Strategies for Resisting Eating Disorders Over the Life Course—A Mother-Daughter Case Analysis

Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians

Feelings of guilt are human emotions that may arise if a person committed an action that contradicts basic moral mores or failed to commit an action that is considered moral according to their ethical standards and values. Psychological scholarship distinguishes between altruistic guilt (AG) and deontological guilt (DG). AG results from having caused harm to an innocent victim, either by acting or failing to act, whereas DG is caused by violating a moral principle. Although physicians may be expected to experience frequent feelings of guilt in their demanding and intensive work, it is surprising to find that this issue has not been explored in the professional literature on medical ethics. To that end, we conducted a qualitative study that included personal in-depth interviews with Sunni Muslim gynaecologists. These doctors provide underground infertility care and perform religiously forbidden treatments involving sex selection and gamete donation. They opened their hearts and spoke about the emotionally taxing pangs of conscience they suffer. Analysing their narratives led us to characterize their feelings of guilt as DG. We discuss the causes for their plight and the way they cope with it, compare DG to the concept of moral distress, and call for future research on clinicians' feelings of guilt and pangs of conscience.

Treatment of eating disorders in older people: a systematic review

BACKGROUND

Historically, eating disorders were not identified in older populations and it is only in more recent times that there is greater recognition of the existence of eating disorders among the elderly. This is despite the high level of morbidity and mortality associated with these disorders. Current guidelines focus on treatment of eating disorders within the adolescent and general adult age groups, without apparent concessions made for the older age group. The aim of this study was to review existing literature on the demographics and treatment of eating disorders in older people.

METHODS/DESIGN

A systematic review of the literature was conducted using CINAHL, MEDLINE, EMBASE, PsycInfo, Scopus, and Web of Science to identify publications focusing on treatment of eating disorders in people over the age of 65 years, age of diagnosis, gender distribution, treatment setting, and treatment outcomes.

RESULTS

A total of 35 articles (reporting on 39 cases) were relevant to our study, with 33 of the 35 articles being either case studies or case series. The mean age of participants was 73.2 years (range 66-94 years) with the majority (84.6%) being female. Most cases (84.6%) were diagnosed with anorexia nervosa, and 56.4% of all cases were reported as late onset (i.e., after age 40 years). The vast majority (94.8%) received treatment, of which 51.5% was hospital-based treatment. In case descriptions where improvement was reported, the majority described a multidimensional approach that included a combination of hospital admission, therapy and pharmacotherapy. Overall, 79.5% of cases who underwent treatment for an eating disorder improved, while 20.5% relapsed or died as a result of the complications from their eating disorder. There were significant inconsistencies and omissions in the way cases were described, thereby impacting on the interpretation of the results and potential conclusions.

CONCLUSIONS

The information available on the treatment of eating disorders in people over the age of 65 years is limited. The quality of case reports to date makes it difficult to suggest specific assessment or treatment guidelines for this population.

Mothers’ strategies to strengthen their daughters’ body image

Existing studies of the mother–daughter relationship have focused mainly on the transfer of negative body image messages or on risk of eating disorders, and have paid little attention to how this relationship might serve as a resource for building body-acceptance or resilience to disordered eating. On the basis of a secondary analysis of four qualitative samples, we examined how mothers and their now-adult daughters reflect on the ways in which the mothers tried to promote positive body image and resilience to body dissatisfaction in their daughters. Using a content analysis, we have identified five strategies: (a) filtering – being cautious and sensitive in communicating about body image issues, (b) transmitting awareness of the dangers of eating disorders, (c) positive reinforcement – providing affirmations in regard to daughters’ bodies; (d) discussion – providing tools for criticism of the dominant body-related social discourse; and (e) positivity – shifting the focus from food, body-size and weight loss to making healthy choices and taking pleasure in food. Identification of these strategies emphasizes the many potential avenues for growth and development inherent in mother–daughter relationships.