1
|
Ng QX, Lim YL, Loke W, Chee KT, Lim DY. Females with Eating Disorders and Urinary Incontinence: A Psychoanalytic Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084874. [PMID: 35457741 PMCID: PMC9028028 DOI: 10.3390/ijerph19084874] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023]
Abstract
Eating disorders (EDs) are complicated mental illnesses with significant treatment resistance and dropout rates. For successful treatment, it is important for clinicians to better understand the patients’ narrative and their lived experiences. A thorough psychodynamic understanding of patients’ childhood attachment and primary relationships, personality traits and mental processes is, therefore, crucial for managing patients with ED. Interestingly, several studies have observed an association between functional urinary symptoms and individuals with ED. EDs such as anorexia nervosa are associated with an increased risk of all urinary symptoms, and functional incontinence was also more common in extreme female athletes with low energy availability and with disordered eating. There is, however, a dearth of literature describing this relationship, and the underlying mechanisms remain remote. In this paper, we present a psychoanalytic approach to the presence of urinary symptoms in females with EDs. We hypothesize that these symptoms are tied to specific traits or characteristics of ED patients, namely the overarching need for control, a pathological strive for perfection and the self-denial of basic bodily urges. This is discussed in relation to psychopathological processes, development and personality factors commonly seen in patients with ED.
Collapse
Affiliation(s)
- Qin Xiang Ng
- MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore; (Y.L.L.); (W.L.)
- Correspondence: ; Tel.: +65-6638-6979
| | - Yu Liang Lim
- MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore; (Y.L.L.); (W.L.)
| | - Wayren Loke
- MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore; (Y.L.L.); (W.L.)
| | - Kuan Tsee Chee
- Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore 539747, Singapore; (K.T.C.); (D.Y.L.)
| | - Donovan Yutong Lim
- Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore 539747, Singapore; (K.T.C.); (D.Y.L.)
| |
Collapse
|
2
|
Mahon C, Seekis V. Systematic Review of Digital Interventions for Adolescent and Young Adult Women's Body Image. Front Glob Womens Health 2022; 3:832805. [PMID: 35392118 PMCID: PMC8982933 DOI: 10.3389/fgwh.2022.832805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background A growing number of digital interventions have been developed to address a range of mental health issues including body image. Identifying effective interventions for body image is important given the prevalence of body image concerns and their associated negative outcomes among young women. This review aimed to critically evaluate current evidence on the use of digital interventions for adolescent and young adult women's body image. Methods A literature search was performed in November 2021 across three databases, PsychINFO, Web of Science and Pubmed to identify studies published with keywords and synonyms of "body image" and "digital interventions" that have been conducted with girls/women aged 10-25 years. Studies were included if they assessed a universal body image intervention delivered through a digital platform (e.g., web-based, mobile phone) and if they reported body image outcomes using validated measures. Two authors independently screened studies extracted data and assessed the quality of studies. Results Eight of 15 interventions were effective in improving at least one body image outcome from pre-post intervention; however, effect sizes were mostly small-medium, and few effects were maintained at follow-up. Studies were heterogeneous in terms of delivery format, duration, sample characteristics, quality, and outcomes. Discussion Findings suggest that digitally delivered interventions can effectively improve some body image outcomes in young women. Characteristics of effective studies are discussed and suggestions for future work on intervention development in this field are provided. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021281435, identifier CRD42021281435.
Collapse
Affiliation(s)
- Ciara Mahon
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Veya Seekis
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| |
Collapse
|
3
|
Vinchenzo C, Lawrence V, McCombie C. Patient perspectives on premature termination of eating disorder treatment: a systematic review and qualitative synthesis. J Eat Disord 2022; 10:39. [PMID: 35296356 PMCID: PMC8928624 DOI: 10.1186/s40337-022-00568-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND High rates of premature treatment termination are a well-reported issue in eating disorder treatment, and present a significant barrier for treatment effectiveness and longer term health outcomes of patients with eating disorders. Understanding patient perspectives on this phenomenon is essential in improving treatment completion rates and informing research and intervention development. The aim of this review is to synthesise qualitative literature on patient perspectives of premature termination of eating disorder treatment and to summarise the key issues leading to discontinuation of treatment. METHODS A systematic review of 1222 articles was conducted to identify studies using qualitative methods to investigate patient experiences of prematurely terminating eating disorder treatment. Ten articles were included in the review, with thematic synthesis used to analyse the primary research and develop overarching analytical themes. RESULTS Conflict around enmeshment of eating disorder with identity, and lack of support with reconstructing a sense of self without the eating disorder; challenges of managing pressures of social and clinical relationships while feeling unheard and misunderstood by both; expectations and disappointments around treatment; and dissatisfaction with progress were key themes behind premature termination of treatment. CONCLUSIONS The findings of this review demonstrate the key issues influencing the decision to end treatment early, highlighting the contribution of individual, environmental, and service-level factors. Implications of these factors are discussed and suggestions raised for future research and service development.
