 female, 4 male). Six focus groups were conducted with members of the SA community in Leicester, UK (participants n=28, 23 female, 5 male), recruited from a local university, two charities and Children, Young People and Family Centres. Findings - A number of themes emerged as possible factors for delaying early access to help: lack of knowledge about EDs and their potential seriousness, ideals regarding body shape, family living circumstances and the role of food in the community. Participants acknowledged stigma among their community associated with mental health issues, including EDs and concerns about confidentiality when approaching services, particularly primary care. Originality/value - General practitioners and specialist services need to be aware of the potential barriers to help-seeking for EDs as early specialist help is recommended for effective treatment. An educational campaign around EDs specifically designed with the SA community in mind may improve awareness, reduce stigma and promote early help-seeking. © Emerald Publishing Limited.