Training in sport environments that emphasize leanness and muscularity may damage athletes' body image and negatively influence male athletes' eating behaviors and attitudes. The Questionnaire for Eating Disorder Diagnosis and the Bulimia Test – Revised were completed anonymously online by 732 male intercollegiate athletes. Most male collegiate athletes were classified as asymptomatic (82.9%), followed by symptomatic (16%) and eating disordered (1.1%). The most common forms pathogenic behaviors were excessive exercise (51.6%), binge eating (21.4%), and dieting or fasting (20.5%). Results suggested that athletes who participate in weight class sports are at higher risk for developing these behaviors than endurance sport or ball game athletes. Counseling and other implications for professionals working with athletes are discussed.

Purpose of the Study: The purpose of this study was to test an investigator-developed culturally relevant eating disorder assessment tool, the Risk Assessment of Eating Disorders (RAED), for eventual clinical application in assessing eating disorders in Hispanic women. This study also examined clinical guidelines, developed by the investigator to guide providers in using culturally appropriate behaviors during the assessment process.Research Questions: 1. What do Hispanic women identify and endorse as relevant areas of assessment for detection of potential eating disorders? 2. What culturally competent questions and provider behaviors or interactions do Hispanic women endorse as enabling them to volunteer specific information about their eating disorders? Background: Although some knowledge exists regarding appropriate and effective assessment questions to detect eating disorders, clinicians lack a culturally relevant and brief tool for use in primary care. Literature on existing assessment instruments and the Theory of Cultural Marginality informed development of the tool and guidelines.Method: Five Hispanic females with diagnosed eating disorders completed the RAED tool and scored items for relevance and clarity. This was followed by interviews and discussions with participants concerning perceptions of provider behaviors that enable or inhibit women reporting specific disordered eating behaviors to providers. Results: The results supported relevance and clarity of a 14-item RAED for assessing eating disorders. Seven clinical guidelines were developed on culturally appropriate provider behaviors to help Hispanic women volunteer specific information on their eating disorder behaviors. Discussion: A shorter assessment was developed for eventual use in advance practice nursing. The participants also identified provider behaviors including empathy, a non-judgmental attitude, and being willing to sit down with the patients, as enabling them to speak up about their eating disorder. The Theory of Cultural Marginality was useful in developing the RAED items and Provider Guidelines for assessment. Continued research of the RAED and clinical guidelines was recommended to provide adequate empirical support for use of the assessment tools and theory by advance practice nurses in primary care of Hispanic women, as well as all women with eating disorders.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 2017 / Introduction. Eating disorders are an important group of mental illnesses in Psychiatry. The aetiology is multifactorial, developing from distorted beliefs around body image and shape, with resultant abnormal eating behaviours. This study explores the views and perceptions of a group of university students regarding their peers’ body image and shape and eating behaviours, which they experienced (at the time) during their senior high school years. The majority of these students attended high schools in Johannesburg. Method. This was an explorative, qualitative study using qualitative methods. A sample of 153 participants was voluntarily recruited from students in the Faculty of Health Sciences at the University of the Witwatersrand. A manually distributed anonymous questionnaire was used, with questions about their high school peers’ personality traits, early and late childhood experiences, eating behaviour, and the last three years of high school environment. Questions in each section were deconstructed and categorised into subthemes. Subthemes were further deconstructed into replicated ideas. These subthemes and ideas were presented in hierarchical tables. Findings in this study were compared with the literature. Results. The most commonly described subtheme of participants’ perceptions of high school peers’ personality traits was “poor self-confidence”. The most replicated subthemes of views on peers’ childhood experiences were “personal conflict with members of the family”, “a disruptive home environment” and “mother’s attitude”. In terms of peers’ eating behaviour, a subtheme on “body shapes” included “fat”, “skinny” and “fit” and “muscular” bodies. In terms of the high school environment, the subtheme of “bullying and peer discrimination” was regarded as important, while “the impact of media” was regarded as extremely important. Fifty percent of participants viewed body image to be important for social status. There were mixed views on whether specific programmes should be introduced to identify pupils at risk. Conclusion. Although bullying and peer pressure have been described as contributing factors in the development of eating behaviour problems in high school learners, as perceived by a group of university students, the most prominent potential contributing factor considered was the media, specifically social media. This finding could contribute to further research looking at the role of social media, not only its relationship in the potential development of a Psychiatric Illness, but possibly, too, its role in the educational and rehabilitation process. / MT2017

