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Objectives To assess the extent and nature of psychosurgery currently being performed in Australia and New Zealand, and the present status of legislation regulating its practice. Methods Details of current legislation were obtained through inspection of statutes and direct communication with Departments of Health. All full and associate members of the Neurosurgical Society of Australasia were surveyed by postal questionnaire. Ninety-eight neurosurgeons were surveyed, of whom 72 (73%) replied. Results In the 1980s a mean of nine (SD, 5.9) operations were performed per year; about two were performed per year in the late 1980s. Ninety per cent of these operations were performed at one centre in Sydney. The most common indications were severe and medically intractable depression and obsessive-compulsive disorder. Surgery is now exclusively stereotactic and involves the creation of lesions in the orbitomedial frontal or cingulate tracts or a combination of the two. The nature and type of surgery are comparable to those in other centres in the Western world. Regulatory legislation is in place in most, but not all, States in Australia and in New Zealand. Conclusions Further developments of other forms of psychiatric treatments may make psychosurgery, in its present form and at its present level of validation, redundant. If it is to have a resurgence, it would have to be based on a much sounder theoretical premise, and a stronger demonstration of efficacy and predictability of effect.

Aims: Beyond care to ensure there is no untoward inducement or coercion, rarely is consideration given to the reasons people participate in medical research. The present study aimed to explore this within a general practice based survey of eating disorders in women. Further aims were to assess the adequacy of the information provided to participants, and any perceived psychological impact from their involvement.Methods: The survey comprised two stages, first, the subject sample was screened for bulimic eating disorders by questionnaire, and second, likely cases were interviewed to confirm diagnosis and evaluate subject characteristics. A random sample of those who did not meet criteria for interview were interviewed. At the close of the interview respondents were asked a single qualitative question about their reasons for participation. Following the interview, respondents were asked to complete a confidential questionnaire regarding the adequacy of the information and any effects of the interview. This w...

Aims: The study aims were to describe the outcome of patients who had gastric bypass surgery within the last 5 years. Specifically, their current levels of general psychiatric symptomatology, eating disorder symptoms, social functioning and defence style were assessed. Variables tested, that may have influenced outcome tested, were age, marital status, weight, height and defence style.Method: All patients were sent a set of postal questionnaires between one month and five years following gastric surgery. These were the Cooper Modified Social Adjustment Scale (SAS-M), the Defence Style Questionnaire (DSQ-40), the Symptom Checklist 53 (SCL-53) and the Eating Disorder Examination Questionnaire (EDE-Q). Patients were also asked to respond to an open question about their views of the surgery and their outcome. Clinical and weight loss data were obtained through case records.Results: 69 (85%) of eligible patients competed the questionnaires. Their mean age and BMI at the time of the operation was 40.7 years and...

Background Many risk factors have been implicated for eating disorders, although little is known about those for binge eating disorder. Methods A community-based, case-control design was used to compare 52 women with binge eating disorder, 104 without an eating disorder, 102 with other psychiatric disorders, and 102 with bulimia nervosa. Results The main risk factors identified from the comparison of subjects with binge eating disorder with healthy control subjects were certain adverse childhood experiences, parental depression, vulnerability to obesity, and repeated exposure to negative comments about shape, weight, and eating. Compared with the subjects with other psychiatric disorders, those with binge eating disorder reported more childhood obesity and more exposure to negative comments about shape, weight, and eating. Certain childhood traits and pronounced vulnerability to obesity distinguished the subjects with bulimia nervosa from those with binge eating disorder. Conclusions Binge eating disorder appears to be associated with exposure to risk factors for psychiatric disorder and for obesity. When compared with the wide range of risk factors for bulimia nervosa, the risk factors for binge eating disorder are weaker and more circumscribed. Premorbid perfectionism, negative self-evaluation, and vulnerability to obesity appear especially to characterize those in whom bulimia nervosa subsequently develops.

