Friday, June 8, 2018

Psychotherapeutic Treatment for Anorexia Nervosa: A Systematic Review and Network Meta-Analysis

 Background: The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy. Weight gain was chosen as the primary outcome criterion. We also aimed to compare treatment effects according to service level (inpatient vs. outpatient) and age group (adolescents vs. adults). Methods:The data bases PubMed, Cochrane Library, Web of Science, Cinahl, and PsychInfo were used for a systematic literature search (until Feb 2017). Search terms were adapted for data base, combining versions of the search terms anorexia, treat*/therap* and controlled trial. Studies were selected using pre-defined in- and exclusion criteria. Data were extracted by two independent coders using piloted forms. Network-meta-analyses were conducted on all RCTs. For a comparison of service levels and age groups, standard mean change (SMC) statistics were used and naturalistic, non-randomized studies included. Results: Eighteen RCTs (trials on adults: 622 participants; trials on adolescents: 625 participants) were included in the network meta-analysis. SMC analyses were conducted with 38 studies (1,164 participants). While family-based approaches dominate interventions for adolescents, individual psychotherapy dominates in adults. There was no superiority of a specific approach. Weight gains were more rapid in adolescents and inpatient treatment. Conclusions: Several specialized psychotherapeutic interventions have been developed and can be recommended for AN. However, adult and adolescent patients should be distinguished, as groups differ in terms of treatment approaches considered suitable as well as treatment response. Future trials should replicate previous findings and be multi-center trials with large sample sizes to allow for subgroup analyses. Patient assessment should include variables that can be considered relevant moderators of treatment outcome. It is desirable to explore adaptive treatment strategies for subgroups of patients with AN. Identifying and addressing maintaining factors in AN remains a major challenge. Front Psychiatry. 2018 May 1;9:158. doi: 10.3389/fpsyt.2018.00158. eCollection 2018.

This is the final week to call your Representative and ask for their support for a GAO study on eating disorders prevention and treatment for military members!

Servicemembers and their families have higher rates of eating disorders than the civilian population. We are asking our Representatives to sign-on to a letter requesting the Government Accountability Office to conduct a study on:
  • What steps the military is taking to screen for and prevent eating disorders within servicemembers during the entire life cycle of service
     
  • How many military members and military families sought treatment for an eating disorder
     
  • A comprehensive review of the availability and access to eating disorder treatment for military members and their families
The letter is led by Representatives Seth Moulton (D-MA) and Walter Jones (R-NC) and can be read here.
Please help us build support for this important study by contacting your Representative!

The deadline for your Representative to sign-on to the letter is Friday, June 8th.


"Hello, my name is _____[FULL NAME] and I am a constituent from _____ [CITY, STATE].

I'm calling to ask the Representative to support the bipartisan letter led by Congressmen Jones and Moulton currently circulating in the House. The letter requests a comprehensive GAO study be conducted on how the military screens and prevents eating disorders within servicemembers and the availability and access to treatment for military members and their families.

It is important to me that the Representative sign-on to this letter because...
[ADD YOUR REASON WHY YOU WANT TO KNOW HOW THE MILITARY ADDRESSES EATING DISORDERS]

Thank you."
 



Thank you for taking action!
 

