eating disorders research project

Understanding the early life risk factors of Avoidant Restrictive Food Intake Disorder (ARFID) from a lived experience perspective

ARFID is an eating/feeding disorder mainly affecting children, characterised by fear and anxiety about eating or food, without any concerns about body size/shape. The disorder was recognised a decade ago but has so far received very little research attention and is extremely poorly understood. Up to 1 in 4 children receiving treatment for eating disorders are estimated to have ARFID; and up to 1 in 7 children in the wider community.   

There is an urgent need to identify early life risk factors for ARFID to recognise infants and children who are at high risk and inform early prevention and intervention efforts.

The project

The objective of this research is to   examine the extent to which mental health difficulties and neurodevelopmental conditions co-occur with ARFID.

Dr Nas and her team will work in partnership with families with lived experience to co-develop a practical evidence-based tool for easy early identification of   children at risk for ARFID.  In this project, families who are directly affected by ARFID will lead the way by co-designing the entire research programme – from deciding on the questions that need to be answered, helping the researchers to carry out the study and helping to explain the findings to other families affected by ARFID.

The process

As well as working with caregivers, and individuals with ARFID, Dr Nas will also be undertaking   secondary analyses of Gemini, a large population-based British birth cohort of 2402 families with twins (n=4804). It is the largest twin study ever set up to examine genetic and environmental influences on early growth with detailed information on early life health problems (such as tube-feeding, days spent in special care), infant milk-feeding and appetite, and has one of the largest and richest dietary datasets for toddlers in the UK (exceeding that of the National Diet and Nutrition Survey at that age). Importantly, it is one of the few datasets that has characterised ARFID and other mental health and neuroatypicality symptoms.

The potential

In the s hort-term, this project will publish work on the quantitative and qualitative research conducted, and to bring awareness to the role of lived experience in ARFID. Beyond this, we aim to develop a screening tool that could aid healthcare professionals in diagnosing ARFID; and , therefore, reduce waiting and referral times and the overall cost to the NHS. 

Cross-disorder approach to delineate the roles of neuroinflammation in three early-onset psychiatric conditions

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• Open access
• Published: 20 August 2024

Views and experiences of eating disorders treatments in East Asia: a meta-synthesis

• See Heng Yim 1 , 2 &
• Ulrike Schmidt 1 , 2  

Journal of Eating Disorders volume  12 , Article number:  120 ( 2024 ) Cite this article

Metrics details

Introduction

Although there have been qualitative meta-syntheses on experiences of eating disorders treatments, there is a paucity of syntheses specifically examining the perspectives and experiences of eating disorders treatments (ED) in East Asia (EA). Such synthesis could facilitate a better understanding of culture-specific perspectives and experiences. This review complements a quantitative scoping review published on ED treatments in EA (Yim & Schmidt, 2023), where most interventions reviewed focused on cognitive behavioural therapy (CBT) and internet interventions. The present meta-synthesis summarises stakeholders’ views on treatments and to synthesise clinical and research recommendations.

A systematic search of five databases and a citation search were conducted to identify relevant studies and data were analysed using thematic synthesis. Out of the 301 studies found, a total of 12 papers were included in the analysis.

A diverse range of treatments, such as family therapy, paediatric/psychiatric inpatient care, CBT, and counselling, were discussed. Three overarching themes were identified: Delineating Physical and Psychological Recovery; ‘I am not alone in this battle’; and Barriers to Change. The themes further delve into the various obstacles to recovery, including financial concerns and limited access to professionals and services. Culture-specific factors include family obligations and promoting family harmony. Balancing interdependence and independence from one’s family, as well as understanding family body ideals versus broader societal body ideals, are important considerations in ED interventions.

Some themes paralleled other qualitative syntheses, highlighting improved family relationships, perceived authoritarianism in treatments, and financial barriers. The review extends beyond the previous findings, revealing nuanced factors like family roles, cultural values, and norms. Clinical recommendations include incorporating family context in treatment and considering cultural influences on body image ideals. Capacity building through telemedicine and increased training is essential for advancing ED treatment in East Asia. Continued research is needed to better understand and treat people affected by ED in EA.

Plain English Summary

Research on eating disorders (EDs) treatment mainly focuses on Western countries, with little exploration of experiences in East Asia. To fill this gap, we reviewed 12 studies on the perspectives of individuals, families and clinicians regarding EDs treatments in East Asia. Our synthesis identified three main themes:

Physical and Psychological Recovery : Effective treatment needs to address both physical and mental aspects of recovery.

Finding Support – ‘I am not alone in this battle’ : Many individuals find strength in knowing they are not alone.

Barriers to Change : Obstacles like financial difficulties, limited EDs knowledge from professionals, and cultural factors can hinder recovery.

Cultural-specific factors such as family obligations and maintaining family harmony can impact on treatment motivation and effectiveness. Balancing family’s wishes/ interdependence and personal aspirations/ independence can also be a challenge. Our findings highlight the need for culturally sensitive treatments. Expanding telemedicine and increasing provider training can also help overcome treatment barriers. In conclusion, understanding cultural and contextual factors is essential for developing effective support systems and improving ED treatment outcomes in East Asia.

Eating disorders (EDs) research has been historically centred in the Global North. However, in the past decade, more attention has been paid to non-WEIRD (Western, Educated, Industrial, Rich, Democracies) populations. Reviews report an increasing incidence of EDs in regions in East Asia (EA), where the prevalence of EDs may now be comparable to that reported in North America or Europe [ 1 ]. Young females are seen as an at-risk population for developing EDs in almost every country in EA. The exceptions include North Korea, because as of 2023, there have been no studies conducted in that country. There is also no epidemiological study on EDs in Mongolia [ 2 ]. Chen et al. [ 2 ] also report that in China, the prevalence of binge eating disorder (BED) exceeds that of bulimia nervosa (BN), with both being higher than the prevalence of anorexia nervosa (AN).

Different cultural factors have been hypothesised to contribute to the development and maintenance of EDs. Previous studies suggest that self-construal, which refers to how individuals define themselves in terms of independence from or interdependence with others, could influence treatment seeking when experiencing psychological distress [ 3 ]. Asians, who often endorse collectivistic values and exhibit interdependent self-construal, may articulate treatment goals in terms of benefiting their family. Another relevant concept is family harmony, particularly emphasised in ethnic Chinese culture, the largest ethnic group in EA. Values such as promoting interpersonal and family harmony and ‘saving face’ are seen as important and may affect help-seeking behaviours [ 4 ]. Contemporary EA societies face conflicting collectivistic and individualistic values where people grapple with bicultural contextual forces. Negotiating these conflicting value systems can lead to identity conflict, potentially serving as risk factors for body dissatisfaction and disordered eating [ 5 ]. Dysfunctional psychological individuation, the process of developing a sense of self and transitioning from hierarchical to symmetrical (more equal relationship between equal adults) parent-child relationships, is linked to the development of mental health conditions [ 6 ]. Additionally, values such as filial piety may hinder the process of individuation from the family [ 7 ].

Body image disturbance has been a core diagnostic criterion in the West. Research on body image dissatisfaction in EA has been mixed. Sing Lee [ 8 ] identified the presence of non-fat-phobic AN in EA, differentiating from the EDs phenotype in the West. Other studies have consistently identified high drive of thinness and body dissatisfaction in countries such as China [ 9 ] and South Korea [ 10 ]. Whilst earlier studies suggested that Westernisation is a factor in body image disturbance in EA [ 11 ], other researchers have challenged these findings. A 12-month prospective study found that Asian women reported more pressure and body comparison from social media depictions from Asian media when compared to Western media, suggesting that Asian media influences were more salient [ 12 ]. Other cross-cultural studies identified that Chinese American students have less body dissatisfaction than other American students [ 13 ]. That said, the impact of Westernisation may be reflected in the racialisation of body, where Asian Americans may be more distressed by certain body parts such as the shape of their eyes/nose, or their breast size [ 14 ]. Although it is difficult to directly compare East Asians living in the diaspora or as international students with those East Asians that are residing in their home countries, the research findings point to the nuanced influence of Westernisation on body ideals.

Policy, alongside cultural norms, can significantly influence individuals’ mental health and recovery. China’s historical One Child Policy (OCP) has been a focal point of research, examining how the policy led to an imbalanced gender ratio in China with more males than females, as well as how being an only child may impact social development compared to having siblings. Some studies suggest that only children may exhibit more self-centred and competitive behaviours [ 15 ], others report contradictory findings. For instance, Settles et al. [ 16 ] referenced the heightened pressure from parents onto their only children to excel academically, equating academic success with overall success [ 16 ]. Additionally, the systemic devaluation of females is evident, as seen in Zhejiang Province, China, where couples were allowed a second child only if the first child was a girl.

Yim & Schmidt [ 17 ] conducted a systematic scoping review on psychological treatments for EDs in EA. Compared to Europe and North America, there were significantly fewer EDs intervention studies. Out of the 18 published studies, most were feasibility or uncontrolled studies, but they generally showed good intervention acceptability and positive effects on ED symptoms. Notably, cognitive therapies were the predominant approach used, with family therapy largely absent in the literature despite being a first-line treatment for EDs in countries like the UK [ 18 ]. Qualitative studies in EA can complement quantitative findings. For instance, [ 7 ] described a culturally-adapted family therapy model based on the Micucci [ 19 ] approach. This model views the family’s response to the illness as a symptomatic cycle and aims to address family conflicts, including marital issues, which distinguishes it from ED-focused family therapies like Family-based treatment (FBT) and the Maudsley model (FT-ED). Additionally, the model focuses on promoting individuation of the young person from their family. Tan et al. [ 20 ] described the most helpful family involvement in the Asian context would be maternalistic, where family is a supportive, caring and loving, rather than paternalistic, which is seen as taking control of the decisions. Yim & Schmidt [ 17 ] also reported structural adaptations of EDs treatments such as having shortened treatment sessions for practical reasons, where healthcare is not free and specialist centres are far away in some regions in EA.

