BackgroundOther Specified Feeding and Eating Disorders are characterized by less frequent symptoms or symptoms that do not meet full criteria for another eating disorder. Despite its high prevalence, limited research has examined differences in severity and treatment outcome among patients with OSFED compared to threshold EDs [Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder ]. The purpose of the current study was to examine differences in clinical presentation and treatment outcome between a heterogenous group (...) of patients with OSFED or threshold EDs.MethodPatients with threshold EDs or OSFED presenting for eating disorder treatment completed self-report questionnaires at intake and discharge to assess eating disorder symptoms, depression symptoms, impairment, and self-esteem.ResultsAt intake, OSFED patients showed lower eating concerns compared to patients with BN, but similar levels compared to AN and BED. The OSFED group showed higher restraint symptoms compared to BED, and similar restraint to AN and BN. Global symptoms as well as shape and weight concerns were similar between OSFED and threshold ED groups. There were no differences between diagnostic groups in self-esteem, depression scores, or symptom change from intake to discharge.DiscussionOur findings suggest that individuals with OSFED showed largely similar ED psychopathology and similar decreases in symptoms across treatment as individuals diagnosed with threshold EDs. Taken together, findings challenge the idea that OSFED is less severe and more resistant to treatment than threshold EDs. (shrink)

In this article, I argue that various epistemic challenges associated with eating disorders (EDs) can negatively affect the care of already marginalized patient groups with various EDs. I will first outline deficiencies in our understanding of EDs—in research, healthcare settings, and beyond. I will then illustrate with examples cases where discriminatory misconceptions about what EDs are, the presentation and treatment of EDs, and who gets EDs, instantiate obstacles for the treatment of various ED patient groups.

Introduction. Eating Disorders (EDs) are serious psychiatric disorders, impacting physical and psychosocial functioning, often with a chronic course and high mortality rates. The two continua model of mental health states that mental health is a complete state, that is not merely the absence of mental illness, but also the presence of mental health. This model was studied among ED patients by comparing the levels of well-being to the Dutch general population and by examining the of well-being and psychopathology. Method. (...) A total of 468 female ED patients participated in this study during application and intake at a specialized ED treatment centre in the Netherlands. They filled out questionnaires about well-being (MHC-SF), general psychopathology (OQ-45), and ED psychopathology (EDE-Q). Categorical and mean well-being levels were calculated. Also, the correlates of these variables were examined with Pearson correlation and multiple hierarchical regression analysis. Results. ED patients showed lower levels of emotional, psychological and social well-being on average compared to the general population. About 26% of the ED patients experienced low levels of well-being (languishing). However, also 13% experienced high levels of well-being (flourishing), varying between 9% in Anorexia Nervosa to 25% in Binge Eating Disorder. ED psychopathology and general well-being showed a moderate negative correlation. For patients with Bulimia Nervosa and Binge Eating Disorder however no such correlation was found. Lower general psychopathology, not having a history of hospitalization for the ED, and adaptive personal functioning were correlated with well-being among ED patients. Conclusion This study shows initial support for the two continua model of mental health among ED patients. Psychopathology and well-being should be considered as related, but distinct dimensions of mental health in ED patients. Further research should focus on the possible reciprocal relationships between psychopathology and well-being during recovery. It is recommended to monitor well-being during treatment and to implement interventions for well-being to realize complete recovery for those patients with inadequate levels of well-being. (shrink)

Night eating syndrome is currently classified as an Other Specified Feeding or Eating Disorder under the Diagnostic Statistical Manual−5. This systematic review aims to consolidate the studies that describe the sociodemographic, clinical and psychological features of NES in a population of patients with eating disorders, obesity, or those undergoing bariatric surgery, and were published after the publication of the DSM-5. A further aim was to compare, where possible, NES with BED on the aforementioned variables. (...) Lastly, we aimed to appraise the quality of the studies being included in the review. We conducted a systematic search on three databases which resulted in the selection of 22 studies for the review. We included the articles that studied patients with NES and their sociodemographic, clinical and psychological features in a clinical population, through a quantitative study design. Articles were excluded if the NES patients included in the study had a comorbid psychological disorder, and/or the sample was collected from a university/non-clinical population, and/or the study design was qualitative, and/or NES features were compared with any other disorder, except BED. Our study found that no conclusions about the link between any sociodemographic feature and an NES diagnosis could be made. Further, NES patients presented with elevated ED pathology and higher occurrence of depressive symptoms than controls. Contrary to the literature suggesting that NES and Binge Eating Disorder patients often report overlapping features, questioning the validity of NES as an ED diagnosis, we found that BED can be differentiated from NES by the higher occurrence of emotional eating, body related concerns and abnormal eating episodes. The review also suggested an overlap between NES and Sleep-Related Eating Disorder. We recommend that it is essential to study NES as an independent disorder to further develop its diagnostic criteria and treatment options, thereby, increasing the quality of life of the patients suffering from this syndrome. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Eating Disorders and Mimetic Desire René Girard Stanford University Among younger women, eating disorders are reaching epidemic proportions. The most widespread and spectacular at this moment is the most recently identified, the so-called bulimia nervosa, characterized by binge eating followed by "purging," sometimes through laxatives or diuretics, more often through self-induced vomiting. Some researchers claim that, in American colleges, at least one third of the female (...) student population is involved to some degree. (Since nine out of ten sufferers are women I will use feminine pronouns in this paper but some undergraduates at Stanford tell me that the epidemic is spreading to male students.) G.M.F. Russell, the first researcher who focused on the specific aspects ofmodern bulimia, is usually presented as the discoverer of a new illness. The title ofhis 1979 publication contradicts this view: "Bulimia Nervosa: An Ominous Variant ofAnorexiaNervosa." And, indeed, all the symptoms he describes had been mentioned before in connection with anorexia (see Bruch). The insurance companies and the medical profession like only welldefined illnesses, and so does the public. We all try to distance ourselves from pathological contamination by giving it a name. Eating disorders are often discussed as ifthey were new varieties ofmeasles or oftyphoid fever. Why distrust the distinction between two illnesses with symptoms as radically opposed as those of anorexia and bulimia? Because we live in a world where eating too much and not eating enough are opposite but inseparable ways ofcoping with the slenderness imperative that dominates 2 René Girard our collective imaginations. Most of us oscillate all our lives between attenuated forms ofthese two pathologies. The man in the street understands perfectly a truth that most specialists prefer not to confront. Our eating disorders are caused by our compulsive desire to lose weight. Most books on the subject acknowledge the universal calorie phobia but somewhat absent-mindedly, as if it could not be the major cause ofa serious illness. How could a fundamentally healthy desire become the cause ofpathological behavior, even ofdeath? Many people would be healthier, no doubt, ifthey ate less. In view of this fact, it is not illogical to suppose that, in anorexia, there must be some motivation other than this healthy desire, some unconscious drive, no doubt, that generates abnormal behavior. By turning anorexia and bulimia into two separate pathologies, the classificators make it easier for us to lose sight of their common basis. The bankruptcy of modern theories The search for hidden motivations is the alpha and omega, ofcourse, of our modern culture. Our number one principle is that no human phenomenon is really what it seems to be. A satisfactory interpretation must rely on one of the hermeneutics of suspicion that have become popular in the nineteenth and twentieth century, or on several ofthese, on a cocktail of soupçon: psychoanalysis, Marxism, feminism, etc. We automatically assume that social phenomena have little if anything to do with what is obvious in them, in this case the rejection offood. In anorexia, psychoanalysts usually diagnose "a refusal of normal sexuality," due to the patient's excessive desire "to please her father," etc. These explanations are still invoked in books being written right now but the voice is growing fainter. Around this sort of thing the smell of mustiness is overpowering. Even in Lacan's own land, the old arrogance is gone. Early in my life, I had an opportunity to observe that the eating practices ofyoung women have nothing to do with a desire to please their fathers. Just before World War II, a pretty cousin of mine was dieting furiously and her father, my uncle, was storming about helplessly, trying to get her to eat more. Fathers, as a rule, are not pleased to see their daughters starve themselves. This particular father was also a physician, at a time when the medical profession had not yet caught the disease it was already trying to cure. Eating Disorders andMimetic Desire3 This uncle was our family doctor and, as such, had great prestige in my eyes, at least until that day. I had not yet read Freud but my later skepticism regarding his conception offatherhood may well originate in this incident. I immediately... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Eating Disorders and Mimetic Desire René Girard Stanford University Among younger women, eating disorders are reaching epidemic proportions. The most widespread and spectacular at this moment is the most recently identified, the so-called bulimia nervosa, characterized by binge eating followed by "purging," sometimes through laxatives or diuretics, more often through self-induced vomiting. Some researchers claim that, in American colleges, at least one third of the female (...) student population is involved to some degree. (Since nine out of ten sufferers are women I will use feminine pronouns in this paper but some undergraduates at Stanford tell me that the epidemic is spreading to male students.) G.M.F. Russell, the first researcher who focused on the specific aspects ofmodern bulimia, is usually presented as the discoverer of a new illness. The title ofhis 1979 publication contradicts this view: "Bulimia Nervosa: An Ominous Variant ofAnorexiaNervosa." And, indeed, all the symptoms he describes had been mentioned before in connection with anorexia (see Bruch). The insurance companies and the medical profession like only welldefined illnesses, and so does the public. We all try to distance ourselves from pathological contamination by giving it a name. Eating disorders are often discussed as ifthey were new varieties ofmeasles or oftyphoid fever. Why distrust the distinction between two illnesses with symptoms as radically opposed as those of anorexia and bulimia? Because we live in a world where eating too much and not eating enough are opposite but inseparable ways ofcoping with the slenderness imperative that dominates 2 René Girard our collective imaginations. Most of us oscillate all our lives between attenuated forms ofthese two pathologies. The man in the street understands perfectly a truth that most specialists prefer not to confront. Our eating disorders are caused by our compulsive desire to lose weight. Most books on the subject acknowledge the universal calorie phobia but somewhat absent-mindedly, as if it could not be the major cause ofa serious illness. How could a fundamentally healthy desire become the cause ofpathological behavior, even ofdeath? Many people would be healthier, no doubt, ifthey ate less. In view of this fact, it is not illogical to suppose that, in anorexia, there must be some motivation other than this healthy desire, some unconscious drive, no doubt, that generates abnormal behavior. By turning anorexia and bulimia into two separate pathologies, the classificators make it easier for us to lose sight of their common basis. The bankruptcy of modern theories The search for hidden motivations is the alpha and omega, ofcourse, of our modern culture. Our number one principle is that no human phenomenon is really what it seems to be. A satisfactory interpretation must rely on one of the hermeneutics of suspicion that have become popular in the nineteenth and twentieth century, or on several ofthese, on a cocktail of soupçon: psychoanalysis, Marxism, feminism, etc. We automatically assume that social phenomena have little if anything to do with what is obvious in them, in this case the rejection offood. In anorexia, psychoanalysts usually diagnose "a refusal of normal sexuality," due to the patient's excessive desire "to please her father," etc. These explanations are still invoked in books being written right now but the voice is growing fainter. Around this sort of thing the smell of mustiness is overpowering. Even in Lacan's own land, the old arrogance is gone. Early in my life, I had an opportunity to observe that the eating practices ofyoung women have nothing to do with a desire to please their fathers. Just before World War II, a pretty cousin of mine was dieting furiously and her father, my uncle, was storming about helplessly, trying to get her to eat more. Fathers, as a rule, are not pleased to see their daughters starve themselves. This particular father was also a physician, at a time when the medical profession had not yet caught the disease it was already trying to cure. Eating Disorders andMimetic Desire3 This uncle was our family doctor and, as such, had great prestige in my eyes, at least until that day. I had not yet read Freud but my later skepticism regarding his conception offatherhood may well originate in this incident. I immediately... (shrink)

