General Practitioners are poor at identifying the eating disorders

Waller, Glenn; Micali, Nadia; James, Alison V.

doi:10.1080/21662630.2013.859437

Cited by 27 publications

(32 citation statements)

References 26 publications

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“…Inexperience has been linked to more negative reactions to service users with EDs in previous research (Franko & Rolfe, 1996). It has been suggested that the difficulties generalist staff experience in identifying and responding to EDs reflect the reluctance of clients to report them, and lack of knowledge about treatment options (Waller, Micali, & James, 2014).…”

Section: Discussionmentioning

confidence: 95%

“…Inexperience has been linked to more negative reactions to service users with EDs in previous research (Franko & Rolfe, ). It has been suggested that the difficulties generalist staff experience in identifying and responding to EDs reflect the reluctance of clients to report them, and lack of knowledge about treatment options (Waller, Micali, & James, ). The systemic pressure of lack of time seemed to be felt most keenly in primary care, while the surveillance culture and frustrations around communication were predominantly reported in inpatient settings.…”

Section: Discussionmentioning

confidence: 99%

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The lived experience of working with people with eating disorders: A meta‐ethnography

Graham

Tierney

Chisholm

et al. 2020

Intl J Eating Disorders

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Objective Working with people with eating disorders (EDs) is known to elicit strong emotional reactions, and the therapeutic alliance has been shown to affect outcomes with this clinical population. As a consequence, it is important to understand healthcare professionals' (HCPs') experiences of working with this client group. Method A meta‐synthesis was conducted of qualitative research on HCPs' lived experiences of working with people with EDs. The results from the identified studies were analyzed using Noblit and Hare's meta‐ethnographic method. Data were synthesized using reciprocal translation, and a line of argument was developed. Results Thirty‐seven studies met the inclusion criteria. Reciprocal translation resulted in a key concept: “Coping with caring without curing.” This was underpinned by the following third‐order concepts: (a) “The dissonance and discomfort of being a helper struggling to help,” (b) “Defending against the dissonance,” and (c) “Accepting the dissonance to provide safe and compassionate care.” These concepts were used to develop a line‐of‐argument synthesis, which was expressed as a new model for understanding HCPs' experiences of working with people who have an ED. Discussion Although the conflict associated with being a helper struggling to help led some HCPs to avoid and blame people with EDs, others adopted a compassionate stance characterized by humanity, humility, balance, and awareness.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

The lived experience of working with people with eating disorders: A meta‐ethnography

Graham

Tierney

Chisholm

et al. 2020

Intl J Eating Disorders

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“…Targeting adolescents with ED and ED behaviors in the community, firstly by improving identification, 53 and secondly by delivering low-intensity early intervention programs, 54 might lead to high public health benefit. Although more research in population-based samples needs to address the distribution and impact of less-studied ED, future DSM revisions and upcoming ICD revisions should take into consideration removing or lowering frequency thresholds of ED behaviors across diagnostic subtypes and the inclusion of purging disorder as a diagnostic entity.…”

Section: Discussionmentioning

confidence: 99%

Adolescent Eating Disorders Predict Psychiatric, High-Risk Behaviors and Weight Outcomes in Young Adulthood

