Increased eating disorder frequency and body image disturbance among fashion models due to intense environmental pressure: a content analysis.

Introduction: Female fashion models are under intense occupational pressure. The present study focuses on assessing the lived experience of fashion models with regards to their dieting and exercising habits, body image perception, eating disorder-like symptoms, and experience of abuse via self-narrated reports. Methods: Series of open questions were distributed among international fashion models (N=84, mean age=23.2 years; mean BMI=16.9) selected by convenience and snowball sampling. Models from 17 countries participated. The questions targeted models' eating, exercising, dieting habits, body image perception, and eating disorder symptoms. The average word count of the transcripts was 2473.9 (SD = 2791.6). Thematic content analysis was performed on the transcripts. A total of 31 codes were created to address disordered eating and body image concerns. Results: Negative body-related claims appeared in 89.3%, and positive claims in 64.3% of the models' transcripts. Negative remarks about eating were made by 45.2% of the participants, and 23.8% positively. Control over their food intake was exercised by 78.6% of the participants and 40.5% used extreme calorie restriction. Models who talked more positively about their bodies expressed significantly more frequently extreme calorie restriction. Extreme sports habits occurred in 23.8% of the transcripts, obsessive sports habits were claimed by 11.9% of participants. Self-induced vomiting was prominent in 14.3% of the answers. Criticism from other industry members was experienced by 83.3% of the participants while 44.0% received body appreciation. Body image disorder-like symptoms were expressed by 63.1% of models. Such models mentioned significantly more often content about eating disorders and talked significantly more negatively about eating. Psychological problems were mentioned by 48.8%, whereas 16.7% took part in psychotherapy. Those who partake in therapy mentioned significantly more eating disorder content in their narratives. Abuse was mentioned by 25.0% of the models. Conclusion: Fashion models are experiencing increased environmental pressure to conform to the extreme slimness ideal. There is a heightened prevalence of disordered eating and other weight-controlling behaviours among fashion models to succeed in their careers. Qualitative research is crucial in understanding the more subtle dynamics in conforming to and maintaining the thin beauty ideal.

The current sociocultural background of eating disorders.

Eating disorders (EDs) are complex phenomena that are partly influenced by sociocultural factors. The thin body ideal of Western civilization, disseminated by mass media and reinforced by the fashion industry, plays a significant role. In this cultural environment, the social perception of the human body has undergone a change.

[The role of dietitians in the care of patients with eating disorder].

Dietitians play an important role in the care of patients with eating disorders. However, the precise conditions are not yet defined. This limits the clarity of the role of the dietitian within the dietetic profession as well as in a broader sense among the health care providers. In Hungary, there is no comprehensive guideline on it yet, so the aim of the present paper is to clarify the role, tasks, and competence boundaries of the dietitians. First, we provide guidance for the recognition of eating disorders by overviewing the symptoms, the diagnostic criteria, and the most important aspects of biopsychosocial assessment. Second, we take stock of the tasks of the dietitian, as a member of the therapeutic team in the treatment of eating disorders in outpatient and inpatient settings.

Adverse childhood experiences increase the risk for eating disorders among adolescents.

Purpose: Traumatic events often feature prominently in eating disorders. A questionnaire survey to assess the relation of eating disorder risk to the frequency of adverse childhood experiences (ACEs) and the possible association of eating disorder risk with a particular type of ACE was conducted in a community sample of Hungarian adolescents. Methods: Demographic and anthropometric data, risk for eating disorders (by SCOFF questionnaire), and ACEs (by ACE score calculator) were collected from 432 adolescents aged 12-17 years. Results: Adolescents who had undergone four or more ACEs were 5.7 times more likely to be in the high eating disorder risk group than those who did not report any ACEs. Cumulative maltreatment showed a greater association with overall risk for eating disorders than cumulative family dysfunction. There is an increased risk of eating disorders from emotional maltreatment (OR = 3.475), physical maltreatment (OR = 3.440), sexual maltreatment (OR = 10.973), and emotional neglect (OR = 3.331). Dysfunctional family circumstances revealed an association with household mental illness (OR = 3.401). Conclusion: Our study of the connection between eating disorder risk and ACE is the first of its kind in Central and Eastern Europe. Maltreatments had a greater role than family dysfunctions in increasing the risk of eating disorders. Our findings contribute to a more precise understanding of the role that ACEs play in eating disorders. It is important to bring to clinicians' attention the importance of ACEs in the diagnosis and therapy of eating disorders and their potentially fundamental significance for therapy.

