research paper questions on eating disorders

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Eating disorders

Affiliations.

1 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Electronic address: [email protected].
2 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
3 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
PMID: 32171414
DOI: 10.1016/S0140-6736(20)30059-3

Eating disorders are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes towards weight, body shape, and eating play a key role in the origin and maintenance of eating disorders. Eating disorders have been increasing over the past 50 years and changes in the food environment have been implicated. All health-care providers should routinely enquire about eating habits as a component of overall health assessment. Six main feeding and eating disorders are now recognised in diagnostic systems: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder, pica, and rumination disorder. The presentation form of eating disorders might vary for men versus women, for example. As eating disorders are under-researched, there is a great deal of uncertainty as to their pathophysiology, treatment, and management. Future challenges, emerging treatments, and outstanding research questions are addressed.

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Eating disorders: innovation and progress urgently needed. The Lancet. The Lancet. Lancet. 2020 Mar 14;395(10227):840. doi: 10.1016/S0140-6736(20)30573-0. Lancet. 2020. PMID: 32171393 No abstract available.

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Research Article

40 years of research on eating disorders in domain-specific journals: Bibliometrics, network analysis, and topic modeling

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation School of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Perú

Carlos A. Almenara

Published: December 15, 2022
https://doi.org/10.1371/journal.pone.0278981
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Previous studies have used a query-based approach to search and gather scientific literature. Instead, the current study focused on domain-specific journals in the field of eating disorders. A total of 8651 documents (since 1981 to 2020), from which 7899 had an abstract, were retrieved from: International Journal of Eating Disorders (n = 4185, 48.38%), Eating and Weight Disorders (n = 1540, 17.80%), European Eating Disorders Review (n = 1461, 16.88%), Eating Disorders (n = 1072, 12.39%), and Journal of Eating Disorders (n = 393, 4.54%). To analyze these data, diverse methodologies were employed: bibliometrics (to identify top cited documents), network analysis (to identify the most representative scholars and collaboration networks), and topic modeling (to retrieve major topics using text mining, natural language processing, and machine learning algorithms). The results showed that the most cited documents were related to instruments used for the screening and evaluation of eating disorders, followed by review articles related to the epidemiology, course and outcome of eating disorders. Network analysis identified well-known scholars in the field, as well as their collaboration networks. Finally, topic modeling identified 10 major topics whereas a time series analysis of these topics identified relevant historical shifts. This study discusses the results in terms of future opportunities in the field of eating disorders.

Citation: Almenara CA (2022) 40 years of research on eating disorders in domain-specific journals: Bibliometrics, network analysis, and topic modeling. PLoS ONE 17(12): e0278981. https://doi.org/10.1371/journal.pone.0278981

Editor: Alberto Baccini, University of Siena, Italy, ITALY

Received: February 5, 2021; Accepted: November 27, 2022; Published: December 15, 2022

Copyright: © 2022 Carlos A. Almenara. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data that support the findings of this study are publicly available from the OSF repository: https://osf.io/5yzvd/ (DOI: 10.17605/OSF.IO/5YZVD ).

Funding: Funding for this study was obtained from Universidad Peruana de Ciencias Aplicadas (A-006-2021).

Competing interests: The author has no competing interest to declare.

Introduction

There are a large and growing number of scientific publications on eating disorders (ED) [ 1 – 3 ]. ED are mental disorders characterized by a continuous disturbance in eating behavior, such as Anorexia Nervosa [ 4 ]. ED are usually defined according to manuals like the Diagnostic and Statistical Manual of Mental Disorders (DSM) [ 4 ]. The spectrum of ED can share some symptoms (e.g., fear of fatness ), and these symptoms negatively impact psychosocial functioning and physical health. Due to the complexity of ED like Anorexia Nervosa, scholar literature about them covers different disciplines, such as ED related to: visual arts (e.g., art history) [ 5 ], sociology (e.g., social history) [ 6 ] and even dentistry (e.g., oral health) [ 7 ]. Thus, ED literature has a broad diversity.

Previous bibliometric studies about ED have focused on: identifying the distribution by language, region and country, as well as topics and their trends [ 1 ], productivity trends and collaboration patterns [ 2 ], most cited works in Anorexia Nervosa research [ 8 ], cross-cultural aspects of ED [ 3 ], comparison of citations between types of journals [ 9 ], female authorship [ 10 ], secular trends in the scientific terminology [ 11 , 12 ], the gap between scientific research and clinical practice [ 13 ], the use of keywords [ 14 ], and network analyses of common terms used in the field [ 15 ]. In particular, the current study complements the work by He et al. [ 1 ].

A standard practice of these studies is to retrieve the literature by performing a systematic search in databases like Web of Science or Scopus (i.e., employing a query-based approach), although there are some caveats worth mentioning. As noted elsewhere [ 16 , 17 ], those two databases differ in journal coverage and their use can introduce bias favoring science publications (e.g., biomedicine) in detriment of arts and humanities, other than overrepresenting English-language journals. Second, databases in general (including others like PubMed, Dimensions, JSTOR), differ in their search engine functionality and information retrieval capabilities.

For example, some databases offer a controlled vocabulary like a thesaurus or taxonomy from which to choose the search terms (e.g., the Medical Subject Headings [MeSH] in PubMed), whereas others offer a full text search. Regarding the latter, indexing scanned documents to offer a full text search, requires pre-processing methods like optical character recognition (OCR), known to include typos, and post-OCR processing, both affecting information retrieval accuracy [ 18 – 23 ].

In other words, a query-based approach, although widely used, can be affected by several factors, including: domain expertise to design the most appropriate search strategy, the characteristics of the selected database(s), including indexation accuracy (e.g., due to OCR typos). The former is particularly important because scholars are not always consistent in using the terminology [ 24 ]. In fact, their selection of keywords is not systematic, but rather influenced by factors like their background knowledge and previous experience [ 25 ]. In this regard, within the field of ED, scholars are encouraged to use appropriate terminology [ 26 , 27 ], usually a controlled vocabulary such as the Thesaurus of Psychological Index Terms. This helps to optimize the Knowledge Organization Systems (KOS) of journals and databases, such as a controlled vocabulary for information retrieval [ 14 , 28 ].

In sum, most previous studies have employed a query-based search, being compelled to choose among different databases, search terms, and search strategies [ 29 ]. Nevertheless, this approach not necessarily recognizes the boundaries and limitations of both databases and we as humans interacting with machines, using diverse information retrieval strategies, and dealing with information overload [ 30 , 31 ].

An alternative to the query-based approach is the one proposed in this study: to select a set of specialty journals exclusively devoted to the study of ED. Although this sampling could seem arbitrary, it was adopted: (1) to complement the findings of previous studies [ 1 , 2 ] and (2) because it has in fact a sound base: the intellectual and social structure of knowledge [ 32 – 36 ]. We must recognize that documents need to be understood with regard to "the broader contexts in which they are produced, used, and cited" [ 37 , p. 42]. Thus, the following sections will explain how domain-specific journals are tightly tied to an organized social and disciplinary structure. Moreover, I will explain how this approach does not necessarily exclude all ED literature from non-domain-specific journals, but rather incorporates part of it into their citations. Finally, from a complex systems perspective, I will show how domain-specific journals can be conceived as a specialized subset from the larger and more complex network comprising all ED literature.

Domain-specific journals and its social structure

From a scientometric perspective, science, metaphorically conceived as a knowledge space or knowledge landscapes , can be defined in terms of a network of scholars that produce a network of knowledge [ 35 ]. In the former case, the social function of science has long been recognized (e.g., by Thomas Kuhn): scholars produce and communicate scientific knowledge and this organized activity has the characteristics of a social process [ 36 , 38 ]. More importantly, the patterns of interactions and communication within this social organization are tightly tied, rather than isolated, to the knowledge they produce [ 36 ].

An exemplary case is the role of journal editors as gatekeepers, with studies identifying editorial gatekeeping patterns [ 39 , 40 ]. According with the Network Gatekeeping Theory, inspired by the work of Kurt Lewin, gatekeeping refers to the control in the flow of information [ 41 , 42 ]. In the field of ED, this intellectual and social organization of knowledge can be seen in professional societies like the Academy of Eating Disorder, which since 1981 publishes the most renowned scientific journal: The International Journal of Eating Disorders. Within its editorial board, there are distinguished scholars that can act as gatekeepers to ensure quality control and that manuscripts published by the journal are in line with the aims and scope of it.

In sum, domain-specific journals have the goal of publishing information within the boundaries of their aims and scope, allowing the diffusion of specialized knowledge.

Domain-specific journals and its disciplinary organization

From a network perspective, specialty journals are also indicators of disciplinary organization [ 43 ], which exerts a non-trivial influence at both the global and local level of the network. To be more precise, if we visualize a network [e.g., 2 , 44 , 45 ], the local density of specialty journals evidence emerging patterns such as citation patterns by articles from the same journal or group of journals [ 43 ]. At the author level, these patterns reflect the local influence of specialty journals on scholars who adhere to their research tradition and their contributions help to advance a research agenda [ 46 ].

For example, domain-specific journals on ED often publish curated information from conferences [e.g., 47 ] or special issues about a specialized topic [e.g., 48 ], which commonly include a research agenda [ 48 ], setting the stage for future research. As we mentioned above, similar literature, such as special issues about ED published in other journals [e.g., 49 ], is not necessarily excluded in the analysis of domain-specific journals. Rather, such literature is commonly cited in documents from domain-specific journals and can be included in a citation analysis. Importantly, these citation patterns suggest that the former intellectual and social structure of knowledge constrains what is being studied in the future [ 46 ]. Thus, in the upcoming years, most of this specialized literature is expected to become an active research front [ 32 ], as evidenced by its high number of citations.

Finally, it is worth mentioning that the analysis of these patterns can reveal latent hierarchies and topological properties of journal networks. In fact, domain-specific journals can be identified through the study of the hierarchical organization of journal networks. When hierarchical network analysis is used to identify the capability of journals to spread scientific ideas, multidisciplinary journals are found at the top of the hierarchy, whereas more specialized journals are found at the bottom [ 50 , 51 ]. Similarly, significant articles from a specific domain have unique topological properties that can affect the dynamic evolution of the network [ 52 ]. In sum, it is important to recognize the topological properties of networks and their latent hierarchies, both at the journal level and document level. In our case, focusing on domain-specific journals, it would be like zooming into the most central part (core) of the network topology to analyze its organization and distinctive features. Indeed, this approach is commonly employed, for example, when studying network subsets such as niches or communities in complex systems.

Domain-specific journals and complex adaptive systems

Domain-specific journals can also be comprehended from a complex systems standpoint, as the aggregation of the intellectual, social, and citation patterns outlined above. According to the Structural Variation Theory [ 53 ], the body of scientific knowledge can be conceived as a complex adaptive system (CAS). As such, it can be described and studied as a complex network with a series of characteristics like non-linearity, emergence, and self-organization; and a series of social, conceptual, and material elements that evolve over time [ 46 ]. Ideally, we must study CAS holistically to understand the properties of the system at the macrolevel [ 54 ]. In our case, this would require including all scholar literature on ED, which could be attempted using a query-based approach and employing ad hoc methodologies (e.g., iterative citation expansion) [ 45 ]. However, complex systems emerge from rules and behavior of lower-level components, and there is growing interest in understanding complexity from its simplest and fundamental elements and patterns [ 55 , 56 ]. In our case, this can be accomplished by zooming into domain-specific patterns that emerge from the relational structure and organization of journals and papers [ 46 ], rather than focusing on the whole system which comprises all the scientific literature on ED.

This approach can be described in terms of modularity , a structural property of systems: the local density of specialty journals is indicative of a structural module or subsystem [ 57 ]. This property of complex systems is important because it recognizes, as we did above, the existence of subsets within networks. Indeed, scientometric studies usually attempt to detect communities based on the principle of modularity by grouping similar literature (i.e., clustering) [ 44 , 58 ]. However, in the approach used in this study, rather than using bibliographic connections (e.g., through co-citation analysis) to detect domain-specific literature, we can use logical connections [ 59 ], to identify modules that operate as domain-specific representations [ 60 ]. In other words, domain-specific journals can be seen as clusters of articles that are logically linked because they all pertain to a given domain, which is explicitly stated in the aims and scope of the journals.

This modular organization has some advantages over others such as a hierarchy (e.g., Scimago categorization of journals) or a cluster obtained by literature partitioning algorithms. First, it has the advantage of reducing both complexity bias and hierarchical bias . The former is the tendency to assume and adopt a more complex system (the opposite to Occam’s Razor: prefer the simplest explanation), which means to analyze all ED literature. The latter assumes that behavior is directed in a hierarchical fashion, where a central authority passes instructions to all agents in the system [ 54 ]. Second, although it still recognizes a hierarchical structure composed by diverse classes of subsystems, it assumes heterarchy [ 43 , 61 ], which means that both hierarchical and nonhierarchical elements can be present in a system; holarchy , which means that systems are composed of components that can be recognized as subsystems [ 62 ]; and glocal control , which means that local and global phenomena in a system are achieved by local actions [ 63 ]. In simple words, sampling a set of domain-specific journals reduces complexity without affecting assumptions such as a categorical hierarchy of journals.

The current study

To expand on previous studies [ 1 , 2 ], the current study aims to answer the following research questions:

Which are the most cited documents in this domain-specific corpus of articles?

Which are the most important authors and their collaboration networks?

Which are the most relevant topics in this domain-specific corpus of articles?

How have the identified topics evolved over time (since 1981 to 2020)?

To answer these questions, this study employs a hybrid methodology. First, basic bibliometrics will be performed to identify the most cited documents. Second, network analysis will be employed to identify the most important authors and their networks of collaboration. Third, text mining, natural language processing, and machine learning algorithms will be used to identify the most relevant topics (i.e., topic modeling). Finally, a simple time series analysis will be performed to examine the evolution of these topics over time. The procedure employed for the analyses is detailed in the methods section below (and S5 File ), whereas the dataset and the code to perform the analyses are shared in a public repository ( https://doi.org/10.17605/OSF.IO/5YZVD ), allowing the reproducibility of results [ 64 ].

Data collection

The methodology workflow is presented in Fig 1 .

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https://doi.org/10.1371/journal.pone.0278981.g001

First, in May 2020, a search of journals was performed in Scimago Journal Reports (SJR, https://www.scimagojr.com/ ), using the term “eating disorders”. In this step, the following five journals were identified: International Journal of Eating Disorders (ISSNs: 0276–3478, 1098-108X), European Eating Disorders Review (ISSNs: 1072–4133, 1099–0968), Eating Disorders (ISSNs: 1064–0266, 1532-530X), Eating and Weight Disorders (ISSNs: 1124–4909, 1590–1262), and Journal of Eating Disorders (ISSN: 2050-2974). The official website of each journal was then visited to confirm that the scope of the journal specifically includes the publication of research articles on eating disorders. It should be noted that the journal Advances in Eating Disorders (ISSNs: 2166–2630, 2166–2649) was not included because it was not found in SJR, it was published only between 2013 and 2016, it was incorporated into the journal Eating Disorders , and by the time of writing this article, it was not indexed neither in Scopus ( https://www.scopus.com ) nor in Web of Science ( https://www.webofknowledge.com ).

Next, also in May 2020, the Scopus database was chosen to retrieve the document records from the aforementioned journals. The election was made for no other reason than the capability of Scopus to retrieve several structured information (metadata, such as the abstract), and the file types for download are easy to manage, such as comma-separated values (CSV). Therefore, all document records published by these journals were searched in Scopus using the ISSN as the search term (e.g., ISSN (0276–3478) OR ISSN (02763478) OR ISSN (1098-108X) OR ISSN (1098108X) ). A total of 8651 documents between 1981 and 2020 were retrieved (of which 7899 had an abstract): 4185 (48.38%) from the International Journal of Eating Disorders, 1540 (17.80%) from Eating and Weight Disorders, 1461 (16.88%) from the European Eating Disorders Review, 1072 (12.39%) from Eating Disorders, and 393 (4.54%) from the Journal of Eating Disorders. These 8651 documents included a total of 213,744 references. It should be noted that the International Journal of Eating Disorders is the oldest of these journals, established in 1981. The S7 and S8 Files provide the number of documents per year and per journal. The document records were downloaded from Scopus both as comma separated values (CSV) and as BibTex ( http://www.bibtex.org/ ), and selecting all fields available (i.e., title, author, abstract, etc.). Due to copyright, the full text of all documents was not retrieved but rather their metadata (i.e, title, author, date, abstract), whilst the dataset shared online ( https://doi.org/10.17605/OSF.IO/5YZVD ) is the one obtained after the preprocessing procedures detailed below.

Analyses were performed using open software: R Statistical Software 4.0.3 (Bunny-Wunnies Freak Out) [ 65 ], and Python programming language version 3.9.1 ( https://www.python.org/ ).

Bibliometric analysis and network analysis in R

The biblioshiny application from the R package bibliometrix [ 66 ] was used to preprocess the CSV file. Next, it was used to identify the most cited documents. Local citations (i.e., citations only from documents whithin the dataset), and global citations (i.e., citations made by any document from the whole Scopus database), were computed. Biblioshiny was also used for network analysis as described by Batagelj & Cerinšek [ 67 ], and Aria & Cuccurullo [ 66 ]. Regarding the network, it is defined as a pair of sets: a set of nodes or vertices and a set of edges (link between nodes) [ 68 ]. In this study, when authors were treated as nodes, a link would represent co-authorship or collaboration [see 69 ]. More precisely, the Louvain algorithm for community detection [ 70 ] was used to identify communities within the collaboration network. This algorithm identifies densely connected nodes within the network (i.e., communities) [e.g., 71 ]. It works unconstrained to automatically extract a number of clusters although it requires basic network parameters as input. These network parameters were: up to 100 nodes, a minimum of two edges by node, and the removal of isolated nodes. For network layout visualization, the Fruchterman & Reingold [ 72 ] algorithm was chosen. Finally, common centrality measures were calculated: betweenness, closeness, and PageRank. Betweenness centrality refers to “the frequency that a node is located in the shortest path between other nodes” [ 73 , p. 772]. Closeness centrality refers to nodes that can easily reach others in the network, whilst PageRank , originally created to rank websites [ 74 ], has been used to rank authors because it takes into account the weight of influential nodes [ 75 ].

Topic modeling: Dimensionality reduction and matrix factorization

As can be seen in the workflow ( Fig 1 ), once network analysis was finished, a series of steps (detailed in S5 File ) were necessary to preprocess the dataset prior to topic modeling. Topic modeling refers to applying machine learning techniques to find topics by extracting semantic information from unstructured text in a corpus [ 76 ]. As we explain in S5 File , to this point we end up with a high-dimensional and sparse document-term matrix. In other words, we have many features (columns) each corresponding to a term in our corpus, and for a given document (rows) we have many columns with zero values meaning the term of that column is not in the given document. To deal with sparsity, we can perform dimensionality reduction to obtain a representation that effectively captures the variability in the data. In summary, dimensionality reduction can be categorized in feature extraction and feature selection ; the former combines the original feature space into a new one, whereas the latter selects a subset of features [ 77 ].

As explained in S5 File , the term frequency (TF) and the term frequency-inverse document frequency (TF-IDF) were used as feature extraction for vectorization. Then, the following machine learning algorithms were applied for topic modeling: Latent Dirichlet Allocation (LDA) [ 78 ], Latent Semantic Analysis (LSA or Latent Semantic Indexing) [ 79 ], Hierarchical Dirichlet Process (HDP) [ 80 ], and Non-negative Matrix Factorization (NMF) [ 81 ]. LDA is a generative probabilistic model that decomposes the document-term matrix into a topic-term matrix and a document-topic matrix, and it is commonly used for topic discovering from a corpus [e.g., 82 ]. LSA utilizes a truncated Singular Value Decomposition for decomposition and can work efficiently on TF or TF-IDF sparse matrices. In a fully unsupervised framework, the HDP model is characterized by inferring the number of topics on its own. Finally, NMF is an alternative approach that implements the Nonnegative Double Singular Value Decomposition, an algorithm suitable for sparse factorization [ 83 ].

First, the GENSIM library [ 84 ] was used for topic modeling because it provides a way to calculate topic coherence , an index to compare models based on measures of segmentation, probability estimation, confirmation measure, and aggregation [see 85 ]. Therefore, based on a TF matrix, HDP, LSA, NMF, and LDA were performed in GENSIM and compared in topic coherence. Once identified the topic modeling algorithms with the highest topic coherence, scikit-learn [ 86 ] was used because it provides an Exhaustive Grid Search option for ensemble learning the models (i.e., automatically fine-tuning the parameters to find the most optimal). Finally, once the topics were extracted, a simple time series analysis was performed to visualize the changes over time in the topics found. This analysis consisted of simply plotting the number of documents for each topic across years, from 1981 to 2020.