Qualitative synthesis provides a richer understanding that goes beyond understanding the effects of interventions on symptoms, and include stakeholders’ views, perceptions and experiences of treatments. To our knowledge, there is no qualitative synthesis of EDs treatment experiences nor professionals’ views of ED treatments in EA. A previous synthesis looked at experiences of family-based treatment (FBT) for AN among adolescents [ 21 ]. Themes such as relinquishing control ambivalently (initial treatment resistance, authoritative care), improved family relationships, and failure to address family issues were identified. Such synthesis can facilitate a better understanding of culture-specific perspectives of all stakeholders, which may lay a foundation for hypothesis-generation and testing in future EDs interventions research. Hence, the aim of this review is to synthesise the views and experiences of patients, families and healthcare professionals of EDs treatments in EA, with a particular focus on the cultural aspects influencing treatments.

The search was conducted according to the Enhancing Transparency in Reporting the synthesis of Qualitative research (ENTREQ) statement [ 22 ]. The search strategy was devised in consultation with a specialist librarian, and included both a database and citation search. Four English databases were comprehensively searched: Embase, Global Health, Ovid Medline, APA PsycINFO (any time till June 2024). As researcher SHY also understands Chinese, the Chinese research database was also searched ( https://oversea.cnki.net/kns/defaultresult/index ) with the search term eating disorders (饮食/进食失调) using subject headings search. Search terms were (eating disorder* or bulimia or anorexia or binge eating or disordered eating or ARFID or Avoidant Restrictive Food Intake Disorder) AND (China or Hong Kong or Taiwan or Macau or Macao or Mongolia or Japan or Korea or Chinese or Taiwanese or Mongolian or Japanese or Korean or east Asia or east Asian or far east) AND (qualitative or interview). Keyword search and subject heading search together with title/abstract search was done (see supplementary info for an example of search string).

Inclusion criteria .

Peer-reviewed qualitative studies on the views, experiences or perceptions of EDs interventions, from service providers, patients, or families in East Asia. Regions in East Asia include China, Hong Kong, Japan, Macau, Mongolia, North Korea, South Korea and Taiwan (Asia Society, https://asiasociety.org/countries-regions/east-asia ).

Articles published in English or Chinese.

Exclusion criteria .

Studies on the East Asian diaspora.

Descriptive studies or single case study without a clear qualitative data collection and analysis methodology, clinical opinion papers.

Books, dissertations, conference abstracts.

Data analysis and extraction

Screening and deduplication were done on Rayyan software [ 23 ]. Thomas and Harden [ 24 ] thematic synthesis method was chosen for its suitability in understanding people’s views and experiences of EDs treatments to inform clinical practice, as opposed to developing theories or models like grounded theory. As no previous reviews existed in this area, integrating existing studies in a review was crucial for informing future clinical practice and research. Unlike quantitative meta-analysis, which focuses on prediction, this method emphasises interpretive explanations. In this study approach, although the data search was systematic, the purpose of study inclusion was purposive rather than exhaustive, aiming for conceptual understanding rather than data saturation. SHY independently conducted the screening of the texts and discussed any uncertainties with US.

The analysis proceeded in several steps. Firstly, the first author, SHY, familiarised herself with the papers. Themes and all participants’ quotes from both the Results and Discussion sections of each paper were then extracted and coded line-by-line using QSR NVivo [ 25 ]. Additional information such as participant demographics, diagnosis, and research method were also extracted to preserve study context. Codes were then grouped and categorised inductively based on their meanings, with attention paid to draw out culture-specific themes. The free codes were grouped together hierarchically in NVivo and printed out where annotations were made by hand to help generate themes. The analytical theme generation process aimed to extend beyond the original study themes and was reviewed by the second author.

Quality assessment

The methodological quality of the included studies was assessed using the appraisal tool CASP Qualitative Studies Checklist (Critical Appraisal Skills Programme, 2018) (Table  1 ). The ten appraisal questions focus on research design, recruitment method, data collection, researcher/participant relationship, ethical considerations, data analysis, clarity of findings, and importance/value of the research. The authors of the checklist did not recommend scoring up the results but instead emphasised using the appraisal tool qualitatively. SHY completed the CASP and this was checked by US. The quality of the studies did not particularly impact on the theme generation, but instead provides context for the overall analysis.

Reflexivity

It is important to be aware of researchers’ biases and positionality in qualitative analysis. SHY is Chinese by ethnicity and was born and raised in Hong Kong. She completed her undergraduate and postgraduate studies in the UK and works in the National Health Service in the UK as a clinical psychologist, where intrinsically western and white-orientated models were taught and practiced. Therefore, she is aware of her background where on the one hand, she understands culture-specific issues in some parts on EA, on the other hand, she is in a slightly detached position professionally and geographically. US is a UK-trained psychiatrist who is originally from Germany and has extensive experience in EDs. She approached the research topic and data from the point of view of an EDs expert as well as using her experience of treating EDs patients from East Asia in the UK as well as collaborating with East Asian researchers. She is aware of her positionality as a White European woman and this allows her to discuss the cultural differences between East and West with SHY.

A total of 12 studies were included. However, two of the studies (Ma and Lai, 2006; Ma, 2008) were based on the same cohort of participants. In one of these papers, the research focus was on perceived treatment effectiveness, and in the other on experiences of treatment. Figure  1 shows the PRISMA chart. None of the Chinese language studies were qualitative studies on experiences of EDs interventions and hence all included studies were in English. Table  2.1 & 2.2 shows a summary of the study characteristics and extracted settings and themes. Overall, most studies examined people with AN except for [ 26 ] who included people with BN, purging disorder and night eating disorder, and [ 27 ] who included BN. One study examined parents’ views and perceptions of help for AN in Hong Kong [ 28 ], and two studies examined professionals’ views and perceptions of treating young people with AN in Taiwan [ 29 ]; [ 30 ]. The mean age of the participants interviewed was below age 30 for all patient-related studies. All studies were conducted in Chinese-speaking (Cantonese and Mandarin) regions of EA. The majority of the patients interviewed identified as females – one out of 69 participants in total across all studies identified as male.

PRISMA flowchart

Three main themes were identified.

Theme 1. Delineating physical and psychological recovery

People with lived experience of EDs described how treatment ‘ was helpful but [they were] not symptom free ’ ( [ 26 ]. In particular, participants often described the distinction between physical health and their psychological health, suggesting that recovery involves both components and that (inpatient) treatments seem to only support physical recovery. A participant noted, ‘ the only positive impact was physical health , others (were) all negative; but without that I would have already died.’ [ 31 ]. Another participant concurred, ‘I did not find the staff helped me with my anxieties about my weight…I was not helped psychologically , it was all about the physical improvements’ [ 28 ]. However, without psychological recovery, participants described their symptoms worsened post-discharge. For example, participant said ‘I think it [bingeing and purging becoming even worse after discharge] might be because I have gained lots of weight during the period of receiving inpatient care , but I could not psychologically accept it…thus…I started to fast badly , and after a while , my bingeing emerged and my urge to eat got even stronger.’ [ 28 ]. This view was shared among professionals as well. One dietician in Taiwan reflected that “ We should study psychology. Anorexia is not only physical’ [ 29 ].

On the other hand, there are other participants who described a full recovery (‘ [I] live like a normal person’ [ 28 ].

Theme 2. ‘I am not alone in this battle’

This theme includes three pairs of relational dyads – the patients in relation to their families, their therapists, and their peers.

Sub-theme 2.1. The dialectics of interdependence and independence

In the included studies, it appears that certain cultural values of interdependence and filial piety may provide a fertile ground for EDs to develop. As a participant (person with an ED) put it,

‘I wanted to have some freedom from my parents but I didn’t want to go against them. Their control/protection was benign , good for me , but it’s seamless and suffocating. I just need some space to make my own choice. Anorexia was part of my identity because eating and weight are the only things I have control over’ [ 4 ].

Mealtimes are seen as a non-negotiable duty especially if the older family members prepare the dishes. As mentioned by a Taiwanese woman with lived experience of an ED: ‘ mealtime was held to be sacred , reflecting the Chinese belief that eating works towards preserving harmony , cohesion , and unity in the family. Grandmother’s cooking and food serving signified her devotion to , and affection for , her children. The entire family was , in turn , expected to reciprocate their grandmother’s gesture by observing filial piety and obeying her rules about food and meals’ [ 4 ].

For some participants, the need to obey senior family members, fulfil family duties, and prioritise others’ needs may suppress their own needs and lead to internal conflicts: ‘ I should get more involved with my parent’s business , care more about how they feel and what they want’ [ 4 ]. The researchers speculated that this may also relate to traditional Chinese culture, where males are more valued than females, and daughters feel the need to live up to the family’s expectations when they are an only child. In these situations, healing involves individuation from interdependence and exploring self-identity to prevent relapse [ 32 ]. This quote illustrates this point: ‘ as I started seeing myself independent from my mum , I became more comfortable and no longer felt inferior to her… my bingeing and purging frequency reduced.’ [ 4 ]. Another participant from the same study described moving out of the family home as a turning point towards EDs recovery [ 4 ].

Nevertheless, the cultural value of interdependence can also serve as a protective and motivating factor towards recovery. Instead of citing personal reasons for recovery, some participants described their motivation to get better for their parents, influenced by the cultural value of ‘saving face’: ‘ … My anorexia was a face-losing thing…I felt like becoming too much a burden…I was eager to become normal again…so that I could save face for my parents’ [ 4 ]. When a participant looked back on the recovery, one discussed the cultural value that emphasises ‘the body is given by the parents’: ‘ I vomited the money you earned…. I hurt the body you have given me…again and again’ [ 26 ].

Similarly, recognising that the family will unconditionally accept them regardless of whether they manage to meet their parents’ expectations, can also be motivating. One participant described how her family will always stand by her side,

‘I really decided to walk out of this eating disorder swamp. I felt that , no matter what , my parents would love me , even when I’m vomiting and when I am the ugliest. Perhaps they couldn’t understand me , but because that’s me , they would accept this person unconditionally’ [ 26 ].