Graham, Noelle Comparisons are drawn between media reporting of eating disorders and other.forms of self-harm. Proper understanding of these illnesses can protect sufferers from further harm caused by inaccurate and insensitive reporting.

The purpose of this paper is to define and describe the main phenomenological dimensions of the life-world of persons prone to Feeding and Eating Disorders (FEDs), within the framework of a model that considers abnormal eating behaviour an epiphenomenon of a more profound disorder of lived corporeality and identity. The core idea is that persons with FEDs experience their own body first and foremost as an object being looked at by another, rather than coenaesthetically or from a (...) first-person perspective. Alienation from one’s own body and the need to feel oneself only through the gaze of the others can be illuminated by looking at it in the light of the Sartrean concept of feeling a lived-body-for-others. (shrink)

Objective: There is lack of information on the presentation of eating disorders (EDs) in Saudi Arabia using gold standard clinical tools. The present study aimed to provide data on the presentation of EDs in Saudi Arabia using clinically validated measures.Method: Hundred and thirty-three individuals (33 male) with a mean age of 22 years (2.63) completed three measures: the Eating Disorder Examination (EDE), a semi-structured interview, the Eating Disorder Examination Questionnaire (EDE-Q), a self-report measure, and the (...) Depression Anxiety and Stress Scale (DASS-21) to measure comorbid symptoms.Results: Individuals in Saudi Arabia reported higher levels of restraint, eating concern and shape concern and a higher global score, but lower levels of weight concern on the EDE-Q compared to the EDE. Female participants reported a higher global score, alongside significantly higher scores on the restraint, shape concern and weight concern subscales than males. The most common ED subtype was other specific feeding or ED. Compared with Western community samples, symptom severity in this purposive sample obtained from community settings was significantly higher in this sample.Discussion: Individuals with eating, weight and shape concerns in Saudi Arabia may feel more comfortable expressing their symptoms on a self-report tool compared with a face to face interview. However, it is possible that a self-report measure may over-estimate the severity of symptoms. The data suggest that clinicians in Saudi Arabia should regularly screen for EDs in all genders. It is also important to note that ED symptoms are a cause for concern in young people in Saudi Arabia. (shrink)

Background: Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in several mental disorders. Some studies have suggested that eating disorders may also be associated with impairments in mentalizing. The aim of this work is to investigate the possible presence of mentalizing subtypes in a sample of patients with EDs.Method: A sample of patients with eating disorders completed a battery of measures assessing mentalization and related variables, including (...) the Reflective Functioning Questionnaire, the Difficulties in Emotion Regulation Strategies, the Interpersonal Reactivity Index. Clinicians rated patients in relation to imbalances in different dimensions of mentalization to prementalizing modes and attachment style by using the Mentalization Imbalances Scale, the Modes of Mentalization Scale, and the Adult Attachment Questionnaire. A latent profile analysis was conducted to test the possible presence of different subgroups. MANOVA was used to test the possible differences between the four mentalizing profiles in relation to emotion dysregulation, empathy, and adequate and impairments in mentalizing.Results: The latent profile analysis suggested the presence of four different profiles in relation to impairments in the dimensions of mentalization: affective/self/automatic imbalances, external imbalance, cognitive/self/automatic imbalances, and cognitive/other/automatic imbalances. Patients belonging to profile 1 are characterized by the prevalence of affective mentalization that overwhelms the capacity to reflect on mental states with an imbalance on the self-dimension; profile 2 patients are excessively focused on the external cues of mentalization; profile 3 patients are characterized by an over-involvement on the cognitive and self-facets of mentalization, with an impairment in adopting the other mind perspective; and profile 4 patients have similar impairments compared to profile 3 patients but with an excessive focus on others and deficits in self-reflection. These profiles were heterogeneous in terms of EDs represented in each group and presented significant differences on various variables such as attachment style, emotion dysregulation, empathy, interpersonal reactivity, and reflective function. This study represents, so far, the first work that confirms the presence of different mentalizing patterns in ED patients.Conclusions: ED patients can be classified in relation to impairments in different dimensions of mentalization above and beyond ED diagnosis. (shrink)

