Information about the types of eating disorders, some reasons why the military community are at risk, warning signs and how to get help. The Missouri Eating Disorders Council (MOEDC) created this document so support service members, veterans and their families.

ObjectiveAnorexia nervosa (AN) is a disorder characterized by atypical patterns of reward valuation (e.g. positive valuation of hunger). Atypical reward processing may extend into social domains. If so, such findings would be of prognostic significance as impaired social functioning predicts worse outcome. We explore neural circuits implicated in social reward processing in individuals with a history of AN who are weight-restored relative to controls and examine the effects of illness course on the experience of social value.Method20 weight-restored individuals with a history of AN (AN-WR) and 24 healthy control (HC) participants were assessed using fMRI tasks that tapped social reward: smiling faces and full human figures that varied in attractiveness and weight.ResultsAN-WR differed from HC in attractiveness ratings by weight (negatively correlated in AN-WR). While there were no significant differences when viewing smiling faces, viewing full figures resulted in decreased activation in regions implicated in reward valuation (the right caudate) for AN-WR and this region was negatively correlated with a sustained course of the disorder. Exploratory whole brain analyses revealed reduced activation in regions associated with social reward, self-referential processing, and cognitive reappraisal (e.g., medial prefrontal cortex, striatum, and nucleus accumbens) with sustained disorder course.DiscussionThe rewarding value of full body images decreases with a sustained disorder course. This may reflect an extension of atypical reward processing documented in AN-WR, perhaps as a function of starvation dampening visceral motivational signals; the deployment of cognitive strategies that lessen the experience of reward; and/or the nature of the stimuli themselves as provocative of eating disorder symptoms (e.g., thin bodies). These findings did not extend to smiling face stimuli. Advances in technology (e.g., virtual avatars, text messaging) may provide novel means to build relationships, including therapeutic relationships, to support improved social connections without threats to symptom provocation.

PurposeThe unique constraints to everyday life brought about by the COVID-19 pandemic have been suggested to negatively impact those with pre-existing mental health issues such as eating disorders. While individuals with eating disorders or disordered eating behaviors likely represent a vulnerable group to the COVID-19 pandemic, the impact of the pandemic is yet to be fully established.MethodsWe systematically examined the impact of the COVID-19 pandemic on eating disorders and disordered eating behaviors. We searched electronic databases MEDLINE, PsycINFO, CINAHL, and EMBASE for literature published until October 2021. Eligible studies were required to report on individuals with or without a diagnosed eating disorder or disordered eating behaviors who were exposed to the COVID-19 pandemic.FindingsSeventy-two studies met eligibility criteria with the majority reporting an increase in eating disorder or disordered eating behaviors associated with the COVID-19 pandemic. Specifically, it appears children and adolescents and individuals with a diagnosed eating disorder may present vulnerable groups to the impacts of the COVID-19 pandemic.DiscussionThis mixed systematic review provides a timely insight into COVID-19 eating disorder literature and will assist in understanding possible future long-term impacts of the pandemic on eating disorder behaviors. It appears that the role of stress in the development and maintenance of eating disorders may have been intensified to cope with the uncertainty of the COVID-19 pandemic. Future research is needed among understudied and minority groups and to examine the long-term implications of the COVID-19 pandemic on eating disorders and disordered eating behaviors.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=284749, PROSPERO [CRD42021284749].