Collapse
Affiliation(s)
- Cecilia Vinchenzo
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, De Crespigny Lane, PO26, London, SE5 8AF, UK
| | - Vanessa Lawrence
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, De Crespigny Lane, PO26, London, SE5 8AF, UK
| | - Catherine McCombie
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, De Crespigny Lane, PO26, London, SE5 8AF, UK.
| |
Collapse
|
4
|
Bryant E, Aouad P, Hambleton A, Touyz S, Maguire S. 'In an otherwise limitless world, I was sure of my limit.' † Experiencing Anorexia Nervosa: A phenomenological metasynthesis. Front Psychiatry 2022; 13:894178. [PMID: 35978851 PMCID: PMC9376373 DOI: 10.3389/fpsyt.2022.894178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia Nervosa (AN) has the highest mortality rate of the mental disorders, with still less than 50% of affected individuals achieving recovery. Recent calls to bring innovative, empirical research strategies to the understanding of illness and its core psychopathological features highlight the need to address significant paucity of efficacious treatment. The current study brings a phenomenological approach to this challenge, synthesizing lived experience phenomena as described by qualitative literature. Fifty-three studies published between the years 1998 and 2021 comprising a total of 1557 participants aged 12-66 suffering from AN or sub-threshold AN are included. Reciprocal and refutational analysis generated six key third-order constructs: "emotion experienced as overwhelming," "identity," "AN as a tool," "internal conflict relating to Anorexia," "interpersonal communication difficulties" and "corporeality." Twenty-six sub-themes were identified, the most common being fear, avoidance, AN as guardian/protector, and AN as intertwined with identity. Some themes associated with current treatment models such as low self-esteem, need for social approval and feelings of fatness were less common. We highlight the significant role of intense and confusing emotion in AN, which is both rooted in and engenders amplified fear and anxiety. Restrictive eating functions to numb these feelings and withdraw an individual from a chaotic and threatening world whilst providing a sense of self around which to build an illness identity. Results have implications for therapeutic practice and overly protective weight and shape focused medical treatment models, which may serve to reinforce the disease.
Collapse
Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ashlea Hambleton
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| |
Collapse
|
5
|
Bouguettaya A, Klas A, Moulding R, King R, Knight T. Perfectionism as a social identity in eating disorders: A qualitative investigation of identity navigation. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ayoub Bouguettaya
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Anna Klas
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Richard Moulding
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Ross King
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | | |
Collapse
|
6
|
Bouguettaya A, Moulding R, King RM, Harrold G. The relationships between socially prescribed perfectionism, in-group affect, negative urgency, and disordered eating in women. Scand J Psychol 2019; 60:369-376. [PMID: 31006891 DOI: 10.1111/sjop.12539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/13/2019] [Indexed: 01/03/2023]
Abstract
Socially prescribed perfectionism (SPP) is often considered as a key risk factor for disordered eating (DE). However, current conceptualizations of SPP largely assume that this perfectionism pressure is non-specific (i.e., a global pressure), despite research indicating that for females experiencing DE, female-dominated groups impose this pressure (as a perceived norm). Furthermore, this relationship may be mediated by a negative reaction to this pressure, in the form of impulsivity (or negative urgency). To date, no research has investigated whether the relationship between SPP and DE is mediated by negative urgency, nor has there been research clarifying how in-group identification relates to DE, independent of SPP and negative urgency. To address these gaps, we assessed these variables in 147 female dieters (Mage = 25.12 years, SD = 3.08) using a cross-sectional design. Consistent with our hypotheses, negative urgency fully mediated the link between female-based SPP and disordered eating, while female-based in-group affect (identification) was predictive of disordered eating (although the latter relationship was not sustained in a multiple regression model). These findings suggest that the SPP from other women may relate to DE through increasing negative urgency, and that the link between in-group (female) affect and DE may be better explained by SPP's link to DE.
Collapse
Affiliation(s)
| | | | - Ross M King
- Faculty of Health, Deakin University, Australia
| | | |
Collapse
|
7
|
Speaking the unspeakable: Artistic expression in eating disorder research and schema therapy. ARTS IN PSYCHOTHERAPY 2016. [DOI: 10.1016/j.aip.2016.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|