Bulimic Eating Disorders (including bulimia nervosa and binge eating disorder) are unfortunately common problems among Australian females. The scope, morbidity and chronicity of these disorders combine to make them important women's health problems. Surprisingly, while these are distressing and disruptive conditions, research suggests many sufferers are not receiving treatment despite the existence of effective psychosocial treatments. Therefore, increasing access to care is a critical contemporary issue in improving health outcomes for sufferers of these conditions. This paper discusses identified barriers to the receipt of treatment and recent refinements to existing evidence based treatments, namely, the development of Cognitive-Behavioural self-help treatment manuals and their application in the treatment of Bulimic Eating Disorders. The potential benefits of Guided and Unguided Self-Help in overcoming barriers to care are outlined and research examining the efficacy of these approaches for the treatment of Bulimic Eating Disorders reviewed. Methodological limitations of previous research indicate that the clinical utility of these approaches, particularly for bulimia nervosa, are unclear. However, previous encouraging findings and the potential benefits of these approaches support further research into the wider evaluation of these approaches particularly in primary care settings. A trial in progress is outlined and the implications of positive findings for major stakeholders discussed.

The aims of this study were to evaluate the accuracy of AN-DRG version 2.0 codings.Ninety-two separations, covering three of the most commonly occurring AN-DRGsin psychiatry, were reviewed by a psychiatrist. The AN-DRG diagnosis was thencompared to that given by morbidity coders. There was agreement for 69 (79- per cent)separations and disagreement for 18 (21- per cent) separations. Recoding of the 18separations altered average length of stay data and the funding received. The high errorrate of coding stimulated changes to the training of morbidity coders and registrars.

In Reply.— It is reassuring that Sach- dev and colleagues found rates of improvement similar to those in our group. We agree that face-to-face interviews are best to evaluate how patients are doing after psychosurgery, but unfortunately, almost all of the patients we were able to follow up lived great distances from our institution, and such contact was not feasible. We also agree that MRI confirmation of lesion location is of utmost importance, and we now use MRI to confirm the location of the probe before making the lesion, a technique that allows for precise localization of the lesions. We also have found that by using older techniques, some of the lesions may well have missed the cingulate bundle and that sometimes the cingulate gyrus and corpus callosum were affected. Caution is necessary in evaluating neuropsychologic assessments like the Wisconsin Card Sorting Test since the patients referred for psychosurgery are likely

Sixty-nine female patients, mean age 27.5 years (range 20-40), with a past or current history of anorexia nervosa (DSM Ill-R) had spinal trabecular bone density assessed by single energy quantitative CT scan. Current exercise and dietary calcium levels were assessed by detailed questionnaires and categorized. A semi-structured interview was used to record weight, menstruation, exercise and dietary calcium intake histories from early adolescence. Serum sex hormones and total calcium assays were measured. Bone density was significantly lower in the patients compared to 31 controls. Bone density was significantly positively correlated with body mass index, and negatively correlated with illness duration and duration of amenorrhoea. Exercise levels, dietary calcium intake and taking an oestrogen pill did not correlate significantly with bone density. Recovered patients did not have osteopaenia but they had shorter illness histories than non-recovered patients. Management to minimise bone loss should focus on weight gain and resumption of normal menstruation.