Therapy provides a space for the family to ‘ have a deeper chat’ and to facilitate a greater understanding of each other, improving the family relationships. This includes both the parent-child dyad as well as sibling dyad:

‘The therapist did not talk much about eating in treatment. She worked on the family relationships. Let’s understand her work in this way. With the onset of the illness , the family must have problems and the family relationship must be damaged… when our communication improved and our relationships were repaired , we became more harmonious and the child would listen to other parents.’ [ 27 ]. ‘In fact , I can see that both my brother and sister want to help me , but I can’t accept the way they help me…now I can see that they just want to give some ideal solutions to me. ’ [ 33 ].

Some studies emphasise the role of the father and increasing paternal presence (e.g., [ 27 ]). Traditionally, it is assumed that mums are responsible for domestic matters as well as the children’s wellbeing. As a mum put it, ‘[the child’s] father is a CEO of a huge company and I don’t want to upset him. I want him to concentrate his energy and time on work. I told him about my difficulty only when I could no longer handle it’ [ 27 ]. A father reflected on his guilt towards not caring for his daughter: ‘… I should stay behind to take more care of her’ [ 27 ]. Therapy plays a pivotal role in fostering and enhancing the father’s presence, while also illuminating the daughter’s longing for paternal care. In a case study, Lily, a participant, reported that her improved relationship with her father facilitated a return to normal and regular eating habits. As a result of therapy, her father began dedicating more time to the family, acknowledging that he previously prioritised rest over spending time with family. In another scenario where the individual’s father had passed away, the therapist emerged as a dependable father figure, providing invaluable support and understanding [ 4 ].

Subtheme 2.2. Clinician as a trusted and safe base

Both clinicians and patients described important common factors in therapy such as calm, patience and building trust. In the paediatric wards, the nurses mentioned “ You must take the time to establish a relationship with her. She is willing to rely on you , and she is willing to tell you where the problem is .” [ 29 ]. A patient mentioned ‘the therapist has really good temper. No one can stand to talk to me so long , except my mother , including my brother and sister. And her tone makes me think that she’s a person I can trust.’ [ 34 ]. Developing a safe base allows the families to then explore more difficult topics. Studies describe the use of the word ‘ as a bridge’ to recount the role of therapist in treatment:

‘She made me feel confident. We began to trust her (the therapist). We felt that she can help us. With that trust in mind , I feel free to disclose my feelings honestly…my body weight dropped and I was very frightened….I had no confidence and was very fearful. She (the therapist) looked at me with a warm smile and in a firm tone , said that she had confidence in me and I could make it’ [ 34 ].

Subtheme 2.3. Relating to peers with EDs

References to sharing and comparing EDs behaviours, such as sharing purging techniques, were noted [ 28 ]. For instance, one participant described observing peers using their iPad to calculate meal calories and researching diets online to lose weight after discharge. In the analysis, the authors hypothesised that due to the historical One-Child Policy in China, being on the ward might be the participants’ first time living with peers away from their families. They wondered whether some of the group dynamics of cooperation and conflict might be attributed to the lack of experience of living with siblings.

On the other hand, positive aspects from peers were also noted, such as finding people to talk to: ‘I had been keeping this secret (my ED) for an extremely long time without finding somebody to talk to’ as well as reducing vomiting behaviours due to others reporting to the nurses [ 31 ].

Theme 3. Barriers to change

Four aspects of barriers were described: financial, structural, coercive practice and cultural.

Subtheme 3.1. ‘I am wasting my family’s money’

One participant mentioned, “Psychotherapy or counselling would cost me 400/500 yen (approximately 70 USD) per session. I am still a student and don’t have much money. I thought I could follow self-help resources and treat myself” [ 26 ]. While she expressed an individual perspective, others described, “We are not wealthy as a family,” indicating a family-oriented viewpoint among the participants. For instance, one participant discussed how their family did not consider finances a barrier to treatment:

‘…I can see that my family doesn’t care about money when compared to my health , and my sister also wastes her study time to keep on seeing the therapist every week. Now I can see that they all treat me very , very well , and want me to be healthy again.’ [ 32 ].

Subtheme 3.2. Unavailable professionals and services

Participants were dissatisfied by the lack of specialist services, as well as the lack of knowledge of EDs among healthcare professionals. This is evident in terms of the short period of time they are being seen for:

‘The diagnostic process involved me describing my situation and the doctor asking me more questions…diagnosed me with bulimia nervosa. The whole process took about 6 to 7 minutes. It was very short and nonspecific. I feel my condition was not taken seriously.’ [ 26 ].

The scarcity of specialist services was mentioned by multiple participants. One of them said, ‘ treatment resources are only available at big hospitals’ in mainland China [ 26 , 35 ]. In Hong Kong, parents described how difficult it was to find therapists that are knowledgeable about AN:

‘I really don’t know where you could find family therapists that specialise in treating anorexia in Hong Kong… in foreign countries , there is usually a team which put strong emphasis on family support and teamwork , and such kind of support is totally unavailable in Hong Kong’ [ 28 ].

The lack of knowledge among professionals can also lead to patients and families feeling invalidated. A doctor mentioned that amenorrhoea could be stress-related and could be a common gynaecological issue, or patients were told to use willpower to overcome their EDs. Parents expressed feeling blamed:

‘During the consultation , we were scolded by the psychiatrist [in A & E]. Have I done anything wrong? He told me that my daughter was well-behaved but I left her in other people’s care. Hey , I have to work! I have already tried my best to find something that is suitable for my daughter.’ [ 28 ].

These experiences by parents are echoed by professionals in Taiwan, who acknowledged their treatment knowledge gap:

One physician said, “ Our care for anorexia is taught by the attending physician one by one , from the intensive care unit to the ward care , and then to the outpatient care. In fact , education is carried out during the follow-up process and the ward rounds. This kind of education only means that the few people who are cared for know how to take care of them. Nurses still don’t know how to care of them” [ 29 ].

The other gap acknowledged was the lack of awareness of non-AN EDs. In a study where a hypothetical vignette of a female who vomits and binges were presented, researchers noted that almost every clinician in the study specified AN rather than BN [ 35 ].

Subtheme 3.3. Coercive practice

Coercive practices, particularly within inpatient settings, were reported, involving the use or threat of restraints and nasogastric (NG) tubes. For instance, a nurse mentioned that even the visible presence of an NG tube could be employed as a form of coercion [ 29 ]. Describing their own experience as a former inpatient, one individual expressed deep distress regarding witnessing physical restraints [ 28 ]. Such experiences resulted in negative treatment experiences, with participants recounting psychological trauma and nightmares related to their inpatient care [ 28 ]. In outpatient family therapy, mothers described feeling like a ‘villain’ and needing to force feed their child [ 28 ]. In view of such practices, participants expressed that such treatment compelled them to act against their desires, and they doubted its efficacy in addressing their weight-related fears [ 32 ].

Subtheme 3.4. Converging and diverging cultural ideals

While thin ideals are often valued in EA cultural norms, there are also contrasting views that perceive thinness as a Western ideal. Participants in the study perceived being chubby as the ideal in Chinese culture, as one individual expressed: “In our culture, being chubby should mean pretty and lucky. My first memory of the really thin women were western models and movie stars…my mum always said they are ugly” [ 4 ]. This contradicts the thinness ideal highlighted in other studies (e.g. 11). Interestingly, exposure to the actual environment in the West helped correct participants’ perceptions of body ideals, which proved beneficial to their recovery:

‘[the participant] highlighted that these cross-cultural exposures and experiences living abroad had enabled and empowered her to challenge the stereotyped images of beauty portrayed and perpetuated by western media… “after I moved to the US , I realised that people here do not look like those in the movies…” ’ [ 4 ].

Study quality

Most studies used adequate qualitative methodologies. The main quality issues identified include not mentioning ethical considerations, lacking researcher reflexivity, lacking details regarding the analytic steps, and that in some studies (e.g. where family therapy was the treatment modality), the analysing researcher was also the treating therapist, which may introduce bias (see Table  1 for more detail).

The 12 studies included in the review generated three analytical themes in response to our research question on people’s experiences of treatment in East Asia (Table  3 ). Cultural aspects relating to people’s experiences were considered when identifying themes.

A diverse range of treatment was described - including family therapy, paediatric/ psychiatric inpatient care, cognitive behavioural therapy, and faith-based counselling. This contrasts with the systematic quantitative scoping review by Yim & Schmidt [ 16 ], where CBT and internet interventions were the main treatments in focus. Some of the themes share similarities to other qualitative syntheses on AN treatment such as improved family relationships as well as the perceived authoritarianism and control in treatments [ 18 ], and the use of restraints and NG tube in inpatient wards. Similar to the findings from Yim & Schmidt [ 16 ], participants also directly mentioned financial barriers and the unavailability of specialist professionals/ services.

The current review goes beyond the cultural adaptations described in Yim and Schmidt [ 16 ]. More nuanced factors such as family roles, cultural values and norms were shared by participants, which can be important issues to be addressed in therapy. With respect to policy, the historical One Child Policy (OCP) in mainland China was mentioned in Wu and Harrison [ 28 ] where they hypothesised that this could potentially impact the interpersonal dynamics in inpatient settings. This was not mentioned in other studies in Yim & Schmidt’s [ 16 ] review. Whether or not the OCP affects the social literacy of single children is under debate, as the single child will still be interacting with peers at school [ 15 ]. This is also potentially confounded by the nature of EDs where body comparison is part of the symptomatic behaviour. It is difficult to disentangle the relative influences on people’s negative experiences in inpatient treatments. In contrast, the impact of OCP is wide-ranging and other impacts may influence the development or maintenance of an eating disorder. OCP has led to an imbalanced sex ratio with more males to females in China and having one child only may be seen as a deprivation of one’s reproductive choice. This also adds to the pressure of looking after one’s elderly parents without the support of other siblings. At the same time, single children (especially girls) faced immense pressure to excel, and are enrolled in multiple tutorials and extracurricular activities [ 16 ]. The pressure to achieve, in addition to preserving the family’s ‘face’, may contribute to the development of an ED [ 26 ]. Relating to the negative aspects of peer influence in EDs wards, it would be useful to explore if similar issues were found in group therapies. Future studies could also explore how single children versus non-single children perceive group or residential treatments (i.e. where there are the same rules for all).

