Background: The prognosis for underweight individuals with an eating disorder (ED) and posttraumatic stress disorder (PTSD) is worse than for their peers without these comorbid symptoms. This... Show moreBackground: The prognosis for underweight individuals with an eating disorder (ED) and posttraumatic stress disorder (PTSD) is worse than for their peers without these comorbid symptoms. This qualitative study explores the experiences of trauma-focused Imagery Rescripting (ImRs) therapy of underweight inpatients being treated for an ED. Objective: To test the feasibility and to improve ImRs by understanding the experiences and perspectives of people with an ED and PTSD who, when underweight, received ImRs as an adjunct to their inpatient ED treatment. Method: To explore how underweight people with an ED experience and perceive ImRs, we used a qualitative study design involving semi-structured interviews with 12 participants. After analysis, the data were summarized and classified within a thematic framework that focused on experiences and improving the ImRs method. Results:The thematic analysis resulted in the following 6 main themes; (1) Expectations of ImRs; (2) Ability to participate in ImRs; (3) Effect of ImRs; (4) Experience of ImRs technique; (5) Conditions under which ImRs is given; (6) In depth-analysis. The results show that despite the fear of disappointment the participants appreciate addressing the PTSD and ED symptoms simultaneously. Further, results showed that it had been possible for them to attend ImRs but that the effects of ImRs were not uniformly perceived. Also, participants indicated that a caring context is important and that ImRs should not be scheduled immediately before a meal. Finally, the treatment generated hope. Conclusions: The findings of this study demonstrated the feasibility of the integration of ImRs trauma treatment for individuals who are being treated in an ED inpatient treatment setting, and are in contrast to standard practice where the focus of inpatient treatment has been ED-symptom improvement without comprehensively addressing past traumatic experiences during an underweight phase. Show less
Melisse, B.; Blankers, M.; Beurs, E. de; Furth, E.F. van 2022
Background: Saudi Arabia is undergoing rapid sociocultural changes, which may have led to an increase of body mass index and eating disorder pathology. The aim of this study is to investigate... Show moreBackground: Saudi Arabia is undergoing rapid sociocultural changes, which may have led to an increase of body mass index and eating disorder pathology. The aim of this study is to investigate whether body dissatisfaction, self-esteem, having lived abroad, cultural orientation, perceived stress, media use, and socioeconomic status are correlates of eating disorder pathology with body mass index as a covariate. Additional aims are to investigate if cultural orientation is associated with symptomatology and if stress is a covariate in the association between eating disorder pathology and Western orientation. Method: Self-report measures were administered in a convenience Saudi community sample (N = 1225) between April 2017 and May 2018. Hierarchical multiple linear regression analyses with eating disorder pathology as dependent variable were performed to establish the associations among the variables. Results: After adjusting for the effect of BMI, only body dissatisfaction and eating disorder pathology were moderately associated. Eating disorder pathology and body dissatisfaction were more severe among Saudi citizens with a higher BMI. Discussion: Several explanations for the lack of associations of westernization, self-esteem, and stress with eating disorder pathology are reviewed and discussed. The majority of this convenience sample existed of young unmarried Saudi females of high socioeconomic status. Of the total sample, 35% displayed eating disorder pathology which may be a reflection of the high rates of excess weight. Plain English summary: Eating disorders were assumed to be rare in Saudi Arabia, however, Saudi citizens report both, increased pressure to be thin and eating disorder pathology. Saudi Arabia is dealing with rapid sociocultural changes. Consequences of these sociocultural changes, which might be associated with eating disorder pathology, are an increase of BMI, body dissatisfaction, low self-esteem, westernization, perceived stress, media use, and socioeconomic status. In addition, the increase in BMI might strengthen the associations between eating disorder pathology and body dissatisfaction, low self-esteem, perceived stress, media use, and socioeconomic status. Alternative explanations might be that cultural values are associated with different eating disorder symptoms or that eating disorder pathology is associated with stress stemming from transformation that aims to empower women and modernize Saudi society. This study showed that only BMI and body dissatisfaction were associated with eating disorder pathology, and BMI was a covariate in the association between eating disorder pathology and body dissatisfaction. Preventative programs focused on avoidance of maladaptive weight loss strategies and the improvement of body satisfaction might be beneficial in Saudi Arabia. Show less
Background The prevalence of eating disorders has been assumed to be low in the Arab world, due to the alleged absence of the thin ideal. However, the Arab world is undergoing rapid sociocultural... Show moreBackground The prevalence of eating disorders has been assumed to be low in the Arab world, due to the alleged absence of the thin ideal. However, the Arab world is undergoing rapid sociocultural changes, and there are reports of an increase of the desire to be thin. This literature review therefore provides point-prevalence of Arabs at high risk for eating disorders, and a comprehensive synthesis of correlates of eating disorder symptoms, eating disorder-related variables and of a high risk for eating disorders. Method Several electronic databases were searched for published, peer-reviewed studies between 1986 and 2019 involving several key terms. From 317 screened studies, 81, mainly cross-sectional, were included. Preferred Reporting Items for Systematic reviews and meta-analyses was used as guidance and the quality of studies were assessed using the Newcastle-Ottawa scale. Results Estimates of individuals at high risk for eating disorders ranged from 2 to 54.8%. The eating disorder-related variables identified were desire to be thin, body dissatisfaction, disturbed-, and dieting- eating behavior. Identified correlates were increased affluence, media use, western influences, and obesity. An additional finding was that in some cases eating disorders were expressed somatically rather than psychiatrically. Discussion In the Arab world, females were most at risk for eating disorders and eating disorder symptoms. Sociocultural changes gave rise to the thin ideal and the prevalence of obesity, increasing the risk for the development of eating disorder-related variables and eating disorders. The literature on eating disorders in the Arab world suffers from potential limitations due to the use of non-validated assessment tools. Further research is necessary, particularly on the development and validation of a culturally sensitive assessment tool. Improved knowledge is likely to increase the number of people seeking treatment and decrease the stigma of psychotherapy. Show less