The Importance of Accepting Your Messy Self

The Importance of Accepting Your Messy Self

By Leora Fulvio, MFT
If I had to winnow down the recovery process into one sentence, I’d give you four short words:
Be kind to yourself.
But if we all knew how to do this, there wouldn’t be multiple in-patient treatment programs, psychiatrists prescribing various psychopharmacological meds and websites and seminars dedicated to the process of recovery. Heck, I wrote a 300+ page book on the topic myself.
So why, if it’s so simple, does it seem so difficult?
Eating disorders are conditions of self-hatred, a lack of self-acceptance, impatience with oneself, a disconnection from the self and from others. Eating disorders are also a distinct embodiment of fear. Our eating disorders are a manifestation of all the ways that we believe ourselves to be not good enough, totally unacceptable, and unworthy, and this is what we do to ourselves when are disconnected from our body and spirit.  We are afraid of being rejected, of people not loving us, of being left by our lovers, our partners, our families, of not being good enough, of being completely alone… and so we try to take control. We can’t control other people so we do our best to control our bodies in order to ensure that we are not rejected and that love stays with us. When we try to control our bodies rather than to love and connect with them, we become disembodied and disconnected. In the battle for control, nobody wins. The rejection that you are so desperately avoiding with an eating disorder feels more alive and more pervasive because you are actually rejecting yourself.
So, if a belief that we are not good enough and a fear of being rejected by others are maintaining factors, then the cure should be easy — self-love and self-confidence and self-security. But it’s not. Because all of these fears become incredibly intertwined with survival. We are afraid that if we muster up the courage to love ourselves, we will be alone. We will die alone. We are afraid that self-love means we are giving up on ourselves and thus giving up on ever being loved by anyone else. We have to please everyone else so that nobody leaves us. But… what if everyone feels that way? What if everyone is as afraid as we are. Should everyone be doing this?
It’s simple to say, “I’ll be kind to myself after I lose ten (or 50 or 100 or 200) pounds,” but to say, “I accept myself right now, for who I am in this moment,” and to treat yourself the way you treat a best friend, with love and kindness rather than judgment, anger and punishment… that’s where the real healing work is.
Sure, it’s easy to believe that you love yourself when you’re “being good” but what about when you mess up? The real test is ¾ can you love yourself when you’re a total mess?  Because you’re going to mess up. I promise you that. Life is messy. Being human is extremely messy. We are born into a big mess (no birth is clean as you all know…) and each day at least something messy happens. We are messy both physically and emotionally. But that’s okay. It’s all part of the human experience. And we are all, all of us very messy. Even those of us who are obsessively clean ¾ still messy. And that’s okay. It’s all okay. Because for all the mess there is a purity and a perfection that is 1 million percent beauty. This is the real test; can you love yourself when you’re messy?  This is the practice.
Next time you are messy, next time you binge, or purge, or overeat, or undereat, or overexercise, or drink too much, or yell at your kids… I want you to thank yourself for giving yourself the opportunity to practice being kind to yourself when you’re not “being good.” And then, give yourself credit for being human, forgive yourself, think about how to be kind to yourself in that moment and how to treat yourself with love and compassion.
The irony is that once you start to be kind to yourself, the real work of recovery begins.
So herein lies the challenge… learning to accept yourself at your messiest. Learning how to love that person who has their head in the toilet, their finger down their throat, the one who is elbow deep in a binge, who can’t get off that treadmill. Because when you are alone with that eating disorder – and we know that eating disorders love to “get us alone…” when we are alone with ED in our heads, we need that loving voice to come and put a gentle hand on our backs and say, “it’s okay! It’s okay! I promise you, it’s okay! You are perfect and whole and complete in this moment, you are human, you are a very real human being and you’re just trying to cope with your fears and your pain… but you know what? I love you! I love you no matter what! I love you when you’re sick or healthy, I love you no matter what your size is and I love you when you perfectly imperfect…”
You need this voice inside of you. Because without it, you’re trapped alone with ED in your head. And that’s just no way to recover. Recovery needs self-love and self- advocacy in order to unfold and flourish.
So how do we practice self-acceptance and self-kindness?
It starts with a noticing. Whenever you notice yourself thinking unkind thoughts about yourself or berating yourself, try to redirect that thought. Tell yourself, “I am human, I am doing the best I can, I am working toward full recovery… body, mind, and spirit.”
Take a deep breath and notice how it feels in your body to accept yourself rather than to reject yourself. Then, let yourself be in the place of self-kindness, even if for a brief moment. As you practice this, each of those brief moments become longer moments, which eventually creates a new way of thinking, feeling, and behaving.  Notice with kindness, acceptance, and move forward with your next step for recovery.