BACKGROUND: Depression is recognised as a major public health problem that has a substantial impact on individuals and on society. People with depression may consider using complementary therapies such as acupuncture, and an increasing body of research has been undertaken to assess the effectiveness of acupuncture for treatment of individuals with depression. This is the second update of this review. OBJECTIVES: To examine the effectiveness and adverse effects of acupuncture for treatment of individuals with depression. To determine: • Whether acupuncture is more effective than treatment as usual/no treatment/wait list control for treating and improving quality of life for individuals with depression. • Whether acupuncture is more effective than control acupuncture for treating and improving quality of life for individuals with depression. • Whether acupuncture is more effective than pharmacological therapies for treating and improving quality of life for individuals with depression. • Whether acupuncture plus pharmacological therapy is more effective than pharmacological therapy alone for treating and improving quality of life for individuals with depression. • Whether acupuncture is more effective than psychological therapies for treating and improving quality of life for individuals with depression. • Adverse effects of acupuncture compared with treatment as usual/no treatment/wait list control, control acupuncture, pharmacological therapies, and psychological therapies for treatment of individuals with depression. SEARCH METHODS: We searched the following databases to June 2016: Cochrane Common Mental Disorders Group Controlled Trials Register (CCMD‐CTR), Korean Studies Information Service System (KISS), DBPIA (Korean article database website), Korea Institute of Science and Technology Information, Research Information Service System (RISS), Korea Med, Korean Medical Database (KM base), and Oriental Medicine Advanced Searching Integrated System (OASIS), as well as several Korean medical journals. SELECTION CRITERIA: Review criteria called for inclusion of all published and unpublished randomised controlled trials comparing acupuncture versus control acupuncture, no treatment, medication, other structured psychotherapies (cognitive‐behavioural therapy, psychotherapy, or counselling), or standard care. Modes of treatment included acupuncture, electro‐acupuncture, and laser acupuncture. Participants included adult men and women with depression diagnosed by Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM‐IV), Research Diagnostic Criteria (RDC), International Statistical Classification of Diseases and Related Health Problems (ICD), or Chinese Classification of Mental Disorders Third Edition Revised (CCMD‐3‐R). If necessary, we used trial authors' definitions of depressive disorder. DATA COLLECTION AND ANALYSIS: We performed meta‐analyses using risk ratios (RRs) for dichotomous outcomes and standardised mean differences (SMDs) for continuous outcomes, with 95% confidence intervals (CIs). Primary outcomes were reduction in the severity of depression, measured by self‐rating scales or by clinician‐rated scales, and improvement in depression, defined as remission versus no remission. We assessed evidence quality using the GRADE method. MAIN RESULTS: This review is an update of previous versions and includes 64 studies (7104 participants). Most studies were at high risk of performance bias, at high or unclear risk of detection bias, and at low or unclear risk of selection bias, attrition bias, reporting bias, and other bias. Acupuncture versus no treatment/wait list/treatment as usual We found low‐quality evidence suggesting that acupuncture (manual and electro‐) may moderately reduce the severity of depression by end of treatment (SMD ‐0.66, 95% CI ‐1.06 to ‐0.25, five trials, 488 participants). It is unclear whether data show differences between groups in the risk of adverse events (RR 0.89, 95% CI 0.35 to 2.24, one trial, 302 participants; low‐quality evidence). Acupuncture versus control acupuncture (invasive, non‐invasive sham controls) Acupuncture may be associated with a small reduction in the severity of depression of 1.69 points on the Hamilton Depression Rating Scale (HAMD) by end of treatment (95% CI ‐3.33 to ‐0.05, 14 trials, 841 participants; low‐quality evidence). It is unclear whether data show differences between groups in the risk of adverse events (RR 1.63, 95% CI 0.93 to 2.86, five trials, 300 participants; moderate‐quality evidence). Acupuncture versus medication We found very low‐quality evidence suggesting that acupuncture may confer small benefit in reducing the severity of depression by end of treatment (SMD ‐0.23, 95% CI ‐0.40 to ‐0.05, 31 trials, 3127 participants). Studies show substantial variation resulting from use of different classes of medications and different modes of acupuncture stimulation. Very low‐quality evidence suggests lower ratings of adverse events following acupuncture compared with medication alone, as measured by the Montgomery‐Asberg Depression Rating Scale (MADRS) (mean difference (MD) ‐4.32, 95% CI ‐7.41 to ‐1.23, three trials, 481 participants). Acupuncture plus medication versus medication alone We found very low‐quality evidence suggesting that acupuncture is highly beneficial in reducing the severity of depression by end of treatment (SMD ‐1.15, 95% CI ‐1.63 to ‐0.66, 11 trials, 775 participants). Studies show substantial variation resulting from use of different modes of acupuncture stimulation. It is unclear whether differences in adverse events are associated with different modes of acupuncture (SMD ‐1.32, 95% CI ‐2.86 to 0.23, three trials, 200 participants; very low‐quality evidence). Acupuncture versus psychological therapy It is unclear whether data show differences between acupuncture and psychological therapy in the severity of depression by end of treatment (SMD ‐0.5, 95% CI ‐1.33 to 0.33, two trials, 497 participants; low‐quality evidence). Low‐quality evidence suggests no differences between groups in rates of adverse events (RR 0.62, 95% CI 0.29 to 1.33, one trial, 452 participants). AUTHORS' CONCLUSIONS: The reduction in severity of depression was less when acupuncture was compared with control acupuncture than when acupuncture was compared with no treatment control, although in both cases, results were rated as providing low‐quality evidence. The reduction in severity of depression with acupuncture given alone or in conjunction with medication versus medication alone is uncertain owing to the very low quality of evidence. The effect of acupuncture compared with psychological therapy is unclear. The risk of adverse events with acupuncture is also unclear, as most trials did not report adverse events adequately. Few studies included follow‐up periods or assessed important outcomes such as quality of life. High‐quality randomised controlled trials are urgently needed to examine the clinical efficacy and acceptability of acupuncture, as well as its effectiveness, compared with acupuncture controls, medication, or psychological therapies.