First, bibliometric analyses were performed to identify the most cited documents. Local citations are presented in Table 1 (and the S1 File ), whereas global citations are in Table 2 (and the S2 File ).

https://doi.org/10.1371/journal.pone.0278981.t001

https://doi.org/10.1371/journal.pone.0278981.t002

Next, a network analysis was performed to identify the most important authors ( Table 3 ) and their collaboration networks ( Fig 2 , see also S3 File , a dataset, and S4 File , an interactive visualization in HTML and JavaScript, also available online: https://osf.io/5yzvd/ ). This collaboration network analysis identified eight clusters with 96 authors: (1) red color, 4 authors; (2) blue, 15 authors; (3) green, 17 authors; (4) purple 21 authors; (5) orange, 2 authors; (6) brown, 18 authors; (7) pink, 2 authors; (8) grey, 17 authors.

https://doi.org/10.1371/journal.pone.0278981.g002

https://doi.org/10.1371/journal.pone.0278981.t003

Regarding the most relevant topics, LDA and NMF were superior to HDP and LSA in topic coherence. Then, when ensemble learning was used for LDA (based on TF) and NMF (based on TF-IDF), NMF provided the most meaningful results, and 10 topics were identified ( Table 4 ).

https://doi.org/10.1371/journal.pone.0278981.t004

The labels for the topics were manually added based on the top 10 keywords and their respective weights. Thus, each topic was manually labeled as follows: (1) risk factors for eating disorders, (2) body image dissatisfaction, (3) Binge Eating Disorder diagnosis, (4) weight loss, weight control, and diet, (5) clinical groups, (6) treatment outcome, (7) family and parent-child, (8) binge and purge episodes, (9) gender and subgroups, (10) EDNOS.

To examine how these topics have evolved over time, a simple time series analysis plot was created ( Fig 3 and S6 File ).

Note . Values in the y-axis are the sum of the weight values from the NMF analysis for topic dominance, per year and per topic. Values go from minimum 0 to maximum 11.2 (see S6 File ).

https://doi.org/10.1371/journal.pone.0278981.g003

This study analyzed 8651 documents between 1981 and 2020 from domain-specific journals in the field of eating disorders. The aims were: to identify the most cited documents, the most important authors and their collaboration networks, and the most relevant topics and their evolution over time. The results expand previous findings of studies that employed a query-based approach and included articles dating back as far as 1900 [ 13 ]. In particular the results expand the studies by Jinbo He et al. (2022) and Juan-Carlos Valderrama-Zurián, et al. (2017), which employed a similar methodology [ 1 , 2 ]. For example, He et al. (2022) created a collaboration network, although it was based on countries rather than authors [ 1 ]. Therefore, the results obtained here (e.g., author centrality measures, author clusters) provide a more fine grained understanding of the relevance and contribution of individual authors and their collaboration networks. Furthermore, He et al. (2022) [ 1 ] identified top authors based on traditional performance metrics (e.g., h-index), and it should be noted that there is some criticism towards their use and a claim to shift towards more responsible metrics of research excellence [ 87 ]. Then, He et al. (2022) [ 1 ] employed LDA for topic modeling, whilst this study employed NMF. Although LDA is largely used, in this study NMF outperformed LDA in interpretability, reproducibility, and as we said above, it suits better for short texts, as is the case of article abstracts used here. Finally, the top journals identified by He et al. (2022) confirmed that the five journals selected for this study are in fact among the most important in the field of eating disorders [ 1 ]. In the case of Valderrama-Zurián, et al. (2017) [ 2 ], they also focused on authors’ productivity trends whereas their social network analysis was focused on network metrics such as the number of nodes and edges over time, which precludes to inspect the social network at the author level. Therefore, this study also expands on the findings of Valderrama-Zurián, et al. (2017) [ 2 ].

Below, we discuss in more detail the results of the analysis employed to answer the four research questions outlined in the introduction.

Bibliometric analysis

The top cited documents were all from the International Journal of Eating Disorders. As noted above, this journal is the oldest one (it started in 1981), and it has the largest number of articles per year, with the exception of the year 2019 when it was outperformed by the Eating and Weight Disorders journal (see S7 and S8 Files). The majority of top cited documents were related to the development of instruments for the assessment of eating disorders or the course and outcome of eating disorders. For example, we can see in the results the most common instruments used for the screening of eating disorders, as well as the evaluation of its core symptoms: Eating Disorder Inventory (EDI), Body Shape Questionnaire (BSQ), Dutch Eating Behavior Questionnaire (DEBQ), and Eating Disorder Examination Questionnaire (EDE-Q). These instruments are widely used to screen the general population, as well as in clinical settings, together with more recent instruments [ 88 ]. It should be noted, however, that in clinical practice settings the use of instruments for the diagnosis and the different phases of the treatment process is not necessarily widespread [ 89 , 90 ]. To reduce this gap, some authors suggest to provide assessment training and/or assessment guidelines for mental health professionals and general practitioners in primary health care [ 91 , 92 ]. This can help obtain a comprehensive clinical assessment, particularly of individuals with higher risk such as young adolescents with restrictive Anorexia Nervosa [ 93 ]. The instruments mentioned above are reliable measures, and they could be used online for a quick screening or session by session for ongoing monitoring, although further research is necessary [e.g., 94 – 96 ].

The rest of most cited documents include important review articles on epidemiology (Hoek & van Hoeken, 2003, in Table 1 ); the course and outcome of eating disorders (Berkman, Lohr & Bulik, 2007; Strober, Freeman & Morrell, 1997; in Table 1 ); and the diagnosis of Binge Eating Disorder (Spitzer et al., 1992, 1993, in Table 1 ). These results are similar to previous studies in which measurement methods (including instrument development), epidemiology, and review articles were the most common type of document [ 8 , 9 ].

Finally, the large number of articles on the diagnosis of Binge Eating Disorder, which was not fully recognized as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) until its fifth edition [ 4 ], reveal that the recognition of Binge Eating Disorder as an own disorder took several years. To reach expert consensus in a shorter time, eating disorder professionals should pay special attention to emerging eating problems, such as Orthorexia Nervosa [ 97 ].

Network analysis

The network analysis identified eight clusters with 96 authors. Previous studies have examined the network of authors in the field in terms of network statistics such as number of edges or network density [ 2 ]. By contrast, this study provides a more fine-grained network analysis, identifying experts and group of experts in the field of eating disorders. As seen in the results section, the majority are distinguished authors with contributions dating back to the early 1980s.

The author with the largest betweenness centrality was Ross D Crosby (Sanford Center for Biobehavioral Research, United States), followed by James E Mitchell (University of North Dakota, United States) which has the largest value in PageRank. Authors with high betweenness centrality can act as both enablers and gatekeepers of information flow between communities [ 75 ]. Moreover, it has been found that authors with high betweenness centrality establish more collaborations than those high in closeness centrality [ 75 ]. In summary, the results of centrality measures can help to identify experts in the field of eating disorders, particularly authors that can quickly reach other authors in the network (high in closeness), act as gatekeepers (high in betweenness), or relate to influential others (high in PageRank).

Regarding the clusters identified by the network analysis, in the same cluster of Ross D Crosby and James E Mitchell are found other renowned authors like Daniel Le Grange (University of California, San Francisco, United States), Stephen A Wonderlich (Sanford Center for Biobehavioral Research, United States), and Carol B Peterson (University of Minnesota, United States). Among the most relevant results of collaboration of this cluster we can find studies on the ecological momentary assessment of eating disorders [ 98 ], the psychometric properties of the EDE-Q [ 99 ], and the diagnosis of Binge Eating Disorder [ 100 ].

The second largest cluster includes authors like Cynthia M Bulik (University of North Carolina at Chapel Hill, United States), Walter H Kaye (University of California, San Diego, United States), and Katherine A Halmi (Weill Cornell Medical College, United States). The results of their collaboration include studies related to the phenotypic characterization of eating disorders, such as the International Price Foundation Genetic Study, a multisite study that included a large sample of patients with eating disorders and their families [e.g., 101 ].

Finally, the third largest cluster includes authors like Janet Treasure (King’s College London, England), Ulrike Schmidt (King’s College London, England), and Tracey D Wade (Flinders University, Australia), which are widely recognized by the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) [ 102 , 103 ]. Interestingly, this is the only cluster that includes collaborations with authors from non-English speaking countries, more specifically from Spain. Examples of these collaborations include studies resulting from the Wellcome Trust Case Control Consortium 3 (WTCCC3) and the Genetic Consortium for AN (GCAN) [ 104 ], and other studies with clinical samples in Spain [e.g., 105 ].

On the other hand, the results reveal the importance of multisite studies that strengthen collaboration and originate in relevant outcomes for the prevention and treatment of eating disorders. Research groups could look for opportunities to collaborate in multisite studies and strengthen both their interdisciplinary and transdisciplinary collaboration, and their collaboration with less common partners such as stakeholders and policy makers [ 106 , 107 ]. By establishing these integrative and strategic collaborations we can promote translational research, and thus helping to reach broader public health goals [ 108 ].

Topic modeling

The combination of TF-IDF and NMF provided meaningful results, identifying 10 topics. After labeling these topics based on the first 10 keywords and their respective weights, we can see that most of the research on eating disorders done in the past 40 years has focused on their prevention and treatment. Interestingly, the time trend analysis of these topics revealed a noticeable change in the first lustrum of the 1990s. Whereas during the early 1980s the study of clinical groups (topic 5) was the most dominant topic, from the mid-1990s, this topic was surpassed by the study of risk factors of eating disorders (topic 1). This indicates an increasing interest for the prevention rather than solely the treatment of eating disorders. This result is consistent with the historical shift that occurred in the United States when in 1992 the Institute of Medicine (IOM) Committee on Prevention of Mental Disorders was created [ 109 ]. Then two years later, a report on reducing risk factors for mental disorders and promoting a preventive approach in research was published [ 110 ]. As expected, this shift had echo in several scholars at the time, became a research front, and relevant publications started to include more information on the prevention of eating disorders, including a special issue [ 111 ], book chapters [ 112 ], and progressively entire books [ 113 ]. It is important to note that this historical shift, as well as later others like in 2017 [ 114 ], were favorable, because in other cases like obesity, it took more time to focus on its prevention due to different issues, including the pressure of the weight loss industry and its commercial interest [ 115 ].

Another interesting finding was that the outcome of the treatment of eating disorders (topic 6), is the second most important topic of 2013, and this finding has important aspects to discuss. First, the surge of state-of-the-art machine learning algorithms provide several opportunities to build intelligent systems for precision medicine. Thus, the treatment course and outcome of eating disorders can be more personalized, guided, and enhanced with the help of predictive technologies and intelligent systems [e.g., 116 ]. Second, as suggested elsewhere [ 117 ], the advantages of technology can be particularly relevant for certain age groups like adolescents, and when a digital intervention is employed [ 118 ]. In summary, treatment outcome is currently an important topic, and future studies can deploy digital interventions and machine learning algorithms for a more precise treatment planning.

Limitations and conclusions

Although this study has strengths, such as using data and code that allows the reproducibility of the results, readers should consider some limitations. First, the analysis of most cited documents is for all the time span, and more recent highly cited documents are underrepresented. Moreover, the journal Advances in Eating Disorders was not included due to indexing issues. Nevertheless, this study provides the code and a detailed procedure to allow researcher to perform further analyses, such as document co-citation analysis. Future studies can also evaluate the Mexican Journal of Eating Disorders ( Revista Mexicana de Trastornos Alimentarios , ISSN 2007-1523), which has published articles primarily in Spanish [ 119 ]. Second, the network analysis included close to 100 scholars mostly with a long trajectory in the field, and this can be a limitation in representing more younger scientists or newcomers [ 2 ]. Future studies can focus on a larger number of scholars and apply different techniques in network analysis, such as other community detection techniques [e.g., 120 ]. Finally, the results of topic modeling suggested a solution of 10 topics out of up to 30 topics solution models tested. Although there is not a universally accepted approach to establish the number of topics, this study relied on several strategies, including ensemble learning, to automatically fine-tune the parameters of the machine learning algorithms, stability, and heuristic approaches [ 121 ]. Future studies can try other machine learning algorithms and techniques to retrieve topics [ 121 ].

In conclusion, this study analyzed 40 years of research on eating disorders, identified the most cited articles, networks of collaboration, experts in the field, and the 10 major topics in the field.

Supporting information

S1 file. most local cited documents..

https://doi.org/10.1371/journal.pone.0278981.s001

S2 File. Most global cited documents.

https://doi.org/10.1371/journal.pone.0278981.s002

S3 File. Network statistics.

https://doi.org/10.1371/journal.pone.0278981.s003

S4 File. Network of collaboration including close to one hundred authors.

https://doi.org/10.1371/journal.pone.0278981.s004

S5 File. Data preprocessing and text representation in Python.

https://doi.org/10.1371/journal.pone.0278981.s005

S6 File. Sum of NMF results for topic dominance per year and per topic.

https://doi.org/10.1371/journal.pone.0278981.s006

S7 File. Number of documents per year and per journal.

https://doi.org/10.1371/journal.pone.0278981.s007

S8 File. Trends over time in number of documents per journal.

https://doi.org/10.1371/journal.pone.0278981.s008

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Publications
Published Papers, 2024

Published Papers by year

Walter Kaye and the UCSD Eating Disorders Research team have published over 250 papers on the neurobiology of eating disorders. These publications include behavioral, treatment, and cognitive neuroscience studies that have improved understanding of the clinical presentation, genetics, neurotransmitter systems, and neural substrates involved in appetite dysregulation and disordered eating. These studies are guiding the development of more effective, neurobiologically informed interventions.

Change in motivational bias during treatment predicts outcome in anorexia nervosa
Sophie R. Abber MS, Susan M. Murray PhD, Carina S. Brown MS, Christina E. Wierenga PhD
doi: 10.1002/eat.24156. Epub 2024 February 01.
Wiley Online Library
The acceptability, feasibility, and possible benefits of a neurobiologically-informed 5-day multifamily treatment for adults with anorexia nervosa
Christina E. Wierenga, Laura Hill, Stephanie Knatz Peck, Jason McCray, Laura Greathouse, Danika Peterson, Amber Scott, Ivan Eisler, Walter H. Kaye
oi: 10.1002/eat.22876. Epub 2018 May 2.
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List of 122 Eating Disorder Research Topics

Are you looking for some eating disorder research topics that you can use as your own? Of course, you are! Otherwise, why would you be reading this blog post? Well, the good news is that we have just what you are looking for right here on this page.

No, you don’t have to download anything. You don’t have to pay anything either. All our 122 eating disorder research topics are free to use as you see fit. We have just finished updating the list, so you can find unique topics that are entirely original. Nobody in your class has probably found them, so you’re safe.

Best Eating Disorder Research Topics on the Internet

Every student should focus on studying or learning for his terms or exams. However, hunting for eating disorder research topics can take hours – if not days. You probably don’t have so much free time on your hands. This is why, if you need to write an eating disorders research paper, you should first visit our blog. You will find that our topics are the best on the Internet. Also, here is what you get if you visit our page periodically:

Our list of topics is updated relatively frequently, so you will probably be able to get an original topic right here in just a couple of minutes. All our topics are relatively easy to write about. You can find plenty of information online about 99% of these topics. You will never have to pay anything to get topics. They are all free. You are also free to reword them to suit your needs. You can get a list of new topics from our expert writers if you can’t find what you are looking for on this page.

So, let’s take a look at our list of the latest and most interesting eating disorder research topics.

Anorexia Research Paper Ideas

Talking about anorexia may not be the easiest thing in the world, but we have some anorexia research paper ideas that are not that complicated right here:

What causes anorexia in children?
The 3 most effective anorexia nervosa treatments
How do affected people perceive their anorexia?
Physical effects of anorexia nervosa
Psychological effects of anorexia
The ethics behind the nasogastric tube treatment
The link between anorexia and infertility
The link between osteoporosis
The link between anorexia and heart damage
Cultural factors that influence the occurrence of anorexia
Does anorexia cause depression?
Anorexia nervosa in evolutionary psychiatry

Eating Disorders Research Paper Topics

Have you been asked by your professor to write a research paper on an eating disorder or related subject? Check out these unique eating disorders research paper topics:

Best screening tools for eating disorders
Compare and contrast 2 eating disorders
Discuss eating disorders to social media
A short history of eating disorders
How can one achieve body positivity?
Most interesting myths about eating disorders
Differences between bulimia and anorexia
What causes the relapse of eating disorders?
The epidemic of anorexia in the United States
Mass media’s effect on body image in the UK
Gender role in eating disorders

Children Eating Disorders

We can guarantee that if you write about children eating disorders, you will capture the attention of your professor from the first two sentences. Give these topics a try:

Self-injury in children with anorexia
Occurrence of bulimia nervosa in adolescents
Treating autistic children with anorexia
What causes eating disorders among children in the US?
Correcting children’s eating disorders in the United Kingdom
Preventing relapses in young children
The developmental psychology behind eating disorders
Mental development problems in children with anorexia
Successful parenting to prevent the occurrence of anorexia
Television and its effects on self-esteem
The link between fat-shaming and anorexia

Binge Eating Disorder Topics

Yes, binge eating is a very serious eating disorder. So why now write an essay about it? Check out these interesting binge eating disorder topics and pick the one you like:

The social problems associated with binge eating
The psychological problems caused by binge eating
Physical issues caused by the binge eating disorder
Differences between binge eating and bulimia
Differences between binge eating and anorexia nervosa
Prevalence of binge eating in healthy adults in the US
Underreporting problems in the male population
Benefits of counseling
Surgery affects on binge eating
Best lifestyle interventions in cases of binge eating
Effective medication against binge eating disorders

Eating Disorder Topics for College

If you are a college student, you need a more complex topic to win a top grade. Take a look at these great eating disorder topics for college and take your pick:

Household income effects on bulimia incidence
The accuracy of the Eating Disorder Examination
Effects of anorexia on the reproductive system
An in-depth analysis of the refeeding syndrome
Using hypnotherapy to treat bulimia nervosa
The effect of selective serotonin reuptake inhibitor on binge eating
Using olanzapine in anorexia nervosa cases
Cognitive-behavioral therapy for binge eating
The mortality rate of anorexia nervosa patients
The effects of fluoxetine on bulimia nervosa patients
The role of antidepressants in treating bulimia

Complex Eating Disorder Research Topics

If you want to impress your professor and awe your classmates, you may need to consider picking a topic from our list of complex eating disorder research topics below:

Discuss physical morbidity caused by eating disorders
The first documented case of anorexia nervosa
An in-depth look at eating disorder psychosocial morbidity
Binge eating in the Roman society
Effective methods for eating recovery
Sports effects on the occurrence of bulimia nervosa
Bulimia nervosa in the 18th century
Analyze the accuracy of the Anorectic Behavior Observation Scale
An in-depth look at evolutionary psychiatry
Topiramate and zonisamide for treating binge eating
Using anti-obesity medications for bulimia and binge eating

Bulimia Nervosa Essay Topics

Of course, you can write an essay about bulimia nervosa or something related to it. Let’s help you with some bulimia nervosa essay topics:

5 lesser-known facts about bulimia
Famous people who had bulimia
The psychological consequences of bulimia
Physical effects of bulimia nervosa
Gender’s role in the bulimia nervosa disorder
Effective methods to diagnose bulimia
Effective treatments against bulimia nervosa
First symptoms of bulimia
Incidence of bulimia cases among children in the US
Can willpower alone treat bulimia nervosa?

Eating Disorder Research Topics in Nursing

If you are a nursing student (or are attending a nursing class), you may find these eating disorder research topics in nursing highly interesting:

Nursing’s role in eating disorder recovery
Discuss nursing best practices when dealing with anorexia
Nursing techniques for patients with bulimia
Treating the symptoms of anorexia nervosa effectively

Treatments for Eating Disorders

Your professor will surely appreciate you taking the time to research various treatments for eating disorders. You may get some bonus points if you use one of these topics:

The best treatment for bulimia nervosa
A universal treatment for all eating disorders
Medications that are effective against the binge eating disorder
Talk about the use of hypnosis to treat eating disorders
Discuss the cure rate for anorexia nervosa

Anorexia Nervosa Research Paper Topics

Did you run out of ideas for your eating disorder research paper? No problem, just check out the following anorexia nervosa research paper topics and pick the one you like:

First symptoms and manifestations of anorexia nervosa
Is anorexia nervosa contagious?
Genetic transmission of the anorexia nervosa disorder
Risk factors that influence anorexia nervosa in the United States
Effective medication for the anorexia nervosa disorder

Gender Issues and Eating Disorders

Yes, there are many gender issues that you can talk about when it comes to eating disorders. We have an entire list of gender issues and eating disorders ideas right here for you:

The gender with the highest rates of eating disorders
Men and their struggle with anorexia nervosa
Gender issues that make diagnosis difficult
Mortality rates of eating disorders by gender
Stereotypes related to eating disorders

Easy Eating Disorder Research Topics

These easy eating disorder research topics are for students who don’t want to spend days doing the research and writing the essay:

What causes bulimia?
Psychiatric help for eating disorder patients
Effective medications that prevent anorexia episodes
What causes anorexia nervosa?
How can the binge eating disorder be treated effectively?
Psychological problems caused by eating disorders

Controversial Eating Disorder Research Topics

Take a look at some controversial eating disorder research topics and pick one. Probably nobody in your school has even thought about writing a paper on any of these ideas:

Anorexia Nervosa portrayal in the media in the United States
Forced therapy in eating disorders in Eastern Europe
Negative social media effects on the treatment of eating disorders
False positives when diagnosing people with eating disorders
Palliative care for people with anorexia and co-morbidities

Eating Disorder Topics for High School

If you are a high school student, you will be thrilled to learn that we have some very simple topics about eating disorders. Check out our list of eating disorder topics for high school students:

An in-depth analysis of anorexia nervosa
The history of binge eating in the United States
Effective treatment options for bulimia nervosa
The best way to diagnose an eating disorder
The role of the family in treating eating disorders
Dangerous medications used to treat eating disorders

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A Retrospective Literature Review of Eating Disorder Research (1990–2021): Application of Bibliometrics and Topical Trends

Eunhye park.

