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Varela C, Hoyo Á, Tapia-Sanz ME, Jiménez-González AI, Moral BJ, Rodríguez-Fernández P, Vargas-Hernández Y, Ruiz-Sánchez LJ. An update on the underlying risk factors of eating disorders onset during adolescence: a systematic review. Front Psychol 2023; 14:1221679. [PMID: 38023032 PMCID: PMC10663237 DOI: 10.3389/fpsyg.2023.1221679] [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] [Received: 05/12/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Eating disorders (EDs) are serious psychological problems that affect not only the individual, but also their entire environment. The prevalence rates of EDs are higher among the adolescent population. A better understanding of ED risk factors is essential to design effective prevention and intervention programs that focus beyond the areas of weight and appearance. Methods The main objective of this systematic review was to identify the risk factors of EDs and provide a comprehensive approach, analyzing the interplay between individuals, their inner circle, and the society characteristics. The Web of Science, Scopus, CENTRAL and PsycInfo databases were searched. Results The initial search produced 8,178 references. After removing duplicates and performing the selection process by three independent reviewers, 42 articles were included in the systematic review according to the pre-specified inclusion criteria. The results suggest the relevance of society and the inner circle on the development of EDs. Discussion The internalization of the thin ideal, promoted by the current society, and living in an unsupportive, unaffectionate, non-cohesive environment were associated with the onset of EDs symptomatology. Other associated variables with this ED indicator were poor-quality relationships and feeling judged about appearance. These aspects seem to be essential for the development of individual characteristics like self-esteem or adaptative coping during adolescence. This systematic review has shown the complex etiology of EDs and the relevance of the interplay between the different areas involved. Furthermore, this information could be relevant to improve the design of innovative and more effective prevention and intervention programs. Systematic review registration PROSPERO, identifier CRD42022320881.
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Affiliation(s)
- Carmen Varela
- Universitat de Barcelona, Barcelona, Spain
- Departamento de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad de Burgos, Burgos, Spain
- Área de Psicología, Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | - Ángela Hoyo
- Área de Psicología, Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | | | | | - Benito Javier Moral
- Área de Psicología, Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
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Zsigo C, Sfärlea A, Lingl C, Piechaczek C, Schulte-Körne G, Feldmann L, Greimel E. Emotion Regulation Deficits in Adolescent Girls with Major Depression, Anorexia Nervosa and Comorbid Major Depression and Anorexia Nervosa. Child Psychiatry Hum Dev 2023; 54:1476-1488. [PMID: 35412201 PMCID: PMC10435395 DOI: 10.1007/s10578-022-01353-4] [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] [Accepted: 03/19/2022] [Indexed: 11/03/2022]
Abstract
In adolescence, both major depression (MD) and anorexia nervosa (AN) are associated with deficits in emotion regulation (ER). However, studies have yet to compare ER profiles within the disorders and the effect of comorbid MD+AN is unclear. This study examined the habitual use of ER in 229 girls, aged 12-18 years, with MD (n = 84), AN (n = 37), comorbid MD+AN (n = 25), and healthy girls (n = 83). Girls with MD, AN and MD+AN reported more maladaptive and less adaptive ER strategies than healthy girls. MD and MD+AN groups showed more frequent use of maladaptive ER compared to only AN, with no differences between only MD and MD+AN. This suggests that MD+AN is not necessarily associated with higher ER deficits, rather, an additional diagnosis of MD exacerbates impairments in AN. Identifying specific ER profiles can provide important targets in prevention and treatment for AN, MD and AN+MD.
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Affiliation(s)
- Carolin Zsigo
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany.
| | - Anca Sfärlea
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Carolin Lingl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Charlotte Piechaczek
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Lisa Feldmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Ellen Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
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Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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Stewart C, Konstantellou A, Kassamali F, McLaughlin N, Cutinha D, Bryant-Waugh R, Simic M, Eisler I, Baudinet J. Is this the 'new normal'? A mixed method investigation of young person, parent and clinician experience of online eating disorder treatment during the COVID-19 pandemic. J Eat Disord 2021; 9:78. [PMID: 34193291 PMCID: PMC8243044 DOI: 10.1186/s40337-021-00429-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Prior to the COVID-19 pandemic, research in virtual care for young people with eating disorders was preliminary and implementation rare. This study explored the experience of young people, parents and clinicians when therapy was transitioned to virtual provision as a result of the UK lockdown in March 2020. METHODS A mixed-method approach was used in this study. Online questionnaires that included a mixture of rating (Likert scale) and free-text response questions were completed by 53 young people with any eating disorder, 75 parents and 23 clinicians. Questions focused on the experience of online treatment as well as the impact on engagement, perceived treatment efficacy and preferences around treatment mode in the future. Likert scale questions were analysed using a summary approach. Free-text responses were analysed qualitatively using reflexive thematic analysis. RESULTS Responses to rating scale questions indicate satisfaction with treatment, good engagement and ability to manage technology. Young people who had transitioned care, rather than started care virtually in lockdown, rated therapy as less effective. However, individual accounts of experience were more varied. Reflexive thematic analysis of free-text responses identified key themes of 1) Making it work, 2) Home as a therapeutic space, and 3) Disrupted connection and 4) Into the future. CONCLUSIONS These results have implications for ongoing care during the pandemic and for future implementation of virtual care in the treatment of young people with eating disorders. Particular issues arising are the trade-off between accessibility and therapeutic engagement and depth and need for consideration of equal access to treatment in socially unequal societies.
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Affiliation(s)
- Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Fatema Kassamali
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Natalie McLaughlin
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Darren Cutinha
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Rachel Bryant-Waugh
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK.
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
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