Collectivist culture, where family harmony and ‘saving face’ are esteemed [ 4 ], can present a complex dynamic. Whilst this cultural value may impede help-seeking due to stigma, participants also noted that it functions as a motivator for getting better. Another significant cultural value is Filial Piety, where researchers speculate it may hinder patient’s individuation process [ 7 ]. The necessity for individuation becomes evident as participants highlighted pivotal moments in their ED recovery, such as moving out of the family home or moving abroad for studies [ 4 ]. Initially, participants with EDs struggled with parental expectations and prioritised family wishes over personal aspirations. For some, their EDs may serve the function of creating distance/ challenging parental control or wishes without overtly going against them [ 4 ]. This is potentially compounded by cultural beliefs favouring men over women, leading girls to internalise feelings of inferiority. Balancing familial and individual needs emerges as a central focus in EDs therapy for them. However, similar to other culture-specific values, filial piety can potentially also be a protective factor, motivating patients to comply with parental directives and attend therapy. The idea of interdependent self-construal is pertinent here [ 14 ]. Patients described relational motives to recovery, such as ‘I am “vomiting” your money and your love’. The process of individuation also includes maintaining family connections. Echoing findings by Medway and Rhodes [ 18 ], some family therapy studies in East Asia (e.g., [ 27 ] underscore the reorganisation of family dynamics and roles, often with increased paternal involvement. Yim & Schmidt [ 17 ] speculated that CBT was preferred to family therapy due to most parents working full-time in East Asia. This sentiment is reflected in some parents’ statements like ‘Hey, I have to work!’ However, the present review suggests that the benefits of family therapy are being recognised for restructuring family dynamics and roles, as well as increasing communications and bonding. This is evidenced in the theme ‘I am not alone in this battle’, where family relationships are perceived as improved, and families come together and the patient did not feel judged or uncared for by their parents. This agrees with Tan et al’s [ 20 ] view of using a maternalistic approach in treating ED patients in Asia.

Clinical recommendations

This review, along with Yim and Schmidt (2023), identified treatment, training and research gaps for EDs in EA. We propose the following clinical implications and recommendations:

EDs conceptualisation in EA

Clinicians in EA need to have greater awareness of EDs in general, especially EDs other than AN [ 35 ]. Although our combined reviews show that individual treatment approaches seem to be the norm in EA, it will be useful to include the family context as part of the formulation and treatment planning.

Clinicians should have an awareness of how culture relates to one’s formulation of an ED whilst attending to individual differences. Some examples of culturally informed treatment planning may include harnessing the interdependence and cultural norms of ‘sacred’ family meals as an act of care rather than the family being cast in the role of a ‘villain’. It may be appropriate to consider both interdependent, relational motivators and goals, in addition to personal goals towards recovery, paying attention to the process of individuation whilst maintaining connectedness.

The role of body image

Body image ideals appear to be another conflicting value. On the one hand, studies mentioned how thin ideals are pervasive in EA (e.g. 13), which could be an influence from Westernisation. On the other hand, participants described being ‘chubby’ as being valued [ 4 ]. Whilst there may be generational differences in body ideals, it could also create a sense of internal conflicts if young people’s perceived ideals are different from those of their parents. With the conflicting findings from the studies regarding the relative influence of Western and Asian media (e.g. [ 12 ]), it is important for clinicians to consider a multidimensional conceptualisation of body image and not to make assumptions around the body ideals that the individual is influenced by. Moreover, it may be important to include the family’s perception and ideals of the person’s weight and shape.

Capacity building

The advancement of telemedicine can facilitate better more in-depth training of medical professionals on understanding and treating EDs (e.g. see [ 36 ], as well as increasing the affordability and accessibility of treatments, and also capacity building of evidence-based EDs treatments in EA. It is recommended that journal special issues, conference themes on culture and EDs, or special interest groups/ clinical research networks on EDs in East Asia/for East Asians should be organised to facilitate knowledge and skills exchange.

Limitations

All the included studies are conducted in the Chinese (Mandarin and Cantonese)-speaking regions in EA. Our search strategy did not include grey literature which is a limitation. Some researchers may argue that qualitative studies are context specific and a synthesis of such findings may de-contextualise them. Whilst the aim of this review is not to provide generalisability, it is worth acknowledging that in terms of context transferability, people’s experiences and views in other regions such as Japan and Korea are unknown. It may be that relevant papers were written in the respective languages and therefore not found in our search. Nevertheless, the settings and populations of the included studies were listed in Tables  2.1 and 2.2 , which could assist in the interpretation of the transferability of the findings.

Research recommendations

Most of the EDs study participants experienced AN in the studies, and little is known about the experiences of people with BN, BED, or the relatively newer ARFID diagnosis in the region. This is especially pertinent as the prevalence of BED and BN is higher than that of AN in China [ 2 ].

The prevailing models of treating AN in the West such as ED-focused family approaches for adolescents, are also an underexplored area, so we could not identify whether there are differences in people’s experiences or perceived effectiveness of an ED-focused therapy versus the modified Micucci’s model. The concept of non-fat phobic AN was not mentioned in the studies. Moreover, the studied populations were relatively young (most of them were under 30). Future research on older individuals with EDs in EA would be valuable.

Gender is another key area that needs to be addressed. Across all the included studies, only one patient identified as male. Given most of the studies identified were conducted in China, and that China has a larger male to female ratio, the finding is therefore somewhat surprising. It is difficult to understand how gender and its intersection with aspects of EA culture may influence treatment experiences.

In terms of methodology, it is important for future research to consider researchers bias and reflexivity to increase transparency, credibility and research rigor.

Given that professionals may perceive EDs as a gastrointestinal or gynaecological issue, it is likely that EDs are under-detected within those specialities. Future explorations of specific cultural factors and the relative influence of different body ideals are needed, and understanding the unique cultural struggles of the East Asian Diaspora versus East Asians residing in their home countries.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Eating disorder(s)

Anorexia Nervosa

Bulimia Nervosa

Binge Eating Disorder

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Acknowledgements

Ulrike Schmidt receives funding from the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC) and by the Medical Research Council/Arts and Humanities Research Council/Economic and Social Research Council Adolescence, Mental Health and the Developing Mind initiative as part of the EDIFY program, Grant/Award Number: MR/W002418/1.

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SHY designed and planned the review with supervision from US. SHY performed the search and extracted the data, and data interpretation was performed by SHY and US. SHY wrote the manuscript with support and supervision from US. All authors reviewed the manuscript.

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Yim, S.H., Schmidt, U. Views and experiences of eating disorders treatments in East Asia: a meta-synthesis. J Eat Disord 12 , 120 (2024). https://doi.org/10.1186/s40337-024-01070-4

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The impact of the COVID-19 pandemic on eating disorders risk and symptoms: a retrospective study

Elisabetta straface.

1 Center for Gender-Specific Medicine, Biomarkers Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, 00161 Italy

6 Biomarkers Unit, Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena, Rome, 299 - 00161 Italy

Isabella Tarissi De Jacobis

2 Emergency Acceptance and General Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Piazza di Sant’Onofrio 4, Rome, 00165 Italy

Teresa Capriati

3 Gastroenterology and Nutritional Rehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Piazza di Sant’Onofrio 4, Rome, 00165 Italy

Italo Pretelli

4 Anorexia and Eating Disorder Unit, Child and Adolescent Psichiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Piazza di Sant’Onofrio 4, Rome, 00165 Italy

Annalisa Grandin

Cristina mascolo.

5 Pediatric Academic Department, University of Rome Tor Vergata, Via Cracovia 50, Rome, 00133 Italy

Lucrezia Gambardella

Camilla cittadini, alberto villani, maria rosaria marchili, associated data.

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Social distancing and quarantine imposed by the authority during the COVID-19 pandemic caused restrictions, which had a negative impact on eating behavior, especially among adolescents. We proposed a retrospective study aimed to evaluate the effect of the COVID-19 pandemic on eating disorders risk and symptoms.

In this study, a group of 127 pediatric patients (117 females and 10 males) with eating disorders admitted to the Bambino Gesù Children’s Hospital of Rome (Italy), in the period between August 2019 and April 2021, was analyzed. All patient data were collected from patients’ electronic medical records.

We found that 80.3% of patients were at the onset of eating disorders and that 26% of patients had familiarity for psychotic disorders. Often these patients had comorbidities and alterations in blood parameters such as leukocytopenia, neutropenia, hypovitaminosis and hormonal problems that could affect their future.

Conclusions

Our findings could provide a framework for developing clinical and educational interventions to mitigate the short- and long-term negative impact of the pandemic on adolescent future health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-023-01443-6.

The lockdown imposed by the authority during COVID-19 pandemic, although effective in reducing the transmission of the infection, resulted in marked changes in the lifestyle of the general population (e.g., social distancing, isolation and quarantine, closure of the schools, businesses, gyms, and restaurants). Early reports suggest that social distancing and quarantine are having adverse consequences on mental health including high levels of stress, anxiety, depression, sleep disturbances, and in particular eating disorders (EDs) [ 1 ]. It has been observed that individuals with pre-existing EDs and / or obesity may be particularly vulnerable, due to the associated psychiatric comorbidities and metabolic anomalies [ 2 ]. EDs are serious mental health disorders that cause impairments in physical health, development, cognition, and psychosocial function and can go undetected for months or years. They are common in childhood and adolescence and often are followed by comorbid disorders such as anxiety, self-harm, and substance use [ 3 , 4 ]. Frequently, they have been associated with both suicidal and para-suicidal behaviors, as well as suicide [ 5 ].