1 Department of Food Nutrition, College of BioNano Technology, Gachon University, Seongnam 13120, Korea; rk.ca.nohcag@krape

Woo-Hyuk Kim

2 Department of Consumer Science, College of Commerce and Public Affairs, Incheon National University, Incheon 22012, Korea

Associated Data

Not applicable.

Despite the growing importance of eating disorders in society and academic literature, only a few bibliometric review studies using bibliometric analysis were available. Hence, this study aimed to explore and uncover hidden research topics and patterns in articles in terms of eating disorders over the last 30 years. In total, 4111 articles on eating disorders were analyzed using bibliometrics, network analyses, and structural topic modeling as the basis of mixed methods. In addition to general statistics about the journal, several key research topics, such as eating disorder (ED) treatment, ED symptoms, factors triggering ED, family related factors, eating behaviors, and social factors, were found based on topic correlations. This study found the key research variables that are frequently studied with EDs, such as AN, BN, BED, and ARFID. This study may help clinicians comprehend important risk factors associated with EDs. Moreover, the findings about key ED research topics and their association can be helpful for future studies to construct a comprehensive ED research framework. To our knowledge, this is the first study to use topic modeling in an academic journal on EDs and examine the diversity in ED research over 30 years of published research.

1. Introduction

According to the National Eating Disorder Association (NEDA) [ 1 ], about 30 million people in the United States (US) suffer from eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) at least once in their lifetime. NEDA also reported that people who have AN at some point in their lives account for nearly 1% of females and 0.3% of males, while those who have BN account for roughly 1.5% of females and 0.1% of males [ 1 ]. BED is more common than AN and BN, with roughly 3.5 percent of women and 2.0 percent of men experiencing BED in their lives [ 1 ].

EDs are complicated illnesses that induce a variety of mental and physical health symptoms, significantly increasing the disease burden [ 2 ]. Through a national survey with the representative US adults, Udo and Grilo [ 3 ] uncovered that psychiatric disorders, especially substance use disorders, mood disorders, and anxiety disorders, were more prevalent among groups of the US adults suffering from three types of EDs (i.e., AN, BN, and BED) than those without specific EDs. Moreover, they discovered EDs could increase rates of somatic comorbidities, such as arthritis, hypertension, sleep problems, and high cholesterol [ 3 ].

ED research has developed into a diverse and specialized field owing to the complicated nature of these diseases, having made practical and theoretical contributions in various areas, such as the conceptualization of EDs [ 4 , 5 ], diagnosis [ 6 , 7 ], treatment and intervention [ 8 , 9 ], and risk factors associated with EDs [ 10 , 11 ]. For continuous academic development, researchers must actively communicate and collaborate with other scholars, even in other disciplines or subject areas, if necessary [ 12 ]. However, the rapid growth of specialized and multidisciplinary ED research may challenge researchers, especially young researchers, to understand the progress in the sub-research topics of ED research [ 13 ]. An overall understanding of ED research can be even more difficult as trends and research foci in ED studies may change over time in line with the evolving concepts and environments around ED [ 14 ].

Formal or casual in-person meetings or researchers’ individual efforts to search for information online or offline can be helpful for scholarly communication. With the advent of online databases and bibliometrics, the development of academic achievement can be easily structured, and information exchange among researchers can be traced [ 15 ]. Therefore, bibliometric methods can provide practical, impartial approaches to evaluating the publication profiles of a journal and research outcomes [ 13 , 16 ]. Citation analysis, a part of bibliometrics, can demonstrate how scholars communicate to conduct research and revolutionize ED research [ 12 ]. This study also implemented topic modeling to discover prominent research themes and associations among research topics. A retrospective literature review of ED research can provide a broad understanding of key research areas and trends over time. Based on the findings of this study, researchers and practitioners can comprehend areas of research that have hitherto been influential or areas of study that will require greater input from fellow researchers and practitioners in the future.

Previous studies conducted an extensive review of ED research published in 1980, 1990, and 2000 through collaboration between statistical and field experts [ 17 , 18 ]. Based on solid empirical evidence, the authors successfully illustrate the historical changes in methodological approaches and hypothesis testing and draw useful implications for academic stakeholders, such as researchers, reviewers, and editorial boards. However, no studies have been conducted since 2006 that evaluate the bibliographic data and research output of ED studies to diagnose academic progress and establish sustainable development. Hence, the current study aims to summarize the history of articles on eating disorders by showcasing its intellectual structure according to authors, citations, and, more importantly, research perspectives on the topic since 1990. Of the numerous journals that accept ED-related research, this study focused on the ED-specialized journal, International Journal of Eating Disorders ( IJED ), which has been one of the most influential journals in the field of ED over the past three decades. The research questions (RQs) were as follows:

RQ 1. What are the general characteristics of ED studies published in articles on eating disorders?
RQ 2-1. Which articles on eating disorders received the most attention from other researchers?
RQ 2-2. What was the status of the researchers’ collaboration in developing ED research?
RQ 2-3. Which papers have been widely cited as grounds for ED research?
RQ 3. What topics are being actively studied in the field of ED and how has the popularity of these topics changed over time?

To our knowledge, our study is the first to apply bibliometrics and topic modeling to content in an academic journal addressing EDs to explore the diversity of studies on the subject over 30 years. Hence, this study introduced bibliometric methods to the field of ED research. The methodology and findings of this study are expected to contribute to the continuous development of ED research and inspire researchers in the field.

2. Methodology

2.1. data collection.

The Web of Science (WoS) database was used to collect all articles published in International Journal of Eating Disorders ( IJED) between January 1990 and August 2021. For data collection, this study chose one representative ED-related journal, IJED. According to Shah et al. [ 19 ], Archives of General Psychiatry , American Journal of Psychiatry , International Journal of Eating Disorders , and Psychological Medicine published the most influential, in other words, most cited, ED research. Out of these journals, IJED was the only ED-specialized journal. Although there are other prestigious ED-specialized journals with high impact factors, such as Eating disorders, Journal of eating disorders, European Eating Disorders Review , this study focused on IJED. Since the main foci of the aforementioned ED-specialized journals can vary, we chose one journal to control the influence of journal features on bibliometric results. Papers published in Eating Disorders , for example, have been available in the WoS since 2012, and papers published in Journal of Eating Disorders have been available since 2017. Because the availability of papers published in various ED journals varies, the topic summary results may be influenced accordingly.

In the WoS database, all article-related information, such as keywords, abstracts, volumes, issues, and page counts; information about the authors, including names, affiliations, and ORCID; and citation information, such as the number of citations and cited references, were retrieved. Of the 4160 articles retrieved from the WoS, 49 that did not contain essential article information (i.e., year of publication, volume, or issue) were excluded, leaving 4111 articles for data analysis. By following the common practices of previous reviews and bibliometric studies [ 17 , 20 , 21 ], this study divided the dataset into three periods to discover the key characteristics of the journal in each decade: 1990–1999, 2000–2009, and 2010–August 2021.

2.2. Bibliometric Analysis

This study applied two computer-assisted tools to efficiently capture the massive amount of journal-related information over the past 30 years: (1) the R-based bibliometric package “bibliometrix”, and (2) structural topic modeling (STM), an R-based text mining tool.

Traditionally, bibliographic data have been analyzed manually, which largely relies on the researchers’ subjective judgments of the data and requires a significant amount of time for data analysis. However, as the size of the data increases and the reproducibility of the results becomes more important, automatic analysis techniques such as bibliometrics have been widely applied [ 15 ]. Bibliometrics are statistical or quantitative analyses of a comprehensive range of the data in the literature and have been widely applied in various academic disciplines [ 21 , 22 , 23 , 24 ]. Bibliometric analysis tools often provide statistical summaries of journals or articles, author characteristics, institution or country characteristics, and citation characteristics. This study conducted bibliometrics using the R studio (R version 3.6.3 (1 September 2021) with the R-package, “bibliometrix”. (version 3.1.4) [ 25 ]. The general statistics of the journals and citation characteristics were examined using this package.

The “bibliometrix package” was used for network analysis to identify collaborative author relationships and co-citation patterns. For the author collaborative relationship network, each node of the network indicates the author of the articles on eating disorders, and the researchers who collaborated are connected with a line. Only key edges and 30 nodes consisting of key authors were used for network visualization to improve the visibility of the network. Each node represents the cited reference for the co-citation network, and the top 30 giant nodes are included for network visualization. For both networks, betweenness centrality was calculated because of its good performance in detecting influential nodes in the network [ 26 , 27 ]. The sizes of the nodes and labels are proportional to their degree in the network. For both the author’s collaborative relationship network and the co-citation network, community detection was performed using the default setting to identify the key groups.

2.3. Topic Modeling

To identify major research topics in articles published in Eating Disorders , we conducted topic modeling , which is computer-based text analysis. Because the key information about each article is concentrated in the title, abstract, and keywords, these three pieces of information were combined and analyzed for text mining. Python3 (version 3.7.3) was used for data cleaning to improve the quality of the text mining results. We performed text cleaning using two Python packages: Natural Language Toolkit, better known as “NLTK (version 3.4.4)”, and Gensim (version 3.8.0).

For topic modeling, an STM algorithm was applied with the “stm” package (version 1.3.6) in R [ 28 ]. Topic modeling is a machine learning approach that automates the modeling process with multiple iterations. However, for machines to produce results, users of the topic modeling algorithm must determine the optimal number of topics for the dataset and provide that information as input. If the number of topics is too small, machine-generated topics may not capture important sub-research topics or research trends. If the number of topics is too large, on the other hand, multiple similar topics can be generated redundantly. To identify the proper range of topics, held-out likelihood scores were calculated for different topics and used as a quantitative index. To ensure the quality of topic modeling results, the authors of this study performed an additional review of the machine-generated results. That is, the two authors of this paper (both have expertise in the implemented methods, and one is a registered dietitian) have manually reviewed the top words and abstracts highly associated with each topic to confirm whether the results were reasonable and interpretable. Following these procedures, a topic model was built with 47 topics.

Each topic consisted of a series of terms that addressed specific themes. The algorithm examined the associations between the terms in the dataset and terms often used in the same document or context were grouped together. Because topic modeling is probabilistic modeling, the machine calculates each term’s probability of being associated with the 47 topics and each document’s probability of the same to obtain a probability score called the topic weight (β) . Because the sum of 47 topic weights per document is always one, a topic closely related to one document has a topic weight close to one, whereas the topic weight given low relatedness is close to zero.

Because the machine computes the probability of one document being associated with all 47 topics, the associations among the topics could be examined as well. More specifically, topics that often occurred together in the same document had strong associations, and topic networks were created based on these associations. To do so, the “topicCorr” function in the “stm” package was applied. This process provided us with insights into more general and broader trends in topics in the selected article sample. Based on topic correlation, the modularity optimization method (“cluster_optimal” in the igraph package in R) was used to apply a community detection algorithm with a high modularity score. The modularity score was applied to discover the optimal community structure in complex networks.

STM has a function of testing the effects of document-level metadata on topic weights, which is available as an “estimateEffect” function in the “stm” package [ 29 ]. To simulate the effects of document covariates on topic weights, a component of document-level metadata is included as a parameter ( X ) instead of a global mean prior applicable for all documents [ 29 ]. The topic weight was referred to from a multivariate normal linear distribution [ 29 ]. With the “estimateEffect” function, we compared topic weights across the three periods to uncover shifts in the popularity of topics over time. Specifically, the “pointestimate” method was used to estimate the expected topic weights ( β) by each value of covariates (that is, three-time points by each decade), and the “difference” method was used to calculate the difference in the expected topic weights and confidence intervals. Since this approach can contrast two groups with binary data, topic weights of the 1990s were compared with those of the 2000s and 2010s, and the 2000s with the 2010s.

2.4. Research Topic Classification

Two metrics, overall popularity and historical trends, were utilized for topic classification. Topic estimates were used as indicators to determine the overall popularity of topics. The topics ranking within the top 25% by median topic estimates were classified into “high”, between the 25th percentile and the 75th percentile into “moderate”, and below 25% into “low”.

For historical trend classification, topic weight estimates were compared every decade based on 95% confidence intervals as the basis for determining one of the following historical trend classifications: “increasing”, “decreasing”, and “constant”. Historical trends of topics were classified as “increasing” (or “decreasing”) if the low and high confidence intervals did not contain zeros and their weights increased (or decreased) over time. If the low and high confidence intervals contain zeros, those topics are classified as “constant”. Figure 1 illustrates a summary of the implemented methods.

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Summary of methodology.

3.1. General Characteristics of Articles in Terms of Eating Disorders

As illustrated in Figure 2 , an average of 132 articles were published in the ED’s journals each year between 1990 and 2020 (2020 was excluded from the average calculation as this year was not complete at the time of data analysis). The number of publications peaked in 2004 at 341, nearly three times the annual average. Although the change in the number of articles over time was not significant, it tended to increase at the end of each 10 years. Of the 4111 articles, the number of articles published between 1990 and 1999 was 952, 1419 between 2000 and 2009, and 1740 between 2010 and 2021. Of these years, 2004 emerged as the peak year for the number of publications.

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The number of articles published in Eating Disorders .

3.2. Citation Characteristics

Table 1 lists the top 20 articles of each decade that received the most citations regarding the characteristics of citations. The article that received the most citations throughout the 30 years, was “Assessment of Eating Disorders: Interview or Self-Report Questionnaire?” [ 30 ]. Among the articles published in the first decade, those on scale development tended to be cited frequently. In the second decade, the article “The Effect of Experimental Presentation of Thin Media Images on Body Satisfaction: A Meta-Analytic Review” [ 31 ] received the most citations, and studies involving systematic reviews or meta-analyses were cited most frequently. Among articles published since 2010, “Psychometric Evaluation of the Eating Disorder Examination and Eating Disorder Examination-Questionnaire: A Systematic Review of the Literature” [ 32 ] received the most citations. In the final period, studies involving systematic reviews and meta-analyses were often cited, as were those with broader research topics (e.g., ethnic groups and the Internet).

Top 20 most cited papers published in each decade.

Period	First Author	Year	Title	Citation Counts
First decade: 1990–1999	Fairburn, C.G.	1994	Assessment of Eating Disorders—Interview or Self-Report Questionnaire	2998
	Luce, K.H.	1999	The Reliability of the Eating Disorder Examination-Self-Report Questionnaire Version (EDE-Q)	628
	Spitzer, R.L.	1993	Binge Eating Disorder—Its Further Validation in a Multisite Study	586
	Strober, M.	1997	The Long-Term Course of Severe Anorexia Nervosa in Adolescents: Survival Analysis of Recovery, Relapse, and Outcome Predictors Over 10–15 Years in a Prospective Study	586
	Spitzer, R.L.	1992	Binge Eating Disorder—a Multisite Field Trial of the Diagnostic-Criteria	561
	Cash, T.F.	1997	The Nature and Extent of Body-Image Disturbances in Anorexia Nervosa and Bulimia Nervosa: A Meta-Analysis	460
	Collins, M.E.	1991	Body Figure Perceptions and Preferences Among Preadolescent Children	437
	Arnow, B.	1995	The Emotional Eating Scale—the Development of a Measure to Assess Coping with Negative Affect by Eating	426
	Heinberg, L.J.	1995	Development and Validation of the Sociocultural Attitudes Towards Appearance Questionnaire	397
	Wiseman, C.V.	1992	Cultural Expectations of Thinness in Women—An Update	382
	Killen, J.D.	1994	Pursuit of Thinness and Onset of Eating Disorder Symptoms in a Community Sample of Adolescent Girls—a 3-Year Prospective Analysis	361
	Holderness, H.C.	1994	Co-Morbidity of Eating Disorders and Substance-Abuse Review of the Literature	309
	Bryantwaugh, R.J.	1996	The Use of the Eating Disorder Examination with Children: A Pilot Study	300
	Pope, H.G.	1999	Evolving Ideals of Male Body Image as Seen Through Action Toys	272
	Westenhoefer, J.	1999	Validation of the Flexible and Rigid Control Dimensions of Dietary Restraint	270
	Thompson, J.K.	1995	Development of Body-Image, Eating Disturbance, and General Psychological Functioning in Female Adolescents—Covariance Structure Modeling and Longitudinal Investigations	227
	Rosen, J.C.	1996	Body Shape Questionnaire: Studies of Validity and Reliability	220
	Serpell, L.	1999	Anorexia Nervosa: Friend or Foe?	220
	Thompson, J.K.	1991	Psychometric Qualities of the Figure Rating-Scale	219
Second decade: 2000–2009	Rucker, C.E.	1992	Body Images, Body-Size Perceptions, and Eating Behaviors among African-American and White College Women	215
	Groesz, L.M.	2002	The Effect of Experimental Presentation of Thin Media Images on Body Satisfaction: A Meta-Analytic Review	927
	Hoek, H.W.	2003	Review of the Prevalence and Incidence of Eating Disorders	821
	Thompson, J.K.	2004	The Sociocultural Attitudes Towards Appearance Scale-3 (SATAQ-3): Development and Validation	617
	Berkman, N.D.	2007	Outcomes of Eating Disorders: A Systematic Review of the Literature	328
	Smolak, L.	2000	Female Athletes and Eating Problems: A Meta-Analysis	320
	Bulik, C.M.	2007	Anorexia Nervosa Treatment: A Systematic Review of Randomized Controlled Trials	306
	Striegel-Moore, R.H.	2009	Gender Difference in the Prevalence of Eating Disorder Symptoms	287
	Presnell, K.	2004	Risk Factors for Body Dissatisfaction in Adolescent Boys and Girls: A Prospective Study	286
	Cash, T.F.	2004	The Assessment of Body Image Investment: An Extensive Revision of the Appearance Schemas Inventory	263
	Leit, R.A.	2001	Cultural Expectations of Muscularity in Men: The Evolution of Playgirl Centerfolds	262
	Cohane, G.H.	2001	Body Image in Boys: A Review of the Literature	259
	Peterson, C.B.	2007	Psychometric Properties of the Eating Disorder Examination-Questionnaire: Factor Structure and Internal Consistency	243
	Luce, K.H.	2008	Eating Disorder Examination Questionnaire (EDE-Q): Norms for Undergraduate Women	239
	O’Dea, J.A.	2000	Improving the Body Image, Eating Attitudes, and Behaviors of Young Male and Female Adolescents: A New Educational Approach That Focuses on Self-Esteem	235
	Fichter, M.M.	2006	Twelve-Year Course and Outcome Predictors of Anorexia Nervosa	228
	Katzman, D.K.	2005	Medical Complications in Adolescents with Anorexia Nervosa: A Review of the Literature	215
	Cash, T.F.	2002	The Impact of Body Image Experiences: Development of the Body Image Quality of Life Inventory	212
	Stice, E.	2000	Dissonance Prevention Program Decreases Thin-Ideal Internalization, Body Dissatisfaction, Dieting, Negative Affect, and Bulimic Symptoms: A Preliminary Experiment	211
	Bydlowski, S.	2005	Emotion-Processing Deficits in Eating Disorders	211
	Godart, N.T.	2002	Comorbidity Between Eating Disorders and Anxiety Disorders: A Review	208
Third decade: 2010–2021	Berg, K.C.	2012	Psychometric Evaluation of the Eating Disorder Examination and Eating Disorder Examination-Questionnaire: A Systematic Review of the Literature	494
	Gearhardt, A.N.	2012	An Examination of the Food Addiction Construct in Obese Patients with Binge Eating Disorder	269
	Keel, P.K.	2010	Update On Course and Outcome in Eating Disorders	240
	Marques, L.	2011	Comparative Prevalence, Correlates of Impairment, and Service Utilization for Eating Disorders Across US Ethnic Groups: Implications for Reducing Ethnic Disparities in Health Care Access for Eating Disorders	222
	Vall, E.	2015	Predictors of Treatment Outcome in Individuals with Eating Disorders: A Systematic Review and Meta-Analysis	214
	Tiggemann, M.	2013	Netgirls: The Internet, Facebook, and Body Image Concern in Adolescent Girls	211
	Allison, K.C.	2010	Proposed Diagnostic Criteria for Night Eating Syndrome	194
	Smink, F.R.E.	2014	Prevalence and Severity of DSM-5 Eating Disorders in a Community Cohort of Adolescents	193
	Couturier, J.	2013	Efficacy of Family-Based Treatment for Adolescents with Eating Disorders: A Systematic Review and Meta-Analysis	172
	Vocks, S.	2010	Meta-Analysis of the Effectiveness of Psychological and Pharmacological Treatments for Binge Eating Disorder	171
	Hay, P.	2013	A Systematic Review of Evidence for Psychological Treatments in Eating Disorders: 2005–2012	158
	Fichter, M.M.	2016	Mortality in Eating Disorders—Results of a Large Prospective Clinical Longitudinal Study	156
	Bryant-Waugh, R.	2010	Feeding and Eating Disorders in Childhood	155
	Wildes, J.E.	2010	Emotion Avoidance in Patients with Anorexia Nervosa: Initial Test of a Functional Model	145
	Rohde, P.	2015	Development and Predictive Effects of Eating Disorder Risk Factors during Adolescence: Implications for Prevention Efforts	137
	Mabe, A.G.	2014	Do You “Like” My Photo? Facebook Use Maintains Eating Disorder Risk	136
	Keel, P.K.	2013	Psychosocial Risk Factors for Eating Disorders	131
	Tasca, G.A.	2014	Attachment and Eating Disorders: A Review of Current Research	112
	Mclean, S.A.	2015	Photoshopping the Selfie: Self Photo Editing and Photo Investment Are Associated with Body Dissatisfaction in Adolescent Girls	112
	Hill, L.S.	2010	SCOFF, the Development of An Eating Disorder Screening Questionnaire	111

Author collaboration was visualized using the top 30 authors with the highest betweenness centrality scores to display collaborative relationships among researchers ( Figure 3 ). Betweenness centrality in the author collaboration network represents the researcher’s capacity to influence other researchers and spread information quickly [ 33 ]. The size and label of nodes are proportional to the frequency of each node in the author collaboration network. This means that authors with larger node sizes and labels often collaborate, and these researchers quickly transfer scientific knowledge. As a result, four clusters were found, centered on researchers with high betweenness centrality: Mitchell, JE in Cluster 1; Wifley, DE in Cluster 2; Builk, CM in Cluster 3; and Crosby RD in Cluster 4.

