Background: Eating disorders are commonly occurring illnesses that frequently cause substantial physical, emotional and psychosocial impairments (Fairburn, et al., 2008). The prevalence of this debilitating condition has led to substantial efforts by researchers and clinicians to search for different ways of understanding the illness for the sole purpose of increasing the presently poor treatment outcomes. Existing theoretical and research literature looking at the role of shame and guilt in eating disorders have put forward a convincing assertion that shame and guilt are poignant features in the psychopathology and symptomatology of the condition. However, these reports have not provided in-depth explanation into how people suffering from eating disorders experience shame and guilt and very little qualitative research has been conducted in this area. Likewise, the interwoven relationship and the differences between shame and guilt and their role in eating disorders psychopathology and symptomatology remain unclear. Aims and Method: The present study is an Interpretative Phenomenological Analysis (IPA) that recognises the uniqueness of an individual’s experience of complex phenomenon such as eating disorder. Thus it aims to explore the understanding and sense-making of shame and guilt experiences by listening to the voices of six people who have been diagnosed and treated for eating disorders using semi-structured interviewing method. The study also explores the role of shame and guilt in treatment particularly their implication in the disclosure of information in the course of treatment. Findings and Discussion: The analysis identified five main themes; the intensity of shame and guilt experience AND the pervasiveness of shame and guilt experience, Guilt and shame as integrated into all facets of the ED, Existential questioning of identity, shame and guilt lived out and developed in different context/ Locus of responsibility. Contribution to knowledge: The study provides deeper understanding of participants’ subjective experience of shame and guilt. The study highlights that shame and guilt are experiences that are intertwined with all facets of eating disorders as well as the individual’s identity. Finally, shame and guilt were described as experiences that negatively impacted on treatment process. The implications of this for counseling psychology practice are discussed, and suggestions for future research are made.

In recent decades, there has been an increased focus on the idealization of thinness and the pressure and expectancy to be thin, which contributes to a rising number of individuals that experience severe body dissatisfaction and body distortion, and in turn, eating disorders. Eating disorders are one of the most common chronic conditions within the youth population, approximately 13% of the adolescent youth population will suffer from at least one eating disorder by age 20, and a majority of those affected will be female. Rural health care providers encounter many health care disadvantages when detecting and treating eating disorders including physical location and distance to nearest healthcare or specialty service, ethnicity, and socioeconomic status. These disadvantages are often responsible for the inability of providers to prevent, screen for, identify, and treat eating disorders. The focus of this practice improvement project (PIP) was to determine how primary care providers in a rural clinic perceived the implementation of the Screening for Disordered Eating (SDE) in adolescent females ages 11-19. During implementation, the providers were also to identify and refer those scoring 2 or greater to a counselor, mental health specialist, and/or eating disorder specialist. Implementation began with an educational meeting explaining eating disorders and their prevalence, as well as the introduction and explanation of the SDE tool. A survey was then completed by the providers to assess the relevance of the information provided to their practice. During the implementation period, providers were to screen all adolescent females ages 11-19 using the SDE tool and refer those scoring 2 or greater. Participating providers then completed a post-implementation survey assessing their perceptions on the ease, accuracy, and applicability of the SDE tool. Overall, based on the post-implementation, providers believe screening for eating disorders is important and the SDE tool is easy and applicable to their practice. Screening for Disordered Eating completion rates (14.1%) and referral rates (17.4%) of those scoring 2 or greater were lower than expected. The prevalence of eating disorders continues to rise and continued use of the SDE tool in the primary care setting is strongly recommended.

Excerpt: The study by Linna et al1 posited that “eating disorders appear to be associated with several adverse perinatal outcomes, particularly in offspring.” The adverse outcomes included anemia, slow fetal growth, premature contractions, and perinatal death. However, this conclusion cannot be supported by the data because the authors failed to correct the standard value of P = .05 to account for the large number of hypothesis tests. This leads to what is known as type 2 error and causes a hypothesis to be accepted that is actually false.

Depth of client experiencing has been associated with positive therapeutic outcomes across theoretical orientations. Experiencing describes a particular mode of cognitive-affective processing in which clients use internal felt experience as the basis for self-examination and the resolution of personally significant issues. Given evidence that eating disorders are associated with particular disruptions of cognitive-affective processing, it is likely that experiencing plays a role in the successful treatment of eating pathology. However, no study to date has examined the relationship between experiencing and outcome in eating disorder treatment. The purposes of the current study were to examine depth of client experiencing during cognitive-behavioral treatment for eating disorders and to investigate the relationship between experiencing and outcome. Regression analyses suggested no significant relationship between depth of experiencing and outcome. However, results indicated that a restricted range of experiencing occurred during the treatment, which may have limited the possibility of detecting a relationship. A number of factors that may have contributed to the restricted range of experiencing in the sample are considered and discussed.

