Loneliness and eating disorders

This article examines the link between loneliness and eating disorders. This concept is evaluated through a systematic review of the literature that links loneliness and eating disorders and through a survey of themes connecting the 2 conditions. Eating disorders-including anorexia nervosa, bulimia nervosa, and eating disorders that are not otherwise specified, which include binge eating disorder-are challenging health issues. Each of these diagnoses specifically relates to loneliness. This negative emotion contributes to and fuels eating disorder symptoms. Negative interpersonal relationships, both real experiences and individuals' skewed perceptions, exacerbate eating disorders and feelings of loneliness. Characteristics that have been associated with loneliness clearly relate to eating disorders. Understanding this relationship is vital, so that we can appreciate our patients' struggles and work to target these intense emotions within the treatment setting. We need to be aware of the power of loneliness as it applies to individuals in general and specifically to those struggling with disordered eating.     

The self and eating disorders

In our review, we focus on self-related constructs in the context of eating disorders with four aims. First, we examine a variety of self-related constructs that have been theoretically and empirically linked to the development and course of eating disorders. In addition to the more well-researched constructs of self-esteem and self-efficacy, we also report on findings related to selflessness, contingent self-worth, self-objectification, ego-syntonicity, self-concept clarity, self-compassion, social comparison, self-oriented perfectionism/self-criticism, and narcissism. Second, we discuss self-related constructs that may be especially relevant to comorbidities common among those with eating disorders. Third, we review intervention and prevention programs where self-related constructs play a prominent role. Lastly, we share future research directions regarding self-related constructs and eating disorders that we believe will advance a deeper understanding of the role of the self in the eating disorders.     

Neuropeptides in eating disorders

The past decade has witnessed a dramatic acceleration in research on the role of the neuropeptides in the regulation of eating behavior and body weight homeostasis. This expanding research focus has been driven in part by increasing public health concerns related to obesity and the eating disorders anorexia nervosa (AN) and bulimia nervosa (BN). Preclinical advances have been facilitated by the development of new molecular and behavioral research methodologies. With a focus on clinical investigations in AN and BN, this article reviews research on selected hypothalamic and gut-related peptide systems with prominent effects on eating behavior. Studies of the orexigenic peptides neuropeptide Y and the opioid peptides have shown state-related abnormalities in patients with eating disorders. With respect to gut-related peptides, there appears to be substantial evidence for blunting in the meal-related release of the satiety promoting peptide cholecystokinin in BN. Fasting plasma levels of the orexigenic peptide ghrelin have been found to be elevated in patients with AN. As discussed in this review, additional studies will be needed to assess the role of nutritional and body weight changes in neuropeptide alterations observed in symptomatic eating disorder patients, and to identify stable trait-related abnormalities in neuropeptide regulation that persist in individuals who have recovered from an eating disorder.     

Reflections on athletes and eating disorders

ObjectivesThe purposes of this paper were to offer reflections, thoughts, and observations on the burgeoning research regarding eating disorders in athletes over the past 25 years, to comment on the findings and clinical implications of the studies contained in this special issue, and to provide suggestions for future research.ResultsDisordered eating and eating disorders are complex, multidimensional, and multiply determined, and can affect the health and performance of athletes in both genders and most sports. Although coaches and teammates can be significant sources of weight and body image pressure, they can also play a positive role in identification and prevention.ConclusionsFurther research is needed in several areas. These include a broader focus that includes athletes believed to be at less risk, most notably males and non-lean sport athletes, and ironically younger athletes, who may be at greatest risk. We also need more research related to treatment of athletes with eating disorders and especially how we might better motivate them for recovery.     