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Author collaboration network.

In addition, a co-citation network was drawn to identify the relationships among the representative sources frequently cited by articles of Eating Disorders ( Figure 4 ). Each node of the co-citation network represents a cited reference source, and links between nodes are created if the corresponding nodes are cited by the same source. Articles frequently cited in the same journal tend to be densely networked. Densely connected nodes are grouped into the same cluster, and each cluster often shares similarities in terms of research topics. In this study, two large communities were discovered. The references in community one mainly focused on the assessment of eating disorders and clinical features (e.g., [ 30 , 34 , 35 , 36 , 37 ]). The references in community 2 are mainly about theory building and tool development (e.g., [ 32 , 38 , 39 , 40 ]).

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Co-citation network.

3.3. Characteristics of Research Topics

3.3.1. discovery of prominent research topics.

Topic modeling and topic network analysis revealed the 47 most prominent research topics and their associations ( Table 2 ) and the representative article for each topic ( Table 3 ). At the topic level, technology (Topic 5 and T5) was the most popular among the 47 most salient research topics, accounting for approximately 3.8% of the total topic weight. The top words for that topic were “Internet”, “online”, “professional”, “technology”, and “international”. The article most closely associated with that topic was “User-Centered Design for Technology-Enabled Services for Eating Disorders [ 41 ]”. This result indicates online space became an important medium for ED diagnosis and clinical practices.

Topic summary.

Group Label	Topic Name	Top Words	Topic Weight
BED risk factors	T22 Dieting	weight, diet, overweight	0.032
	T29 BED	binge eating, obese, binge eater	0.031
	T1 EDNOS	bed, ednos, subthreshold	0.029
	T7 Food intake	food, activation, craving	0.021
	T36 Cognitive avoidance	cognitive, avoidance, deficit	0.020
	T46 Eating behavior on mood	mood, intake, fat	0.019
	T27 Restrained eating	restraint, shape, stroop	0.017
	T4 Obesity	obesity, time, sleep	0.014
Factors triggering ED	T40 Sexual orientation	woman, heterosexual, man	0.030
	T31 Internalization	peer, internalization, body_dissatisfaction	0.025
	T25 Body size	body, size, image	0.025
	T33 Ethnicity	Asian, American, ethnic	0.022
	T19 Gender	female, male, gender	0.020
	T34 Body image, appearance	body_image, appearance, disturbance	0.020
	T17 Self-esteem	esteem, self, low_self	0.016
	T8 Fragile groups	athlete, student, school	0.016
AN, BN risk factors	T18 BN	bulimia, nervosa, dsm	0.032
	T20 AN	anorexia nervosa, death, psychiatric	0.028
	T43 Purge behavior	purge, frequency, purging	0.023
	T42 Birth	bone, bear, birth	0.022
	T30 Risk of comorbidity	risk, comorbid, suicide	0.020
	T35 Abuse	abuse, impulsivity, sexual_abuse	0.020
	T6 Bulimic symptom	bulimic, bulimic_symptom, anger	0.019
Treatment	T32 Syndrome	syndrome, anorexic, deficiency	0.031
	T21 Metabolism	serum, brain, concentration	0.028
	T11 Medical complication	medical, complication, anorexia nervosa	0.025
	T44 Inpatient treatment	admission, discharge, inpatient	0.023
	T3 BMI	bmi, body_mass, index_bmi	0.018
	T38 Weight change	weight, relapse, gain	0.012
Social factors	T5 Technology	internet, online, professional	0.038
	T9 Special care	interpersonal, carer, skill	0.024
	T10 Economic impact	cost, healthcare, economic	0.015
	T14 Social impact	social, distress, sexual	0.014
ARFID risk factors	T24 Family-based treatment	adolescent, family, fbt	0.023
	T15 ARFID	arfid, avoidant, sensitivity	0.017
	T47 Parental impact	parent, parental, child	0.014
	T16 Pregnancy	pregnancy, mother, maternal	0.012
Stand-alone	T23 Recovery	recovery, motivation, recover	0.019
	T26 Network analysis	network, fear, strength	0.022
	T28 Perfectionism	perfectionism, obsessive, compulsive	0.015
	T37 Genetics	twin, genetic, lifetime	0.020
	T39 Physical activity	exercise, physical_activity, physical	0.014
	T41 Stigma	stigma, youth, barrier	0.015
	T45 Medication	medication, placebo, open	0.018
	T2 Cognitive-behavioral	cbt, cognitive, clinician	0.027
	T12 Personality	personality, anxiety, attachment	0.014
	T13 Self-shame	self, shame, feeling	0.022

Representative articles highly associated with each topic.

Group Label	Topic Name	Representative Article: Title (References)
BED risk factors	T22 Dieting	Eating disorders, dieting, and the accuracy of self-reported weight [ ]
	T29 BED	Hunger and binge eating: a meta-analysis of studies using ecological momentary assessment [ ]
	T1 EDNOS	Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: Reduction of eating disorder not otherwise specified and validity [ ]
	T7 Food intake	Forbidden fruit: Does thinking about a prohibited food lead to its consumption? [ ]
	T36 Cognitive avoidance	Cognitive avoidance of threat cues: Association with eating disorder inventory scores among a non-eating-disordered population [ ]
	T46 Eating behavior on mood	Effects of eating behavior on mood: a review of the literature [ ]
	T27 Restrained eating	Dietary restraint and addictive behaviors: The generalizability of Tiffany’s cue reactivity model [ ]
	T4 Obesity	Time trends in obesity and eating disorders [ ]
Factors triggering ED	T40 Sexual orientation	A comparison of lesbians, gay men, and heterosexuals on weight and restrained eating [ ]
	T31 Internalization	Do universal media literacy programs have an effect on weight and shape concern by influencing media internalization? [ ]
	T25 Body size	Experimental manipulation of visual attention affects body size adaptation but not body dissatisfaction [ ]
	T33 Ethnicity	The impact of racial stereotypes on eating disorder recognition [ ]
	T19 Gender	The development and validation of the muscularity-oriented eating test: A novel measure of muscularity-oriented disordered eating [ ]
	T34 Body image, appearance	Body image, social comparison, and eating disturbance: A covariance structure modeling investigation [ ]
	T17 Self-esteem	Kindness begins with yourself: The role of self-compassion in adolescent body satisfaction and eating pathology [ ]
	T8 Fragile groups	Female athletes and eating problems: A meta-analysis [ ]
AN, BN risk factors	T18 BN	Comparative validity of the Chinese versions of the bulimic inventory test Edinburgh and eating attitudes test for DSM-IV eating disorders among high school dance and nondance students in Taiwan [ ]
	T20 AN	An audit of a British sample of death certificates in which anorexia nervosa is listed as a cause of death [ ]
	T43 Purge behavior	The use of multiple purging methods as an indicator of eating disorder severity [ ]
	T42 Birth	Season of birth bias and anorexia nervosa: Results from an international collaboration [ ]
	T30 Risk of comorbidity	Suicidality in adolescents and adults with binge-eating disorder: Results from the national comorbidity survey replication and adolescent supplement [ ]
	T35 Abuse	Trait-defined eating disorder subtypes and history of childhood abuse [ ]
	T6 Bulimic symptom	Anger and bulimic psychopathology among nonclinical women [ ]
Treatment	T32 Syndrome	A case report of Usher’s syndrome and anorexia nervosa [ ]
	T21 Metabolism	Plasma tryptophan levels and anorexia in liver cirrhosis [ ]
	T11 Medical complication	Digestive complication in severe malnourished anorexia nervosa patient: a case report of necrotizing colitis [ ]
	T44 Inpatient treatment	A naturalistic comparison of two inpatient treatment protocols for adults with anorexia nervosa: Does reducing duration of treatment and external controls compromise outcome? [ ]
	T3 BMI	Body composition and menstrual status in adults with a history of anorexia nervosa-at what fat percentage is the menstrual cycle restored? [ ]
	T38 Weight change	Elevated pre-morbid weights in bulimic individuals are usually surpassed post-morbidly: Implications for perpetuation of the disorder [ ]
Social factors	T5 Technology	User-centered design for technology-enabled services for eating disorders [ ]
	T9 Special care	The use of guidelines for dissemination of “best practice” in primary care of patients with eating disorders [ ]
	T10 Economic impact	Key factors that influence government policies and decision making about healthcare priorities: Lessons for the field of eating disorders [ ]
	T14 Social impact	Eating disorders treatment experiences and social support: Perspectives from service seekers in mainland China [ ]
ARFID risk factors	T24 Family-based treatment	Family-based treatment: Where are we and where should we be going to improve recovery in child and adolescent eating disorders [ ]
	T15 ARFID	Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22 [ ]
	T47 Parental impact	The relationship between parent feeding styles and general parenting with loss of control eating in treatment-seeking overweight and obese children [ ]
	T16 Pregnancy	Documenting the course of loss of control over eating prior to, during and after pregnancy among women with pre-pregnancy overweight and obesity [ ]
Stand-alone	T23 Recovery	# recovery: Understanding recovery from the lens of recovery-focused blogs posted by individuals with lived experience [ ]
	T26 Network analysis	Network analysis: An innovative framework for understanding eating disorder psychopathology [ ]
	T28 Perfectionism	Stress situation reveals an association between perfectionism and drive for thinness [ ]
	T37 Genetics	Twin studies and the etiology of eating disorders [ ]
	T39 Physical activity	Monitoring eating and activity: Links with disordered eating, compulsive exercise, and general wellbeing among young adults [ ]
	T41 Stigma	Interventions to reduce the stigma of eating disorders: A systematic review and meta-analysis [ ]
	T45 Medication	Bulimia nervosa treatment: A systematic review of randomized controlled trials [ ]
	T2 Cognitive-behavioral	Patients’ experiences of brief cognitive-behavioral therapy for eating disorders: A qualitative investigation [ ]
	T12 Personality	Relationships among attachment styles, personality characteristics, and disordered eating [ ]
	T13 Self-shame	Within-persons predictors of change during eating disorders treatment: An examination of self-compassion, self-criticism, shame, and eating disorder symptoms [ ]

Dieting (T22) and BN (T18) were also widely studied topics, accounting for approximately 3.2% of the total topic weight. This result indicates that many researchers were interested in dieting (related to weight evaluation) as well as BN. An article related to dieting is “Eating Disorders, Dieting, and the Accuracy of Self-Reported Weight” [ 42 ]. The popularity of dieting topic demonstrated that many ED researchers found self-evaluation of body weight or excessive weight control relevant to EDs.

One article associated with BN is “Comparative Validity of the Chinese Versions of the Bulimic Inventory Test Edinburgh and Eating Attitudes Test for DSM-IV Eating Disorders Among High School Dance and Nondance Students in Taiwan” [ 43 ]. Compared to other ED topics (e.g., BED [T29], AN [T20], ARFID [T15]), BN was most widely studied in IJED . However, it should be noted that Topic 29 (BED) and Topic 1 (EDNOS) were related to binge eating, and these two topics accounted for about 6% of the overall topic weight, which is larger than BN. As shown in Table 2 , both Topic 29 (BED) and Topic 1 (EDNOS) contained keywords related to binge eating. Topic 29 and Topic 1 may diverge due to revisions in the definition of BED in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and DSM-5. In the fourth edition of the DSM-IV, BED was classified as an Autonomous Eating Disorder not Otherwise Specified (EDNOS) [ 44 ]. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in May 2013, BED was listed in addition to other eating disorder diagnoses, BN and AN [ 45 , 46 ]. As this study targeted the ED research over three decades, those topics related to binge eating may have been classified into the eating behavior group rather than ED symptoms. In summary, the most researched ED-related topics in IJED were BED (accounting for nearly 6%), BN (3.2%), AN (2.8%), and ARFID (1.7%).

3.3.2. Research Topic Network

Some topics tended to have overlapped themes and characteristics. Based on the degree of similarities shared by the topics, topic correlations were estimated and topic network structures were identified ( Figure 5 ). As a result of the topic network analysis and community detection, six groups of 37 of the 47 topics were produced, leaving 10 stand-alone topics. The groups included BED risk factors (Group 1), factors triggering ED (Group 2), AN, BN risk factors (Group 3), treatment (Group 4), social factors (Group 5), and ARFID risk factors (Group 6). Groups 1, 3, and 6 were formed by connecting important risk factors with an emphasis on key EDs. Group 1 comprised, for example, BED-related topics and risk factors that are frequently studied in the context of BED.

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Topic network result.

The group with the most significant total topic weight, accounting for approximately 18.3% of the total topic weight, was mostly related to BED risk factors: EDNOS (T1), obesity (T4), food intake (T7), dieting (T22), restrained eating (T27), BED (T29), cognitive avoidance (T36), and eating behavior on mood (T46). The close link between obesity (T4) and two binge eating topics (T1 and T29) was found, which demonstrated that many ED researchers were interested in the effects of obesity on binge eating. For instance, Amianto, Ottone, Abbate Daga, and Fassino [ 44 ] conducted a systematic review study with binge eating research and many studies were conducted with obese population. Similarly, the edge of BED topic (T29) was connected to food intake (T7), dieting (T22), and dietary behavior (T46), showing that much research examined the effects of food behaviors on BED.

Another major group, accounting for approximately 17.4% of the total topic weight, was the factors triggering EDs. In that group, research topics included the effects of gender (T19 and T40), body image and self-esteem (T17, T25, and T34), internalization (T31), ethnicity (T33), and groups at risk of ED (T8). T19 and T40 dealt with gender issues, but their research foci differed. Studies related to T40 (labeled as gender/gender identity) examined whether biological gender or gender identity can influence EDs, whereas T19 (labeled as a gender stereotype) questioned the impact of social preconceptions about gender attributes, such as masculinity and femininity, on EDs.

Group 3 was labeled as “AN, BN risk factor”, accounting for 16.4% of the total topic weight. This group consists of bulimic symptoms (T6), BN (T18), AN (T20), risk of comorbidity (T30), abuse (T35), birth (T42), and purge behavior (T43). We found a close relationship between AN (T20) and the birth topic (T42), indicating that many researchers examined the effects of birth-related issues on AN. The close relationship between these two topics can be supported by many previous studies examining the relationships between birth patterns and AN [ 91 , 92 ]. Similarly, the abuse topic (T35) was closely related to bulimic symptoms (T6) and BN (T18) and purge behavior (T43). The results may indicate that researchers who investigated BN and purging disorder frequently considered various forms of abuses, such as sexual [ 93 ], physical [ 94 ], emotional [ 95 ], and substance abuse [ 96 ].

Other topic groups included ED treatment (13.7%), social factors (9.1%), and family-related factors (6.6%). ARFID was found to be often studied with the family-based treatment (FBT) topic (T24). Several previous studies suggested that FBT could be used to treat people with ARFID [ 97 , 98 ], which explains the close connection between the ARFID (T15) topic and FBT (T24). FBT is also linked to the parent effect topic (T47), indicating that ARFID was frequently considered in the context of the family.

3.3.3. Classification of Research Topics by Overall Popularity and Historical Trend

Research topics were classified according to historical trends and overall popularity based on two metrics: changes in topic weights and expected topic estimates ( Table 4 ). In addition, topics were grouped using a combination of overall popularity and historical trends in topic popularity (see Figure 6 ).

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Classification of research topics by overall popularity and popularity trend.

Expected topic weight comparisons over three decades.