The book offers an accessible account of EDs and closely examines the concept of addiction, Drawing on a wide range of medical, psychological, physiological, sociological and philosophical sources, the book examines the benefits and risks of exercise for the ED population, explores the links between EDs and other abuses of the body in the sports environment and addresses the issue of athletes with disordered eating behaviour. Importantly, the book also surveys current legislation and professional codes of conduct that (...) guide the work of fitness professionals and clinicians in this area and I presents a clear and thorough set of case histories and action points to help professionals better understand, and care for, their clients with EDs. --. (shrink)

Transtheoretical integrative decision-making models help clinicians to use patient factors that are known to predict outcomes in order to inform individualized treatment. Patient factors with a strong evidence base include: functional impairment, social support and interpersonal functioning, complexity and comorbidity, coping style, level of resistance, and subjective distress. Among those with binge-eating disorder (BED), patient factors have not been extensively characterized relative to norms or other clinical samples. We used an integrative decision-making model of these six domains (...) of patient factors related to patient outcomes to characterize a sample of 424 adult treatment-seeking patients with BED. Data were from medical charts, a demographics questionnaire, and validated psychometric scales. We then compared these data to published data from normative and other eating disorder (ED) samples. Results showed that the average patient with BED: (1) was significantly more functionally impaired compared to non-clinical norms but somewhat less impaired than other patients with ED, (2) demonstrated clinically significant problems in social support and interpersonal functioning, (3) presented with complex comorbid pathology and high levels of chronicity, (4) used a more internalizing coping style compared to the norm and other ED samples, (5) had low levels of resistance to interventions, and (6) experienced a moderately high level of subjective distress indicating good motivation for treatment. Corresponding recommendations to these findings are that the average patient with BED should be provided higher intensity treatment that is longer in duration, interpersonally-focused, directive in nature, and emphasizing self-reflection and insight. Despite the nomothetic nature of the findings, clinicians are encouraged to assess these patient domains in order to come to an ideographic case conceptualization and to tailor precision treatment to the individual patient with BED. (shrink)

There is robust evidence that women with eating disorders (EDs) display an attention bias (AB) for disorder-salient stimuli. Emerging data suggest that the presence of these biases may be due, in part, to neurological deficits, such as poor set shifting and weak central coherence. While some have argued that these biases function to predispose and/or act to maintain disordered eating behaviours, evidence supporting this view has rarely been examined. This report summarises and integrates the existing literature on (...) AB in EDs and other related psychiatric disorders to better understand its potential role in the development and maintenance of an ED. The domains reviewed include experimental data using the dot-probe and modified Stroop task and neurobiological findings on AB in women with EDs as well as the role of AB in current theoretical models. We conclude by proposing an integrated model on the role of AB in EDs and discuss treatment approaches aimed at modifying these biases. (shrink)

Qualitative inquiry into eating disorders is burgeoning, offering valuable and innovative insights into various aspects of the condition. This study used life‐history interviews with 20 women who had recovered from anorexia nervosa, bulimia nervosa or both and who had remained healthy. The interviews focused on the women's narratives and experience rather than a diagnostic therapeutic model. Three themes of control, connectedness and conflict emerged as significant in the development, experience of, and recovery from an eating disorder. The (...) development of the condition was attributed to a lack of control, a sense of non‐connectedness to family and peers and extreme conflict with significant others. Recovery occurred when the women re‐engaged with life, developed skills necessary for conflict resolution and rediscovered their sense of self. Rather than viewing the development of, and recovery from an eating disorder as separate and discrete events, the data from the life‐history interviews suggest they are better viewed as one entity — that is, the journey of an individual attempting to discover and develop their sense of self. This perspective challenges some current constructs of eating disorders; it is not a condition in and of itself but a symptom of deeper issues that if addressed, when the individual is ‘ready’ to make that choice, will lead to recovery. (shrink)

Since the advent of the women's movement, women have made unprecedented gains in almost every field, from politics to the professions. Paradoxically, doctors and mental health professionals have also seen a staggering increase in the numbers of young women suffering from an epidemic of depression, eating disorders, and other physical and psychological problems. In The Cost of Competence, authors Brett Silverstein and Deborah Perlick argue that rather than simply labeling individual women as, say, anorexic or depressed, it is (...) time to look harder at the widespread prejudices within our society and child-rearing practices that lead thousands of young women to equate thinness with competence and success, and femininity with failure. They argue that continuing to treat depression, anxiety, anorexia and bulimia as separate disorders in young women can, in many cases, be a misguided approach since they are really part of a single syndrome. Furthermore, their fascinating research into the lives of forty prominent women from Elizabeth I to Eleanor Roosevelt show that these symptoms have been disrupting the lives of bright, ambitious women not for decades, but for centuries. Drawing on all the latest findings, rare historical research, cross-cultural comparisons, and their own study of over 2,000 contemporary women attending high schools and colleges, the authors present powerful new evidence to support the existence of a syndrome they call anxious somatic depression. Their investigation shows that the first symptoms usually surface in adolescence, most often in young women who aspire to excel academically and professionally. Many of the affected women grew up feeling that their parents valued sons over daughters. They identified intellectually with their successful fathers, not with their traditional homemaker mothers. Disordered eating is one way of rejecting the feminine bodies they perceive as barriers to achievement and recognition. Silverstein and Perlick uncover medical descriptions matching their diagnosis in Hippocratic texts from the fourth century B.C., in anthropological studies of Africa, Asia, and Latin America, and in case studies of many noted psychologists and psychiatrists, including the "hysteric" patients Freud used to develop his theories on psychoanalysis. They have also discovered that statistics on disordered eating, depression, and a host of other symptoms soared in eras in which women's opportunities grew--particularly the 1920s, when record numbers of women entered college and the workforce, the boyish silhouette of the flapper became the feminine ideal, and anorexia became epidemic, and again from the 1970s to the present day. The authors show that identifying this devastating syndrome is a first step toward its prevention and cure. The Cost of Competence presents an urgent message to parents, educators, policymakers, and the medical community on the crucial importance of providing young women with equal opportunity, and equal respect. (shrink)

Asian American women demonstrate higher rates of disordered eating than other women of color and comparable rates to European American women. Research suggests that leading sociocultural predictors, namely pressures for thinness and thin-ideal internalization, are predictive of disordered eating in Asian American women; however, no known studies have tested the intersection of sociocultural and culture-specific variables (e.g., ethnic identity, biculturalism, acculturative stress) to further elucidate disordered eating risk in this vulnerable, understudied group. Accordingly, this project used (...) path analysis to simultaneously examine the role of sociocultural and culture-specific effects on disordered eating in Asian American college women (N = 430). Self-report measures assessing disordered eating, sociocultural (pressures for thinness; thin-ideal internalization) and culture-specific (ethnic identity, biculturalism, acculturative stress) variables revealed that a number of sociocultural and culture-specific factors are predictive of disordered eating. Consistent with prior research, heightened perceived pressures for thinness and thin-ideal internalization were predictive of disordered eating, and thin-ideal internalization partially mediated the relationship between pressures for thinness and disordered eating. Acculturative stress predicted disordered eating and fully accounted for the inverse relationship between biculturalism and disordered eating. Overall, findings highlighted the salience of sociocultural predictors for disordered eating in Asian American women and identified biculturalism and acculturative stress as culture-specific contributors that may uniquely impact vulnerability to disordered eating in Asian American women. Thus, the combined consideration of sociocultural and culture-specific factors may be important in disordered eating research and in the development of individualized treatment plans for Asian American women. (shrink)