The HealthLink BC Mental Health and Substance Use (MHSU) data set includes the following: Programs that offer early intervention, transitional care or other services that supplement and facilitate primary and adjunctive therapies; which offer community mental health education programs; or which link people who are in need of treatment with appropriate providers. Programs that provide preventive, diagnostic and treatment services in a variety of community and hospital-based settings to help people achieve, maintain and enhance a state of emotional well-being, personal empowerment and the skills to cope with everyday demands without excessive stress or reliance on alcohol or other drugs. Treatment may include emotional support, introspection and problem-solving assistance using a variety of modalities and approaches, and medication, as needed, for individuals who have a substance use disorder involving alcohol and/or other drugs or for people who range from experiencing difficult life transitions or problems in coping with daily living to those with severe, chronic mental illnesses that seriously impact their lives. Multidisciplinary programs, often offered on an inpatient basis with post-discharge outpatient therapy, that provide comprehensive diagnostic and treatment services for individuals who have anorexia nervosa, binge-eating disorder, bulimia or a related eating disorder. Treatment depends on the specific type of eating disorder involved but typically involves psychotherapy, nutrition education, family counseling, medication and hospitalization, if required, to stabilize the patient's health. Alliance of Information & Referral Systems (AIRS) / 211 LA County taxonomy is the data classification used for all HealthLink BC directory data, including this MHSU data set (https://www.airs.org/i4a/pages/index.cfm?pageid=1). AIRS taxonomy and data definitions are protected by Copyright by Information and Referral Federal of Los Angeles County, Inc (https://211taxonomy.org/subscriptions/#agreement)

PurposeThe unique constraints to everyday life brought about by the COVID-19 pandemic have been suggested to negatively impact those with pre-existing mental health issues such as eating disorders. While individuals with eating disorders or disordered eating behaviors likely represent a vulnerable group to the COVID-19 pandemic, the impact of the pandemic is yet to be fully established.MethodsWe systematically examined the impact of the COVID-19 pandemic on eating disorders and disordered eating behaviors. We searched electronic databases MEDLINE, PsycINFO, CINAHL, and EMBASE for literature published until October 2021. Eligible studies were required to report on individuals with or without a diagnosed eating disorder or disordered eating behaviors who were exposed to the COVID-19 pandemic.FindingsSeventy-two studies met eligibility criteria with the majority reporting an increase in eating disorder or disordered eating behaviors associated with the COVID-19 pandemic. Specifically, it appears children and adolescents and individuals with a diagnosed eating disorder may present vulnerable groups to the impacts of the COVID-19 pandemic.DiscussionThis mixed systematic review provides a timely insight into COVID-19 eating disorder literature and will assist in understanding possible future long-term impacts of the pandemic on eating disorder behaviors. It appears that the role of stress in the development and maintenance of eating disorders may have been intensified to cope with the uncertainty of the COVID-19 pandemic. Future research is needed among understudied and minority groups and to examine the long-term implications of the COVID-19 pandemic on eating disorders and disordered eating behaviors.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=284749, PROSPERO [CRD42021284749].

BackgroundEvidence for anorexia and bulimia in relation to the risk of ulcerative colitis (UC) is limited and inconsistent. The objective of this research was to utilize bi-directional, two-sample Mendelian randomization (MR) analysis to predict the causal association between anorexia nervosa and bulimia nervosa with UC.MethodsThe genome-wide association studies (GWAS) provided data for anorexia and bulimia from the UK Biobank, utilizing single-nucleotide polymorphisms (SNP) as instrumental variables. Additionally, genetic associations with UC were collected from various sources including the FinnGen Biobank, the UK Biobank and the International Inflammatory Bowel Disease Genetics Consortium (IIBDGC). The main analytical approach utilized in this study was the inverse-variance-weighted (IVW) method. To evaluate horizontal pleiotropy, the researchers conducted MR-Egger regression and MR-PRESSO global test analyses. Additionally, heterogeneity was assessed using the Cochran’s Q test.ResultsThis study found a negative association between genetically predicted bulimia (OR = 0.943, 95% CI: 0.893–0.996; p = 0.034) and the risk of UC in the IIBDGC dataset, indicating that individuals with bulimia have approximately a 5.7% lower risk of developing UC. No association was observed in the other two datasets. Conversely, genetically predicted anorexia was not found to be causally associated with UC. In bi-directional Mendelian randomization, UC from the IIBDGC dataset was negatively associated with the risk of anorexia (OR = 0.877, 95% CI: 0.797–0.965; p = 0.007), suggesting that UC patients have approximately a 12.3% lower risk of developing anorexia, but not causally associated with bulimia.ConclusionGenetically predicted bulimia may have a negative association with the onset of UC, while genetically predicted anorexia does not show a causal relationship with the development of UC. Conversely, genetically predicted UC may have a negative association with the development of anorexia.