The purpose of this project was to summarize psychotherapy outcomes for eating disorders using meta-analysis. Psychotherapy was defined as any psychosocial treatment including face-to-face therapy, self-help, and Internet approaches. All primary studies, meeting inclusion/exclusion criteria from 1980 to 2010, were included. Results suggested that individuals treated with active treatments demonstrate better outcomes than those in control conditions (d= 0.33, p <.01, 95% CI [0.19-0.46]). CBT was the most often occurring treatment in the primary studies and a small effect, favoring CBT, was found when the treatment was compared to all other active treatments (d = 0.16, p = .02, 95% CI [0.03-0.28]). Internet and self-help approaches continue to show promise with Internet treatments demonstrating superior outcomes to control conditions (d = 0.54, p <.01, 95% CI [0.19-0.90]). More research is needed to determine whether these approaches can suffice as stand-alone treatments or if they are best used in addition to already well-established approaches (i.e., individual CBT). The meta-analysis also explored whether treatment type, outcome measure, diagnosis, attrition, and diagnostic severity moderate treatment effect. Finally, the meta-analysis updated and improved upon previous meta-analyses by focusing on randomized controlled trials, including all diagnoses of eating disorder, only combining effect sizes from similar conditions, including all possible studies that meet inclusion criteria, computing and comparing effect sizes for outcome measures beyond those considered primary to eating disorder treatment, and also addressing outcomes for all brands of psychotherapy including traditional talk therapy, self-help, and Internet approaches.

Body image, broadly defined as an individual's general experience of his or her physical appearance, is a multidimensional phenomenon that has been found to affect functioning throughout the lifetime. Although some degree of dissatisfaction has been found to be a common aspect of the female experience, research suggests that a disturbance in body image can result in a number of clinical complications, particularly the development of an eating disorder (ED). Despite the relationship between body image and EDs, examinations of the cognitive underpinnings of the relationship between body image disturbance and EDs are relatively few and inconclusive. Research indicates that individuals with an ED diagnosis exhibit cognitive rigidity (deficits in set-shifting ability) and weak central coherence(as demonstrated by performance on measures of information processing style). However, research has not established whether individuals with body image disturbance who do not meet criteria for an ED exhibit comparable performance. The aim of the current study was to determine whether individuals with body image disturbance exhibit similar patterns of neuropsychological functioning. A sample of women with high levels of body image disturbance completed a battery of cognitive tests and outcomes were compared to a group of women with little disturbance and also compared with performance of individuals with diagnosed EDs as cited in previous studies. Overall, the results do not clearly indicate that women with body image disturbance have difficulties with set-shifting tasks and global information processing, however some preliminary patterns did emerge. These preliminary findings extend existing theoretical models of body image and have potential to inform clinical efforts aimed at improving treatment protocols for body image disturbance and EDs by targeting these aspects of neurocognition during treatment.

Eating disorders fall within the top nine health ailments affecting young people today. These illnesses such as Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified affect a large number of people, particularly female adolescents. The disorders can further cause complications in one’s health, systemically and orally, sometimes resulting in death. The purpose of this paper is to closely examine published studies examining the link between eating disorders and oral health. Multiple studies have found that patients suffering from eating disorders are more likely to develop tooth erosion. Behaviors often found in eating disorder patients such as self-induced vomiting and ingestion of highly acidic diets can lead to such enamel loss, a condition that is irreversible. Other researchers disagree about whether eating disorders can lead to an increase in dental caries, with some finding amplification and others finding no significant results. Parotid gland swelling is another side effect of eating disorders but this complication often recedes once the unhealthy behavior is halted. Most studies have not yet found a link between these illnesses and increased periodontal disease. However, they do seem to lead to decreased unstimulated salivary flow rates. Furthermore, it also appears that the disorders lead to augmented levels of S. mutans and Lactobacilli. One’s oral mucosa can also be affected via angular cheilitis and oral candidiasis. Additionally, eating disorders may serve as a risk factor for bone and joint disorders such as osteoporosis and temporomandibular joint disorders, respectively. The illnesses may show effect outside the oral cavity through Russell’s sign on one’s knuckles and oral function may be impaired. With all these possible oral complications being some of the first to indicate the presence of an eating disorder, dentists may be integral to identifying and stopping the progression of the disease. However, it has been suggested that eating disorder patients may have greater dental anxiety keeping them from visiting the dentist in the first place, let alone divulging their disease to their dentist. Furthermore, oral health professionals may not be adequately prepared to notice the presence of an eating disorder. Dental schools must do more to teach future oral health professionals about eating disorders, especially in the clinic, as simple suggestions like avoiding brushing one’s teeth immediately after participating in self-induced vomiting may help to reduce the likelihood of enamel erosion. Through this analysis it was determined that while sufficient baseline research has been done, there is still a great deal more to learn about how eating disorders affect one’s oral health. There are multiple forms of diagnostic criteria that could possibly prevent patients from receiving the best treatment possible. Furthermore, more research needs to be done on disorders other than Anorexia Nervosa and Bulimia Nervosa as not every patient falls under these two categories. Since it has been shown that certain types of medication can decrease one’s salivary flow rate, future studies need to also consider any medication that patients may be on. In order to really aid those affected by eating disorders, men should be considered as future subjects too, since most studies have currently only focused on women. By completing more research on eating disorders and their consequences on oral health, health care professionals will be better able to serve those affected.

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