|
1
|
Bren Z, Goldstein A, Lavan O, Fennig S. Do previous pediatric inpatient interventions predict better outcomes for psychiatric inpatient treatment of anorexia nervosa? Int J Adolesc Med Health 2025:ijamh-2025-0028. [PMID: 40248875 DOI: 10.1515/ijamh-2025-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Accepted: 04/01/2025] [Indexed: 04/19/2025]
Abstract
OBJECTIVES To explore the benefits and drawbacks of pediatric hospitalization of adolescents with anorexia nervosa prior to psychiatric hospitalization. METHODS Epidemiologic data, anthropometric measures, and vital signs, as well as hospitalization characteristics and outcomes, were collected retrospectively and analyzed for 104 patients aged 12-18 years old. RESULTS Pediatric hospitalization prior to psychiatric admission did not result in significant advantages in treatment outcomes. Furthermore, no significant advantages were attributed to long pediatric hospitalization as compared to short hospitalization. CONCLUSIONS This study suggests that for treating adolescent anorexia nervosa, pediatric hospitalization should be recommended only for immediate correction of urgent and life-threatening physical conditions, with short stays preferred over long pediatric hospitalization.
Collapse
Affiliation(s)
- Ziv Bren
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Amit Goldstein
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Orly Lavan
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Silvana Fennig
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| |
Collapse
|
|
2
|
Strid C, Lindfors P, Andersson C, Berman AH. Eating disorders and psychiatric comorbidity among first-year university students in Sweden: Prevalence and risk factors. J Eat Disord 2025; 13:52. [PMID: 40114279 PMCID: PMC11924712 DOI: 10.1186/s40337-025-01230-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 02/25/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND This study explored eating disorders (ED) prevalences, comorbidity of ED with other mental disorders, and risk factors for ED among university students. ED included binge eating disorder (BED), bulimia nervosa (BN), or other specified feeding and eating disorders (OSFED). METHODS A total of 3425 first-year university students in Sweden completed an online survey covering a range of criteria for psychiatric diagnoses, within the World Mental Health International College Student (WMH-ICS) initiative. Pearson's χ2 -tests were used to compare algorithm-based diagnostic prevalences for eating disorders and other comorbid psychiatric disorders between three groups: students with ED with or without other comorbid psychiatric disorders (A), students with psychiatric disorders but no ED comorbidity (B), and students with no psychiatric disorders (C). Multinomial logistic regression was used to calculate between-group comparisons of odds ratios for independent risk factors, where group B served as the reference group for comparisons with groups A and C. RESULTS Of the total sample, 75% had at least one psychiatric disorder and 28% had at least one lifetime ED diagnosis. Students with ED (group A) reported higher prevalences for comorbid anxiety disorders, depression, suicidal behavior, and non-suicidal self-injury compared to students with psychiatric disorders but no ED (group B). Group A participants exhibited a higher risk of hazardous drinking, were more likely to have received medical treatment, and to identify as bisexual. Compared to group B, students with no psychiatric disorders (group C) were more likely to report better mental and physical health, but less likely to engage in hazardous drinking, and to have sought mental health treatment. CONCLUSIONS A large proportion of students with ED had additional psychiatric disorders, indicating that individuals with ED suffer from multiple mental health problems. It is crucial that student health services acquire competency to offer effective ED assessment and treatment.
Collapse
Affiliation(s)
| | - Petra Lindfors
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Anne H Berman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
|
3
|
Croci MS, Brañas MJAA, Javaras KN, Dechant E, Jurist J, Steigerwald G, Choi-Kain LW. General Psychiatric Management for Adolescents With Borderline Personality Disorder and Eating Disorders. Am J Psychother 2025; 78:24-34. [PMID: 39083007 DOI: 10.1176/appi.psychotherapy.20230045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Borderline personality disorder and eating disorders frequently co-occur among youths. These disorders emerge in adolescence, during the critical developmental period of building an independent sense of self and the capacity to relate to one's community. Because of core differences in the development and psychopathology of borderline personality disorder and eating disorders, adjustments are required when treating these disorders when they co-occur. Few established treatment approaches can address these disorders simultaneously. Evidence-based psychotherapies for borderline personality disorder, such as dialectical behavior therapy and mentalization-based treatment, have been adapted to accommodate the shared vulnerabilities and features of the two disorders. However, these approaches are specialized, intensive, and lengthy and are therefore poorly suited to implementation in general psychiatric or primary health care, where most frontline mental health care is provided. Generalist approaches can fill this public health gap, guiding nonspecialists in structuring informed clinical management for these impairing and sometimes fatal disorders. In this overview, the authors describe the adjustment of good (or general) psychiatric management (GPM) for adolescents with borderline personality disorder to incorporate the prevailing best practices for eating disorder treatment. The adjusted treatment relies on interventions most clinicians already use (diagnostic disclosure, psychoeducation, focusing on life outside treatment, managing patients' self-destructive behaviors, and conservative psychopharmacology with active management of comorbid conditions). Limitations of the adjusted treatment, as well as guidelines for referring patients to specialized and general medical treatments and for returning them to primary generalist psychiatric care, are discussed.
Collapse
Affiliation(s)
- Marcos S Croci
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Marcelo J A A Brañas
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Kristin N Javaras
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Esther Dechant
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Julia Jurist
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Georgia Steigerwald
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Lois W Choi-Kain
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| |
Collapse
|
|
4
|
Fuller S, Thomson S, Nicholls D, Tan J. Nasogastric tube feeding under physical restraint: understanding the effects on parents and how to support them. Nurs Child Young People 2025:e1546. [PMID: 39829345 DOI: 10.7748/ncyp.2025.e1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND Nasogastric tube (NGT) feeding under physical restraint is a clinical intervention that may be required when a child or young person is medically unstable secondary to restrictive eating. AIM To explore the experiences of parents when their child receives NGT feeding under physical restraint and understand the effects of this on them. METHOD This is a secondary analysis of data from two previous studies on NGT feeding under physical restraint - one in mental health wards and one in children's wards - in which semi-structured interviews had been conducted with patients, staff and parents. For this secondary analysis, the authors thematically analysed 31 transcripts of interviews with parents. FINDINGS Parents reported a range of emotions which could be conflicting in nature, notably relief and shame. In both studies, parents understood the necessity of NGT feeding under physical restraint but experienced the intervention as traumatic. They expressed empathy for staff facilitating the restraint. In the children's wards study, some parents described conflict and damaged relationships with staff, and three parents had participated in physically restraining their child for NGT feeding. CONCLUSION Nursing staff should be aware that NGT feeding under physical restraint is distressing for parents. Adopting a trauma-informed framework may help to mitigate the traumatic effects on parents and, in turn, on their child.
Collapse
Affiliation(s)
- Sarah Fuller
- Child and Adolescent Mental Health, Northamptonshire Healthcare NHS Foundation Trust, Northampton, England
| | - Sharon Thomson
- Child and Adolescent Mental Health, East London NHS Foundation Trust, Bedford, England
| | - Dasha Nicholls
- Brain Sciences, Imperial College London, London, England
| | | |
Collapse
|
|
5
|
Sandri E, Sguanci M, Cantín Larumbe E, Cerdá Olmedo G, Piredda M, Mancin S. Influence of Nutrition, Lifestyle Habits, and Socio-Demographic Determinants on Eating Disorder Symptoms in the Spanish Young Adult Population: A Cross-Sectional Nationwide Survey. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1565. [PMID: 39459352 PMCID: PMC11509460 DOI: 10.3390/medicina60101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 09/16/2024] [Accepted: 09/22/2024] [Indexed: 10/28/2024]
Abstract
Eating disorders represent a complex and multifaceted public health challenge, highly prevalent among young people. Background and Objectives: To examine the prevalence of eating disorders in the Spanish young adult population aged 18-30 years, and their correlation with various eating habits and lifestyle factors. Materials and Methods: A descriptive, cross-sectional survey was carried out using a non-probabilistic snowball sample. The valid and reliable NutSo-HH Scale was employed to collect data on nutrition, lifestyle, and health habits. Results: Data were collected from 9692 Spanish young adults, of which 101 (1.04%) were diagnosed with anorexia nervosa and 71 (0.73%) with bulimia nervosa. The prevalence of anorexia and bulimia was significantly higher (p < 0.001) in women than in men, regardless of socio-demographic variables such as educational level, income, region, and size of city of residence. A considerable percentage of participants showed possible symptoms of eating disorders. Nutritionally, individuals with eating disorders consumed less fast food and fried or ultra-processed food but tended to consume coffee and energy drinks more frequently. Additionally, sleep quality and duration were more adversely affected in individuals with eating disorders compared to the general population. Sedentary lifestyles did not significantly differ between those with eating disorders and healthy individuals, though physical activity increased in people with bulimia. Conclusions: The interplay between young adults' dietary habits, lifestyle factors, and mental health underscores the urgent need for targeted interventions to effectively address these complex public health challenges.
Collapse
Affiliation(s)
- Elena Sandri
- Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, c/Quevedo, 2, 46001 Valencia, Spain; (E.S.); (G.C.O.)
- Doctoral School, Catholic University of Valencia San Vicente Mártir, c/Quevedo 2, 46001 Valencia, Spain
| | - Marco Sguanci
- Department of Medicine and Surgery, Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy;
| | - Eva Cantín Larumbe
- Faculty of Data Science, Polytechnical University of Valencia, Camí de Vera s/n, 46022 Valencia, Spain;
| | - Germán Cerdá Olmedo
- Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, c/Quevedo, 2, 46001 Valencia, Spain; (E.S.); (G.C.O.)
| | - Michela Piredda
- Department of Medicine and Surgery, Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy;
| | - Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Viale Montpellier, 1, 00128 Rome, Italy;
| |
Collapse
|
|
6
|
Kasson E, Szlyk HS, Li X, Constantino-Pettit A, Smith AC, Vázquez MM, Wilfley DE, Taylor CB, Fitzsimmons-Craft EE, Cavazos-Rehg P. Eating disorder symptoms and comorbid mental health risk among teens recruited to a digital intervention research study via two online approaches. Int J Eat Disord 2024; 57:1518-1531. [PMID: 38445416 PMCID: PMC11262972 DOI: 10.1002/eat.24186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION It is crucial to identify and evaluate feasible, proactive ways to reach teens with eating disorders (EDs) who may not otherwise have access to screening or treatment. This study aimed to explore the feasibility of recruiting teens with EDs to a digital intervention study via social media and a publicly available online ED screen, and to compare the characteristics of teens recruited by each approach in an exploratory fashion. METHOD Teens aged 14-17 years old who screened positive for a clinical/subclinical ED or at risk for an ED and who were not currently in ED treatment completed a baseline survey to assess current ED symptoms, mental health comorbidities, and barriers to treatment. Bivariate analyses were conducted to examine differences between participants recruited via social media and those recruited after completion of a widely available online EDs screen (i.e., National Eating Disorders Association [NEDA] screen). RESULTS Recruitment of teens with EDs using the two online approaches was found to be feasible, with 934 screens completed and a total of 134 teens enrolled over 6 months: 77% (n = 103) via social media 23% (n = 31) via the NEDA screen. Mean age of participants (N = 134) was 16 years old, with 49% (n = 66) identifying as non-White, and 70% (n = 94) identifying as a gender and/or sexual minority. Teens from NEDA reported higher ED psychopathology scores (medium effect size) and more frequent self-induced vomiting and driven exercise (small effect sizes). Teens from NEDA also endorsed more barriers to treatment, including not feeling ready for treatment and not knowing where to find a counselor or other resources (small effect sizes). DISCUSSION Online recruitment approaches in this study reached a large number of teens with an interest in a digital intervention to support ED recovery, demonstrating the feasibility of these outreach methods. Both approaches reached teens with similar demographic characteristics; however, teens recruited from NEDA reported higher ED symptom severity and barriers to treatment. Findings suggest that proactive assessment and intervention methods should be developed and tailored to meet the needs of each of these groups. PUBLIC SIGNIFICANCE This study examined the feasibility of recruiting teens with EDs to a digital intervention research study via social media and NEDA's online screen, and demonstrated differences in ED symptoms among participants by recruitment approach.
Collapse
Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anna Constantino-Pettit
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arielle C Smith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Melissa M Vázquez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Denise E Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | | | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
|
7
|
Di Luzio M, Bellantoni D, Bellantoni AL, Villani V, Di Vincenzo C, Zanna V, Vicari S, Pontillo M. Similarities and differences between eating disorders and obsessive-compulsive disorder in childhood and adolescence: a systematic review. Front Psychiatry 2024; 15:1407872. [PMID: 38895032 PMCID: PMC11183500 DOI: 10.3389/fpsyt.2024.1407872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Background The developmental age, comprising childhood and adolescence, constitutes an extremely important phase of neurodevelopment during which various psychiatric disorders can emerge. Obsessive-Compulsive Disorder (OCD) and Eating Disorders (ED) often manifest during this critical developmental period sharing similarities but also differences in psychopathology, neurobiology, and etiopathogenesis. The aim of this study is to focus on clinical, genetic and neurobiological similarities and differences in OCD and ED. Methods This study is based on a PubMed/MEDLINE and Cochrane Central Register for Controlled Trial (CENTRAL). The research adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results The aforementioned search yielded an initial collection of 335 articles, published from 1968 to September 2023. Through the application of inclusion and exclusion criteria, a total of 324 articles were excluded, culminating in a final selection of 10 articles. Conclusions Our findings showed both differences and similarities between OCD and ED. Obsessive-compulsive (OC) symptoms are more prevalent in ED characterized by a binge/purge profile than in those with a restrictive profile during developmental age. OC symptomatology appears to be a common dimension in both OCD and ED. When presents, OC symptomatology, exhibits transversal characteristic alterations in the anterior cingulate cortex and poorer cognitive flexibility. These correlations could be highlighted by genetic overlaps between disorders. A comprehensive definition, integrating psychopathological and neurobiological aspects could significantly aid treatment selection and thereby influence the prognosis of these patients.
