Eating Disorders and Pregnancy: The Case of Anorexia

The question of the link between pregnancy and eating disorders is an important question. At the moment, there are few concrete answers for these patients. Despite common fertility challenges, patients who suffer from ED are able to access maternity. ED and pregnancy can either have an easy evolution or experience a lot of trouble. Many studies describe obstetrical and foetal complications (low birthweight, inadequate intra-uterine growth, small head circumference, miscarriage, caesarean section). Those patients are frequently reluctant to address their disease with their specialist, who also often doesn’t know how to screen the signs. The lack of official data to train the specialists further increases these difficulties. However, ED are frequent in the general population and young patients are likely to eventually want to become mothers. It is thus essential to know how to screen those patients early and accurately to improve their treatment and care. Eating disorders impact the pregnancy, the delivery and the postpartum as well as the growth of the baby. It is an important public health problem. The evolution from being a woman to becoming a mother is a difficult one, and even more so when the women is suffering from ED. Those patients must handle their nutritional fears, the anxiety about their body changing with pregnancy and the daily challenges. The early interactions with their baby have consequences on their development. It seems necessary to evaluate how to improve the screening and the patient care in ED patients. Screening should begin from the pregnancy desire to the postpartum. This patient care should be based on a multidisciplinary care team.

Racial and Ethnic Differences in Orthorexia Nervosa Symptomatology and Other Disordered Eating

While some research has explored racial and ethnic differences in disordered eating, this study may be the first to examine these differences in orthorexia nervosa, involving obsessive-compulsive thoughts and behaviors concerning healthy eating, which negatively impact one’s life. Adult participants, recruited from college courses and social media, completed an online survey with the Orthorexia Nervosa Inventory (ONI) and the Eating Attitudes Test-26 (EAT-26). Regarding racial and ethnic background, 743 were White, 249 were Hispanic, 87 were Black, 61 were Asian or Pacific Islander, and 110 were biracial/multiracial. A MANCOVA revealed that the racial and ethnic groups did not differ on the ONI subscales assessing orthorexic behaviors, impairments, and emotions, after accounting for gender, BMI, and EAT-26 total scores that were covariates. In contrast, a second MANCOVA did reveal group differences on the EAT-26 subscales, after accounting for gender, BMI, and ONI total scores that were covariates. Black participants scored significantly lower than the other racial and ethnic groups on the subscale assessing dieting behaviors characteristic of anorexia nervosa, and the subscale assessing binge-eating and purging behaviors characteristic of bulimia nervosa. Further, Hispanic participants scored significantly lower than White participants on the latter subscale. These findings suggest that while orthorexic symptomatology does not differ based on race and ethnicity, a Black race and Hispanic ethnicity may be protective factors against disordered eating, perhaps related either to cultural norms concerning body image or to the resiliency and social support among the Black and Hispanic communities.

Eating Disorders among Students in Northern Benin (2023)