The Connections Between the Brain and Urges to Binge and Purge

The Connections Between the Brain and Urges to Binge and Purge

By Tammy Beasley, RDN, CEDRD, CSSD
“I did it again. And again! I can’t seem to control my bingeing no matter how hard I try. What is wrong with me?” Listening to a client who wants to recover from bulimia or binge eating disorder tell you the same thing shared in the last session can feel discouraging for both of you. The desire to recover is strong but the body and brain seem to be resisting. And each repeated behavior increases feelings of shame and hopelessness that things can or will ever change.  Hunger and fullness signals, the body’s built-in fuel gauge, no longer seem to communicate correctly or effectively. Science has told us that an eating disorder can distort and confuse the brain and stomach’s ability to translate hunger and fullness messages. Science also tells us that as the brain and stomach heal, the body can relearn how to hear and trust those messages again, not only through nutritional rehabilitation itself but also by creating new behavior pathways that reduce the urges over time.
Current research is teaching us new layers of understanding about the interconnectedness of the brain, the gut and the urges entangled within both. The brain has less capability of creating new pathways to handle familiar urges when it is being flooded under a swell of emotions triggered by shame and hopelessness. Consider a natural disaster like flooding and the impact that flood gates can have on protecting the land and community. These flood gates, built over time as a counter-response to repeated flood patterns, hold back the rush of water and open opportunities for the community to take different routes to safety.  Likewise, when the brain is flooded under a wave of emotions, it is very difficult to interrupt, slow down, or even see another way out of the familiar binge/purge cycle.  However, if that same cycle is slowed down by a “flood gate” and the brain can then emotionally engage in a new way within a safe space, a fresh pathway begins to develop and alternatively create new patterns that strengthen recovery and gradually restore trust in the fuel gauge signals.  If the shame and judgment that surrounds those urge cycles can also be simultaneously disrupted, the body can learn to embrace both physical and emotional urges as equally powerful opportunities to write another healing chapter in the recovery journey.
A starting place for creating new brain pathways to respond to the binge/purge, or binge/restrict, cycle is understanding the physiological changes created by the binge cycle and its influence on the inevitable emotional cycle that follows. Shame is the single most pervasive trigger that intersects all physiological and emotional responses to the binge cycle. Therefore, the most important objective is to begin seeing hunger and fullness signals, or lack thereof, through a filter for shame reduction. Observing hunger and fullness through a lens of self-compassion and a frame of hope neutralizes shame. How is this possible? The first step is making sense of the science occurring within the body. Understanding the physiological responses that can occur both before, during and after a binge helps reduce the “surprise factor,” begin a neutral and renewing conversation with the body and open the door to curiosity instead of judgment.
An array of hormones and neurotransmitters carry messages back and forth between the brain and gut.  The scope of this conversation centers on the physiological responses to dopamine and insulin, specifically within the context of learned responses that can be “rewired” by the brain. Dopamine, a hormone released in response to pleasure received from activities like eating, is associated with reward, and evidence supports that the brain begins automating its response to a behavior if it is repeated, or “rewarded”, often. If the brain can predict a reward, it can respond to the dopamine trigger in the presence of or simply by seeing the binge foods. Evidence also suggests that brain reward circuitry is more active when sugary foods are consumed in hungry subjects as compared to subjects who are satisfied, and not hungry. The key message to embrace in the early stages of breaking the binge cycle’s hold on the brain is two-fold: 1) awareness that this “automated” response to binge foods as physiologically “learned” and can be “un-learned” over time reduces the shame triggered by assumptions that willpower has failed, and 2) periods of restriction as “punishment” for a binge can lower blood sugar levels and subsequently increase the desire for sugary-based binge foods in a hungry state.
In addition to dopamine, insulin regulation is progressively imbalanced over time with repetitive binge/purge, or binge/restrict cycles. Taste buds initiate the digestion and absorption process and are the first to signal the brain that glucose is on its way. The brain in turn tells the pancreas to prepare for the glucose load by releasing insulin, which serves as the key to cell doors to allow the glucose to enter and be used for energy. If the binge carries a large amount of sugar-based foods, the body adapts by producing large amounts of insulin just after eating, which in turn can potentially increase appetite for more. If the binge is then purged before all the foods consumed can be digested and absorbed, the body responds with insulin-produced hypoglycemia because of the presence of too much insulin in comparison to the glucose actually absorbed. The key message to embrace in this early stage of breaking the binge cycle’s hold on the brain is also two-fold: 1) awareness of this learned response and subsequent imbalance of insulin/blood sugar regulation can and will adjust over time, and 2) hunger and cravings can be intense in the early stages and will normalize alongside the insulin/blood-sugar balance. Knowing these inevitable, learned physiological responses ahead of time removes the “surprise factor” when experiencing them and helps reduce shame triggers sparked by feelings of body betrayal and “failed willpower.” Just as these patterns have been learned by the brain, new pathways can also be learned. Understanding these hormonal influences is one of the flood gates that can hold back the emotional deluge and allow space and time for new thoughts and patterns to develop.