		1990–1999	2000–2009	2010–2021	Difference in Topic Estimate	A Two-Sided 95% Confidence Interval							Historical	Overall
		1990–1999	2000–2009	2010–2021		90s–00s		90s–10s		00s–10s			Historical	Overall
	Topic Label	Topic Estimate				ci. Lower	ci. Upper	ci. Lower	ci. Upper	ci. Lower	ci. Upper	Topic Weight	Trend Classification	Popularity Classification
BED risk factors	T1 EDNOS	0.024	0.026	0.028	0.002	0.007	−0.002	0.007	−0.002	0.007	−0.002	0.029	Constant	High
	T4 Obesity	0.020	0.018	0.016	−0.002	0.002	−0.005	0.002	−0.005	0.002	−0.005	0.014	Constant	Low
	T7 Food intake	0.019	0.020	0.020	0.001	0.004	−0.003	0.005	−0.003	0.004	−0.003	0.021	Constant	Moderate
	T22 Dieting	0.031	0.025	0.019	−0.006	−0.003	−0.009	−0.003	−0.010	−0.003	−0.009	0.032	Decreasing	High
	T27 Restrained eating	0.028	0.020	0.011	−0.009	−0.005	−0.012	−0.005	−0.012	−0.005	−0.012	0.017	Decreasing	Moderate
	T29 BED	0.034	0.028	0.021	−0.006	−0.002	−0.011	−0.003	−0.011	−0.003	−0.011	0.031	Decreasing	High
	T36 Cognitive avoidance	0.019	0.021	0.023	0.002	0.006	−0.002	0.006	−0.002	0.006	−0.002	0.020	Constant	Moderate
	T46 Dietary behavior	0.022	0.018	0.014	−0.004	0.000	−0.007	−0.001	−0.008	−0.001	−0.007	0.019	Decreasing	Moderate
Factors triggering ED	T8 Fragile groups	0.017	0.017	0.017	0.000	0.004	−0.003	0.004	−0.003	0.004	−0.003	0.016	Constant	Low
	T17 Self-esteem	0.024	0.019	0.013	−0.005	−0.002	−0.009	−0.002	−0.009	−0.002	−0.009	0.016	Decreasing	Low
	T19 Gender difference	0.021	0.020	0.019	−0.001	0.003	−0.004	0.003	−0.004	0.003	−0.004	0.020	Constant	Moderate
	T25 Body size	0.028	0.023	0.017	−0.006	−0.002	−0.010	−0.002	−0.010	−0.002	−0.010	0.025	Decreasing	Moderate
	T31 Body dissatisfaction	0.021	0.024	0.027	0.003	0.008	−0.001	0.007	−0.001	0.007	−0.002	0.025	Constant	High
	T33 Ethnicity	0.026	0.022	0.018	−0.004	0.000	−0.008	0.000	−0.008	0.000	−0.009	0.022	Decreasing	Moderate
	T34 Body image	0.026	0.020	0.015	−0.006	−0.002	−0.009	−0.002	−0.009	−0.002	−0.009	0.020	Decreasing	Moderate
	T40 Sexual orientation	0.029	0.024	0.020	−0.004	−0.001	−0.007	−0.001	−0.007	−0.001	−0.008	0.030	Decreasing	High
AN, BN risk factors	T6 Bulimic symptoms	0.033	0.022	0.011	−0.011	−0.007	−0.015	−0.007	−0.015	−0.007	−0.015	0.019	Decreasing	Moderate
	T18 BN	0.043	0.029	0.014	−0.015	−0.011	−0.018	−0.011	−0.018	−0.011	−0.018	0.032	Decreasing	High
	T20 AN	0.033	0.033	0.032	−0.001	0.004	−0.007	0.004	−0.007	0.004	−0.007	0.028	Constant	High
	T30 Risk of comorbidity	0.014	0.020	0.025	0.006	0.010	0.002	0.010	0.002	0.009	0.002	0.020	Increasing	Moderate
	T35 Abuse	0.028	0.022	0.015	−0.006	−0.003	−0.010	−0.003	−0.010	−0.003	−0.010	0.020	Decreasing	Moderate
	T42 Birth	0.022	0.024	0.026	0.002	0.006	−0.002	0.006	−0.002	0.006	−0.002	0.022	Constant	Moderate
	T43 Purge behavior	0.018	0.021	0.025	0.004	0.007	0.000	0.007	0.000	0.007	0.000	0.023	Constant	Moderate
Treatment	T3 BMI	0.015	0.018	0.021	0.003	0.006	0.000	0.006	0.000	0.006	0.000	0.018	Constant	Moderate
	T11 Complication	0.026	0.026	0.026	0.000	0.004	−0.005	0.004	−0.004	0.004	−0.004	0.025	Constant	High
	T21 Hormone	0.031	0.029	0.027	−0.002	0.003	−0.008	0.003	−0.007	0.003	−0.008	0.028	Constant	High
	T32 Syndrome	0.043	0.031	0.019	−0.012	−0.007	−0.017	−0.007	−0.017	−0.007	−0.017	0.031	Decreasing	High
	T38 Weight change	0.018	0.016	0.014	−0.002	0.001	−0.005	0.001	−0.005	0.001	−0.005	0.012	Constant	Low
	T44 Inpatient treatment	0.013	0.021	0.028	0.007	0.011	0.003	0.012	0.003	0.011	0.003	0.023	Increasing	Moderate
Social factors	T5 Online	0.020	0.033	0.045	0.013	0.019	0.007	0.019	0.007	0.019	0.007	0.038	Increasing	High
	T9 Special care	0.017	0.022	0.028	0.006	0.010	0.001	0.010	0.001	0.010	0.001	0.024	Increasing	Moderate
	T10 Cost of illness	0.010	0.017	0.025	0.007	0.012	0.004	0.011	0.004	0.011	0.004	0.015	Increasing	Low
	T14 Social impact	0.014	0.015	0.016	0.001	0.004	−0.002	0.004	−0.002	0.004	−0.002	0.014	Constant	Low
ARFID risk factors	T15 ARFID	0.007	0.017	0.027	0.010	0.014	0.006	0.014	0.006	0.014	0.006	0.017	Increasing	Moderate
	T16 Pregnancy	0.014	0.014	0.014	0.000	0.004	−0.003	0.004	−0.003	0.004	−0.003	0.012	Constant	Low
	T24 Family-based treatment	0.012	0.019	0.026	0.007	0.010	0.003	0.010	0.003	0.010	0.003	0.023	Increasing	Moderate
	T47 Parental impact	0.008	0.010	0.012	0.002	0.004	0.000	0.004	0.000	0.004	0.000	0.014	Constant	Low
Stand-alone	T2 Cognitive-behavioral theory	0.018	0.024	0.030	0.006	0.011	0.001	0.011	0.001	0.011	0.001	0.027	Increasing	High
	T12 Personality	0.018	0.019	0.019	0.000	0.004	−0.004	0.004	−0.004	0.004	−0.004	0.014	Constant	Low
	T13 Self-shame	0.021	0.022	0.022	0.000	0.004	−0.004	0.004	−0.004	0.004	−0.004	0.022	Constant	Moderate
	T23 Recovery	0.013	0.018	0.024	0.006	0.009	0.002	0.009	0.002	0.009	0.002	0.019	Increasing	Moderate
	T26 Network analysis	0.015	0.023	0.031	0.008	0.012	0.004	0.012	0.004	0.012	0.004	0.022	Increasing	Moderate
	T28 Perfectionism	0.019	0.018	0.017	−0.001	0.003	−0.005	0.003	−0.005	0.003	−0.005	0.015	Constant	Low
	T37 Genetics	0.023	0.021	0.020	−0.001	0.003	−0.006	0.003	−0.006	0.003	−0.006	0.020	Constant	Moderate
	T39 Physical activity	0.012	0.015	0.018	0.003	0.007	0.000	0.007	0.000	0.007	0.000	0.014	Constant	Low
	T41 Stigma	0.012	0.017	0.023	0.006	0.010	0.002	0.010	0.002	0.010	0.002	0.015	Increasing	Low
	T45 Medication	0.021	0.021	0.022	0.000	0.005	−0.004	0.005	−0.004	0.005	−0.004	0.018	Constant	Moderate

In terms of historical trends, the following 11 topics were classified into “increasing” as their topic weights have increased over time: cognitive-behavioral theory (T2), online (T4), special care (T9), cost of illness (T10), ARFID (T15), recovery (T23), family-based treatment (T24), network analysis (T26), risk of comorbidity (T30), stigma (T41), and inpatient treatment (T44). In particular, popularity of topics belonging to Group 5 (social factor) and Group 6 (family) tend to increase over time, considering the topic weights of three topics out of four topics in Group 5 (social factor) and two topics out of four topics in Group 6 (family) were classified into “increasing” in historical trends.

The topic weights of the following 13 topics tend to be “decreasing”: bulimic symptoms (T6), self-esteem (T17), BN (T18), dieting (T22), body size (T25), restrained eating (T27), overeating (T29), syndrome (T32), ethnicity (T33), body image, appearance (T34), abuse (T35), sexual orientation (T40), and dietary behavior (T46). This trend was evident in the topics of Group 2 (factors triggering ED), as the topic weights of six out of eight topics decreased.

Finally, 23 subjects were classified as “constant” in the historical trends because there was no significant difference in topic weights over the three decades. These topics included binge-eating diagnosis (T1), BMI (T3), obesity (T4), food intake (T7), fragile groups (T8), medical complications (T11), personality (T12), self-shame (T13), social impact (T14), pregnancy (T16), gender differences (T19), AN (T20), hormones (T21), perfectionism (T28), body dissatisfaction (T31), cognitive avoidance (T36), genetics (T37), weight change (T38), physical activity (T39), birth (T42), purge behavior (T43), medication (T45), and parental impact (T47).

Expected topic weights were considered to determine the overall popularity of the topic. The following 12 topics were in the top 25th percentile of the median topic weights: binge-eating diagnosis (T1), cognitive-behavioral theory (T2), online (T5), medical complications (T11), BN (T18), AN (T20), hormones (T21), dieting (T22), overeating (T29), body dissatisfaction (T31), syndrome (T32), and sexual orientation (T40). The results show that many ED studies on treatment have been conducted, given that three out of six topics in Group 4 (treatment) were classified as “high” in the overall popularity classification.

The following 12 topics were in the bottom 25th percentile of the median topic weights, meaning they have been understudied compared to other major topics: obesity (T4), fragile groups (T8), cost of illness (T10), personality (T12), social impact (T14), pregnancy (T16), self-esteem (T17), perfectionism (T28), weight change (T38), physical activity (T39), stigma (T41), and parental impact (T47).

4. Discussion

This study implemented bibliometric analysis and a text mining approach to answer three major research questions. To answer RQ1, this study identified the general characteristics of ED studies. We found that the number of articles published in Eating Disorders has grown steadily. This indicates that the importance of ED topics has escalated, and each paper published in Eating Disorders has received more attention from researchers than in the past.

The main goal of RQ2 is to identify how ED research was developed, and citation patterns were examined to answer three specific research questions. As the first step of citation analysis, this study pinpointed articles that received the most attention from fellow researchers interested in EDs in the first (1990–1999), second (2000–2009), and third decade (2010–2021) of the ED research and how those articles served as guidance on their own. Among the articles published in the first decade, articles concerning assessment tool development received many citations. In the second decade, systematic review and meta-analysis studies that summarize the past ED research outcomes and propose future research directions were cited frequently. In the third decade, the popularity of studies using systematic reviews and meta-analysis remained high, but internet-based studies also drew a lot of interest from academics. This finding implies that research that serves as the foundation for further investigations and summarizes previous research outcomes is widely cited. However, such citation patterns may change over time.

Secondly, the author collaboration network was examined. The author collaboration network allows tracing collaborative efforts devoted to ED research. This result could show how knowledge is disseminated among researchers in developing ED research and the researchers who played a critical role in spreading knowledge. Specifically, we discovered four major hubs of the ED research in the author collaboration network. The prolific authors were centered in the network.

The final step of citation analysis was co-citation network analysis. The co-citation network reveals the key articles or documents that establish the foundation of ED research. In addition to academic research published in academic journals, many studies frequently cited all editions of handbooks of “ Diagnostic and Statistical Manual of Mental Disorders ” by the American Psychiatric Association. This handbook is commonly used in the United States for psychiatric illness diagnosis. High centrality scores of these handbooks indicate that ED diagnosis is an important part of the ED research. By examining the associations among these cited references, this study also discovered salient research themes that underpin ED research. One stream of research themes was related to ED-related theories and tool development, and the other was related to the diagnosis and treatment of ED. This implies that articles on eating disorders are concerned with both the theoretical and clinical features.

To answer RQ3 regarding the research topic landscape, this study applied topic modeling and topic network analysis. We discovered the 47 most outstanding topics and the associations among these topics by examining the similarities among the ED research topics. As a result of the topic clustering, we found that ED researchers were particularly interested in the relationships between key EDs and risk factors. Based on the keyword network analysis, Shah, Ahmad, Khan, and Sun [ 19 ] discovered that BN and AN frequently appeared in the top 100 ED articles that are frequently cited. Alongside this previous finding, this study discovered that ED topics played an important role in the research topic clusters by linking ED-related risk factors. As a result of topic clustering, we found that EDs were studied in different contexts and variables. Many BED studies, for example, focused on eating behaviors and dietary patterns, while the effects of family-related factors on ARFID were often examined. Moreover, many AN studies focused on birth-related issues and various types of abuse were examined to comprehend BN.

Beyond that, our study revealed both snapshots and the evolution of research topics related to EDs frequently studied by researchers. This study utilized two indicators, overall topic popularity and historical trends of topic popularity, to demonstrate the progress of research development for specific research topics and track the varying popularity of each research topic over time. Higher societal and academic demands on a particular subject may lead researchers to investigate the related topic more actively than in the past. A recent bibliometric study on ED research [ 99 ] revealed that ED researchers’ interest in ED treatment has been steadily increasing. Compared to previous findings, our study can demonstrate more specific results. For example, we discovered that cognitive-behavioral theory is popular among ED researchers and its popularity is growing. In addition, we found that the overall popularity of AN was high and the popularity of this topic tends to be constant. The overall popularity of BN and BED were high, but weights of these topics tend to decrease over time. On the contrary, the overall popularity of ARFID was moderate but the popularity tends to increase over time. This result indicates that AN, BN, and BED were extensively investigated. However, BN and BED were less studied than the past as interest in ARFID grows. According to previous research in India [ 16 ], AN was the most extensively studied in India ED literature, followed by BED and BN. Similar to our findings, the share of BN research decreased over time, while the popularity of AN and BED increased significantly [ 16 ]. Based on our findings, young researchers may need to pay closer attention to these research topics, which have received more attention from ED researchers than in the past. In contrast, some topics were understudied and thus had much room for contribution, which requires more attention from researchers for the sustainable and continuous development of ED research.

5. Conclusions

This study aimed to illustrate the evolution of the articles of Eating Disorders , a leading peer-reviewed, SSCI-indexed journal for nutrition and dietetics, psychiatry, and psychology since 1990, by applying a computer-assisted bibliometric approach combined with text mining. In the process, we analyzed the major attributes of the journal, including authors, citations, and characteristics of research topics, and compared the results over three decades.

Our summary of key articles and authors in the field may facilitate a search for fundamental concepts or results prevalent in the previous ED research. Our findings regarding the research topic network demonstrated the topics that researchers and clinicians frequently considered together. For instance, a particular risk factor, such as abuse, was often studied together with BN. Based on this result, researchers and clinicians may connect the dots with regard to the evaluation of particular risk factors in different types of EDs that are understudied. Our findings concerning changes in topics published across three decades of the articles demonstrated that the popularity of research topics has evolved over time. Often the researchers choose research topics from the socially sensitive and pressing issues. Given that research topics that are actively studied can demonstrate the socially relevant ED issues within each time period, our results can benefit researchers to comprehend specific ED issues that are considered important. Clinicians and researchers can also use the summary to identify important topics related to EDs that have been continually studied by researchers or important but understudied topics for further development in the field.

Despite contributions, our study had several limitations and thus we encourage future research directions to overcome the limitations of this study. Firstly, this study chose only one journal for analysis. However, as mentioned in the methodology, there are many prestigious ED-related journals and other journals that publish ED studies. Hence, our findings may not be representative. Still, our findings can be important empirical evidence to understand ED research trends over time. Secondly, this study utilized the machine learning algorithm to identify salient ED-related research topics and to detect the relationships among them. This approach can demonstrate which topics were frequently studied together in the empirical research. However, this approach may not be consistent with the existing studies grounded on the formal classification system and frameworks. Hence, future studies need to compare the results derived from the machine learning approach and expert classifications. Thirdly, since bibliometrics are highly influenced by the quality of the database, our results could have been similarly influenced as well. For instance, WoS does not provide links or information to track authors who may have changed their names. This study focused on author collaboration networks rather than examining the general statistics of the authors to overcome this problem. Future studies need to examine the impact of authors in the ED research. Finally, we analyzed the articles according to their titles, keywords, and abstracts using an automated text mining approach. Although, such data points contain essential information about the articles and offer a good summary, more specific information (e.g., methodology used and participant profile) was inaccessible and should be considered in future analyses of the development of studies on EDs.

Funding Statement

This work was supported by Incheon National University Research Grant in 2021.

Author Contributions

Data curation, E.P. and W.-H.K.; Formal analysis, E.P. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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103 Eating Disorders Essay Topics

🏆 best essay topics on eating disorders, 📚 eating disorders research paper examples, 👍 good eating disorders research topics & essay examples, 🎓 most interesting eating disorders research titles, 💡 simple eating disorders essay ideas, ❓ eating disorder research questions.

Essay on Eating Disorders in Adolescents
Anorexia Nervosa and Bulimia Nervosa
Eating Disorders: Diagnosis and Treatment
Eating Disorders: Types and Causes
“The Globalization of Eating Disorders” by Susan Bordo
The Impact of Media on Eating Disorders
Anorexia Nervosa: Signs and Symptoms, Treatment
Treatment of Eating Disorders Eating disorders are major health challenges currently and in the future if appropriate measures are not taken, so each individual should take a closer look at health issues.
Effect of Social-cultural Factors on Eating Disorders Research however shows that women get the disease at a lower age compared to men, with most of them beginning at adolescence.
Normal Dieting and Eating Disorders Healthy dieting behaviors are essential for people’s health and well-being. This paper discusses the difference between normal dieting and eating disorders.
Anorexia Nervosa: Treatment of Eating Disorders The main goal of treatment for patients with anorexia nervosa is to restore healthy nutrition, which cannot be achieved through pharmacological treatment.
Behavioral Addictions: Gambling, Eating Disorders, Shopping Gambling, shopping, and internet addiction are complicated issues that can be difficult to handle owing to a variety of economic and political variables.
Psychosocial Risk Factors for Eating Disorders by Keel and Forney Idealization of thinness and subsequent issues with body image and weight are emphasized by Keel and Forney in the findings.
Anorexia Nervosa Among Eating Disorders in Adolescence Anorexia nervosa is characterized by an incessant desire to be thin, hence the unhealthy eating behaviors that include starving.
Eating Disorders and Therapeutic Support Eating disorders are significant mental and physical diseases that entail complicated and harmful interactions with food, feeding, exercising, and self-image.
Eating Disorders Among Athletes The pressure from the necessity to become successful is one of the major factors contributing to the emergence and development of eating disorders in athletes.
Social Control in Eating Disorders The need for food is a basic need aimed at maintaining homeostasis and obtaining the energy and nutrients necessary for life.
Anorexia Nervosa & Bulimia Nervosa Anorexia nervosa and bulimia nervosa are both eating disorders; due to the peculiarities of the course of disorders, it can sometimes be difficult to distinguish them.
Eating Disorders and Programs That Address Body Image Issues The paper states that excessive weight and disordered eating are significant public health issues in America and other western countries.
The Scoff Questionnaire: Risk of Eating Disorders The paper discusses a method to identify children at risk of eating disorders. The children were provided with both relevant referrals and treatment.
Eating Disorders and Social Interactions The paper indicates that social surroundings can make people feel insecure and push towards the development of eating disorders.
Eating Disorders: Finding the Right Treatment An eating disorder is becoming a significant health concern among people. There are many factors connected to the root cause of eating behavior.
Eating Disorders: “Out of Control?” by Claes et al. The study “Out of control?” by Claes et al. aims to investigate variations between restrictive and bingeing/ purging eating disorders.
Food Allergies and Eating Disorders Along with food allergies, mental health disorders are widely spread diseases. Eating disorders, such as anorexia, bulimia nervosa, and binge eating, are common among young women.
Media Effects on Eating Disorder Symptoms In terms of modern technology-based society, media exposure has significantly increased its influence and role in the lives of its large audience.
Bulimia Nervosa Diagnosis and Procedural Plan The patient has been showing the tendency to vomit after every instance of food intake, which is the primary sign of bulimia nervosa.
Obsessive-Compulsive and Eating Disorders in Children In both OCD and ED, developmental milestones are crucial to consider because they can help indicate points of positive versus adverse health.
Swan’s Case as an Example of an Eating Disorder Being focused on success in ballet and becoming a recognized dancer, Swan demonstrates anxiety because of the possible weight gain.
Teen Anorexia: Mental Illness and an Eating Disorder Adolescents have increasingly been diagnosed with anorexia. They often have a nervous type of pathology, which is a psychological illness and is accompanied by an eating disorder.
Eating Disorders in Adult Women This paper discusses eating disorders in adult women and treatment alternatives to reverse the health care challenge, which is threatening the health of this group.
Orthorexia as an Eating Disorder in the DSM Adequate nutrition ensures quality of life, including the level of health and the body’s ability to cope with physical, mental, and psycho-emotional stress.
Eating Disorders Like Bulimia Nervosa and Anorexia Nervosa Though the loss of weight might be a positive aspect of healthy diets, people with orthorexia Nervosa do not have a disordered body image nor a determination for thinness.
Binge Eating Disorder: Information for Patients The paper highlights Binge-eating disorder as a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating.
Genetic Factors as the Cause of Anorexia Nervosa Genetic predisposition currently seems the most plausible explanation among all the proposed etiologies of anorexia.
Orthorexia Nervosa and Eating Disorder Orthorexia nervosa is becoming a serious problem for the patient’s physical and psychological health, hence the attention of nutritionists should be focused on studying this disorder.
The Problem of Anorexia Among College Students Anorexia nervosa and eating disorders in college students and adolescents are the problems that require immediate intervention.
Eating Disorders: Why Do We Need to Control Our Nutrition? People with confirmed diagnoses of eating disorders need qualified help from specialists since neglecting a healthy diet is fraught with dangerous health outcomes.
Anorexia Nervosa: History, Diagnosis and Treatment Anorexia nervosa among the eating disorders which is considered in the psychiatric illness. There are categories that have been advanced in the diagnosis of this illness.
Plausible Causes for Male Eating Disorders These days, however, things have changed significantly and out of five million Americans who suffer from eating disorders each year the percentage of males is tangible.
Anorexia Nervosa as a Brain Disorder Anorexia nervosa is an eating disorder characterized by an uncontrollable desire to be thin, low weight, food restrictions, and a fear of gaining pounds.
Anorexia Nervosa, Its Etiology and Treatment One of the eating disorders that affect a significant number of young individuals nowadays is anorexia nervosa.
Anorexia Nervosa: Perspectives and Treatment The purpose of this paper is to review the causes of anorexia nervosa and to propose a treatment plan for patients experiencing this health problem.
Anorexia Nervosa: Psychological and Physiological Therapy The design of therapy of anorexia nervosa needs to incorporate both psychological and biological components so the patient could resume proper dieting and gain weight.
Inpatients’ Eating Disorders and Countermeasures This paper explores the efficacy of meal supervision, patient and nurse education as the tools for improving the efficacy of nutrition, and enhancing patient outcomes.
Eating Disorders in Adult Population The major part of this paper is the design of the group proposal about group therapy and its application in the eating disorder in adult population.
Theoretical and Methodological Considerations for Research on Eating Disorders and Gender
Body Dissatisfaction and Eating Disorders
Eating Disorders Among Different Cultures
Causes, Effects, and Solutions to Eating Disorders
Adonis Complex Eating Disorders
Are Eating Disorders Really About Food
Eating Disorders and the Treatment Applicable Effectiveness
Linking Eating Disorders With Genetics
Childhood Sexual Abuse and Eating Disorders
Nutrition Intervention for Eating Disorders
Photoshopping Images and How It Impacts Eating Disorders
Eating Disorders and Its Effects on the Lives and Relationships
The Correlation Between Social Media and The Development of Eating Disorders
Eating Disorders Affecting American Women
How And Why People Develop Eating Disorders
Theories Behind Eating Disorders: Negative Impact on Young Youth
Examining Eating Disorders and Social Learning Theory to Draw Useful Conclusions
Hidden Eating Disorders During Bodybuilding
Eating Disorders and Methods of Its Treatment
The Relationship Between Ghrelin and Eating Disorders
Body Image and Eating Disorders Among Young Ballerinas
Eating Disorders Are Common Among American Children
Fashion Triggers Eating Disorders
Bulimia and Anorexia: The Dangers of Eating Disorders
Cognitive Behavior Therapy and Eating Disorders
The Three Major Eating Disorders in the United States
Childhood Factors and Eating Disorders Symptoms
Causes and Analysis of Eating Disorders and The Theory of Social Learning
The Prevalence and Causes of Eating Disorders in the United States
The Role Of Social Identity In Eating Disorder
Why Do Athletes Struggle With Eating Disorders?
What Is the Connection Between Body Image and Eating Disorders?
Can Affirmations End Binge Eating Disorder?
Do People With Eating Disorders See Themselves Differently?
What Is Eating Disorder Most Common Among College Students?
How Does Beauty Standards Cause Eating Disorders?
Why Is Looking in the Mirror So Hard for People With Eating Disorders?
Do Athletes Struggle With Eating Disorders?
How Can a Patient Overcome an Eating Disorder?
Which Personality Trait Is Linked to Eating Disorders?
Can You Control if You Have an Eating Disorder?
What Kinds of Medicine Are Helpful to Patients With Eating Disorders?
Do Eating Disorders Have a Genetic Link?
Which Eating Disorder Is Most Likely to Be Helped by Antidepressants?
Can Perfectionism Translate Into Eating Disorder?
What Interpersonal Factors Can Cause Eating Disorders?
Is Clinical Depression Associated With Eating Disorders?
What Are the Four Main Psychological Emotional States That Associated With Eating Disorders?
Which Personality Type Is Most Likely to Have an Eating Disorder?
Can Stress Cause Eating Disorders and Depression?
Why Might There Be a Strong Connection Between Eating Disorders and Depression?
Which Eating Disorder Has the Highest Mortality?
Do Females Have the Same Rates of Eating Disorders as Males?
What Is the Most Important Part of Treating Eating Disorders?
How Does Social Media Influence the Prevalence of Eating Disorders?

