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Editorial on the Research Topic. Extreme Eating Behaviours.

Research suggests that, similar to individuals with an Autism Spectrum Disorder, people with Anorexia Nervosa demonstrate an inability to utilize Theory of Mind concepts. Theory of Mind allows healthy control populations to attribute mental states to others by accurately predicting and understanding the behavior of others. This study's intent was to further explore the relationship between eating disorders and Theory of Mind. Using an online survey management system (Qualtrics), 210 female students from a large metropolitan southeastern university completed the Drive for Thinness subscale of the Eating Disorder Inventory and the Reading the Mind in the Eyes task. It was predicted that higher Drive for Thinness would be associated with a diminished capacity for Theory of Mind concepts. Using a bivariate correlation, the findings were not found to be statistically significant in support of the hypothesis, but provide strong implications for future research.

Bakgrund: Anorexia nervosa och bulimia nervosa är komplexa ätstörningar som medför stort lidande för patienterna. Patienterna drar sig bort från att söka vård då de bland annat inte har sjukdomsinsikt men även andra bidragande faktorer som medför olika känslor kring vårdupplevelsen. Syfte: Belysa upplevelsen av vården bland patienter med anorexia nervosa och bulimia nervosa. Metod: Litteraturöversikt där elva artiklar valdes ut, granskades och sammanställdes för att besvara syftet. Resultat: Upplevelsen av vården bland patienter med anorexia nervosa och bulimia nervosa redovisas via tre huvudteman; patienters upplevelse av att ta första steget till vård, att vara patient och att tillfriskna under vårdtiden. Under varje huvudtema tillkommer två subteman. Det framkom att det är en komplex vårdprocess som innerverar ett brett spektrum av känslor samt olika faktorer som medför både positiva och negativa känslor för berörd patientgrupp. Det föreligger även betydande faktorer i omvårdnaden som påverkar patientens relation till sjuksköterskan samt hur behandlingen, omvårdnaden och tillfrisknande sker. Konklusion: Att vårda patienter med anorexia nervosa och bulimia nervosa är komplext. Genom visat stöd, kommunikation, empati och en god relation mellan sjuksköterskan och patienten kan en adekvat vård utföras där patienten får en god vårdupplevelse. / Background: Anorexia nervosa and bulimia nervosa are complex eating disorders that cause suffering to patients. Patients tend to avoid seeking treatment because, among other things, they have no insight into the disease, but also other contributing factors that lead to different feelings about the care experience. Aim: To shed light on the experience of care among patients with anorexia nervosa and bulimia nervosa. Method: Literature review where eleven articles were selected, reviewed and compiled to answer the purpose. Findings: The experience of care among patients with anorexia nervosa and bulimia nervosa is reported via three main themes; patients' experience of taking the first step, patients' care experience and recovering during the care period. Under each main theme, two subthemes are added. It turned out that it is a complex care process that innervates a wide range of emotions as well as various contributes both positive and negative emotions for this group of patients. Conclusion: Caring for patients with anorexia nervosa and bulimia nervosa is complex.Through shown support, communication, empathy and a good relationship between the nurse and the patient, adequate care can be carried out where the patient gets a good care experience.