Introduction: From their earliest hours, human beings are able to identify a source of food and to feed themselves. Feeding is therefore one of the most instinctive human functions. It is regulated by several factors (physiological, psycho-affective and environmental) whose disruption can lead to eating disorders. Objective: The aim of this study was to investigate eating disorders among students in the town of Parakou in 2023. Method: Descriptive cross-sectional study conducted from January to July 2023 in various universities in the city of Parakou, Benin. The study population consisted of all students in grades 1 to 7 at these universities. A two-stage non-proportional stratified sampling technique combined with a simple random draw was adopted. The Eating Attitude Test-26, Bulimia Inventory Test Edinburgh and a set of questions focusing on the diagnostic criteria for pica were used to screen for pica and other disorders such as anorexia, bulimia nervosa and binge eating disorder. Data were analyzed using SPSS (Statistical Package for Social Sciences) version 25. Results: A total of 607 students were surveyed, 323 of whom had eating disorders. A prevalence of 53.21% of students at risk of eating disorders was found. In relation to the total population, the prevalences of anorexia, bulimia nervosa, binge eating disorder and pica were 45.96%, 0.82%, 15.48% and 12.68% respectively. In multivariate analysis, seven factors explained the risk to develop at least one eating disorder among the students surveyed. These were: urban area of residence (OR (95% CI) = 5.059 (1.75 - 14.65);p = 0.003);year of study (OR (95% CI) = 0.47 (0.28 - 0.79);p = 0.035);type of university attended (private university: OR (95% CI) = 1.63 (1.08 - 2.44);p = 0.019);parents’ marital status (couple or not) (OR (95% CI) = 1.50 (1.01 - 2.24);p = 0.046);father’s level of education: secondary (OR (CI 95%) = 3.85 (1.96 - 7.54);p 0.001)/higher (OR (CI 95%) = 2.83 (1.36 - 5.86);p = 0.005);mother’s one: secondary (OR (CI 95%) = 0.30 (0.18 - 0.51);p 0.001)/superior (OR (CI 95%) = 0.31 (0.16 - 0.61);p = 0.001);the presence of doubtful (OR (CI95% = 1.69 (1.11 - 2.58);p = 0.009) or certain anxiety symptomatology (OR (CI 95%) = 1.69 (1.11 - 2.58);p = 0.009). Conclusion: More than half the students in Parakou had at least one eating disorder. Diagnostic studies are needed, even if preventive actions are already necessary.

Biopsychosocial Review of Eating Disorders

Eating disorders are among the deadliest mental illnesses known to occur. Eating disorders directly cause 10,200 deaths each year, which is one death every 52 minutes. About 9% of the global population is affected by eating disorders at some point during their lifetime. This paper aims to provide a better understanding of the factors that contribute to the onset of eating disorders. Specifically, we examine biological factors, such as genetics, family history and the neuroscience behind eating disorders;furthermore, we explore psychological factors including other mental health conditions and their correlation, personality traits and behavioral risk factors;lastly, we consider social factors related to the onset of eating disorders, such as childhood and social environment, the media, and demographic factors.

Functional gastrointestinal disorders in eating disorder patients:Altered distribution and predictors using ROME Ⅲ compared to ROME Ⅱ criteria

AIM:To compare the prevalence of Functional gastrointestinal disorders(FGIDs)using ROMEⅢand ROMEⅡand to describe predictors of FGIDs among eating disorder(ED)patients.METHODS:Two similar cohorts of female ED inpatients,aged 17-50 years,with no organic gastrointestinal or systemic disorders,completed either the ROMEⅢ(n=100)or the ROMEⅡ(n=160)questionnaire on admission for ED treatment.The two ROME cohorts were compared on continuous demographic variables(e.g.,age,BMI)using Student’s t-tests,and on categorical variables(e.g.,ED diagnosis)usingχ2-tests.The relationship between ED diagnostic subtypes and FGID categories was explored usingχ2-tests.Age,BMI,and psychological and behavioural predictors of the common(prevalence greater than 20%)ROMEⅢFGIDs were tested using logistic regression analyses.RESULTS:The criteria for at least one FGID were fulfilled by 83%of the ROMEⅢcohort,and 94%of the ROMEⅡcohort.There were no significant differences in age,BMI,lowest ever BMI,ED diagnostic subtypes or ED-related quality of life(QOL)scores between ROMEⅡand ROMEⅢcohorts.The most prevalent FGIDs using ROMEⅢwere postprandial distress syndrome(PDS)(45%)and irritable bowel syndrome(IBS)(41%),followed by unspecified functional bowel disorders(U-FBD)(24%),and functional heartburn(FH)(22%).There was a 29%or 46%increase(depending on presence or absence of cyclic vomiting)in functional gastroduodenal disorders because of the introduction of PDS in ROMEⅢcompared to ROMEⅡ.There was a 35%decrease in functional bowel disorders(FBD)in RomeⅢ(excluding U-FBD)compared to ROMEⅡ.The most significant predictor of PDS was starvation(P=0.008).The predictor of FH(P=0.021)and U-FBD(P=0.007)was somatisation,and of IBS laxative use(P=0.025).Age and BMI were not significant predictors.The addition of the 6-mo duration of symptoms requirement for a diagnosis in ROMEⅢadded precision to many FGIDs.CONCLUSION:ROMEⅢconfers higher precision in diagnosing FGIDs but self-induced vomiting should be excluded from the diagnosis of cyclic vomiting.Psychological factors appear to be more influential in ROMEⅡthan ROMEⅢ.