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Eating Disorders Research Paper

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I. Overview of Eating Disorder Terms

II. Continuum of Health Related to Eating Disorders

III. Diagnostic Criteria

A. anorexia nervosa, b. bulimia nervosa, c. eating disorders not otherwise specified.

IV. Epidemiology

V. Psychological and Social Impairment

VI. Medical Complications

Vii. detection and assessment, viii. treatment, a. psychotherapy, b. medication, c. nutritional counseling, d. hospitalization.

IX. Prevention

I. Overview of Eating Disorder Terms

The word “nervosa” indicates that each of these conditions is a “nervous disorder.” Psychological difficulties are likely to be involved in the development of these disorders, and also are likely to be exacerbated by the eating-disordered behavior. “Anorexia” means “lack of appetite.” The hallmark feature of anorexia nervosa (AN) is failure to maintain a minimally normal body weight. The meaning of the term “bulimia” is “ox hunger,” or “hungry as an ox.” Bulimia nervosa (BN) is characterized by recurrent episodes of binge eating (i.e., eating large amounts of food accompanied by a sense of loss of control) and compensatory behaviors (e.g., purging, fasting, or excessive exercise). Overlap between the symptoms of these disorders occurs in some individuals. Furthermore, individuals may engage in disturbed eating behaviors and/or indicate intense body image disparagement, but not meet full criteria for anorexia nervosa or bulimia nervosa. Detailed information about diagnostic criteria are provided later in this research paper. It is important to note that eating-related behaviors may be best conceptualized as existing along a continuum ranging from “healthy” to “unhealthy” eating-related behaviors and body image.

II. Continuum of Health Related to Eating Disorders

The pursuit of and preoccupation with beauty represent a central feature of the female sex-role stereotype. Therefore, it is possible that attractiveness, and specifically body image, have a greater influence on self-concept for women than for men. Although standards of beauty have varied widely across time and cultures, the mass media have contributed to the development of a more uniform standard of beauty.

Unfortunately, the current images of women that are portrayed in the media often represent unrealistic weights and shapes for most women. In a classic study, Garner and colleagues demonstrated a consistent decrease in body weights and measurements of two (albeit arguable) standards of beauty (e.g., Miss America pageant winners, and Playboy centerfolds) over two decades (1950s to 1970s). Fashion models are now 23 % thinner than average women, compared to 8% thinner than average woman three decades ago. Indeed, models who depict the in-vogue “waif” look are likely to have a body weight consistent with criteria for anorexia nervosa.

Given the preponderance of images of thinness as the ideal for beauty that are depicted in the media, it is not surprising that many females would perceive their bodies as inadequate. Because women naturally have more body fat than men, even those who are of normal body weight may judge themselves as overweight. In a recent national survey, over 40% of females reported having a negative body image. Although almost one half of young girls reported wanting to lose weight in one survey, only 4% actually were found to be overweight. Women are far more likely to rate their ideal figure to be significantly thinner than actual size than are men.

Therefore, perceptions that one is overweight may be potentially more distressing for women and may lead to attempts to control body weight and shape through methods such as dieting. Female college students report dieting at much higher rates than their male counterparts. In a recent large-scale national survey data from the Centers for Disease Control and Prevention, containing a sample of over 60,000 adults, 38% of female and 24% of male adults reported to be trying to lose weight, and 44% of females versus 15 % of males in high school sample of over 11,000 students reported to be trying to lose weight.

The high prevalence rates of negative body image attitudes and dietary behaviors found among females has been referred to as “normative discontent.” Therefore, although not necessarily “healthy,” it may in fact be “normal” for women in Western cultures to hold disparaging views toward their bodies and to engage in activities aimed at modifying their weight and shape. However, body image disparagement and dieting behaviors may pose as risk factors for the development of an eating disorder. Initial degree of body image dissatisfaction has been found to predict increased eating disturbance in longitudinal studies of adolescent girls and to predict eating disordered behavior in adults. Similarly, the interaction between body image and other risk factors (e.g., pressure for thinness) increased probability of reporting eating disturbance in female athletes. In a study of adult ballet students, body dissatisfaction and dietary restriction were found to predict eating-disordered symptoms.

Therefore, individuals who derive self-esteem primarily or exclusively based on the perception of body image may be at increased risk for development of an eating disorder. It has been argued that individuals who develop eating disorders unquestionably accept and internalize societal messages about thinness as the ideal for female attractiveness. Excessive dietary restraint, often used as a means to modify body weight and shape in an attempt to more closely correspond to a thin ideal of beauty, has been posited to increase the potential for development of binge eating. Secondary symptoms of semi-starvation resulting from prolonged dietary restriction or fasting, such as increases in preoccupation with food, urges to binge eat, and depressed mood, may lead to further exacerbation of body image disparagement and disturbed eating. Although body image concerns and dieting practices are commonplace for many women, when body image disparagement and eating disturbances become extreme and begin to interfere with functioning or to compromise health, an eating disorder may be diagnosed.

Although the symptoms of the various eating disorder syndromes overlap considerably and often are characterized as along a continuum, classification of specific eating disorders is based on criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

The primary distinguishing feature of anorexia nervosa (AN) is the refusal to maintain a minimally normal body weight (i.e., at least 85% of expected body weight considering age and height). Despite their excessively low-weight status, individuals with AN exhibit intense fear of gaining weight. Such individuals experience their body weight or shape in a distorted manner (e.g., size distortion) and often indicate intense distress regarding body image. Body weight or shape unduly influences self-evaluation, often being the primary determinant of self-esteem. Absence of three or more consecutive menstrual cycles (i.e., amenorrhea) is also required to make a diagnosis of AN. Perhaps the feature that presents the greatest challenge in accurately assessing and effectively treating this disorder is the adamant denial of the seriousness of maintaining an excessively low body weight. Individuals with anorexia nervosa may also engage in recurrent binge eating and purging (i.e., self-induced vomiting, abuse of laxatives, or diuretics), which is classified as the binge eating/purging subtype of AN. Absence of recurrent binge eating and purging characterizes the restricting type of AN.

Within the past two decades bulimia nervosa (BN) only has been recognized as a distinct clinical disorder. The primary feature of BN is recurrent binge eating (i.e., eating large amounts of food in a short time period accompanied by a sense of loss of control) followed by methods of inappropriate compensation. Compensatory methods include purging (i.e., self-induced vomiting, or abuse of laxatives, or diuretics), fasting, or excessive exercise. Symptom frequency for a diagnosis of bulimia nervosa entails binge eating and compensatory behavior(s) occurring on average at least twice a week for a 3-month period. Perception of body shape and weight unduly influencing self-evaluation also is required for the diagnosis of BN. A diagnosis of BN is not given to individuals who receive a diagnosis of AN, because that diagnosis takes precedence. Subclassification of BN is based on type of recurrent compensatory methods, referred to as purging and nonpurging types.

A large number of individuals engage in disturbed eating behaviors, but do not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa, in which case a diagnosis of eating disorder not otherwise specified (ED-NOS) may be appropriate. Examples of symptom constellations that might meet the criteria for ED-NOS include bulimic behavior occuring less frequently than two times per week or purging in the absence of binge eating behavior. Another example of ED-NOS, binge eating disorder (BED), which is characterized by recurrent binge eating in the absence of compensatory behaviors, has been listed in the appendix of DSM-IV as a diagnosis warranting further research.

IV. Epidemiology of Eating Disorders

Although increasing prevalence combined with increased recognition of eating disorder problems for women has contributed to the perception that eating disorders have become an “epidemic,” this is not supported by epidemiological research. However, the high prevalence of eating disorders is well documented, with women representing the majority of those afflicted. Although these disorders are most commonly seen in women, approximately 5% to 10% of individuals who develop anorexia nervosa or bulimia nervosa are men. Research on AN and BN indicate that these disorders are most often found among Caucasian adolescent and young adult females in industrialized countries espousing the ideology of Western culture. The most recent figures indicate that from .10% to 1.0% of young females have AN. Prevalence rates are higher for BN, ranging from 1% to 3% of young women when using stringent diagnostic criteria.

Increased rates of anorexia nervosa and bulimia nervosa have been associated with certain professions (e.g., fashion models, ballet dancers) that emphasize thinness. Elevated rates of eating disorders have also been found among individuals involved in competitive athletics, particularly those in which maintenance of a low body weight is competitively advantageous (e.g., gymnastics, running, wrestling). It is possible that participation in such activities poses as a risk factor in the development of an eating disorder. Alternatively, some individuals with established eating disorders (or body image disparagement) may be drawn to such activities, in order to use compulsive exercise as a socially condoned form of dietary compensation in efforts to maintain or achieve a low body weight.

Psychological and Social Impairment

Body image disturbance is a central feature of anorexia nervosa and bulimia nervosa. Body size overestimation among individuals with AN and BN has been empirically documented. Among individuals with AN and BN, marked fluctuations of body image disparagement frequently occur, which may precipitate and/or result from intensified eating disordered behavior.

Increased psychological distress often is found among individuals with an eating disorder. Relatively high rates of comorbid psychopathology (especially affective disorders) have been reported for samples of individuals with anorexia nervosa. In addition, problems with past or present substance abuse are not uncommon among eating disordered samples. Individuals with eating disorders also display a pattern of cognitive abnormalities, such as a dichotomous thinking style. Low self-esteem and difficulties in interpersonal relationships are often reported by individuals seeking treatment for eating disorders.

The extent to which these psychological and social difficulties may be involved in the development of eating disorders remains unclear and could be clarified by prospective, longitudinal studies. However, it is important to note that many of these symptoms are ameliorated with treatment that results in reduction or cessation of eating disordered behaviors.

Several thorough reviews are available providing detailed accounts of adverse medical sequale of eating disorders. Although prevalence rates for anorexia nervosa (AN) are relatively low, the medical consequences can be grave. Mortality rates for AN at long-term follow-up range from 6% to 20% and up to one-fourth of anorectic individuals develop severe, chronic disabilities resulting from the disorder. The results of prolonged malnutrition found in AN include certain visibly recognizable symptoms, including obvious weight loss, dry hair and skin, alopecia (i.e., hair loss), and excessive lanugo hair (e.g., fine, downy body hair). Cold intolerance, sleep disturbances, headaches, and fatigue are common among individuals with AN. Prolonged protein depletion resulting from chronic malnutrition results in additional symptoms, detectable through laboratory examinations. Abdominal pain and bloating, and constipation are often reported by individuals with AN, which may be due to delayed gastric emptying. Constipation also may result from laxative abuse and starvation. Among the most serious consequences of AN are osteoporosis, growth stunting, and cardiac complications.

Although mortality rates for bulimia nervosa are low, fatalities have been documented as a result of gastric rupture after binge eating, esophageal perforations (i.e., Boerhooves syndrome), and cardiomyopathy due to chronic ingestion of Ipecac. Fluid loss due to recurrent purging can result in dehydration and electrolyte imbalance, potentially leading to cardiovascular disturbances. Recurrent vomiting may result in esophageal erosion. Constipation and abdominal bloating and pain may result from binge eating.

Several factors contribute to the secretive nature of eating disorders, including denial of the seriousness of symptoms, embarrassment regarding the symptoms, and/or fear of the consequences of relinquishing the disturbed behaviors (i.e., potential weight gain or increased anxiety). Consequently, eating disorders often go unnoticed and can be challenging to assess, although warning signs are often present. Secretive eating, refusal to eat in public, and frequent dieting may be indicative that an individual is struggling with some form of an eating disorder; these symptoms are usually found in individuals with either anorexia nervosa or bulimia nervosa. Behavioral indications of purging behavior include spending excessive amounts of time in bathrooms or frequently going to a bathroom immediately following eating. Excessive or compulsive physical activity may also indicate the use of exercising as a form of dietary compensation. The use of stringent diets or fasting for extended periods of time may signal the presence of an eating disorder. Substantial changes in body weight, including weight fluctuations, or continued weight gain or loss may also be indicative of an eating disorder.

Emaciation is usually the primary physical indication of anorexia nervosa. Measurements of body weight obviously aids in determining if an individual is below 85% of expected weight; however, individuals with AN may drink excessive amounts of fluid or wear concealed weights in an attempt to manipulate assessment of body weight. Overactivity (e.g., continuous body movement or pacing) is often observed among individuals with AN. As described above, some of the additional detectable signs of AN include dry skin and hair, lanugo, and alopecia. Ammenorhea may also indicate the possibility of AN, although the use of oral contraceptives may complicate the detection of this symptom.

Although frequent weight fluctuations may signal the presence of bulimia nervosa (BN), many individuals with BN are of normal weight and appear relatively healthy. Although BN is usually less easily detected than anorexia nervosa, certain signs may aid in its detection. One indication of recurrent self-induced vomiting, sometimes referred to as a “Russell’s sign,” is the development of callouses or scarring on the back of the hand resulting from abrasion during self-induced vomiting. This symptom may not be present in those individuals who primarily use alternative forms of purging (i.e., laxative, diuretic, or enema abuse), who have nonpurging BN, or who after prolonged vomiting have come to do so reflexively. Self-induced vomiting may also contribute to hypertrophy of the salivary glands, creating a swollen appearance of the neck and face (i.e., “puffy cheeks”). Although this symptom may be fairly pronounced in some women, it is not detectable in the majority of individuals with BN. Additional signs include the presence of small skin hemorrhages (i.e., facial petechiae) or conjunctival hemorrhages that may result from forceful vomiting. Dental enamel erosion, most pronounced on the inside surface of the upper teeth, is another indication of purging that may produce protrusion of dental fillings or discoloration (i.e., darkening) of the teeth. This symptom, which is easily detected during dental examinations, may be overlooked during routine physical examinations unless specifically assessed. Edema may be present for those who abuse laxatives or diuretics. Individuals with BN often present with complaints of “bloating,” constipation, or lethargy. Laboratory tests may be used to detect electrolyte imbalance, although such abnormalities are detected in only approximately 40% of individuals with BN.

Psychotherapy is commonly used in the treatment of eating disorders. One form of psychotherapeutic intervention, cognitive behavioral therapy (CBT) has been the most extensively studied. Based on the work of Beck for the treatment of depression, CBT is a time-limited, present-focused, solution-oriented form of therapy. This approach is based on “collaborative empiricism” in which the client and therapist actively work together using an experimental approach to resolve a specified problem. As applied to eating disorders, the primary focus is on modifying disordered eating behaviors and distorted cognitions about food, weight, and shape. A combination of behavioral techniques, cognitive interventions, and emphasis on relapse prevention are integrated in this approach. The efficacy of CBT has been demonstrated in several studies of BN. Favorable reduction rates of binge eating (ranging from 77% to 93%) and purging (74% to 94 %) have been reported for five of the most recent, large studies. Methods used in behavior therapy (BT) also are commonly integrated in CBT treatment for individuals with eating disorders. Studies comparing BT with CBT have generally demonstrated that the addition of cognitive interventions to behavioral methods are associated with similar or greater clinical gains.

The efficacy of an alternative type of psychotherapy, Interpersonal Psychotherapy (IPT), recently has been demonstrated in treating individuals with BN, as well as BED. IPT is time-limited, present-focused, and solution-oriented. IPT differs from CBT in that the emphasis of treatment is on modification of interpersonal interactions, rather than eating disordered behavior or cognitions.

Another therapeutic approach that has been investigated is supportive-expressive therapy, a short-term, nondirective, dynamically informed modality that conceptualizes core conflicts in terms of interpersonal issues. Although supportive-expressive therapy was found to be effective in reducing binge eating in this study, CBT was found to be associated with greater improvements in many aspects of eating disturbance and psychopathology, and a higher rate of remission in bulimic symptoms.

Alternative psychotherapeutic approaches to treating individuals with eating disorders recently have been well articulated, although no controlled outcome studies have yet to be conducted. The relative efficacy of psychodynamic therapy is unclear given the absence of empirical data. However, this approach may be beneficial for clients who have not derived benefit from less intensive interventions, such as CBT. Feminist therapists have convincingly argued for the importance of considering sociocultural and political issues in designing interventions for individuals with eating disorders. The potential efficacy of psychotherapeutic interventions incorporating feminist perspectives warrant future empirical investigation.

Although favorable results have been reported using psychotherapy, particularly CBT and IPT, several limitations of this body of research warrant discussion. Despite the substantial rates of symptom reduction and remission reported in these studies, it is important to note that approximately one-third to one-half of participants remained symptomatic at the end of treatment. Furthermore, strict inclusion criteria utilized in research studies such as these limit the generalizability of the findings, which may not be representative of the majority of individuals seeking treatment for bulimia nervosa. Data are not available regarding the relative efficacy of individual versus group administration of CBT or IPT. Additional research comparing the relative efficacy of alternative psychotherapeutic approaches is warranted. However, this body of literature provides support for the efficacy of using solution-focused psychotherapeutic interventions such as CBT and IPT in treating individuals with BN.

Despite the fact that anorexia nervosa (AN) has received attention from clinical researchers for several decades, little empirical data are available regarding efficacy of psychotherapy for this disorder. To a large extent, the paucity of AN treatment research is attributable to the logistical difficulties involved in implementing controlled studies with this population. Only four outpatient psychotherapy studies of AN have been reported to date, with some suggestions of effectiveness. The potential benefits of using behavioral modification programs (which overlap to a certain extent with CBT interventions) during inpatient hospitalization has received support in several studies. Although limited empirical data are available regarding the relative efficacy of individual versus family therapy in treating individuals with eating disorders, some therapists have convincingly articulated the potential benefits of using family approaches in working with eating disordered individuals. Some empirical support exists for using family therapy for younger individuals with AN. Additional research is needed to investigate various psychotherapeutic interventions for treating individuals with AN, and relapse prevention strategies, given the substantial rate of relapse in those who initially respond to treatment.