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / INTRODUCTION: Evidence supporting outpatient treatments for anorexia nervosa (AN) is severely lacking, due to low retention rates and poor outcome in treatment studies. One explanation for patient drop-out is weak treatment alliances, which are also associated with poor outcome. This study investigates a novel treatment for AN, Alliance Focused Treatment (AFT), which attends to ruptures in the alliance as well as interpersonal difficulties and emotional avoidance commonly associated with AN. Group analyses are presented along with one detailed case. METHOD: Seven women with AN-spectrum illnesses were randomized to receive both AFT and Behavioral Change Treatment (BCT) using a replicated single case A-B-C-B design. Participants began with a Baseline Phase (A) and then received the experimental treatment (AFT) and the comparison treatment (BCT) in alternating fashion. This design allowed each participant to provide comparison (control) data for each treatment. "Time" (session number) was used as a covariate in analyses. Each treatment phase was four weeks long, with twice-weekly sessions. Participants recorded daily kilocalorie intake and post-session treatment alliance. Generalized Estimating Equations were used to examine differences in kilocalorie intake and treatment alliance between phases and within participants. Graphs of slopes of kilocalorie and alliance change for each participant, in each phase, facilitated observation of treatment effects. RESULTS: Six participants completed treatment. Significant overall increases in kilocalorie intake were observed only in BCT relative to a baseline period when controlling for time, however, both AFT and BCT showed interactions with time indicating kilocalorie intake increased in both conditions. No significant differences between active treatments in kilocalorie intake were observed. Participants rated global working alliance significantly higher in BCT, while they rated the task dimension of alliance significantly higher in AFT. Global patient-rated treatment alliance was significantly associated with kilocalorie intake, and the relationship between global alliance and kilocalorie intake became stronger over time. Participants rated ruptures in 39% of sessions and frequently reported discussion of the rupture as a component of its resolution. DISCUSSION: This study provides preliminary support for the feasibility and effect of AFT and BCT, and highlights the importance of the alliance in treating adults with AN. / 2031-01-02

Background: Eating disorder (ED) researchers continue to explore the effectiveness of e-therapy in improving symptoms and its treatment acceptability, however issues relating to poor uptake, adherence and dropout pose a challenge. Within this portfolio, the systematic review aimed to explore adherence to e-therapy for the treatment of ED, specifically exploring rates and predictors of uptake, completion, and dropout from randomised controlled trials (RCT) of ED e-therapy. The empirical project aimed to explore in-depth symptom change for ED cases engaged in blended internet-based cognitive behavioural therapy (ICBT) and face-to-face ED input. Acceptability of blended input was also explored. Methods: For the systematic review, literature searches were undertaken in March and September 2017 across EMBASE, PsycINFO, MEDLINE, Ovid and Cochrane Central Register of Controlled Trials (CENTRAL) and ProQuest databases. Key papers were assessed against five quality criteria (random assignment to groups, blinding to treatment allocation, quality of content, level of contact, sample size with sufficient power). Using a retrospective case series design, the empirical project explored changes over time of ED, anxiety, depression, quality of life (QoL), motivation for change, overall psychological functioning and clinician-rated/patient-rated improvement. Standardised health assessment measures captured symptoms over multiple time-points, and data was analysed using t-tests, multi-level modelling (MLM) and visual analysis. Acceptability of treatment was tentatively explored using an open feedback questionnaire. Results: Systematic review results identified intervention (content, acceptability, delivery method/location), participant (nature of symptoms, BMI, education, prior therapy, personality, views on e-therapy) and therapist-related factors (therapeutic support) were indicated in predicting uptake, completion and dropout across ED e-therapy. In the empirical project, study findings were inconclusive regarding symptom change attributable to blended input. Model fit improved when severity of ED symptoms predicted overall psychological functioning and patient-rated improvement over time, however findings were non-significant - potentially due to the study being underpowered. Conclusions: Promising evidence exists for ED e-therapy as an acceptable treatment option, however understanding which content nurtures engagement best is needed. Further research is needed into the factors predicting ED blended treatment outcome.

This study presents an in-depth case study of eight sessions of spiritually integrated psychotherapy with a 20-year-old woman recovering from an Eating Disorder. The inclusion and utility of session-to-session outcome data as well as systematic follow up data in conjunction with in-depth qualitative interviews are shown. The therapist and client's perspectives are highlighted over the course of treatment. Three clinical areas of focus (renewing identity, reducing self-contempt, and fostering hope) are extracted from the qualitative interviews and the therapeutic process of weaving them together is highlighted. The Tau-U and SMA single case study statistical analyses are used to highlight clinical gains and maintenance.

The age of onset for eating disorders (anorexia and bulimia nervosa) among females is typically late adolescence. In the present study, it was hypothesized that the onset of eating disorders is related to the late-adolescent developmental task of identity development. Thirty-three late adolescent and young adult females who met DSM-III-R criteria for an eating disorder (anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified) and 33 control females completed the Extended Objective Measure of Ego Identity status -- 2 (EOMEIS-2). Results of chi square analyses revealed no significant differences between eating disorder and control females with regard to status of identity development. However, when identity status subscale scores were treated as continuous variables, several significant between-group mean differences emerged. In line with expectations, eating disorder subjects scored higher on ideological diffusion and moratorium, and they scored lower on ideological achievement. Eating disorder subjects also scored higher on interpersonal diffusion and lower on interpersonal achievement. In addition, there were significant correlations between ideological diffusion and measures of depression and anxiety. Unexpectedly, there were also significant correlations between ideological moratorium and measures of depression, anxiety, social alienation, family discord, and borderline personality symptomatology. The possible implications of these results for understanding frequently occurring, co-morbid symptoms in eating disorder subjects are discussed.

