Latin American countries lead in Google search volumes for anorexia nervosa and bulimia nervosa: Implications for global mental health research.

The Eating Disorder Journal

(January 2019, Vol. 20, No.1)

EDReferral.com

Although eating disorders occur worldwide, prevalence data beyond Euro-American contexts are sparse, and eating disorders largely remain outside global mental health agendas. This study aims to address this gap in the epidemiological literature through a global infodemiological comparison of Google search volumes for the topics "Anorexia nervosa" and "Bulimia nervosa." METHOD: Data were generated through Google Trends, a tool that assesses the relative search volumes of keywords and topics. Google Trends data, collected from January 1, 2004 to December 31, 2016, were obtained for the relative search volumes of the topics "Anorexia nervosa" and "Bulimia nervosa" worldwide. RESULTS: The findings revealed that Latin American countries accounted for the top 10 in search volume for both topics, with Mexico ranked first until 2016, when Bolivia rose to the top of the list. DISCUSSION: The results suggest that eating disorders are of considerable and consistent salience across Latin America, and that population-based, nationally representative studies to assess the prevalence of eating disorders in Latin American countries should be prioritized within global mental health research agendas. Int J Eat Disord. 2018 Nov 26. doi: 10.1002/eat.22969. [Epub ahead of print]

Progress in Developing Pharmacologic Agents to Treat Bulimia Nervosa.

The Eating Disorder Journal

(January 2019, Vol. 20, No.1)

EDReferral.com

This is a review of the past and current progress in developing pharmacologic agents for the treatment of individuals with bulimia nervosa (BN). We searched the literature and clinical trial registries for compounds studied in BN, the related condition, binge eating disorder (BED), and preclinical models of binge-eating behavior. Drug classes evaluated included antidepressants, antiepileptic drugs, stimulants and other medications for attention-deficit/hyperactivity disorder, opioid antagonists, and weight loss agents, among others. The only available drugs with established efficacy in BN at this time include antidepressants (especially selective serotonin reuptake inhibitors [SSRIs]) and the antiepileptic topiramate, though the efficacy of these compounds is modest at best. The only medications we found currently receiving empirical study in people with BN were fluoxetine, other serotonergic antidepressants, intranasal naloxone, lisdexamfetamine dimesylate, phentermine-topiramate combination, the antiandrogenic oral contraceptive ethinyl estradiol plus drospirenone, and prazosin. Preclinical models suggest that nociceptin receptor antagonists, the selective serotonin 5-HT2C receptor agonist lorcaserin, monoamine stabilizers, and selective orexin-1 receptor antagonists might be helpful. We found no evidence of a drug developed specifically for the treatment of individuals with BN. Future areas for research in the pharmacotherapy of BN are suggested. Importantly, until drugs are developed specifically for eating disorders, drugs developed for other conditions that are centrally acting and associated with beneficial psychotropic effects and/or reduced appetite or weight loss might be considered for repurposing in BN. CNS Drugs. 2018 Dec 6. doi: 10.1007/s40263-018-0594-5. [Epub ahead of print]

Progress in Developing Pharmacologic Agents to Treat Bulimia Nervosa.

The Eating Disorder Journal

(January 2019, Vol. 20, No.1)

EDReferral.com

This is a review of the past and current progress in developing pharmacologic agents for the treatment of individuals with bulimia nervosa (BN). We searched the literature and clinical trial registries for compounds studied in BN, the related condition, binge eating disorder (BED), and preclinical models of binge-eating behavior. Drug classes evaluated included antidepressants, antiepileptic drugs, stimulants and other medications for attention-deficit/hyperactivity disorder, opioid antagonists, and weight loss agents, among others. The only available drugs with established efficacy in BN at this time include antidepressants (especially selective serotonin reuptake inhibitors [SSRIs]) and the antiepileptic topiramate, though the efficacy of these compounds is modest at best. The only medications we found currently receiving empirical study in people with BN were fluoxetine, other serotonergic antidepressants, intranasal naloxone, lisdexamfetamine dimesylate, phentermine-topiramate combination, the antiandrogenic oral contraceptive ethinyl estradiol plus drospirenone, and prazosin. Preclinical models suggest that nociceptin receptor antagonists, the selective serotonin 5-HT2C receptor agonist lorcaserin, monoamine stabilizers, and selective orexin-1 receptor antagonists might be helpful. We found no evidence of a drug developed specifically for the treatment of individuals with BN. Future areas for research in the pharmacotherapy of BN are suggested. Importantly, until drugs are developed specifically for eating disorders, drugs developed for other conditions that are centrally acting and associated with beneficial psychotropic effects and/or reduced appetite or weight loss might be considered for repurposing in BN. CNS Drugs. 2018 Dec 6. doi: 10.1007/s40263-018-0594-5. [Epub ahead of print]

Eating Disorders Patients and the Internet

Vol. 29 / No. 6 — Eating Disorders Review0

Although the Internet has many benefits, negative effects emerged from concentration on body image, weight, and comparisons with the ‘thin ideal.’

