Implications

Research

This IRR may serve as a foundation for designing prevention and intervention studies. Building on findings reported here, longitudinal studies and the use of methods designed to determine causal relationships among eating disorders and associated factors are indicated. Studies may be designed to examine the interrelationship among the factors associated with eating disorders identified in this IRR, as well as their contribution to the development of eating disorders in females. Researchers might explore the role of positive mediating factors found among individuals in whom these characteristics have been identified, but who did not develop a subsequent eating disorder.

It would be of benefit for researchers to work with large samples representative of the population, including male and female participants. When gathering self-report data, researchers should use diagnostic criteria or clinical observational instruments to verify client responses when possible. Other eating disorders should be examined for a relationship to each of the factors found through this IRR to be associated with anorexia and bulimia.

Education and Practice

Practitioners in multiple disciplines, including medical, behavioral, and/or mental health fields need to work as multidisciplinary teams to meet the various needs of this population. All practitioners involved need specific education regarding eating disorders and associated factors to identify, treat, and/or refer individuals with eating disorders early. This includes the physical and psychological symptoms associated with eating disorders, including the personality traits of perfectionism and impulsivity and feelings of shame. Practitioners should be open and responsive to problems identified as being associated with eating disorders, including sexual abuse and substance abuse, where an open channel of communication should be established to help the client feel able to disclose information (Murray & Waller, 2002). Practitioners in a variety of practice settings and programs should know the most pertinent questions to ask, how to phrase them, and how to handle the emotions elicited.

Individuals in practice with children and adolescents should be aware of developmental stages and findings related to the chronological onset of the eating disorders and associated disorders, as these may have important implications for the formation or presence of other disorders and treatment implications. School nurses, psychologists, coaches and counselors who come into contact with children and adolescents should be aware of signs of sexual abuse and eating disorders and know both how to address these concerns initially and where to refer this population for further assistance and treatment. Pediatric nurses should be aware of physical signs of eating disorders to note during physical examination, such as abnormal weight, body mass index, or lab results that could indicate a problem with nutrition and fluid balance. Nurses in drug and psychiatric treatment settings should routinely assess for eating disorders due to the frequent comorbidity of these disorders with substance abuse and other psychiatric disorders.

There are also implications for policy development, especially in adolescent or mental health settings. Questions designed specifically to identify eating disorders should be added to the routine admission process, the physical assessment, and history-taking guidelines for new patients. There should also be policies regarding parental notification and involvement for minors with eating disorders. Guidelines for treating various levels of severity should be adopted to ensure that patients with eating disorders are referred for treatment appropriately. Patients should also be informed of treatment options, such as inpatient, outpatient, and self-help or support groups locally and nationally. Protocols for patient care in the hospital should include routine weights, a record of food and fluid intake, and urinary and bowel output for all patients. Those individuals who have purged should be monitored following meals and snacks to ensure that they retain all food.

Conclusions>>