Collapse
Affiliation(s)
- Michelangelo Di Luzio
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Domenica Bellantoni
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Valeria Villani
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina Di Vincenzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valeria Zanna
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Life Sciences and Public Health Department, Catholic University, Rome, Italy
| | - Maria Pontillo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| |
Collapse
|
|
8
|
McDaid D, Treasure J, Fernández-Aranda F, Herpertz-Dahlmann B, Quoidbach V, Dickson S, Gorwood P. Quantifying the economic value of earlier and enhanced management of anorexia nervosa for adults in England, Germany and Spain: improving the care pathway. Eur Psychiatry 2024; 67:e43. [PMID: 38778019 PMCID: PMC11441344 DOI: 10.1192/j.eurpsy.2024.1751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious mental illness. One-third of people develop severe, enduring, illness, adversely impacting quality of life with high health system costs. This study assessed the economic case for enhanced care for adults newly diagnosed with AN. METHODS A five-state 312-month-cycle Markov model assessed the economic impact of four enhanced care pathways for adults newly diagnosed with AN in England, Germany, and Spain. Enhancements were halving wait times for any outpatient care, receiving specialist outpatient treatment post-referral, additional transitional support post-referral, and all enhancements combined. Care pathways, estimates of impact, resource use, and costs were drawn from literature. Net monetary benefits (NMBs), impacts on health system costs, and disability-adjusted life years (DALYs) averted were estimated. Parameter uncertainty was addressed in multi-way sensitivity analyses. Costs are presented in 2020 purchasing power parity adjusted Euros. RESULTS All four enhanced care pathways were superior to usual care, with the combined intervention scenario having the greatest NMBs of €248,575, €259,909, and €258,167 per adult in England, Germany, and Spain, respectively. This represented maximum NMB gains of 9.38% (€21,316), 4.3% (€10,722), and 4.66% (€11,491) in England, Germany and Spain compared to current care. Healthcare costs would reduce by more than 50%. CONCLUSIONS Early and effective treatment can change the trajectory of AN. Reducing the untreated duration of the disorder is crucial. There is a good economic case in different country contexts for measures to reduce waiting times between diagnosis and treatment and increase access to enhanced outpatient treatment.
Collapse
Affiliation(s)
- David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Fernando Fernández-Aranda
- Psychoneurobiology of Eating and Addictive Behaviours Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Psychology, Bellvitge University Hospital, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy RWTH Aachen University, Aachen, Germany
| | | | - Suzanne Dickson
- European Brain Council, Brussels, Belgium
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Philip Gorwood
- Université Paris Cité, GHU ParisPsychiatrie et Neurosciences, CMME, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France
| |
Collapse
|
|
9
|
Oka A, Hadano S, Ueda MT, Nakagawa S, Komaki G, Ando T. Rare CRHR2 and GRM8 variants identified as candidate factors associated with eating disorders in Japanese patients by whole exome sequencing. Heliyon 2024; 10:e28643. [PMID: 38644811 PMCID: PMC11031761 DOI: 10.1016/j.heliyon.2024.e28643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Eating disorders (EDs) are a type of psychiatric disorder characterized by pathological eating and related behavior and considered to be highly heritable. The purpose of this study was to explore rare variants expected to display biological functions associated with the etiology of EDs. We performed whole exome sequencing (WES) of affected sib-pairs corresponding to disease subtype through their lifetime and their parents. From those results, rare single nucleotide variants (SNVs) concordant with sib-pairs were extracted and estimated to be most deleterious in the examined families. Two non-synonymous SNVs located on corticotropin-releasing hormone receptor 2 (CRHR2) and glutamate metabotropic receptor 8 (GRM8) were identified as candidate disease susceptibility factors. The SNV of CRHR2 was included within the cholesterol binding motif of the transmembrane helix region, while the SNV of GRM8 was found to contribute to hydrogen bonds for an α-helix structure. CRHR2 plays important roles in the serotoninergic system of dorsal raphe nuclei, which is involved with feeding and stress-coping behavior, whereas GRM8 modulates glutamatergic neurotransmission. Moreover, GRM8 modulates glutamatergic neurotransmission, and is also considered to have effects on dopaminergic and adrenergic neurotransmission. Thus, identification of rare and deleterious variants in this study is expected to increase understanding and treatment of affected individuals. Further investigation regarding the biological function of these variants may provide an opportunity to elucidate the pathogenesis of EDs.
Collapse
Affiliation(s)
- Akira Oka
- Department of Molecular Life Sciences, Division of Basic Medical Science and Molecular Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
- The Institute of Medical Sciences, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Shinji Hadano
- The Institute of Medical Sciences, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
- Department of Physiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
- Micro/Nano Technology Center, Tokai University, Hiratsuka, Kanagawa, 259-1292, Japan
| | - Mahoko Takahashi Ueda
- Department of Genomic Function and Diversity, Medical Research Institute, Tokyo Medical and Dental University, Bunkyo, Tokyo, 113-8510, Japan
| | - So Nakagawa
- Department of Molecular Life Sciences, Division of Basic Medical Science and Molecular Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
- The Institute of Medical Sciences, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
- Micro/Nano Technology Center, Tokai University, Hiratsuka, Kanagawa, 259-1292, Japan
| | - Gen Komaki
- Faculty of Medical Science, Fukuoka International University of Health and Welfare, Momochihama, Sawara-ku, Fukuoka, 814-0001, Japan
| | - Tetsuya Ando
- Department of Psychosomatic Medicine, Faculty of Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-higashi, Kodaira, Tokyo, 187-8553, Japan
| |
Collapse
|
|
10
|
Obeid N, Coelho JS, Booij L, Dimitropoulos G, Silva-Roy P, Bartram M, Clement F, de Oliveira C, Katzman DK. Estimating additional health and social costs in eating disorder care for young people during the COVID-19 pandemic: implications for surveillance and system transformation. J Eat Disord 2024; 12:52. [PMID: 38671494 PMCID: PMC11047001 DOI: 10.1186/s40337-024-01003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The impact of the COVID-19 pandemic on young people with eating disorders (EDs) and their families was profound, with surging rates of hospitalizations and referrals reported internationally. This paper provides an account of the additional health and social costs of ED care for young people living in Canada incurred during the COVID-19 pandemic, drawing attention to the available data to inform these estimates while noting gaps in data capacities to account for a full view of the ED system of care. METHODS Three methodologies were used to capture costs: (1) provincial administrative data holdings available at the Canadian Institute of Health Information (CIHI) were used by Deloitte Access Economics to conduct analyses on costs related to hospitalizations, emergency room visits, outpatient visits with physicians and loss of well-being from being on a waitlist. These were examined across three fiscal years (April 1 to March 31, 2019-2022) to compare costs from one year before to two years after the onset of the pandemic, (2) data collected on support-based community ED organizations and, (3) costs identified by young people, caregivers and health care professionals. RESULTS Estimates of additional health care costs and social costs arising from ED care waitlists were estimated to have increased by 21% across the two years after the onset of the pandemic and is likely to represent an underestimate of costs. Costs related to some standard ED care services (e.g. day treatment programs) and support-based community ED organizations that saw a 118% increase in services during this time, are some examples of costs not captured in the current cost estimate. CONCLUSIONS This paper provides a first account of the additional health and social ED care costs associated with the pandemic, which indicate at minimum, a 21% increase. The results invite discussion for more investments in ED services for young people in Canada, as it is unclear if needs are expected to remain elevated. We suggest a call for a national surveillance strategy to improve data holdings to aid in managing services and informing policy. A robust strategy could open the door for much-needed, data-informed, system transformation efforts that can improve ED care for youth, families and clinicians.
Collapse
Affiliation(s)
- Nicole Obeid
- Eating Disorders Research Lab, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, K1H 8L1, Ottawa, ON, Canada.
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
| | - Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Gina Dimitropoulos
- Calgary Eating Disorder Program, Alberta Health Services, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Patricia Silva-Roy
- Eating Disorders Research Lab, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, K1H 8L1, Ottawa, ON, Canada
| | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy Administration, Carleton University, Ottawa, ON, Canada
| | - Fiona Clement
- Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
|
11
|
Dahlgren CL, Sundgot-Borgen C, Kvalem IL, Wennersberg AL, Wisting L. Further evidence of the association between social media use, eating disorder pathology and appearance ideals and pressure: a cross-sectional study in Norwegian adolescents. J Eat Disord 2024; 12:34. [PMID: 38424579 PMCID: PMC10905800 DOI: 10.1186/s40337-024-00992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Few studies have investigated how the plethora of contemporary social media (SM) platforms relate to, and influence eating disorder (ED) pathology, appearance ideals and pressure to conform to these ideals in youth. METHODS In this study, 1558 girls (53%) and boys (47%), predominantly within the 16-19 age range, completed an online questionnaire assessing SM use and perceived influence on appearance, ED pathology, internalization of appearance ideals and perceived appearance pressure. RESULTS Results showed that ED pathology was common, particularly in girls, and that internalization of body ideals was gender specific, a thin ideal being more prevalent in girls, and a muscular ideal being more common in boys. Results also showed a strong association between ED pathology and perceived pressure to conform to these appearance ideals. One fourth of the participants reported spending four hours or more on SM daily, and 80% of girls reported that SM, particularly Instagram and TikTok, had a negative influence on how they felt about their appearance. These girls had significantly higher levels of ED pathology and reported higher levels of appearance pressure from the media. CONCLUSION A clear pattern of associations between photo- and video specific SM platforms, ED pathology, internalization of body ideals and perceived pressure was found in this study. Adolescent girls appeared to be particularly at risk. The results illustrate an imperative need to keep addressing the potential risks of SM use in adolescents, and to continue monitoring the effect of SM on young people's view of themselves, their appearance, and their eating habits. Future studies should attempt to identify aspects of SM use that may be particularly detrimental for girls and boys in their formative years, but also those that may enhance adolescents' satisfaction and appreciation of their body and appearance. TRIAL REGISTRATION The study is registered in the Open Science Framework (Identifier: 10.17605/OSF.IO/5RB6P https://doi.org/10.17605/OSF.IO/5RB6P ).
Collapse
Affiliation(s)
- Camilla Lindvall Dahlgren
- Department of Psychology, Oslo New University College, Lovisenberggata 13, 0456, Oslo, Norway.
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital-Ullevål, Oslo, Norway.
| | - Christine Sundgot-Borgen
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital-Ullevål, Oslo, Norway
| | - Ingela Lundin Kvalem
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Anne-Louise Wennersberg
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital-Ullevål, Oslo, Norway
| | - Line Wisting
- Division of Mental Health and Addiction, Regional Department of Eating Disorders, Oslo University Hospital-Ullevål, Oslo, Norway
| |
Collapse
|
|
12
|
Toigo S, Katzman DK, Vyver E, McFaull SR, Iynkkaran I, Thompson W. Eating disorder hospitalizations among children and youth in Canada from 2010 to 2022: a population-based surveillance study using administrative data. J Eat Disord 2024; 12:3. [PMID: 38167164 PMCID: PMC10763198 DOI: 10.1186/s40337-023-00957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) are severe mental illnesses associated with significant morbidity and mortality. EDs are more prevalent among females and adolescents. Limited research has investigated Canadian trends of ED hospitalizations prior to the COVID-19 pandemic, however during the pandemic, rates of ED hospitalizations have increased. This study examined rates of ED hospitalizations among children and youth in Canada from 2010 to 2022, by sex, age, province/territory, length of stay, discharge disposition and ED diagnosis. METHODS Cases of ED hospitalizations among children and youth, ages 5 to 17 years, were identified using available ICD-10 codes in the Discharge Abstract Database from the 2010/11 to 2022/23 fiscal years. The EDs examined in this study were anorexia nervosa (F50.0), atypical anorexia nervosa (F50.1), bulimia nervosa (F50.2), other EDs (F50.3, F50.8) and unspecified EDs (F50.9). Both cases of total and first-time ED hospitalizations were examined. Descriptive statistics and trend analyses were performed. RESULTS Between 2010/11 and 2022/23, 18,740 children and youth were hospitalized for an ED, 65.9% of which were first-time hospitalizations. The most frequent diagnosis was anorexia nervosa (51.3%). Females had significantly higher rates of ED hospitalization compared to males (66.7/100,000 vs. 5.9/100,000). Youth had significantly higher rates compared to children. The average age of ED hospitalization was 14.7 years. Rates of ED hospitalizations were relatively stable pre-pandemic, however during the pandemic (2020-2021), rates increased. INTERPRETATION Rates of pediatric ED hospitalizations in Canada increased significantly during the pandemic, suggesting that there may have been limited access to alternative care for EDs or that ED cases became more severe and required hospitalization. This emphasizes the need for continued surveillance to monitor how rates of ED hospitalizations evolve post-pandemic.
Collapse
Affiliation(s)
- Stephanie Toigo
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada.
| | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ellie Vyver
- Section of Adolescent Medicine, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Steven R McFaull
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
| | - Ithayavani Iynkkaran
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
| | - Wendy Thompson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada
| |
Collapse
|
|
13
|
Irish M, Adams J, Cooper M. Investigating self-blame and trauma symptoms in parents of young people with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2024; 32:80-89. [PMID: 37585595 DOI: 10.1002/erv.3025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Caring for a young person with anorexia nervosa (AN) has been associated with psychological distress and found to be a traumatic experience. This can have an impact on patient and family outcomes. OBJECTIVE This study aimed to investigate whether self-blame cognitions contribute to post-traumatic stress disorder (PTSD) symptoms in parents of young people with AN. METHODS A cross-sectional design was used. One hundred and twenty-three parents of young people with AN completed a range of questionnaires assessing self-blame cognitions and PTSD symptoms. RESULTS Overall, levels of self-blame cognitions were significantly higher in those experiencing higher levels of PTSD symptoms compared to low levels. Additionally, levels of self-blame cognitions significantly predicted PTSD symptoms over and above demographic factors and illness severity, accounting for 22% of unique variance in PTSD symptoms. CONCLUSIONS The findings suggest that negative appraisals regarding self-blame for their child's eating disorder contributed to the potential maintenance of PTSD symptoms. Parents presenting with thoughts of self-blame would benefit from further support to reduce these feelings and, subsequently, reduce carer distress.