This paper contends that eating shapes the self; that is, our practices and understandings of eating can cultivate, reinforce, or diminish important aspects of the self, including agency, values, capacities, affects, and self-understandings. I argue that these self-shaping effects should be included in our ethical analyses and evaluations of eating. I make a case for this claim through an analysis and critique of the hypothesis that young women’s vegetarianism is a risk, sign, or “cover” for eating (...) disorders or disordered eating. After outlining the relevant empirical literature, I suggest that the evidence for this hypothesis is inconclusive. Given this uncertainty, we should consider the risks of making a mistake when accepting or rejecting this understanding of young women’s eating. I argue that these risks importantly include negative effects on the self, such as damage to moral and epistemic agency. Along with other potential consequences of mistakenly accepting the hypothesis, these effects give us reason to reject it pending more conclusive research. Overall, this paper offers a philosophical intervention into the debate over the relationship between vegetarianism and eating disorders while illustrating the ethical importance and relevance of eating as a self-shaping activity. (shrink)

In the Mindfulness-Based Eating Awareness Training program (MB-EAT) (Kristeller and Wolever, 2014; Kristeller and Wolever, in press), mindfulness practice is taught, mindful eating is cultivated, and self-acceptance and spiritual well-being are enhanced. An integrative concept is the value of cultivating ‘wisdom’ in regard to creating a new and sustainable relationship to eating and food. ‘Wisdom’ refers to drawing on personal experience and understanding in a flexible, insightful manner, rather than strictly following external rules and guidelines. Several clinical (...) trials involving variations of MB-EAT have documented substantive improvement in how people relate to their eating, including individuals with both binge eating disorder (BED) and subclinical eating issues. Based on the traditional value of contemplative practices for cultivating spiritual engagement, and on evidence from related research showing that spiritual well-being increases in the Mindfulness-Based Stress Reduction (MBSR) program and is related to other effects, we hypothesized that the MB-EAT program would also engage this aspect of experience, as assessed by the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being subscale (FACIT-Sp), and that increases in spiritual well-being would relate to other measures of adjustment such as emotional balance and improvement in disordered eating. Participants (N = 117) with moderate to morbid obesity, including 25.6% with BED, were randomly assi... (shrink)

The ecofeminist argument for veganism is powerful. Meat consumption is a deeply gendered act that is closely tied to the systematic objectification of women and nonhuman animals. I worry, however, that presenting veganism as "the" moral ideal might reinforce rather than alleviate the disordered status quo in gendered eating, further disadvantaging women in patriarchal power structures. In this chapter, I advocate a feminist account of ethical eating that treats dietary choices as moral choices insofar as they constitute an (...) integral part of our relationships to ourselves and to others. I believe that we should think of dietary choices in Aristotelian moral terms as a mean relative to us, falling on a continuum between the vice of doing injustice to ourselves, on the one hand, and the vice of doing injustice to others, on the other. On this view, what it is moral to eat for individuals is not a fixed ideal, but rather depends on particulars of our physiological, psychological, economic, cultural, and relational situations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 13.2 (2006) 133-141MuseSearchJournalsThis JournalContents[Access article in PDF]Dysfunctions, Disabilities, and Disordered MindsBengt BrüldeFilip RadovicRichard Gipps' and Jerome Wakefield's commentaries on our article are so different from each other that we have decided to deal with them separately. Gipps suggests that we adopt a different framework altogether. In his view, our main question—"What makes a mental disorder mental?"—is somehow defective, and it ought to be (...) replaced by an alternative question, namely, "What makes a mind disordered?" He thinks he can answer this question by providing an alternative account of the mental in terms of intentionality and suigeneris psychological understanding. He also suggests that mental disorders are "alterations within the intentional order." Wakefield, on the other hand, shares most of our "framework assumptions"; for example, he accepts the way we formulate our central question and how we present the different possible answers. The only part of our general project to which he objects is the attempt to find a principled account of what makes a mental function (dysfunction, mechanism, ability, or the like) mental. His main purpose is to defend and develop his own version of the internal cause view, namely, the idea that mental disorders are (harmful) mental dysfunctions. Because Gipps' comments are of a far more general nature than Wakefield's, we respond to Gipps first. This gives us an opportunity to make our "framework assumptions" more explicit.Gipps' Criticism of the Notion of Mental DisorderLet us first note that Gipps' suggestions are often vague. As Gipps himself puts it, his account is "clearly in need of much further clarification and elaboration" (121). This means that we sometimes have to reconstruct what he says to attribute sufficiently clear views to him.Gipps questions our assumption that there is such a thing as a general category of disorder, of which mental and somatic disorders can be regarded as subcategories. Or more precisely, he rejects the view that "disorder" is a proper category (or "semantic category," as he puts it), and he also seems to deny that "mental disorder" is a category. This is supposed to imply that our central question is somehow wrongly formulated, and to pave the way for his reformulation of this question (from now on, "the move").To determine whether Gipps' objection is valid or not, we need to know what he means by the term "category." However, all we are told is that a noun designates a (semantic) category if and only if it has a "unitary sense." Unfortunately, he does not specify what this "unitary sense" consists in. For example, does he implicitly assume that a noun designates a category if and only if there are necessary conditions for membership that are jointly sufficient? The example he offers (see [End Page 133] p. 118) suggests another possible interpretation, however. Here, he claims that the relation between the terms "mental disorder" and "physical disorder" are analogous to the relation between the terms "chemical reaction" and "emotional reaction." This suggests that the term "disorder" as it occurs in the phrase "physical disorder" and the term "disorder" as it occurs in the phrase "mental disorder" have different senses. This is an interesting suggestion that may well be correct, but Gipps does not offer any arguments for the assumption that "disorder" behaves like "reaction." Neither does he offer any examples of proper (semantic) categories.The Move from "Mental Disorders" to "Disordered Minds"In Gipps' view, mental disorders are best conceived of as disorders of the mind, and physical disorders as disorders of the body, and he therefore suggests that we ask what makes a disordered mind disordered rather than what makes a mental disorder mental. But why does Gipps believe that this move from "mental disorder" to "disordered minds" constitutes an improvement? The first reason has already been given, namely that the term "disorder" might not designate a proper category. But this is not a good reason for making the move Gipps suggests unless we assume that "mind" and "body" are proper categories. At this... (shrink)

Aims: The Research Diagnostic Criteria for Temporomandi¬bular Disorders (RDC/TMD) Axis I diagnostic algorithms were demonstrated to be reliable but below target sensitivity and specificity. Empirical data supported Axis I algorithm revisions that were valid. Axis II instruments were shown to be both reliable and valid. An international consensus workshop was convened to obtain recommendations and finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods: A comprehensive search of published TMD diagnostic literature was followed by review and (...) consensus via a formal structured process by a panel of experts for revision of the RDC/TMD. Results: The recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for pain diagnoses and valid criteria for the most common pain-related TMDs and for one intra-articular disorder. The Axis II protocol retains selected RDC/TMD screening instruments augmented with new instruments to better assess the interactions between pain and psychosocial functioning. A comprehensive classification system is also presented. Conclusion: The recommended evidence-based DC/TMD protocol is appropriate for use in both the clinical and research settings. Simple Axis I and II screening tests augmented by validated Axis I and Axis II instruments allow for identification of simple to complex TMD patients. (shrink)