Frequency of disordered eating habits among fashion models.

OBJECTIVE: Sociocultural influences, including an increasing pressure for fashion models to maintain a thin body frame may be crucial in the development of eating disorders. The present study aimed to establish whether fashion models are more likely than non-models to develop eating disorders. METHODS: Female fashion models were selected by snowball sampling (n = 179, mean age: 25.9 SD = 4.70 years). They were compared with an age adjusted control group (n = 261, mean age: 25.0 SD = 4.97 years). Participants completed an online questionnaire containing the Eating Disorder Inventory. RESULTS: The average BMI of the fashion models was in the underweight range (mean BMI = 18.1 SD = 1.68). The BMI of the control group was significantly higher (mean = 22.1 SD = 4.23, p < 0.001). The frequency of simulated anorexia nervosa was 3.9% among the fashion models and 1.1% in the control group (p = 0.057). 14.6% of the models showed subclinical anorexia nervosa symptoms versus 2.7% in the control group (p < 0.001). The ratio of bulimia nervosa and subclinical bulimia nervosa showed no significant difference between the two groups. CONCLUSION: Female fashion models showed no significant difference from the control group in the frequency of anorexia nervosa and bulimia nervosa but had a significantly higher frequency of the subclinical form of anorexia nervosa.

Social media use among children and teenagers with asthma bronchiale / Asthma bronchialéban szenvedo gyermekek közösségimédia-használata

Introduction: The health behavior of patients with asthma bronchiale can be influenced by the virtual world (es., Facebook). It is often used to compensate their attachment deficits. Objective: In this study, the use of social media is analyzed among asthmatic children compared to a healthy control group. Method: 250 asthmatic and 250 healthy children were interviewed from the age of 10 to 18. The Facebook Intensity Scale, the Ten Item Personality Inventory, the Rosenberg Self-Esteem Scale, the short version of the Beck Depression Inventory and the Multidimensional Anxiety Scale for Children were used in the study. Results: Asthmatic children's social media time was significantly lower compared to that of healthy children (p<0.001). However, their feeling of being part of the Facebook community is the main motivation to use it (p<0.001). Higher scores of anxiety and depression, and the lower self-esteem compared to the healthy control group can be detected among asthmatic children (p<0.001). The increased use of Facebook can be shown in both groups of girls. The increased use of Facebook among girls is in connection with a higher score of depression and anxiety (p<0.05). Conclusion: Social media plays a very important role in the life of asthmatic children. The psychoeducation and prevention is of basic importance, because the age group of 10-18-year-old children is vulnerable to the addictive effect of social media.

The applicability of the Eating Disorder Inventory in pregnancy.

PURPOSE: The aim of our study was validating Eating Disorder Inventory (EDI) among pregnant women, who are vulnerable to eating disorders (EDs). METHODS: In 2012-2013, 1146 women (aged 18-47 years) completed a questionnaire including EDI during the first 3 days after delivery. We checked factorial validity of three diagnostic subscales of EDI with confirmative factor analysis and internal validity by Cronbach's alpha and item-total correlation. We also tested discriminative validity by comparing average of the three subscale of EDI in case of ED and non-ED groups. RESULTS: When applying the EDI to pregnant women, it seems necessary to exclude five items on three diagnostic subscales: on the Drive for Thinness subscale, 4 items remain (out of 7); on the Bulimia subscale, 6 items remain (out of 7); the Body Dissatisfaction subscale decreases from 9 to 8 items. Cronbach's alpha and item-total correlation values meet the requirements defined by Garner et al. The internal consistency of the EDI has proved to be appropriate, indicating that it is a reliable screening tool. CONCLUSIONS: Thinking, attitudes, and behaviors connected to eating, along with the relation to altering body weight change during pregnancy. Vomiting usually accompanies pregnancy; body weight gain within wide limits is also regarded as normal during pregnancy. These behaviors and changes are not feasible to use for measuring ED symptoms. These aspects cannot be neglected when screening eating disorders in pregnant women. LEVEL OF EVIDENCE: Level IV evidence obtained from multiple time series with or without an intervention.