The presence of EDs is mainly attributed to (i) family environment (e.g., parental psychiatric disorders, prenatal maternal stress); (ii) restriction to daily activities and movements; (iii) excessive exposure to harmful eating patterns on social media, emotional distress, fear of contagion, and low access to care [ 3 ]. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) [ 6 ], EDs commonly observed in children and adolescents can be classified in anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID). The first is an eating disorder characterized by pathological problems of weight and shape that lead to reduced food intake and consequent low weight [ 7 ]. The second is an ED characterized by recurrent episodes of binges eating followed by compensatory behaviors (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other drugs, fasting, excessive exercise) [ 8 ]. The third is characterized by recurrent episodes of bingeing associated with distress overeating or eating in the absence of hunger [ 9 ]. The last is characterized by avoidance or restriction of food, motivated by fear of the adverse consequences of eating or a lack of interest in eating [ 10 ].

Some studies state that, with respect to men, women have a higher risk of developing health problems related to EDs. The ratio of women to men for EDs has been reported to range from 4: 1 to 10: 1 and significantly increases during puberty [ 6 ]. A growing number of studies conducted during the pandemic have documented a worsening of eating disorder symptoms and syndromes in a variety of population groups [ 11 – 15 ].

Some studies showed increased eating restriction in people with AN, and more frequent binge-eating episodes in those with BN or BED [ 16 – 18 ]. In the first wave of the pandemic, an increase in symptoms such as anxiety, depression and eating disorders has been observed mainly in adolescents with pre-existing EDs. Instead, during the second and subsequent waves of the pandemic a surge in suicidal ideation and suicide attempts among adolescents has been reported in many countries [ 19 ].

Given the severity of these disorders, our study is aimed to explore, in a sample of young Italian peoples, the effect of the COVID-19 pandemic on eating disorders risk and symptoms.

This is a retrospective study based on data from the medical records of adolescents admitted to the Bambino Gesù Children’s Hospital of Rome (Italy) in the period between August 2019 and April 2021. Our findings could provide a framework for developing clinical and educational interventions to mitigate the short- and long-term negative impact of the pandemic on the future health of adolescents.

This is a retrospective observational study of a group of pediatric patients with EDs admitted to the Bambino Gesù Children’s Hospital of Rome (Italy) in the period between August 2019 and April 2021. In this study 230 patients with EDs were enrolled, but only 127 patients (117 females and 10 males) who had a follow-up after 1 month, 3 months and, in some cases, 12 months of antipsychotic therapy, were evaluated. Medical history, comorbidities, and laboratory data were obtained from patients’ electronic medical records related to admission (T0) and follow-up.

The study was approved by ethics committee of the Bambino Gesù Children’s Hospital of Rome (approval number: 2526-OPBG-2021). A written informed consent was obtained from adult patients and parents of patients under the age of 18.

During hospitalization, patients were subjected to (i) laboratory analyses for the evaluation of blood cells count and screening for specific vitamins and mineral deficiencies; and (ii) electrocardiogram, echocardiogram, abdomen ultrasound, and magnetic encephalic resonance.

All methods were performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards.

After diagnosis, the patients were treated with antipsychotics drugs as follows: 23 patients with antipsychotics; 80 with antipsychotics in combination with serotonin uptake inhibitors; 9 with antipsychotics in combination with benzodiazepines; 2 with antipsychotics in combination with anxiolytics; 1 with antipsychotics in combination with lithium; and 3 with serotonin uptake inhibitors. Moreover, 9 patients did not receive any drug treatment.

Statistical analysis

Correlations were evaluated by using Pearson correlation (r correlation coefficient). To test the probability of significant differences, individual group comparisons were evaluated using Bonferroni’s test. p < 0.05 values were considered statistically significant. A two-way analysis of variance using JMP 10 software (SAS Institute srl, Milan, Italy) was used to connect changes observed in ED patients with some comorbidities.

General characteristics of partecipants

A total of 127 patients (117 females and 10 males) with EDs, aged between 10 and 18 years, were included in this study. Most of the patients (74%) lived on central Italy while a small percentage (26%) in southern Italy. Patients were hospitalized for an average of 24 days (range 3–83). A very low percentage of patients included in this study was anorexic (5.5%) or had avoidant restrictive food intake disorder (ARFID, 4.7%), while 89.8% of patients had unspecified eating disorders. Except two patients who had a weight of 76.2 and 81.5 kg respectively, and a body mass index (BMI) of 24.3 and 28.2 Kg/m 2 respectively, the other patients had a median weight value of 37.2 Kg (range 22.5–52.6 Kg) and median BMI value of 14.96 Kg/m 2 (range 11.3–28.2 Kg/m 2 ). As shown in the Tables  1 and 102 patients (94 females and 8 males) were at the first onset of the disease, while 25 patients (23 females and 2 males) had clinical relapse. In addition, 79 patients (75 females and 4 males) had previously been hospitalized and 33 patients (32 females and 1 male) had familiarity for psychotic disorders. Specially, they were familiar for depression (7%), anxiety (1.6%), EDs (4.7%), and psychosis (4%). Moreover, the patients had familiarity for diabetes (3.9%); hyperthyroidism (3.1%) and hypothyroidism (2.4%). During hospitalization, echocardiographic examination highlighted pericardial effusion in 10 patients (7.8%) and pericardial cleavage in 7 patients (5.5%). Abdominal echography in 9 patients revealed pathologies such as angioma, calculosis of the cholecode and modest fluid flap in the pelvic cavity. Nuclear magnetic resonance of the brain resulted in a pathological outcome in only 7 patients.

General characteristics of ED patients

BMI, body mass index; EDs, eating disorders

Comorbidity in ED patients

As listed in the Table  2 , patients analyzed in this study had comorbidity.

Comorbidities detected in ED patients

A high percentage of females (64%) had amenorrhea. All patients had low lymphocytopenia, while 38% of patients had neutropenia and 13.4% of patients had thrombocytopenia. Many patients had bradycardia (60.6%) and hypovitaminosis (93.5%), while a small percentage (7%) had hypercreatinemia and hyperazotemia. In addition, these patients also had disorders such as depression (14%), anxiety (3.9%), psycosis (4.7%), specific learning disorder (3.9%) or multiple psychiatric disorders (13.4%). Two patients had also attempted suicide.

Screening for vitamins and thyroid hormones

As previously reported, a high percentage of these patients had hypovitaminosis. In particular, a deficiency of vitamin A (6% of patients); vitamin B1 (7% of patients); vitamin B6 (9.4% of patients); vitamin B12 (6.3% of patients) and vitamin C (27% of patients) was detected (Table  3 ). Moreover, we found that vitamin D3 was deficient in the 22.8% of patients and insufficient in the 42% of patients. In addition, 56.6% of patients had high levels of ferritin, while 7.9% of patients had high levels of thyrotrophic hormone (TSH). Instead, 21% of patients had low levels of vitamin B9 (folic acid), while 21.3% of patients had low levels of thyroxine (FT4) (Table  3 ).

Percentage of patients with variables having a different value from reference values

TSH, thyrotrophic hormone; FT4, thyroxine

Correlations between variables

Considering that all patients have lymphocytopenia as comorbidity, we correlated leukocyte number with some variables. As shown in Table  4 we found that lymphocytes number correlated significantly (p < 0.0001) with body weight (rho = 0.08); BMI (rho = 0.016); neutrophil count (rho = 0.065), vitamin B1 (rho = 0.06); vitamin B6 (0.11); vitamin D3 (rho = 0.02); ferritin (rho = 0.089); sideremia (rho = 0.012); and cholesterol (rho = 0.18). Conversely, no correlation was found between lymphocytes number and vitamin A (rho = -0.14); vitamin B12 (rho = -0.07); vitamin B9 (rho = -0.11); TSH (rho = -0.06); FT4 (rho = -0.104); and triglycerides (rho = -0.19). Moreover, to connect hematological changes detected in ED patients with comorbidity such as bradycardia, amenorrhea, anxiety, and depression, a regression analysis was performed, but no correlations were found.

Correlation between variables

BMI, body mass index; TSH, thyrotrophic hormone; FT4, thyroxine

Efficacy of therapy

Antipsychotic treatment positively influenced both body weight and BMI of patients. As shown in Fig.  1 , compared to T0, weight increased by 10.4% after 1 month and by 26.2% after 3 months of antipsychotic treatment. Body weight increase after 3 months was significant (p < 0.05). Similarly, the BMI increased by 12.3% after 1 month and by 15% after 3 months of treatment.

A workflow chart of the study

Effects of antipsychotic treatment on body weight and BMI of EDs patients. In the histogram are shown the values of body weight and BMI after 1 and 3 months of treatments with antipsychotics. The values are expressed as delta percentage compared to T0. *p < 0.05

The COVID-19 pandemic resulted in restrictions, which had a negative impact on physical activity and eating behavior, especially among young population. Children and adolescents affected by pre-existing eating disorders, being more sensitive to social stress [ 18 ] and having difficulties to control emotions [ 19 ], may be particularly vulnerable. In our retrospective study a group of 127 pediatrics patients with EDs admitted to the Bambino Gesù Children’s Hospital of Rome (Italy) during the COVID-19 pandemic were studied and hematologic complications (lymphocytopenia and neutropenia), amenorrhea, bradycardia, alterations in hormone status and psychiatric comorbidities (anxiety and depression) were found.