The present study investigated perceptions, attitudes, and beliefs toward individuals with anorexia nervosa (AN) of varying weight. The primary aim was to examine the associations between eating disorder symptom level and stigma toward eating disorders, perceptions of acceptability/desirability of AN, and perceptions of severity of AN. The second aim was to investigate the impact of body weight on males’ and females’ perceptions and attitudes toward AN, specifically on their stigma toward eating disorders, perception of the severity of AN, and perception of acceptability or desirability of AN behaviors and characteristics. Two-hundred fifty-seven university students (187 females, 70 males, mean age = 22.5, SD = 6.59) in undergraduate courses participated in the online study, and were randomly assigned to view one of three underweight female figures (extremely thin, moderately thin, and mildly thin). Participants read a vignette describing an individual meeting full diagnostic criteria for anorexia and completed measures assessing stigma toward individuals with AN and eating disorder symptomatology. Regarding the first aim, it was hypothesized that an inverse relationship would emerge between eating disorder pathology in participants and stigmatizing attitudes and beliefs. In support of the hypothesis, findings revealed that increased acceptability of AN and greater perceptions of AN severity were associated with higher levels of eating disorder symptoms. In contrast to the hypothesis, current self-reported eating disorder symptoms were not significantly associated with lower levels of eating disorder stigma. It was also hypothesized that female participants would perceive AN as more positive and acceptable, and as less severe than male participants. The hypothesis was partially supported in that females indicated less stigma toward EDs and reported perceiving AN to be more serious than males. Greater acceptability was not more common among women. In regard to the second aim, there was no significant group differences found in eating disorder stigma, perceived acceptance of AN, and perceived severity of AN according to weight conditions, which was contrary to expectations. Implications of the study are discussed in terms of future research.

Doctor of Philosophy(PhD) / Research indicates that eating disorders and anxiety disorders frequently co-occur. The prevalence of anxiety disorders amongst anorexia nervosa and bulimia nervosa samples has been reported in a number of investigations. Despite the significant number of research papers investigating the comorbidity between eating disorders and anxiety disorders, many are plagued by methodological problems, limiting the usefulness of findings. Furthermore, there is a significant lack of research examining the prevalence of eating disorders among anxiety patients, and as a result, the frequency of eating disorder pathology among patients presenting to specialty anxiety clinics is unclear. The current research investigated the prevalence of comorbid eating and anxiety disorders amongst 152 women presenting for either eating disorder treatment or anxiety disorder treatment. The prevalence of anxiety disorders was determined from a sample of 100 women presenting for inpatient and outpatient eating disorder treatment. The prevalence of eating disorders was determined from a sample of 52 women presenting for outpatient treatment of an anxiety disorder. The current study found that 65% of women with eating disorders also met criteria for at least one comorbid anxiety disorder. Furthermore, 69% reported the onset of the anxiety disorder to precede the onset of the eating disorder. Of the anxiety disorders diagnosed, Social Phobia was most frequently diagnosed (42%) followed by PTSD (26%), GAD (23%), OCD (5%), Panic/Ag (3%) and Specific Phobia (2%). We also found that 13.5% of women presenting for anxiety treatment also met criteria for a comorbid eating disorder. The results of this study suggest that the prevalence of eating and anxiety disorder comorbidity is high. It is hoped that the present research will have significant etiological and therapeutic implications and further the understanding of the development and maintenance of eating disorder pathology.

Doctor of Clinical Psychology / Master of Science / Despite a number of different psychotherapeutic approaches having been examined for use with patients with eating disorders, there is still no established psychological treatment associated with acceptable levels of long-term recovery. These poor recovery rates are associated with the observation that eating disorder patients are often ambivalent, or even resistant, to treatment. As such, research has begun to explore the use of Motivational Enhancement Therapy (MET), a treatment approach that aims to engage ambivalent and change resistant patients in the treatment process, with these individuals. Poor motivation to recover is particularly prominent within the inpatient eating disorder setting. However, no previous study has examined the use of MET to foster willingness to engage in treatment with this group of patients. The objectives of the current study were twofold. Firstly, an examination of the effectiveness of an inpatient eating disorders unit affiliated was undertaken in order to further the research base upon which future inpatient interventions can be built and compared. The second objective was to develop and evaluate a brief MET group program for inpatient eating disorder sufferers. The goal of the intervention was to enhance patients’ motivation to more effectively utilise the inpatient program and to hence positively impact upon their psychological, physical and behavioural functioning. Forty-two consecutive inpatients meeting DSM-IV criteria for an eating disorder were recruited into the current study and sequentially allocated to groups. Twenty-three inpatients completed four MET groups in addition to routine hospital care. A control group of 19 participants in the standard hospital treatment program was also employed (TAU group). The inpatient unit was associated with significant improvements on a number of physical, behavioural and emotional outcome measures. Despite no significant differences between the MET and the TAU groups being found on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer-term motivation and engagement, and to promote treatment continuation. This study hopes to start a constructive debate on the role of MET in the inpatient eating disorders unit.