Eating disorders (EDs) are a complex group of psychiatric conditions that involve dysfunctional eating patterns, nutritional alterations, and other comorbid psychopathologies. Some women with EDs may develop problematic internet use while they attempt to get information on dieting/weight control or get online support from people with similar problems. They may also drift toward tobacco smoking as a method to regulate their weight or to cope with their weight-related dysphoria. The occurrence of these conditions in EDs may prolong disease course and impede recovery. This study used structural equation modeling to investigate nutritional status (noted by body mass index, BMI), depression psychopathology, internet addiction (depicted by the Internet Addiction Test), Facebook addiction (depicted by the Bergen Facebook Addiction Scale), and smoking among 123 Spanish women diagnosed with EDs (mean age = 27.3 ± 10.6 years). History of hospitalization, marital status, age, and the level of education predicted BMI in certain ED groups. BMI did not predict depression, but it predicted internet addiction, Facebook addiction, and smoking in certain ED groups. Depression did not predict BMI, internet/Facebook addition, or smoking in any ED group. Some sociodemographic and clinical variables had indirect effects on depression, internet addiction, and Facebook addiction while age was the only variable expressing a direct effect on all outcome measures. Age, education, and history of prolonged treatment predicted smoking in certain ED patients. The findings signify that a considerable target for interventional strategies addressing nutritional and addictive problems in EDs would be women with high BMI, history of hospitalization, history of prolonged treatment, who are particularly young, single, and less educated. Replication studies in larger samples, which comprise various subtypes of EDs from both genders, are warranted to define the exact interaction among the addressed variables.

This publication provides the most timely statistics available relating to NHS funded secondary mental health, learning disabilities and autism services in England. This information will be of use to people needing access to information quickly for operational decision making and other purposes. These statistics are derived from submissions made using version 3.0 of the Mental Health Services Dataset (MHSDS). This edition includes final statistics for June 2018 and provisional statistics for July 2018. NHS Digital review the quality and completeness of the submissions used to create these statistics on an ongoing basis. More information about this work can be found in the Accuracy and reliability section of this report. Fully detailed information on the quality and completeness of particular statistics in this release is not available due to the timescales involved in reviewing submissions and engaging with data providers. The information that has been obtained at the time of publication is made available in the Provider Feedback sections of the Data Quality Reports which accompany this release. Information gathered after publication is released in future editions of this publication series. More detailed information on the quality and completeness of these statistics and a summary of how these statistics may be interpreted is made available later in our Mental Health Bulletin: Annual Report publication series. All elements of this publication, other editions of this publication series, and related annual publication series' can be found in the Related Links below. Please be aware, the data quality reports (and associated CSVs) that usually accompany the statistical reports within this publication have not been published. We have identified errors within the data quality reports and as such will not be able to publish them at this time. The files will be made available as soon as possible. NHS Digital apologises for any inconvenience caused. Also included this month is the first regular data release of perinatal mental health. This analysis is an analysis of women in contact with mental health services who were new or expectant mothers between July 2017 and June 2018. Please note: AMH04 (People in contact with adult mental health services on CPA at the end of RP with HoNOS recorded) and MHS-DIM03 (The number of SNOMED stop clock codes recorded in Procedure code for Eating Disorder referrals where Age at Service Referral Received Date is under 19) has not been included in this publication. NHS Digital will issue AMH04 and MHS-DIM03 as soon as possible. NHS Digital apologises for any inconvenience caused.

