Body Image Concern and Eating Disorder Symptoms Among Elite Icelandic Athletes.

The aim of this study was to analyse body image concerns and symptoms of eating disorders in elite Icelandic athletes according to their sex, and sport practiced. The participants were 755 athletes (24.8 ± 3.5 years in age) who compete at the highest possible level in Iceland. Representing 20 different sports, they were divided into five sports groups. Three questionnaires were used: the Body Shape Questionnaire to assess body image concerns; the Bulimia Test-Revised to assess the main symptoms of bulimia; and the Eating Disorder Examination Questionnaire to identify disordered eating attitudes and behaviours. A chi-squared test was used to analyse differences in prevalence of body image concern and eating disorders, a t-test for the differences between men and women, and a one-way ANOVA to compare the different sports. The main findings were that 17.9% of the athletes presented severe or moderate body image dissatisfaction, and 18.2% (25.3% of the women) were above the clinical cutoff for body image concern. Women's scores were higher than men's (whole sample and ball games) in all variables except restraint. These results seem to point to the existence of a real problem that athlete, coaches, doctors, and institutions need to take into account.

[Eating Disorder Treatment in Iceland - Treatment adherence, psychiatric co-morbidities and factors influencing drop-out]. / Átröskunarmedferd á Íslandi - sjúkdómsmnd, medferdarheldni og forspárpættir brofalls.

OBJECTIVE: Treatment adherence in patients with eating disorders (ED) in Iceland is unknown. The aim of the study was to investigate treatment drop-out and explore factors that influence premature termination of treatment in a specialized ED treatment unit, at the University Hospital of Iceland, during the period of September 1, 2008 - May 1, 2012. MATERIAL AND METHODS: The study is retrospective and naturalistic. Hospital records of referred patients were examined. Those meeting the ICD 10 criteria of anorexia nervosa (AN) (F50.0, F50.1), bulimia nervosa (BN) (F50.2, F50.3) and eating disorder not otherwise specified (EDNOS) (F50.9) were included. The total sample was 260 and 182 patients met inclusion criteria. No-shows were 7%. Drop-out was defined as premature termination of treatment without formal discharge. RESULTS: The sample consisted of 176 women and 6 men, mean age 26.3 years. BN was diagnosed in 52.7% of patients, EDNOS in 36.8% AN in 10.4%. 74.7% had one or more co-morbid psychiatric diagnosis. Anxiety- and/or depression were diagnosed in 72.5%, Attention hyperactivity deficiency disorder in 15.4% and personality disorders in 8.2%. Lifetime prevalence of substance use disorders (SUDs) was 30.8%. Drop-out from treatment occurred in 54.4% of cases (with approximately 1/3 returning to treatment), 27.5% finished treatment and 18.1% were still in treatment at the end of the follow up period. Treatment adherence was significantly higher in patients who had a university degree, in those who had themselves taken the initiative to seek ED treatment and in those with higher anxiety scores at assessment. AN patients did better than other ED patients while patients with SUDs showed a tendency for higher drop-out (p=0.079). CONCLUSION: The drop-out rates were similar to what has been reported from other western countries. Follow-up time was longer and AN patient did better than expected. Higher education, initiative in seeking treatment and higher anxiety scores on questionnaires were protective.

[Bone mineral density of young women with history of anorexia nervosa]. / Beinthéttni ungra kvenna med sögu um lystarstol.

OBJECTIVE: A decrease in bone mineral density (BMD) is frequently seen in patients with anorexia nervosa (AN). This study was designed to assess BMD of young Icelandic women with current or previous history of AN and identify predictors which might be targets for preventive measures. MATERIAL AND METHODS: The study was retrospective. Participants were women aged 18-40 years, with diagnosis of AN (F50.0, F50.1) attending the anorexia unit at Landspítali - The National University Hospital of Iceland - in 2001-2009, who had undergone measurement of BMD by dual-energy X-ray absorptiometry. A control group consisted of 58 healthy 30 years old women participating in a study of bone health in 2001-2003. RESULTS: At time of BMD measurement the median body mass index (BMI: kg/m2) in the AN group (n=40) was 17.4 (12.3-25.2) compared to 23.6 (18.1-43.7) in the control group (p<0,001). Lumbar spine and hip BMD were 15.3-17.5% lower in AN patients than in control subjects (p<0.001). In both groups there was a strong correlation between BMD and body weight (r=0.354-0.604, p<0.05) and lean mass (r=0.425-0.588, p<0.05). Among patients with AN a correlation was also seen between BMD and lowest weight during the illness (r=0.482-0.499, p<0.01). Among the 26 AN patients who had repeated BMD measurement, a significant decrease in BMD at femoral neck (-6.6%, p=0.030) was observed in those who lost weight between the measurements (n=9). Those who had BMI ≤17.5 between BMD measurements lost 5.5-7.1% of the BMD at the hip (p<0.05). CONCLUSION: Young women with AN have 15% lower bone mass than healthy young women. The relationship between BMD and body weight seems to be a continuum across disease states. Increased body weight may be the most important factor for recovery of bone mass in AN patients.