Antidepressant medications have been found to effectively reduce binge eating and purging symptoms in several bulimia nervosa studies. Four controlled trials involving outpatient samples have demonstrated the superiority of serotonin-reuptake inhibitors (SRIs) in comparison to placebo in reducing bulimic symptoms, although one impatient trial failed to support added benefit for the drug. These medications generally have been found to be well-tolerated. Therefore, fluoxetine hydrochloride (Prozac) administered at daily doses of 60 mg (higher than the recommended dose of 20 mg used to treat individuals with major depressive disorder) is considered by some the first choice for pharmacotherapy for BN. The use of tricyclic antidepressants or monoamine oxidase inhibitors also is supported by research. Although the side effects of these classes of medications may be more problematic for many individuals than the SRIs, they may be beneficial treatment strategies for those individuals who do not respond to the use of SRIs. In addition, some clinicians prefer the second generation tricyclics, such as despiramine, as the initial intervention owing to the lower cost of the medication.

Despite the relative efficacy of antidepressant medications compared to placebo in reducing bulimic symptoms, it is important to note that rates of bulimic symptom remission at end of treatment range from 4 % to 20% in most studies. These rates of symptom remission are lower than those reported in psychotherapy outcome studies. Augmenting psychotherapy with pharmacotherapy may seem indicated in some cases, although results from research on this are mixed. Three studies have reported no benefit to adding antidepressant treatment regimen to psychotherapy on outcome in eating variables, and the results are equivocal in one study. There is some suggestion that certain other symptoms, such as those of depression, may benefit from the combination of interventions.

Little empirical data are available from investigations of the benefits of pharmacotherapy in promoting weight restoration in individuals with anorexia nervosa. Approximately a dozen controlled trials have been conducted on variety of medications, yielding often ambiguous results. Benefits have been demonstrated for the use of amitriptyline in one study and for cyproheptadine in two studies. However, the majority of placebo-controlled studies, investigiating the efficacy of these and other medications (e.g., antipsychotics, clonidine, cisapride, lithium, and tetrahydrocannabinol) have not demonstrated efficacy in promoting weight restoration.

Nutritional counseling is often regarded as a necessary therapeutic component for treatment of individuals with eating disorders. Healthy meal planning is the cornerstone of this approach, which involves providing objective nutritional information about the types and amounts of food necessary to achieve or maintain adequate nutrition and healthy weight. Behavioral strategies are also employed to increase the likelihood of successfully adhering to nutritional recommendations. Nutritional counseling is essential for the treatment of anorexia nervosa, which requires an increase in caloric intake to promote gradual weight restoration at a rate of I to 3 pounds per week. Nutritional counseling is also useful for treating BN to help stabilize the dietary chaos that often promotes binge eating.

At times sufficient medical danger exists (e.g., dehydration, severe electrolyte imbalance, gastrointestinal bleeding, severe emaciation, suicidal ideation) to require inpatient hospitalization. Goals of hospitalization include interruption of weight loss (usually if less than 70 to 75% of ideal body weight), progress toward restoration of healthy body weight, cessation of binge eating or vomiting, treatment of medical complications, and treatment of comorbid conditions (e.g., depression or substance abuse). Hospitalization also may be indicated if clinical benefits are not obtained from adequate outpatient therapy. This may be required for severely underweight individuals who, evidence starvation-induced impaired cognitive functioning.

Day treatment, or partial hospitalization, may be recommended following inpatient discharge or as an alternative to hospitalization. This type of treatment allows patients to receive therapy during the day without requiring an overnight stay. This type of treatment is more economical than inpatient hospitalization and is less socially disruptive. Additional benefits of this type of treatment include allowing the patient to pursue work or education while obtaining intensive treatment, and providing a structured atmosphere during meal times.

IX. Prevention of Eating Disorders

Given the prevalence of these disorders and the seriousness of the psychological and medical sequelae, the prevention of eating disorders is an important area that requires increased attention. Such efforts often involve providing psychoeducational information in school-based settings aimed at reducing unhealthy dieting behavior and enhancing body acceptance, often involving critical analysis of messages conveyed through mass media. A number of eating disorder studies have been conducted to investigate the effectiveness of primary prevention programs. However, an unfortunately consistent finding across such studies is that although knowledge about eating disorders often increases, behavioral changes (i.e., reductions in unhealthy dietary practices) have not been detected among participants. Failure to observe the desired behavioral outcomes of primary prevention programs may be attributable, in part, to a variety of methodological challenges, including the validity of self-report assessments and the relatively low baseline frequency of eating disordered behaviors (e.g., self-induced vomiting) among the general adolescent population. However, it is also possible that, in order to have a significant impact, prevention efforts may need to be delivered to individuals at a younger age (i.e., elementary school). Increased understanding of the complex etiology of anorexia nervosa and bulimia nervosa may be required in order to develop more comprehensive and effective prevention strategies. In addition, relatively little attention has been devoted to investigating the effectiveness of secondary prevention of eating disorders. As such, effective strategies to assist in identifying individuals who are experiencing initial symptoms of an eating disorder and facilitating appropriate treatment remain an important area to be developed.

Stringent diagnostic criteria show that the prevalence for any single eating disorder is rather low. However, combining prevalence rates across various types of disorders reveals that up to 5 to 10% of women may be afflicted with a diagnosable eating disorder (i.e., AN, BN, or ED-NOS). Serious medical, psychological, and social consequences are associated with these disorders.

The treatment of individuals with eating disorders often requires a multifaceted approach (e.g., psychotherapy, pharmacotherapy, nutritional counseling, medical management) involving members of several professional disciplines (e.g., dieticians, psychologists, psychiatrists, internists) and various settings (e.g., inpatient, outpatient, day treatment, residential).

Literature on the treatment of these disorders indicates that substantial progress has been made in the last few decades. However, a sizable subgroup of individuals with either anorexia nervosa or bulimia nervosa do not adequately respond to established therapies, or do respond but subsequently relapse. Much additional work is needed in predicting treatment response, matching individuals to treatments, and developing relapse prevention strategies. Furthermore, effective primary and secondary prevention strategies remain to be established.

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Published: 20 August 2024

Views and experiences of eating disorders treatments in East Asia: a meta-synthesis

See Heng Yim 1 , 2 &
Ulrike Schmidt 1 , 2

Journal of Eating Disorders volume 12 , Article number: 120 ( 2024 ) Cite this article

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Introduction

Although there have been qualitative meta-syntheses on experiences of eating disorders treatments, there is a paucity of syntheses specifically examining the perspectives and experiences of eating disorders treatments (ED) in East Asia (EA). Such synthesis could facilitate a better understanding of culture-specific perspectives and experiences. This review complements a quantitative scoping review published on ED treatments in EA (Yim & Schmidt, 2023), where most interventions reviewed focused on cognitive behavioural therapy (CBT) and internet interventions. The present meta-synthesis summarises stakeholders’ views on treatments and to synthesise clinical and research recommendations.

A systematic search of five databases and a citation search were conducted to identify relevant studies and data were analysed using thematic synthesis. Out of the 301 studies found, a total of 12 papers were included in the analysis.

A diverse range of treatments, such as family therapy, paediatric/psychiatric inpatient care, CBT, and counselling, were discussed. Three overarching themes were identified: Delineating Physical and Psychological Recovery; ‘I am not alone in this battle’; and Barriers to Change. The themes further delve into the various obstacles to recovery, including financial concerns and limited access to professionals and services. Culture-specific factors include family obligations and promoting family harmony. Balancing interdependence and independence from one’s family, as well as understanding family body ideals versus broader societal body ideals, are important considerations in ED interventions.

Some themes paralleled other qualitative syntheses, highlighting improved family relationships, perceived authoritarianism in treatments, and financial barriers. The review extends beyond the previous findings, revealing nuanced factors like family roles, cultural values, and norms. Clinical recommendations include incorporating family context in treatment and considering cultural influences on body image ideals. Capacity building through telemedicine and increased training is essential for advancing ED treatment in East Asia. Continued research is needed to better understand and treat people affected by ED in EA.

Plain English Summary

Research on eating disorders (EDs) treatment mainly focuses on Western countries, with little exploration of experiences in East Asia. To fill this gap, we reviewed 12 studies on the perspectives of individuals, families and clinicians regarding EDs treatments in East Asia. Our synthesis identified three main themes:

Physical and Psychological Recovery : Effective treatment needs to address both physical and mental aspects of recovery.

Finding Support – ‘I am not alone in this battle’ : Many individuals find strength in knowing they are not alone.

Barriers to Change : Obstacles like financial difficulties, limited EDs knowledge from professionals, and cultural factors can hinder recovery.

Cultural-specific factors such as family obligations and maintaining family harmony can impact on treatment motivation and effectiveness. Balancing family’s wishes/ interdependence and personal aspirations/ independence can also be a challenge. Our findings highlight the need for culturally sensitive treatments. Expanding telemedicine and increasing provider training can also help overcome treatment barriers. In conclusion, understanding cultural and contextual factors is essential for developing effective support systems and improving ED treatment outcomes in East Asia.

Eating disorders (EDs) research has been historically centred in the Global North. However, in the past decade, more attention has been paid to non-WEIRD (Western, Educated, Industrial, Rich, Democracies) populations. Reviews report an increasing incidence of EDs in regions in East Asia (EA), where the prevalence of EDs may now be comparable to that reported in North America or Europe [ 1 ]. Young females are seen as an at-risk population for developing EDs in almost every country in EA. The exceptions include North Korea, because as of 2023, there have been no studies conducted in that country. There is also no epidemiological study on EDs in Mongolia [ 2 ]. Chen et al. [ 2 ] also report that in China, the prevalence of binge eating disorder (BED) exceeds that of bulimia nervosa (BN), with both being higher than the prevalence of anorexia nervosa (AN).

Different cultural factors have been hypothesised to contribute to the development and maintenance of EDs. Previous studies suggest that self-construal, which refers to how individuals define themselves in terms of independence from or interdependence with others, could influence treatment seeking when experiencing psychological distress [ 3 ]. Asians, who often endorse collectivistic values and exhibit interdependent self-construal, may articulate treatment goals in terms of benefiting their family. Another relevant concept is family harmony, particularly emphasised in ethnic Chinese culture, the largest ethnic group in EA. Values such as promoting interpersonal and family harmony and ‘saving face’ are seen as important and may affect help-seeking behaviours [ 4 ]. Contemporary EA societies face conflicting collectivistic and individualistic values where people grapple with bicultural contextual forces. Negotiating these conflicting value systems can lead to identity conflict, potentially serving as risk factors for body dissatisfaction and disordered eating [ 5 ]. Dysfunctional psychological individuation, the process of developing a sense of self and transitioning from hierarchical to symmetrical (more equal relationship between equal adults) parent-child relationships, is linked to the development of mental health conditions [ 6 ]. Additionally, values such as filial piety may hinder the process of individuation from the family [ 7 ].

Body image disturbance has been a core diagnostic criterion in the West. Research on body image dissatisfaction in EA has been mixed. Sing Lee [ 8 ] identified the presence of non-fat-phobic AN in EA, differentiating from the EDs phenotype in the West. Other studies have consistently identified high drive of thinness and body dissatisfaction in countries such as China [ 9 ] and South Korea [ 10 ]. Whilst earlier studies suggested that Westernisation is a factor in body image disturbance in EA [ 11 ], other researchers have challenged these findings. A 12-month prospective study found that Asian women reported more pressure and body comparison from social media depictions from Asian media when compared to Western media, suggesting that Asian media influences were more salient [ 12 ]. Other cross-cultural studies identified that Chinese American students have less body dissatisfaction than other American students [ 13 ]. That said, the impact of Westernisation may be reflected in the racialisation of body, where Asian Americans may be more distressed by certain body parts such as the shape of their eyes/nose, or their breast size [ 14 ]. Although it is difficult to directly compare East Asians living in the diaspora or as international students with those East Asians that are residing in their home countries, the research findings point to the nuanced influence of Westernisation on body ideals.

Policy, alongside cultural norms, can significantly influence individuals’ mental health and recovery. China’s historical One Child Policy (OCP) has been a focal point of research, examining how the policy led to an imbalanced gender ratio in China with more males than females, as well as how being an only child may impact social development compared to having siblings. Some studies suggest that only children may exhibit more self-centred and competitive behaviours [ 15 ], others report contradictory findings. For instance, Settles et al. [ 16 ] referenced the heightened pressure from parents onto their only children to excel academically, equating academic success with overall success [ 16 ]. Additionally, the systemic devaluation of females is evident, as seen in Zhejiang Province, China, where couples were allowed a second child only if the first child was a girl.

Yim & Schmidt [ 17 ] conducted a systematic scoping review on psychological treatments for EDs in EA. Compared to Europe and North America, there were significantly fewer EDs intervention studies. Out of the 18 published studies, most were feasibility or uncontrolled studies, but they generally showed good intervention acceptability and positive effects on ED symptoms. Notably, cognitive therapies were the predominant approach used, with family therapy largely absent in the literature despite being a first-line treatment for EDs in countries like the UK [ 18 ]. Qualitative studies in EA can complement quantitative findings. For instance, [ 7 ] described a culturally-adapted family therapy model based on the Micucci [ 19 ] approach. This model views the family’s response to the illness as a symptomatic cycle and aims to address family conflicts, including marital issues, which distinguishes it from ED-focused family therapies like Family-based treatment (FBT) and the Maudsley model (FT-ED). Additionally, the model focuses on promoting individuation of the young person from their family. Tan et al. [ 20 ] described the most helpful family involvement in the Asian context would be maternalistic, where family is a supportive, caring and loving, rather than paternalistic, which is seen as taking control of the decisions. Yim & Schmidt [ 17 ] also reported structural adaptations of EDs treatments such as having shortened treatment sessions for practical reasons, where healthcare is not free and specialist centres are far away in some regions in EA.

Qualitative synthesis provides a richer understanding that goes beyond understanding the effects of interventions on symptoms, and include stakeholders’ views, perceptions and experiences of treatments. To our knowledge, there is no qualitative synthesis of EDs treatment experiences nor professionals’ views of ED treatments in EA. A previous synthesis looked at experiences of family-based treatment (FBT) for AN among adolescents [ 21 ]. Themes such as relinquishing control ambivalently (initial treatment resistance, authoritative care), improved family relationships, and failure to address family issues were identified. Such synthesis can facilitate a better understanding of culture-specific perspectives of all stakeholders, which may lay a foundation for hypothesis-generation and testing in future EDs interventions research. Hence, the aim of this review is to synthesise the views and experiences of patients, families and healthcare professionals of EDs treatments in EA, with a particular focus on the cultural aspects influencing treatments.

The search was conducted according to the Enhancing Transparency in Reporting the synthesis of Qualitative research (ENTREQ) statement [ 22 ]. The search strategy was devised in consultation with a specialist librarian, and included both a database and citation search. Four English databases were comprehensively searched: Embase, Global Health, Ovid Medline, APA PsycINFO (any time till June 2024). As researcher SHY also understands Chinese, the Chinese research database was also searched ( https://oversea.cnki.net/kns/defaultresult/index ) with the search term eating disorders (饮食/进食失调) using subject headings search. Search terms were (eating disorder* or bulimia or anorexia or binge eating or disordered eating or ARFID or Avoidant Restrictive Food Intake Disorder) AND (China or Hong Kong or Taiwan or Macau or Macao or Mongolia or Japan or Korea or Chinese or Taiwanese or Mongolian or Japanese or Korean or east Asia or east Asian or far east) AND (qualitative or interview). Keyword search and subject heading search together with title/abstract search was done (see supplementary info for an example of search string).

Inclusion criteria .

Peer-reviewed qualitative studies on the views, experiences or perceptions of EDs interventions, from service providers, patients, or families in East Asia. Regions in East Asia include China, Hong Kong, Japan, Macau, Mongolia, North Korea, South Korea and Taiwan (Asia Society, https://asiasociety.org/countries-regions/east-asia ).

Articles published in English or Chinese.

Exclusion criteria .

Studies on the East Asian diaspora.

Descriptive studies or single case study without a clear qualitative data collection and analysis methodology, clinical opinion papers.

Books, dissertations, conference abstracts.

Data analysis and extraction

Screening and deduplication were done on Rayyan software [ 23 ]. Thomas and Harden [ 24 ] thematic synthesis method was chosen for its suitability in understanding people’s views and experiences of EDs treatments to inform clinical practice, as opposed to developing theories or models like grounded theory. As no previous reviews existed in this area, integrating existing studies in a review was crucial for informing future clinical practice and research. Unlike quantitative meta-analysis, which focuses on prediction, this method emphasises interpretive explanations. In this study approach, although the data search was systematic, the purpose of study inclusion was purposive rather than exhaustive, aiming for conceptual understanding rather than data saturation. SHY independently conducted the screening of the texts and discussed any uncertainties with US.

The analysis proceeded in several steps. Firstly, the first author, SHY, familiarised herself with the papers. Themes and all participants’ quotes from both the Results and Discussion sections of each paper were then extracted and coded line-by-line using QSR NVivo [ 25 ]. Additional information such as participant demographics, diagnosis, and research method were also extracted to preserve study context. Codes were then grouped and categorised inductively based on their meanings, with attention paid to draw out culture-specific themes. The free codes were grouped together hierarchically in NVivo and printed out where annotations were made by hand to help generate themes. The analytical theme generation process aimed to extend beyond the original study themes and was reviewed by the second author.

Quality assessment

The methodological quality of the included studies was assessed using the appraisal tool CASP Qualitative Studies Checklist (Critical Appraisal Skills Programme, 2018) (Table 1 ). The ten appraisal questions focus on research design, recruitment method, data collection, researcher/participant relationship, ethical considerations, data analysis, clarity of findings, and importance/value of the research. The authors of the checklist did not recommend scoring up the results but instead emphasised using the appraisal tool qualitatively. SHY completed the CASP and this was checked by US. The quality of the studies did not particularly impact on the theme generation, but instead provides context for the overall analysis.

Reflexivity

It is important to be aware of researchers’ biases and positionality in qualitative analysis. SHY is Chinese by ethnicity and was born and raised in Hong Kong. She completed her undergraduate and postgraduate studies in the UK and works in the National Health Service in the UK as a clinical psychologist, where intrinsically western and white-orientated models were taught and practiced. Therefore, she is aware of her background where on the one hand, she understands culture-specific issues in some parts on EA, on the other hand, she is in a slightly detached position professionally and geographically. US is a UK-trained psychiatrist who is originally from Germany and has extensive experience in EDs. She approached the research topic and data from the point of view of an EDs expert as well as using her experience of treating EDs patients from East Asia in the UK as well as collaborating with East Asian researchers. She is aware of her positionality as a White European woman and this allows her to discuss the cultural differences between East and West with SHY.

A total of 12 studies were included. However, two of the studies (Ma and Lai, 2006; Ma, 2008) were based on the same cohort of participants. In one of these papers, the research focus was on perceived treatment effectiveness, and in the other on experiences of treatment. Figure 1 shows the PRISMA chart. None of the Chinese language studies were qualitative studies on experiences of EDs interventions and hence all included studies were in English. Table 2.1 & 2.2 shows a summary of the study characteristics and extracted settings and themes. Overall, most studies examined people with AN except for [ 26 ] who included people with BN, purging disorder and night eating disorder, and [ 27 ] who included BN. One study examined parents’ views and perceptions of help for AN in Hong Kong [ 28 ], and two studies examined professionals’ views and perceptions of treating young people with AN in Taiwan [ 29 ]; [ 30 ]. The mean age of the participants interviewed was below age 30 for all patient-related studies. All studies were conducted in Chinese-speaking (Cantonese and Mandarin) regions of EA. The majority of the patients interviewed identified as females – one out of 69 participants in total across all studies identified as male.

PRISMA flowchart

Three main themes were identified.

Theme 1. Delineating physical and psychological recovery

People with lived experience of EDs described how treatment ‘ was helpful but [they were] not symptom free ’ ( [ 26 ]. In particular, participants often described the distinction between physical health and their psychological health, suggesting that recovery involves both components and that (inpatient) treatments seem to only support physical recovery. A participant noted, ‘ the only positive impact was physical health , others (were) all negative; but without that I would have already died.’ [ 31 ]. Another participant concurred, ‘I did not find the staff helped me with my anxieties about my weight…I was not helped psychologically , it was all about the physical improvements’ [ 28 ]. However, without psychological recovery, participants described their symptoms worsened post-discharge. For example, participant said ‘I think it [bingeing and purging becoming even worse after discharge] might be because I have gained lots of weight during the period of receiving inpatient care , but I could not psychologically accept it…thus…I started to fast badly , and after a while , my bingeing emerged and my urge to eat got even stronger.’ [ 28 ]. This view was shared among professionals as well. One dietician in Taiwan reflected that “ We should study psychology. Anorexia is not only physical’ [ 29 ].

