Suzanne Abraham

On the receiving end—patient perception of the side-effects of cancer chemotherapy

We conducted a survey to identify and rank side-effects perceived by 99 patients receiving cancer chemotherapy. Non-physical side-effects constituted 54% of the 15 most severe symptoms, and included the thought of coming for treatment, the length of time taken by treatment and having to have a needle. Major physical side-effects were vomiting, nausea and hair loss. Differences in ranking of severity of side-effects were evident when patient groups were divided by sex, age, marital status and domestic situation, as well as by diagnosis, treatment and response. Evaluation of patient perception of the severity of side-effects is an aid to striking the cost benefit balance when deciding whether to use cancer chemotherapy.

How patients describe bulimia or binge eating

Thirty-two patients who complained of episodes of ravenous overeating which they felt unable to control (bulimia) were asked to describe their behaviour and symptoms. There was considerable variation both between and within individuals, but a number of factors were defined which appeared to be common to all with the complaint. It is difficult to set up strict criteria for the recognition of bulimia, and those that have recently been proposed are criticized in the light of our present findings. Bulimia is usually associated with an excessive concern about body weight. It occurs in patients with anorexia nervosa, in whom it is often a relatively early feature of the illness, but it is also found in subjects of normal weight or obese subjects who have never been emaciated. Episodes of bulimia are usually preceded by dysphoric mood states. The gorging may alleviate the dysphoria temporarily, but many patients later experience negative feelings such as depression and self-depreciation. The ability to induce vomiting after a bulimic episode is a major influence determining the clinical presentation.

Eating and Exercise Disorders in Young College Men

Abstract The authors used the computerized Eating and Exercise Examination to investigate eating, weight, shape and exercise behaviors in a convenience sample of 93 male college students. One fifth of the men worried about their weight and shape, followed rules about eating, and limited their food intake. Between 9% and 12% were unhappy with their body shape, felt fat, and seriously wanted to lose weight. Exercise was important for the self-esteem of 48% of the students. Thirty-four percent were distressed when they could not exercise as much as they wanted, 27% followed rules about exercising, and 14% worried about the amount of exercise they were doing. The respondents met clinical diagnoses for objective binge eating (3%), self-induced vomiting (3%), bulimia nervosa (2%), and exercise disorders (8%). Although 9% reported disordered eating, none had sought treatment. Health professionals should be aware that eating and exercise disorders may be present in college men and that screening may help in the early identification of these problems.

Body weight, exercise and menstrual status among ballet dancers in training

Summary. A prospective study of the menstrual pattern and weight changes was made in the first year of training of 29 new female entrants to a professional ballet school. Seventy‐nine per cent of the student girls had menstrual disturbances at entry: primary amenorrhoea, four; secondary amenorrhoea, 11; irregular menses, eight. The incidence of secondary amenorrhoea increase substantially by the end of the year (20), but was not associated with any significant change in body weight. Only three students menstruated regularly during the year. Menstrual regularity improved during periods of injury and long vacation and it appears that deterioration of the menstrual pattern during dancing periods was related to strenuous physical exercise rather than to any change in body weight.

Characteristics of eating disorders among young ballet dancers

The characteristics of anorexia nervosa and bulimia nervosa were studied in ballet dancers in full-time training and compared with other young women at school. Dancers had higher scores on the Eating Attitudes Test. Dancers were more likely to have an eating disorder when strict modified DSM-3-R criteria were applied. Currently 1 dancer (1.6%) and no student had anorexia nervosa, 1 dancer (1.6%) and 3 students (1.3%) had bulimia nervosa and 5 dancers (8.3%) and 9 students (4.2%) had an unclassified eating disorder. Another dancer had been treated for anorexia nervosa in the past. One dancer was treated for bulimia nervosa and 6 for weight loss. Dancers were more likely to have been told to increase their body weight. Dancers were not more likely to be afraid of losing control of their weight and becoming obese if they attempted weight gain, to ignore the advice to gain weight or resist gaining weight. Regular self-induced vomiting was reported by 4% of women. Dancers are at risk for the development of eating disorders. Ballet dancers are under pressure to maintain low body weight. The low body weight and menstrual disturbance found among young dancers during training are two of the characteristics of anorexia nervosa Ballet dancers use behaviours aimed at weight control and weight loss. In dancers and professional groups under intense pressure to diet, low body weight and amenorrhoea are not sufficient criteria to diagnose anorexia nervosa. These behaviours can result in binge eating and multiple behaviours aimed at preventing binge eating. Whether the characteristics of bulimia among dancers are sufficient for a diagnosis of bulimia nervosa to be made is unknown. The aim of this paper is to study the characteristics of the eating disorders anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified among young ballet dancers in full-time ballet training and to provide information about the risk of development of eating disorders among young women required to maintain below average body weight while continuing above average exercise.

