Eating disorder features and quality of life: Does gender matter?

Redefining diagnostic parameters: the role of overvaluation of shape and weight in binge-eating disorder: a systematic review

INTRODUCTION

Overvaluation of shape and weight is a critical component in understanding and diagnosing eating disorders. While the transdiagnostic model states that overvaluation of shape and weight is the core pathology of all eating disorders, this concept is not a criterion for binge-eating disorder. The lack of recognition of overvaluation of shape and weight may lead to overlooking, and consequently failure to address this construct during treatment. The aim of the present review is to examine whether overvaluation is a critical component in understanding and diagnosing binge-eating disorder and whether it should be addressed during treatment, and therefore be added as a criterion of binge-eating disorder.

METHODS

The present review was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42024541433). PsycINFO, Web of Science, PubMed (Medline), and Google Scholar were used in order to systematically search and review literature by using a list of keywords related to overvaluation of shape and weight and binge-eating disorder. All N = 93 peer-reviewed studies were published in English from 1993 onwards.

RESULTS

Overvaluation of shape and weight was more severe among individuals with binge-eating disorder compared to individuals with solely a similar high BMI. In addition, levels of overvaluation in binge-eating disorder were comparable in severity with that of individuals of the other named eating disorder subtypes. Overvaluation was positively associated with other psychiatric symptoms, a risk factor for the onset of binge eating in adolescents and predicted poorer treatment outcomes. It was not clear whether overvaluation predicted dropout from Cognitive Behavior Therapy interventions.

DISCUSSION

It is suggested to consider including overvaluation of shape and weight as a criterion for the diagnosis of binge-eating disorder. Including overvaluation in the DSM and ICD may prevent overlooking this construct, and potentially enhance treatment outcomes. It is suggested that overvaluation of shape and weight is the core pathology of all eating disorders. However, this concept is not a criterion for a binge-eating disorder diagnosis. The lack of recognition of overvaluation of shape and weight may lead to overlooking, and consequently failure to address this construct during treatment. The aim of the present review is to examine whether overvaluation is a critical component in understanding and diagnosing binge-eating disorder and whether it should be addressed during treatment, and therefore be added as a criterion of binge-eating disorder. Consequently, a total of N = 93 peer-reviewed studies were examined. It was found that overvaluation of shape and weight was associated with the severity of eating disorder psychopathology, and was comparable in severity with that of individuals diagnosed with anorexia nervosa and bulimia nervosa. There is enough evidence to include overvaluation in the DSM and ICD as a criterion for binge-eating disorder. Consequently, this may prevent overlooking this construct, and potentially enhance treatment outcomes.

Self-reported health related quality of life in children and adolescents with an eating disorder

BACKGROUND

Eating disorders in children and adolescents can have serious medical and psychological consequences. The objective of this retrospective quantitative study is to gain insight in self-reported Health Related Quality of Life (HRQoL) of children and adolescents with a DSM-5 diagnosis of an eating disorder.

METHOD

Collect and analyse data of patients aged 8-18 years, receiving treatment for an eating disorder. At the start and end of treatment patients completed the KIDSCREEN-52, a questionnaire measuring HRQoL.

RESULTS

Data of 140 patients were analysed. Children diagnosed with Anorexia Nervosa, Bulimia Nervosa, and Other Specified Feeding or Eating Disorder all had lower HRQoL on multiple dimensions at the start of treatment, there is no statistically significant difference between these groups. In contrast, patients with Avoidant Restrictive Food Intake Disorder only had lower HRQoL for the dimension Physical Well-Being. HRQoL showed a significant improvement in many dimensions between start and end of treatment, but did not normalize compared to normative reference values of Dutch children.

CONCLUSION

The current study showed that self-reported HRQoL is low in children with eating disorders, both at the beginning but also at the end of treatment. This confirms the importance of continuing to invest in the various HRQoL domains.

Anonymous Online Survey on Disordered Eating, Drive for Muscularity, Sexual Orientation, and Satisfaction with Life in Young Swedish Males

Psychiatric conditions in general, including eating disorders, are stigmatizing conditions. The stigma of eating disorders is even more pronounced among males. We conducted an anonymous, online survey to explore the feasibility of recruiting participants for collecting sensitive information, and the relation among eating disorders, drive for muscularity, satisfaction with life, and sexual preference in males (N = 824) aged 15-30 years in Sweden. Internet survey method was a feasible way of recruiting males and obtaining sensitive information. Drive for muscularity was positively related to eating psychopathology. Interestingly, only the attitudinal aspect of the drive for muscularity was negatively related to satisfaction with life, whereas the behavioral component of the drive for muscularity was unrelated to quality of life. Drive for muscularity and disordered eating were not significantly different across participants with various sexual orientations. Our findings corroborate and extend previous research by using an anonymous Internet-based survey that may be less contaminated by social desirability or reporting bias due to the sensitivity of some of the questions.