The various jurisdictions worldwide that now legally permit assisted suicide (or voluntary euthanasia) vary concerning the medical conditions needed to be legally eligible for assisted suicide. Some jurisdictions require that an individual be suffering from an unbearable and futile medical condition that cannot be alleviated. Others require that individuals must be suffering from a terminal illness that will result in death within a specified timeframe, such as six months. -/- Popular and academic discourse about assisted suicide paradigmatically focuses on (...) individuals with ‘physical,’ i.e., non-psychiatric medical conditions, such as cancer or AIDS. Here I defend analyses of the notions of unbearable suffering, futility, and terminality that imply that, regardless of which of these medical conditions is invoked, at least some individuals with severe and persistent psychiatric illnesses satisfy these conditions and ought to be classified as legally eligible for assisted suicide. The legal and moral case for a right to assisted suicide is therefore not in principle weaker for the severely psychiatrically disordered than for those with ‘typical’ terminal or futile medical conditions. (shrink)

Eating disorders are evolutionarily novel conditions that lead to some of the highest mortality rates of all psychiatric disorders. Several evolutionary hypotheses have been proposed for eating disorders, but only the intrasexual competition hypothesis is extensively supported by evidence. We present the mismatch hypothesis as a necessary extension to the current theoretical framework of eating disorders. This hypothesis explains the evolutionarily novel adaptive metaproblem that has arisen when mating motives and readily available food rewards conflict with one (...) another. This situation is exacerbated in contemporary environments characterized by sedentary lifestyles, caloric surplus and the ubiquity of social comparisons that take place via social media. Our psychoneuroimmunological model connects ultimate-level causation with proximate mechanisms by showing how the adaptive metaproblem between mating motives and food rewards leads to chronic stress and, further, to disordered eating. Chronic stress causes neuroinflammation, which increases susceptibility to OCD-like behaviors that typically co-occur with eating disorders. Chronic stress upregulates the serotonergic system and causes dysphoric mood in patients with restricting-type anorexia nervosa. Dieting, however, reduces serotonin levels and dysphoric mood, leading to a vicious serotonergic-homeostatic stress/starvation cycle whereby cortisol and neuroinflammation increase through stringent dieting. Between-individual and within-individual variation in eating disorders partially arises from (co)variation in gut microbiota and stress responsivity, which influence neuroinflammation and the serotonergic system. In binge-related eating disorders, even a short period of fasting drops serotonin levels, a state alleviated by binge eating. Eating disorder treatments should aim to reduce the chronic stress, neuroinflammation, stress responsivity and gut dysbiosis that fuel the disorders. We review the advances that have been made in recent years in understanding how to best treat eating disorders, outlining directions for future clinical research. Connecting ultimate causes with proximate mechanisms and treating biopsychosocial causes rather than manifest symptoms will enable more effective and sophisticated long-term interventions for the millions of people who suffer from eating disorders. (shrink)

Understanding Eating Disorders is an original contribution to the field of healthcare ethics. It develops a new theory concerning the moral basis of eating disorders, and places such disorders for the first time at the centre of philosophical discourse. The book explores the relationship that people have with food and their own body by looking at genetics and neuro-physiology, sociology and family studies, clinical psychology and psychiatry, and frames abnormal eating at the extreme of a spectrum of (...) normal behaviours, directed by moral values. Giordano argues that abnormal eating is not a psycho-pathological phenomenon, but the coherent implementation of ordinary moral values with a long tradition in Western culture. The book also contains a detailed analysis of UK legislation, accompanied by a timely critique of the law on treatment of mental disorders in general and of eating disorders in particular. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pathology of the Mind: Disorder Versus DisabilityRichard G. T. Gipps (bio)Keywordsorder, disorder, ability, disability, mental illnessAlfredo Gaete (2008) describes mental disorders as impairments in intentionality, phenomenal consciousness, and intelligence that cause harm to the affected person. I found persuasive Gaete’s claim that the concept of ‘mental disorder’ is best understood as nontheoretical and nontechnical. I also find compelling his argument that a previous contribution of my (...) own—which relied in part on specifying different senses of ‘disorder’ in psychological, physiological, and social cases—was misguided. Further, his suggestion that we ought at least to attempt analysis in terms of necessary and sufficient conditions before we seek out less definitive characterizations (in terms of family resemblances) also persuades me, although I find myself less sanguine than he about the general possibility of achieving such analyses.One of Gaete’s principal claims is that mental disorder is helpfully understood in terms of an absence of a capacity—that is, as a disability. There are two related objections—or two aspects of the same objection—that I would like to offer the author with respect to this claim. These may well not be conclusive, but will I hope at least function as foils against which the author can usefully sharpen his argument. One objection suggests that there is a viable distinction between the concepts of mental disorder and mental disability, as commonly used in clinical contexts, which the account offered seems unable to respect. The second suggests that the account may not be able to theorize what is argued to be the essential contribution of the concepts of order and disorder (as opposed to ability and disability) to the everyday concept of mental disorder. Accordingly, it questions the power of a disability approach such as Gaete’s to capture the essential nature of mental disorder.In his paper, Gaete classifies mental retardation and developmental, or (what in the United Kingdom are known as) learning, disabilities (autism, etc.) as cases of mental disorder. I found this surprising because it is not common linguistic practice in the psychological circles in which I operate. It would also seem to make a nonsense of commonly accepted ideas like: “Mental disorders are more likely to occur in patients with developmental disabilities (e.g., in autism, Asperger, or Down syndrome) than in the general population.” (For an example, see Campbell and Malone [1991]). On Gaete’s classification, it would appear that people with autism eo ipso have a mental disorder, and [End Page 341] hence the commonly accepted idea would need to be interpreted as merely a statement about comorbidities of different disorders of the same general (i.e., mental) type. But that is not, I believe, how the term is commonly used, and Gaete’s suggestion must therefore be treated as revisionary rather than descriptively analytical.One way of reconstructing a rationale underlying the distinction between mental disabilities and mental disorders is as follows. A developmental disability involves a failure of (certain aspects of) the mind to grow and reach an expected level or type of organization. A mental disorder by contrast involves a disturbance or disorganization (not simply an impoverishment) within the mind at whichever level of organization it has reached. As the mind develops, and reaches new levels or types of organization, the forms which mental disorders may take accordingly change.Autism and schizophrenia provide helpful illustrations of this distinction. Autism represents a failure of (among other things) the social mind to develop in childhood. The person with moderate to severe autism may attain at best a very shaky grasp on the realities of other minds and social conventions. That is, the degree of mental structure they obtain—their social competencies or capacities—will likely remain limited. It is this fundamental deficit that marks out the disability, and not the social anxieties or other such disturbances that can beset the autistic person.Schizophrenia, by contrast, tends to occur at late adolescence, when the individual has developed higher levels of—albeit often fragile—mental structure. Yet it is not the fragility of such mental structure, but rather the disruptions that can occur within such structures as have developed, that mark them out... (shrink)