Author(s): Phillipa Hay[sup.1] and Stephen Touyz[sup.2] Editorial This year's Editorial began its life in the Antipodean summer in a bay close to where the sounds of bell birds and tui, "the most melodious wild music" first received international attention from records of Cook's journeys in the eighteenth century [1]. At that time global journeys were dangerous and rare and their scientific discoveries took years to reach a publisher. Now we live in a world community with rapid communications that means that (on a good day) one can communicate to anywhere with an internet connection from the shores Cook took refuge in in 1770. Eating Disorders, like communications, are now global. By its inherent qualities of open access the Journal of Eating Disorders is in a position to disseminate and reach every corner of the world, and the people within them working in the field of eating disorders who have access to the internet. Alongside this there is an imperative that we understand eating disorders and how to manage them in ways that are helpful beyond our own perspective. In 2015 the Journal of Eating Disorders published its first special series on "The Current Status of Eating Disorders: General and Special Population studies". Many of the papers that were submitted were from Asia and the accompanying review by Pike and Dunne [2] underscores the rise in eating disorders across Asia in particular. Another article in the special series points to the increasing prevalence of eating disorders across all age groups, both sexes and throughout all socio-economic groups in Australia [3]. Furthermore throughout 2015 the Journal's website conveyed an invitation from the World Health Organization Global Clinical Practice network for readers to contribute their expertise in Eating and Feeding Disorders to the current revisions to the ICD-11 [4]. Whilst similar to the DSM-5 [5] there will be differences in diagnostic criteria reflecting global cultural and clinical diversity. In 2016 researchers and clinicians working across the world thus have the opportunity to have input into the ICD-11 and its final criteria scheduled to be published in 2017. Along with globalisation and revisions to diagnostic criteria there are increasing challenges to our conceptualisation of "What is an eating disorder". Pike and Dunne's [2] review points to the diversity of expression of an eating disorder within population samples in Asia. For example, they report a study which found no body image disorder and/or no fat phobia in a large minority of Japanese women with anorexia nervosa. In their review they also point to the factors of industrialization and urbanization as being as great if not more significant than "Westernization" cultural values in understanding the rise of eating disorders in Asia and other parts of the globe. Taken together this underscores the degree to which eating disorders classification is in a state of flux and subject to diverse socio and cultural influences. With the Research Domain Criteria (RDoC) [6] movement leading the way we may come closer to an understanding of the neuroscience of appetite, satiety and its relationship to eating and weight facilitating a new understanding of disorders of feeding and eating. We anticipate increasing science in this area written and published in the Journal. It is also important to distil the science and disseminate it to clinicians and the wider community and in this regard the systematic and scientific review is imperative. The Pike and Dunne, and other reviews published in the journal reflect this and for the first time this year we gave a prize both for a primary research paper and for a review paper. We congratulate again our prize winners, for 2015: Dr Loa Clausen [7] and Dr Carmel Harrison [8]. Finally, reflecting the growing globalisation of science, the journal encourages and endeavours to support papers from non-English speaking countries. We recognise however that it is imperative to better develop the processes that allow that to occur, and to have efficient processes in place. …

Psychological distress and deficits in executive functioning are likely to be important barriers to effective weight loss maintenance. The purpose of this paper is twofold. First, in the light of recent evidence in the fields of neuropsychology and obesity, particularly on the deficits in the executive function in overweight and obese individuals, a conceptual and theoretical framework of obesity maintenance is introduced by way of a clinical obesity maintenance model (COMM). It is argued that psychological variables, that of habitual cluster Behaviors, emotional dysregulation, mood, and health literacy, interact with executive functioning and impact on the overeating/binge eating behaviors of obese individuals. Second, cognizant of this model, it is argued that the focus of obesity management should be extended to include a broader range of maintaining mechanisms, including but not limited to cognitive deficits. Finally, a discussion on potential future directions in research and practice using the COMM is provided.

