Considerations for Athletes with Eating Disorders Based on Levels of Care.

ABSTRACT: This article provides an overview of levels of care for eating disorders (EDs) and considerations that are specific to elite athletes. We discuss the following levels of care in terms of ED pathology and treatment aspects that may be unique to athletes: 1) inpatient and residential care, 2) intensive outpatient and partial hospitalization treatment, and 3) outpatient. Illustrative case studies also are presented to highlight distinctions between levels of care and athlete-specific nuances to treatment approaches and health care teams. Finally, we review aspects of return to play plans for elite athletes with EDs.

Predicting a comprehensive operationalization of eating disorder recovery: Examining self-concept, personality, and negative affect.

OBJECTIVE: Our goal was to examine potential predictors of a comprehensive operationalization of eating disorder recovery, characterized by physical, behavioral, and cognitive recovery, focusing on constructs related to self-concept, personality, and negative affect. METHOD: Participants were women with a history of an eating disorder who provided data via survey and interview at two time points separated by about 7-8 years and who met criteria for an eating disorder diagnosis at baseline (N = 36). RESULTS: Logistic regression models revealed that self-esteem was a significant predictor of recovery status (OR = 1.12, p = .039) such that individuals with higher self-esteem at baseline demonstrated significantly greater odds of being in full recovery at follow-up. However, when self-esteem was considered in a set along with baseline imposter phenomenon and anxiety, no single construct emerged as a significant unique predictor of recovery in logistic regression analyses. DISCUSSION: These results highlight the potential importance of self-esteem in relation to recovery, with clinical implications related to bolstering self-esteem as part of eating disorder treatment. Future research should continue to explore predictors using a comprehensive operationalization of eating disorder recovery in larger, more diverse samples to optimally identify factors associated with achieving recovery.

Body appreciation and intuitive eating in eating disorder recovery.

OBJECTIVE: Eating disorder recovery research has emphasized the absence of symptoms over the presence of adaptive aspects like positive body image and healthy eating attitudes. The current study examined how body appreciation and intuitive eating related to eating disorder recovery using a comprehensive recovery definition (physical, behavioral, and cognitive recovery). METHOD: Data were collected from 66 women with an eating disorder history and 31 controls with no history of eating pathology. Participants completed an online survey followed by a phone interview. RESULTS: The fully recovered group did not differ from controls on body appreciation, with both groups endorsing significantly higher levels of body appreciation than the partially recovered and current eating disorder groups. Similarly, the fully recovered group did not differ from controls on overall intuitive eating, with both groups endorsing significantly higher levels of overall intuitive eating than the partially recovered and current eating disorder groups. DISCUSSION: Positive psychological constructs such as body appreciation and intuitive eating relate to eating disorder recovery status. Understanding recovery within a strengths-based framework may inform intervention and relapse prevention.

The self and eating disorders.

In our review, we focus on self-related constructs in the context of eating disorders with four aims. First, we examine a variety of self-related constructs that have been theoretically and empirically linked to the development and course of eating disorders. In addition to the more well-researched constructs of self-esteem and self-efficacy, we also report on findings related to selflessness, contingent self-worth, self-objectification, ego-syntonicity, self-concept clarity, self-compassion, social comparison, self-oriented perfectionism/self-criticism, and narcissism. Second, we discuss self-related constructs that may be especially relevant to comorbidities common among those with eating disorders. Third, we review intervention and prevention programs where self-related constructs play a prominent role. Lastly, we share future research directions regarding self-related constructs and eating disorders that we believe will advance a deeper understanding of the role of the self in the eating disorders.

Longitudinal follow-up of a comprehensive operationalization of eating disorder recovery: Concurrent and predictive validity.

OBJECTIVE: We aimed to replicate the concurrent validity of a comprehensive definition of eating disorder recovery (physical, behavioral, and cognitive indices) in a sample followed up 7-8 years from baseline, and to examine, for the first time with this comprehensive definition, predictive validity. METHOD: Participants were 66 women with a history of an eating disorder and 31 age-matched controls who completed an online survey and phone interview. RESULTS: In general, women who were fully recovered were statistically indistinguishable from controls and had significantly less eating disorder attitudes and behaviors than the partially recovered and eating disorder groups. Being fully recovered at baseline was a robust predictor of stability: of those fully recovered at baseline, 80% remained fully recovered at follow-up. One-third of those with an eating disorder and one-half of those in partial recovery at baseline attained full recovery at follow-up. DISCUSSION: These findings support the current operationalization of eating disorder recovery, encompassing physical, behavioral, and cognitive indices, as valid and highlight that full recovery is not only possible but predicts full recovery years later. Future research should examine this operationalization in diverse samples and study trajectories of recovery to identify predictors.

Haptic shared control improves neural efficiency during myoelectric prosthesis use.

Clinical myoelectric prostheses lack the sensory feedback and sufficient dexterity required to complete activities of daily living efficiently and accurately. Providing haptic feedback of relevant environmental cues to the user or imbuing the prosthesis with autonomous control authority have been separately shown to improve prosthesis utility. Few studies, however, have investigated the effect of combining these two approaches in a shared control paradigm, and none have evaluated such an approach from the perspective of neural efficiency (the relationship between task performance and mental effort measured directly from the brain). In this work, we analyzed the neural efficiency of 30 non-amputee participants in a grasp-and-lift task of a brittle object. Here, a myoelectric prosthesis featuring vibrotactile feedback of grip force and autonomous control of grasping was compared with a standard myoelectric prosthesis with and without vibrotactile feedback. As a measure of mental effort, we captured the prefrontal cortex activity changes using functional near infrared spectroscopy during the experiment. It was expected that the prosthesis with haptic shared control would improve both task performance and mental effort compared to the standard prosthesis. Results showed that only the haptic shared control system enabled users to achieve high neural efficiency, and that vibrotactile feedback was important for grasping with the appropriate grip force. These results indicate that the haptic shared control system synergistically combines the benefits of haptic feedback and autonomous controllers, and is well-poised to inform such hybrid advancements in myoelectric prosthesis technology.

Social media and disordered eating among middle-aged women: Not just an adolescent concern.

Evidence suggests social media use is strongly linked to disordered eating (e.g., binge eating and dietary restraint) among adolescent and young adult women, in part because it promotes engagement in social comparison (the tendency to evaluate one's own standing or ability by comparing it to another's). Yet no study has examined the impact of social media use and comparison on disordered eating among middle-aged women. Participants (N = 347), ages 40-63, completed an online survey about their social media use, social comparison, and disordered eating (bulimic symptoms, dietary restraint, and broad eating pathology). Results indicated that 89 % (n = 310) of middle-aged women used social media in the past year. Most participants (n = 260; 75 %) used Facebook, and at least a quarter used Instagram or Pinterest. Approximately 65 % (n = 225) used social media at least daily. Controlling for age and body mass index, social media-specific social comparison was positively associated with bulimic symptoms, dietary restriction, and broad eating pathology (all ps < 0.001). Multiple regression models evaluating frequency of social media use and social media-specific social comparison together revealed that social comparison explained a significant amount of unique variance in bulimic symptoms, dietary restriction, and broad eating pathology (all ps < 0.001) above and beyond frequency of social media use. Instagram explained a significant proportion of variance of dietary restraint compared to other social media platforms (p = .001). Findings suggest a large percentage of middle-aged women frequently engage with some type of social media. Further, social media-specific social comparison, rather than frequency of social media use, may be driving disordered eating in this age group of women.