The prevalence of eating disorders in recently admitted psychiatric in-patients

Disordered Eating among People with Schizophrenia Spectrum Disorders: A Systematic Review

Disordered eating, or abnormal eating behaviours that do not meet the criteria for an independent eating disorder, have been reported among people with schizophrenia. We aimed to systemati-cally review literature on disordered eating among people with schizophrenia spectrum disorder (SSD). Seven databases were systematically searched for studies that described the prevalence and correlates of disordered eating among patients with SSD from January 1984 to 15 February 2021. Qualitative analysis was performed using the National Institutes of Health scales. Of 5504 records identified, 31 studies involving 471,159 subjects were included in the systematic review. The ma-jority of studies (17) rated fair on qualitative analysis and included more men, and participants in their 30s and 40s, on antipsychotics. The commonest limitations include lack of sample size or power calculations, poor sample description, not using valid tools, or not adjusting for con-founders. The reported rates were 4.4% to 45% for binge eating, 16.1% to 64%, for food craving, 27% to 60.6% for food addiction, and 4% to 30% for night eating. Positive associations were re-ported for binge eating with antipsychotic use and female gender, between food craving and weight gain, between food addiction and increased dietary intake, and between disordered eating and female gender, mood and psychotic symptoms. Reported rates for disordered eating among people with SSD are higher than those in the general population. We will discuss the clinical, treatment and research implications of our findings.

Nutrition risk screening methods for adults living with severe mental illness: A scoping review

AIM

Adults living with severe mental illness experience a greater burden of physical comorbidities and earlier mortality than the general population. Malnutrition, overnutrition, dysphagia, constipation and disordered eating have been observed in this population and can lead to poor nutritional status. Early identification of such conditions may reduce their impact on functional status, quality of life and health outcomes. This scoping review aimed to identify all nutrition risk screening methods published in English internationally for use with adults living with severe mental illness and ascertain which, if any, were validated for the target population.

METHODS

A four-step search strategy was used to search six electronic databases and grey literature, from inception to April 2020, for articles reporting nutrition risk screening methods used in this population. Information on the content and validity of screening methods was extracted and analysed by three independent reviewers.

RESULTS

Seventeen nutrition risk screening methods were identified, of which three were validated within a population of adults with severe mental illness. One screening method was found for both malnutrition and dysphagia risk, respectively, and three for constipation risk. No single method was found for overnutrition. Eleven screening methods were identified for disordered eating risk, of which two were validated for the target population.

CONCLUSIONS

Nutrition risk screening methods and their validation in adults living with severe mental illness are inadequately researched. This scoping review highlights the need for future research to develop new or validate existing screening methods specifically for the target population.

Personality disorders in eating disorder not otherwise specified and binge eating disorder: a meta-analysis of comorbidity studies

A meta-analysis was conducted to identify the proportion of comorbid personality disorders (PDs) in patients with eating disorder not otherwise specified (EDNOS) and binge eating disorder (BED). A search identified 20 articles in the period of 1987 to 2010. For EDNOS and BED, the comorbid proportions for any PD were 0.38 and 0.29, respectively; for cluster C PDs, 0.38 and 0.30, respectively (avoidant PD, 0.18 and 0.12, and obsessive-compulsive PD, 0.11 and 0.10, respectively); and for cluster B PDs, 0.25 and 0.11, respectively (borderline, 0.12 and 0.10). This pattern converged with findings on anorexia nervosa and bulimia nervosa, except being lower. Because the comorbidity profiles for EDNOS and BED were highly similar, their underlying PD pathology seems similar. Few moderators were significant, except for interviews yielding lower estimates than that of questionnaires. The variance statistic for any PD comorbidity was wide for EDNOS and narrow for BED, thus partly supporting BED as a distinct eating disorder category and EDNOS as a potentially more severe condition than BED.

Screening for eating disorders in a psychiatric outpatient population

BACKGROUND

Some studies have found "hidden" eating disorders in psychiatric patients. However, eating behaviour, weight, and body image concerns are usually weakly assessed among psychiatric patients.

OBJECTIVES

a) To analyse the prevalence of eating disorders (ED) in patients referred from primary care for psychiatric assessment; and b) to analyse the psychopathological variables associated with these disorders. Methods. Ninety-three patients underwent psychometric assessment using Derogatis' Symptom Checklist-90-R, the Rosenberg Self-Esteem Scale, the Perceived Stress Questionnaire, the Eating Attitudes Test-40 (EAT-40), the Bulimic Investigatory Test, Edinburgh (BITE), and the Body Dissatisfaction Scale of the Eating Disorders Inventory-2. The subsequent clinical assessment, applying DSM-IV-R criteria for ED, was conducted by means of interview with those patients whose scores on the EAT-40 and BITE were above the cut-off points.

RESULTS

The assessments confirmed one case of bulimia nervosa and three of unspecified eating disorder, these accounting for 1.07% and 3.22%, respectively.

CONCLUSION

The existence of hidden ED in psychiatric patients, especially as regards bulimic behaviour, and the correlation between eating disorder symptoms and different psychopathological variables make it important for clinicians to conduct a proper assessment when faced with "anxiety and depressive syndromes", which are a common feature of primary care referrals for psychiatric assessment.

Cultural expectations of thinness in Chinese women

The present study examined the ideal woman's figure among Chinese people in Hong Kong over the past three decades by analyzing the data from the Miss Hong Kong Beauty Pageant from 1975-2000. Results indicate that Miss Hong Kong Pageant winners and Miss Photogenic winners have always been taller and thinner than average women in Hong Kong. The data also suggest that a curvaceous body shape with a narrow waist set against full hips appears to be an important component of feminine beauty among the Chinese. This ideal matches closely to what has been depicted in classical Chinese literature and challenges the commonly held belief that Chinese feminine beauty standards value plumpness.

The BULIT-R: its reliability and clinical validity as a screening tool for DSM-III-R bulimia nervosa in a female tertiary education population

The Bulimia Test (BULIT) has been updated to accommodate the DSM-III-R criteria for bulimia nervosa. Therefore, in this study, we evaluated the psychometric properties of the BULIT-R using a sample of young women at a tertiary educational institute. The results showed all 28 BULIT-R items correlated highly with the total test score (average = .59) and the internal reliability was high (.92). In terms of its concurrent validity, the BULIT-R correlated highly (.90) with the Bulimia Investigatory Test Edinburgh (BITE), a screening measure argued to detect bulimia nervosa. In terms of criterion-related validity, the optimal cutoff for the BULIT-R as a screening measure was 98 with this sample, using a semistructured DIS-III R interview administered by experienced clinicians who specialize in eating disorders. At this cutoff, the sensitivity was 100%, the specificity 99.0%, the negative predictive value 100%, and the positive predictive value 71.3%.