Health protective regulation of the fashion industry / A divatipar egészségvédelmi szabályozása.

Összefoglaló. A divatiparra vonatkozó egészségvédelmi szabályozások hiányosak. A karcsúság elérését célzó szociokulturális nyomás a divatiparon belül fokozott, a divatmodelleket gyakran késztetik kórosan alacsony testsúly elérésére, ami pszichológiai abúzusnak felel meg. Ezért a modellek közt az evészavarok prevalenciája magasabb az átlagpopulációhoz képest. A divatvilág veszélyei között ezeken túl a szexuális abúzus, a financiális visszaélések, illetve a fiatalkorúak foglalkoztatásával kapcsolatos szabályozatlanság említendo. A kockázatok csökkentése érdekében fontos volna nemzetközi szabályozásokat bevezetni a divatszakmában. Az erre irányuló kezdeményezések eloször 2006-ban jelentek meg Spanyolországban: a modellek foglalkoztatásának feltétele volt az egészséges tápláltsági állapot alsó határától minimálisan elmaradó testtömegindex (18,0) elérése. Késobb Franciaországban az evészavarok gyakoriságának mérséklésére törvénybe foglalták a modellek kötelezo egészségügyi vizsgálatát, illetve az utólagosan módosított divatfotók megjelölését. E szabályozások azonban könnyen kijátszhatók. A törvényhozás mellett különbözo szervezetek alkottak olyan irányelveket, amelyek a modellek egészségvédelmét szolgálták. Ezek az iránymutatások elsosorban a biztonságos munkavégzésre, a fiatalkorúak foglalkoztatásának korlátozására és az emberi méltóság megtartására irányulnak. A divatszakmában eloforduló feszültségek vezettek továbbá olyan nonprofit szervezetek megalakulásához, amelyek a modellek érdekvédelméért dolgoznak. A divatmodellek egészségvédelmét célzó jogi szabályozás a mai kultúrában domináns karcsúságideál megváltoztatását is szolgálná, mert a szociális tanulás révén a divatot követo átlagnépesség utánozza a modelleket. A divatmodellek egészségének védelme tehát népegészségügyi vonatkozással is bír. Orv Hetil. 2021; 162(23): 905-910. Summary. The fashion industry is lacking sufficient health protective regulations. There is an increased sociocultural pressure to be thin. Fashion models are often forced to reach abnormally low body weight, which can be regarded as psychological abuse. This leads to a higher prevalence of eating disorders among models compared with the general population. Some of the other dangers associated with the fashion industry are sexual harassment, financial exploitation, and unregulated minor labour force. To reduce these risks, it is crucial to introduce international regulations in the fashion industry. The first initiative for such regulations took place in Spain in 2006 when the condition for models' employment was for their body mass index (BMI) not to drop below 18.0, which is close to the low end of healthy BMI. Later in France, to decrease the prevalence of eating disorders, a legislation on compulsory medical examination for models was made. Also, retouching of photos had to be disclosed. Regulations like these, however, can easily be eluded. Different organisations implemented guidelines, such as establishing safe working conditions, limiting underage labour force, and maintaining dignity to protect models' health. Tension within the fashion industry led to the formation of non-profit organisations seeking the protection of models' interest. Regulations protecting models' health in the fashion industry would encourage society to adjust its predominant ideal for thinness. Just as the general population tends to follow fashion trends portrayed by fashion models, so would they likely imitate the new look of models. Hence, the protection of models' health goes beyond the fashion industry. It has public health implications as well. Orv Hetil. 2021; 162(23): 905-910.

