Common use of General Background Clause in Contracts

General Background. The eating disorders [anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS)] are biologically based serious mental disorders which typically develop in mid- adolescence at a developmentally sensitive time (▇▇▇▇▇ et al., 2009; Treasure et al., 2010). About 90% of sufferers are female. Life-time prevalence rates, for full and partial AN in the general population, range from 0.9% to 4.3% for females (▇▇▇▇▇▇ et al., 2006; ▇▇▇▇ et al., 2006), and from 4% to 7% for full and partial BN (e.g. ▇▇▇▇▇▇ et al., 2003). The overall incidence and prevalence of AN and BN is stabilising in Western countries (▇▇▇▇▇▇ et al., 2005; van Son et al., 2006), but increasingly younger people are affected. The incidence of EDNOS and BED continues to rise, as does the combination of ED and obesity (▇▇▇▇▇ et al., 2008; ▇▇▇ et al., 2008). Eating disorders have major psychological, physical and social sequelae (▇▇▇▇▇ et al., 2006). Comorbidity is the rule rather than the exception (Treasure et al., 2010) with particularly high rates of anxiety related disorders (▇▇▇▇, 2004) and depression (▇▇▇▇▇▇ et al., 2006). Approximately half of people with an ED show full recovery, a third improve and the remainder stay chronically ill (▇▇▇▇▇▇▇▇▇▇▇, 2002; ▇▇▇▇▇▇▇▇▇▇▇ and ▇▇▇▇▇, 2009). The mortality of AN is high (▇▇▇▇▇▇ et al., 2010; ▇▇▇▇▇▇▇▇▇▇▇▇ et al., 2009), with 12 times the annual death rate of all causes of mortality for females aged 15–24 years in the general population (▇▇▇▇▇▇▇▇, 1995). However, the introduction of specialist services appears to have improved survival rates (▇▇▇▇▇▇▇▇ et al., 2006). Less is known about the mortality rates of BN and EDNOS, although a recent large study suggests this may be as elevated as that of AN (Crow et al., 2009). The costs of ED extend to carers who report high levels of psychological distress (▇▇▇▇▇ & ▇▇▇▇▇▇▇▇, 2003; ▇▇▇▇ et al., 2007). In terms of the efficacy of psychological treatments for ED, progress in the treatment of adults with AN remains limited (▇▇▇▇▇ et al., 2004). Whilst Cognitive Behaviour Therapy (CBT) is the leading treatment for BN and related disorders (Hay & ▇▇▇▇▇▇▇▇▇▇, 2003; ▇▇▇▇▇▇▇▇ et al., 2008), in the treatment of adults with AN no clear ‘frontrunner’ has as yet emerged (▇▇▇▇▇ et al., 2007). The new generation of treatment programmes for ED includes components which focus on emotional and/or social processes, such as emotional dissociation (▇▇▇▇▇▇ et al., 2004), self esteem, emotional avoidance and interpersonal functioning (▇▇▇▇▇▇▇▇ et al., 2009; ▇▇▇▇▇▇▇ & ▇▇▇▇▇▇▇▇, 2006; ▇▇▇▇▇▇▇▇ et al., 2005). Below, some selected topics are going to be reviewed in more detail, as they are more directly relevant to this thesis.