Bakgrund: Ätstörning är ett utbrett sjukdomstillstånd. Diabetes mellitus typ 1 kombinerat med ätstörning kan leda till fysiska och psykiska komplikationer. Patienter behöver ofta god vägledning och omsorg för att kunna hantera sitt tillstånd. Syfte: Studiens syfte var att beskriva patienters upplevelser av att leva med diabetes mellitus typ 1 och ätstörning. Metod: Litteraturstudien baserades på tio vetenskapliga studier. Använda databaser var PubMed, CINAHL och PsycINFO. Sju av studierna var genomförda med kvalitativ metod och tre med både kvalitativ och kvantitativ metod. Studierna analyserades med kvalitativ innehållsanalys. Resultat: Efter genomförd innehållsanalys identifierades nio underkategorier och tre huvudkategorier. Huvudkategorierna var: Laborering av insulindoser; Psykisk påverkan; Behov av stöd. Konklusion: Resultatet visade att deltagarna uttryckte behov att bli sedda såväl som hörda i sitt sjukdomstillstånd. Det fanns ett behov för vårdpersonal att tydligare samverka mellan olika vårdinsatser för att samsjukligheten skulle uppmärksammas och ombesörjas i tid. Vården behöver göras mer personcentrad för att tidigare och effektivare kunna erbjuda adekvat information, utbildning och stöd. Det finns även behov att integrera familj och eventuellt andra med liknande erfarenhet som stöd. Resultatet pekade även på en kunskapsbrist inom vården och att vårdpersonal är i behov av utbildning för att ombesörja deltagarnas behov av vård. / Background: Eating disorder is a widespread condition. Diabetes mellitus type 1 combined with eating disorder can lead to physical and psychological complications. Patients often need good guidance and care to manage their condition. Aim: The study’s purpose was to describe patients’ experiences of living with diabetes mellitus type 1 and eating disorder. Method: The literature review was based on ten scientific articles. Databases used were PubMed, CINAHL and PsycINFO. Seven of the articles were created using qualitative methods and three with both qualitative and quantitative methods. The articles were thematically analyzed. Result: Through content analysis nine subcategories and three categories were identified. The categories were: Experimentation with insulin dosage; Psychological impact; Need for support. Conclusion: The results showed that the participants expressed a need to feel seen as well as heard in their illness. There was a need for healthcare personnel to collaborate more clearly between different healthcare interventions for this comorbidity to be noticed and attended to in time. Healthcare need to be made more person-centered to be able to both earlier and more efficiently offer adequate information, training, and support. There is also a need to integrate family and potentially others with similar experiences as support. The result also pointed to a lack of knowledge within healthcare and that healthcare personnel need training to take care of the participants' need for healthcare.

The Covid-19 pandemic presented unprecedented challenges, with global lockdowns impacting individuals on a profound scale. Many took to social media to cope with feelings of anxiety and isolation. Lockdown conditions and social media carry with them particular challenges, triggers and temptations for those with eating disorders, namely in the form of online communities promoting eating disorders and disordered behaviors as a legitimate lifestyle choice. This study examines pro-eating disorder Twitter communities before, during and after the initial Covid-19 lockdown (Mid-March to May 2020) to examine the influence of confinement on leadership dynamics and content trends. Utilizing data obtained through Twitter’s Academic API, I constructed monthly retweet network time-slices spanning from November 2019 to September 2020. Through social network analysis and analyzing turnover rates of top users, the evolution of influential users was assessed to test whether the circumstances created by Covid-19 restrictions would disrupt the established leadership paradigm or the period would maintain stable leadership based on expectations proposed by the literature of preferential attachment in scale-free networks. Contrary to expectations, influential users exhibited high turnover throughout the period and the network showed no tendency towards preferential attachment or any scale-free behavior in degree distributions. The high rate of leader turnover further increased in May and a higher proportion of new users achieved the highest number of in-degree ties into the latter months, but this hint at a cohort shift did not align with covid lockdown as predicted, instead occurring at the end of lockdown and continuing until the end of the studied period. Ultimately, users’ mostly fleeting popularity was largely based on the current content interests of the group rather than the individual user’s network position. The increase in activity predicted to co-occur with covid restrictions did not materialize until the summer months, therefore cannot be definitively linked to lockdown. The fluctuations in topic popularity detected in the topic model suggest a possible seasonal component to the rhythms of this community that requires further research. This exclusive longitudinal analysis of retweet networks as they were affected by covid-19 lockdown conditions challenges previous research on influence in social networks and online communities with findings of more dynamic leadership. Understanding the influence dynamics of this community can inform efforts to combat the spread of potentially harmful content and provide valuable insights for eating disorder specialists navigating the influences that may affecting their patients.