On the other hand, there are other participants who described a full recovery (‘ [I] live like a normal person’ [ 28 ].

Theme 2. ‘I am not alone in this battle’

This theme includes three pairs of relational dyads – the patients in relation to their families, their therapists, and their peers.

Sub-theme 2.1. The dialectics of interdependence and independence

In the included studies, it appears that certain cultural values of interdependence and filial piety may provide a fertile ground for EDs to develop. As a participant (person with an ED) put it,

‘I wanted to have some freedom from my parents but I didn’t want to go against them. Their control/protection was benign , good for me , but it’s seamless and suffocating. I just need some space to make my own choice. Anorexia was part of my identity because eating and weight are the only things I have control over’ [ 4 ].

Mealtimes are seen as a non-negotiable duty especially if the older family members prepare the dishes. As mentioned by a Taiwanese woman with lived experience of an ED: ‘ mealtime was held to be sacred , reflecting the Chinese belief that eating works towards preserving harmony , cohesion , and unity in the family. Grandmother’s cooking and food serving signified her devotion to , and affection for , her children. The entire family was , in turn , expected to reciprocate their grandmother’s gesture by observing filial piety and obeying her rules about food and meals’ [ 4 ].

For some participants, the need to obey senior family members, fulfil family duties, and prioritise others’ needs may suppress their own needs and lead to internal conflicts: ‘ I should get more involved with my parent’s business , care more about how they feel and what they want’ [ 4 ]. The researchers speculated that this may also relate to traditional Chinese culture, where males are more valued than females, and daughters feel the need to live up to the family’s expectations when they are an only child. In these situations, healing involves individuation from interdependence and exploring self-identity to prevent relapse [ 32 ]. This quote illustrates this point: ‘ as I started seeing myself independent from my mum , I became more comfortable and no longer felt inferior to her… my bingeing and purging frequency reduced.’ [ 4 ]. Another participant from the same study described moving out of the family home as a turning point towards EDs recovery [ 4 ].

Nevertheless, the cultural value of interdependence can also serve as a protective and motivating factor towards recovery. Instead of citing personal reasons for recovery, some participants described their motivation to get better for their parents, influenced by the cultural value of ‘saving face’: ‘ … My anorexia was a face-losing thing…I felt like becoming too much a burden…I was eager to become normal again…so that I could save face for my parents’ [ 4 ]. When a participant looked back on the recovery, one discussed the cultural value that emphasises ‘the body is given by the parents’: ‘ I vomited the money you earned…. I hurt the body you have given me…again and again’ [ 26 ].

Similarly, recognising that the family will unconditionally accept them regardless of whether they manage to meet their parents’ expectations, can also be motivating. One participant described how her family will always stand by her side,

‘I really decided to walk out of this eating disorder swamp. I felt that , no matter what , my parents would love me , even when I’m vomiting and when I am the ugliest. Perhaps they couldn’t understand me , but because that’s me , they would accept this person unconditionally’ [ 26 ].

Therapy provides a space for the family to ‘ have a deeper chat’ and to facilitate a greater understanding of each other, improving the family relationships. This includes both the parent-child dyad as well as sibling dyad:

‘The therapist did not talk much about eating in treatment. She worked on the family relationships. Let’s understand her work in this way. With the onset of the illness , the family must have problems and the family relationship must be damaged… when our communication improved and our relationships were repaired , we became more harmonious and the child would listen to other parents.’ [ 27 ]. ‘In fact , I can see that both my brother and sister want to help me , but I can’t accept the way they help me…now I can see that they just want to give some ideal solutions to me. ’ [ 33 ].

Some studies emphasise the role of the father and increasing paternal presence (e.g., [ 27 ]). Traditionally, it is assumed that mums are responsible for domestic matters as well as the children’s wellbeing. As a mum put it, ‘[the child’s] father is a CEO of a huge company and I don’t want to upset him. I want him to concentrate his energy and time on work. I told him about my difficulty only when I could no longer handle it’ [ 27 ]. A father reflected on his guilt towards not caring for his daughter: ‘… I should stay behind to take more care of her’ [ 27 ]. Therapy plays a pivotal role in fostering and enhancing the father’s presence, while also illuminating the daughter’s longing for paternal care. In a case study, Lily, a participant, reported that her improved relationship with her father facilitated a return to normal and regular eating habits. As a result of therapy, her father began dedicating more time to the family, acknowledging that he previously prioritised rest over spending time with family. In another scenario where the individual’s father had passed away, the therapist emerged as a dependable father figure, providing invaluable support and understanding [ 4 ].

Subtheme 2.2. Clinician as a trusted and safe base

Both clinicians and patients described important common factors in therapy such as calm, patience and building trust. In the paediatric wards, the nurses mentioned “ You must take the time to establish a relationship with her. She is willing to rely on you , and she is willing to tell you where the problem is .” [ 29 ]. A patient mentioned ‘the therapist has really good temper. No one can stand to talk to me so long , except my mother , including my brother and sister. And her tone makes me think that she’s a person I can trust.’ [ 34 ]. Developing a safe base allows the families to then explore more difficult topics. Studies describe the use of the word ‘ as a bridge’ to recount the role of therapist in treatment:

‘She made me feel confident. We began to trust her (the therapist). We felt that she can help us. With that trust in mind , I feel free to disclose my feelings honestly…my body weight dropped and I was very frightened….I had no confidence and was very fearful. She (the therapist) looked at me with a warm smile and in a firm tone , said that she had confidence in me and I could make it’ [ 34 ].

Subtheme 2.3. Relating to peers with EDs

References to sharing and comparing EDs behaviours, such as sharing purging techniques, were noted [ 28 ]. For instance, one participant described observing peers using their iPad to calculate meal calories and researching diets online to lose weight after discharge. In the analysis, the authors hypothesised that due to the historical One-Child Policy in China, being on the ward might be the participants’ first time living with peers away from their families. They wondered whether some of the group dynamics of cooperation and conflict might be attributed to the lack of experience of living with siblings.

On the other hand, positive aspects from peers were also noted, such as finding people to talk to: ‘I had been keeping this secret (my ED) for an extremely long time without finding somebody to talk to’ as well as reducing vomiting behaviours due to others reporting to the nurses [ 31 ].

Theme 3. Barriers to change

Four aspects of barriers were described: financial, structural, coercive practice and cultural.

Subtheme 3.1. ‘I am wasting my family’s money’

One participant mentioned, “Psychotherapy or counselling would cost me 400/500 yen (approximately 70 USD) per session. I am still a student and don’t have much money. I thought I could follow self-help resources and treat myself” [ 26 ]. While she expressed an individual perspective, others described, “We are not wealthy as a family,” indicating a family-oriented viewpoint among the participants. For instance, one participant discussed how their family did not consider finances a barrier to treatment:

‘…I can see that my family doesn’t care about money when compared to my health , and my sister also wastes her study time to keep on seeing the therapist every week. Now I can see that they all treat me very , very well , and want me to be healthy again.’ [ 32 ].

Subtheme 3.2. Unavailable professionals and services

Participants were dissatisfied by the lack of specialist services, as well as the lack of knowledge of EDs among healthcare professionals. This is evident in terms of the short period of time they are being seen for:

‘The diagnostic process involved me describing my situation and the doctor asking me more questions…diagnosed me with bulimia nervosa. The whole process took about 6 to 7 minutes. It was very short and nonspecific. I feel my condition was not taken seriously.’ [ 26 ].

The scarcity of specialist services was mentioned by multiple participants. One of them said, ‘ treatment resources are only available at big hospitals’ in mainland China [ 26 , 35 ]. In Hong Kong, parents described how difficult it was to find therapists that are knowledgeable about AN:

‘I really don’t know where you could find family therapists that specialise in treating anorexia in Hong Kong… in foreign countries , there is usually a team which put strong emphasis on family support and teamwork , and such kind of support is totally unavailable in Hong Kong’ [ 28 ].

The lack of knowledge among professionals can also lead to patients and families feeling invalidated. A doctor mentioned that amenorrhoea could be stress-related and could be a common gynaecological issue, or patients were told to use willpower to overcome their EDs. Parents expressed feeling blamed:

‘During the consultation , we were scolded by the psychiatrist [in A & E]. Have I done anything wrong? He told me that my daughter was well-behaved but I left her in other people’s care. Hey , I have to work! I have already tried my best to find something that is suitable for my daughter.’ [ 28 ].

These experiences by parents are echoed by professionals in Taiwan, who acknowledged their treatment knowledge gap:

One physician said, “ Our care for anorexia is taught by the attending physician one by one , from the intensive care unit to the ward care , and then to the outpatient care. In fact , education is carried out during the follow-up process and the ward rounds. This kind of education only means that the few people who are cared for know how to take care of them. Nurses still don’t know how to care of them” [ 29 ].

The other gap acknowledged was the lack of awareness of non-AN EDs. In a study where a hypothetical vignette of a female who vomits and binges were presented, researchers noted that almost every clinician in the study specified AN rather than BN [ 35 ].

Subtheme 3.3. Coercive practice

Coercive practices, particularly within inpatient settings, were reported, involving the use or threat of restraints and nasogastric (NG) tubes. For instance, a nurse mentioned that even the visible presence of an NG tube could be employed as a form of coercion [ 29 ]. Describing their own experience as a former inpatient, one individual expressed deep distress regarding witnessing physical restraints [ 28 ]. Such experiences resulted in negative treatment experiences, with participants recounting psychological trauma and nightmares related to their inpatient care [ 28 ]. In outpatient family therapy, mothers described feeling like a ‘villain’ and needing to force feed their child [ 28 ]. In view of such practices, participants expressed that such treatment compelled them to act against their desires, and they doubted its efficacy in addressing their weight-related fears [ 32 ].

Subtheme 3.4. Converging and diverging cultural ideals

While thin ideals are often valued in EA cultural norms, there are also contrasting views that perceive thinness as a Western ideal. Participants in the study perceived being chubby as the ideal in Chinese culture, as one individual expressed: “In our culture, being chubby should mean pretty and lucky. My first memory of the really thin women were western models and movie stars…my mum always said they are ugly” [ 4 ]. This contradicts the thinness ideal highlighted in other studies (e.g. 11). Interestingly, exposure to the actual environment in the West helped correct participants’ perceptions of body ideals, which proved beneficial to their recovery:

‘[the participant] highlighted that these cross-cultural exposures and experiences living abroad had enabled and empowered her to challenge the stereotyped images of beauty portrayed and perpetuated by western media… “after I moved to the US , I realised that people here do not look like those in the movies…” ’ [ 4 ].

Study quality

Most studies used adequate qualitative methodologies. The main quality issues identified include not mentioning ethical considerations, lacking researcher reflexivity, lacking details regarding the analytic steps, and that in some studies (e.g. where family therapy was the treatment modality), the analysing researcher was also the treating therapist, which may introduce bias (see Table 1 for more detail).

The 12 studies included in the review generated three analytical themes in response to our research question on people’s experiences of treatment in East Asia (Table 3 ). Cultural aspects relating to people’s experiences were considered when identifying themes.

A diverse range of treatment was described - including family therapy, paediatric/ psychiatric inpatient care, cognitive behavioural therapy, and faith-based counselling. This contrasts with the systematic quantitative scoping review by Yim & Schmidt [ 16 ], where CBT and internet interventions were the main treatments in focus. Some of the themes share similarities to other qualitative syntheses on AN treatment such as improved family relationships as well as the perceived authoritarianism and control in treatments [ 18 ], and the use of restraints and NG tube in inpatient wards. Similar to the findings from Yim & Schmidt [ 16 ], participants also directly mentioned financial barriers and the unavailability of specialist professionals/ services.

The current review goes beyond the cultural adaptations described in Yim and Schmidt [ 16 ]. More nuanced factors such as family roles, cultural values and norms were shared by participants, which can be important issues to be addressed in therapy. With respect to policy, the historical One Child Policy (OCP) in mainland China was mentioned in Wu and Harrison [ 28 ] where they hypothesised that this could potentially impact the interpersonal dynamics in inpatient settings. This was not mentioned in other studies in Yim & Schmidt’s [ 16 ] review. Whether or not the OCP affects the social literacy of single children is under debate, as the single child will still be interacting with peers at school [ 15 ]. This is also potentially confounded by the nature of EDs where body comparison is part of the symptomatic behaviour. It is difficult to disentangle the relative influences on people’s negative experiences in inpatient treatments. In contrast, the impact of OCP is wide-ranging and other impacts may influence the development or maintenance of an eating disorder. OCP has led to an imbalanced sex ratio with more males to females in China and having one child only may be seen as a deprivation of one’s reproductive choice. This also adds to the pressure of looking after one’s elderly parents without the support of other siblings. At the same time, single children (especially girls) faced immense pressure to excel, and are enrolled in multiple tutorials and extracurricular activities [ 16 ]. The pressure to achieve, in addition to preserving the family’s ‘face’, may contribute to the development of an ED [ 26 ]. Relating to the negative aspects of peer influence in EDs wards, it would be useful to explore if similar issues were found in group therapies. Future studies could also explore how single children versus non-single children perceive group or residential treatments (i.e. where there are the same rules for all).

Collectivist culture, where family harmony and ‘saving face’ are esteemed [ 4 ], can present a complex dynamic. Whilst this cultural value may impede help-seeking due to stigma, participants also noted that it functions as a motivator for getting better. Another significant cultural value is Filial Piety, where researchers speculate it may hinder patient’s individuation process [ 7 ]. The necessity for individuation becomes evident as participants highlighted pivotal moments in their ED recovery, such as moving out of the family home or moving abroad for studies [ 4 ]. Initially, participants with EDs struggled with parental expectations and prioritised family wishes over personal aspirations. For some, their EDs may serve the function of creating distance/ challenging parental control or wishes without overtly going against them [ 4 ]. This is potentially compounded by cultural beliefs favouring men over women, leading girls to internalise feelings of inferiority. Balancing familial and individual needs emerges as a central focus in EDs therapy for them. However, similar to other culture-specific values, filial piety can potentially also be a protective factor, motivating patients to comply with parental directives and attend therapy. The idea of interdependent self-construal is pertinent here [ 14 ]. Patients described relational motives to recovery, such as ‘I am “vomiting” your money and your love’. The process of individuation also includes maintaining family connections. Echoing findings by Medway and Rhodes [ 18 ], some family therapy studies in East Asia (e.g., [ 27 ] underscore the reorganisation of family dynamics and roles, often with increased paternal involvement. Yim & Schmidt [ 17 ] speculated that CBT was preferred to family therapy due to most parents working full-time in East Asia. This sentiment is reflected in some parents’ statements like ‘Hey, I have to work!’ However, the present review suggests that the benefits of family therapy are being recognised for restructuring family dynamics and roles, as well as increasing communications and bonding. This is evidenced in the theme ‘I am not alone in this battle’, where family relationships are perceived as improved, and families come together and the patient did not feel judged or uncared for by their parents. This agrees with Tan et al’s [ 20 ] view of using a maternalistic approach in treating ED patients in Asia.

Clinical recommendations

This review, along with Yim and Schmidt (2023), identified treatment, training and research gaps for EDs in EA. We propose the following clinical implications and recommendations:

EDs conceptualisation in EA

Clinicians in EA need to have greater awareness of EDs in general, especially EDs other than AN [ 35 ]. Although our combined reviews show that individual treatment approaches seem to be the norm in EA, it will be useful to include the family context as part of the formulation and treatment planning.

Clinicians should have an awareness of how culture relates to one’s formulation of an ED whilst attending to individual differences. Some examples of culturally informed treatment planning may include harnessing the interdependence and cultural norms of ‘sacred’ family meals as an act of care rather than the family being cast in the role of a ‘villain’. It may be appropriate to consider both interdependent, relational motivators and goals, in addition to personal goals towards recovery, paying attention to the process of individuation whilst maintaining connectedness.

The role of body image

Body image ideals appear to be another conflicting value. On the one hand, studies mentioned how thin ideals are pervasive in EA (e.g. 13), which could be an influence from Westernisation. On the other hand, participants described being ‘chubby’ as being valued [ 4 ]. Whilst there may be generational differences in body ideals, it could also create a sense of internal conflicts if young people’s perceived ideals are different from those of their parents. With the conflicting findings from the studies regarding the relative influence of Western and Asian media (e.g. [ 12 ]), it is important for clinicians to consider a multidimensional conceptualisation of body image and not to make assumptions around the body ideals that the individual is influenced by. Moreover, it may be important to include the family’s perception and ideals of the person’s weight and shape.

Capacity building

The advancement of telemedicine can facilitate better more in-depth training of medical professionals on understanding and treating EDs (e.g. see [ 36 ], as well as increasing the affordability and accessibility of treatments, and also capacity building of evidence-based EDs treatments in EA. It is recommended that journal special issues, conference themes on culture and EDs, or special interest groups/ clinical research networks on EDs in East Asia/for East Asians should be organised to facilitate knowledge and skills exchange.

Limitations

All the included studies are conducted in the Chinese (Mandarin and Cantonese)-speaking regions in EA. Our search strategy did not include grey literature which is a limitation. Some researchers may argue that qualitative studies are context specific and a synthesis of such findings may de-contextualise them. Whilst the aim of this review is not to provide generalisability, it is worth acknowledging that in terms of context transferability, people’s experiences and views in other regions such as Japan and Korea are unknown. It may be that relevant papers were written in the respective languages and therefore not found in our search. Nevertheless, the settings and populations of the included studies were listed in Tables 2.1 and 2.2 , which could assist in the interpretation of the transferability of the findings.

Research recommendations

Most of the EDs study participants experienced AN in the studies, and little is known about the experiences of people with BN, BED, or the relatively newer ARFID diagnosis in the region. This is especially pertinent as the prevalence of BED and BN is higher than that of AN in China [ 2 ].

The prevailing models of treating AN in the West such as ED-focused family approaches for adolescents, are also an underexplored area, so we could not identify whether there are differences in people’s experiences or perceived effectiveness of an ED-focused therapy versus the modified Micucci’s model. The concept of non-fat phobic AN was not mentioned in the studies. Moreover, the studied populations were relatively young (most of them were under 30). Future research on older individuals with EDs in EA would be valuable.

Gender is another key area that needs to be addressed. Across all the included studies, only one patient identified as male. Given most of the studies identified were conducted in China, and that China has a larger male to female ratio, the finding is therefore somewhat surprising. It is difficult to understand how gender and its intersection with aspects of EA culture may influence treatment experiences.

In terms of methodology, it is important for future research to consider researchers bias and reflexivity to increase transparency, credibility and research rigor.

Given that professionals may perceive EDs as a gastrointestinal or gynaecological issue, it is likely that EDs are under-detected within those specialities. Future explorations of specific cultural factors and the relative influence of different body ideals are needed, and understanding the unique cultural struggles of the East Asian Diaspora versus East Asians residing in their home countries.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Eating disorder(s)

Anorexia Nervosa

Bulimia Nervosa

Binge Eating Disorder

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Acknowledgements

Ulrike Schmidt receives funding from the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC) and by the Medical Research Council/Arts and Humanities Research Council/Economic and Social Research Council Adolescence, Mental Health and the Developing Mind initiative as part of the EDIFY program, Grant/Award Number: MR/W002418/1.

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SHY designed and planned the review with supervision from US. SHY performed the search and extracted the data, and data interpretation was performed by SHY and US. SHY wrote the manuscript with support and supervision from US. All authors reviewed the manuscript.

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Yim, S.H., Schmidt, U. Views and experiences of eating disorders treatments in East Asia: a meta-synthesis. J Eat Disord 12 , 120 (2024). https://doi.org/10.1186/s40337-024-01070-4

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A Retrospective Literature Review of Eating Disorder Research (1990–2021): Application of Bibliometrics and Topical Trends

Woo-Hyuk Kim

Associated Data

1. Introduction

2. Methodology

2.2. Bibliometric Analysis

2.3. Topic Modeling

2.4. Research Topic Classification

3.1. General Characteristics of Articles in Terms of Eating Disorders

3.2. Citation Characteristics

3.3. Characteristics of Research Topics

3.3.2. Research Topic Network

3.3.3. Classification of Research Topics by Overall Popularity and Historical Trend

4. Discussion

5. Conclusions

Funding Statement

Author Contributions

Institutional Review Board Statement

103 Eating Disorders Essay Topics

Eating Disorders Research Paper

Academic Writing, Editing, Proofreading, And Problem Solving Services

III. Diagnostic Criteria

VI. Medical Complications

I. Overview of Eating Disorder Terms

II. Continuum of Health Related to Eating Disorders

IV. Epidemiology of Eating Disorders

IX. Prevention of Eating Disorders

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Views and experiences of eating disorders treatments in East Asia: a meta-synthesis