One area often overlooked in treatment is the time eating disorders patients spend on the Internet, according to a group of Israeli researchers (Front Psychol. 2018; 9:2128. d/fpsyg.2018.02128. doi 10.3389). And, the social interactions online can have positive and negative effects; patients can gain a sense of connectedness but also face comparing themselves unfavorably to the “thin ideal.”

Dr. Rachel Bachner-Melman and colleagues at Soroka University Medical Center, Beersheba, Israel, compared the scope, Internet use patterns, and degree of online need satisfaction of girls and women with and without a lifetime eating disorder diagnosis. The study group included 122 females 12 to 30 years of age; 53 had an eating disorder and were recruited from a hospital-based treatment program, and 69 age-matched controls with no current or prior eating disorder who were recruited from social media sites. All participants completed questionnaires that assessed disordered eating, body image, positive and negative affect, general distress and life satisfaction, and also completed an online survey about their Internet use, how often they watched and posted pictures and videos, online friendships and social comparisons, and their mood after leaving the Internet.

Similar time spent online, but distinct differences 

Both study groups spent a mean of 6 1/2 hours online each day. However, those with eating disorders spent more of their online time visiting forums and reading blogs than did control group members. In fact, more than half of their time online was devoted to eating, weight, and body image, significantly more than control participants (56.7% versus 29.1%, respectively).

The group with eating disorders watched significantly more videos online than did controls. However, both groups were equally likely to view pictures posted by others, but those with lifetime diagnoses of eating disorders were less likely to post pictures of themselves and others online than were controls.

After being active online, as, for example, commenting, posting pictures and offering advice to others online, those with eating disorders reported feeling sadder than did control group members. There was, however, no significant difference between the groups in their experience of relief, fear of others’ reactions to their comments, and satisfaction from having contributed something positive to the sites.

The authors noted that the study results showed several negative aspects of Internet use by women with eating disorders, and areas that might be targeted in treatment. Women with eating disorders tended to use the Internet to focus on eating, weight, and body image. They also tended to have a higher ratio of online to offline friends, to compare their appearance to others’ online photos, and to leave the Internet with negative feelings. This pattern was also associated with the severity of symptoms, body dissatisfaction, negatively associated with satisfaction with life.

Suggestions

The researchers had several suggestions for clinicians treating patients who frequently use the Internet to visit forums and blogs. Use of the Internet should be a topic in therapy with people who have an eating disorder.  Parents can also be informed about Internet use and take a greater interest in the eating- and body image-related Internet options open to young people and to be alert for possible signs of negative effects.

While encouraging the sense of connectedness that patient feel with being online, clinicians can also help patients develop “real life” social skills, such as social problem-solving and better recognition of facial expressions. Patients can also be encouraged to create connections with healthy people around them, and to speak about their disorders, helping reduce the need to do so exclusively or mainly online.

Collegiate Female Athletes’ Knowledge About Eating Disorders

Vol. 29 / No. 6 — Eating Disorders Review0

Knowing the signs and symptoms of an eating disorder brought the lowest scores.

Athletes are a group at high risk for disordered eating, and one would hope they would be knowledgeable about eating disorders. In fact, athletic organizations such as the National Association of Intercollegiate Athletics (NCAA) have engaged in raising awareness about eating disorders (these efforts may focus on larger athletic programs). When a team of American and Swedish researchers compared general knowledge about eating disorders and confidence in that knowledge among a group of female athletes, they were surprised to learn that despite the women’s confidence in their knowledge of eating disorders, their actual understanding fell far short.

Dr. Megan E. Rosa-Caldwell and colleagues recruited 51 women from an NCAA Intercollegiate Athletics university and asked them to complete a 30-question exam assessing 5 different categories related to eating disorders (Peer J. 2018; doi 10.7717/peer). 5868).

Most scores were unsatisfactory

Fifty-one female college athletes (mean age: 19.7 years) completed the study. The average score was 69.1%. Only 23% achieved an adequate score of >80% correct, despite the fact that most thought their level of knowledge was good. Most could identify risk factors but scored the worst on identifying signs and symptoms. As the authors noted, most of the athletes lacked knowledge about eating disorders.