The next phase is discovering and practicing three steps to reconnect to hunger and fullness, using these steps as flood gates holding back the force of emotional flooding to allow a safe space for new pathways to develop. The first step is meal timing. Research supports the body’s ability to reset the “clock” for food metabolism. In a 2017 research report in Current Biology (Wehrens, SMT, et al.), “meal timing exerts a variable influence over human physiological rhythms, with notable changes occurring in aspects of glucose homeostasis.” However, this same study notes that only “plasma glucose, but not insulin or triglyceride, rhythms are delayed by late meals.”  Translation? A 5-hour delay between meals changed the rhythm of glucose homeostasis, or balance, but did not seem to influence insulin balance in the same way. This discovery seems to reflect the insulin-produced hypoglycemia phenomenon and further strengthens the role of timing of meals and snacks as a “flood gate” for new brain pathways. This flood gate is defined by a breakfast meal within a few hours of rising and from that point forward, consuming food every 3 to 4 hours. In the early stages, the hunger and fullness signals remain distorted and most likely will not coincide with the timing of meals and snacks. However, remaining consistent with this meal timing flood gate allows space for the body, brain and gut to heal and new pathways to be created.  Similar to syncing meals and snacks with a new time zone when flying to another country even if not experiencing hunger cues that match, the body can readjust its hunger and fullness to these new patterns over time.
The second step is fuel, or food, balance. Saying “fuel” in place of “food” is a conscious choice that also serves as a flood gate to hold back the emotional meanings attached to food created by disordered eating thoughts and beliefs. Fuel implies a more neutral description and active purpose that can help diffuse anxiety and fear that may be triggered by the word “food”. Even if for a moment, reducing negative emotions by changing the language used can be a powerful tool that strengthens the new brain pathway. Every time “fuel” is used, the flood gate holds a little longer and the safe space can be explored a little deeper. The fuel choices made for each meal and snack are uniquely varied for each person and offer opportunities to experiment with how different combinations of fuel choices physically and emotionally feel.  Research supports both variety and use of energy dense foods like proteins as associated with reduced eating disorder behaviors and recidivism. Meals adequate in protein have been shown to decrease the desire to binge and produce longer thermic effects. Translation here? Protein produces more heat when it is digested, which can lead to longer satiety and subsequently decrease the desire to binge by supporting more stable blood sugar levels.  This step requires permission to choose and consume a variety of fuels in a variety of combinations. Permission embraces curiosity, not perfection. Staying curious about how different choices feel in the body, sustain energy, and change moods broadens the definition of balance. Defined as “to bring to equilibrium, to move in rhythm to and from; equal in value,” also includes “mental steadiness or emotional stability.” Therefore, balance is not only in the tangible fuel choices but also the intangible emotions and judgment around eating itself. The flood gate of fuel balance offers unlimited opportunities to hold back the emotional flooding with each different combination and try out the new pathways that are beginning to develop.
Fuel balance naturally leads to the third step, repetition.  It is the repetition of meal timing and fuel balance, growing from an attitude of curious permission before, during and after eating, that strengthens the flood gates to hold on a little longer each time.  A consistently fueled body is not nearly as vulnerable to physiological triggers. When physical cravings are reduced, emotional triggers are more clearly recognized.  These emotional cravings do not have to open the gates and release the emotional flooding, nor do they represent failure to create new brain pathways. In fact, these same emotional cravings can support new pathways when used as opportunities to practice curiosity and embrace self-compassion for what is needed in that very moment. Emotional cravings are as real as physical cravings, and the healing comes in being able to differentiate the two and learn from both equally, without shame. Both can be embraced in recovery and reveal an opportunity to balance and restore trust in both food and body again.
Using intentionally focused effort and shifting attention to something meaningful within either scenario immerses the mind into something other than the binge or craving itself. As the mind repeats this shifted attention and the body repeats this new behavior pattern, both supported by flood gates of awareness, meal timing, fuel balance and repetition, the habitual emotional flooding is held back. Over time, the brain is emotionally engaged in a healing way as the focus and patterns are held more frequently and for longer periods of time. This fresh pathway can strengthen recovery as the urge to binge lessens and trust in both food and body is gradually restored.

