Hubertus Himmerich
Ahmad Saedisomeolia
Ute Krügel- 1Department of Psychological Medicine, King's College London, London, United Kingdom
- 2School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Montreal, QC, Canada
- 3Rudolf Boehm Institute of Pharmacology and Toxicology, Medical Faculty, University of Leipzig, Leipzig, Germany
Editorial on the Research Topic
Community series in extreme eating behaviors—Volume II
Introduction: recent developments in eating disorders and obesity
Currently, a significant and multi-dimensional shift in how we perceive eating disorders (EDs) and obesity is taking place.
Firstly, the perception of the spectrum of disorders associated with disordered eating has widened, leading to the addition of avoidant restrictive food intake disorder, pica and rumination disorder to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (1), to an increased clinical and scientific interest in disordered eating in physical health problems such as cancer (2) and type 1 diabetes mellitus (3) and to a better understanding of the transdiagnostic features of body dysmorphic disorder, muscle dysmorphia and eating disorders (4).
Secondly, new genetic discoveries have opened our eyes for the metabo-psychiatric nature of eating disorders and their brain-related biological pathogeneses (5). This new perception of EDs is driving novel discoveries and developments regarding psychopharmacological treatments (6), nutritional interventions including pre- and pro-biotics (7), brain stimulation and targeted psychotherapeutic interventions to train specific brain functions such as attention (8) and impulsiveness (9). These new perspectives also help to generate an integrated view of the diagnosis and treatment of EDs and their psychological and physical co-morbidities (10). Additionally, researchers are making progress in understanding the psychological and behavioral underpinnings of obesity such as loss of control eating (11) and grazing (12).
Thirdly, the awareness of the importance of inclusiveness in EDs and obesity research is rising. For example, sexual minority groups have been identified as presenting an elevated risk for eating disorder symptoms and behaviors (13), and it has been noticed that people from ethnic minority backgrounds often experience greater difficulties in accessing support for an ED or other mental health problems (14).
Finally, there is a growing body of evidence that indicates the potential benefit of creative and receptive arts therapies in EDs and related mental health problems. For example, the therapeutic application of music such as listening to classical music, singing in a group and songwriting have been reported to be helpful in EDs (15) and in their most frequent co-morbidities like personality disorders (16) and obsessive-compulsive disorder (17).
Content of the second volume of “Extreme Eating Behaviors”
Because of these exciting developments in the field of EDs and obesity and the success of our initial Research Topic on “Extreme Eating Behaviors” (18) published in 2019, we were encouraged to issue a second volume on this Research Topic which covers brain research, psychological and physical aspects of eating behaviors, EDs and obesity, eating-related traits of specific population groups, and novel treatments for EDs.
Armon et al. investigated differences in brain activation in response to sweet and sour tastes in female study participants with and without bulimia nervosa and found differences in several brain regions which may be central to perception and processing of taste, including the operculum, the anterior cingulate cortex, the midbrain, and the cerebellum.
Munguía et al., Hussenoeder et al., Staníková et al., and Saure et al. investigated the relationship between physical and psychological risk factors of EDs and obesity such as thyroid hormone levels, food addiction, anxiety, food preferences, sensory processing, and autistic traits. Interesting findings from their studies include the association between sensory sensitivity and food addiction on the one hand and anxious symptoms and problems with specific food groups on the other hand as well as the potential involvement of thyroid hormone signaling in food preferences and the development of obesity.
Two articles addressed the connections between EDs and physical health problems: Riedlinger et al. examined gastrointestinal complaints in patients with anorexia nervosa, and Paszynska et al. analyzed that there is a high risk of dental caries and erosive tooth wear in children and adolescents with anorexia nervosa.
The articles by Gulec et al. and Stein et al. cover eating-related psychopathological and behavioral aspects in specific minority groups, namely a lesbian, gay, bisexual, transgender, intersexual, and queer (LGBTIQ) sample in Turkey and a sample of Jewish ultra-orthodox religious men. Stein et al. found that Jewish ultra-orthodox religious males with obsessive-compulsive disorder might be at risk for severe undernutrition because their rigid observance of Jewish everyday laws might interfere with their eating. As in this group of patients, the loss of weight did not result from body image concerns, Stein et al. argue that these patients should rather be diagnosed with restricting type ED than with anorexia nervosa. However, the authors themselves indicate that their diagnostic opinion is debatable. For clarity, we would like to inform the readers that body image disturbance is not mandatory for the diagnosis of anorexia nervosa according to DSM-5 (1). A lack of insight into the seriousness of the disease together with a significantly low body weight and the fear of weight gain, for example, would suffice (1).
From a historic point of view, we would like to mention that the role of religion or religiousness has been discussed as a pathophysiological, maintaining, protective, diagnostic, or therapeutic factor of EDs from the beginning of academic psychiatry (19–21) until today (22).
Regarding novel treatments, Flynn et al. published a protocol for an innovative study that allows to test whether concurrent self-administered transcranial direct current stimulation (tDCS) and attention bias modification training might be suitable to improve symptoms of binge eating disorder.
Expression of gratitude and good wishes
We are thankful to all the authors mentioned above who submitted excellent manuscripts for this Research Topic. We also thank our reviewers who gave useful feedback and thus helped to improve the manuscripts and the second volume in its entirety.
Even though a single Research Topic cannot cover all the facets of EDs and of obesity research, we hope that this article Research Topic is making a decent contribution to the field. In this sense, we wish to attract attention to some so far underestimated disease aspects with this second volume of “Extreme Eating Behaviors”.
Author contributions
All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Publishing (2013).