Collapse
Affiliation(s)
- Madeleine Irish
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Isis Education Centre, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Joanna Adams
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Isis Education Centre, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Isis Education Centre, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| |
Collapse
|
|
14
|
Søeby M, Gribsholt SB, Clausen L, Richelsen B. Fracture Risk in Patients with Anorexia Nervosa Over a 40-Year Period. J Bone Miner Res 2023; 38:1586-1593. [PMID: 37578122 DOI: 10.1002/jbmr.4901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
Researchers have reported increased fracture risk in patients with anorexia nervosa (AN), but more knowledge on the long-term risk and the effects of age, male sex, and time-related changes is still needed. We examined the long-term (up to 40 years) fracture risk among patients with AN compared to a matched comparison cohort from the general population. We utilized data from the Danish Health Care Registers to identify 14,414 patients with AN (13,474 females and 940 males) diagnosed between 1977 and 2018, with a median age of 18.6 years and median follow-up time of 9.65 years. We calculated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) using Cox regression analysis for overall and site-specific fracture risks. The overall aHR of any fracture was 1.46 [95% CI: 1.36 to 1.48], with an aHR of 1.50 [95% CI: 1.43 to 1.57] for females and 0.95 [95% CI: 0.82 to 1.1] for males. For specific fractures we found an association with femur fractures both in females 4.06 [95% CI: 3.39 to 4.46] and in males 2.79 [95% CI: 1.45 to 2.37] and for fractures of the spine (females 2.38 [95% CI: 2.00 to 2.84], males 2.31 [95% CI: 1.20 to 4.42]). The aHR of any fracture decreased from 1.66 [95% CI: 1.52 to 1.81] in the period from 1977 to 1997 to 1.40 [95% CI: 1.33 to 1.40] from 1998 to 2018. In conclusion, we found that AN was associated with a 46% increased risk of any fracture up to 40 years after diagnosis. We found no overall increased risk in males, but in both sexes we found a particularly high site-specific fracture risk in the spine and femur. Fracture risk decreased in recent decades, indicating that more patients with AN have been diagnosed with presumably less severe disease and that the earlier detection and intervention of AN in recent years may translate into a lower facture risk. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Mette Søeby
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Sigrid Bjerge Gribsholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Bjørn Richelsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
|
15
|
Chen J, Liu K, Zhang J, Liu S, Wang Y, Cao R, Peng X, Han M, Han H, Yao R, Fu L. Parental Pressure on Child Body Image, BMI, Body Image Dissatisfaction Associated with Eating Disorders in School-Age Children in China: A Path Analysis. Psychol Res Behav Manag 2023; 16:3247-3258. [PMID: 37609642 PMCID: PMC10440685 DOI: 10.2147/prbm.s418535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/05/2023] [Indexed: 08/24/2023] Open
Abstract
Background Children's eating behaviors, body shape and body image cognition may be more susceptible to the influence of their parents, but these influences may be weakened with age. There may be different association pathways between parental pressure on children's body image (PPCBI), body mass index (BMI), body image dissatisfaction (BID) and eating disorders (EDs) among children and adolescents at different developmental stages. Methods The stratified cluster sampling method (Stratified by grade, and took the classes as clusters) was used to select 486 students aged 8-15 years in two 9-year schools. Children's body height, weight, testicular volume and breast development were measured. PPCBI, BID, and EDs were investigated using the Appearance-related Social Stress Questionnaire, Body Size Questionnaire (BID-14), and EDI-1 scale, respectively. Results The boys before puberty initiation had significantly higher EDs score (182.3±50.8) than girls before puberty initiation (164.1±58.1) (P<0.05). There were significant association pathways of PPCBI→BMI→BID→EDs and PPCBI→BID→EDs in boys before puberty initiation (β=0.035, P<0.01; β=0.059, P<0.01), in boys after puberty initiation (β=0.032, P<0.01; β=0.175, P<0.001), and in girls after puberty initiation (β=0.026, P<0.01; β=0.172, P<0.001). There was a positive association pathway of PPCBI→EDs in boys before puberty initiation (β=0.30, P<0.001) and PPCBI→BID→EDs in girls before puberty initiation (β=0.176, P<0.01). Conclusion Parental pressure on children's body image may positively associate with children's eating disorders through BMI and body image dissatisfaction in boys and girls after puberty initiation and directly associate with eating disorders in boys before puberty initiation; however, it may indirectly associate with eating disorders only through BID in girls before puberty initiation.
Collapse
Affiliation(s)
- Jiaoyan Chen
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Keke Liu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Juan Zhang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Songhui Liu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Yuanyuan Wang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Ruiyao Cao
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Xingwang Peng
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Mei Han
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Hui Han
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Rongying Yao
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Lianguo Fu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| |
Collapse
|
|
16
|
Mosuka EM, Murugan A, Thakral A, Ngomo MC, Budhiraja S, St Victor R. Clinical Outcomes of Refeeding Syndrome: A Systematic Review of High vs. Low-Calorie Diets for the Treatment of Anorexia Nervosa and Related Eating Disorders in Children and Adolescents. Cureus 2023; 15:e39313. [PMID: 37351245 PMCID: PMC10281854 DOI: 10.7759/cureus.39313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Over the years, the standard of care for re-alimentation of patients admitted for the treatment of anorexia nervosa (AN) has been a conservative or cautious approach described as "start low and go slow." These traditional refeeding protocols advocate for a low-calorie diet that restricts carbohydrates, with the primary goal of hypothetically lowering the risk of refeeding syndrome (RFS) and its complication. However, no consensus exists for the optimal inpatient approach to refeeding children and adolescents with AN. There is still some disagreement about what constitutes an ideal pace for nutritional rehabilitation. Varying treatment protocols have emerged across the globe, often reflecting the preferences and biases of individual practitioners and contributing to the lack of a universally accepted protocol for refeeding in AN. Although it is widely accepted that low-caloric refeeding (LCR) is safe for inpatient treatment of AN, this strategy has been shown to have several significant drawbacks, leading to increased criticism of the LCR method. Research from the last decade has led to calls for a more aggressive refeeding protocol, one that suggests a higher caloric intake from the offset. As a result, this research aimed to conduct a systematic review of the existing literature on strategies for refeeding hospitalized pediatric/adolescent patients with AN and related eating disorders. We aimed to compare high-caloric refeeding (HCR) and LCR in terms of weight gain, length of stay, and risk of RFS. We conducted a thorough search of medical databases for abstracts published in English, including Google Scholar, PubMed, and MEDLINE, to find relevant studies published between 2010 and February 2023. Our focus was on articles that evaluated high versus low refeeding protocols in children and adolescents hospitalized for treating AN and related eating disorders. Only articles that reported on at least one of the outcome variables of interest, such as hypophosphatemia, weight gain, RFS, or length of hospital stay, were considered. This review included 20 full-text articles published in the last decade on the HCR protocol in children and adolescents, with a total sample size of 2191 participants. In only one of the 20 studies did researchers find evidence of a true clinical case of RFS. We, therefore, found no evidence that HCR increased the risk of RFS in adolescents, even in those with a very low body mass index (BMI). However, evidence suggests a lower BMI at the time of hospital admission is a better predictor of hypophosphatemia than total caloric intake. In conclusion, based on the evidence from this review, a high-caloric diet or rapid refeeding in children/adolescents suffering from AN may be both safe and effective, with serial laboratory investigations and phosphate supplementation as needed. Hence, more research, particularly, randomized controlled trials, is required to help shape an evidence-based refeeding guideline outlining target calorie intakes and rates of advancement to assist clinicians in the treatment of adolescents with AN and related eating disorders.
Collapse
Affiliation(s)
- Emmanuel M Mosuka
- Pediatrics, Brookdale University Hospital Medical Center, New York, USA
| | - Anushree Murugan
- Pediatrics, Brookdale University Hospital Medical Center, New York, USA
| | - Abhinav Thakral
- Pediatrics, Brookdale University Hospital Medical Center, New York, USA
| | - Mbelle C Ngomo
- Medicine, Université de Yaoundé, Faculté de Médecine et des Sciences Biomédicales, Yaoundé, CMR
| | - Sushil Budhiraja
- Pediatrics, Brookdale University Hospital Medical Center, New York, USA
| | | |
Collapse
|
|
17
|
Auger N, Steiger H, Luu TM, Chadi N, Low N, Bilodeau-Bertrand M, Healy-Profitós J, Ayoub A, Brousseau É, Israël M. Shifting age of child eating disorder hospitalizations during the Covid-19 pandemic. J Child Psychol Psychiatry 2023. [PMID: 37012056 DOI: 10.1111/jcpp.13800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND We studied the effect of the Covid-19 pandemic on child eating disorder hospitalizations in Quebec, Canada. Quebec had one of the strictest lockdown measures targeting young people in North America. METHODS We analyzed eating disorder hospitalizations in children aged 10-19 years before and during the pandemic. We used interrupted time series regression to assess trends in the monthly number of hospitalizations for anorexia nervosa, bulimia nervosa, and other eating disorders before the pandemic (April 2006 to February 2020), and during the first (March to August 2020) and second waves (September 2020 to March 2021). We determined the types of eating disorders requiring hospital treatment and identified the age, sex and socioeconomic subgroups that were most affected. RESULTS Hospitalization rates for eating disorders increased during the first (6.5 per 10,000) and second waves (12.8 per 10,000) compared with the period before the pandemic (5.8 per 10,000). The increase occurred for anorexia nervosa as well as other types of eating disorders. The number of girls and boys aged 10-14 years admitted for eating disorders increased during wave 1. Wave 2 triggered an increase in eating disorder admissions among girls aged 15-19 years. Hospitalization rates increased earlier for advantaged than disadvantaged youth. CONCLUSIONS The Covid-19 pandemic affected hospitalizations for anorexia nervosa as well as other eating disorders, beginning with girls aged 10-14 years during wave 1, followed by girls aged 15-19 years during wave 2. Boys aged 10-14 years were also affected, as well as both advantaged and disadvantaged youth.
Collapse
Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Howard Steiger
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital, Montreal, QC, Canada
| | - Nicholas Chadi
- Department of Pediatrics, Sainte-Justine Hospital, Montreal, QC, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marianne Bilodeau-Bertrand
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Émilie Brousseau
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Mimi Israël
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| |
Collapse
|
|
18
|
Lacroix E, Smith AJ, Husain IA, Orth U, von Ranson KM. Normative body image development: A longitudinal meta-analysis of mean-level change. Body Image 2023; 45:238-264. [PMID: 36965235 DOI: 10.1016/j.bodyim.2023.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 03/27/2023]
Abstract
This meta-analysis synthesized longitudinal data on mean-level change in body image, focusing on the constructs of body satisfaction and dissatisfaction, body esteem, perceived attractiveness, valuation, self-objectification, and body shame. We searched five databases and accessed unpublished data to identify studies that assessed body image at two or more time points over six months or longer. Analyses were based on data from 142 samples representing a total of 128,254 participants. The age associated with the midpoint of measurement intervals ranged from 6 to 54 years. Multilevel metaregression models examined standardized yearly mean change, and the potential moderators of body image construct, gender, birth cohort, attrition rate, age, and time lag. Boys and men showed fluctuations in overall body image with net-improvements between ages 10 and 24. Girls and women showed worsening body image between ages 10 and 16, but improvements between ages 16 and 24. Change was greatest between ages 10 and 14, and stabilized around age 24. We found no effect of construct, birth cohort, or attrition rate. Results suggest a need to revise understandings of normative body image development: sensitive periods may occur somewhat earlier than previously believed, and body image may show mean-level improvements during certain age ranges.
Collapse
Affiliation(s)
- Emilie Lacroix
- Department of Psychology, University of New Brunswick, 38 Dineen Dr., Fredericton, NB E3B 5A3, Canada.
| | - Alyssa J Smith
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
| | - Incé A Husain
- Department of Psychology, University of New Brunswick, 38 Dineen Dr., Fredericton, NB E3B 5A3, Canada
| | - Ulrich Orth
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Kristin M von Ranson
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
| |
Collapse
|
|
19
|
Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia-a rapid review. J Eat Disord 2023; 11:23. [PMID: 36793104 PMCID: PMC9933292 DOI: 10.1186/s40337-023-00738-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/22/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Understanding of the epidemiology and health burden of eating disorders has progressed significantly in the last 2 decades. It was considered one of seven key areas to inform the Australian Government commissioned National Eating Disorder Research and Translation Strategy 2021-2031, as emerging research had highlighted a rise in eating disorder prevalence and worsening burden-of-illness. The aim of this review was to better understand the global epidemiology and impact of eating disorders to inform policy decision-making. METHODS Using a systematic Rapid Review methodology, ScienceDirect, PubMed and Medline (Ovid) were searched for peer-reviewed studies published between 2009 and 2021. Clear inclusion criteria were developed in consultation with experts in the field. Purposive sampling of literature was conducted, which predominately focused on higher-level evidence (meta-analyses, systematic reviews, and large epidemiological studies), synthesised, and narratively analysed. RESULTS 135 studies were deemed eligible for inclusion in this review (N = 1324). Prevalence estimates varied. Global Lifetime prevalence of any eating disorder ranged from 0.74 to 2.2% in males, and 2.58-8.4% in females. Australian 3-month point-prevalence of broadly defined disorders was around 16% in females. Eating disorders appeared more prevalent in young people and adolescents, particularly females (in Australia: eating disorders ~ 22.2%; disordered eating ~ 25.7%). Limited evidence was found on sex, sexuality and gender diverse (LGBTQI +) individuals, particularly males, who had a six-fold increase in prevalence compared to the general male population, with increased illness impact. Similarly, limited evidence on First Australian's (Aboriginal and Torres Strait Islander) suggests prevalence rates similar to non-Indigenous Australians. No prevalence studies were identified specifically assessing culturally and linguistically diverse populations. Global disease burden of any eating disorder was 43.4 age-standardised disability-adjusted-life-years per 100,000; increasing by 9.4% between 2007 and 2017. Australian's total economic cost was estimated at $84 billion from years-of-life lost due to disability and death, and annual lost earnings ~ $1.646 billion." CONCLUSIONS There is no doubt that eating disorder prevalence and impact are on the rise, particularly in at-risk and understudied populations. Much of the evidence came from female-only samples, and Western, high-income countries which more readily have access to specialised services. Future research should examine more representative samples. There is an urgent need for more refined epidemiological methods to better understand these complex illnesses over time, to guide health policy and development-of-care.
