A consensus document on definition and diagnostic criteria for orthorexia nervosa.

PURPOSE: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. METHODS: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. RESULTS: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. CONCLUSIONS: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. LEVEL OF EVIDENCE: Level V: opinions of expert committees.

Psychotherapists in danger: The ethics of responding to client threats, stalking, and harassment.

The ethics issues involved when clients threaten, stalk, or harass their psychotherapists have generally been neglected in the literature, leaving few psychologists prepared to manage such challenging situations. This article presents 3 clinical vignettes and recommendations resulting from a recent conference in Colorado on this important topic. In essence, the article seeks to address ways psychotherapists can balance the ethical challenges of simultaneously protecting clients and themselves. Each vignette is considered from ethical, clinical, and legal perspectives. Suggestions for the individual practitioner include reference to the principles and standards in the American Psychological Association's Ethics Code, professional consultation, and an increased emphasis on self-care. Recommendations for the profession involve ideas for the American Psychological Association's Ethics Code Task Force as well as a call for further research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Individuals who self-identify as having "orthorexia nervosa" score in the clinical range on the Eating Attitudes Test-26.

PURPOSE: In recent years, there has been growing interest in pathologically healthful eating, often called orthorexia nervosa (ON). Much of the literature in this area has been about point prevalence of ON in particular populations, which range from less than 1% to nearly 90% depending on the study. Despite this interest, there has been no extensive examination of whether those with pathologically healthful eating are detected by screening instruments that identify disordered eating. This study examines whether individuals who self-report suffering from ON score in the clinical range on the 26-item Eating Attitudes Test (EAT-26). METHOD: Individuals (n = 354) sampled from both clinical and non-clinical settings were administered the EAT-26 to determine whether those who self-identify as having ON scored in a range that suggests disordered eating. RESULTS: Participants who self-report suffering from ON had a mean EAT-26 score of 30.89 (SD 12.60) scoring in a range that urges individuals to seek additional advice on whether there is an eating disorder present (scores of 20 and higher fall in a range suggesting a possible eating disorder). Furthermore, those in the ON group scored no differently than those reporting other eating disorders, but significantly higher than a non-clinical control group. CONCLUSIONS: Our findings indicate that a screening instrument for a possible eating disorder is sensitive to pathologically healthful eating (but has no specificity). LEVEL OF EVIDENCE: Level III, case control analytic study.

Prevalence of orthorexia nervosa is less than 1 %: data from a US sample.

PURPOSE: Orthorexia nervosa, or pathological dieting based on being "healthy," has been of growing interest. Clinical data are limited to less than a half-dozen case studies reporting instances of medical problems due to healthful eating. However, more than a dozen studies using a measure to identify orthorexia, the ORTO-15, report very high prevalence rates in non-clinical samples. Point prevalence rates are reported from 6 % to nearly 90 %. Such variability could be due to cultural issues or psychometric problems with the instrument. This study examines prevalence rate of orthorexia in a US sample. METHOD: The ORTO-15 was administered to 275 US college students along with other questions regarding diet, exercise, and health. RESULTS: While the ORTO-15 indicated a prevalence rate of 71 %, only 20 % of the sample endorsed a dietary practice of removing a particular food type (e.g. meat) from their diet. Those who endorsed following a vegan diet had the highest (less pathological) mean ORTO-15 score. Further, when classifying participants based on their seriousness about healthy eating and whether their diet had led to impairment in everyday activities and medical problems, less than 1 % of the sample fell into such a category. CONCLUSION: As in other countries, a large proportion of a non-clinical US sample scored in the orthorexia range on the ORTO-15. However, this instrument is likely unable to distinguish between healthy eating and pathologically healthful eating. Our estimate is that orthorexia nervosa like anorexia nervosa and bulimia nervosa, is not a common condition.

On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.

There has been a growing interest among clinicians and researchers about a condition where people restrict their diet based not on quantity of food they consume, but based on its quality. Bratman (1997) coined the term "orthorexia nervosa" to describe people whose extreme diets - intended for health reasons - are in fact leading to malnutrition and/or impairment of daily functioning. There has also recently been intense media interest in people whose highly restrictive "healthy" diet leads to disordered eating. Despite this condition being first described in the U.S., and receiving recent media interest here, orthorexia has largely gone unnoticed in the North American literature. This review article details the literature of orthorexia nervosa, describing its emergence as a condition first described by a physician in a yoga magazine, to its being discussed in the scientific literature. It also reviews prevalence studies and discusses marked shortcomings in the literature. Finally, diagnostic criteria are proposed, as are future directions for research.

Handle with care: the challenges of transporting suicidal patients.

In July 2007, a suburban Denver ambulance began a routine "psych transfer" of a 36-year-old woman from a hospital to a psychiatric facility. During transport, the woman leapt from the moving ambulance onto a busy interstate. She later died of her injuries. Similar incidents are by no means uncommon. In September 2007, another psych transfer ended in tragedy after a suicidal patient jumped from a moving ambulance in Lansing, Mich., and was hit and killed by a car. Three other deaths from patients jumping from ambulances (one in 2002 and two more in 2005) in Michigan were reviewed recently in a medical journal as a warning to providers about the possibility of suicidal patients killing themselves during transport. Deaths resulting from intoxicated persons jumping from moving police cars have also been documented.

Can methicillin-resistant Staphylococcus aureus be found in an ambulance fleet?