One of the central considerations to be taken into account in evaluating the ethics of compensation for donated plasma is respect for donor autonomy. And one of the main arguments against compensated donation systems is that many donors do or would come from circumstances of poverty that restrict their alternatives in a way that compromises those donors’ autonomy. In this paper, I develop and defend a novel version of this “compromised autonomy argument” which improves upon extant versions by employing a (...) more nuanced account of the relationship between alternatives and autonomy. According to the version of that argument I offer, donors lack autonomy with respect to the sale of their plasma if their economic circumstances leave them with no choice but to sell their plasma on the basis of a desire they have had no choice but to hold. After explicating the key terms of this argument, I examine its policy implications. I argue that, given several reasonable empirical assumptions, my argument implies that a majority of individuals whose income falls below a specified threshold would indeed lack autonomy with respect to the sale of their plasma. Most individuals whose income falls above that threshold, on the other hand, would be able to autonomously sell their plasma. I argue that respect for donor autonomy therefore speaks in favor of an income-restricted system of compensated donation which permits collection centers to purchase plasma from those whose income falls above the relevant threshold, but not those below it. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vice, Mental Disorder, and the Role of Underlying Pathological ProcessesNancy Nyquist Potter (bio) and Peter Zachar (bio)Keywordsresponsibility, virtue theory, cultural norms, psychopathologyThe issues discussed by John Sadler are among the most complicated in the philosophy of psychiatry, if for no other reason than that they highlight an area where disciplinary fault lines between clinical psychiatry/ psychology and philosophy seem most evident. We spent a year writing an (...) article on the relationship between the assessment of personality disorders and moral evaluations, and these fault lines became manifest not only between ourselves, but also when discussing our ideas with members of the various disciplines.Many practicing psychiatrists acknowledge that moral attributions (such as manipulativity) might be made about people with certain disorders (such as borderline personality disorder), but also find the argument that psychiatric diagnoses are moral rather than medical conditions to be a ludicrous bit of antipsychiatry in the Szaszian tradition. Philosophers, on the other hand, are less involved with these diagnostic categories in their day-to-day work and are more willing to be skeptical. Whether they are doing philosophy of psychiatry, moral theory, or sociopolitical philosophy, they are interested in digging a little bit deeper and are not impressed by arguments to the effect that—it’s obvious that these are really disorders. Being “obvious” is not a persuasive philosophical argument.The metaphysical task of determining what belongs in the category of criminality compared with other ways of sorting behavior has parallels in moral philosophy: Why is fraud, or theft, criminalized whereas (most) lying is not? Why is one set of moral norms enforceable, whereas a second set is aspirational? Does the difference involve property, where infractions of property are thought to be more serious wrongs than lying, which is “only” psychological rather than material? Are the “most serious” wrongs the ones we mark as crimes? Why is sodomy still criminalized in some areas but betraying one’s lifelong love is viewed as morally reprehensible but not criminal? Both actions are private, and only one seems to do harm—unfaithfulness—yet that is the one that is not criminalized. The point here is that, regardless of domain, our classification systems need to be justifiable, yet justification is most often mystifying. [End Page 27]The same is true for classifying mental disorders. The class of mental disorders appears to be a somewhat inconsistent collection of heterogeneous conditions and does not form a natural kind (Zachar 2000). At the most, the class of mental disorders names a family of loosely related conditions and the reasons for inclusion can shift from disorder to disorder.If the class of mental disorders does not specify an internally coherent kind akin to gold, deciding on the scope of psychiatric practice becomes an important problem. As Sadler asks, for what reasons do we classify pedophilia with schizophrenia—both as disorders—but omit sadism? This is an important question of disciplinary scope.This question of scope is itself ethically charged because, on the one hand, bringing a condition under the purview of psychiatry offers the possibility for treatment, and at least establishes the goal of improving the lives of people with specific kinds of problems. Making lives better is one of the humanistic justifications for science itself; clearly it is a raison d’être of psychiatry. On the other hand, medicalization sets up the conditions for a certain kind of social control. Hospitalization, educational services, day treatment, and disability payments are all contingent upon psychiatric diagnostic practices. These programs and the institutions that manage them are both socially available and socially prescribed. The diagnosed behaviors can now be considered to be entities, and explanations of them can be developed. New technologies for altering them will also be introduced. Such practices have been associated with dehumanization (Phillips 2009).Two important questions also need to be distinguished. The first is a question for moral philosophy—What degree of responsibility do people with putative mental disorders have for their behaviors? For example, should people with psychotic disorders or personality disorders be held responsible for crimes they commit? If so, under what conditions? Should responsibility for certain behavior be mitigated? If so, under what conditions? Moral philosophy... (shrink)

Sufferers of eating disorders often hold false beliefs about their own body size. Such beliefs appear to violate norms of rationality, being neither grounded by nor responsive to appropriate forms of evidence. I defend the rationality of these beliefs. I argue that they are in fact supported by appropriate evidence, emanating from proprioceptive misperception of bodily boundaries. This argument has far‐reaching implications for the explanation and treatment of eating disorders, as well as debates over the relationship between rationality (...) and human psychology. (shrink)

Simona Giordano presents the first full philosophical study of ethical issues in the treatment of anorexia and bulimia nervosa. Beginning with a comprehensive analysis of these conditions and an exploration of their complex causes, she then proceeds to address legal and ethical dilemmas such as a patient's refusal of life-saving treatment. Illustrated with many case-studies, Understanding Eating Disorders is an essential tool for anyone working with sufferers of these much misunderstood conditions, and for all those ethicists, lawyers, and medical (...) practitioners engaged with the widely relevant issues they raise. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on address- ing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined (...) as a syndrome that reflects a dysfunction and is usually associated with significant distress or disability. More importantly, there is an explicit statement saying that all mental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

Many who suffer from eating disorders claim that they see themselves as “fat”. Despite decades of research into the phenomenon, behavioural evidence has failed to confirm that eating disorders involve visual misperception of own-body size. I illustrate the importance of this phenomenon for our understanding of perceptual processing, outline the challenges involved in experimentally confirming it, and provide solutions to those challenges.