The ABCs of Going to College

The ABCs of Going to College

By Victoria Freeman (MSW RSW), Kristen Anderson (LCSW), Dr. Gina Dimitropoulos (MSW, PhD)
The transition to college is hard and it can be even harder when you’ve struggled with an eating disorder. It’s easy to make comparisons when watching others take that next step if you aren’t ready; AND waiting until you are ready is the best next stepfor you. Studies show that students with active mental health challenges drop out of school at much higher rates than their peers1 and if you go before you’re ready, you may end up in a revolving door of starting and stopping that derails your college experience.  Working with your supports to think about your best next step is an important part of making a decision about college.
To recover, you built a support system – a scaffold – that allowed you to learn and grow and you no doubt gained a lot of skills along the way! In the transition to college you will face exciting challenges that will require you to use your skills in a new way. The ABCs of going to college are here to help you assess how ready you are for the transition and to help you build a plan for success.

Anticipate
College can be a very exciting and stressful time with many new responsibilities as well as new social, academic, and work experiences. The first step in assessing how ready you are for this next step is reflecting on what challenges may be ahead of you and your loved-ones.
Use the categories below to anticipate challenges you might face in your transition to college:
FinancesDorms
Dating
Making New Friends
Roommates
Papers
Staying Connected with Family
Drugs/Alcohol
Cafeteria Food
Recreational Activities Nights Out
Social Events
Sleep
Exams
Sexuality
Eating Out
Staying Connected with Old Friends

Increased Academic Pressure and Difficulty
Gender
Working while in School
Build a Safety Plan
Now that you have reflected on the new challenges and experiences college will bring, the next step is making sure you are ready to manage your own recovery and what that entails. There are many predictable challenges to college, like the stress of final exams or eating more independently than you have before. However, there may be times when challenges you couldn’t expect complicate things! For example, how would you cope if you got the flu and got behind in your readings. What would you do if a tough social situation caused you extra stress?
Remember, it’s normal to experience slips. Slips can be part of the recovery process and learning how to manage them is an important skill.  Ensuring an awesome college experience means having your plan to get help lined up before you’re in crisis mode.
Use the following check-list with your supports to build your own safety plan.
College Check List
  • I can go grocery shopping independently
  • I can cook and prepare my own meals
  • I can consistently follow an appropriate meal plan for me
  • I can eat out with friends without symptoms
  • I know I need to prioritize sleep and good self-care to stay healthy and productive
  • I have signed up with counselling and/or accessibility services on campus just in case I need them
  • I know who will manage my medical care and I am familiar with medical services on campus
  • I have researched if there are local supports or groups
  • I have thought about how to talk about my eating disorder history (if and when I want to) with new friends, roommates, partners, etc.
  • I know who to call if I am struggling, and I know when to call them 
    (ex: if I have symptoms __ times per week)
(ex: if my weight changes by __ amount)
(ex: if I experience: panic attack/insomnia/etc.)
  • Other:
Cope Healthfully
Eating disorders have very severe, long-term consequences on health and mental health and no one chooses to have one. Still, it is not uncommon over the course of the illness for eating disorder symptoms to begin serving a functional role in life.  Understanding how symptoms may have helped you in the past, can prevent you from engaging with them in the future.
Check off the items that reflect your experience and
identify alternative coping strategies that will be more supportive of long-term success