OBJECTIVE: To perform an initial screening study of methicillin-resistant Staphylococcus aureus (MRSA) contamination in an ambulance fleet. METHODS: This was a cross-sectional study of MRSA contamination in an ambulance fleet operating in the western United States in June 2006. Five specific areas within each of 21 ambulances (n = 105) were tested for MRSA contamination using dacron swabs moistened with a 0.85% sterile saline solution. These samples were then plated onto a screening media of mannitol salt agar containing 6.5% NaCl and 4 mcg/mL oxacillin. RESULTS: Thirteen samples isolated from 10 of the 21 ambulances (47.6%) in the sample group tested positive for MRSA. CONCLUSIONS: The results of this preliminary study suggest that ambulances operating in the emergency medical services (EMS) system may have a significant degree of MRSA contamination and may represent an important reservoir in the transmission of potentially serious infections to patients.

Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis.

BACKGROUND: Helicopters have become a major part of the modern trauma care system and are frequently used to transport patients from the scene of their injury to a trauma center. While early studies reported decreased mortality for trauma patients transported by helicopters when compared with those transported by ground ambulances, more recent research has questioned the benefit of helicopter transport of trauma patients. The purpose of this study was to determine the percentage of patients transported by helicopter who have nonlife-threatening injuries. METHODS: A meta-analysis was performed on peer-review research on helicopter utilization. The inclusion criteria were all studies that evaluated trauma patients transported by helicopter from the scene of their injury to a trauma center with baseline parameters defined by Injury Severity Score (ISS), Trauma Score (TS), Revised Trauma Score (RTS), and the likelihood of survival as determined via Trauma Score-Injury Severity Score (TRISS) methodology. RESULTS: There were 22 studies comprising 37,350 patients that met the inclusion criteria. According to the ISS, 60.0% [99% confidence interval (CI): 54.5-64.8] of patients had minor injuries, According to the TS, 61.4% (99% CI: 60.8-62.0) of patients had minor injuries. According to TRISS methodology, 69.3% (99% CI: 58.5-80.2) of patients had a greater than 90% chance of survival and thus nonlife-threatening injuries. There were 25.8% (99% CI: -1.0-52.6) of patients discharged within 24 hours after arrival at the trauma center. CONCLUSIONS: The majority of trauma patients transported from the scene by helicopter have nonlife-threatening injuries. Efforts to more accurately identify those patients who would benefit most from helicopter transport from the accident scene to the trauma center are needed to reduce helicopter overutilization.

Safety and effectiveness of fentanyl administration for prehospital pain management.

OBJECTIVE: To determine the safety and effectiveness of fentanyl administration for prehospital pain management. METHODS: This was a retrospective chart review of patients transported by ambulance during 2002-2003 who were administered fentanyl citrate in an out-of-hospital setting. Pre- and post-pain-management data were abstracted, including vital signs, verbal numeric pain scale scores, medications administered, and recovery interventions. In addition, the emergency department (ED) charts of a subgroup of these patients were reviewed for similar data elements. RESULTS: Of 2,129 patients who received fentanyl for prehospital analgesia, only 12 (0.6%) had a vital sign abnormality that could have been caused by the administration of fentanyl. Only one (0.2%) of the 611 patients who had both field and ED charts reviewed had a vital sign abnormality that necessitated a recovery intervention. There were no admissions to the hospital, nor patient deaths, attributed to fentanyl use. There was a statistically significant improvement in subjective pain scale scores (8.4 to 3.7). Clinically, this correlates with improvement from severe to mild pain. CONCLUSION: This study showed that fentanyl was effective in decreasing pain scores without causing significant hypotension, respiratory depression, hypoxemia, or sedation. Thus, fentanyl citrate can be used safely and effectively for pain management in the out-of-hospital arena.

Are emergency medical technician-basics able to use a selective immobilization of the cervical spine protocol?: a preliminary report.

OBJECTIVE: To be a first step in determining whether emergency medicine technician (EMT)-Basics are capable of using a protocol that allows for selective immobilization of the cervical spine. Such protocols are coming into use at an advanced life support level and could be beneficial when used by basic life support providers. METHOD: A convenience sample of participants (n=95) from 11 emergency medical services agencies and one college class participated in the study. All participants evaluated six patients in written scenarios and decided which should be placed into spinal precautions according to a selective spinal immobilization protocol. Systems without an existing selective spinal immobilization protocol received a one-hour continuing education lecture regarding the topic. College students received a similar lecture written so laypersons could understand the protocol. RESULTS: All participants showed proficiency when applying a selective immobilization protocol to patients in paper-based scenarios. Furthermore, EMT-Basics performed at the same level as paramedics when following the protocol. Statistical analysis revealed no significant differences between EMT-Basics and paramedics. A follow-up group of college students (added to have a non-EMS comparison group) also performed as well as paramedics when making decisions to use spinal precautions. Differences between college students and paramedics were also statistically insignificant. CONCLUSIONS: The results suggest that EMT-Basics are as accurate as paramedics when making decisions regarding selective immobilization of the cervical spine during paper-based scenarios. That laypersons are also proficient when using the protocol could indicate that it is extremely simple to follow. This study is a first step toward the necessary additional studies evaluating the efficacy of EMT-Basics using selective immobilization as a regular practice.

Detecting neuropsychological malingering: effects of coaching and information.

Concerns that patients presenting for neuropsychological assessment may not be putting forth maximum effort during testing has prompted the development of measures designed to detect malingering and incomplete effort. Two of these measures are the Computerized Assessment of Response Bias-97 (CARB-97) and Word Memory Test (WMT). Despite widespread use of these instruments, no study has been published determining the vulnerability of neuropsychological malingering measures to explicit coaching or brain injury information. The present study, using analog participants, found that the CARB-97 and WMT differentiate "normal" from "malingered" instructional sets, and show little difference between nai;ve and coached malingering efforts. There was also little difference between providing brain injury information and a no-information condition, but when effects were present, the information group generally scored worse. Further, it was found that response times (RTs), in addition to items correct, may also be effective in detecting those who are not giving their full effort.