What are People’s Experiences of Orthorexia Nervosa, as Described in Online Blogs?

This thesis also includes a systematic review entitled: What is the Relationship between Vegetarianism and Eating Pathology? A Systematic Literature Review Abstract: Recent trends in dieting have placed more emphasis on an individual’s responsibility for healthy and moral eating, and seen a rise in food group elimination diets. Vegetarianism (the elimination of meat and animal products) is becoming more mainstream in the UK, yet there is debate whether vegetarianism can serve as a way of hiding disordered eating, providing an acceptable reason for food restriction and restraint. To date, there is mixed evidence as to whether there is a relationship between vegetarianism and disordered eating, and if so, what the nature of this relationship might be. This systematic literature review aimed to look at existing research examining the relationship between vegetarianism and eating pathology. A search was carried out in four key electronic databases, and four relevant journals. 662 records were identified, and 24 (comprising 26 relevant studies) were retained after data screening. Findings suggest an increased prevalence of vegetarianism amongst eating disorder patients compared with controls, and higher rates of self-reported disordered eating amongst vegetarians compared with non-vegetarians in non-clinical samples. Nevertheless, research to date is limited by over-reliance on convenience sampling in mainly female non-clinical populations, and poor operationalisation of vegetarianism. Future research would benefit from clearer definitions of vegetarianism and its subgroups, more qualitative research exploring individual’s experiences and perspectives, and more diverse samples. Research classifying subgroups based on their motivation for restriction would also be helpful, as it is likely that the reasons for dietary restrictions, as well as the foods that are restricted, are important in predicting eating pathology. Keywords: Vegetarianism, Eating Pathology, Eating Disorder, Anorexia Nervosa, Bulimia Nervosa, Orthorexia NervosaOrthorexia Nervosa (ON) is the term for a proposed new eating disorder, used to describe a pathological obsession with healthy or ‘clean’ eating. For individuals with ON, the obsession with eating ‘healthy’ foods, and the elimination of foods considered ‘unhealthy’ or ‘impure’, results in impairment to social, physical, occupational and/or other areas of functioning. Whilst there is still debate as to whether ON describes a distinct eating disorder, and there is no consensus around diagnostic criteria as yet, ON is an emerging topic for research, with more cases coming to light both clinically, and in the media. Although some quantitative research has been carried out in ON, particularly focusing on the measurement and prevalence rates of this proposed disorder, no qualitative studies have been published to date to explore individuals’ personal experiences of ON. Thus, for this project, 40 pre-existing blog entries describing first-person experiences of ON from fifteen women bloggers were analysed using thematic analysis. Five key themes were identified: 1) confusion around diagnosis, 2) initial motivations for a healthier lifestyle, 3) fuelling the problem- social influences, 4) when healthy becomes unhealthy…, and 5) avoidance, isolation and compensation. The clinical implications of these findings were explored, particularly focusing on the social context of ON, diagnostic crossover between ON and other eating disorders, and the role of fear, perfectionism and perceived control. Whilst the debate around the diagnosis of ON continues, these bloggers’ accounts suggest that ON is experienced as a legitimate and debilitating disorder, worthy of clinical and research investigation in its own right

What are people’s experiences of orthorexia nervosa? A qualitative study of online blogs

Purpose Orthorexia nervosa (ON) is a proposed new eating disorder, used to describe a pathological obsession with healthy or ‘clean’ eating. Although some quantitative research has been carried out in ON, very little qualitative work has been published to date to explore individual experiences of ON. Thus, this study aimed to explore individuals’ personal experiences of ON, as described in online blogs. Methods Fifteen women bloggers, who self-identified as having ON, consented for their blog entries to be analysed in this study. Forty pre-existing blog entries describing the first-person experiences of ON were analysed using thematic analysis. Results Three key themes were discussed: (1) initial motivations for a healthier lifestyle, (2) fuelling the problem—social influences, and: (3) when healthy becomes unhealthy. Bloggers described the role of social messages, comparison with others around ideas of ‘healthiness’, as well as confusion around diagnosis as factors influencing their disordered eating. They also described the exacerbating impact of perfectionism and perceived control, as well as a confirmatory cycle of fear and avoidance. For some bloggers, increased physical symptoms in response to feared foods provided confirmation for these fears, further exacerbating food avoidance. Conclusion Whilst the debate around the diagnosis of ON continues, these bloggers’ accounts suggest that ON is experienced as a legitimate, debilitating disorder, worthy of clinical and research investigation. This study provides evidence of some of the potential triggers and maintaining factors for this disordered eating style

The power and value of placebo and nocebo in painful osteoarthritis.