As in every religious issue, the two main resources of Islām which are the Qur’ān and the Sunnah/ḥadīths are the first reference sources for deciding the things that are forbidden by Islam. There is no evidence in the Qur’ān that suggests specific types of animals are forbidden to eat except pork. Other than pork, only the animals which are slaughtered without the name of Allah, their blood and their carcass are forbidden to consume. Except these restricted ill-gotten meats, in (...) the Qur’ānic verses there are no other limitations referring to different animals. However, in Ḥadīth sources there are some narratives referring to the Prophet Muḥammad, implying that He named some other forbidden animals beside the ones specified in the Qur’ān. Collecting the narratives and evaluating them as a whole will contribute for a better understanding of the rules and principles of prohibitions that the Prophet Muḥammad imposed on this issue. Moreover, it will help to identify whether those rulings on some animals are unconditional and world-wide or cause-related and thus changeable according to the conditions. Furthermore, in this matter, although some animals‘ meat are not mentioned as forbidden in the Qur’ān, they are banned by the Prophet Muḥammad. This brings the need to highlight the importance of the capacity of the Prophet Muḥammad on deciding what is permissible (ḥalāl) and forbidden (ḥarām) in the religion.SummaryWhile the authority for determining what is ḥalāl (lawful) and what is ḥarām(forbidden) belongs essentially to Allah, the Prophet Muḥammad is also authorized to appoint what is ḥalāl-ḥarām by Allah.Authority of the Prophet Muḥammadrelated to the issue is not absolute and stems from the Qur’ān. Ḥalāland ḥarāmin the Qur’ān prescribed by Allah can be included in the concepts of maʿrūf (right) - munkar (wrong) andṭayyibāt (clean) - hkabāis (filthy). It is understood that the Prophet Muḥammadgrounded his commands in the concept of hkabāis.Prohibitions related to animal meats in the Qur’ānare limited to four: carcass, blood, pork and animals, which are not slaughtered in the name of Allah. However, in the Ḥadīth resources there are some narratives about the Prophet’s prohibition on consuming some types of animals other than the forbidden animals specified in the verses. These narratives can be classified in three titles:1. Animals, which are prohibited to be eaten 2. Animals, which are prohibited because of the way they are fed and slaughtered3. The matter of prohibition of the animals, which are commanded or forbidden to be slaughtered by the Prophet Muḥammad.At the end of the studies conducted based upon ḥadīth resources, in particular Kutūb al-Sittah (the well-known six ḥadīth books), it has been discovered that the animals, which are mentioned as not being permissible in the narratives, they are limited to domesticated donkey and the species of “predatory animals, predatory birds”, namely wolf, fox and cat. Even though the narratives about hyena imply as eatable, hyena is included in this article as it’s a predatory animal.The narratives regarding the prohibition of meat of domesticated donkey were transferred by approximately twenty Companions in respect to the time of the Battle of Khyber. This prohibition is generally stated in the ḥadīthresources as: “We were having dire hunger at the nights of Khyber. When the day for Khyber came, we encountered domesticated donkeys. We immediately slaughtered them. When we put the meat in the pot and started to boil it, crier of the Prophet Muḥammadcalled “Knock over the pots and don’t eat any of the donkey meat”. Regarding the issue there are such statements of some Companions like “we were banned from eating domesticated donkey”, “The Prophet banned the meat of domesticated donkey” among the narratives about the ban. In addition to a large number of narratives about the prohibition of domesticated donkey meat, there are two narratives related to permission of the Prophet for eating domesticated donkey and a narrative that Ibn ‘Abbās did not accept the ban. One of the said narratives is not among the narratives in the Kutūb al-Sittah while the other one is stated solely in the Sunanof Abū Dāwūd and thought to be acceptable by the traditionists. Even though this narrative’s authenticity is accepted, it is understood that there is an implication for the permission based on a necessity. According to the narrative, Ibn ʿAbbās referred to 145thverse of the surah al-An’am as a proof to his view saying “What ḥalālis what Allah allowed, what ḥaramis what Allah forbidden and the things about which there is no judgement of Allah are mubāḥ (permissible)”. As for us, the fact that Ibn ʿAbbās did not accepted the prohibition implies that he did not recognize the Prophet’s command related to the prohibition as an absolute prohibition. The conveyances of many Companions, which are consistent with each other, about the Prophet’s prohibition on eating domesticated donkey during the Battle of Khyber, proved that the prohibition was applied. Even though there is no dispute about prohibiting domesticated donkey, it is controversial whether the prohibition is absolute, constant or provisional based on certain reasons. It is more reasonable to accept that this prohibition was provisional and it was based on certain reasons. Because there are many narratives bearing information that this prohibition was due to several reasons and this is a situation which needs to be considered. Accordingly, there are three reasons, nearly all of which are attributed to judgement of the Companions. These were the facts that domesticated donkey was used in transportation; it used to eat filth and it was slaughtered/consumed without distributing booty/paying taxes. The seeking of the Companions for any reason for this prohibition indicates that they needed to comprehend this prohibition and that the prohibition is not absolute and constant.There is no explanation neither in the resources where the narratives are included nor in the annotation about when, where, why and in which context the prohibition regarding the predatory animals was realized. It is highly possible to assume that the Prophet prohibited these animal as they eat carcass. Another interesting issue within this regard is the fact that there are narratives and views indicating permissibility of eating hyena, which is a predatory, while predatory animals are forbidden in the narratives. Statements of the Prophet related to permissibility of eating hyena, which are considered authentic by traditionists and information about the Arabs who used to eat hyena and some of the Companions who praised eating hyena indicate that urf (custom) has a primary and decisive role about permissibility of eating meats. Regarding this matter about the hyenas, the narratives pointing out some Companions like ʿĀʾisha bint Abī Bakr and Ibn ‘Abbās who viewed prohibition of animals other than the prohibited animals in the Qur’an as inapplicable and other issues referring to the dispute indicate that prohibition of the Prophet Muḥammadfor predators can not be accepted as an absolute and unquestionable prohibition. Some of the prohibitions mentioned in ḥadīth narratives, except these animals, stem from the way of feeding and slaughtering of some animals. It is understood that consuming meat and milk of the animals that eat filth is prohibited in order to abstain from the things harming human health and mujassam (killing an animal with an arrow, etc. by fastening it as a target) is prohibited as carcass is banned and it is not permissible to torture and harm animals. Some of the prohibitions are related to the some animals, which were allowed and banned to slaughter by the Prophet. As the Prophet commanded some animals to be slaughtered and some animals not, meat of these animals was considered as forbidden. There is a dispute among the scholars, whilst there is not any statement of the Prophet about whether the animals included in this group can be eaten or not. It is seen that the Prophet ordered to slaughter some of the animals and prohibited to slaughter some other animals based on several reasons. (shrink)

We determined the prevalence of eating disorder symptoms among elite Spanish athletes from a broad range of sports and levels of competition and examined the associations between the presence of symptoms and perceived sport-specific weight pressures. We surveyed 646 elite athletes representing 33 sports from top-division teams and two elite athlete training centers in Catalonia. Based on the results of the Eating Attitudes Test-26 responses, 5.1% of athletes were at risk of EDs. The highest rates of ED (...) symptoms were observed in male endurance athletes and female esthetic athletes. Competition level was not a risk factor. The only gender differences in the presence of ED symptoms by competing level were observed in athletes competing at the national level. Female athletes with ED symptoms scored higher on the two subscales of the Spanish version of the Weight Pressures in Sport tool: coach and sport-specific pressures and pressures from teammates and due to uniform. Male athletes with ED symptoms scored higher on the pressures due to uniform subscale. Finally, symptomatic female but not male athletes competing at international and national levels also perceived greater sport-specific weight pressures. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on addressing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as (...) a syndrome that reflects adysfunctionand is usually associated with significantdistress or disability. More importantly, there is an explicit statement saying thatallmental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Personal Narratives: Parenting Children With Autism Spectrum Disorders Through the Transition to AdulthoodCatherine Cornell, Julie Herren, Susan Osborne, and Kelly WeissTransition years: From Learning, Living and Loving to Maintenance and MediocrityCatherine CornellWhat does every parent of an autistic child worry about the most? For those of us with severely affected children, the answer to that question is: “Who will care for my child and keep her safe when I (...) am gone?”I drove my daughter back to her “group home” for a scheduled drop off on Saturday. There was only one car in the driveway and the house van was gone. Lily was not happy about returning “home.” Agitated, she opened the door to the car, almost before it was stopped, ran to the back of the house, and up the fire escape stairs to the door of her third floor bathroom, as if she was avoiding going through the main living rooms of the house. I called up to her that there was no one at home and she came back down and pushed through the unlocked door. Racing ahead of me, she was already shed of her clothes and in the shower: her self–calming method that she used whenever returning to the house. Thirty minutes later, after three attempts to leave the shower and throwing up in the shower, she dressed and ran back out to our car. I played her favorite music, attempting to calm her anxiety. This transition, from home to “group home,” was increasingly difficult due to recent changes in staff and housemates. Having no one there to greet her was ratcheting up the anxiety level for both of us.When the on–call manager came, Lily was so distraught that I asked for her medications and took her back home with me. Two days later she was calm enough and I was reassured enough to return her to the house. Somehow the house manager made the incident my fault. Perhaps I did react strongly, but on reflection, what triggered the strong reaction in me was the insecurity I felt at finding no one home. It seemed like a breach of trust. Like we were left, abandoned, our plans shattered and at the mercy of fate. Strong emotions for a little mix–up in communications (if that is what it was) but, nevertheless, there it is—how I felt and more to the point how my daughter felt.I relate this story because it illustrates what has changed the most about our lives since Lily left her school and entered the world of adult services: missing is the feeling of trust and security that responsible caring people would keep Lily safe when my husband and I cannot.My 25–year–old daughter Lily has severe autism. She was the most beautiful and easy baby imaginable and appeared to develop normally until she began to lose speech and have night terrors at 15 months of age. She was diagnosed initially with atypical autism, then pervasive developmental disorder not otherwise specified, and finally with autism at age four.From age four to twenty–two, she attended a specialized school for autism where she received age level academics, therapies for speech, and training in self–care and independent living. She did not do well in academics nor did she regain her lost speech. She did learn to care for herself with assistance and, as important, she gained social and behavioral skills and learned to live with others in a social way. She [End Page E1] also learned recreational and vocational skills that would be transferrable to the community, such as bicycle riding, rollerblading, swimming and jogging. The philosophy of her school was to build self–esteem and confidence by teaching music, art and physical skills—in small steps, ensuring success, and then building on those skills.In her last year at school, Lily was a happy and well–adjusted member of her small group of five young women living in a town house with support from trained school staff. She participated in job programs, earning money by recycling and working for Meals–On–Wheels. She went out into the community with her group... (shrink)

Khalafzai, Rida Usman The prevalence of eating disorders is increasing. This article provides an overview of these disorders and explores the biological and social conditions that influence their development.