Although case studies in avoidant/restrictive food intake disorder (ARFID) indicate severe nutritional deficiencies in those with a highly limited amount or variety of food intake, systematic analyses on food intake in treatment-seeking children and adolescents with ARFID are lacking. Within this study, n = 20 patients with an interview-based diagnosis of ARFID (0–17 years) were included and compared to n = 20 healthy controls individually matched for age and sex. Children or parents completed three-day food diaries and a food list. Macronutrient, vitamin, and mineral supply was determined based on the percentage of their recommended intake. The results showed a significantly lower total energy and protein intake in ARFID versus controls, with trends for lower fat and carbohydrate intake. ARFID subtypes of limited amount versus variety of food intake significantly differed in macro-, but not micronutrient intake. Those with ARFID met only 20–30% of the recommended intake for most vitamins and minerals, with significantly lower intake relative to controls for vitamin B1, B2, C, K, zinc, iron, and potassium. Variety of food intake was significantly reduced in ARFID versus controls in all food groups except carbohydrates. This study demonstrated that ARFID goes along with reduced everyday life macro- and micronutrient intake, which may increase the risk for developmental and health problems. Future studies additionally assessing serum nutrient levels in a larger sample may further explore differences in food intake across diverse ARFID presentations.

Bakgrund Ätstörningar är ett växande samhällsproblem och kan förekomma hos en person oavsett kroppsvikt, könsidentitet eller etnicitet. Fördomar om hur en stereotypisk person med ätstörning ser ut och beter sig förekommer både i samhället och inom hälso- och sjukvården. Personer med ätstörningar förekommer såväl i primärvården som i den specialiserade ätstörningsvården. Eftersom ätstörningar orsakar ett psykiskt och somatiskt hot mot personens hälsa behöver sjuksköterskan inom alla vårdkontexter ha kunskap och förståelse om personens upplevelse av situationen.  Syfte Syftet med litteraturstudien är att beskriva personers upplevelse av att erhålla vård vid ätstörningar. Metod En icke-systematisk litteraturöversikt baserat på 15 vetenskapliga originalartiklar. Med hjälp av olika kombinationer av sökord inhämtades artiklarna från databaserna CINAHL och PubMed. En kvalitetsgranskning av artiklarna genomfördes utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. En integrerad dataanalys användes för att sammanställa resultatet.  Resultat Det sammanställda resultatet presenterades under tre huvudkategorier: Upplevelser av ett viktfokus, Behovet av att bli tagen på allvar samt Vårdrelationens betydelse. Resultatet indikerar att oavsett ätstörningsdiagnos upplevs ätstörningsvården ofta exkluderande. Därtill är det viktigt att bli bekräftad i sin sjukdom och att utveckla en medmänsklig vårdrelation. Slutsats Denna litteraturöversikt visade att när ätstörningsvården upplevs inkluderande och anpassar vården efter personen finns goda möjligheter att erhålla ett positivt behandlingsresultat. Med ökad kunskap och förståelse om ätstörningar kan sjuksköterskan i sitt omvårdnadsansvar bemöta önskemålet om att ätstörningsvården ska utgå från ett helhetsperspektiv. / Background Eating disorders are a growing problem in society and can occur in persons regardless of body weight, gender identity, or ethnicity. Stereotypes about how a person with an eating disorder looks and behaves exist both within society and within the healthcare system. People with eating disorders can seek care and support in both primary health-care settings and specialized eating disorder services. Since eating disorders pose a psychological and somatic threat to a person’s health, nurses in all areas of care need to have knowledge and understanding of the person’s situation.  Aim The aim of this literature review is to describe the person’s experience of receiving care for eating disorders.  Method A non-systematic literature review based on 15 scientific original articles. The articles were retrieved from the databases CINAHL and PubMed using various combinations of keywords. A quality assessment of the articles was conducted based on Sophiahemmet University's assessment criteria for scientific classification and quality. An integrated data analysis approach was used to compile the results. Results The compiled results were presented under three main categories: Experiences of a weight focus, The need to be taken seriously, and Significance of the healthcare relationship. The results indicate that regardless of the eating disorder diagnosis, the eating disorder care is often experienced as excluding. Additionally, it is important for the person to get the illness confirmed and to develop a compassionate patient-caregiver relationship.  Conclusions This literature review showed that when eating disorder care is experienced as inclusive and tailored to the person, there are good opportunities to achieve a positive treatment outcome. With increased knowledge and understanding about eating disorders, nurses through their nursing responsibilities can meet the desire for eating disorder care to be based on a holistic perspective.

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