Quality of Life: Eating Disorders

Objective: There is a lack of measurements with predictive validity that are specific for quality of life (QOL) in patients with eating disorders. Method: A total of 306 eating disorder patients treated as inpatients completed the Quality of Life for Eating Disorders (QOL ED): 109 at both admission and discharge from hospital, 65 at both admission and after 12months. Patients also completed well-validated measures of eating disorders, psychological dysfunction and general physical and mental QOL. QOL ED consists of 20 self-report questions that provide scores for the domains of behaviour, eating disorder feelings, psychological feelings, effects on daily life, effects on acute medical status and body weight, and a global score. Results: QOL ED domain scores correlated appropriately with previously validated wellknown measures of eating disorders, psychological dysfunction, general QOL and behaviour and body weight (p < 0.001). The QOL ED shows high reliability (Cronbachs alpha=0.93). All scores changed significantly and appropriately during inpatient hospital treatment and between admission and 12 months after discharge from hospital (p < 0.001). The scores differed for anorexia nervosa, bulimia, eating disorder not specified (EDNOS) and no diagnosis. All no diagnosis (recovered) domain and global scores were significantly different from all diagnoses scores (p < 0.001). Conclusion: This quick, simple instrument fulfils all potential uses for QOL assessments in the clinical and research settings associated with eating disorders, including outcome.

Health-related quality of life and eating disorders: A review and update

OBJECTIVE The aim of this article is to provide a narrative review of empirical studies related to health-related quality of life (HRQOL) and eating disorders and to report recent changes in the measurement of HRQOL in eating disorders. METHOD Twenty-five articles of central importance to the topic were identified in a systematic search of six databases. All articles were selected based on a consensus relevancy rating process. Key themes were extracted from the articles and validated by all authors. RESULTS We identify six themes in the extant empirical literature. DISCUSSION We discuss these six themes and review them in light of the fact that they are identified in studies using only generic measures of HRQOL. Four recently developed disease-specific HRQOL measures specific to patients with eating disorder are discussed.

Sexuality and reproduction in bulimia nervosa patients over 10 years

The reproductive and sexual histories of women who had recovered or were recovering from bulimia nervosa were examined. Of 48 consecutive female patients, 43 were studied 10-15 years after first presenting for treatment. At follow-up, 74% were considered recovered and 26% still had an eating disorder. Only 2 women fulfilled the criteria for bulimia nervosa. A history of amenorrhea was common (81% of women), 63% of women being without their menstrual periods for more than 12 months. Menstruation was present in women at a body mass index of 19 or more who were no longer using the weight loss practices of self-induced vomiting, laxative abuse, and starvation. Bulimia nervosa women are more likely to be investigated for infertility when their eating disorder is active. Bulimia sufferers are sexually active, but have times of withdrawing from their partners and ceasing sexual behavior. They associate their sexual feeling with body weight, pregnancy, breastfeeding, and status of their relationships. Marital breakdown is also more common but only if the eating disorder was active at the time of marriage. Forty-five percent left their relationship had a negative effect on their eating disorder. Short-term episodes of bulimic-free behavior are associated with pregnancy and breastfeeding in some pregnancies. Termination of pregnancy occurs more often. The prevalence of miscarriage, hyperemesis gravidarum, and postnatal depression was greater among women who had not recovered from their eating disorder at the time of their pregnancy. Recovery from eating disorder behavior before attempting conception reduces the prevalence of the gynecologic, obstetric, and psychiatric problems associated with eating disorder behavior.

The psychosexual histories of adolescent girls and young women with anorexia nervosa

Comprehensive psychosexual histories were elicited from 31 female patients with anorexia nervosa. The subjects showed a wide spectrum of sexual knowledge, attitudes and behaviour. Some appeared to be markedly inhibited, while others were experienced and assertive in regard to sexual matters. Age at interview appeared to be the major factor determining whether individual patients were sexually experienced or not. A majority of patients felt that a sexual challenge had precipitated their illness, and most reported a decrease in sexual interest and enjoyment following weight loss, particularly when this was severe. The effect of the illness on actual sexual behaviour, however, was variable, some patients decreasing and others increasing their sexual activity.

Knowledge, beliefs, attitudes, and behaviors related to weight control, eating disorders, and body image in Australian trainee home economics and physical education teachers.

OBJECTIVE To examine the knowledge, beliefs, and attitudes about weight control and eating disorders among trainee home economics and physical education teachers and to assess their body image and weight control practices. The association between actual body weight and body image was also examined. DESIGN Survey research was undertaken using a self-report questionnaire. Height and weight were measured. SUBJECTS/SETTINGS Trainee home economics and physical education teachers (N = 216, 96% participation rate) in their last month of training at three major state teacher training universities completed a questionnaire during their regular class times. MAIN OUTCOME MEASURES Advice teachers give to overweight adolescents knowledge and beliefs about eating disorders, body image, desired weight, food habits, dieting, body appearance ratings, weight control practices, and diagnosed and self-reported eating disorders. STATISTICAL ANALYSIS PERFORMED Descriptive statistics, chi square, and analyses of variance compare gender and Body Mass Index differences. RESULTS Males (85%) and females (87%) advised young overweight adolescents to diet to lose weight. Twenty percent of females and 13% of males regularly skipped breakfast. The advise given showed a lack of specific nutrition education about weight control, adolescent nutritional needs, and fad diets. Participants held misconceptions about eating disorders, and a range of 14% to 72% answered these questions incorrectly. Fourteen percent of females self-reported that they currently had an eating disorder, but only 6% had received treatment. Some females used potentially dangerous methods of weight loss, including 19% who abused laxatives and 10% who induced vomiting. IMPLICATIONS Trainee home economics and physical education teachers need specific nutrition information and training about eating disorders, weight control, and suitable advice for overweight students. The female trainee teachers in our study had a poor body image and disordered eating similar to other young women in Western countries, and this should be taken into account by teacher training institutions.