Some possible explanations

While there is a substantial amount of research on eating disorders risk and prevalence of this among athletes at large universities, little research has been done at smaller athletic programs, which often lack the resources that are present at the larger universities, such as access to team physicians, team-specific athletic trainers, or dietitians.

The authors note that overconfidence may also play a role, citing the Dunning Kruger effect, first outlined in the 1990s (J Personality Soc Psychol. 1999; 77:1121). An individual may have high confidence in his or her knowledge of a subject but in fact does not have the ability to see the limitations of their knowledge. Coaches or teammates who cannot recognize problematic eating behavior but who are also confident in their ability to do so can have serious ramifications.

This study points to potential challenges in small collegiate athletic programs and may also identify an overlooked need for increased efforts to improve awareness efforts. An individual may lack the knowledge to identify signs and symptoms of disordered eating among his or her peers, yet have high confidence in the ability to do so. Improving knowledge about eating disorders in these athletes could thus have a large impact.

When People with Anorexia Injure Themselves

Vol. 29 / No. 6 — Eating Disorders Review0

Difficulty regulating emotions is a common component of an eating disorder, and self-injury  may act as a coping mechanism for dealing with overwhelming emotions. This was one finding from a recent study of patients with anorexia nervosa or eating disorders not otherwise specified (J Eat Disord. 2018; 6:26).

Dr. Linda Smithius and colleagues at Parnassus Psychiatric Institute, Rotterdam, used a cross-sectional design and a self-report questionnaire to measure the prevalence and characteristics of self-harm behavior among 136 patients with eating disorders. The authors found that 41% of their study subjects had injured themselves during the previous 30 days. Those who injured themselves had been in treatment longer and were more likely to have a secondary psychiatric diagnosis, suggesting more severe illness than those who did not injure themselves. These patients also stated they a reduction in negative feelings and increased relief after hurting themselves. Afterwards they also could articulate the emotions that led them to injure themselves. The Dutch researchers were also able to isolate the intensity of two emotions in particular, “feeling angry at myself” and “feeling angry at others.”

The authors noted that emotion regulation appears to differ between subtypes of anorexia nervosa, so that patients with the purging subtype have reported greater difficulty regulating their emotions than do patients with restrictive-type anorexia nervosa (J Eat Disord. 2016; 4:17). The findings replicate work using intensive self-monitoring strategies such as ecological momentary assessment to measure the impact of self-injury on emotion regulation

Large Study Analyzes Compulsive Exercise and Eating Disorders

ol. 29 / No. 6 — Eating Disorders Review0

One finding: Nearly half of eating disorders patients were compulsive exercisers.

In the largest study to date of compulsive exercise in adults with eating disorders, more than 9,000 female and male patients were examined for tell-tale symptoms (J Eat Disord. 2018; 6:11). Dr. Elin Monell and colleagues at the Karolinska Institute and the Stockholm Health Care Services, both in Stockholm, Sweden, gathered their data from the Stockholm database, a clinical database for specialized eating disorders treatment centers throughout Sweden. The database includes all treatment modalities, including medical, psychosocial and nutritional data and records the length and intensity of treatment.

In Sweden, about 60% of treatment is given as outpatient care; approximately 25% of patients receive day treatment and residential care. Records of patients registered from March 2005 to October 2017, were identified, and 9,117 patients with histories of eating disorders were included in the final study. All participants were studied with semi-structured interviews and questionnaires, including the Structured Eating Disorder Interview, the Eating Disorder Examination questionnaire(EDE-Q), The Structural Analysis of Social Behavior,and the Structural Clinical Interview for DSM-IV-Axis 1 Disorders(SCID-1).

Compulsive exercise at admission

Of the total sample of 9,117 patients, 96.3% were female, and the patients’ ages ranged between 18 and 81 years. Compulsive exercise was noted in 48.2% of female patients at admission and in 45.5% of male patients, where it was most often linked to eating disorders not otherwise specified or to bulimia nervosa. Both males and females who compulsively exercised had more general eating disorders pathology and restraint than did those who did not compulsively exercise. Females with compulsive exercise diagnoses were slightly younger, had a fairly shorter duration of eating disorders, and a slightly lower body mass index than did non-compulsive exercisers.

Compulsive exercise predicted a slightly lower remission rate in men, and women who had never engaged in compulsive exercise or had ceased using it remitted twice as quickly as those who continued to use compulsive exercise during treatment.

The authors noted that compulsive exercise was a transdiagnostic symptom in their study. Their results are similar to those of a prior study of adolescents with eating disorders. This growing body of literature suggests that while exercise has received relatively little attention, it deserves greater focus, both in research and in clinical practice.