This paper reviews some recent advances in our understanding of the effects of sham or dummy interventions on pain and other symptoms in osteoarthritis (OA), and outlines two new approaches to the investigation of placebo and nocebo effects. We argue that the placebo effect provides us with a valuable way of investigating the nature of conditions like OA. For example, by examining which symptoms, biochemical markers or imaging features do or do not respond to placebo, we might learn more about the relationships between pathology and symptoms in OA. Placebo and nocebo effects are positive or negative outcomes resulting from the human interactions and contexts in which healthcare consultations take place. Subtle changes in behaviours and the environments in which consultations take place can have major effects on pain and other symptoms being experienced by people with OA. Nocebo effects are particularly powerful, leading to many health-care professionals (HCPs) causing unintended harm to their clients. Based on our own research, we conclude that beneficial outcomes are most likely to occur when both the (HCP) and the client feel safe and relaxed, and when the experiences of the client are validated by the (HCP). These findings have important implications for clinical practice. We believe that research in this field needs to be 'trans-disciplinary', escaping from the constraints of the purely biomedical, deterministic, positivist paradigm of most medical research. We provide the example of our own work which combines performance studies and scholarship, with psychology and medicine

Resilience and surgeons: train the individual or change the system?

We investigate both sides of the coin

Conceptualisations of health in orthorexia nervosa: a mixed-methods study

Purpose Limited research has explored conceptualisations of health and healthy eating in orthorexia nervosa (ON). This mixed-methods study aimed to investigate how ‘health’ and ‘healthy eating’ are conceptualised by individuals at risk for ON. This study examined the potential relationships between health anxiety, beliefs about health controllability and orthorexic symptomatology in our broader sample. Methods A total of 362 participants took a survey on health anxiety (measured with the HAQ), beliefs about the controllability of one’s own health (IMHLC) and ON symptomatology (E-DOS and EHQ). Participants ‘at risk’ for ON (n=141), also completed an online qualitative survey about conceptualisations of health and healthy eating. Qualitative data were analysed using thematic analysis (part A). The PROCESS macro for SPSS was used for the quantitative analysis (part B). Results Conceptualisations of health and healthy eating were complex. Four themes were generated from our qualitativedata: ‘health is more than thin ideals’, ‘healthy food equals healthy mind’, ‘a body that works for you’ and ‘taking control of your body’. Our quantitative analysis revealed that health anxiety and beliefs in health controllability independently predicted ON symptomatology. Conclusion A richer understanding of what health means in the context of ON is important, given the centrality of this concept to the proposed classifcation of this disordered eating style. Our fndings highlight that both health anxiety and health controllability are important targets for future investigation, given their potential relevance to the aetiology and treatment of ON

The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences

Objective: The Covid-19 pandemic has wrought disruption to everyday life and services, and emerging evidence suggests that those with eating disorders (EDs) are likely to experience marked distress and exacerbation of their symptoms. However, little is known around the most relevant factors to symptom change; whether certain emotion regulation and coping strategies are linked to better outcomes; and how people with EDs are adjusting to psychological interventions moving online. Method: In a mixed-method design, we collected qualitative and quantitative data from 207 (76 males) self-selected UK residents with self-reported ED, who described and ranked impacts of the pandemic on their symptoms. Regression analysis examined whether emotion regulation strategies were associated with self-reported symptom change, ED symptomatology, and negative emotional states. Thematic analysis explored participants’ experiences of the pandemic, particularly factors affecting their ED, coping strategies used, and experiences of psychological intervention. Results: Most participants (83.1%) reported worsening of ED symptomatology, though factors affecting symptom change differed between specific EDs. Emotion regulation, such as having fewer strategies, poorer emotional clarity, and non-acceptance of emotions, explained nearly half of the variance in emotional distress during the pandemic. Qualitative findings indicated that difficult emotions (such as fear and uncertainty), changes to routine, and unhelpful social messages were triggering for participants during the pandemic. While some participants described employing positive coping strategies (such as limiting social media exposure), many reported using ED behaviours (among other maladaptive strategies, like alcohol use) to cope with the pandemic. Finally, loss of treatment support, feeling underserving of support and experiencing a ‘detached connection’ online were further exacerbating factors for these participants. Discussion: While our sample was self-selected and may not represent all people with EDs, our results suggest that people with EDs have been strongly affected by the pandemic. Some aspects of online treatment were found to be beneficial but our findings suggest it also needs some improvement. Our paper discusses implications for online treatment such as taking into account personal circumstances and, in a time where people have limited control over the antecedents of negative emotion, the need to develop skills to manage emotions when they arise