Low self-esteem predicts orthorexia nervosa, mediated by spiritual attitudes among frequent exercisers.

OBJECTIVE: The aim of this study was to measure how orthorexic tendencies relate to age, self-esteem, and spirituality. We conducted the study on a sample of Hungarian adults performing regular fitness activity. METHOD: 175 participants completed a four-part online survey: demographics and training habits, the Rosenberg Self-Esteem Scale, the Eating Habits Questionnaire-Revised (EHQ-R), and one of the Spiritual Awareness questionnaire's subscale. We performed univariate linear regression to assess the predictor role of age on orthorexic tendencies. Mediation analysis was conducted to determine the effect of self-esteem on orthorexic tendencies and the mediator role of spiritual attitudes. RESULTS: Age negatively correlated with EHQ-R, and there were no gender differences. Lower self-esteem was a predictor for orthorexic tendencies with the total effect of ß = -0.3046 (p < 0.0001). In part, this is a direct relationship, but it is mediated by spiritual awareness as well. DISCUSSION: Among frequent exercisers, strict dieting is likely to originate from a lack of self-esteem due to perfectionist standards, social comparison, and the aspiration of being in control. In case self-esteem is achieved through spiritual approaches, individuals may experience positive changes in their attitudes toward eating and their bodies as well. In the future, it is important to confirm whether the EHQ-R indicates diagnostic boundaries. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study.

BACKGROUND: The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. AIMS: (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. METHODS: The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). RESULTS: Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. CONCLUSIONS: The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.

Eating disorder characteristics among Hungarian medical students: Changes between 1989 and 2011.

BACKGROUND AND AIMS: There are contradictory findings on time changes in the prevalence of eating disorders (EDs). The first epidemiological studies in Hungary were carried out in the late 1980s. The objective of the present study was to follow the changes in the prevalence of EDs in medical students after a period of 22 years. METHODS: A questionnaire survey was conducted in 1989 and in 2010. The sample comprised medical students: 538 subjects (248 males and 290 females) in 1989 and 969 subjects (261 males and 708 females) in 2010. The questionnaire contained sociodemographic and anthropometric items, the Eating Behaviour Severity Scale, the General Health Questionnaire, the Anorexia Nervosa Inventory for Self-Rating, and the Eating Disorder Inventory (EDI). In the second wave, three subscales of the EDI-2 and the SCOFF questionnaire were added. RESULTS: Current and desired body mass index were significantly higher in the second study. Binge eating at least once a week was reported less frequently (2.7% vs 6.8% in males, 6.1% vs 13% in females) in 2010. The proportion of subclinical anorexia nervosa was higher among females in 2011 (2.5% vs 0.3%, P < 0.01). Among males, the proportion of counterregulatory behaviours increased significantly (from 8.9 to 14.6%). DISCUSSION AND CONCLUSIONS: The increase of the proportion of subclinical anorexia nervosa and that of male EDs may relate to the importance of the changes in the sociocultural background. Further representative studies are proposed in other countries of Central and Eastern Europe among medical students and in the general population.

COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study.

Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational-theoretical structure of the CIES. Adequate goodness-of-fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face-to-face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.

[Antidepressants sometimes lead to rapid remission in the treatment of anorexia nervosa]. / Az antidepresszívumok az anorexia nervosa kezelésében néha gyors remisszióhoz vezetnek.

In the treatment of anorexia nervosa the dominant role of psychotherapies is proposed, while pharmacotherapy has a limited effi cacy. Because of the broad comorbidity spectrum of the disorder, other psychiatric disorders are often present. Among them depression is frequent, so one of the selective theories of eating disorders stresses the importance of the relationship with depression. In everyday practice we frequently encounter anorexic patients whose depressive symptoms are mild or moderate, and these are often regarded as usual accompanying phenomena of anorexia. The three case reports described in the present study support that it is worth to consider the application of antidepressants in such situations. In all three cases antidepressants were initiated following ineffi cacy of psychotherapy, and they produced a dramatic eff ectiveness not only in depressive symptoms, but also in the whole anorexic syndrome. In the complex therapy of anorexia nervosa antidepressants may yield a very good therapeutic eff ect in cases with comorbid, even subthreshold depression.