Disordered eating behaviors in type 1 diabetic patients

Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially diff icult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following compo- nents: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight andshape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.

Eating disorders in adolescents with type 1 diabetes:Challenges in diagnosis and treatment

Eating disorders(ED) are characterized by a persistent disturbance of eating that impairs health or psychosocial functioning.They are associated with increased rates of medical complications and mortality.Insulin omission is a unique purging behavior available to individuals with type 1 diabetes mellitus(T1DM).The standard treatment regimen for T1 DM requires a major focus on food andeating patterns.Moreover,intensive insulin therapy is associated with increasing body weight.These factors,combined with the psychological burden of chronic disease management and depression,may contribute to ED.The comorbidity of ED in T1 DM patients is associated with poorer glycemic control and consequently higher rates of diabetes complications.Early recognition and adequate treatment of ED in T1 DM is essential.

Prevalence of functional dyspepsia and its subgroups in patients with eating disorders

AIM:To study the prevalence of functional dyspepsia(FD)(Rome Ⅲ criteria) across eating disorders(ED),obese patients,constitutional thinner and healthy volunteers.METHODS:Twenty patients affected by anorexia nervosa,6 affected by bulimia nervosa,10 affected by ED not otherwise specified according to diagnostic and statistical manual of mental disorders,4th edition,nine constitutional thinner subjects and,thirtytwo obese patients were recruited from an outpatients clinic devoted to eating behavior disorders.Twentytwo healthy volunteers matched for age and gender were enrolled as healthy controls.All participants underwent a careful clinical examination.Demographic and anthropometric characteristics were obtained from a structured questionnaires.The presence of FD and,its subgroups,epigastric pain syndrome and postprandial distress syndrome(PDS) were diagnosed according to Rome Ⅲ criteria.The intensity-frequency score of broader dyspeptic symptoms such as early satiety,epigastric fullness,epigastric pain,epigastric burning,epigastric pressure,belching,nausea and vomiting were studied by a standardized questionnaire(0-6).Analysis of variance and post-hoc Sheffè tests were used for comparisons.RESULTS:90% of patients affected by anorexia nervosa,83.3% of patients affected by bulimia nervosa,90% of patients affected by ED not otherwise specified,55.6% of constitutionally thin subjects and 18.2% healthy volunteers met the Postprandial Distress Syndrome Criteria(χ 2,P < 0.001).Only one bulimic patient met the epigastric pain syndrome diagnosis.Postprandial fullness intensity-frequency score was significantly higher in anorexia nervosa,bulimia nervosa and ED not otherwise specified groups compared to the score calculated in the constitutional thinner group(4.15 ± 2.08 vs 1.44 ± 2.35,P = 0.003;5.00 ± 2.45vs 1.44 ± 2.35,P = 0.003;4.10 ± 2.23vs 1.44 ± 2.35,P = 0.002,respectively),the obese group(4.15 ± 2.08vs 0.00 ± 0.00,P < 0.001;5.00 ± 2.45vs 0.00 ± 0.00,P < 0.001;4.10 ± 2.23 vs 0.00 ± 0.00,P < 0.001,respectively) and healthy volunteers(4.15 ± 2.08 vs 0.36 ± 0.79,P < 0.001;5.00 ± 2.45 vs 0.36 ± 0.79,P < 0.001;4.10 ± 2.23 vs 0.36 ± 0.79,P < 0.001,respectively).Early satiety intensity-frequency score was prominent in anorectic patients compared to bulimic patients(3.85 ± 2.23 vs 1.17 ± 1.83,P = 0.015),obese patients(3.85 ± 2.23 vs 0.00 ± 0.00,P < 0.001) and healthy volunteers(3.85 ± 2.23 vs 0.05 ± 0.21,P < 0.001).Nausea and epigastric pressure were increased in bulimic and ED not otherwise specified patients.Specifically,nausea intensity-frequencyscore was significantly higher in bulimia nervosa and ED not otherwise specified patients compared to anorectic patients(3.17 ± 2.56 vs 0.89 ± 1.66,P = 0.04;2.70 ± 2.91 vs 0.89 ± 1.66,P = 0.05,respectively),constitutional thinner subjects(3.17 ± 2.56 vs 0.00 ± 0.00,P = 0.004;2.70 ± 2.91 vs 0.00 ± 0.00,P = 0.005,respectively),obese patients(3.17 ± 2.56 vs 0.00 ± 0.00,P < 0.001;3.17 ± 2.56 vs 0.00 ± 0.00,P < 0.001 respectively) and,healthy volunteers(3.17 ± 2.56 vs 0.17 ± 0.71,P = 0.002;3.17 ± 2.56 vs 0.17 ± 0.71,P = 0.001,respectively).Epigastric pressure intensityfrequency score was significantly higher in bulimic and ED not otherwise specified patients compared to constitutional thin subjects(4.67 ± 2.42 vs 1.22 ± 1.72,P = 0.03;4.20 ± 2.21 vs 1.22 ± 1.72,P = 0.03,respectively),obese patients(4.67 ± 2.42 vs 0.75 ± 1.32,P = 0.001;4.20 ± 2.21vs 0.75 ± 1.32,P < 0.001,respectively) and,healthy volunteers(4.67 ± 2.42 vs 0.67 ± 1.46,P = 0.001;4.20 ± 2.21vs 0.67 ± 1.46,P = 0.001,respectively).Vomiting was referred in 100% of bulimia nervosa patients,in 20% of ED not otherwise specified patients,in 15% of anorexia nervosa patients,in 22% of constitutional thinner subjects,and,in 5.6% healthy volunteers(χ 2,P < 0.001).CONCLUSION:PDS is common in eating disorders.Is it mandatory in outpatient gastroenterological clinics to investigate eating disorders in patients with PDS?