Collapse
|
|
20
|
Yu Z, Muehleman V. Eating Disorders and Metabolic Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2446. [PMID: 36767812 PMCID: PMC9916228 DOI: 10.3390/ijerph20032446] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Eating disorders are complex diseases with multifactorial causes. According to the Diagnostic and Statistical Manual of Mental Disorders text version (DSM-5-TR) and the WHO International Classification of Diseases and Related Health Problems (ICD-11), the major types of eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder. The prevalence of eating disorders is alarmingly increasing globally. Moreover, the COVID-19 pandemic has led to more development and worsening of eating disorders. Patients with eating disorders exhibit high rates of psychiatric comorbidities and medical comorbidities such as obesity, diabetes, and metabolic syndrome. This paper aims to review and discuss the comorbidities of eating disorders with those metabolic diseases. Eating disorder treatment typically includes a combination of some or all approaches such as psychotherapy, nutrition education, and medications. Early detection and intervention are important for the treatment of eating disorders.
Collapse
Affiliation(s)
- Zhiping Yu
- Department of Nutrition and Dietetics, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA
| | - Valerie Muehleman
- Department of Nutrition and Dietetics, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA
- Beaufort Jasper Hampton Comprehensive Health Services, Inc., P.O. Box 357, Ridgeland, SC 29926, USA
| |
Collapse
|
|
21
|
Panariello F, Borgiani G, Bronte C, Cassero G, Montanari G, Falcieri M, Rugo MA, Trunfio O, De Ronchi D, Atti AR. Eating Disorders and Disturbed Eating Behaviors Underlying Body Weight Differences in Patients Affected by Endometriosis: Preliminary Results from an Italian Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1727. [PMID: 36767095 PMCID: PMC9914624 DOI: 10.3390/ijerph20031727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to characterize the prevalence of eating disorders (EDs), disturbed eating behaviors (DEBs), and emotional eating attitudes (EEAs) among patients affected by endometriosis in order to understand a potential crosslink between this impacting gynecological disease and a Body Mass Index shift. A total of 30 patients were recruited at an endometriosis outpatient clinic in Bologna and were assessed by using standardized instruments and specific questionnaires for EDs, DEBs, and EEAs. Sociodemographic information and endometriosis clinical features and history information were collected by adopting a specific questionnaire. Retrospective reports of lifetime Body Mass Index (BMI) changes, current BMI, peak pain severity during the last menstrual period, and the average of pain intensity during the last intermenstrual period were used for a correlation with the mean score from eating-behavior scales' assessment. The preliminary results indicate that, although only 3.33% of endometriosis patients are affected by ED, statistically significant differences at the mean scores of DEBs and EEAs assessment scales were found by stratifying patients on the basis of BMI levels at risk for infertility and coronary heart disease and on the basis of moderate/severe pain levels. The enrichment of the sample size and the recruitment of the control group to complete the study enrollment will allow us to investigate more complex and strong correlation findings and to assess the prevalence of EDs among endometriosis patients.
Collapse
Affiliation(s)
- Fabio Panariello
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy
| | - Gianluca Borgiani
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy
| | - Concetta Bronte
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy
| | - Giovanni Cassero
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy
| | - Giulia Montanari
- Endometriosis and Pelvic Pain Outpatient Clinic (Regional Diagnostic and Therapeutic Path), Family Care Center (Local Heath Authority of Bologna, Department of Primary Care), 40123 Bologna, Italy
| | - Marcella Falcieri
- Endometriosis and Pelvic Pain Outpatient Clinic (Regional Diagnostic and Therapeutic Path), Family Care Center (Local Heath Authority of Bologna, Department of Primary Care), 40123 Bologna, Italy
| | | | - Ornella Trunfio
- Eating Disorder Clinic Residenza Gruber, 40141 Bologna, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy
| |
Collapse
|
|
22
|
No effects of acute tryptophan depletion on anxiety or mood in weight-recovered female patients with anorexia nervosa. Eur Arch Psychiatry Clin Neurosci 2023; 273:209-217. [PMID: 35511296 PMCID: PMC9957824 DOI: 10.1007/s00406-022-01414-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previous studies have suggested that individuals recovered from anorexia nervosa (AN) are characterized by increased serotonergic (5-HT) activity that might be related to elevated levels of anxiety. Assuming these traits to be also present in individuals at risk for AN, it was further hypothesized that restricting food intake might be a means to temporarily alleviate dysphoric affective states by reducing central nervous availability of tryptophan (TRP), the sole precursor of 5-HT. One study that supported this hypothesis found anxiolytic effects in individuals with a history of AN during an experimentally induced short-term depletion of TRP supply to the brain. METHODS In this placebo-controlled, double-blind cross-over study, 22 patients weight-recovered from AN (recAN) and 25 healthy control participants (HC) completed questionnaires assessing anxiety and momentary mood during acute tryptophan depletion (ATD), a dietary intervention that lowers central 5-HT synthesis. RESULTS The ATD procedure effectively reduced the ratio of TRP to competing for large neutral amino acids in the peripheral blood, indicating decreased TRP supply to the brain. Effects of ATD on anxiety and mood did not differ between recAN and HC. Bayesian null hypothesis testing confirmed these initial results. DISCUSSION Our results do not support the hypothesis that short-term depletion of TRP and its impact on the brain 5-HT reduces anxiety or improves mood in AN. As the evidence for the role of 5-HT dysfunction on affective processes in patients with AN is limited, further studies are needed to assess its relevance in the pathophysiology of AN.
Collapse
|
|
23
|
Herpertz-Dahlmann B, Dempfle A, Eckardt S. The youngest are hit hardest: The influence of the COVID-19 pandemic on the hospitalization rate for children, adolescents, and young adults with anorexia nervosa in a large German representative sample. Eur Psychiatry 2022; 65:e84. [PMID: 36403977 DOI: 10.1192/j.eurpsy.2022.2345] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has severely impacted the mental health of children and adolescents. Young people at risk for anorexia nervosa (AN) have been especially shown to be affected. There are no studies that have investigated the respective proportions of hospitalized children, adolescents, and young adults separately as well as of both sexes during the COVID-19 crisis. METHODS This study is based on the administrative data of the largest German statutory health insurance. All children (0-14 years) and adolescents (15-19 years) with a discharge diagnosis of typical and atypical AN according to the International Classification of Diseases (ICD)-10 were included. Admission rates per 10,000 person-years were calculated separately by sex and age group, based on admission numbers from the 9-month interval from January to September of 2019, 2020, and 2021 and the number of insured persons per sex and age group of each year. RESULTS The entire sample comprised approximately 4.7 million children and adolescents. There was a highly significant increase of 40% (relative risk (RR): 1.4; [1.27, 1.55]; p < 0.0001) in admission rates in the female children's and the adolescents' group (RR:1.32; [1.24, 1.41]; p< 0.0001) between the pre-COVID-19 and peri-COVID-19 periods in 2019 and 2021, respectively. Among males, hospitalization rates significantly increased in the children (RR: 1.69; [1.09, 2.62]; p < 0.02). CONCLUSIONS Young people appear to be especially prone to develop AN during a crisis, such as with social isolation and school closures. Home-based or mobile pediatric services should be established to prevent this often chronic and disabling disorder in young patients.
Collapse
Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH University, Aachen, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
| | - Stefan Eckardt
- Techniker Krankenkasse (Techniker Health Care Service), State Representation North Rhine-Westphalia, Düsseldorf, Germany
| |
Collapse
|
|
24
|
Watson HJ, Thornton LM, Yilmaz Z, Baker JH, Coleman JR, Adan RA, Alfredsson L, Andreassen OA, Ask H, Berrettini WH, Boehnke M, Boehm I, Boni C, Buehren K, Bulant J, Burghardt R, Chang X, Cichon S, Cone RD, Courtet P, Crow S, Crowley JJ, Danner UN, de Zwaan M, Dedoussis G, DeSocio JE, Dick DM, Dikeos D, Dina C, Djurovic S, Dmitrzak-Weglarz M, Docampo-Martinez E, Duriez P, Egberts K, Ehrlich S, Eriksson JG, Escaramís G, Esko T, Estivill X, Farmer A, Fernández-Aranda F, Fichter MM, Föcker M, Foretova L, Forstner AJ, Frei O, Gallinger S, Giegling I, Giuranna J, Gonidakis F, Gorwood P, Gratacòs M, Guillaume S, Guo Y, Hakonarson H, Hauser J, Havdahl A, Hebebrand J, Helder SG, Herms S, Herpertz-Dahlmann B, Herzog W, Hinney A, Hübel C, Hudson JI, Imgart H, Jamain S, Janout V, Jiménez-Murcia S, Jones IR, Julià A, Kalsi G, Kaminská D, Kaprio J, Karhunen L, Kas MJ, Keel PK, Kennedy JL, Keski-Rahkonen A, Kiezebrink K, Klareskog L, Klump KL, Knudsen GPS, La Via MC, Le Hellard S, Leboyer M, Li D, Lilenfeld L, Lin B, Lissowska J, Luykx J, Magistretti P, Maj M, Marsal S, Marshall CR, Mattingsdal M, Meulenbelt I, Micali N, Mitchell KS, Monteleone AM, et alWatson HJ, Thornton LM, Yilmaz Z, Baker JH, Coleman JR, Adan RA, Alfredsson L, Andreassen OA, Ask H, Berrettini WH, Boehnke M, Boehm I, Boni C, Buehren K, Bulant J, Burghardt R, Chang X, Cichon S, Cone RD, Courtet P, Crow S, Crowley JJ, Danner UN, de Zwaan M, Dedoussis G, DeSocio JE, Dick DM, Dikeos D, Dina C, Djurovic S, Dmitrzak-Weglarz M, Docampo-Martinez E, Duriez P, Egberts K, Ehrlich S, Eriksson JG, Escaramís G, Esko T, Estivill X, Farmer A, Fernández-Aranda F, Fichter MM, Föcker M, Foretova L, Forstner AJ, Frei O, Gallinger S, Giegling I, Giuranna J, Gonidakis F, Gorwood P, Gratacòs M, Guillaume S, Guo Y, Hakonarson H, Hauser J, Havdahl A, Hebebrand J, Helder SG, Herms S, Herpertz-Dahlmann B, Herzog W, Hinney A, Hübel C, Hudson JI, Imgart H, Jamain S, Janout V, Jiménez-Murcia S, Jones IR, Julià A, Kalsi G, Kaminská D, Kaprio J, Karhunen L, Kas MJ, Keel PK, Kennedy JL, Keski-Rahkonen A, Kiezebrink K, Klareskog L, Klump KL, Knudsen GPS, La Via MC, Le Hellard S, Leboyer M, Li D, Lilenfeld L, Lin B, Lissowska J, Luykx J, Magistretti P, Maj M, Marsal S, Marshall CR, Mattingsdal M, Meulenbelt I, Micali N, Mitchell KS, Monteleone AM, Monteleone P, Myers R, Navratilova M, Ntalla I, O’Toole JK, Ophoff RA, Padyukov L, Pantel J, Papežová H, Pinto D, Raevuori A, Ramoz N, Reichborn-Kjennerud T, Ricca V, Ripatti S, Ripke S, Ritschel F, Roberts M, Rotondo A, Rujescu D, Rybakowski F, Scherag A, Scherer SW, Schmidt U, Scott LJ, Seitz J, Silén Y, Šlachtová L, Slagboom PE, Slof-Op ‘t Landt MC, Slopien A, Sorbi S, Świątkowska B, Tortorella A, Tozzi F, Treasure J, Tsitsika A, Tyszkiewicz-Nwafor M, Tziouvas K, van Elburg AA, van Furth EF, Walton E, Widen E, Zerwas S, Zipfel S, Bergen AW, Boden JM, Brandt H, Crawford S, Halmi KA, Horwood LJ, Johnson C, Kaplan AS, Kaye WH, Mitchell JE, Olsen CM, Pearson JF, Pedersen NL, Strober M, Werge T, Whiteman DC, Woodside DB, Gordon S, Maguire S, Larsen JT, Parker R, Petersen LV, Jordan J, Kennedy M, Wade TD, Birgegård A, Lichtenstein P, Landén M, Martin NG, Mortensen PB, Breen G, Bulik CM. Common Genetic Variation and Age of Onset of Anorexia Nervosa. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 2:368-378. [PMID: 36324647 PMCID: PMC9616394 DOI: 10.1016/j.bpsgos.2021.09.001] [Show More Authors] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/08/2022] Open
Abstract
Background Genetics and biology may influence the age of onset of anorexia nervosa (AN). The aims of this study were to determine whether common genetic variation contributes to age of onset of AN and to investigate the genetic associations between age of onset of AN and age at menarche. Methods A secondary analysis of the Psychiatric Genomics Consortium genome-wide association study (GWAS) of AN was performed, which included 9335 cases and 31,981 screened controls, all from European ancestries. We conducted GWASs of age of onset, early-onset AN (<13 years), and typical-onset AN, and genetic correlation, genetic risk score, and Mendelian randomization analyses. Results Two loci were genome-wide significant in the typical-onset AN GWAS. Heritability estimates (single nucleotide polymorphism-h 2) were 0.01-0.04 for age of onset, 0.16-0.25 for early-onset AN, and 0.17-0.25 for typical-onset AN. Early- and typical-onset AN showed distinct genetic correlation patterns with putative risk factors for AN. Specifically, early-onset AN was significantly genetically correlated with younger age at menarche, and typical-onset AN was significantly negatively genetically correlated with anthropometric traits. Genetic risk scores for age of onset and early-onset AN estimated from independent GWASs significantly predicted age of onset. Mendelian randomization analysis suggested a causal link between younger age at menarche and early-onset AN. Conclusions Our results provide evidence consistent with a common variant genetic basis for age of onset and implicate biological pathways regulating menarche and reproduction.