The power of invalidating communication: Receiving invalidating feedback predicts threat-related emotional, physiological, and social responses

© 2016 Guilford Publications, Inc. Previous studies have found that communicating acceptance and understanding (validation) enhances the recipient's psychological and physiological wellbeing compared with receiving nonunderstanding feedback (invalidation). Yet, such studies have not established whether it is validation or absence of invalidation that is beneficial. This study examined the social, physiological, and emotional effects of validating and invalidating feedback in more detail, by employing a control group. Ninety healthy volunteers were randomly allocated to receive validating, invalidating, or no feedback during a series of stressor tasks. Self-report ratings, psychophysiological measurements and social engagement behaviors were recorded. While there were no significant differences between validated and control participants, invalidated participants showed increased physiological and psychological arousal on several measures and reduced social engagement behaviors compared with the other two groups. the relevance of these findings for understanding adverse effects of invalidation during clinical interactions is discussed

Early evaluation of a DBT-informed online intervention for people with eating disorders

Objectives Eating disorders (EDs) have a worldwide prevalence of 7.8%, with towering mortality rates and high healthcare costs. The current recommended treatment for EDs principally works by directly targeting ED thoughts and behaviours, but recovery rates are low. A multifaceted link between difficulties with emotions and EDs is now widely established, and newer third-wave therapies that aim to address these underlying emotion difficulties are promising. The current study piloted an online emotion self-help intervention which was co-developed with clinicians and people with lived experienced of EDs. The intervention aimed to specifically address difficulties with emotion identification and regulation, as well as unhelpful beliefs about emotions, which are believed to give rise to and maintain ED thoughts and behaviours. Method We recruited 39 people with self-reported EDs to test this intervention over a one-week period. Our participants were asked to complete a series of questionnaires measuring emotion processes and psychopathology on Day 1 (T1) before being given access to the intervention. Participants were then asked to practice the newly acquired skills for seven days, before taking the same questionnaires on Day 9 (T2). We also asked participants to qualitatively report on their experience of the intervention. Results We found significant improvements in ED psychopathology (ED-15), depression (PHQ-9), and anxiety (GAD-7) pre- to post-intervention, with medium to large effect sizes. All our emotion variables namely alexithymia (TAS-20), difficulties regulating emotions (DERS-SF), and unhelpful beliefs about emotions (EBQ) also showed significant changes post-intervention with medium to large effect sizes. Most importantly, changes in emotion regulation processes were linked to improved eating psychopathology. The qualitative analysis corroborated this finding, highlighting how the intervention helped them form new beliefs about emotions, which helped them reduce ED behaviours. Discussion Significant improvements in emotion processing and regulations, as well as psychopathology, along with positive qualitative feedback, suggest that the intervention effectively met its aims of increasing awareness of the link between emotions and eating psychopathology, providing help to identify and regulate emotions, and normalising emotional experiences. While our results are promising, further research is required to assess its effectiveness longer term and in clinical settings

What trial participants need to be told about placebo effects to give informed consent: a survey to establish existing knowledge among patients with back pain.

INTRODUCTION: Patients require an accurate knowledge about placebos and their possible effects to ensure consent for placebo-controlled clinical trials is adequately informed. However, few previous studies have explored patients' baseline (ie, pretrial recruitment) levels of understanding and knowledge about placebos. The present online survey aimed to assess knowledge about placebos among patients with a history of back pain. DESIGN: A 15-item questionnaire was constructed to measure knowledge about placebos. Additional questions assessed sociodemographic characteristics, duration and severity of back pain, and previous experience of receiving placebos. SETTING: Participants recruited from community settings completed the study online. RESULTS: 210 participants completed the questionnaire. 86.7% had back pain in the past 6 months, 44.3% currently had back pain. 4.3% had received a placebo intervention as part of a clinical trial and 68.1% had previously read or heard information about placebos. Overall knowledge of placebos was high, with participants on average answering 12.07 of 15 questions about placebos correctly (SD=2.35). However, few participants correctly answered questions about the nocebo effect (31.9% correct) and the impact of the colour of a placebo pill (55.2% correct). CONCLUSIONS: The findings identified key gaps in knowledge about placebos. The lack of understanding of the nocebo effect in particular has implications for the informed consent of trial participants. Research ethics committees and investigators should prioritise amending informed consent procedures to incorporate the fact that participants in the placebo arm might experience adverse side effects