The ethics of exercise in eating disorders:Can an ethical principles approach guide the next generation of research and clinical practice?

1.Introduction Eating disorders(ED)are the most common psychiatric disorders afflicting young women^1 and contribute to great detriments in psychological,social,and physical health.^(2,3)Unfortunately,ED treatments tend to be long lasting,intensive,and expensive.~4Additionally,individuals with ED seeking treatment use healthcare services more frequently than non-ED individu-

Eating disorders and psychosis: Seven hypotheses

Psychotic disorders and eating disorders sometimes occur in the same person, and sometimes, but not always, at the same time. This can cause diagnostic confusion and uncertainty about treatment. This paper examines seven ways in which symptoms of both conditions can co-exist. The literature on this topic consists to a large extent of case reports, so that firm conclusions cannot be drawn from their examination. There is no consistent sequence in the co-occurrence of the two conditions-eating disorders sometimes precede, and sometimes follow the onset of psychosis. The advent of the psychosis, and sometimes the treatment of the psychosis can cure the eating disorder, but it can sometimes aggravate it. Psychosis is not necessarily a mark of severity in the course of an eating disorder, and food refusal can occur independent of severity in psychotic illness, but it can be a cause of death. There is some genetic association and some overlap of physiologic, cognitive and brain structure deficits in the two types of disorder. The connection between the two, however, remains speculative. The area of comorbidity and overlapping symptoms in psychiatry requires more research. Clinical recommendations include attentionto the different individual ways in which these two disparate conditions often overlap.