Micali¹,

Solmi²,

Horton³

et al. 2015

Journal of the American Academy of Child & Adolescent Psych

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195

219

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Objective To investigate whether anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorders (OSFED), including purging disorder (PD), subthreshold BN, and BED at ages 14 and 16, are prospectively associated with later depression, anxiety disorders, alcohol and substance use, and self-harm. Method Eating disorders were ascertained at 14 and 16 years of age in 6,140 youth at age 14 (58% of those eligible) and 5,069 at age 16 (52% of those eligible) as part of the prospective Avon Longitudinal Study of Parents and Children (ALSPAC). Outcomes (depression, anxiety disorders, binge drinking, drug use, deliberate self-harm, weight status) were measured using interviews and questionnaires about 2 years following predictors. Generalized estimating equation models adjusting for gender, socio-demographic variables, and prior outcome were used to examine prospective associations between eating disorders and each outcome. Results All eating disorders were predictive of later anxiety disorders. AN, BN, BED, PD, and OSFED were prospectively associated with depression (respectively AN: odds ratio [OR]=1.39 [95% CIs: 1.00-1.94]; BN: OR=3.39[1.25-9.20]; BED: OR=2.00 [1.06-3.75]; PD: OR=2.56 [1.38-4.74]). All eating disorders but AN predicted drug use and deliberate self-harm (BN: OR=5.72[2.22-14.72], PD: OR=4.88[2.78-8.57], subthreshold BN: OR=3.97[1.44-10.98], subthreshold BED: OR=2.32[1.43-3.75]). Whilst BED and BN predicted obesity (respectively OR=3.58 [1.06-12.14] and OR=6.42 [1.69-24.30]), AN was prospectively associated with underweight. Conclusions Adolescent eating disorders, including subthreshold presentations, predict negative outcomes, including mental health disorders, substance use, deliberate self-harm, and weight outcomes. This study highlights the high public health and clinical burden of eating disorders among adolescents.

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“…Such an approach ignores a large group of individuals with ED and ED symptoms who do not access treatment[11,12], limiting both the usefulness of the classification and potentially introducing bias in studying potential risk factors and outcomes. This limitation is particularly relevant to adolescence, given the time-lag between onset of symptoms (peaking in adolescence) and access to treatment[13], and the known lower treatment-seeking levels amongst adolescents and young adults[14,15]. Thus, studying ED behaviour patterns in population-based samples is a useful approach to advancing our understanding of how these manifestations present in the community.…”

Section: Introductionmentioning

confidence: 99%

Eating disorder behaviours amongst adolescents: investigating classification, persistence and prospective associations with adverse outcomes using latent class models

Micali

Horton

Crosby

et al. 2016

Eur Child Adolesc Psychiatry

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Diagnostic criteria for eating disorders (ED) remain largely based on clinical presentations, but do not capture the full range of behaviours in the population. We aimed to derive an empirically based ED behaviour classification using behavioural and body mass index (BMI) indicators at three time-points in adolescence, and to validate classes investigating prospective associations with adverse outcomes. Adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC) provided data on ED at age 14 (n = 6615), 16 (n = 5888), and 18 years (n = 5100), and had weight and height measured. Psychological and behavioural outcomes were assessed at 15.5/16 and 17.5/18 years. We fit gender- and age-stratified latent class models, and employed logistic regression to investigate associations between classes and later outcomes. One asymptomatic and two symptomatic (largely representing higher and lower frequency ED behaviours) classes were observed at each time-point, although their relative prevalence varied by age and gender. The majority of girls in symptomatic classes remained symptomatic at subsequent assessments. Girls in symptomatic classes had higher odds of subsequent anxiety and depressive disorders, binge drinking, drug use, and deliberate self-harm. Data analyses were underpowered amongst boys. The presence of two symptomatic classes (characterised by different ED behaviour frequency) and their prospective association with adverse outcomes suggest a need to refine diagnostic thresholds based on empirical data. Despite some instability of classes, particularly in mid-adolescence, evidence that half of girls in symptomatic classes remained symptomatic suggests persistence of ED behaviours in adolescence, and highlights a need for early identification to reduce chronicity.

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General Practitioners are poor at identifying the eating disorders

Cited by 27 publications

References 26 publications

The lived experience of working with people with eating disorders: A meta‐ethnography

The lived experience of working with people with eating disorders: A meta‐ethnography

Adolescent Eating Disorders Predict Psychiatric, High-Risk Behaviors and Weight Outcomes in Young Adulthood

Eating disorder behaviours amongst adolescents: investigating classification, persistence and prospective associations with adverse outcomes using latent class models

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