Academic journal article Journal of Eating Disorders

Quality of Life in Anorexia Nervosa, Bulimia Nervosa and Eating Disorder Not-Otherwise-Specified

Academic journal article Journal of Eating Disorders

Quality of Life in Anorexia Nervosa, Bulimia Nervosa and Eating Disorder Not-Otherwise-Specified

Article excerpt

Author(s): Hannah DeJong[sup.1], Anna Oldershaw[sup.1], Lot Sternheim[sup.1], Nelum Samarawickrema[sup.1], Martha D Kenyon[sup.1], Hannah Broadbent[sup.1], Anna Lavender[sup.2], Helen Startup[sup.2], Janet Treasure[sup.1] and Ulrike Schmidt[sup.1]

Background

In recent years, the assessment of Quality of Life (QoL) in people with eating disorders (EDs) has been subject to considerable research interest. The World Health Organisation defines QoL as 'an individual's perception of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards and concerns' [1]; page 145. It is a multidimensional construct that is understood to include perceptions about various areas of life, including physical, psychological, social and emotional domains [1]. QoL measures are beginning to be recognized as a key patient-oriented measure of outcome [2]. To date, studies in EDs have indicated significantly reduced QoL in this patient group, to a degree that is comparable with QoL findings in various other serious illnesses and disorders, such as angina and anxiety disorders [3, 4]. Individuals with EDs seem to be particularly impaired in psychological and social domains [5, 6].

Patterns of diagnostic differences are inconsistent across studies, with some studies finding no significant differences between diagnostic groups [7, 8], some reporting lower QoL in individuals with anorexia nervosa (AN) than bulimia nervosa (BN) [9-11], and others reporting higher QoL in AN [12, 13]. However, studies that report higher QoL in AN also report seemingly contradictory findings, such as an increased presence of suicidal thoughts and self-harming behaviours in this group [12]. It is also notable that studies finding less impairment in AN have tended to use generic, rather than ED specific measures of QoL, which - as has been hypothesized - may be less sensitive to certain aspects of impairment associated with these disorders [14]. Inconsistencies in the differences reported across diagnostic groups may also be attributable to the presence of diagnostic subtypes. There is some evidence that individuals with bingeing and/or purging forms of AN are more impaired than individuals with restrictive AN [8, 15]. Several authors have suggested that a lack of insight into the negative impact of restrictive AN may inflate self-reported measures of QoL in this group - restrictive EDs are often experienced as ego-syntonic due to the valued weight loss associated with these disorders [13, 16].

It remains unclear how specific symptoms and behaviours associated with EDs impact on QoL. There is evidence that the presence of both bingeing [9, 17-19] and purging behaviours [14, 20, 21] negatively affect QoL in both clinical and community samples, but evidence regarding the impact of the frequency of these behaviours is sparse and contradictory [6, 19, 22, 23]. The effect of BMI on QoL is relatively unexplored, particularly in underweight ED samples [6], though there is some evidence that QoL falls with decreased BMI [11]. There is similarly little evidence on the relationship between illness chronicity and QoL, though one study has found lower QoL in individuals with illness duration greater than five years compared to those ill for less than five years [24].

The present study used the Clinical Impairment Assessment (CIA) [25, 26], a measure of QoL specifically designed for use in ED populations. The CIA is designed to assess the perceived effects of having an ED on various domains, including social, emotional and cognitive aspects. Relevant domains were identified by clinicians and through interviews with patients diagnosed with an ED. The authors decided not to include items about possible physical effects of having an ED (e.g. feeling faint or cold, palpitations), arguing that individuals with EDs may not necessarily associate these effects with their eating behaviours. …

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