Collapse
Affiliation(s)
- Hunna J. Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- School of Psychology, Curtin University, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Zeynep Yilmaz
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jessica H. Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonathan R.I. Coleman
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, King’s College London and South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Roger A.H. Adan
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, the Netherlands
- Altrecht Eating Disorders Rintveld, Zeist, the Netherlands
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ole A. Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Helga Ask
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Wade H. Berrettini
- Department of Psychiatry, Center for Neurobiology and Behavior, Philadelphia, Pennsylvania
| | - Michael Boehnke
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Ilka Boehm
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Claudette Boni
- INSERM 1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Katharina Buehren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Josef Bulant
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Roland Burghardt
- Department of Child and Adolescent Psychiatry, Klinikum Frankfurt/Oder, Frankfurt, Germany
| | - Xiao Chang
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sven Cichon
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
- The Center for Eating Disorders at Sheppard Pratt, Baltimore, Maryland
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Roger D. Cone
- Life Sciences Institute and Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, University of Montpellier, Montpellier, France
| | - Scott Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
- The Center for Eating Disorders at Sheppard Pratt, Baltimore, Maryland
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - James J. Crowley
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Unna N. Danner
- Department of Clinical Psychology, Faculty of Social Sciences, University Utrecht, Utrecht, the Netherlands
- Altrecht Eating Disorders Rintveld, Zeist, the Netherlands
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - George Dedoussis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | | | - Danielle M. Dick
- Department of Psychology, Commonwealth University, Richmond, Virginia
- College Behavioral and Emotional Health Institute, Commonwealth University, Richmond, Virginia
- Department of Human and Molecular Genetics, Commonwealth University, Richmond, Virginia
| | - Dimitris Dikeos
- First Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Christian Dina
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France
| | - Srdjan Djurovic
- NORMENT Centre, Department of Clinical Science, University of Oslo, Oslo, Norway
- Department of Medical Genetics, University of Bergen, Bergen, Norway
| | | | - Elisa Docampo-Martinez
- Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Barcelona, Spain
| | - Philibert Duriez
- INSERM 1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
- GHU Paris Psychiatrie et Neurosciences, CMME, Paris, France
| | - Karin Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Centre for Mental Health, Würzburg, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Johan G. Eriksson
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Geòrgia Escaramís
- Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Barcelona, Spain
| | - Tõnu Esko
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Xavier Estivill
- Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Barcelona, Spain
- Genomics and Disease, Bioinformatics and Genomics Programme, Centre for Genomic Regulation, Barcelona, Spain
| | - Anne Farmer
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital Bellvitge-IDIBELL and CIBEROBN, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Manfred M. Fichter
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
- Schön Klinik Roseneck Affiliated With the Medical Faculty of the University of Munich, Prien, Germany
| | - Manuel Föcker
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Lenka Foretova
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
| | - Andreas J. Forstner
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Centre for Human Genetics, University of Marburg, Marburg, Germany
| | - Oleksandr Frei
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Steven Gallinger
- QIMR Berghofer Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, University of Montpellier, Montpellier, France
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ina Giegling
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Johanna Giuranna
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fragiskos Gonidakis
- First Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Philip Gorwood
- INSERM 1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
- CMME (GHU Paris Psychiatrie et Neurosciences), Hôpital Sainte Anne, Paris, France
| | - Mònica Gratacòs
- Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Barcelona, Spain
| | - Sébastien Guillaume
- QIMR Berghofer Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, University of Montpellier, Montpellier, France
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yiran Guo
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hakon Hakonarson
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joanna Hauser
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospitaland, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Sietske G. Helder
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
- Zorg op Orde, Delft, the Netherlands
| | - Stefan Herms
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Anke Hinney
- Nic Waals Institute, Lovisenberg Diaconal Hospitaland, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christopher Hübel
- National Institute for Health Research Biomedical Research Centre, King’s College London and South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - James I. Hudson
- Biological Psychiatry Laboratory, McLean Hospital/Harvard Medical School, Boston, Massachusetts
| | - Hartmut Imgart
- Eating Disorders Unit, Parklandklinik, Bad Wildungen, Germany
| | - Stephanie Jamain
- Inserm U955, Institut Mondor de recherches Biomédicales, Laboratoire, Neuro-Psychiatrie Translationnelle, and Fédération Hospitalo-Universitaire de Précision Médecine en Addictologie et Psychiatrie, University Paris-Est-Créteil, Créteil, France
| | - Vladimir Janout
- Faculty of Health Sciences, Palacky University, Olomouc, Czech Republic
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital Bellvitge-IDIBELL and CIBEROBN, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ian R. Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
| | - Antonio Julià
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Gursharan Kalsi
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Deborah Kaminská
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Leila Karhunen
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
- Institute of Public Health and Clinical Nutrition, Department of Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Martien J.H. Kas
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, the Netherlands
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, the Netherlands
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - James L. Kennedy
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Anna Keski-Rahkonen
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Kirsty Kiezebrink
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Lars Klareskog
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
- Institute of Public Health and Clinical Nutrition, Department of Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, Lansing, Michigan
| | - Gun Peggy S. Knudsen
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria C. La Via
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie Le Hellard
- Department of Clinical Science, K.G. Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Laboratory Building, Haukeland University Hospital, Bergen, Norway
| | - Marion Leboyer
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
- Inserm U955, Institut Mondor de recherches Biomédicales, Laboratoire, Neuro-Psychiatrie Translationnelle, and Fédération Hospitalo-Universitaire de Précision Médecine en Addictologie et Psychiatrie, University Paris-Est-Créteil, Créteil, France
| | - Dong Li
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa Lilenfeld
- Department of Clinical Psychology, the Chicago School of Professional Psychology, Washington, DC
| | - Bochao Lin
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, the Netherlands
| | - Jolanta Lissowska
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, the Netherlands
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jurjen Luykx
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, the Netherlands
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Pierre Magistretti
- Department of Psychiatry, University of Lausanne-University Hospital of Lausanne, Lausanne, Switzerland
- BESE Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Mario Maj
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychiatry, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Sara Marsal
- InsideOut Institute for Eating Disorders, The Charles Perkins Centre, the University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, NSW Health, St. Leonards, New South Wales, Australia
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Christian R. Marshall
- Department of Paediatric Laboratory Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Morten Mattingsdal
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychiatry, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Ingrid Meulenbelt
- Department of Biomedical Data Science, Leiden University Medical Centre, Leiden, the Netherlands
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Pediatrics Gynaecology and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Karen S. Mitchell
- Women’s Health Sciences Division, National Center for PTSD, Boston, Massachusetts
- Department of Psychiatry, Boston University, Boston, Massachusetts
| | | | - Palmiero Monteleone
- Department of Psychiatry, University of Lausanne-University Hospital of Lausanne, Lausanne, Switzerland
- BESE Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Richard Myers
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama
| | - Marie Navratilova
- Department of Cancer, Epidemiology and Genetics, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Ionna Ntalla
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | | | - Roel A. Ophoff
- Center for Neurobehavioral Genetics, University of California at Los Angeles, Los Angeles, California
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
| | | | - Hana Papežová
- Eating Disorders Unit, Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dalila Pinto
- Division of Psychiatric Genomics, Department of Psychiatry, and Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York
| | - Anu Raevuori
- Department of Adolescent Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Adolescent Psychiatry, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnologies, University of Pisa, Pisa, Italy
| | - Nicolas Ramoz
- INSERM 1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Ted Reichborn-Kjennerud
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Valdo Ricca
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- Department of Health Science, University of Florence, Florence, Italy
| | - Samuli Ripatti
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin, Berlin, Germany
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Biometry, University of Helsinki, Helsinki, Finland
| | - Stephan Ripke
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin, Berlin, Germany
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Biometry, University of Helsinki, Helsinki, Finland
| | - Franziska Ritschel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorders Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Marion Roberts
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
| | - Alessandro Rotondo
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Adolescent Psychiatry, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnologies, University of Pisa, Pisa, Italy
| | - Dan Rujescu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Filip Rybakowski
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorders Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Stephen W. Scherer
- McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Genetics and Genome Biology and the Center for Applied Genomics, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, King’s College London and South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Laura J. Scott
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Yasmina Silén
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Lenka Šlachtová
- Department of Biochemistry and Molecular Biology, Institute of Organic Chemistry and Biochemistry, Prague, Czech Republic
| | - P. Eline Slagboom
- Department of Biomedical Data Science, Leiden University Medical Centre, Leiden, the Netherlands
| | - Margarita C.T. Slof-Op ‘t Landt
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
- Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
| | - Agnieszka Slopien
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCSS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Beata Świątkowska
- Department of Environmental Epidemiology, the Reference Center for Asbestos Exposure and Health Risk Assessment, Lódź, Poland
| | - Alfonso Tortorella
- Adolescent Health Unit, Second Department of Pediatrics, Athens, Greece
- Department of Psychiatry, University of Perugia, Perugia, Italy
| | - Federica Tozzi
- Brain Sciences Department, Stremble Ventures, Limassol, Cyprus
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, King’s College London and South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Artemis Tsitsika
- Adolescent Health Unit, Second Department of Pediatrics, Athens, Greece
- Department of Psychiatry, University of Perugia, Perugia, Italy
| | - Marta Tyszkiewicz-Nwafor
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Konstantinos Tziouvas
- Pediatric Intensive Care Unit, “P. & A. Kyriakou” Children's Hospital, University of Athens, Athens, Greece
| | - Annemarie A. van Elburg
- Department of Clinical Psychology, Faculty of Social Sciences, University Utrecht, Utrecht, the Netherlands
- Altrecht Eating Disorders Rintveld, Zeist, the Netherlands
| | - Eric F. van Furth
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
- Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
| | - Esther Walton
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, Helsinki, Finland
| | - Elisabeth Widen
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, Helsinki, Finland
| | - Stephanie Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, Tuebingen, Germany
- Centre of Excellence for Eating Disorders, University Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, Tuebingen, Germany
- Centre of Excellence for Eating Disorders, University Tuebingen, Tuebingen, Germany
| | - Andrew W. Bergen
- Oregon Research Institute, Eugene, Oregon
- Biorealm Research, Walnut, California
| | - Joseph M. Boden
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Harry Brandt
- The Center for Eating Disorders at Sheppard Pratt, Baltimore, Maryland
| | - Steven Crawford
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
- The Center for Eating Disorders at Sheppard Pratt, Baltimore, Maryland
- Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Katherine A. Halmi
- New York Presbyterian Hospital-Westchester Division, Weill Cornell Medical College of Cornell University, White Plains, New York
| | - L. John Horwood
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Allan S. Kaplan
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Walter H. Kaye
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota
| | - Catherine M. Olsen
- Cancer Control Group, University of Queensland, Brisbane, Queensland, Australia
| | - John F. Pearson
- Biostatistics and Computational Biology Unit, University of Otago, Christchurch, New Zealand
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Michael Strober
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Thomas Werge
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - David C. Whiteman
- QIMR Berghofer Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - D. Blake Woodside
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Program for Eating Disorders, University Health Network, Toronto, Ontario, Canada
| | - Scott Gordon
- QIMR Berghofer Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, University of Montpellier, Montpellier, France
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Charles Perkins Centre, the University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, NSW Health, St. Leonards, New South Wales, Australia
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Janne T. Larsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus, Denmark
- Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Richard Parker
- QIMR Berghofer Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Liselotte V. Petersen
- National Centre for Register-based Research, Aarhus BSS, Aarhus, Denmark
- Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Clinical Research Unit, Canterbury District Health Board, Christchurch, New Zealand
| | - Martin Kennedy
- Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Tracey D. Wade
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
- Inserm U955, Institut Mondor de recherches Biomédicales, Laboratoire, Neuro-Psychiatrie Translationnelle, and Fédération Hospitalo-Universitaire de Précision Médecine en Addictologie et Psychiatrie, University Paris-Est-Créteil, Créteil, France
| | - Nicholas G. Martin
- QIMR Berghofer Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Preben Bo Mortensen
- National Centre for Register-based Research, Aarhus BSS, Aarhus, Denmark
- Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, King’s College London and South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
|
25
|
Huckins LM, Signer R, Johnson J, Wu YK, Mitchell KS, Bulik CM. What next for eating disorder genetics? Replacing myths with facts to sharpen our understanding. Mol Psychiatry 2022; 27:3929-3938. [PMID: 35595976 PMCID: PMC9718676 DOI: 10.1038/s41380-022-01601-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023]
Abstract
Substantial progress has been made in the understanding of anorexia nervosa (AN) and eating disorder (ED) genetics through the efforts of large-scale collaborative consortia, yielding the first genome-wide significant loci, AN-associated genes, and insights into metabo-psychiatric underpinnings of the disorders. However, the translatability, generalizability, and reach of these insights are hampered by an overly narrow focus in our research. In particular, stereotypes, myths, assumptions and misconceptions have resulted in incomplete or incorrect understandings of ED presentations and trajectories, and exclusion of certain patient groups from our studies. In this review, we aim to counteract these historical imbalances. Taking as our starting point the Academy for Eating Disorders (AED) Truth #5 "Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses", we discuss what we do and do not know about the genetic underpinnings of EDs among people in each of these groups, and suggest strategies to design more inclusive studies. In the second half of our review, we outline broad strategic goals whereby ED researchers can expand the diversity, insights, and clinical translatability of their studies.
Collapse
Affiliation(s)
- Laura M Huckins
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Mental Illness Research, Education and Clinical Centers, James J. Peters Department of Veterans Affairs Medical Center, Bronx, NY, 14068, USA
| | - Rebecca Signer
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jessica Johnson
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ya-Ke Wu
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen S Mitchell
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
|
26
|
Gerges S, Hallit S, Malaeb D, Obeid S. Maladaptive Cognitive Schemas as Predictors of Disordered Eating: Examining the Indirect Pathway through Emotion Regulation Difficulties. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11620. [PMID: 36141891 PMCID: PMC9517382 DOI: 10.3390/ijerph191811620] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 06/16/2023]
Abstract
A scarcity of research has looked into the association of maladaptive core beliefs with dysfunctional eating patterns. Moreover, no prior study has considered the potential role of difficulties in negative emotion regulation when disentangling the complex correlations between early maladaptive schemas and disturbed eating habits. Our study aimed at exploring the distinct relationships between early maladaptive schemas and disordered eating, while investigating the indirect role of emotion regulation difficulties within these associations. We collected data from 982 Lebanese young adults (18-30 years old), distributed across the five Lebanese governorates, who completed the Eating Attitudes Test (EAT-26), the Young Schema Questionnaire-Short Form 3 (YSQ-SF3), and the Difficulties in Emotion Regulation Scale-16 Item Version (DERS-16). The results showed that the disconnection and rejection schema domain, under which the early maladaptive schema of mistrust was the most predictive of disordered/inappropriate eating attitudes. All the remaining maladaptive schema domains (i.e., the impaired autonomy/performance, impaired limits, other-directedness, and overvigilance/inhibition schema domains) exerted significant indirect effects on disordered eating attitudes through difficulties in emotion regulation. Our findings gave prominence to a potential intrinsic mechanism through which maladaptive cognitive schemas are linked to disordered eating behaviors, emphasizing the role of emotion dysregulation as a cardinal actor within this model. They sustain the surmise that cognitively and emotionally vulnerable individuals exhibit stronger propensities for inappropriate dietary patterns, as a means to offset their inner weakness. This study broadens the medical community's insights into the underpinning processes behind eating disorder psychopathology and could therefore make a step towards the adoption of innovative therapeutic approaches that promote emotion regulation skills in the context of schema therapy.