2. Zhang F, Shen A, Jin Y, Qiang W. The management strategies of cancer-associated anorexia: A critical appraisal of systematic reviews. BMC Complement Altern Med. (2018) 18:236. doi: 10.1186/s12906-018-2304-8
3. Rama Chandran S, Zaremba N, Harrison A, Choudhary P, Cheah Y, Allan J, et al. Disordered eating in women with type 1 diabetes: Continuous glucose monitoring reveals the complex interactions of glycaemia, self-care behaviour and emotion. Diabet Med. (2021) 38:e14446. doi: 10.1111/dme.14446
4. Lang K, Kerr-Gaffney J, Hodsoll J, Jassi A, Tchanturia K, Krebs G. Is poor global processing a transdiagnostic feature of body dysmorphic disorder and anorexia nervosa? A meta-analysis. Body Image. (2021) 37:94–105. doi: 10.1016/j.bodyim.2021.01.012
5. Bulik CM, Carroll IM, Mehler P. Reframing anorexia nervosa as a metabo-psychiatric disorder. Trends Endocrinol Metab. (2021) 32:752–61. doi: 10.1016/j.tem.2021.07.010
6. Himmerich H. Treasure J. Psychopharmacological advances in eating disorders. Expert Rev Clin Pharmacol. (2018) 11:95–108. doi: 10.1080/17512433.2018.1383895
7. Dhopatkar N, Keeler JL, Mutwalli H, Whelan K, Treasure J, Himmerich H. Gastrointestinal symptoms, gut microbiome, probiotics and prebiotics in anorexia nervosa: A review of mechanistic rationale and clinical evidence. Psychoneuroendocrinology. (2022) 147:105959. doi: 10.1016/j.psyneuen.2022.105959
8. Mercado D, Schmidt U, O'Daly OG, Campbell IC, Werthmann J. Food related attention bias modification training for anorexia nervosa and its potential underpinning mechanisms. J Eat Disord. (2020) 8:1. doi: 10.1186/s40337-019-0276-9
9. Ince B, Schlatter J, Max S, Plewnia C, Zipfel S, Giel KE, et al. Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review. J Eat Disord. (2021) 9:38. doi: 10.1186/s40337-021-00384-x
10. Himmerich H, Kan C, Au K, Treasure J. Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences. Pharmacol Ther. (2021) 217:107667. doi: 10.1016/j.pharmthera.2020.107667
11. Catania J, Spirou D, Gascoigne M, Raman J. Loss of control as a transdiagnostic feature in obesity-related eating behaviours: A systematic review. Eur Eat Disord Rev. (2023) 31:24–45. doi: 10.1002/erv.2936
12. Teodoro MC, Conceição EM, de Lourdes M, Alves JR, Neufeld CB. Grazing's frequency and associations with obesity, psychopathology, and loss of control eating in clinical and community contexts: A systematic review. Appetite. (2021) 167:105620. doi: 10.1016/j.appet.2021.105620
13. O'Flynn JL, Nowicki GP, Laveway K, Gordon AR, Rodgers RF. Toward inclusivity: A systematic review of the conceptualization of sexual minority status and associated eating disorder outcomes across two decades. Int J Eat Disord. (2023) 56:350–65. doi: 10.1002/eat.23830
14. Coelho H, Price A, Kiff F, Trigg L, Robinson S, Thompson Coon J, et al. Experiences of children and young people from ethnic minorities in accessing mental health care and support: Rapid scoping review. Health Soc Care Deliv Res. (2022) 2022:8437. doi: 10.3310/XKWE8437
15. Testa F, Arunachalam S, Heiderscheit A, Himmerich H. A systematic review of scientific studies on the effects of music in people with or at risk for eating disorders. Psychiatr Danub. (2020) 32:334–45. doi: 10.24869/psyd.2020.334
16. Haslam R, Heiderscheit A, Himmerich H. A systematic review of scientific studies on the effects of music in people with personality disorders. Int J Environ Res Public Health. (2022) 19:15434. doi: 10.3390/ijerph192315434
17. Truong TPA, Applewhite B, Heiderscheit A, Himmerich H. A systematic review of scientific studies and case reports on music and obsessive-compulsive disorder. Int J Environ Res Public Health. (2021) 18:11799. doi: 10.3390/ijerph182211799
18. Himmerich H, Saedisomeolia A, Krügel U. Editorial: Extreme eating behaviours. Front Psychiatry. (2021) 11:639219. doi: 10.3389/fpsyt.2020.639219
19. Steinberg H, Himmerich H. Johann Christian August Heinroth (1773–1843): The first professor of psychiatry as a psychotherapist. J Relig Health. (2012) 51:256–8. doi: 10.1007/s10943-011-9562-9
20. Bergner L, Himmerich H, Kirkby KC, Steinberg H. Descriptions of disordered eating in German Psychiatric Textbooks, 1803-2017. Front Psychiatry. (2021) 11:504157. doi: 10.3389/fpsyt.2020.504157
21. Heinroth JC. Lehrbuch der Störungen des Seelenlebens oder der Seelenstörungen und ihrer Behandlung. Leipzig: Bey Fr Chr Wilh Vogel. (1818). p. 781.
Keywords: eating disorders, anorexia nervosa, bulimia nervosa, eating, physical health, obesity
Citation: Himmerich H, Saedisomeolia A and Krügel U (2023) Editorial: Community series in extreme eating behaviors—Volume II. Front. Psychiatry 14:1200098. doi: 10.3389/fpsyt.2023.1200098
Received: 04 April 2023; Accepted: 05 April 2023;
Published: 27 April 2023.
Edited and reviewed by: Stephan Zipfel, University of Tübingen, Germany
Copyright © 2023 Himmerich, Saedisomeolia and Krügel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Hubertus Himmerich, hubertus.himmerich@kcl.ac.uk