Fructose-sorbitol ingestion provokes gastrointestinal symptoms in patients with eating disorders

AIM:To evaluate gastrointestinal(GI) symptoms and breath hydrogen responses to oral fructose-sorbitol(F-S) and glucose challenges in eating disorder(ED) patients.METHODS:GI symptoms and hydrogen breath concentration were monitored in 26 female ED inpatients for 3 h,following ingestion of 50 g glucose on one day,and 25 g fructose/5 g sorbitol on the next day,after an overnight fast on each occasion.Responses to F-S were compared to those of 20 asymptomatic healthy females.RESULTS:F-S provoked GI symptoms in 15 ED patients and one healthy control(P < 0.05 ED vs control) .Only one ED patient displayed symptom provocation to glucose(P < 0.01 vs F-S response) .A greater symptom response was observed in ED patients with a body mass index(BMI) ≤ 17.5 kg/m 2 compared to those with a BMI > 17.5 kg/m 2(P < 0.01) .There were no differences in psychological scores,prevalence of functional GI disorders or breath hydrogen responses between patients with and without an F-S response.CONCLUSION:F-S,but not glucose,provokes GI symptoms in ED patients,predominantly those with low BMI.These findings are important in the dietary management of ED patients.

Validity and reliability of eating disorder assessments used with athletes： A review

Background： Prevalence of eating disorders （EDs） among college-aged athletes has risen in recent years. Although measures exist for assessing EDs, these measures have not been thoroughly reviewed in athletes. This study reviewed the validity and reliability evidence of the commonly used measures for assessing EDs in athlete populations aged 18--26 years. Methods： Databases were searched for studies of regarding ED on male and/or female athletes. Inclusion criteria stated the study （a） assessed EDs in an athlete population 18--26 years of age and （b） investigated EDs using a psychometric measure found valid and/or reliable in a non- athlete population and/or athlete population. Results： Fifty studies met the inclusion criteria. Seven and 22 articles, respectively, studied EDs behaviors in male and female athletes whereas 21 articles studied EDs in combined-gender samples. The five most commonly used measures were the Eating Attitudes Test （EAT）, Eating Disorder Inventory （EDI）, Bulimia Test-Revised （BULIT-R）, Questionnaire for Eating Disorder Diagnosis （QEDD）, and the Eating Disorder Examination Questionnaire （EDE-Q）. Conclusion： Only seven studies calculated validity coefficients within the study whereas 47 cited the validity coefficient. Twenty-six calculated a reliability coefficient whereas 47 cited the reliability of the ED measures. Four studies found validity evidence for the EAT, EDI, BULIT-R, QEDD, and EDE-Q in an athlete population. Few studies reviewed calculated validity and reliability coefficients of ED measures. Cross- validation of these measures in athlete populations is clearly needed.

Eating disorders, body image, and dichotomous thinking among Japanese and Russian college women

This study explored cross-cultural differences between Japan and Russia in terms of women’s body images, proneness to eating disorders, and the effects of dichotomous thinking. Participants included 419 Japanese and 187 Russian college women who completed the Dichotomous Thinking Inventory (DTI), the 26-item version of the Eating Attitudes Test, and responses regarding nine figures representing female body shapes. The mean age of the participants was 19.8 years, with no significant age differences between the countries. The results showed that Japanese women have leaner ideal body images than Russian women, whereas there were no cross-cultural differences in the participants’ real body images. DTI scores among Russian participants were higher than DTI scores among Japanese participants, which indicated that Russian women think more dichotomously than Japanese. Structural equation modeling indicated a significantly negative effect of dichotomous thinking only on real body image in Russia;the ideal body image had greater effects on eating disorder in Russia than in Japan.