The elaborated intrusion (EI) theory of desire (Kavanagh, Andrade, & May, 2005) attributes the motivational force of cravings to cognitive elaboration, including imagery, of apparently spontaneous thoughts that intrude into awareness. We report a questionnaire study in which respondents rated a craving for food or drink. Questionnaire items derived from EI theory formed a single factor alongside factors for anticipated reward/relief, resistance, and opportunity. In a multiple regression predicting strength of craving, the first three factors accounted for 36% of the (...) variance. Opportunity did not enter the model. In a second study, the difference between individuals' strong and weak cravings to take part in a sporting activity was shown to be related to visual, auditory, and general imagery, and to anticipated reward or relief from engaging in the activity. Implications for treatment of craving-related disorders are discussed in the light of these results and of other research indicating that interference with imagery can reduce the strength of craving. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Mean It’s Not My Fault:Learning about Lipedema, a Fat DisorderCatherine A. Seo“As a surgeon there is nothing more I can do for you. You need to lose 75 pounds before I can even consider repairing the damage done.” Implied and not directly stated, “… Because it’s your fault.” I sat listening, dumbfounded. I was at one of the top teaching hospitals in the country, face to face with (...) a respected Harvard Medical School trained surgeon who came highly recommended.I had seemingly irreversible damage that was leading to permanent immobility. I was experiencing excessive and uncontrollable swelling in my extremities. I was in unrelenting pain that prevented me from sleeping through the night.The surgeon looked down at the floor avoiding my gaze and—after never before mentioning weight as a possible contraindication to surgery during any of our interactions associated with five surgeries, in over two years, including at least 25 consultations, pre-op, post-op, or follow-up visits stated—in essence, “I can’t help you. You are too fat. It’s your fault.” Not until now, this moment, a couple of months after “the-surgery-gone-wrong-that-ended-in-terrible-complications,” I was being told that it was my fault.He then looked down at his pager that had conveniently buzzed within minutes after he delivered this news, and then walked out of the examining room leaving me to fend for myself in dealing with serious and life-changing complications. Susan1*, his Nurse Practitioner, printed out and handed me a standard listing of BMI calculations, marched me into the common hallway to weigh me, pointed out my BMI >30, reinforced the message that he would do nothing to remedy this horrific situation unless I lost 75 pounds, and then sent me on my way.I stood outside the hospital in shock. This just wasn’t happening, and it couldn’t be happening to me. I had grown to trust this surgeon, and I was struggling to comprehend what had just happened. As the shock wore off, I reengaged in several failed attempts to get help from him. He seemed to have convinced himself that the reason the surgery had gone awry was because of my excess weight, and not because, as I later learned, I had been misdiagnosed and the procedure, as it was performed, was far too aggressive. My health condition was deteriorating and it appeared as if weight was being scapegoated for the complications.If a solution was to be found, I was going to have to find it. After many months of research, I discovered that I have lipedema, an unrecognized [End Page E6] and generally misdiagnosed hereditary, genetically-based fat disorder. I had always had lipedema, which in my case seems to have been triggered at least since puberty. There are an estimated 17 million women in the USA alone who have lipedema, unrecognized or misdiagnosed.I, like most other women in America, knew that weight was a personal choice, and fat is a result of eating too much. Or was it? This ingrained and culturally accepted structure of knowledge began to disintegrate. I then asked the question, if this disease of lipedema is a fat disorder—and I had been to many, many doctors in my 63 years—why was it never identified? Why was I left to struggle in a constant battle trying to accomplish the impossible? I then learned about and named “anti-fat bias” and began to unravel the answers.About LipedemaAccording to Karen L. Herbst, Ph.D., M.D., endocrinologist and expert on fat disorders, lipedema (lipoedema in Europe) is an inherited genetic disease, affecting at least 11% of women of all sizes, from the extremely thin to the morbidly obese, resulting in localized fat that is bilateral, symmetrical and usually from the waist to just above the ankles. It can also affect the upper arms. Unlike the “normal” fat of obesity, lipedemic fat cannot be lost through diet and exercise. It is not uncommon for the comorbidity of overweight or obesity to accompany lipedema. Allen and Hines, physicians at the Mayo Clinic, first named Lipedema in 1940.Believed... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Psychopathy, Other-Regarding Moral Beliefs, and Responsibility”R. A. Duff (bio)AbstractI make four criticisms of Fields’s account of one type of psychopathy as a responsibility-negating personality disorder which involves an incapacity to form other-regarding moral beliefs. First, his account of what it is to hold moral beliefs (in terms of accepting universal practical principles) actually specifies neither a necessary, nor a sufficient, condition for holding a (...) moral belief. Second, he is too quick to dismiss the suggestion that what psychopaths suffer from is an inability to understand moral concepts and values. Third, he does not show why we should ascribe an incapacity to accept moral beliefs to the psychopath, rather than a culpable failure to do so. Fourth, he suggests too weak a criterion of criminal liability, as requiring only the capacity to act for prudential reasons.KeywordsMoral beliefs, moral understanding, incapacity, criminal liabilityFields argues that we can properly count at least one type of psychopathy as a personality disorder which negates moral responsibility. This is not because, as others have argued, such psychopaths cannot understand moral concepts and moral values, but because they suffer an incapacity to form other-regarding moral beliefs, i. e., to accept practical moral principles; we cannot hold them morally responsible for failing to accept or obey moral principles which they lack the capacity to accept. Nor, he also argues, should we hold them criminally liable, since they lack that capacity to act for prudential reasons to which a deterrent system of law appeals.His paper rightly emphasizes the interdependence of psychiatry and philosophy, in this as in other contexts. A psychiatric account of psychopathy as a disorder involving some kind of moral incapacity must depend for its precise sense on an adequate account of the concepts of moral capacity and incapacity: an account which should draw on the resources of moral philosophy. Philosophers who aim to understand those concepts will do well to attend, as Fields does attend, to psychiatric discussions and case histories: not only because this is necessary if their comments on mental disorder or on psychopathy are to be adequately informed, but also because careful attention to the problematic phenomena of mental disorder can also illuminate our understanding of the rational powers and capacities which are lacking or distorted in the disordered, and which philosophers hope to analyze. Fields is also clearly right to emphasize that the criteria of moral responsibility might not be the same as the appropriate [End Page 283] criteria of criminal liability: that the question of whether psychopaths should be criminally liable cannot necessarily be answered simply by determining whether they are morally responsible.However, I do not think that he has provided an adequate account of psychopathy as a personality disorder which negates moral responsibility and criminal liability. I will comment on four aspects of his discussion.First, as Fields recognizes, one who wants to argue that psychopaths lack the capacity to form moral beliefs owes us an account of what it is to form, or hold, a moral belief. Fields’s account is familiar, but arguable. To hold a moral belief is to accept, and to be motivated by, a universal practical principle: a principle which one regards as providing very strong reasons for action, and breaches of which arouse such responses as (third-person) disapproval or (first-person) guilt. It could be plausibly objected, however, that accepting some universal practical principle is neither a necessary nor a sufficient condition for holding a moral belief.It is not a sufficient condition, partly because not any universal practical principle which an agent treats as being important can intelligibly count as a moral principle. The principle “One should never split an infinitive” cannot, by itself, count as a moral principle; and if someone treated it as if it were a moral principle, we would judge his moral understanding, and his rational capacities, to be seriously impaired. This suggests that a purely formal account of the “moral,” like Fields’s (an account that pays no attention to the content of what could count as a moral principle) cannot be adequate (see Foot 1978). A further, related reason for the... (shrink)