Eating psychopathology and psychosocial impairment in patients treated at a Singapore eating disorders treatment programme

Abstract

INTRODUCTIONThere is limited data on the psychopathology of eating disorders in Singapore. This study: (a) described levels of eating psychopathology and psychosocial impairment among individuals diagnosed with eating disorders at our hospital; and (b) compared the related psychopathology of these patients. RESULTS A majority of participants were women and of Chinese ethnicity. Diagnoses included anorexia nervosa (AN; 41.6%), bulimia nervosa (BN; 29.6%) and eating disorder not otherwise specified (EDNOS; 28.8%). Mean age at presentation was 20.52 ± 7.14 years and mean body mass index was 17.84 ± 4.18 kg/m 2 . Individuals with AN were significantly younger at presentation and had shorter duration of untreated illness compared to those with BN and EDNOS. There were no significant differences in the CIA scores of the diagnostic groups. Participants with BN scored higher in all subscales of the EDE-Q than those with AN and EDNOS. Our sample scored lower in most subscales of EDE-Q when compared to treatment centres in Sweden, Australia and the United States. METHODSCONCLUSION Our clinical sample reported lower scores of psychopathology compared to overseas centres. This could be attributed to the higher percentages of BN and EDNOS diagnosed in overseas populations. Individuals with AN showed higher levels of psychopathology in our study compared to patients from the United States.

Estimated prevalence of eating disorders in Singapore

“…In contrast to past research conducted in other Asian countries (Lee, Ho, & Hsu, 1993), the general clinical presentation of EDs in Singapore appears to be similar to that of Western cultures (Ng et al, 2018;Teh et al, 2020;Ung, Lee, & Kua, 1997). Patients with EDs reported the presence of body image disturbance, high weight and shape concerns and frequent engagement in compensatory behaviors.…”

“…Due to the lack of Singapore data, the IHME estimates are extrapolated from prevalence in other Asian countries. Studies that gather data on EDs in Singapore are primarily based on the national treatment centers for EDs (Goh, Lee, Lim, & Lum, 2016; Lee, Lee, Pathy, & Chan, 2005; Ng, Kuek, & Lee, 2018). Between 1994 and 2002, 138 patients (91.3% females) with AN presented for treatment at a tertiary hospital (Lee et al, 2005); between 2003 and 2010, 281 patients (95.7% females, ages 12–40 years with a BMI < 18.5 kg/m 2 presented with AN (55.2% with AN‐restrictive subtype, 24.9% with AN‐binge/purge) and eating disorder not otherwise specified (EDNOS; 19.9%; Goh et al, 2016).…”

“…Between 1994 and 2002, 138 patients (91.3% females) with AN presented for treatment at a tertiary hospital (Lee et al, 2005); between 2003 and 2010, 281 patients (95.7% females, ages 12–40 years with a BMI < 18.5 kg/m 2 presented with AN (55.2% with AN‐restrictive subtype, 24.9% with AN‐binge/purge) and eating disorder not otherwise specified (EDNOS; 19.9%; Goh et al, 2016). A broader study of patients at a tertiary hospital between 2010 and 2012 ( n = 257; 92.6% females) found 41.6% patients with AN, 29.6% with BN and 28.8% with EDNOS (Ng et al, 2018). Patients were usually ethnic Chinese females between the ages of 18 and 22 years.…”

Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature

“…Two studies (n = 644) used a clinical interview plus an additional research assessment with an adapted version of the eating disorder diagnostic scale (Stice, Telch, & Rizvi, 2000) to confirm onset date (Brown et al, 2018;Flynn et al, 2020). Two studies (n = 2,027) measured onset date using participant self-report (Beat, 2017;Schlegl et al, 2019), one (n = 285) reported that this was 'assessed at admission' (Bühren et al, 2013), three (n = 1,298) relied on young person and/or parental self-report (Kwok et al, 2019;Lieberman et al, 2019;Shu et al, 2015), and three (n = 503) did not define how onset was determined (Andrés-Pepiñá et al, 2019;Ng et al, 2018;Nicholls et al, 2011). To measure the start of treatment, or end of DUED, six studies (n = 1,508) used the date of entrance into specialised treatment (Andrés-Pepiñá et al, 2019;Brown et al, 2018;Bühren et al, 2013;Flynn et al, 2020;Kwok et al, 2019;Lieberman et al, 2019), five (n = 2,433) used questionnaires (Beat, 2017;Neubaeur et al, 2014;Nicholls et al, 2011;Schlegl et al, 2019;Weigel et al, 2014), and three (n = 1,091) did not explicitly define how start of treatment date was measured (Gumz et al, 2018;Ng et al, 2018;Shu et al, 2015).…”

Development of a new Japanese version of the Clinical Impairment Assessment Questionnaire

“…The CIA has been the most widely used questionnaire to measure the severity of psychosocial impairment due to eating disorders [4]. Overseas it has been translated into various languages and, with the reliability and validity of these translated versions having already been confirmed, they are widely used for research and clinical use [5][6][7][8][9][10][11]. In order to investigate if the CIA can be used for patients with different cultural, socioeconomic, and ethnic backgrounds, versions were developed for non-Western populations such as Fijian [6], Persian [9], and Singaporean (the majority of participants of Chinese ethnicity) [11].…”