Association between Dopamine Transporter Gene (<i>DAT1</i>) Polymorphisms and Eating Disorders with Binge Eating Behavior

Objectives: Dyshomeostasis of the dopaminergic system is implicated in the pathophysiology of eating disorders (EDs). We have previously reported an association between 3'-UTR VNTR (three prime untranslated region variable number of tandem repeat) of the Dopamine Transporter 1 (DAT1) gene and ED with binge eating behavior (EDBEB). Here we investigated whether variants in the coding region of the DAT1 gene also associate with EDBEB. Methods: The coding region and exon-intron junctions of the DAT1 gene were screened by direct sequencing using genomic DNA from EDBEB patients (n = 90) and healthy subjects (n = 114) on whom 3'-UTR VNTR variants had been previously determined. Results: rs2270912 and rs28363130, two of five known polymorphisms found by this screen, were significantly associated with EDBEB patients by genotype (p = 0.003, p = 0.011, respectively) and allele (p = 0.003, p = 0.012, respectively) frequency compared with healthy subjects. Interestingly, these polymorphisms associate with the risk 3'-UTR VNTR variant of EDBEB. Conclusion: Although our sample size was small, we show here that rs2270912 and rs28363130 associates with EDBEB and might act with 3'-UTR VNTR as a haplotype. These findings support the notion that the DAT1 gene plays a key role in the dopaminergic system of EDBEB.

The association between ADHD and eating disorders/pathology in adolescents: A systematic review

Background: Attention-Deficit/Hyperactivity Disorder (ADHD), one of the most common neurodevelopmental conditions of childhood, is associated with high rates of mood and behavioral disorders. Preliminary evidence suggests that ADHD may also be associated with eating disorders (ED) or eating pathology (EP). This systematic review synthesizes the extant published literature on this association among youth ages 12-21 years. Methods: Literature searches were performed using Medline, Ovid/Psych Info, Google Scholar, and via manual inspection of bibliographies. Cross-sectional, case-control, and prospective studies published in English with sample sizes larger than 50, participant ages 12-21 years, and assessed ADHD and ED or EP, were considered for review. Case reports, feeding, and drug studies were excluded. Results: Preliminary searches yielded 337 articles;eight articles met inclusion/exclusion criteria. Two studies documented an association between ADHD and ED, and three studies found an association between ADHD and EP. Youth with ADHD were nearly 3 to 6 times more likely to develop an ED than youth without ADHD, and were also more likely to have higher rates of EP, body dissatisfaction, and desire to lose weight/ drive for thinness. Impulsivity was predictive of EP, and ADHD youth with co-occurring mood/behavioral disorders and punitive parental relationships were at higher risk. Conclusions: Five of eight studies documented an association between ADHD and ED or EP in adolescents. Future research is needed to confirm and refine further these findings. The findings have clinical implications, including the inclusion of ED/EP in screening and anticipatory guidance efforts. Evaluating whether medical management of ADHD may be efficacious in preventing and/or treating ED/EP is also warranted.

Relationship between Binge Eating Disorder (BED) and Development of Metabolic Syndrome (METs): A Systematic Review

Binge Eating Disorder (BED) or uncontrolled food consumption is strongly associated with metabolic syndrome as a significant risk factor for health. Metabolic Syndrome (MetS) is characterized by central adiposity, high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, hypertension, and increased fasting blood glucose. Approximately 9% of the general population suffer from Binge eating disorder (BED), a significant risk factor for Metabolic Syndrome (MetS). This study evaluates the association between Binge Eating disorder (BED) and Metabolic Syndrome (MetS) development through a systematic review. Through analysis of previous studies, we discovered that 93 percent of those with BED had metabolic syndrome parameters in a series of investigations on BED conducted in general care. This systematic review aims to connect the frequency of binge-eating episodes and the development of metabolic syndrome. We have extracted five major studies (n = 5) through screening following systematic review standards.