 
Functions of the Eating Disorder

 
Alternative, Healthy Coping Strategy
□      Helps me deal with strong emotions by distracting me or numbing outEx: Build a self-care kit filled with distracting or soothing items like music and coloring

□      Helps me feel like I can fit-in, in a world filled with social pressures about shape and weight Ex: Look for a group or club on campus that aligns with my interests, and not the interests of the eating disorder
□      Helps me feel safe and that people in my life are going to stay close Ex: Talk to my loved ones when I’m struggling


□      Helps relieve pressure
(ex: “If I’m sick, I can put things on hold – I’m not sure I can cut it here”) 
Ex: Get connected with accessibility services and create a step-by-step plan for completing homework on time.
□      Helps me to feel more in controlEx: Practice grounding strategies like deep breathing to help me feel in control
□      Helps me deal with boredomEx: Practice urge surfing: When the urge to have symptoms comes up, try to find another activity for 30-minutes before giving in to the urge (ex: visiting a friend, mindful walk)
□      Other
□      Other


Anticipate, Build a Safety Plan + Cope Healthfully

Hopefully these exercises have helped you tackle the ABCs of assessing
if college is the right step for you, right now.
The last piece of guidance we will leave you with is to approach making these decisions with self-compassion2. It is easy to get caught up in external pressures, beliefs, expectations, or comparison making with our peers – but remember – being a young adult means being in a period of change, discomfort and self-discovery. Research shows that it’s way more normal to feel uncertain about just about everything than it is to have it all figured out3.
So with that in mind…
…We wish you luck in making your decision and we hope you challenge yourself to say NO to comparisons and to say YES

When Parents Encourage Children and Teens to Diet

Vol. 29 / No. 2  

Parents who tell a child or teen they need to go on a weight loss diet might be surprised at the long-term outcome. According to Dr. Jerica M. Berge and researchers at the University of Minnesota, Minneapolis, encouraging children and teens to diet can have harmful long-term weight, weight-related and emotional health effects in adulthood and can even be transmitted to the next generation (Pediatrics. March 2018; published online before print.)
Dr. Berge and her fellow researchers have hypothesized that teens who were encouraged to diet by their parents before the age of 19 would be at higher risk for developing unhealthy dieting behaviors, would weigh more and have worse emotional health when they became adults. They also would be more likely to encourage their own kids to diet.
The authors used data from 1998-1999 and follow-up surveys about 17 years later from Project EAT, a longitudinal study of dietary intake, physical activity, weight control behaviors, and weight status (http://www.sphresearch.umn.edu/epi/project-eat/). After initial school-based surveys and anthropometric measurements with middle school and high school students and interviews and surveys of their parents, the students were followed after 5 and 10 years, as they transitioned to early and middle young adulthood. The EAT surveys also trace behavioral changes during the transition from young adulthood to parenthood. The study group included 556 socioeconomically, racially and/or ethnically diverse adolescents (64.6% female) who provided data at both time points.

What the analysis showed

The authors’ hypotheses were largely confirmed. Teens who were encouraged to diet by their parents had a higher risk of using unhealthy diet behaviors, had poorer emotional outcomes, and worse body satisfaction. There was, in fact, intergenerational transmission: teens who were encouraged to diet were more likely to encourage their children to diet.