Background Obesity stigma has been shown to increase binge eating, whilst positive regard for eating disorders (EDs) may increase dietary restriction which can also lead to binge eating and weight gain. In the context of increasing prevalence of both obesity and EDs exploring community attitudes towards these illnesses may uncover new variables worthy of consideration in population health campaigns. The aim of the study was to explore community perceived stigma and conversely favourable regard toward eating disorder (ED) sufferers of varying weight status, and understand how the attitudes of obese individuals may differ from those of non-obese individuals. Data for this purpose were derived from interviews with individuals participating in a general population health survey. Vignettes of an underweight female with Anorexia Nervosa (AN), a normal weight male with an atypical eating disorder (NWED) and an obese female with Binge Eating Disorder (BED) were presented to three randomly selected sub-samples of n = 983, 1033 and 1030 respectively. Questions followed that assessed participants’ attitudes towards and beliefs about the person described in the vignette and their eating behaviours. Results Sixty-six per cent of participants who responded to the obese BED vignette believed that there would be discrimination against the person described (primarily because of her weight). Corresponding figures were for the AN and NWED vignettes were 48% and 35%, respectively. A positive regard for weight-loss or body-image-enhancing ED behaviours was reported ‘occasionally’ or more often by 8.8% of respondents to the AN vignette and by 27.5% of respondents to the NWED vignette. Positive regard for ED behaviours was significantly more likely in obese participants (AN: 15%; NWED: 43%). Conclusion The findings support integrated ED and obesity prevention programs that address weight stigma and the social desirability of ED behaviours in vulnerable individuals.

Anorexia Nervosa (AN) is an illness characterised by extreme concern about body weight and shape, severe self-imposed weight loss, and endocrine dysfunction. In spite of its high mortality, morbidity and chronicity, there are few intervention studies on the subject.The aim of this review was to evaluate the efficacy and acceptability of antidepressant drugs in the treatment of acute AN.The strategy comprised of database searches of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register, MEDLINE (1966 to April 28th, 2005), EMBASE (1980 to week 36, 2004), PsycINFO (1969 to August week 5, 2004), handsearching the International Journal of Eating Disorders and searching the reference lists of all papers selected. Personal letters were sent to researchers in the field requesting information on unpublished or in-progress trials.All randomised controlled trials of antidepressant treatment for AN patients, as defined by the Diagnostic and Statistical Manual, fourth edition (DSM-IV) or similar international criteria, were selected.Quality ratings were made giving consideration to the strong relationship between allocation concealment and potential for bias in the results; studies meeting criteria A and B were included. Trials were excluded if non-completion rates were above 50%. The standardised mean difference and relative risk were used for continuous data and dichotomous data comparisons, respectively. Whenever possible, analyses were performed according to intention-to-treat principles. Heterogeneity was tested with the I-squared statistic. Weight change was the primary outcome. Secondary outcomes were severity of eating disorder, depression and anxiety symptoms, and global clinical state. Acceptability of treatment was evaluated by considering non-completion rates.Only seven studies were included. Major methodological limitations such as small trial size and large confidence intervals decreased the power of the studies to detect differences between treatments, and meta-analysis of data was not possible for the majority of outcomes. Four placebo-controlled trials did not find evidence that antidepressants improved weight gain, eating disorder or associated psychopathology. Isolated findings, favouring amineptine and nortriptyline, emerged from the antidepressant versus antidepressant comparisons, but cannot be conceived as evidence of efficacy of a specific drug or class of antidepressant in light of the findings from the placebo comparisons. Non-completion rates were similar between the compared groups.A lack of quality information precludes us from drawing definite conclusions or recommendations on the use of antidepressants in acute AN. Future studies testing safer and more tolerable antidepressants in larger, well designed trials are needed to provide guidance for clinical practice.