In patients with anorexia nervosa literature data associate some hematological complications with malnutrition [ 20 ] and state that leukopenia can promote an alteration of the humoral and cellular immune responses [ 21 ]. In this study we found that most of the patients analyzed suffer from hypovitaminosis due to malnutrition. Among the vitamins evaluated, vitamin C, vitamin B9 (folic acid) and vitamin D3 were deficient in a higher percentage of patients (27, 21, and 64.8% respectively). Vitamin C is an antioxidant vitamin that modulates immune cell function and supports a Th1 cytokine-mediated immune response with sufficient production of pro-inflammatory cytokines [ 22 ]. Vitamin B9 plays an essential role in the synthesis of neurotransmitters and structural elements of neurons. Its deficiency has been associated with disorders linked to mental function such as depression and cognitive function impairment [ 23 ]. Vitamin D3 plays important roles in both cell-mediated and humoral antibody response and has antimicrobial and anti-inflammatory functions. Its deficiency may be related to cognitive impairment and dementia and increases the risk for acquiring several infectious diseases [ 24 ]. In patients with EDs vitamin D3 deficiency has been correlated with osteoporosis risk, while in patients with long-term EDs might be responsible for the lack of the inflammatory response and the depressive symptoms [ 25 ]. Interestingly, in our study a significant (p < 0.0001) correlation between lymphocytes count, body weight, BMI, and some vitamins (B1, B6, C and D3) was found. The correlation between lymphocytes number, vitamin C and vitamin D leads to assume that these patients have a higher susceptibility to infections. Moreover, in the literature it is reported that for many patients with malnutrition one of the key outcomes is amenorrhea [ 20 ]. In our study we found that the amenorrhea affected a high percentage of females (64%) and that these patients, in addition to low body weight, had lymphocytopenia. On this basis we can assume that in these patients the amenorrhea may be an adaptive, but completely reversible condition to malnutrition [ 20 ].

In adolescent, an excellent indicator of nutritional status is serum concentration of thyroid hormones, being they influenced by both the degree of leanness and the current weight trend. In our study, we found that 7.9% of ED patients had high levels of thyrotrophic hormone (TSH) and that 21.3% of patients had low levels of thyroxine (FT4). Increased levels of TSH and low levels of FT4 are typical of hypothyroidism, most often caused by autoimmune thyroid disease such as Hashimoto’s thyroiditis (HT). According to the literature data we found that TSH correlated with some vitamins such as vitamin B1 (rho = 0.025), vitamin B6 (rho = 0.21) and vitamin D3 (rho = 221 0.056) and total cholesterol content (rho = 0.127) [ 26 – 29 ]. Moreover, we found that a small percentage of patients (11.8%) had total cholesterol values higher than the reference values (median values 244.6 mg/dL). This could have important clinical implications and become a risk factor for cardiovascular disease. In addition, in many patients (56%) high serum ferritin levels were found. This is probably due to an increase in muscle catabolism that occurs during the loss of the menstrual cycle [ 30 ]. All these results show that there are frequent comorbidities in eating disorders, mainly related to malnutrition, which need to be analyzed.

The COVID-19 pandemic has negatively affected teens’ eating behavior. The data obtained in this retrospective study show that adolescents who experienced eating disorders during the pandemic, often present comorbidities, and alterations of blood parameters such as leukocytopenia, neutropenia, hypovitaminosis and hormonal problems that could danger their future.

These comorbidities should not be overlooked, but they should be treated in association with psychological treatments.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Acknowledgements

Not applicable.

Abbreviations

Author’ Contributions

Conceptualization, I.T.J., M.R.M., A.G.; data curation, T.C., C.M., L.G., C.C., C.G.; investigations, I.P.; writing-original draft preparation, E.S.; editing, R.V.; supervision, A.V. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Data Availability

Declarations.

The study was approved by ethics committee of the Bambino Gesù Children’s Hospital of Rome (approval number: 2526-OPBG-2021). Informed written consents were obtained by adult patients and parents of patients under the age of 18.

All methods of this study were carried out in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

The authors declare no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Elisabetta Straface, Isabella Tarissi De Jacobis, Alberto Villani and Maria Rosaria Marchili have contributed equally.

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Elisabetta Straface, Email: [email protected] .

Isabella Tarissi De Jacobis, Email: [email protected] .

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Views and experiences of eating disorders treatments in East Asia: a meta-synthesis

Affiliations.

• 1 South London and Maudsley NHS Foundation Trust, London, UK. [email protected].
• 2 Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, De Crespigny Park, Box P059, London, SE5 8AF, UK. [email protected].
• 3 South London and Maudsley NHS Foundation Trust, London, UK.
• 4 Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, De Crespigny Park, Box P059, London, SE5 8AF, UK.
• PMID: 39164776
• DOI: 10.1186/s40337-024-01070-4

Introduction: Although there have been qualitative meta-syntheses on experiences of eating disorders treatments, there is a paucity of syntheses specifically examining the perspectives and experiences of eating disorders treatments (ED) in East Asia (EA). Such synthesis could facilitate a better understanding of culture-specific perspectives and experiences. This review complements a quantitative scoping review published on ED treatments in EA (Yim & Schmidt, 2023), where most interventions reviewed focused on cognitive behavioural therapy (CBT) and internet interventions. The present meta-synthesis summarises stakeholders' views on treatments and to synthesise clinical and research recommendations.

Method: A systematic search of five databases and a citation search were conducted to identify relevant studies and data were analysed using thematic synthesis. Out of the 301 studies found, a total of 12 papers were included in the analysis.

Results: A diverse range of treatments, such as family therapy, paediatric/psychiatric inpatient care, CBT, and counselling, were discussed. Three overarching themes were identified: Delineating Physical and Psychological Recovery; 'I am not alone in this battle'; and Barriers to Change. The themes further delve into the various obstacles to recovery, including financial concerns and limited access to professionals and services. Culture-specific factors include family obligations and promoting family harmony. Balancing interdependence and independence from one's family, as well as understanding family body ideals versus broader societal body ideals, are important considerations in ED interventions.

Discussion: Some themes paralleled other qualitative syntheses, highlighting improved family relationships, perceived authoritarianism in treatments, and financial barriers. The review extends beyond the previous findings, revealing nuanced factors like family roles, cultural values, and norms. Clinical recommendations include incorporating family context in treatment and considering cultural influences on body image ideals. Capacity building through telemedicine and increased training is essential for advancing ED treatment in East Asia. Continued research is needed to better understand and treat people affected by ED in EA.

Keywords: Anorexia nervosa; East Asia; Eating disorder; Meta-synthesis; Psychological therapy.

© 2024. The Author(s).

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• Pike KM, Dunne PE. The rise of eating disorders in Asia: a review. J Eat Disord. 2015;3(1):33. - DOI - PubMed - PMC
• Chen J, Zhu R, zhen, Peng S. fang. Eating disorders (EDs), Chinaepidemiological investigationEpidemiology of Eating Disorders in East Asia. In: Robinson P, Wade T, Herpertz-Dahlmann B, Fernandez-Aranda F, Treasure J, Wonderlich S, editors. Eating Disorders: An International Comprehensive View [Internet]. Cham: Springer International Publishing; 2023. pp. 1–23. https://doi.org/10.1007/978-3-030-97416-9_15-1
• Tan TX, Liu Y, Li G, Yi Z. Independent and interdependent self-construal and anxiety in Chinese College students: a path analysis. J Coll Character. 2022;23(2):127–43. - DOI
• Lee Y, Kuo BCH, Chen PH, Lai NH. Recovery from Anorexia Nervosa in contemporary Taiwan: a multiple-case qualitative investigation from a cultural-contextual perspective. Transcult Psychiatry. 2021;58(3):365–78. - DOI - PubMed
• Reddy SD, Crowther JH. Teasing, acculturation, and cultural conflict: psychosocial correlates of body image and eating attitudes among south Asian women. Cultur Divers Ethnic Minor Psychol. 2007;13(1):45–53. - DOI - PubMed

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• Contagion: Journal of Violence, Mimesis, and Culture

Eating Disorders and Mimetic Desire

• René Girard
• Michigan State University Press
• Volume 3, Spring 1996
• 10.1353/ctn.1996.0010
• View Citation

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Eating Disorders and Mimetic Desire René Girard Stanford University Among younger women, eating disorders are reaching epidemic proportions. The most widespread and spectacular at this moment is the most recently identified, the so-called bulimia nervosa, characterized by binge eating followed by "purging," sometimes through laxatives or diuretics, more often through self-induced vomiting. Some researchers claim that, in American colleges, at least one third of the female student population is involved to some degree. (Since nine out of ten sufferers are women I will use feminine pronouns in this paper but some undergraduates at Stanford tell me that the epidemic is spreading to male students.) G.M.F. Russell, the first researcher who focused on the specific aspects ofmodern bulimia, is usually presented as the discoverer of a new illness. The title ofhis 1979 publication contradicts this view: "Bulimia Nervosa: An Ominous Variant ofAnorexiaNervosa." And, indeed, all the symptoms he describes had been mentioned before in connection with anorexia (see Bruch). The insurance companies and the medical profession like only welldefined illnesses, and so does the public. We all try to distance ourselves from pathological contamination by giving it a name. Eating disorders are often discussed as ifthey were new varieties ofmeasles or oftyphoid fever. Why distrust the distinction between two illnesses with symptoms as radically opposed as those of anorexia and bulimia? Because we live in a world where eating too much and not eating enough are opposite but inseparable ways ofcoping with the slenderness imperative that dominates 2 René Girard our collective imaginations. Most of us oscillate all our lives between attenuated forms ofthese two pathologies. The man in the street understands perfectly a truth that most specialists prefer not to confront. Our eating disorders are caused by our compulsive desire to lose weight. Most books on the subject acknowledge the universal calorie phobia but somewhat absent-mindedly, as if it could not be the major cause ofa serious illness. How could a fundamentally healthy desire become the cause ofpathological behavior, even ofdeath? Many people would be healthier, no doubt, ifthey ate less. In view of this fact, it is not illogical to suppose that, in anorexia, there must be some motivation other than this healthy desire, some unconscious drive, no doubt, that generates abnormal behavior. By turning anorexia and bulimia into two separate pathologies, the classificators make it easier for us to lose sight of their common basis. The bankruptcy of modern theories The search for hidden motivations is the alpha and omega, ofcourse, of our modern culture. Our number one principle is that no human phenomenon is really what it seems to be. A satisfactory interpretation must rely on one of the hermeneutics of suspicion that have become popular in the nineteenth and twentieth century, or on several ofthese, on a cocktail of soupçon: psychoanalysis, Marxism, feminism, etc. We automatically assume that social phenomena have little if anything to do with what is obvious in them, in this case the rejection offood. In anorexia, psychoanalysts usually diagnose "a refusal of normal sexuality," due to the patient's excessive desire "to please her father," etc. These explanations are still invoked in books being written right now but the voice is growing fainter. Around this sort of thing the smell of mustiness is overpowering. Even in Lacan's own land, the old arrogance is gone. Early in my life, I had an opportunity to observe that the eating practices ofyoung women have nothing to do with a desire to please their fathers. Just before World War II, a pretty cousin of mine was dieting furiously and her father, my uncle, was storming about helplessly, trying to get her to eat more. Fathers, as a rule, are not pleased to see their daughters starve themselves. This particular father was also a physician, at a time when the medical profession had not yet caught the disease it was already trying to cure. Eating Disorders andMimetic Desire3 This uncle was our family doctor and, as such, had great prestige in my eyes, at least until that day. I had not yet read Freud but my later skepticism regarding his conception offatherhood may well originate in this incident. I immediately...