Finding ways to intervene earlier

The authors discussed their work from the perspective of Family Systems Theory (FST), which states that the family’s home environment has the greatest influence on weight and weight-related behaviors among children, and that behaviors learned in the family setting in which a person is raised are passed on from generation to generation. They highlight the potential value of the findings for developing preventive interventions. The same preventative effects might be used in treatment to help build a rationale for change (that is, changing eating behaviors and attitudes via ED treatment and to avoid intergenerational transmission of thoughts and attitudes).

How Race, Weight, Sex and Socioeconomic Background Affect ED Diagnoses

Vol. 29 / No. 2  

It remains the case that most people with EDs will not be treated. This probably reflects issues with case-finding, with potential patient awareness of ED, and with treatment access. One more reason, according to Drs. Kendrin Sonneville and S.K. Lipson of the University of Michigan School Of Public Health, Ann Arbor, is the persistence of antiquated ideas about who develops an eating disorder. Historically, EDs have been relegated to the realm of skinny, white affluent girls, a group popularly referred to as “SWAG.”

A study of 1,747 students

The Michigan researchers designed a study to evaluate variations on perceived need for ED treatment, ED diagnosis, past year treatment for an eating disorder, and barriers to receiving treatment, according to weight, race/ethnicity, socioeconomic status, and gender (Int J Eat Disord.2018; DOI: 10.1002/eat.22846). The authors turned to data from the Healthy Bodies Study, taken from two academic years, 2013-2014 and 2014-2015.
A student’s perception of the need for eating disorder treatment was elicited with the following question: “Over the last 12 months, do you think you needed help such as counseling or therapy for issues related to eating and/or body image?” The students who responded were then asked about any counseling or treatment they had subsequently received. The study also asked about prior ED diagnosis. The authors also collapsed self-reported race/ethnicity responses into two major categories, white students and students of color. Socioeconomic status was determined by questions about the student’s family financial situation growing up, and several categories were offered: well to do, comfortable, enough to get by, very poor, and not having enough to get by. Students who responded to the question of gender with answers other than male or female were excluded from the final study group.

Certain disparities by race, weight, and gender emerged

When the authors analyzed their data from 1,747 students with symptoms of an eating disorder, they found that participants with EDs were mostly white (79.9%) and female (84.9%), but most were not affluent (only 19.9% were). Notably, only 2.0% were underweight. Underweight students were far more likely to perceive that they needed treatment, to have received a diagnosis, and to have been treated for their disorder.
White students were more likely to have received a diagnosis than were students of color. Socioeconomic background was involved with perception of a need for treatment and for receiving treatment during the past year; affluent students were far more likely to have received treatment than were poorer students.
When students were asked their reasons for not seeking treatment, 28.1% said they preferred to deal with health issues by themselves. Other responses included not needing counseling or therapy (23.9%), and uncertainty about how serious was their need for treatment or counseling (23.9%).
Students with symptoms of threshold AN were significantly more likely to perceive that they needed treatment, to receive a diagnosis, and to be treated, compared with individuals with other types of eating disorders. The authors stress that their results point to the importance of not perceiving need, rather than traditionally considered barriers such as cost.
Drs. Sonneville and Lipson noted that ED researchers often rely on studies based on clinical rather than community samples, which may perpetuate the myth that there is an increased prevalence of eating disorders among more affluent groups.
As for gender discrepancies, the authors point out that most studies of ED-specific treatment-seeking among community samples do not include men. These are critically important insights. Historically, important ED studies have been conducted with women participants in clinical settings, often in what are likely to be relatively high socioeconomic settings. Each of these factors has shaped our understanding of EDs.

A call for better screening

According to the authors, the results point to the need for examining ways to address the inequities in diagnosis and treatment of EDs, including work to dispel the stereotypes and myths about who gets an ED. Better screening, including universal screening, could be more fully adopted in clinical and community settings, such as at colleges and universities which usually add targeted screenings.