What is day hospital treatment for anorexia nervosa really like? A reflexive thematic analysis of feedback from young people.

BACKGROUND: A significant proportion of young people do not respond to the NICE recommended treatment for anorexia nervosa: Family Therapy. Whilst historically these young people would be admitted to inpatient services, which are associated with greater treatment cost, greater risk of relapse, and worse outcome, more recently evidence is building for the effectiveness of day programmes. One day programme that has been found to be effective is the Intensive Treatment Programme (ITP) of the Maudsley Centre for Child & Adolescent Eating Disorders in London, UK. However, to-date no studies have investigated how young people experience such a day programme. METHOD: Anonymous feedback was completed via online survey by 51 young people over a 5-year period (2018-2023) on discharge from ITP. RESULTS: Four main themes were identified: (1) Support-young people expressed the importance of boundaries but also of feeling validated, and encouraged; (2) Uniqueness: an experience like no other-ITP was described as different to any other treatment received before (both outpatient and inpatient); (3) Relationships - young people valued connecting with others in a similar situation and reflected that relationships at home changed throughout treatment; (4) Self-development - learning skills, developing independence, and exploring an identity outside of the eating disorder was valued. CONCLUSIONS: It is hoped that the reflections from these young people can help to inform clinicians working in DPs and those hoping to set up novel DPs about key aspects of treatment.

This study examined the experiences of young people who attended an intensive treatment day programme (ITP) over a five-year period. 51 young people completed online questionnaires up to one-month after being discharged from the programme between 2018 and 2023. All young people were between the ages of 11­18 and had a diagnosis of anorexia nervosa. The authors explored all free text responses from the young people (for example: what were the most important parts of ITP) and found four common themes. These were: (1) Support ­ feeling validated, encouraged, and finding boundaries helpful, (2) Uniqueness: an experience like no other ­ treatment was different to any received before, (3) Relationships ­ connecting with others in a similar situation and relationships at home changing, (4) Self-development ­ learning skills, finding their identity, and developing independence. It is hoped that the reflections from these young people can help to inform clinicians working in DPs and those hoping to set up novel DPs about key aspects of treatment.

Perceptual Not Attitudinal Factors Predict the Accuracy of Estimating Other Women's Bodies in Both Women With Anorexia Nervosa and Controls.

Disturbance in how one's body shape and size is experienced, usually including over-estimation of one's own body size, is a core feature of the diagnostic criteria of anorexia nervosa (AN). Is this over-estimation specific to women with AN's judgments of their own body? Or is it just a general feature of their judgments about all bodies? If the latter, it would be consistent with a general error in the perception of body size potentially linked to the use of a different set of visual cues for judging body size. If the former, then this suggests that the over-estimation of own body size has a strong attitudinal component and may be part of the psycho-pathology of their condition. To test this hypothesis, 20 women with AN and 80 control observers estimated the body size of 46 women. The results show a strong effect of perceptual factors in estimating body size for both controls and women with AN. This result is consistent with size over-estimation of own body in AN having a strong attitudinal basis and being a core feature of the psycho-pathology of the condition.

An interactive training programme to treat body image disturbance.

OBJECTIVES: Anorexia nervosa (AN) is a life-threatening mental health condition. A core feature is a disturbance of body image, such that sufferers see themselves as fatter than they actually are. DESIGN: We tested the effectiveness of a novel training programme to recalibrate our participants' perception of body size. METHODS: In a novel adaptation of a cognitive bias training programme, participants judged the body size of a series of female bodies and were given feedback to improve their accuracy over four daily training sessions. In Study 1, we recruited young women with high concerns about their body size for a randomized controlled study. In Study 2, we then applied the training programme to a case series of women with atypical AN. RESULTS: In Study 1, the training programme significantly improved the body size judgements of women with high body concerns compared to controls. We also found evidence of improved body image and reduced eating concerns in this group. In Study 2, the programme again recalibrated the body size judgements of women with atypical AN. We also saw evidence of a clinically meaningful reduction in their body size and eating-disordered concerns. CONCLUSIONS: This training has the potential to be a valuable treatment used together with more traditional talking therapies. Statement of contribution What is already known on this subject? A core feature of anorexia nervosa (AN) is an overestimation of body size; sufferers believe themselves to be larger than they are in reality. This study shows that an individual's perceptual boundary between what they classify as a fat versus a thin body is not immutable; it can be changed through a cognitive bias training programme. What does this study add? This means that body size overestimation may now be treatable. Critically, as well as improving the accuracy of body size judgements, we also found a clinically significant improvement in participants' eating-disordered concerns. This demonstrates that a targeted behavioural training regime can change body perception, and the central role that body overestimation has in eating-disordered beliefs.

Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence.

Our aim was to systematically review the prevalence of body dysmorphic disorder (BDD) in a variety of settings. Weighted prevalence estimate and 95% confidence intervals in each study were calculated. The weighted prevalence of BDD in adults in the community was estimated to be 1.9%; in adolescents 2.2%; in student populations 3.3%; in adult psychiatric inpatients 7.4%; in adolescent psychiatric inpatients 7.4%; in adult psychiatric outpatients 5.8%; in general cosmetic surgery 13.2%; in rhinoplasty surgery 20.1%; in orthognathic surgery 11.2%; in orthodontics/cosmetic dentistry settings 5.2%; in dermatology outpatients 11.3%; in cosmetic dermatology outpatients 9.2%; and in acne dermatology clinics 11.1%. Women outnumbered men in the majority of settings but not in cosmetic or dermatological settings. BDD is common in some psychiatric and cosmetic settings but is poorly identified.

The effect of self-focused attention and mood on appearance dissatisfaction after mirror-gazing: An experimental study.

BACKGROUND AND OBJECTIVES: Self-focused attention is hypothesized to be a maintenance factor in body dysmorphic disorder (BDD). The aim of this study was to use an experimental paradigm to test this hypothesis by studying the effect of self-focused attention during mirror-gazing on appearance dissatisfaction. METHODS: An experimental group design was used, in which 173 women were randomly allocated to one of three conditions before mirror-gazing for 2 min: (a) external focus of attention, (b) self-focus of attention, and (c) self-focus of attention with a negative mood induction. RESULTS: After mirror-gazing, participants across all groups rated themselves as being more dissatisfied with their appearance. In both the self-focus conditions, there was an increase in sadness from pre to post mirror gazing, and there was a significant difference in focus of attention for participants in the self-focused, mood-induced group from pre to post manipulation, suggesting mood induction had more of an effect than focus of attention. LIMITATIONS: (1) there was no condition involving an external focus with a negative mood induction, and (2) due to the level of information provided to patients on the nature of the task, we cannot rule out demand characteristics as an influencing factor on our results. CONCLUSIONS: Self-focused attention during mirror-gazing may act indirectly to increase appearance dissatisfaction via the effect of negative mood. Further studies are required to establish the relative contribution of self-focused attention and negative mood to increases in appearance dissatisfaction as a function of mirror-gazing.

Visual biases in judging body weight.

OBJECTIVES: There has been a steady rise in obesity levels in Western countries, and a contributory factor is people's failure to recognize weight gain. Two important visual perceptual biases, contraction bias and Weber's law, that have hitherto been ignored in the obesity literature could contribute to this problem. Contraction bias predicts that the weight of obese bodies will be underestimated and the degree of underestimation will increase as body mass index (BMI) increases. Weber's law predicts that change in the body size will become progressively harder to detect as their BMI increases. METHODS: In Experiment 1, 29 women participants estimated the weight of 120 women varying in their body mass. In Experiment 2, 28 women participants judged which body was the heavier in a 2-alternative forced choice paradigm. RESULTS: In Experiment 1, as predicted the participants showed a progressive underestimation of overweight and obese bodies, ß1  = 0.71, t = 26.96, p < .0001. For Experiment 2, there was a significant effect of the BMI of the bodies being judged on the just noticeable difference needed to discriminate between them: F(1, 196) = 89.39, p < .0001 for 3D bodies and F(1, 86.5) = 44.57, p < .0001 for digital photographs. CONCLUSIONS: Normal visual perceptual biases influence our ability to determine body size: contraction bias and Weber's law mean that as bodies become overweight and obese, it is harder to judge their weight and detect any increase in size. These effects may therefore compromise people's ability to recognize weight gain and undertake compensatory weight control behaviours. Statement of contribution What is already known on this subject? It is common knowledge that obesity levels in the West are rapidly rising and that people fail to recognize weight gain. What has not been widely recognized before is that there are sound perceptual reasons for this failure. Here, we identify two such perceptual biases. What does this study add? Weber's law and contraction bias compromise people's ability to recognize weight gain. It becomes progressively harder to discriminate the size of bodies as their body mass index increases. This compromises the ability to recognize weight gain and undertake compensatory behaviours.