Body image disturbance is a core characteristic of anorexia nervosa which might be grounded in distortions in schematic body representations. In line with this, several studies showed that when walking through door-like apertures of different widths individuals with anorexia nervosa move as if their bodies are larger than they actually are. They turn their body at a higher aperture/shoulder width ratio than healthy individuals. We examined whether oversized body-scaled motoric behaviors may not be restricted to anorexia nervosa but concern a general feature of negative body image attitudes. Therefore, we investigated the relation between negative body image as assessed with shape and weight concerns subscales of the Eating Disorder Examination Questionnaire and aperture/shoulder width turning ratios in women with a healthy weight (N = 62). We found that a more negative body image was unrelated to higher aperture/shoulder width turning ratios. Bayes analysis provided moderate evidence for the null hypothesis that spontaneous body-scaled motoric behaviors are not involved in negative body image. Future studies should disentangle whether being underweight per se is related to distinctive spontaneous body-scaled motoric behaviors or whether an ‘oversized’ body schema is a unique characteristic of anorexia nervosa, potentially contributing to the persistence of this disorder.

"BACKGROUND: To investigate the prevalence and correlates of bipolar disorders in patients with eating disorders (EDs), and to examine differences in effects between major depressive disorder and bipolar disorder on these patients. METHODS: Sequential attendees were invited to participate in a two-phase survey for EDs at the general psychiatric outpatient clinics. Patients diagnosed with EDs (n=288) and controls of comparable age, sex, and educational level (n=81) were invited to receive structured interviews for psychiatric co-morbidities, suicide risks, and functional level. All participants also completed several self-administered questionnaires assessing general and eating-related pathology and impulsivity. Characteristics were compared between the control, ED-only, ED with major depressive disorder, and ED with bipolar disorder groups. RESULTS: Patients with all ED subtypes had significantly higher rates of major depressive disorder (range, 41.3-66.7%) and bipolar disorder (range, 16.7-49.3%) than controls did. Compared to patients with only EDs, patients with comorbid bipolar disorder and those with comorbid major depressive disorder had significantly increased suicidality and functional impairments. Moreover, the group with comorbid bipolar disorder had increased risks of weight dysregulation, more impulsive behaviors, and higher rates of psychiatric comorbidities. LIMITATIONS: Participants were selected in a tertiary center of a non-Western country and the sample size of individuals with bipolar disorder in some ED subtypes was small. CONCLUSION: Bipolar disorders were common in patients with EDs. Careful differentiation between bipolar disorder and major depressive disorder in patients with EDs may help predict associated psychopathology and provide accurate treatment."

Individuals with an eating disorder (ED) often report to be disgusted by their body. Body-related self-disgust could play an important role in the development and maintenance of EDs. We investigated if women with relatively high ED symptom scores indeed respond with disgust upon exposure to their body as indexed by facial electromyography (fEMG) of the m. levator labii superioris and self-report. Given that one’s self-disgust may increase/decrease depending on the relative distance of the own body to the thin ideal, we also assessed women’s disgust for overweight- and thin-morphs of their body. Female undergraduate students (N = 104) were photographed and presented with their (morphed) body pictures, next to disgust-relevant and overweight body control pictures. Higher levels of ED symptoms were associated with stronger self-reported disgust to unedited body-pictures and overweight-morphs. Disgust to thin-morphs was unrelated to ED symptoms. Participants generally showed heightened facial disgust towards overweight morphs, yet the strength of facial disgust was unrelated to ED symptoms. Thus, the findings provide evidence for the involvement of heightened body-related self-disgust in ED symptomatology, albeit only on the basis of self-report.

Abstract copyright UK Data Service and data collection copyright owner.

• to provide annual data about the nation's health;
• to estimate the proportion of people in England with specified health conditions;
• to estimate the prevalence of certain risk factors associated with these conditions;
• to examine differences between population subgroups in their likelihood of having specific conditions or risk factors;
• to assess the frequency with which particular combinations of risk factors are found, and which groups these combinations most commonly occur;
• to monitor progress towards selected health targets
• since 1995, to measure the height of children at different ages, replacing the National Study of Health and Growth;
• since 1995, monitor the prevalence of overweight and obesity in children.