Collapse
Affiliation(s)
- Sarah Gerges
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh P.O. Box 446, Lebanon
- Psychology Department, College of Humanities, Effat University, Jeddah 21478, Saudi Arabia
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib P.O. Box 60096, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman 20550, United Arab Emirates
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil 1401, Lebanon
| |
Collapse
|
|
27
|
Frostad S. Are the Effects of Malnutrition on the Gut Microbiota–Brain Axis the Core Pathologies of Anorexia Nervosa? Microorganisms 2022; 10:microorganisms10081486. [PMID: 35893544 PMCID: PMC9329996 DOI: 10.3390/microorganisms10081486] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Anorexia nervosa (AN) is a disabling, costly, and potentially deadly illness. Treatment failure and relapse after treatment are common. Several studies have indicated the involvement of the gut microbiota–brain (GMB) axis. This narrative review hypothesizes that AN is driven by malnutrition-induced alterations in the GMB axis in susceptible individuals. According to this hypothesis, initial weight loss can voluntarily occur through dieting or be caused by somatic or psychiatric diseases. Malnutrition-induced alterations in gut microbiota may increase the sensitivity to anxiety-inducing gastrointestinal hormones released during meals, one of which is cholecystokinin (CCK). The experimental injection of a high dose of its CCK-4 fragment in healthy individuals induces panic attacks, probably via the stimulation of CCK receptors in the brain. Such meal-related anxiety attacks may take part in developing the clinical picture of AN. Malnutrition may also cause increased effects from appetite-reducing hormones that also seem to have roles in AN development and maintenance. The scientific background, including clinical, microbiological, and biochemical factors, of AN is discussed. A novel model for AN development and maintenance in accordance with this hypothesis is presented. Suggestions for future research are also provided.
Collapse
Affiliation(s)
- Stein Frostad
- Division of Psychiatry, Haukeland University Hospital, 5021 Bergen, Norway
| |
Collapse
|
|
28
|
Herrmann K, Kaluscha R, Liebert A, Spohrs J, Gündel H, von Wietersheim J. First onset of treatment of patients with eating disorders and treatment course: Results of data from a German health insurance company. EUROPEAN EATING DISORDERS REVIEW 2022; 30:787-796. [PMID: 35590442 DOI: 10.1002/erv.2922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/11/2022] [Accepted: 05/10/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examines, inpatient treatment costs, and typical treatment courses of patients with an eating disorder using secondary data. METHOD The data were provided by a German health insurance company (data from 4.2 million members from 2004 to 2010; corresponds to a market share of 6% of all statutorily insured persons in Germany). An age and gender matched control group without an eating disorder diagnosis was assessed for comparisons from the same dataset. RESULTS Two thousand seven hundred and thirty four cases with an eating disorder diagnosis (anorexia nervosa [AN], bulimia nervosa [BN] or combination [ANBN]) were identified. The inpatient costs of treatment were €5471.15 for BN, €9080.26 for AN, €10,809.16 for ANBN and €339.37 for the control group. Interestingly, there are numerous mild episodes of eating disorders that could be successfully treated solely on an outpatient basis with a short treatment duration. CONCLUSION Our findings suggest that course and severity of eating disorders can vary from mild to very severe. Data from health insurance companies depict rather different disease and treatment courses than studies on primary data derived from treatment institutions.
Collapse
Affiliation(s)
- Kristin Herrmann
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Rainer Kaluscha
- Institute for Research in Rehabilitation at Ulm University, Ulm, Germany
| | - Alex Liebert
- Institute for Research in Rehabilitation at Ulm University, Ulm, Germany
| | - Jennifer Spohrs
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| |
Collapse
|
|
29
|
Tang WSW, Ng TJY, Wong JZA, Ho CSH. The Role of Serious Video Games in the Treatment of Disordered Eating: A Systematic Review (Preprint). J Med Internet Res 2022; 24:e39527. [PMID: 36036967 PMCID: PMC9468918 DOI: 10.2196/39527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wymann S W Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tricia J Y Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joseph Z A Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
|
30
|
Frostad S, Bentz M. Anorexia nervosa: Outpatient treatment and medical management. World J Psychiatry 2022; 12:558-579. [PMID: 35582333 PMCID: PMC9048449 DOI: 10.5498/wjp.v12.i4.558] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/20/2021] [Accepted: 02/22/2022] [Indexed: 02/06/2023] Open
Abstract
Anorexia nervosa (AN) is a disabling, costly and potentially deadly illness. Treatment failure and relapse are common after completing treatment, and a substantial proportion of patients develop severe and enduring AN. The time from AN debut to the treatment initiation is normally unreasonably long. Over the past 20 years there has been empirical support for the efficacy of several treatments for AN. Moreover, outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients. Early intervention improves outcomes and should be a priority for all patients. Outpatient treatment is usually the best format for early intervention, and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable. Inpatient care is more disruptive, more costly, and usually has a longer waiting list than does outpatient care. The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult. The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN. The scientific essentials for outpatient treatment are described, including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated. The following aspects are discussed: early intervention, outpatient treatment of AN, including outpatient psychotherapy for severe and extreme AN, how to determine when outpatient treatment is safe, and when transfer to inpatient healthcare is indicated. Emerging treatments, ethical issues and outstanding research questions are also addressed.
Collapse
Affiliation(s)
- Stein Frostad
- Department of Mental Health Research, Division of Psychiatry, Haukeland University Hospital, Bergen 5021, Norway
| | - Mette Bentz
- Child and Adolescent Mental Health Centre, Capital Region of Denmark, University of Copenhagen, Copenhagen 2400, Denmark
| |
Collapse
|
|
31
|
Obeid N, Flament MF, Buchholz A, Henderson KA, Schubert N, Tasca G, Thai H, Goldfield G. Examining Shared Pathways for Eating Disorders and Obesity in a Community Sample of Adolescents: The REAL Study. Front Psychol 2022; 13:805596. [PMID: 35432146 PMCID: PMC9008728 DOI: 10.3389/fpsyg.2022.805596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/16/2022] [Indexed: 11/21/2022] Open
Abstract
Several psychosocial models have been proposed to explain the etiology of eating disorders (EDs) and obesity separately despite research suggesting they should be conceptualized within a shared theoretical framework. The objective of the current study was to test an integrated comprehensive model consisting of a host of common risk and protective factors (socio-environmental, psychological, and behavioral) expected to explain both eating and weight disorders simultaneously in a large school-based sample of adolescents. Data were collected from 3,043 youth (60% female, 14.00 ± 1.61) from 41 schools in the Ottawa region, Canada. Working with interested school staff, validated self-report scales in the form of a questionnaire booklet were administered to participating students to assess several understood risk and protective factors common to both eating disorders and obesity. Anthropometric measurements of weight and height were taken at the end of the questionnaire administration period by trained research staff. Structural equation modeling with cross-validation was used to test the hypothesized model. Findings demonstrated that dysregulated eating was associated with both eating disorder and weight status with diet culture and emotion dysregulation directly associated with some of these disordered eating patterns. It equally pointed to how lifestyle made up of high sedentary behaviors, low vigorous exercise and varied eating patterns contributed to both emotion dysregulation and poor body image which subsequently affected eating issues and weight status simultaneously, signaling the complex interplay of psychosocial factors that underlie these concerns. This study provides evidence for an integrated psychosocial model consisting of socio-environmental, psychological, and behavioral factors may best explain the complex interplay of risk and protective factors influencing eating disorders and obesity. It equally highlights understanding the direct and indirect effects of some of the most salient risk factors involved in eating and weight-related concerns, including the strong effects of diet culture and stressors such as weight-based teasing, providing interventionalists evidence of important risk factors to consider targeting in eating disorder and weight-based prevention efforts.
Collapse
Affiliation(s)
- Nicole Obeid
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- *Correspondence: Nicole Obeid,
| | | | - Annick Buchholz
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Centre for Healthy Active Living, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Katherine A. Henderson
- Department of Psychology, Carleton University, Ottawa, ON, Canada
- Anchor Psychological Services, Ottawa, ON, Canada
| | - Nick Schubert
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Giorgio Tasca
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Helen Thai
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Gary Goldfield
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Psychology, Carleton University, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
|
32
|
Austin A, Flynn M, Shearer J, Long M, Allen K, Mountford VA, Glennon D, Grant N, Brown A, Franklin‐Smith M, Schelhase M, Jones WR, Brady G, Nunes N, Connan F, Mahony K, Serpell L, Schmidt U. The First Episode Rapid Early Intervention for Eating Disorders - Upscaled study: Clinical outcomes. Early Interv Psychiatry 2022; 16:97-105. [PMID: 33781000 PMCID: PMC9291113 DOI: 10.1111/eip.13139] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND First Episode Rapid Early Intervention for Eating Disorders (FREED) is a service model and care pathway for emerging adults aged 16 to 25-years with a recent onset eating disorder (ED) of <3 years. A previous single-site study suggests that FREED significantly improves clinical outcomes compared to treatment-as-usual (TAU). The present study (FREED-Up) assessed the scalability of FREED. A multi-centre quasi-experimental pre-post design was used, comparing patient outcomes before and after implementation of FREED in participating services. METHODS FREED patients (n = 278) were consecutive, prospectively ascertained referrals to four specialist ED services in England, assessed at four time points over 12 months on ED symptoms, mood, service utilization and cost. FREED patients were compared to a TAU cohort (n = 224) of similar patients, identified retrospectively from electronic patient records in participating services. All were emerging adults aged 16-25 experiencing a first episode ED of <3 years duration. RESULTS Overall, FREED patients made significant and rapid clinical improvements over time. 53.2% of FREED patients with anorexia nervosa reached a healthy weight at the 12-month timepoint, compared to only 17.9% of TAU patients (X2 [1, N = 107] = 10.46, p < .001). Significantly fewer FREED patients required intensive (i.e., in-patient or day-patient) treatment (6.6%) compared to TAU patients (12.4%) across the follow-up period (X2 [1, N = 40] = 4.36, p = .037). This contributed to a trend in cost savings in FREED compared to TAU (-£4472, p = .06, CI -£9168, £233). DISCUSSION FREED is robust and scalable and is associated with substantial improvements in clinical outcomes, reduction in inpatient or day-patient admissions, and cost-savings.
Collapse
Affiliation(s)
- Amelia Austin
- Eating Disorders Section, Department of Psychological MedicineKing's College LondonLondonUK
| | - Michaela Flynn
- Eating Disorders Section, Department of Psychological MedicineKing's College LondonLondonUK
| | - James Shearer
- Department of Health Services and Population ResearchKing's College LondonLondonUK
| | - Mike Long
- Kent Surrey Sussex Academic Health Science NetworkCrawleyUK
| | - Karina Allen
- Eating Disorders Section, Department of Psychological MedicineKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Victoria A. Mountford
- Eating Disorders Section, Department of Psychological MedicineKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
- Maudsley HealthAbu DhabiUAE
| | | | - Nina Grant
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Amy Brown
- Sussex Partnership NHS Foundation TrustBrightonUK
| | | | | | | | | | - Nicole Nunes
- Central and North West London NHS Foundation TrustLondonUK
| | - Frances Connan
- Central and North West London NHS Foundation TrustLondonUK
| | - Kate Mahony
- North East London NHS Foundation TrustLondonUK
| | - Lucy Serpell
- North East London NHS Foundation TrustLondonUK
- Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Ulrike Schmidt
- Eating Disorders Section, Department of Psychological MedicineKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| |
Collapse
|
|
33
|
Abstract
PURPOSE OF REVIEW To review the recent literature on the epidemiology of anorexia nervosa and bulimia nervosa in terms of incidence, prevalence and mortality. RECENT FINDINGS Although the overall incidence rate of anorexia nervosa is considerably stable over the past decades, the incidence among younger persons (aged <15 years) has increased. It is unclear whether this reflects earlier detection or earlier age of onset. Nevertheless, it has implications for future research into risk factors and for prevention programs. For bulimia nervosa, there has been a decline in overall incidence rate over time. The lifetime prevalence rates of anorexia nervosa might be up to 4% among females and 0.3% among males. Regarding bulimia nervosa, up to 3% of females and more than 1% of males suffer from this disorder during their lifetime. While epidemiological studies in the past mainly focused on young females from Western countries, anorexia nervosa and bulimia nervosa are reported worldwide among males and females from all ages. Both eating disorders may carry a five or more times increased mortality risk. SUMMARY Anorexia nervosa and bulimia nervosa occur worldwide among females and males of all age groups and are associated with an increased mortality risk.