[The role of traumatization in eating disorders. Possible therapeutic modalities with special regard to cognitive behavioural methods].

In the complex pathomechanism of eating disorders (especially that of bulimia nervosa and binge eating disorder) the traumatic experiences (sexual, physical, emotional abuse, neglect) often play an important role. The consequence of traumas can be the borderline personality disorder, or different disorders of the emotional regulation. These occur mainly in the multiimpulsive subtype of eating disorders with impulse control disorders. In relation to the trauma dissociative phenomena are frequent. In the diagnostics of eating disorders the history of traumatization is essential. Among the therapeutical possibilities the psychodynamic approach is important. Moreover, the newer methods based on cognitive behavioral therapy are effective, e.g., dialectic behavior therapy, integrative cognitive-analytic therapy, and other complex programs of trauma processing, such as the trauma-informed care.

Compulsory treatment in eating disorders: Control, provocation, and the coercion paradox.

In eating disorders, the denial of the illness is a central phenomenon. In the most severe forms of anorexia, compulsory treatment may be necessary. The professional acceptance of involuntary treatment is controversial due to the fact that the autonomy of the patient is juxtaposed with the obligation of the health care practitioner to save lives. This paper discusses the major practical and ethical considerations surrounding this controversy. In addition, case vignettes are used to illustrate various strategies to diminish client resistance and enhance motivation toward treatment. Involving the family is nearly always essential for the treatment of patients with eating disorders. In some cases, parental consultation (i.e., treatment without the client) can also be an option. Home visits, though rarely used, can reframe the therapeutic relationship and provide information about family functioning. In general, a lower level of treatment coercion can be achieved through transparent client-parent and client-therapist communication.

[Eating disorders and fertility].

Common gynecological complications of various eating disorders include infertility, unwanted pregnancy, miscarriage, sexual dysfunction and complications in the treatment of gynecological cancers. Women with eating disorders typically see their gynecologists because of menstrual and other endocrine disorders or unexplained gastrointestinal symptoms, and often report on psychological symptoms (anxiety, depression or decreased libido). In spite of anovulation, menstruation may occur and ovulation without menstruation may be possible, which may lead to an increased incidence of unwanted pregnancies in case of prior or current eating disorders. Ovulation induction due to anovulation associated with weight loss or inappropriate dietary habits, or pregnancy with amenorrhoea may be a significant risk among women with unrecognized eating disorders. In such cases, the primary care is the change of dietary lifestyle and only secondary care is the ovulation induction. The prevalence of eating disorders is high among women who approach infertility clinics. If an eating disorder is confirmed prior to infertility treatment, the patient should be informed of the possible consequences and referred to the necessary psychological support. Such a multidisciplinary approach would allow successful infertility treatments without complications.

[The medical psychology in Hungary: way of thinking, frame of references and applications]. / Az orvosi pszichológia fejlodése hazánkban: szemléleti keretek, határterületek és alkalmazások.

The present study aims at overviewing the different stages of the education of medical psychology in Hungary. In the perspective of the achievements of cognitive and affective neuroscience as well as developmental psychology, we intend to define the roots of doctor-patient relationship, certain determining factors of diagnosis forming and therapy efficiency as well as the essential components of empathy. We attest to the fact that the current psychosomatic medicine with its evidence-based achievements is a valid component and constitutive pillar of everyday medical care. The integrated university level instruction of medical psychology and behavioral sciences aims at consolidating this perspective. We also emphasize that the ill body hinders adequate psychological functioning and mental disorders provide risk factors concerning somatic illnesses. Through spreading health psychology perspective, we support the concept that in everyday medical care, health protection and the development of health conscious behavior relies on responsible, informed and committed decision-making patients as well as on similarly educated extended medical care teams. Orv Hetil. 2018; 159(36): 1455-1464.