The survey includes a number of core questions every year but also focuses on different health issues at each wave. Topics are revisited at appropriate intervals in order to monitor change.

Further information about the series may be found on the NHS Digital Health Survey for England; health, social care and lifestyles webpage, the NatCen Social Research NatCen Health Survey for England webpage and the University College London Health and Social Surveys Research Group UCL Health Survey for England webpage.

Changes to the HSE from 2015:
Users should note that from 2015 survey onwards, only the individual data file is available under standard End User Licence (EUL). The household data file is now only included in the Special Licence (SL) version, released from 2015 onwards. In addition, the SL individual file contains all the variables included in the HSE EUL dataset, plus others, including variables removed from the EUL version after the NHS Digital disclosure review. The SL version of the dataset contains variables with a higher disclosure risk or are more sensitive than those included in the EUL version and is subject to more restrictive access conditions (see Access information). Users are advised to obtain the EUL version to see if it meets their needs before considering an application for the SL version.

COVID-19 and the HSE:
Due to the COVID-19 pandemic, the HSE 2020 survey was stopped in March 2020 and never re-started. There was no publication that year. The survey resumed in 2021, albeit with an amended methodology. The full HSE resumed in 2022, with an extended fieldwork period. Due to this, the decision was taken not to progress with the 2023 survey, to maximise the 2022 survey response and enable more robust reporting of data. See the NHS Digital Health Survey for England - Health, social care and lifestyles webpage for more details.

The EUL version of the HSE 2019 is held under SN 8860.

Core topics:

• General health
• Longstanding illness
• Smoking
• Average weekly alcohol consumption
• Drinking (heaviest day in last week)
• Consent to data linkage (NHS central register, HES)
• Socio-economic information: sex, age, income, education, employment etc
• Prescribed medications (nurse)

Additional topics:

• Social care receipt and provision
• Provision of unpaid care
• Dental health
• Use of GP and counselling services
• Eating disorders

Measurements:

• Height and weight
• Blood pressure (nurse)
• Waist and hip circumference (nurse)
• Blood sample for cholesterol, glycated haemoglobin (nurse)
• Saliva sample (nurse)

Food images are useful stimuli for the study of cognitive processes as well as eating behavior. To enhance rigor and reproducibility in task-based research, it is advantageous to have stimulus sets that are publicly available and well characterized. Food Folio by Columbia Center for Eating Disorders is a publicly available set of 138 images of Western food items. The set was developed for the study of eating disorders, particularly for use in tasks that capture eating behavior characteristic of these illnesses. It contains foods that are typically eaten, as well as those typically avoided, by individuals with eating disorders. Each image has now been rated across 17 different attributes by a large general United States population sample via Amazon’s Mechanical Turk (n = 1054). Ratings included subjective attributes (e.g., tastiness, healthiness, and favorable texture) as well as estimates of nutrient content (e.g., fat and carbohydrate). Each participant rated a subset of stimulus set food items (46 foods) on all 17 dimensions. Additional description of the image set is provided in terms of physical image information and accurate nutritional information. Correlations between subjective ratings were calculated and an exploratory factor analysis and exploratory cluster analysis completed. Outcomes of the factor analysis suggested foods may be described along three latent factors of healthiness, tastiness, and umami taste; the cluster analysis highlighted five distinct clusters of foods varying on these same dimensions. Descriptive outcomes indicated that the stimulus set includes a range of foods that vary along multiple dimensions and thus is likely to be useful in addressing various research questions surrounding eating behavior and cognition in healthy populations, as well as in those with eating disorders. The provision of comprehensive descriptive information allows for stimulus selection that is optimized for a given research question and promotes strong inference.

Item statistics for Parker et al.’s model of the eating disorder examination questionnaire [44] in women and men.

Descriptive statistics of treatment received within three months after admission (therapist-report).