Collapse
Affiliation(s)
- Annelies E. van Eeden
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | | | - Hans W. Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, New York, USA
| |
Collapse
|
|
34
|
Borsdorf B, Dahmen B, Buehren K, Dempfle A, Egberts K, Ehrlich S, Fleischhaker C, Konrad K, Schwarte R, Timmesfeld N, Wewetzer C, Biemann R, Scharke W, Herpertz-Dahlmann B, Seitz J. BDNF levels in adolescent patients with anorexia nervosa increase continuously to supranormal levels 2.5 years after first hospitalization. J Psychiatry Neurosci 2021; 46:E568-E578. [PMID: 34654737 PMCID: PMC8526129 DOI: 10.1503/jpn.210049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/14/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) influences brain plasticity and feeding behaviour, and it has been linked to anorexia nervosa in numerous studies. Findings in mostly adult patients point to reduced serum BDNF levels in the acute stage of anorexia nervosa and rising levels with weight recovery. However, it is unclear whether this increase leads to normalization or supranormal levels, a difference that is potentially important for the etiology of anorexia nervosa and relapse. METHODS We measured serum BDNF at admission (n = 149), discharge (n = 130), 1-year follow-up (n = 116) and 2.5-year follow-up (n = 76) in adolescent female patients with anorexia nervosa hospitalized for the first time, and in healthy controls (n = 79). We analyzed associations with body mass index, eating disorder psychopathology and comorbidities. RESULTS Serum BDNF was only nominally lower at admission in patients with anorexia nervosa compared to healthy controls, but it increased continuously and reached supranormal levels at 2.5-year follow-up. BDNF was inversely associated with eating disorder psychopathology at discharge and positively associated with previous weight gain at 1-year follow-up. LIMITATIONS We compensated for attrition and batch effects using statistical measures. CONCLUSION In this largest longitudinal study to date, we found only nonsignificant reductions in BDNF in the acute stage of anorexia nervosa, possibly because of a shorter illness duration in adolescent patients. Supranormal levels of BDNF at 2.5-year follow-up could represent a pre-existing trait or a consequence of the illness. Because of the anorexigenic effect of BDNF, it might play an important predisposing role for relapse and should be explored further in studies that test causality.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jochen Seitz
- From the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen, Germany (Borsdorf, Dahmen, Buehren, Scharke, Herpertz-Dahlmann, Seitz); the kbo-Heckscher Klinikum, Academic Teaching Hospital, Ludwig Maximilian University, Munich, Germany (Buehren); the Institute of Medical Informatics and Statistics, Kiel University, Germany (Dempfle); the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Wuerzburg, Germany (Egberts); the Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Germany (Ehrlich); the Eating Disorders Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany (Ehrlich); the Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany (Fleischhaker); the Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH University Aachen (Konrad); the JARA-Institute Molecular Neuroscience and Neuroimaging (INM-11), Juelich Research Centre, Germany (Konrad); the Oberberg Fachklinik Konraderhof, Cologne-Huerth, Germany (Schwarte); the Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Germany (Timmesfeld); the Department of Medical Informatics, Biometrics and Epidemiology, Ruhr University Bochum, Germany (Timmesfeld); the Department of Child and Adolescent Psychiatry and Psychotherapy, Cologne City Hospitals, Germany (Wewetzer); the Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Germany (Biemann); the Cognitive and Experimental Psychology, Institute of Psychology, RWTH Aachen University, Germany (Scharke)
| |
Collapse
|
|
35
|
Herpertz-Dahlmann B. Intensive Treatments in Adolescent Anorexia Nervosa. Nutrients 2021; 13:1265. [PMID: 33924294 PMCID: PMC8068891 DOI: 10.3390/nu13041265] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 12/26/2022] Open
Abstract
Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.
Collapse
Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany
| |
Collapse
|
|
36
|
Glashouwer KA, de Jong PJ. The revolting body: Self-disgust as a key factor in anorexia nervosa. Curr Opin Psychol 2021; 41:78-83. [PMID: 33979751 DOI: 10.1016/j.copsyc.2021.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/19/2022]
Abstract
In this article, we present a theoretical model that points to disgust-induced avoidance as a mechanism that can help explain the persistent and excessive food restriction in individuals with anorexia nervosa (AN). Disgust is characterized by intense negative feelings of revulsion and an overwhelming and irresistible urge to avoid potential disgust elicitors. When eating, or even the prospect of eating, elicits overwhelming feelings of disgust in individuals with AN, this could explain why food restriction persists even when someone is in a state of starvation. Following this model, disgust is elicited by the expected impact of food on the own body ("becoming fat") resulting in body-related self-disgust. We argue that limiting food intake may serve to avoid self-disgust. This implies that when self-disgust remains unchanged after treatment of AN, residual levels of self-disgust after treatment could make individuals vulnerable to relapse.
Collapse
Affiliation(s)
- Klaske A Glashouwer
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands; Department of Eating Disorders, Accare Child and Adolescent Psychiatry, Postbus 660, 9700 AR, Groningen, the Netherlands.
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
| |
Collapse
|
|
37
|
Herpertz-Dahlmann B, Bonin E, Dahmen B. Can you find the right support for children, adolescents and young adults with anorexia nervosa: Access to age-appropriate care systems in various healthcare systems. EUROPEAN EATING DISORDERS REVIEW 2021; 29:316-328. [PMID: 33626222 DOI: 10.1002/erv.2825] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) often has its onset in childhood or adolescence. However, there is insufficient knowledge regarding access to and utilisation of age-specific clinical diagnostics and treatment. METHODS A literature review covering the last 10 years was conducted to provide a narrative review of the current state of research on the detection and treatment of young patients with AN in primary and secondary care. RESULTS Most articles were of Western European or US origin. Timely diagnosis of the eating disorder (ED) and treatment options more often depend on the structure and quality of the national health care system than on scientific evidence. Regular paediatric health check-ups and age-appropriate eating disorder services appear to facilitate early diagnosis. Age-specific treatment that also involves the carers is often associated with a higher continuity of care and a better outcome. Although many adolescents require an extension of treatment into young adulthood, individual and health care system-related obstacles in many countries prevent a smooth transition. CONCLUSION To improve outcomes in childhood and adolescent AN, age-specific and timely diagnostic and therapeutic procedures are urgently needed.
Collapse
Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Eva Bonin
- Care Policy and Evaluation Centre, London School of Economics, London, UK
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| |
Collapse
|
|
38
|
Solanki RK, Khanna SK, Solanki G, Yadav KS, Agarwal R, Goyal MK. An adolescent with anorexia nervosa presenting with catatonia. Indian J Psychiatry 2021; 63:116-117. [PMID: 34083840 PMCID: PMC8106439 DOI: 10.4103/psychiatry.indianjpsychiatry_73_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/20/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ram Kumar Solanki
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India. E-mail:
| | - Shashi Kant Khanna
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India. E-mail:
| | - Gunjan Solanki
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India. E-mail:
| | - Kuldeep Singh Yadav
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India. E-mail:
| | - Rishika Agarwal
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India. E-mail:
| | - Manish Kumar Goyal
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India. E-mail:
| |
Collapse
|
|
39
|
Yao S, Larsson H, Norring C, Birgegård A, Lichtenstein P, DʼOnofrio BM, Almqvist C, Thornton LM, Bulik CM, Kuja-Halkola R. Genetic and environmental contributions to diagnostic fluctuation in anorexia nervosa and bulimia nervosa. Psychol Med 2021; 51:62-69. [PMID: 31658910 PMCID: PMC7856409 DOI: 10.1017/s0033291719002976] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/12/2019] [Accepted: 09/26/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Anorexia nervosa and bulimia nervosa are two severe eating disorders associated with high premature mortality, suicidal risk and serious medical complications. Transition between anorexia nervosa and bulimia nervosa over the illness course and familial co-aggregation of the two eating disorders imply aetiological overlap. However, genetic and environmental liabilities to the overlap are poorly understood. Quantitative genetic research using clinical diagnosis is needed. METHODS We acquired a clinical diagnosis of anorexia nervosa (prevalence = 0.90%) and bulimia nervosa (prevalence = 0.48%) in a large population-based sample (N = 782 938) of randomly selected full-sisters and maternal half-sisters born in Sweden between 1970 and 2005. Structural equation modelling was applied to quantify heritability of clinically diagnosed anorexia nervosa and bulimia nervosa and the contributions of genetic and environmental effects on their overlap. RESULTS The heritability of clinically diagnosed anorexia nervosa and bulimia nervosa was estimated at 43% [95% confidence interval (CI) (36-50%)] and 41% (31-52%), respectively, in the study population, with the remaining variance explained by variance in unique environmental effects. We found statistically significant genetic [0.66, 95% CI (0.49-0.82)] and unique environmental correlations [0.55 (0.43-0.66)] between the two clinically diagnosed eating disorders; and their overlap was about equally explained by genetic and unique environmental effects [co-heritability 47% (35-58%)]. CONCLUSIONS Our study supports shared mechanisms for anorexia nervosa and bulimia nervosa and extends the literature from self-reported behavioural measures to clinical diagnosis. The findings encourage future molecular genetic research on both eating disorders and emphasize clinical vigilance for symptom fluctuation between them.
Collapse
Affiliation(s)
- Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Claes Norring
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M. DʼOnofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
|
40
|
Seitz J, Dahmen B, Keller L, Herpertz-Dahlmann B. Gut Feelings: How Microbiota Might Impact the Development and Course of Anorexia Nervosa. Nutrients 2020; 12:E3295. [PMID: 33126427 PMCID: PMC7693512 DOI: 10.3390/nu12113295] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
Anorexia nervosa (AN) can probably be regarded as a "model" for studying the interaction of nutrition with the gut-brain axis, which has drawn increased attention from researchers and clinicians alike. The gut microbiota influences somatic effects, such as energy extraction from food and body weight gain, as well as appetite, gut permeability, inflammation and complex psychological behaviors, such as depression or anxiety, all of which play important roles in AN. As nutrition is one of the main factors that influence the gut microbiota, nutritional restriction and selective eating in AN are likely influencing factors; however, nutritional rehabilitation therapy is surprisingly understudied. Here, we review the general mechanisms of the interactions between nutrition, the gut microbiota and the host that may be relevant to AN, paying special attention to the gut-brain axis, and we present the first specific findings in patients with AN and corresponding animal models. In particular, nutritional interventions, including food selection, supplements, and pre-, pro- and synbiotics that have the potential to influence the gut microbiota, are important research targets to potentially support future AN therapy.
Collapse
Affiliation(s)
- Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, RWTH University Hospital, Neuenhofer Weg 21, 52074 Aachen, Germany; (B.D.); (L.K.); (B.H.-D.)
| | | | | | | |
Collapse
|
|
41
|
Skowron K, Kurnik-Łucka M, Dadański E, Bętkowska-Korpała B, Gil K. Backstage of Eating Disorder-About the Biological Mechanisms behind the Symptoms of Anorexia Nervosa. Nutrients 2020; 12:E2604. [PMID: 32867089 PMCID: PMC7551451 DOI: 10.3390/nu12092604] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
Anorexia nervosa (AN) represents a disorder with the highest mortality rate among all psychiatric diseases, yet our understanding of its pathophysiological components continues to be fragmentary. This article reviews the current concepts regarding AN pathomechanisms that focus on the main biological aspects involving central and peripheral neurohormonal pathways, endocrine function, as well as the microbiome-gut-brain axis. It emerged from the unique complexity of constantly accumulating new discoveries, which hamper the ability to look at the disease in a more comprehensive way. The emphasis is placed on the mechanisms underlying the main symptoms and potential new directions that require further investigation in clinical settings.
Collapse
Affiliation(s)
- Kamil Skowron
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
| | - Magdalena Kurnik-Łucka
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
| | - Emil Dadański
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
| | - Barbara Bętkowska-Korpała
- Department of Psychiatry, Jagiellonian University Medical College, Institute of Medical Psychology, Jakubowskiego St 2, 30-688 Krakow, Poland;
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
| |
Collapse
|
|
42
|
Horváth Z, Román N, Elekes Z, Griffiths MD, Demetrovics Z, Urbán R. Alcohol consumption and risk for feeding and eating disorders in adolescence: The mediating role of drinking motives. Addict Behav 2020; 107:106431. [PMID: 32289746 DOI: 10.1016/j.addbeh.2020.106431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/09/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND A complex and bidirectional association has been assumed between feeding and eating disorders (FEDs) and alcohol consumption. Previous research has demonstrated that alcohol use among individuals with different forms of FEDs is more frequently motivated by two subtypes of internal drinking motives: coping and enhancement motives. Namely, these individuals might use alcohol primarily to regulate internal states, such as to mitigate negative emotions or enhance positive emotions. OBJECTIVES The present study investigated the mediating role of internal drinking motives on the association between risk for FEDs and alcohol consumption over the effects of relevant covariates, such as depressive symptoms or body mass index (BMI). METHODS Hungarian data of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 2015 were used. The final sample included responses from 5457 adolescents (50% males; mean age: 16.62 years). Validated self-report psychometric instruments assessed the level of alcohol use, depressive symptoms and risk for FEDs, and drinking motives. RESULTS Risk for FEDs presented a significant positive relationship with internal drinking motives and alcohol use. In the mediation analysis, a significant indirect effect was identified between risk for FEDs and alcohol use via internal drinking motives among females. CONCLUSIONS Results demonstrated that risk for FEDs was positively associated with internal drinking motives and alcohol use. An indirect effect of risk for FEDs on alcohol consumption via internal drinking motives was discriminated over the impact of depressive symptoms. However, the latter relationship was only found among females which may highlight the gender differences in the relationship between risk for FEDs and alcohol use.
Collapse
|
|
43
|
Incidence of Anorexia Nervosa in Women: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113824. [PMID: 32481615 PMCID: PMC7312606 DOI: 10.3390/ijerph17113824] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
Background: Anorexia nervosa (AN) among the general population is a rare but often fatal illness. Objective: To summarize the incidence of AN using a systematic review and meta-analysis. Methods: Four online databases (PubMed, Scopus, WoS and Embase) were consulted. The review was conducted according to with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was limited to women. The methodological quality of the studies was assessed by the Newcastle–Ottawa Scale (NOS). Results: A total of 31 articles were included in the study. The incidence rate of AN ranged from 0.5 to 318.0 cases per 100,000 women–years. The incidence in studies based on outpatient healthcare services (OHS) was higher than those based on hospital admissions (HA) (8.8 95% CI: 7.83–9.80 vs. 5.0 95% CI: 4.87–5.05). In young women, the incidence in OHS was higher than HA (63.7, 95% CI 61.21–66.12 vs. 8.1 95% CI 7.60–8.53). The linear trend in the incidence of AN was increasing in all ages of women and young women, both in studies with hospital admission records, and in those based on outpatient healthcare services. Conclusion: The incidence of AN depends on the methodology, the type of population and the diagnostic criteria used.
Collapse
|
|
44
|
McClelland J, Robinson L, Potterton R, Mountford V, Schmidt U. Symptom trajectories into eating disorders: A systematic review of longitudinal, nonclinical studies in children/adolescents. Eur Psychiatry 2020; 63:e60. [PMID: 32450945 PMCID: PMC7355161 DOI: 10.1192/j.eurpsy.2020.55] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background. Eating disorders (EDs) are serious mental illnesses that can be life-threatening. Stage of illness models and early intervention strategies could be informed by a better understanding of symptomatology that precedes the onset of an ED. This review aims to explore which symptoms (both ED and other psychiatric disorder-related) exist prior to the onset of an ED and whether there any prospective associations between these symptomatologies. Methods. A systematic literature review was conducted in MEDLINE, Embase, and PsycINFO for large, longitudinal, prospective studies in nonclinical cohorts of children/adolescents that report symptoms prior to the onset of an ED. A quality assessment of included studies was conducted using the Newcastle-Ottawa Quality Assessment Scale. Results. A total of 22 studies were included, and over half were assessed to be of good quality. Studies identified the presence of a broad range of ED and other psychiatric disorder-related symptoms prior to ED onset. Possible prospective associations were identified, including early eating and feeding difficulties in childhood, to ED-related symptoms (e.g., dieting and body dissatisfaction) and other psychiatric disorder-related symptoms (e.g., anxiety and depression) in childhood/early adolescence, progressing to severe symptomatology (e.g., extreme weight control behaviors and self-harm) in mid-adolescence/emerging adulthood. Conclusion. The trajectory of symptoms identified to precede and possibly predict onset of an ED may inform early intervention strategies within the community. Suggestions for further research are provided to establish these findings and the clinical implications of these discussed, in order to inform how best to target prodromal stages of EDs.