[Anorexia nervosa in psychiatric units in Iceland 1983-2008, incidence of admissions, psychiatric comorbidities and mortality]. / Lystarstol 1938-2008 - innlagnir, sjukdomsmynd og lifun.

OBJECTIVE: Information is scarce concerning the incidence of anorexia nervosa (AN) in psychiatric facilities in Iceland. The aim of this study was to describe the incidence of admissions, comorbidity and mortality of patients who were admitted to psychiatric units in Iceland, diagnosed with AN in 1983-2008. MATERIAL AND METHODS: The study is retrospective. 140 medical records with an AN or atypical eating disorder diagnosis according to the ICD-9 and ICD-10 were reviewed. Final sample was 84 patients with confirmed AN diagnosis. RESULTS: Five men and 79 women were admitted to a psychiatric inpatient ward for the first time diagnosed with AN. Average age was 18.7 years. Incidence of admissions for both sexes in the first part of the study period (1983-1995) was 1.43/100.000 persons/year, 11-46 years old, but in the second part (1996-2008) 2.91. The increase was statistically significant (RR=2.03 95% CI 1.28-3.22) and can mainly be explained by an increased incidence of admissions to the children- and adolescent psychiatric wards (CAW). Mortality of women was 2/79 (2.5%) and standard mortality rate 6.25. The average length of stay was 97 days, 67.3 days in adult units and 129.7 days in CAW (p<0.05). In the study period 51 patients (60.7%) were only admitted once. One patient had compulsory admission on his first admission but ten (11.9%) had at some point compulsory admission. The body mass index increased in average from admission to discharge from 15.3 to 17.5 kg/m2. A correlation was found between self harm and suicide attempts and compulsory admissions. CONCLUSION: The study revealed an increased incidence between periods. This might reflect a real increase of AN in the society. Mortality rate was lower than expected.

[Eating disorders: symptomatology, course and prognosis, epidemiology, and psychiatric comorbidity. Review article]. / Atraskanir: einkenni, framvinda, faraldsfraedi og tengsl vid gedsjúkdóma. Yfirlitsgrein.

OBJECTIVE: Eating disorders are a group of serious psychiatric disorders that affect primarily young women and can have serious consequences on their lives and their families. Eating disorders are characterized by disordered eating behaviour with desire for thinness that can result in serious physical and psychological symptoms and death. Eating disorders tend to run a chronic course. Psychiatric comorbidity and physical complications are common among eating disordered patients and these issues need to be taken into consideration during treatment. Prevalence and incidence of eating disorders appears to be increasing in Western societies and follow increased prosperity and obesity problems. There is no reason to believe that the situation is different in Iceland but research is lacking. In this review article we address the main symptoms and diagnostic criteria of three types of eating disorders, that is anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified. The course and prognosis, epidemiology, and psychiatric comorbidity of eating disorders will also be presented. Finally, we discuss the services available to eating disordered patients here in Iceland and the need for further development of the services.

[Reliability and validity of the Icelandic version of the Bulimia Test-Revised (BULIT-R)]. / Próffraedilegir eiginleikar íslenskrar gerdar Bulimia Test-Revised (BULIT-R) prófsins.

OBJECTIVE: The psychometric properties of the Icelandic version of the Bulimia Test-Revised (BULIT-R) were investigated. The BULIT-R is a self-report instrument designed to assess a broad range of eating-disordered behaviour, particularly bulimic symptomatology. MATERIAL AND METHODS: The BULIT-R was administered to 66 female patients receiving outpatient psychiatric treatment. Almost half of the patients (n=32) sought treatment for disturbed eating behaviours and 34 women were in treatment for depression or anxiety. In addition, three other self-report measures were administered to the women, the Eating Disorder Diagnostic Scale (EDDS), the Beck Depression Inventory-II (BDI-II) and the Obsessive-Compulsive Inventory-Revised (OCI-R), in order to assess convergent and divergent validity. RESULTS: The study estimated the reliability and construct validity of the BULIT-R. The internal reliability was high (Cronbach's coefficient alpha = 0,96). The BULIT-R correlated highly with EDDS, a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa and binge eating disorder, and it correlated lower with BDI-II and OCI-R. The BULIT-R differentiated between patients with and without eating-disordered symptomatology. CONCLUSIONS: These results indicate that the Icelandic version of the BULIT-R is a reliable and valid measure to assess eating disordered behaviour, particularly bulimic behaviour among female outpatients.