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Blackbird Initiative – Effective research to combat disordered eating

Flinders university’s blackbird initiative exists to conduct high-level research and develop effective, evidence-based interventions to improve the lives of people affected by eating disorders.

The prevalence of eating disorders in youth doubled in the five years before the onset of the COVID pandemic, affecting one in six females and one in 40 males. The prevalence increased again significantly over COVID. The evidence suggests that while the mental health of youth was impacted adversely across the board over this time, eating disorders increased more than depression or anxiety. Since the end of lockdowns, there has been a further increase in the prevalence of eating disorders in adolescents, both males and females. Despite the increasing and high prevalence of a disorder with one of the highest mortality rates of any mental illness, only one in four youth receive treatment for an eating disorder.

In 2024 The Lancet Psychiatry Commission called for a transformation in mental health implementation research in real-world settings to overcome barriers to scaling. In addition, among the variety of mental health disorders, eating disorders are uniquely associated with ambivalence and denial, which creates further barriers to engagement in interventions.

Identifying critical issues that are causing eating disorders

This first step of the current project will identify, with a variety of stakeholders, the critical issues that are causing eating disorders to develop in young people. We are seeking to identify transdiagnostic targets, the risk factors that cause an eating disorder, to provide an engaging pathway that sidesteps denial and maximizes use of an intervention. Based on consensus across people with lived experience, caregivers, clinicians and researchers, we will nominate ten early intervention transdiagnostic targets.

The second step of the project is to develop ten different interventions that have previously shown an ability to reduce these risk factors, utilising evidence-based principles that make interventions in mental health more effective e.g., utilising the power of cognitive dissonance by getting the young person to argue for change, personalising interventions.

Technology-delivered interventions in mental health

Another important engagement strategy is packaging the interventions in an app that takes no more than 30 minutes to complete. Young people consistently say that in the field of technology-delivered interventions in mental health, they prefer using mobile versions like apps for smartphones. Development of all the interventions will be conducted in co-design with young people with lived experience of disordered eating.

The third step of the research is testing these brief interventions and identifying those that have the most promising outcomes for decreasing disordered eating in young people. Which interventions work best for who will be a focus of the ongoing research. This will enable us to empower young people, via use of an assessment guide, to curate the selection of interventions that best works for them. This process assessment guide will be made available, along with the apps, as a free resource for use in open, unguided settings.

Effects of the pandemic will continue to be experienced by youth

This work will close a knowledge gap between the increasing prevalence of eating disorders in youth and broad access to effective and engaging interventions. This work can result in young people experiencing better health outcomes sooner. This is critical in a world where sustained effects of the pandemic will continue to be experienced by youth via a higher cost of living, heightened perceived vulnerability to disasters outside of one’s control, erosion of social relationships, and interrupted developmental milestones.

Professor Tracey Wade

Matthew Flinders Distinguished Professor Tracey Wade has worked as a clinician and researcher in eating disorders for over 30 years. She has led improvements in mental health through development and application of new interventions and informing policy to ensure evidence-based service provision.

Tracey is the director of the Blackbird Initiative  and the Flinders University Services for Eating Disorders (FUSED). She has cowritten 3 books on cognitive behaviour therapy for eating disorders and perfectionism and has over 300 publications in peer reviewed journals. Her contribution to the field of mental health has been recognised widely.

In 2015 she was elected a Fellow of the Academy of the Social Sciences in Australia. In 2016 she was made an Inaugural Honorary Fellow of the Australian Association for Cognitive and Behaviour Therapy (CBT). In 2019 she was appointed Fellow of the Australian Psychological Society and was a recipient of the Australia and New Zealand Academy of Eating Disorders Distinguished Achievement Award. In 2020 she was the recipient of the Academy of Eating Disorders Outstanding Clinician Award. In 2021 she was given the Channel 7 Children’s Research Foundation Len Frankham award for outstanding achievement in children’s education and wellbeing research, and the Healthy Development Adelaide Award for achieving excellence in research contributing to healthy development. In 2023 she was the recipient of the Australian Association for Cognitive and Behavioural Therapy Distinguished Career Award. In 2024 she is a Global Ambassador for CBT for the World Confederation of Cognitive and Behavioural Therapies.

Over 2024 to 2028 her research work is supported by a prestigious National Health and Medical Research Council Investigator Grant 2025665. The project, Revolutionising early intervention outcomes for youth with emerging eating disorders , seeks to tackle the gap between the rising prevalence of disordered eating and eating disorders in youth aged 14 to 25 years and timely, scalable and engaging interventions.

Click here to visit the website

Tracey Wade Matthew Flinders Distinguished Professor

Flinders University (Flinders University Institute for Mental Health and Wellbeing)

Tel: +61 0403021291

Email: [email protected]

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Researchers establish what the neurodivergent community would like from research on disordered eating

by King's College London

New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London and Birkbeck, University of London, has worked with members of the neurodivergent community to establish what they would like to see prioritized in future research on disordered eating.

"The overlap of disordered eating, autism and ADHD: future research priorities as identified by adults with lived experience" was published in The Lancet Psychiatry .

The researchers hope that a more collaborative approach to studies in this field has the potential to create a greater understanding of why autistic people and people with ADHD are more vulnerable to disordered eating and how best to aid those who need support.

A total of 71 neurodivergent (either autistic and/or with ADHD) adults who had experienced disordered eating responded to an online survey asking about their suggestions and preferences for future research in the field.

A list of recurrent themes from this survey was then taken through to an in-depth workshop with a different group of 14 neurodivergent adults who had also experienced disordered eating. Priorities were thought about from various different angles and in terms of their potential for impact. From this workshop, researchers collated a list of the top 10 research priorities, ranked by order of importance:

• How can treatment for disordered eating be improved for neurodivergent individuals?
• What are other factors that can increase risk of disordered eating in neurodivergent people?
• What is the effect of neurodiversity training and knowledge in clinical services for eating disorders?
• Which treatment interventions for disordered eating are actively unhelpful for neurodivergent individuals?
• Is there a difference between the underlying reasons for disordered eating in neurodivergent people compared with neurotypical people?
• Would better information and education reduce risk for neurodivergent people?
• Is there a link between ADHD characteristics (e.g. impulsivity) and eating disorders?
• How do difficulties in executive functions affect eating behaviors and increase risk of disordered eating?
• Is there a link between sensory sensitivities and disordered eating?
• Do different thinking styles (e.g. black-and-white thinking) contribute to disordered eating behaviors?

Researchers sorted the list into two overarching themes, each with two subgroups:

Priority 1: Improving clinical outcomes

Participants identified that research relating to the improvement of services was the most urgent priority .

Subtheme 1—Improving clinical services

Clinical services for the treatment of eating disorders often aren't set up to accommodate the needs of neurodivergent individuals, and this can make treatment and support less effective.

Despite some progress being made in this area following the development of the PEACE Pathway, there are currently no clinical guidelines that have been agreed upon, and there has been little research conducted into the effectiveness of adapted treatments in autistic populations.

Thus, many of the top ranked priorities asked about how services could be improved and identifying and minimizing potential harms caused by unsuitable treatments.

Subtheme 2—Improving psychoeducation and preventive medicine

Another key priority was on the availability of educational resources for neurodivergent people. While participants were clear that outcomes needed to improve, they also expressed that preventative measures and information that could help people prior to developing a clinical diagnosis could also be helpful and would empower neurodivergent people to understand their own eating behaviors.

Priority 2: Identifying causal mechanisms

A second priority that became apparent through the project was the participants' desire to understand the causal mechanisms linking neurodivergence with disordered eating.

Researchers broke this priority into two further subthemes:

Subtheme 1: Identification of risk factors

Historically, it was assumed that autistic women with anorexia were motivated by weight and body shape, based on explanatory models from neurotypical people. However, this may not be true in neurodivergent people, such that many mechanisms we think (and therefore target during treatment) lead to eating disorders may not be relevant for neurodivergent people.

One potential factor that often comes up in neurodivergent people is that patterns of disordered eating may represent a response to the stress of living in a neurotypical world as a neurodivergent person.

Researchers suggested an avenue of research could be to test the link between stress and disordered eating in both neurodivergent and neurotypical populations to help inform the design of prevention and intervention strategies.

Subtheme 2: The role of autistic and ADHD neurocognitive profiles

Participants asked several questions based around the idea that the cognitive profiles associated with autism and ADHD could increase someone's vulnerability to disordered eating.

Current evidence suggests that there are links between sensory sensitivities and restrictive eating, and between executive functioning and disordered eating, but whether these factors can account for the increased risk for eating disorders in autistic and ADHD populations isn't yet clear.

Dr. Virginia Carter Leno, the study's senior author said, "Experiencing disordered eating is related to a variety of negative health outcomes, and it's important that services are able to meet the needs of all service users requiring treatment.