Leptin functioning in eating disorders

Leptin is an adipocyte-derived hormone, which is involved predominantly in the long-term regulation of body weight and energy balance by acting as a hunger suppressant signal to the brain. Leptin is also involved in the modulation of reproduction, immune function, physical activity, and some endogenous endocrine axes. Since anorexia nervosa (AN) and bulimia nervosa (BN) are characterized by abnormal eating behaviors, dysregulation of endogenous endocrine axes, alterations of reproductive and immune functions, and increased physical activity, extensive research has been carried out in the last decade in order to ascertain a role of this hormone in the pathophysiology of these syndromes. In this article, we review the available data on leptin physiology in patients with eating disorders. These data support the idea that leptin is not directly involved in the etiology of AN or BN. However, malnutrition-induced alterations in its physiology may contribute to the genesis and/or the maintenance of some clinical manifestations of AN and BN and may have an impact on the prognosis of AN.     

Untreated recovery from eating disorders

This retrospective study explored the experience of recovery from anorexia nervosa and bulimia nervosa without professional treatment. A nine-question open-ended electronic survey was posted for a period of four months at a mid-western university. Sixteen female and two male respondents reported recovery from adolescent-onset full syndrome anorexia nervosa or bulimia nervosa. All respondents reported onset factors supporting a sociocultural etiology. Recovery was initiated through the empathic, participatory efforts of parents and friends, or was self-initiated. Respondents with the shortest disorder duration and most complete recovery reported early parental intervention. Onset factors similar to those in research with a clinically treated population were found. Implications of the findings are discussed.     

Risk factors for eating disorders

The authors review research on risk factors for eating disorders, restricting their focus to studies in which clear precedence of the hypothesized risk factor over onset of the disorder is established. They illustrate how studies of sociocultural risk factors and biological factors have progressed on parallel tracks and propose that major advances in understanding the etiology of eating disorders require a new generation of studies that integrate these domains. They discuss how more sophisticated and novel conceptualizations of risk and causal processes may inform both nosology and intervention efforts.     

Obsessive-compulsive symptoms in eating disorders

Obsessive-compulsive symptoms were measured in a consecutive series of new referrals with anorexia nervosa (n = 29) and bulimia nervosa (n = 77). In contrast with previous reports, there was no significant difference on MOCI scores between eating disorder groups and normal controls. A consecutive series of 38 patients with bulimia nervosa then entered a structured treatment programme. Poor outcome cases had a higher score on the MOCI-doubting sub-scale. However, there was no significant difference in obsessive-compulsive scores between those who were binge-free and those who were bingeing daily at the end of treatment and there was no significant in outcome between high and low-scorers on the MOCI. This study fails to support the view that the eating disorders are a subtype of OCD. Previous conflicting results are attributed to selection bias and the effects of low body weight.     

Psychological treatment of eating disorders

Significant progress has been achieved in the development and evaluation of evidence-based psychological treatments for eating disorders over the past 25 years. Cognitive behavioral therapy is currently the treatment of choice for bulimia nervosa and binge-eating disorder, and existing evidence supports the use of a specific form of family therapy for adolescents with anorexia nervosa. Important challenges remain. Even the most effective interventions for bulimia nervosa and binge-eating disorder fail to help a substantial number of patients. A priority must be the extension and adaptation of these treatments to a broader range of eating disorders (eating disorder not otherwise specified), to adolescents, who have been largely overlooked in clinical research, and to chronic, treatment-resistant cases of anorexia nervosa. The article highlights current conceptual and clinical innovations designed to improve on existing therapeutic efficacy. The problems of increasing the dissemination of evidence-based treatments that are unavailable in most clinical service settings are discussed.     

Neuroimaging studies in eating disorders

The understanding of the eating disorders (EDs) anorexia (AN) and bulimia nervosa (BN) has undergone remarkable advancements in the past decade. Most studies that have been done in AN show brain gray and white matter volume loss during the ill state that, at least in part, remit with recovery. Similar patterns occur for brain phospholipids assessed using magnet resonance spectroscopy (MRS). Imaging studies have been used to provide functional information regarding serotonin neuroreceptor dynamics, regional cerebral blood flow, or cerebral glucose metabolism. Such studies have implicated cingulate, frontal, temporal, and parietal regions in AN. Investigators have found that challenges such as food and body image distortions may activate some of these regions, raising the possibility that such studies may shed light on puzzling AN symptoms, such as body image distortions or extremes of appetitive behaviors. Emerging data suggest these disturbances persist after recovery from AN, suggesting the possibility that these are traits that may create a vulnerability to develop an ED. While fewer studies have been done in BN or binge eating disorder, there may be disturbances of serotonin metabolism in similar brain regions. Taken together, these findings give promise for future investigations with the hope of delineating brain pathways that contribute to the etiology of EDs     