Health-related quality of life assessment in eating disorders: adjustment and validation of a specific scale with the inclusion of an interpersonal domain

PURPOSE

Quality of life is a fundamental aspect of both clinical practice and research on eating disorders (ED) due to the significant impacts these disorders have on everyday life. Disorder-specific scales can improve the quality of research and findings and offer greater sensitivity and responsiveness. However, no specific instrument is available in Italian for ED. The aim of this paper is to adjust and to validate a reliable scale with specific items regarding physical and interpersonal well-being.

METHODS

The Italian version of the Eating Disorder Quality of Life (IEDQOL) scale was developed, on the basis of the original English scale, with the addition of items pertaining to physical well-being and interpersonal interactions. In this study, 180 ED patients and 190 healthy controls from the community were enrolled both from inpatient units and outpatient services. A statistical analysis with an exploratory factorial approach was performed in order to validate the tool.

RESULTS

The results showed that the IEDQOL has very good psychometric properties with test-retest validity and sensitivity between patients and controls (d = 2.17 for total score). Moreover, the interpersonal domain showed excellent psychometric values (Cronbach's α > 0.70 in all the subgroups) and a robust correlation with other quality of life constructs.

CONCLUSION

Future studies on the Italian population should use IEDQOL as outcome element that can be useful also with other disorder-specific psychopathological constructs and corroborate the reliability of the data. Future research in the ED field should only use this specific tool.

LEVEL OF EVIDENCE

Case-control analytic study, Level III.

The Role of Body Image, Disordered Eating and Lifestyle on the Quality of Life in Lithuanian University Students

Purpose. The present study aimed to explore the associations between body image concerns (BI), disordered eating (DE), health-related lifestyle, and the different domains of the quality of life (QoL) in a Lithuanian sample of student-aged men and women. Methods. A mixed-gender sample of students (N = 1850, 58.8% were women, average age 21.6 ± 5.0 years) completed a series of questionnaires, including health-related lifestyles, BI, DE, and QoL. A series of simultaneous multiple linear regression analyses were conducted. Mediation analyses were performed to estimate the size of the total, direct, and indirect effects of variables in the models. Results. The analysis of the linear regressions demonstrated that the positive trait of body areas satisfaction was associated with the significantly enhanced QoL in all domains in both genders (for men β = 0.29-0.34; for women β = 0.26-0.33; p < 0.001). DE was associated with a poorer psychological QoL domain in women only (β = -0.07; p = 0.047). The drive for muscularity was associated with a lower QoL in men (β = -0.06-(-0.141); p < 0.05). Body areas satisfaction mediated the associations between body mass index and psychological and physical QoL in both genders (TLI (Tucker Lewis Index) = 0.975; CFI (comparative fit index) = 0.997; RMSEA (Root of the Mean Square Error) = 0.053). Conclusions. Positive traits of BI play essential roles in the QoL of student-aged women and men. The present study adds empirical evidence emphasizing the importance of integrating education about positive body image while implementing healthy lifestyle and QoL promotion programs in student-aged men and women.

Gender bias, other specified and unspecified feeding and eating disorders, and college students: a vignette study

This vignette study examined perceptions of 237 male and female undergraduate students regarding two severity levels (low and high) of other specified (OSFED) and unspecified feeding and eating disorders (UFED) in their male and female peers. Multilevel modeling showed that female characters received stronger endorsements of eating pathology than male characters for similar symptom presentations. College men were more likely than college women to rate female characters as having eating disorders. Gender bias about eating disorders affected men and women differently in this study. Implications for gender-inclusive as well as gender-sensitive eating disorder outreach and prevention are discussed.

Symptoms predicting psychosocial impairment in bulimia nervosa

PURPOSE

The current study aimed to determine which particular eating disorder (ED) symptoms and related features, such as BMI and psychological distress, uniquely predict impairment in bulimia nervosa (BN).

METHODS

Two hundred and twenty-two adults with BN completed questionnaires assessing ED symptoms, general psychological distress, and psychosocial impairment. Regression analyses were used to determine predictors which account for variance in impairment.

RESULTS

Four variables emerged as significant predictors of psychosocial impairment: concerns with eating; concerns with weight and shape; dietary restraint; and general psychological distress.

CONCLUSIONS

Findings support previous work highlighting the importance of weight and shape concerns in determining ED-related impairment. Other ED symptoms, notably dietary restraint and concerns with eating, were also significant predictors as was psychological distress. Results suggest that cognitive aspects of EDs, in addition to psychological distress, may be more important determinants of impairment than behavioural symptoms, such as binge eating or purging.