Anorexia nervosa is one of the earliest psychiatric illnesses to be described in the medical literature with well documented accounts made in the 19th century by both Gull [1] and Lasegue [2]. They both expressed optimism about the eventual outcome of treatment. Since then, there have been many claims about successful outcomes, but all too often only reversal of the undernourished state is achieved [3]. Treatment may have minimal impact on the persistent and unrelenting ruminations pertaining to food, shape and weight which are so characteristic of those with SE-AN. Good progress has been made in treating younger patients with a shorter duration of illness using family-based approaches [4, 5] but it is those who either fail to respond, or go on to develop a severe and enduring form of the disorder (SE-AN), that have received little or no attention to date [6]. Those living with a chronic illness, especially one as debilitating as SE-AN, are entitled to dream of a better tomorrow and to feel understood not only by the medical profession but by the world at large [7]. Almost every day, we are reminded about the extra-ordinary breakthroughs being made in the fight against cancer, whilst we continue to battle over the vexed issues of the imposition of involuntary treatment and the ethics of palliative care. Patients with SE-AN can no longer be ignored for they have suffered for far too long, having to contend with an abysmal quality of life devoid of any hope of an effective treatment on the horizon. This situation is in urgent need of address especially since there has only been one randomised controlled trial to date [8] that has specifically focussed upon those with the severe and enduring form of the illness. Much more needs to be done. The time has now arrived to take the bold step in reconceptualising illness severity in anorexia nervosa especially since there is a growing recognition that the factors that may contribute towards its onset are not necessarily the same as the ones that may perpetuate it [9]. Our current classification system (DSM-5), although an improvement over its predecessors, remains limited in its clinical utility especially when identifying the onset of illness (when treatment is most likely to be effective) and giving special recognition to those when it becomes persistent [10, 11]. We have provided a cogent argument that a clinical staging model, that is so widespread in the conceptualisation and treatment of somatic illness, be adopted in anorexia nervosa. Such a model has been applied in malignancies, cardiac failure, auto-immune disease and burns where both prognosis and treatment are informed by stage [12]. Anorexia nervosa is ideally suited for the adoption of a staging model, because unlike any other psychiatric disorder, it has clearly delineated physical biomarkers of disease progression, for example bradycardia and raised liver enzymes [13] Like so many illnesses, anorexia nervosa exists on a spectrum. Just as there is no single treatment advocated for all cancers, there should not only be one treatment for all patients with anorexia nervosa. It is clear that a 14 year old adolescent with a 3 month history of anorexia nervosa would present differently to a 40 year old woman who has battled the illness for 25 years with multiple hospital admissions and has attempted cognitive behaviour therapy several times. Those with SE-AN are more likely to have high levels of disability, to be under- or unemployed, to be receiving welfare, supported by health benefit plans and become a significant burden to family, carers and health fund providers. In fact on measures such as quality of life, those with SE-AN have been found to be equal in impairment to those with severe depressive disorder as well as schizophrenia [14]. Such factors provide a compelling argument as to why a rehabilitation model of care, not too dissimilar to the ones advocated for those with schizophrenia, needs to be considered for those with a persistent eating disorder including highly specialised acute care when the need arises. It goes without saying that such patients with SE-AN are amongst the most challenging found in mental health care [15]. They have a markedly reduced life expectancy with the highest mortality rate of any mental illness (at 20 years the mortality rate is 20 %). Because the onset of anorexia nervosa occurs at a young age, it is unfortunately not uncommon for death to occur in young adults in their thirties with a further 5-10 % every decade thereafter [16]. They suffer from a myriad of medical complications and are frequent but often reluctant visitors to general and specialist medical facilities as well as primary care services [6]. Most patients with SE-AN are unlikely to fully recover. Some do but they are in the minority. It is therefore extremely important not to focus solely upon symptom reduction, but to also take into account a more holistic model of care. Such a’ recovery model’ needs to take cognisance of the person as a whole by improving not only quality of life, but overall general functioning, employment and access to suitable housing as well [17]. This requires that our more traditional approaches to treatment, developed for earlier stages of severity, undergo a metamorphosis to better fit the needs of those with a chronic and often unrelenting illness [18]. In a recent randomised controlled trial we attempted to capitalise on those principles advocated by the ‘recovery model’ by comparing two psychological treatments which were specifically adapted for those with a more chronic disorder (Cognitive Behaviour Therapy (CBT-SE) and Specialist Supportive Clinical Management (SSCM-SE)) [8]. The hallmark and defining feature of this study, was that for the first time symptom reduction was not designated as a primary outcome measure. Weight gain was actively promoted but the primary goal was an enhanced quality of life. Both treatment arms were successful in promoting change and by the 12th month follow-up period, those patients receiving CBT-SE had lower Eating Disorders Examination global scores as well as a higher readiness to recover than those receiving SSCM-SE. However, the standout feature was the remarkably low treatment attrition rate of 13 % [19] which to our knowledge is one of the lowest ever reported. We need to rethink our treatment strategies by drawing upon the patient’s strengths and competencies rather than merely paying attention to what is ‘wrong’ with them. Undertaking treatment with a poorly motivated, chronically ill patient where loneliness, despair and an empty sense of self prevail, poses unique challenges for clinicians. As Strober [15] has cautioned, such a therapeutic endeavour requires a temperament capable of enduring hours of “…sameness, respect for solitude, the ability to face frailty and profound sickness with relative ease and the ability and willingness to explore the wounds and deprivation of a life passed by”. It is also so important to never lose the sense of hope as some (albeit few) go on to make a complete recovery. Because of the plight of those afflicted with SE-AN [20], researchers and clinicians are now pushing the frontiers of science by exploring new and bold avenues of investigation such as deep brain stimulation [18, 21] and transcranial magnetic stimulation [18, 22]. As we delve into this brave new world, it is important not lose sight of the first rule of medicine - primum non nocere. Some people with SE-AN are so desperate to seek relief for their untold misery that they will agree to almost anything that promises relief from their suffering and despair. The ethical debate has already begun as to whether interventions such as deep brain stimulation is in fact offering hope to the hopeless or merely exploiting the vulnerable [23]. There is now more than ever before a compelling need to bring such new ideas and emerging data to the fore in a timely fashion so that replication of the most promising new data can occur and the ethical considerations widely debated. The wheel may have already started to turn with a plenary session debating this issue at the next Eating Disorder Research Society Meeting [24] in Sicily in September. Furthermore, this journal (Journal of Eating Disorders) plans to publish a special issue entirely dedicated to those patients not only with anorexia nervosa (SE-AN), but those falling within the broader spectrum of eating disorders as well. It is hoped that such a special issue focussing entirely upon those with a persistent eating disorder will not only draw attention to this long-suffering group, but also generate new avenues of exploration as well.