Perversion,eating disorders and sex roles

Abstract

Russell J.M. Perversion, Eating Disorders and Sex Roles. Int Forum Psychoanal 1992;1:98-103. Stockholm. ISSN 0803-706X

Perversion is presented as a fascination with something we also regard as repugnant. A perversion like exhibitionism is a metaphor illuminating the stereotypically masculine. An eating disorder such as bulimia provides a metaphor illuminating the stereotypically feminine. It also fits the account given of perversion. Stereotypes for masculine and feminine, though cultivated in social expectations, are rooted in the infant fantasy world. One is fascinated with the fate of what one has ejected (projected). This contributes to a groundwork for masculinity and exhibitionism. One is fascinated and ambivalent about what one takes in (introjects) which contributes to a groundwork for femininity and bulimia. Genitalia are discovered subsequently, as appropriate representations of these options. Our capacity to be socialized into gender roles, and our discovery of our genitalia en route to this socialization, are foreshadowed by these deeper and earlier styles.     

School counselors' knowledge of eating disorders

The purpose of this study was to examine school counselors' knowledge of adolescent eating disorders, specifically anorexia and bulimia nervosa. Participants were drawn from the national membership of the American Association of School Counselors; they were requested to complete a 43-item questionnaire on eating disorders. Of the 500 participants randomly selected, 337 (67%) returned usable questionnaires. There were 220 female and 117 male counselors; the mean age was 45.2 years. The majority held a master's degree and counseled high school students; the mean number of years they had been school counselors was 12.2. When asked how competent they were in helping students with eating disorders, 11% rated themselves as very competent, 49% believed they were moderately competent, and 40% believed they were not very competent. The majority (75%) did not believe it was their role to treat students with eating disorders; they were instead referred to an eating disorders program (40%), their parents (34%), or a psychiatrist or other physician (34%). The majority of counselors (72%) had encountered anorexic or bulimic students; the most common method of discovering students with a problem was by being informed by fellow students (35%). The majority of respondents were very knowledgeable regarding the signs and symptoms of anorexia and bulimia nervosa. Examination of their general knowledge of eating disorders revealed that they knew more about anorexia than bulimia. The two sources of eating disorders information utilized by at least half of the respondents were professional journals (70%) and workshops/professional conferences (56%).     

Pathological organizations and psychic retreats in eating disorders

A set of characteristic symptoms allow for the relatively straightforward diagnosis of eating disorders. Simultaneously and paradoxically, underlying the eating disorders are a wide variety of personality organizations/disorders, stretching from the neurotic to the borderline and narcissistic, and even to conditions approaching psychosis. This paper will argue that the inherent commonalities can be ascribed to pathological organizations of a similar nature and quality, operational across the spectrum of eating disorders and functioning in a particular, sadomasochistic way. The typical forms that eating disorders take are based on the specific ways that food and the body are used, that is, symptom manifestation. These distinctive symptom manifestations appear to be related to Steiner's (1982, 1993) notion of a psychic retreat. Pathological organizations and psychic retreats are latent until called upon either sporadically or continuously. When activated, these defensive structures operate like a complex psychic skeleton around which the unique psychodynamics of each patient become rearranged and thereby transformed.     

Self-mutilation: a spiritual endeavor

This article explores the phenomenon of self-mutilatory behaviors among practitioners both today and throughout history with the intent of exposing what the author finds to be a radical correlation between mental illness and spirituality. It is the author's belief that today's strong focus on the biology of mental illness, though essential, will extend us only so far in our comprehension of mental pathology; and that an investigation into the spiritual needs of humankind may serve to round out our understanding.