{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T17:43:16Z","timestamp":1782150196550,"version":"3.54.5"},"reference-count":43,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,17]],"date-time":"2022-04-17T00:00:00Z","timestamp":1650153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Eating disorders (EDs) are complicated mental illnesses with significant treatment resistance and dropout rates. For successful treatment, it is important for clinicians to better understand the patients\u2019 narrative and their lived experiences. A thorough psychodynamic understanding of patients\u2019 childhood attachment and primary relationships, personality traits and mental processes is, therefore, crucial for managing patients with ED. Interestingly, several studies have observed an association between functional urinary symptoms and individuals with ED. EDs such as anorexia nervosa are associated with an increased risk of all urinary symptoms, and functional incontinence was also more common in extreme female athletes with low energy availability and with disordered eating. There is, however, a dearth of literature describing this relationship, and the underlying mechanisms remain remote. In this paper, we present a psychoanalytic approach to the presence of urinary symptoms in females with EDs. We hypothesize that these symptoms are tied to specific traits or characteristics of ED patients, namely the overarching need for control, a pathological strive for perfection and the self-denial of basic bodily urges. This is discussed in relation to psychopathological processes, development and personality factors commonly seen in patients with ED.<\/jats:p>","DOI":"10.3390\/ijerph19084874","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T04:21:28Z","timestamp":1650255688000},"page":"4874","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Females with Eating Disorders and Urinary Incontinence: A Psychoanalytic Perspective"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8561-2513","authenticated-orcid":false,"given":"Qin Xiang","family":"Ng","sequence":"first","affiliation":[{"name":"MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu Liang","family":"Lim","sequence":"additional","affiliation":[{"name":"MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayren","family":"Loke","sequence":"additional","affiliation":[{"name":"MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan Tsee","family":"Chee","sequence":"additional","affiliation":[{"name":"Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore 539747, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donovan Yutong","family":"Lim","sequence":"additional","affiliation":[{"name":"Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore 539747, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1038\/mp.2010.125","article-title":"Gene\u2013environment interaction in anorexia nervosa: Relevance of non-shared environment and the serotonin transporter gene","volume":"13","author":"Karwautz","year":"2011","journal-title":"Mol. Psychiatry"},{"key":"ref_2","first-page":"60","article-title":"Reluctance to recover in anorexia nervosa","volume":"13","author":"Espeset","year":"2012","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jpurol.2021.01.041","article-title":"Low energy availability and impact sport participation as risk factors for urinary incontinence in female athletes","volume":"17","author":"Whitney","year":"2021","journal-title":"J. Pediatric Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.jsams.2018.07.008","article-title":"Urinary incontinence and disordered eating in female elite athletes","volume":"22","author":"Carvalhais","year":"2019","journal-title":"J. Sci. Med. Sport"},{"key":"ref_5","first-page":"146","article-title":"The relationship between urinary incontinence and eating disorders in female long-distance runners","volume":"54","author":"Araujo","year":"2008","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.eatbeh.2018.03.002","article-title":"The relative associations of shape and weight over-evaluation, preoccupation, dissatisfaction, and fear of weight gain with measures of psychopathology: An extension study in individuals with anorexia nervosa","volume":"29","author":"Linardon","year":"2018","journal-title":"Eat. Behav."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/S0005-7967(00)00033-4","article-title":"Eating disorder examination questionnaire: Norms for young adolescent girls","volume":"39","author":"Carter","year":"2001","journal-title":"Behav. Res. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0005-7967(98)00102-8","article-title":"A cognitive behavioural theory of anorexia nervosa","volume":"37","author":"Fairburn","year":"1999","journal-title":"Behav. Res. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1002\/eat.23260","article-title":"A framework to conceptualize personal recovery from eating disorders: A systematic review and qualitative meta-synthesis of perspectives from individuals with lived experience","volume":"53","author":"Wetzler","year":"2020","journal-title":"Int. J. Eat. Disord."},{"key":"ref_10","first-page":"38","article-title":"Anorexia nervosa treatment from the patient perspective: A metasynthesis of qualitative studies","volume":"13","author":"Blay","year":"2009","journal-title":"Ann. Clin. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/j.1440-1800.2009.00436.x","article-title":"Understanding women\u2019s experiences of developing an eating disorder and recovering: A life-history approach","volume":"16","author":"Patching","year":"2009","journal-title":"Nurs. Inq."},{"key":"ref_12","unstructured":"Schaefer, J. (2009). Goodbye Ed, Hello Me: Recover from Your Eating Disorder and Fall in Love with Life, McGraw Hill Professional."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.eatbeh.2012.06.005","article-title":"The effects of avoidance coping and coping self-efficacy on eating disorder attitudes and behaviors: A stress-diathesis model","volume":"13","author":"MacNeil","year":"2012","journal-title":"Eat. Behav."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.eatbeh.2005.09.007","article-title":"Maladaptive core beliefs and eating disorder symptoms","volume":"7","author":"Dingemans","year":"2006","journal-title":"Eat. Behav."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/bjc.12120","article-title":"Psychological need satisfaction, control, and disordered eating","volume":"56","author":"Froreich","year":"2017","journal-title":"Br. J. Clin. Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1002\/1098-108X(200012)28:4<370::AID-EAT4>3.0.CO;2-P","article-title":"Attachment patterns in eating disorders: Past in the present","volume":"28","author":"Ward","year":"2000","journal-title":"Int. J. Eat. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.comppsych.2006.09.002","article-title":"Early maladaptive schemas and body mass index in subgroups of eating disorders: A differential association","volume":"48","author":"Unoka","year":"2007","journal-title":"Compr. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1002\/erv.2866","article-title":"Early maladaptive schemas in eating disorders: A systematic review","volume":"30","author":"Maher","year":"2022","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/cp.12067","article-title":"From eating identity to authentic selfhood: Identity transformation in eating disorder sufferers following psychotherapy","volume":"21","author":"Simpson","year":"2017","journal-title":"Clin. Psychol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1080\/02668730600868807","article-title":"A historical overview of the psychodynamic contributions to the understanding of eating disorders","volume":"20","author":"Caparrotta","year":"2006","journal-title":"Psychoanal. Psychother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1097\/01.ju.0000169171.97538.ed","article-title":"Psychosocial and psychosexual development in childhood and adolescence within the exstrophy-epispadias complex","volume":"174","author":"Ebert","year":"2005","journal-title":"J. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s40519-015-0195-y","article-title":"The relationship between eating disorders and sexual trauma","volume":"20","author":"Madowitz","year":"2015","journal-title":"Eat. Weight. Disord.-Stud. Anorex. Bulim. Obes."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1515\/hmbci-2015-0055","article-title":"Sexuality in eating disorders patients: Etiological factors, sexual dysfunction and identity issues. A systematic review","volume":"25","author":"Castellini","year":"2016","journal-title":"Horm. Mol. Biol. Clin. Investig."},{"key":"ref_24","first-page":"61","article-title":"Psychosexual development and eating disorders","volume":"14","author":"Fornari","year":"2003","journal-title":"Adolesc. Med. Clin."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/00006842-195709000-00006","article-title":"Observations on psychological aspects of anorexia nervosa: Report of a case","volume":"19","author":"Meyer","year":"1957","journal-title":"Psychosom. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/BF02190330","article-title":"\u201cIn hunger I am king\u201d\u2014Understanding anorexia nervosa from a psychoanalytic perspective: Theoretical and clinical implications","volume":"22","author":"Chassler","year":"1994","journal-title":"Clin. Soc. Work. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1177\/1363461506070785","article-title":"Clinical, psychological, and personality correlates of asceticism in anorexia nervosa: From saint anorexia to pathologic perfectionism","volume":"43","author":"Fassino","year":"2006","journal-title":"Transcult. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s40519-019-00837-y","article-title":"Asceticism, perfectionism and overcontrol in youth with eating disorders","volume":"26","author":"Obeid","year":"2021","journal-title":"Eat. Weight. Disord.-Stud. Anorex. Bulim. Obes."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S0005-7967(01)00059-6","article-title":"Clinical perfectionism: A cognitive-behavioural analysis","volume":"40","author":"Shafran","year":"2002","journal-title":"Behav. Res. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1002\/1098-108X(200103)29:2<187::AID-EAT1008>3.0.CO;2-R","article-title":"Association between puberty and disordered eating, body image, and other psychological variables","volume":"29","author":"Ackard","year":"2001","journal-title":"Int. J. Eat. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1037\/0021-843X.103.1.137","article-title":"Personality variables and disorders in anorexia nervosa and bulimia nervosa","volume":"103","author":"Vitousek","year":"1994","journal-title":"J. Abnorm. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1080\/02699930902985845","article-title":"Interoceptive awareness in eating disorders: Distinguishing lack of clarity from non-acceptance of internal experience","volume":"24","author":"Merwin","year":"2010","journal-title":"Cogn. Emot."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1038\/nrurol.2016.227","article-title":"Functional urological disorders: A sensitized defence response in the bladder-gut-brain axis","volume":"14","author":"Leue","year":"2017","journal-title":"Nat. Rev. Urol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1002\/eat.20822","article-title":"Nocturnal enuresis in adolescents with anorexia nervosa: Prevalence, potential causes, and pathophysiology","volume":"44","author":"Kanbur","year":"2011","journal-title":"Int. J. Eat. Disord."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"17042","DOI":"10.1038\/nrdp.2017.42","article-title":"Urinary incontinence in women","volume":"3","author":"Aoki","year":"2017","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1136\/bjsports-2012-091880","article-title":"Urinary incontinence in physically active women and female athletes","volume":"48","author":"Goldstick","year":"2014","journal-title":"Br. J. Sports Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1111\/bju.13902","article-title":"Role of serum steroid hormones in women with stress urinary incontinence: A case\u2013control study","volume":"120","author":"Bodner","year":"2017","journal-title":"BJU Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1002\/pds.705","article-title":"Selective serotonin reuptake inhibitor-induced urinary incontinence","volume":"11","author":"Movig","year":"2002","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"112027","DOI":"10.1016\/j.biopha.2021.112027","article-title":"An association between incontinence and antipsychotic drugs: A systematic review","volume":"142","author":"Arasteh","year":"2021","journal-title":"Biomed. Pharmacother."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"541","DOI":"10.2165\/00002512-200825070-00001","article-title":"Drug-induced urinary incontinence","volume":"25","author":"Tsakiris","year":"2008","journal-title":"Drugs Aging"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Ng, Q.X., Lim, Y.L., Loke, W., Yeo, W.S., and Chee, K.T. (2021). Obsessive-Compulsive Disorders and Functional Urinary Disorders: A Fortuitous Association?. Behav. Sci., 11.","DOI":"10.3390\/bs11060089"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1007\/BF03325086","article-title":"Which factors do provoke binge eating? An exploratory study in eating disorder patients","volume":"9","author":"Vanderlinden","year":"2004","journal-title":"Eat. Weight. Disord.-Stud. Anorex. Bulim. Obes."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2464","DOI":"10.1016\/j.juro.2012.09.081","article-title":"Urodynamic studies in adults: AUA\/SUFU guideline","volume":"188","author":"Winters","year":"2012","journal-title":"J. Urol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4874\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:55:33Z","timestamp":1760136933000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/8\/4874"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,17]]},"references-count":43,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["ijerph19084874"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19084874","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,17]]}}}