الفهرس 
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Abstract
Eating disorders are serious illnesses that are associated with severe medical complications and have significant psychiatric comorbidity that could be life-threatening. They also affect the quality of life (Hay & Mondm, 2005; Stice et al 2009). Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorders, rumination disorders, avoidant/restrictive food intake disorders, and night-eating syndrome (Johnson, 2003, Klump et al., 2009). The newly added diagnostic category to the DSM-5 and ICD 11 guidelines, Binge Eating Disorder (BED), is more prevalent than both anorexia nervosa (AN) and bulimia nervosa (BN) combined (American Psychiatric Association, 2013). Besides, DSM-5 newly defines a lower-threshold form of BED, also associated with significant distress or impairment in life functioning: BED of low frequency and/or limited duration can be diagnosed if objective binge eating is occurring less than once per week and/or for shorter than months, while all other DSM-5 criteria Of BED still need to be met (Hilbert, 2019). Binge eating disorder (BED) is probably under-recognized, and in young people may look more like loss of control over eating than true bingeing (Ben Lewis et al., 2016). As compared to the Western countries, the prevalence of EDs in non-Western countries was lower but seemed to be increasing (Makino et al., 2005). Of
Summary
physical and mental disorders, anorexia nervosa and bulimia nervosa combined ranked as the 1 th leading cause of disability-adjusted life years (DALYs) in females aged 15–19years in high-income countries, responsible for . % of all DALYs (Erskinem, 2016)., Keski-Rahkonen and Mustelin state that a basic requirement for advances in the detection and treatment of eating disorders is a better understanding of their epidemiology (Keski-Rahkonen et al., 2016). Given the scarcity of studies on eating disorders in the Middle East in general and in Egypt specifically this study was conducted to find out the prevalence of eating disorders with special attention to the newly added diagnosis BED and the associating emotion recognition deficits. from the earliest descriptions of eating disorders, the relevance of emotional and social factors in their origins has been discussed (Ochsner, 2008). And achieving a better understanding of emotion recognition deficits in ED populations represents an urgent challenge to the field (Rebecca Brewer et al., 2014). Problems interpreting emotion may also contribute to and exacerbate clinical symptoms, thereby impacting on treatment outcomes (Treasure et al., 2012). Consistent with evidence that neurocognitive mechanisms responsible for the subjective experience of emotion make a causal contribution to the
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recognition of emotion in others, alexithymia is negatively associated with emotion recognition in others; According to the alexithymia hypothesis of affective impairment (Grynberg et al., 2012). Therefore to reach a better understanding of emotion recognition deficits with EDs, further understanding of alexithymia is needed. Alexithymia means literally ”no words for mood” (I.M. Lesser, 1981; Ogrodniczuk et al. 2019). The alexithymia construct includes four distinct characteristics: (a) difficulty in identifying and describing feelings, (b) difficulty in distinguishing feelings from the bodily sensations, (c) diminution of fantasy, and (d) concrete and poorly introspective thinking (Taylor, et al. 1991). It is difficult for people with alexithymia to verbally communicate their psychological distress, with failure to seek help from others (Taylor et al., 2003). Therefore, it is suggested that alexithymia can affect recovery from eating disorders, because such cognitive limitations in emotion regulation may predispose the use of maladaptive eating behaviors to deal with stressful situations (Speranza et al., 2007). In addition, the reduced ability to report emotions to the therapist represents another obstacle for therapeutic efficacy (Jänschetal. 2009; Haynos and Fruzzetti, 2011). Given that the studies about alexithymia and its prevalence are relatively limited especially in Egypt, together with its suggested role