Loving her into well-being one day at a time: Narratives of caring for daughters with eating disorders

When a child is diagnosed with an eating disorder, parents are expected to help the child recover. Yet, parents often feel under-prepared and alone, their experiences inadequately known to healthcare professionals. The research aim was to examine the meaning to parents of caring for a child with an eating disorder. Qualitative interviews with 29 parents were analyzed and the parents’ experiences were represented by a collective story of loving her into well-being one day at a time which consisted of two themes: Running on nerves and caring through transformational activism. Running on nerves included threads of feeling lost, traumatized, scarred, and disengaged that mitigated as parents engaged in transformational activism processes directed toward helping themselves, their child, and other parents and children. The findings illustrate the importance of hearing parents’ stories in order to create supportive healing environments and to build capacity within families and health care systems.

The Relationship between Eating Disorders and Stress among Medical Undergraduate: A Cross-Sectional Study

Introduction: Eating disorders are compulsive behaviours that can consume a person’s life to the point of becoming life threatening. Medical college can be a very stressful time and previous studies had found that stress could be a main factor leading to higher risk of eating disorder. We aimed to determine the association between stress and eating disorders among undergraduate medical students. Methods: A cross-sectional study was conducted among 320 respondents comprises of Year 3, 4 and 5 medical students in private medical college in Malaysia, assessed using self-administered questionnaires which consist of social demographic data, EAT-26 and Cohen Perceived Stress Scale. The response rate of this study was 77.4%. Results: With regards to EAT-26, 11.0% of medical students were at risk of developing eating disorder and from this students who have obese BMI status (25%) had 3.9 times more likely to develop eating disorder (95% CI: 1.4 - 10.9). There was significant association between those with unsatisfactory social relationship with friends and peers (OR 2.5, 95% CI 1.0 - 5.9;p value 0.035) and risk of developing eating disorders (OR 3.9, 95% CI 1.4 - 10.9;p value 0.007). For Cohen Perceived Stress Scale (CPSS), 75.5% of the respondents were having high stress level. There was no significant association between stress and the risk of eating disorders with OR 1.0, 95% CI: 0.6 - 1.7;p value 0.887. Conclusion: Majority of medical undergraduates were under stressed and there was a risky trend toward eating disorders in medical. However, based on our results it did not portray any significant association between stress and risk of developing eating disorders. Nevertheless, it should not be completely neglected. It is important to increase the awareness of medical undergraduates regarding eating disorders and its complications.

Sleep Related Eating Disorder as an Unexpected Effect of Zolpidem

Zolpidem is a sedative-hypnotic drug used to treat in sleep disorders, and it is the most commonly prescribed drug for insomnia. It reduces sleep latency and increases total sleep time. However, some studies have reported that zolpidem might induce sleep related eating disorder (SRED). SRED is characterized by recurrent episodes of compulsive and involuntary eating during night sleep, accompanied by partial consciousness and limited subsequent recall. The pathophysiology of SRED is unknown. Patients with SRED usually suffer from other sleep disorders such as sleepwalking, restless legs syndrome, and obstructive sleep apnea. In this article, we present an overview of case reports on SRED induced by zolpidem.

Mindfulness as a Factor in the Relationship between Insecure Attachment Style, Neurotic Personality and Disordered Eating Behavior

Mindfulness, conceptualized as a dispositional trait that differs across individuals, may potentially influence disordered eating behaviors. Previous research has independently identified insecure attachment style and neurotic personality traits as correlates of disordered eating behavior. Thus this current study will investigate whether neurotic personality traits, insecure attachment style and mindfulness predict disordered eating behavior controlling for gender differences. Participants (N = 126) completed the Adult Attachment Scale [1], the Three Factor Eating Questionnaire – Revised 18 [2], The Cognitive and Affective Mindfulness Scale – Revised [3] and the International Personality Item Pool [4]. The results of this cross-sectional study indicated that neurotic personality traits, insecure attachment style and mindfulness were related to disordered eating behaviors. The variance in disordered eating behaviors that was accounted for by neurotic personality traits and insecure attachment style was significantly reduced with the introduction of mindfulness. The results provides preliminary support for the inclusion of mindfulness training in disordered eating behavior interventions for individuals exhibiting an insecure attachment style and neurotic personality traits. Limitations and implications for further research are discussed.