Collapse
Affiliation(s)
- Jessica McClelland
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lauren Robinson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rachel Potterton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Victoria Mountford
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Maudsley Health, Abu Dhabi, United Arab Emirates
| | - Ulrike Schmidt
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
|
45
|
Silén Y, Sipilä PN, Raevuori A, Mustelin L, Marttunen M, Kaprio J, Keski-Rahkonen A. DSM-5 eating disorders among adolescents and young adults in Finland: A public health concern. Int J Eat Disord 2020; 53:520-531. [PMID: 31999001 DOI: 10.1002/eat.23236] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to assess the lifetime prevalence, 10-year incidence, and peak periods of onset for eating disorders as defined by the Fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-5) among adolescents and young adults born in the 1980s in Finland. METHOD Virtually all Finnish twins born in 1983-1987 (n = 5,600) were followed prospectively from the age of 12 years. A subsample of participants (n = 1,347) was interviewed using a semi-structured diagnostic interview in their early twenties. RESULTS The prevalence of lifetime DSM-5 eating disorders was 17.9% for females and 2.4% for males (pooled across genders, 10.5%). The estimated lifetime prevalences for females and males, respectively, were 6.2 and 0.3% for anorexia nervosa (AN), 2.4 and 0.16% for bulimia nervosa (BN), 0.6 and 0.3% for binge-eating disorder (BED), 4.5 and 0.16% for other specified feeding or eating disorder (OSFED), and 4.5 and 1.6% for unspecified feeding or eating disorder (UFED). Among females, the prevalence of OSFED subcategories was as follows: atypical AN 2.1%, purging disorder 1.3%, BED of low frequency/limited duration 0.7%, and BN of low frequency/limited duration 0.4%. The 10-year incidence rate of eating disorders was 1,700 per 100,000 person-years among females (peak age of onset 16-19 years) and 220 per 100,000 person-years among males. DISCUSSION Eating disorders are a common public health concern among youth and young adults, affecting one in six females and one in 40 males. Adequate screening efforts, prevention, and interventions are urgently needed.
Collapse
Affiliation(s)
- Yasmina Silén
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pyry N Sipilä
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Linda Mustelin
- Department of Public Health & Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Mauri Marttunen
- Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Kaprio
- Department of Public Health & Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Anna Keski-Rahkonen
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| |
Collapse
|
|
46
|
Abstract
Eating disorders are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes towards weight, body shape, and eating play a key role in the origin and maintenance of eating disorders. Eating disorders have been increasing over the past 50 years and changes in the food environment have been implicated. All health-care providers should routinely enquire about eating habits as a component of overall health assessment. Six main feeding and eating disorders are now recognised in diagnostic systems: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder, pica, and rumination disorder. The presentation form of eating disorders might vary for men versus women, for example. As eating disorders are under-researched, there is a great deal of uncertainty as to their pathophysiology, treatment, and management. Future challenges, emerging treatments, and outstanding research questions are addressed.
Collapse
Affiliation(s)
- Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Tiago Antunes Duarte
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
|
47
|
Tseng MCM, Tu CY, Hsieh SF, Chang CH. Rates and trends in healthcare-detected incidence of anorexia nervosa and bulimia nervosa: A national health insurance claim data study in Taiwan, 2002-2013. Int J Eat Disord 2020; 53:331-338. [PMID: 31762080 DOI: 10.1002/eat.23203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed to examine the incidence rates of diagnosed anorexia nervosa (AN) and bulimia nervosa (BN) and their variations over time in Taiwan. METHOD The data of individuals with AN and BN, as defined by the International Classification of Diseases, Ninth Revision, Clinical Modification's (ICD-9-CM), were extracted from merged databases by means of unique identification numbers. To fulfill the criteria of incident cases, individuals must not have had an AN or BN diagnosis in the preceding 2 years. The time trends were analyzed using Joinpoint regression analysis. RESULTS The overall AN and BN incidence rates were 1.1 and 6.1 per 100,000, respectively. There was no significant change in the overall incidence rate for AN or both sexes across the study period. A significant increase in AN incidence occurred in the age groups of 10-14 and 30-39 years. The overall incidence rate of BN increased significantly in the few years before 2009 and then decreased. A similar trend occurred among the females and groups aged above 20 years. There was no significant change in the overall BN incidence rate over the whole period. DISCUSSION Compared with Western countries, the AN incidence in Taiwan is very low, whereas the BN incidence is in the lower end of the range. The findings that the age of the first-time detected AN and BN is older in Taiwan and that the significant increases in age-specific incidence are mainly among adults suggest that more effort is needed to detect individuals with AN and BN at a younger age in Taiwan.
Collapse
Affiliation(s)
- Mei-Chih M Tseng
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Chao-Ying Tu
- Department of Psychiatry, National Taiwan University Hospital, Yunlin, Taiwan
| | - Shu-Feng Hsieh
- National Taiwan University Health Data Research Center, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
|
48
|
Dalsgaard S, Thorsteinsson E, Trabjerg BB, Schullehner J, Plana-Ripoll O, Brikell I, Wimberley T, Thygesen M, Madsen KB, Timmerman A, Schendel D, McGrath JJ, Mortensen PB, Pedersen CB. Incidence Rates and Cumulative Incidences of the Full Spectrum of Diagnosed Mental Disorders in Childhood and Adolescence. JAMA Psychiatry 2020; 77:155-164. [PMID: 31746968 PMCID: PMC6902162 DOI: 10.1001/jamapsychiatry.2019.3523] [Citation(s) in RCA: 278] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Knowledge about the epidemiology of mental disorders in children and adolescents is essential for research and planning of health services. Surveys can provide prevalence rates, whereas population-based registers are instrumental to obtain precise estimates of incidence rates and risks. OBJECTIVE To estimate age- and sex-specific incidence rates and risks of being diagnosed with any mental disorder during childhood and adolescence. DESIGN This cohort study included all individuals born in Denmark from January 1, 1995, through December 31, 2016 (1.3 million), and followed up from birth until December 31, 2016, or the date of death, emigration, disappearance, or diagnosis of 1 of the mental disorders examined (14.4 million person-years of follow-up). Data were analyzed from September 14, 2018, through June 11, 2019. EXPOSURES Age and sex. MAIN OUTCOMES AND MEASURES Incidence rates and cumulative incidences of all mental disorders according to the ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research, diagnosed before 18 years of age during the study period. RESULTS A total of 99 926 individuals (15.01%; 95% CI, 14.98%-15.17%), including 41 350 girls (14.63%; 95% CI, 14.48%-14.77%) and 58 576 boys (15.51%; 95% CI, 15.18%-15.84%), were diagnosed with a mental disorder before 18 years of age. Anxiety disorder was the most common diagnosis in girls (7.85%; 95% CI, 7.74%-7.97%); attention-deficit/hyperactivity disorder (ADHD) was the most common in boys (5.90%; 95% CI, 5.76%-6.03%). Girls had a higher risk than boys of schizophrenia (0.76% [95% CI, 0.72%-0.80%] vs 0.48% [95% CI, 0.39%-0.59%]), obsessive-compulsive disorder (0.96% [95% CI, 0.92%-1.00%] vs 0.63% [95% CI, 0.56%-0.72%]), and mood disorders (2.54% [95% CI, 2.47%-2.61%] vs 1.10% [95% CI, 0.84%-1.21%]). Incidence peaked earlier in boys than girls in ADHD (8 vs 17 years of age), intellectual disability (5 vs 14 years of age), and other developmental disorders (5 vs 16 years of age). The overall risk of being diagnosed with a mental disorder before 6 years of age was 2.13% (95% CI, 2.11%-2.16%) and was higher in boys (2.78% [95% CI, 2.44%-3.15%]) than in girls (1.45% [95% CI, 1.42%-1.49%]). CONCLUSIONS AND RELEVANCE This nationwide population-based cohort study provides a first comprehensive assessment of the incidence and risks of mental disorders in childhood and adolescence. By 18 years of age, 15.01% of children and adolescents in this study were diagnosed with a mental disorder. The incidence of several neurodevelopmental disorders peaked in late adolescence in girls, suggesting possible delayed detection. The distinct signatures of the different mental disorders with respect to sex and age may have important implications for service planning and etiological research.
Collapse
Affiliation(s)
- Søren Dalsgaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Erla Thorsteinsson
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Betina B. Trabjerg
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Jörg Schullehner
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Geological Survey of Denmark and Greenland, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Isabell Brikell
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Theresa Wimberley
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Malene Thygesen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Kathrine Bang Madsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Allan Timmerman
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Diana Schendel
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John J. McGrath
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia,Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Preben Bo Mortensen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Carsten B. Pedersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| |
Collapse
|
|
49
|
Strobel C, Quadflieg N, Naab S, Voderholzer U, Fichter MM. Long-term outcomes in treated males with anorexia nervosa and bulimia nervosa-A prospective, gender-matched study. Int J Eat Disord 2019; 52:1353-1364. [PMID: 31444805 DOI: 10.1002/eat.23151] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We report on the long-term outcome of males compared to females treated for anorexia nervosa (AN) or bulimia nervosa (BN). METHODS A total of 119 males with AN and 60 males with BN were reassessed 5.8 ± 4.6 and 7.5 ± 5.9 years (respectively) after treatment and compared to matched female patients. RESULTS At follow-up, males with AN had a higher body weight than females. For AN, remission rates (40% males vs. 41% females) did not differ at follow-up. And at follow-up, more males (34%) than females (19%) had an eating disorder not otherwise specified (ED-NOS; p < .01). At follow-up of AN, there was no binge-eating disorder (BED) and obesity was rare. For BN, remission rates (44% males vs. 50% females) and frequency of AN, BN, BED and ED-NOS did not differ at follow-up. Males with AN scored lower than females at follow-up on most subscales of the Eating Disorder Inventory (EDI) and on somatization, obsessive-compulsive symptoms, and depression (Brief Symptom Inventory). Males with BN scored lower than females with BN on perfectionism and higher on interpersonal distrust (EDI) at follow-up. DISCUSSION Results from the scarce literature on males with ED are inconclusive regarding longer term outcome. In the present study, males with AN showed a slightly better outcome than females. In BN, outcome was about the same in males and females. According to our study, existing treatment is equally effective in both males and females. Additional research on the need of gender-specific diagnosis and therapy is required.
Collapse
Affiliation(s)
- Christine Strobel
- Schön Klinik Roseneck Affiliated with the, Medical Faculty of the University of Munich, Ludwig-Maximilians-University, Prien, Germany
| | - Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Silke Naab
- Schön Klinik Roseneck Affiliated with the, Medical Faculty of the University of Munich, Ludwig-Maximilians-University, Prien, Germany
| | - Ulrich Voderholzer
- Schön Klinik Roseneck Affiliated with the, Medical Faculty of the University of Munich, Ludwig-Maximilians-University, Prien, Germany
| | - Manfred M Fichter
- Schön Klinik Roseneck Affiliated with the, Medical Faculty of the University of Munich, Ludwig-Maximilians-University, Prien, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
|
50
|
Yao S, Kuja-Halkola R, Martin J, Lu Y, Lichtenstein P, Norring C, Birgegård A, Yilmaz Z, Hübel C, Watson H, Baker J, Almqvist C, Thornton LM, Magnusson PK, Bulik CM, Larsson H. Associations Between Attention-Deficit/Hyperactivity Disorder and Various Eating Disorders: A Swedish Nationwide Population Study Using Multiple Genetically Informative Approaches. Biol Psychiatry 2019; 86:577-586. [PMID: 31301758 PMCID: PMC6776821 DOI: 10.1016/j.biopsych.2019.04.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although attention-deficit/hyperactivity disorder (ADHD) and eating disorders (EDs) frequently co-occur, little is known about the shared etiology. In this study, we comprehensively investigated the genetic association between ADHD and various EDs, including anorexia nervosa (AN) and other EDs such as bulimia nervosa. METHODS We applied different genetically informative designs to register-based information of a Swedish nationwide population (N = 3,550,118). We first examined the familial coaggregation of clinically diagnosed ADHD and EDs across multiple types of relatives. We then applied quantitative genetic modeling in full-sisters and maternal half-sisters to estimate the genetic correlations between ADHD and EDs. We further tested the associations between ADHD polygenic risk scores and ED symptoms, and between AN polygenic risk scores and ADHD symptoms, in a genotyped population-based sample (N = 13,472). RESULTS Increased risk of all types of EDs was found in individuals with ADHD (any ED: odds ratio [OR] = 3.97, 95% confidence interval [CI] = 3.81, 4.14; AN: OR = 2.68, 95% CI = 2.15, 2.86; other EDs: OR = 4.66, 95% CI = 4.47, 4.87; bulimia nervosa: OR = 5.01, 95% CI = 4.63, 5.41) and their relatives compared with individuals without ADHD and their relatives. The magnitude of the associations decreased as the degree of relatedness decreased, suggesting shared familial liability between ADHD and EDs. Quantitative genetic models revealed stronger genetic correlation of ADHD with other EDs (.37, 95% CI = .31, .42) than with AN (.14, 95% CI = .05, .22). ADHD polygenic risk scores correlated positively with ED symptom measures overall and with the subscales Drive for Thinness and Body Dissatisfaction despite small effect sizes. CONCLUSIONS We observed stronger genetic association with ADHD for non-AN EDs than for AN, highlighting specific genetic correlation beyond a general genetic factor across psychiatric disorders.
Collapse
Affiliation(s)
- Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Joanna Martin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Claes Norring
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Zeynep Yilmaz
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher Hübel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Hunna Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jessica Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Patrik K. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|