[Potential relationship between juice cleanse diets and eating disorders. A qualitative pilot study]. / A léböjtkúrák és az atípusos evészavarok lehetséges kapcsolata. Kvalitatív elotanulmány.

INTRODUCTION AND AIM: There are two notable eating behaviors that are not far from having their own category as a mental disorder: the purging disorder, that is already among the DSM-5 non-specific eating disorders, and orthorexia nervosa, when a person is fixating too much on healthy foods. Our purpose is to describe how these can be observed in recreational juice cleanse camps, which are very popular today as an alternative health trend. METHOD: The first author recorded her data during multisited ethnographic observations in two Hungarian juice cleanse camps. Based on the diary logs, notes and interviews collected, we will present the motives of eating anomalies that the participants had shown. RESULTS: The main motive of the camp is "detoxification". The lack of solid food, drastically low calorie intake and lots of physical activity will bring an inevitable change in the body, that is interpreted as toxins leaving the body. Participants have also included deliberate use of laxatives in their everyday routines, with which they associate positive connotations and are linked to the spiritual processes of "letting it go" and "renewal" in the spirit of a holistic approach. The use of symbols in the physiological processes was highly noticeable. Rapid weight loss due to diuresis, the desire for "clean" meals, and "self-rewarding" borrowed from the esoteric-self-help culture are also common motives. Due to the refeeding complications, so far two deaths have been reported by camp organizers. CONCLUSIONS: Both purging disorder and orthorexia nervosa can be well-identified in our observations. This shows that also in the non-clinical environment, there is an institutionalization of eating habits that are dangerous to the health. This "detox" is not only physiologically harmful, but it is not proved to provide long-term help in mental health either. As a solution, we advocate developing an appropriate health communication plan for misconceptions about healthy lifestyle and eating, and also a promotion of psychotherapeutic opportunities. Orv Hetil. 2018; 159(28): 1153-1157.

[Risk factors of eating disorders in the narratives of fashion models].

INTRODUCTION: The risk of eating disorders is high in populations who are exposed to slimness ideal, so among fashion models. The present qualitative study evaluates the risk factors of eating disorders in a group of fashion models with semistructured interview. Moreover, the aim of the study was to examine the impact of professional requirements on the health of models. METHODS: The study group was internationally heterogeneous. The models were involved by personal professional relationship. A semistructured questionnaire was used by e-mail containing anthropometric data and different aspects of the model profession. RESULTS: 29 female and three male models, three agents, two designers, three fotographers, one personal trainer and one stylist answered the questionnaire. Transient bulimic symptoms were reported by six female models (21%). Moreover, five female models fulfilled the DSM-5 criteria of anorexia nervosa or bulimia nervosa. Four of them were anorexic (body mass index: 13.9-15.3), one was bulimic. The symptoms of three persons began before the model career, those of two models after it. 17 models reported that the model profession intensively increased the bodily preoccupations. CONCLUSION: The study corroborates the effect of the model profession on the increase of the risk for eating disorders. In the case of the models, whose eating disorder began after stepping into the model profession, the role of the representants of the fashion industry can be suggested as a form of psychological abuse. As the models or in the case of underages their parents accepted the strong requirement of slimness, an unconscious collusion is probable. Our date highlight the health impact of cultural ideals, and call the attention to prevention strategies.

[Guidelines and recommendations in the treatment of eating disorders].

The importance of eating disorders is increasing in the psychiatric practice, underlined by the epidemiological data and the severity of these disorders. In the treatment several approaches can be found, and some of these are controversial. Following the rules of evidence-based medicine an increasing number of guidelines were published. Eating disorders are prevalent and often show a serious course, the guidelines summarizing the recent knowledge in the literature are very useful for the therapists. The present guideline aims to help the everyday practice. It overviews the principles of the treatment of eating disordered patients, the steps of diagnostics, and the therapeutical methods. Many basic and practical techniques are also presented. It discusses the skills which are necessary for the treatment of eating disorders, and the therapeutical traps as well.