Background We sought to evaluate the hypothesis that mental health impairment in underweight women, where this occurs, is due to an association between low body weight and elevated levels of body dissatisfaction and/or eating-disordered behaviour. Methods Subgroups of underweight and normal-weight women recruited from a large, general population sample were compared on measures of body dissatisfaction, eating-disordered behaviour and mental health. Results Underweight women had significantly greater impairment in mental health than normal-weight women, even after controlling for between-group differences in demographic characteristics and physical health. However, there was no evidence that higher levels of body dissatisfaction or eating-disordered behaviour accounted for this difference. Rather, underweight women had significantly lower levels of body dissatisfaction and eating-disordered behaviour than normal-weight women. Conclusions The findings suggest that mental health impairment in underweight women, where this occurs, is unlikely to be due to higher levels of body dissatisfaction or eating-disordered behaviour. Rather, lower levels of body dissatisfaction and eating-disordered behaviour among underweight women may counterbalance, to some extent, impairment due to other factors.

Even for anorexia nervosa, up to 40% of patients will make a good recovery within five years, a further 40% will make a partial recovery and those with persistent illness may yet benefit from supportive therapies. At least 50% of people with bulimia nervosa fully recover and the outcomes with treatment are also as good if not better for binge eating disorder. SUMMARY Eating disorders are common, but treatment is often delayed despite good outcomes with therapy. Family-based treatment is recommended for children and adolescents with anorexia nervosa. An extended form of cognitive behaviour therapy is effective for bulimia nervosa and binge eating disorder and can be used for adults with anorexia nervosa. Selective serotonin reuptake inhibitors may help with bulimia nervosa and binge eating disorder.

Eating disorders affect 2-3% of people and 90% of sufferers are women. Only a minority of sufferers

Public health interventions are needed to reduce stigma towards bulimia nervosa (BN) to enhance appropriate treatment seeking. This study aimed to evaluate persuasiveness of health messages designed to increase mental health literacy about BN. A community sample of adults (N = 2092) completed self-report measures of knowledge about BN, stigma towards BN and ratings of persuasiveness of health messages on dimensions of convincingness and likelihood of changing attitudes. Messages highlighting that BN is a serious mental illness and that BN has nothing to do with attention seeking were rated as significantly more convincing and significantly more likely to change one's and others' attitudes towards BN than messages describing treatment options for BN. Ratings of message convincingness were positively associated with knowledge about BN for males, but not for females. Knowledge was not related to likelihood of changing attitudes. Message convincingness was inversely related to dimensions of stigma, including perceived advantages of BN, and perceptions that people with BN are unreliable and personally responsible for their illness. No relationship was found between stigma and likelihood of messages changing attitudes. The findings from this study provide a clear direction for implementation in public health interventions of particular messages to reduce BN stigma. This abstract was presented in the Prevention & Public Health stream of the 2014 ANZAED Conference.

The detrimental role of excessive exercise in the pathogenesis and maintenance of Anorexia Nervosa (AN) has featured in past research (Casper, 1998; Davis, 1997). A scarcity of research has focused on targeted exercise interventions in treatment and recovery. Research indicates eliminating exercise completely during treatment is not therapeutic (Beumont, Arthur, Russell & Touyz, 1994), and exercise interventions can be beneficial for improving psychological outcomes (Hausenblas, Cook & Chittester, 2008). The current study aims to investigate the role of exercise in treatment and recovery. 24 participants (12 currently diagnosed with AN, 12 recovered from AN) complete the Eating Disorder Examination (Fairburn, Cooper & O'Connor, 2008), Compulsive Exercise Test (Taranis, Touyz & Meyer, 2011) and a semi-structured interview assessing exercise attitudes and behaviours across their lifespan (including through AN). Data collection is ongoing, with interview data analysed qualitatively using narrative inquiry and grounded theory methods. Preliminary data suggests that for some participants, exercise played a pivotal role in treatment and recovery. Thematically, it appears there is a subgroup of participants for whom exercise was a part of their identity pre-morbidly, and that re-establishing healthy exercise is an integral part of their recovery process. Implications for clinical treatment options will be discussed. This abstract was presented in the Adult Treatment and Services stream of the 2013 ANZAED Conference.

The current study explored the role of exercise in the treatment and recovery process of Anorexia Nervosa (AN). 24 female participants completed the study: 10 women currently in treatment for AN; 7 partially recovered and 7 fully recovered, according to strict criteria. Participants undertook a structured interview assessing eating disorder psychopathology and a semi-structured interview where they were invited to share their story of their illness, with a focus on exercise. Narrative inquiry analyses revealed exercise can be a significant part of the individual’s life in various stages - premorbidly, during the illness, in treatment and recovery processes. Analyses demonstrated important themes including: rapid transformation into compulsive exercise during AN; importance of containment processes during treatment, appropriate limit setting and accountability in early stages of recovery; and the resumption of healthy exercise in full recovery. Results were developed into a model of exercise depicting these themes. Clinical implications to support re-integrating healthy exercise in treatment include the use of psycho-education and structured exercise interventions in treatment services. The findings emphasize the need for further clinical guidelines to ensure consistency in management of compulsive exercise in AN patients. Ongoing interpersonal and therapeutic support is required for patients to re-establish healthy exercise in recovery. This abstract was presented in the Peter Beumont Young Investigator award finalist stream of the 2014 ANZAED Conference.