"Eating disorder services need to recognize that the needs of neurodivergent service users may be different to neurotypical people, and more research is needed to better understand the drivers of disordered eating in neurodivergent people.

"Our study has worked with a range of people with lived experience to help identify what they feel needs to be the highest priorities for future research in this area. We hope this list will act as a resource to ensure that future research in the field is informed by the experience and priorities of those with lived experience."

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• DOI: 10.1192/bjo.2024.414
• Corpus ID: 271659511

Assessment and Management of Eating Disorders at Community CAMHS in South Lanarkshire: A Quality Improvement Project

• Tze Hui Fifi Phang , Sophie G. Hall , +2 authors Raghuram Mahalingam Krishnasamy
• Published in BJPsych Open 1 June 2024

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Eating Disorders

Do you or someone you know suffer from an eating disorder?  According to the National Eating Disorders Association ( NEDA) , 28.8 million people in the U.S. will struggle with an eating disorder in their lifetime.  

This page will provide you with information and resources to help you learn about the different diseases, and specific populations, and guide you or someone you know in the process of recovery  and starting to live a fulfilling life! 100% recovery is possible!

*Content on this page was adapted from our former website, Voices4Hope, which was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), ACL Grant #90RT5005 (formerly H133B090018) the Learning and Working During the Transition to Adulthood, and the Substance Abuse and Mental Health Services Administration. The Voices4Hope website was created by and for young adults living with a mental health condition to share the Center's work and other relevant information with their peers.

Types of Eating Disorders

Eating disorders are serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights.  There is no single cause of an eating disorder. Rather, it is a complex combination of biological, psychological, and sociocultural factors that converge and set off an individual’s predisposed genetic vulnerability. 1

There are 9 types of diagnosable eating disorders:

• Anorexia Nervosa
• Bulimia Nervosa
• Binge Eating Disorder
• Avoidant/Restrictive Food Intake Disorder (ARFID)
• Other Specified Feeding or Eating Disorder (OSFED)
• Unspecified Feeding or Eating Disorder (UFED)
• Rumination Disorder

Visit the National Eating Disorders Association (NEDA) to learn more about each type of disorder including diagnostic criteria, warning signs, health consequences, and treatment considerations. 

1 What are Eating Disorders?  National Eating Disorders Association. 21 February 2024. https://www.nationaleatingdisorders.org/what-are-eating-disorders/

Eating Disorder Research

Eating disorders have the  second highest mortality rate of any mental health condition (ANAD,  http://www.anad.org/ ), but full recovery is possible and does happen!

Youth & Young Adults:

• 90% of eating disorders are diagnosed before age twenty ( www.mentalhelp.net ).
• 10% to 20% of female college students and 4% to 10% of college males have eating disorders (Eating for Life Alliance,  http://www.eatingforlife.org/ ). The percentage of college males with eating disorders is said to have increased since this study.
• The percentage of young people with an eating disorder at least doubled due to the COVID-19 pandemic ( JAMA Pediatrics ).

Special Populations:

• One in three males suffer from an eating disorder ( w w w.nationaleatingdisorders.org ) .
• 53% of LGBT individuals have  been diagnosed with an eating disorder ( Journal of Eating Disorders ) .
• Doctors are far less likely to ask BIPOC patients than white patients about eating disorders ( www.anad.org ).
• Native American and Latina women are less likely than white women to receive a referral for follow up care, regardless of the severity of symptoms ( www.anad.o r g ).
• Up to 50% of people with eating disorders also misuse substances ( www.nationaleatingdisorders.org ).

Below are key resources to learn more about eating disorders and find support.

• N ational Eating Disorder s Association (N EDA )
• Multi-Service Eating Disorders Association (MEDA)
• National  A ssociation of A norexia N ervosa and R elated D isorders (ANAD)
• Beat Eating  D isorders
• SAMHSA National Center of Excellence for Eating Disorders (NCEED)
• Office on Women's Health 
• National Institute of Mental Health (NIMH)

Special Populations

• Inclusive Eating Disorder Care (ANAD)
• Eating Disorders in Men and Boys (NEDA)

For Caregivers, Parents, & Siblings

• Caregiver or Sibling Support Group

Body Image & Body Positivity

• More Than a Body
• The Body Positive
• Adios Barbie
• The Body Project

Books & Blogs

• Eating Disorder Hope: Recommended recovery books and ideas
• Boston Public Library: Curated list of eating disorder and body positivity books
• Gurze Books
• Transitions ACR Young Adult Blog: Who's At Your Table
• Transitions ACR Young Adult Blog: My Worth is More Than My Weight
• Transitions ACR Young Adult Blog: How My Mental Health Crisis Impacted My Health
• The Recovery Warrior
• Rethinking Wellness
• S.T.A.Y. Tuned Podcast, Episode 5: The WEIGHT of Weight Stigma (Feat. Dr. Nana Yaa Marfo)
• Recovery Record
• Brighter Bite

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UTHealth Houston researchers launch $3.3M study on how eating patterns and circadian rhythms impact aging

The study is led by Faraz Bishehsari, MD, PhD, (left) and Mahboobeh Mahdavinia, MD, PhD, (right).

Research Alert

Newswise — A groundbreaking research project to understand how diet and eating patterns can affect the body’s internal clock and influence aging is underway at UTHealth Houston, thanks to a $3.3 million grant from the National Institute on Aging.

The study is led by Faraz Bishehsari, MD, PhD, professor and vice chair of Clinical and Translational Research in the Division of Gastroenterology, Hepatology, and Nutrition with McGovern Medical School at UTHealth Houston, and Mahboobeh Mahdavinia, MD, PhD, professor of allergy and immunology , and the John P.  and Kathrine G. McGovern Distinguished Chair in Internal Medicine at McGovern Medical School.

The research holds the promise of uncovering new strategies for disease prevention and healthy aging. By revealing how eating habits and circadian rhythms influence gut and pancreatic health as people age, the research could significantly enhance the quality of life as we age, according to the study team.

Many age-related diseases are linked to low-grade systemic inflammation, sometimes known as “inflammaging,” a term used by some researchers to describe the chronic, low-level inflammation that occurs with aging and affects multiple organs. One of the main causes of this inflammation is the breakdown of the intestinal barrier, which is regulated by the interaction between the gut surface and its microbiome, a collection of bacteria, fungi, viruses, and their genes that naturally live on and inside the human body.

“As we age, changes in the microbiome and intestinal barrier can lead to chronic inflammation and damage to the intestine and other organs, like the pancreas,” said Bishehsari, who is establishing a multidisciplinary Gastroenterology Research Center in the Department of Internal Medicine, which he will direct. “Understanding how these changes occur and how to prevent them can help maintain gut health and prevent chronic diseases associated with the aging process.”

Bishehsari and Mahdavinia will study animals and humans in their research. They will look at how different mealtimes affect inflammation and aging in the guts and pancreas of mice, seeking to identify specific patterns and changes in gut bacteria that link meal timing to the aging process. Doing so will help identify possible biological pathways that accelerate aging.

The team will also study how disruptions to circadian rhythms affect gut bacteria and pancreas functions in humans. By examining human gut bacteria and circadian patterns, Bishehsari and Mahdavinia hope to identify targets for future therapeutic interventions that promote healthy aging.

“With the population of older individuals growing faster than any other age group, prioritizing healthy living in later years is more crucial than ever,” Mahdavinia said.

“Our research could uncover new targets for microbial or circadian interventions that could significantly influence the aging process,” Bishehsari said.

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Completion of Australia’s first publicly-run residential eating disorder centre

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• 21 Aug 2024 11:00 am AEST Date Time

The ACT Government has completed the new Eating Disorders Residential Treatment Centre in Coombs, which will provide specialist care in a brand-new service for the region.

Minister for Mental Health Emma Davidson said that today was an important milestone for people in our community who face or care for someone with an eating disorder.

“The new centre in Coombs is the first government owned and operated facility of its kind in Australia. It provides 24/7 residential care in a place that feels like home so people can apply their skills once they are ready to leave the service,” Minister Davidson said.

“Eating disorders are serious illnesses that can have significant impacts on the physical, psychological, and social-emotional wellbeing of the individuals and families affected. The centre provides therapeutic services that include specialist, intensive nutritional, and psychological treatment.

“For the past few years, we have worked closely with a range of stakeholders on the design. This engagement was undertaken with clinicians, non-government organisations, people with lived experience of eating disorders and the wider Canberra community.

“Over the next few days Canberra Health Services will finalise the centre and from next week appointments will start running. Residential treatments will begin in the coming weeks.”

The establishment of the centre was supported by an Australian Government commitment of $13.5 million over three years.

The specialist residential centre is a new service for the ACT. The centre will complement other eating disorder services in the Canberra region, including the Eating Disorders Clinical Hub and the early intervention service.

Quotes attributable to Dr Jim Hungerford CEO of the Butterfly Foundation:

“It is excellent to see this much needed addition to the eating disorder supports available in the ACT.”

“Butterfly has welcomed the opportunity to share our learnings and insights from opening and running Wandi Nerida, Australia’s first residential recovery centre for eating disorders, located on the Sunshine Coast QLD, with ACT Health and other states as they develop their own public residential treatment facilities around Australia.

“We believe residential treatment, with 24/7 specialist eating disorder care in a home-like environment, is an essential option for successful recovery for many within the stepped system of care for eating disorders, and we’re excited to see more treatment options expanding across Australia for the more than1.1 million Australians directly impacted each year.”

Quotes attributable to David Quilty, ACT Director at Eating Disorder Families Australia:

“Eating Disorders Families Australia (EDFA) ACT Director, David Quilty, said the completion of the Residential Treatment Centre would be warmly welcomed by the families and carers of loved ones with eating disorders.

From day one, the Minister Emma Davidson and the Health Directorate have included representatives of eating disorder families and carers in all aspects of the planning and development of this facility, including the model of care.

EDFA looks forward to families and carers being active participants in the vital role of the Residential Treatment Facility and to continue providing our counselling, education and support services to the broader Canberra community.”

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