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in Eating disorders, the current study was conducted to find out the prevalence of eating disorders and alexithymia among a sample of Egyptian medical students who have a stressful lifestyle which makes them vulnerable to psychiatric comorbidities. University years are a critical period in which young people establish independence and adopt lasting health behaviors (Al-Thani and Khaled , 2018). University students’ life is full of stressful events such as academic demands, transitioning in academic systems between high school and university, leaving home, facing financial problems, and finding new friends (Sreeramareddy et al., 2007). Therefore, university students are vulnerable to some forms of psychological distress, such as depression, anxiety, and stress, which may affect their emotional status. Medical students report higher levels of psychological distress than their same-age peers (Dyrbye, et al., 2014). Medical students are more prone to suffer for example from major depressive disorder (MDD) than other undergraduate students (Puthran et. al., 2016, Rotenstein et al., 2016; Silva et al., 2017). Every year, to 4 physicians commit suicide in the United States according to the American Foundation for Suicide Prevention (Goldman et al,. 2015). Generally, eating disorder behavior occurs as a method of coping to distract oneself from stress. One example of eating disorder
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behavior is called the night eating syndrome (NES), which was caused by a high level of emotional eating (Nolan & Geliebter, 2012). Apart from stress, perfectionism has been evidenced to be an important clue to uncover the relationship between academic burnout and eating disorder (Peixoto-Plácido et al., 2015). Those with maladaptive perfectionism would usually be stressed and frustrated when they cannot achieve what they have targeted. For the above-mentioned reasons, a sample of Egyptian medical students not attending psychiatric clinics was the chosen population for our study to: 1- evaluate the prevalence of eating disorders among a sample of both male and female Egyptian medical students. -screen for binge eating behavior among a sample of both male and female Egyptian university students. - Evaluate the relationship between alexithymia and eating disorders. Using an observational – cross-sectional two-stage study design, 5 5 Egyptian medical students in Ain-Shams University not attending psychiatric clinics, in stratified random sample, were all screened for eating disorders, binge eating behaviors, body dissatisfaction, and alexithymia by a means of administered questionnaires, then the second stage involved applying more detailed questionnaire for eating disorders All students involved in the study were subjected
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to:Designed clinical sheet for demographic data: using designed clinical sheet of eating disorder clinic of Ain Shams University, the Arabic version of General health questionnaire-2 : for psychiatric distress., the Arabic version of Toronto Alexithymia Scale 2 , to measure alexithymia with its subscales., the Arabic version of the Eating Attitude Test -2 (EAT-2 ) as a first step-screening tool for eating disturbances in non-clinical populations., For the students with a cut-off score of on EAT - , they were reached out for stage test: Arabic version of Eating Disorders Inventory (EDI-II) which is a self-report questionnaire used to assess the presence of eating disorders. All students also were subjected to the Arabic version of Body Image Test, to evaluate body dissatisfaction. And Binge Eating Scale to assess the presence of binge eating behavior indicative of an eating disorder. Translated and back translated to Arabic, Validity and reliability for the Arabic version was tested as a part of the study Regarding abnormal eating attitudes, 1 . % of the studied sample showed abnormal eating attitudes according to EAT- with females 14 % and males 8.9 %, As regards screening for binge eating behaviors, 1 . % of the studied sample showed binge eating behaviors on BES, 9. % were moderate and 4% were severe, As regards alexithymia; 4.4% of the
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studied sample had alexithymia, while % were possible alexithymia, In conclusion, this study showed higher prevalence of alexithymia among a sample of Egyptian medical students than average rates in general population, it also showed higher rates of both alexithymia and psychological distress specifically in nd grade, pointing to this grade may need special attention and treated as vulnerable group, meanwhile, prevalence of abnormal eating attitude and body dissatisfaction was matching the average prevalence in literature, while binge eating behaviors were less than that of developed countries, with peak of binge eating in 4th grade (while 4th grade was least in alexithymia and psychological distress) pointing to possible relation of binge eating as a way to alleviate distress, and this hypothesis should be further studied in a future cohort study. It was also noticed in our study that difficulty in identifying feelings (DIF) subscale of alexithymia was a common factor significantly affected variation of scores in all eating disorders scales (EAT- , BES, EDI-II&BIT), suggesting that difficulty identifying feelings may be a core driving feature of alexithymia in relation to eating disorders and may have a predictive value for further study.