The Dark and Comforting Side of Night Eating: Women’s Experiences of Trauma

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this interesting manuscript. The authors explored the experiences of patients with NES and identified two main themes; on the one hand, the night eating as the dark side of the patients, and on the other, the comforting side of the behavior. The powerful quotes from the patients provide excellent evidence for the importance of this topic and the inability of quantitative research approaches to capture the full story.

Content suggestions:

L. 41: the conjunction should be and/or rather than and as meeting both criteria are not required for diagnosis. The impact on functioning should also be mentioned.

L. 121 – Please explain the transcription better. It is close to impossible to record all information in real time. The word transcription may not be the best term to use here? Perhaps the practitioner took notes including quotes?

Comments on the Quality of English Language

Grammatical suggestions:

Title – womens’

Conditions are not spelled with capitals, e.g. night eating syndrome

L. 21 Findings present (not presents)

L. 51 should be ‘have’ (not has)

L.70-71: should be ‘new complex phenomena’

L. 461 should be ‘phenomenological approach’

L. 476 this entire paragraph should be in present tense

Author Response

Reviewer 1:

1. 41: the conjunction should be and/or rather than and as meeting both criteria are not required for diagnosis. The impact on functioning should also be mentioned.

Thank you, we change as you suggested to: and / or (see Page 4).

 

1. 121 – Please explain the transcription better. It is close to impossible to record all information in real time. The word transcription may not be the best term to use here? Perhaps the practitioner took notes including quotes?

Thank you very much,

We change as you suggested to to:

….the practitioner took notes including quotes during the interview by the interviewers (see Page 7).

 

Comments on the Quality of English Language

Grammatical suggestions:

Title – womens’ We changed as suggested.

 

Conditions are not spelled with capitals, e.g. Night eating syndrome (see page 2).

1. 21 Findings present (not presents) Thank you, we changed as suggested
2. 51 should be ‘have’ (not has) – Thank you, we changed as suggested

L.70-71: should be ‘new complex phenomena’ Thank you, we changed as suggested.

1. 461 should be ‘phenomenological approach’ Thank you, we changed as suggested.
2. 476 this entire paragraph should be in present tense – Would you please specify which paragraph you meant?

 

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors 

Thank you for the opportunity to review this paper, that I find original, interesting and valuable for especially clinicians and researchers working with ED. I have some comments that I think would improve the paper:

- Section 2.1.: How did you select the 18 detailed interviews from the whole sample? And how did you assess whether saturation was achieved?

- With which theoretic approach did you analyse the interviews? You mention a phenomenological approach in section 5, but it would be good to mention it earlier in the paper, in the method section.

- Section 2.3.: Can you add a brief description of the specific steps in the analysis: which author did what, and how did you perform the analysis? Did you analyze data together, or separately?

- Were the exclusion criteria related to the ED treatment assessment, or to your study specifically? Why were men excluded?

- Data collection: Were the transcriptions entries for the patient´s charts, or verbatim? How might this affect the results`? 

- I would recommend you to use other pseudonyms for the patients than Patient no. It seems unnecessarily alienating.

- Lines 161 ff: There is something with the font size in the quotes - they are bigger than the actual text.

- Section 3.1.: In this section, it would be good if you introduced the sub-themes. Same goes for section 3.2.

- Lines 361 ff: The conclusion doesn´t quite concur with the heading that explains food as a way of dissociating from reality.

- Lines 483-484: I don´t think quantitative studies can or should validate or generalize your findings, as it is a different approach. The qualitative data can stand in their own right. It would be good, however, if you in this section included reflections on the trustworthiness of your study, for example based on this paper: Shenton, Andrew K. ‘Strategies for Ensuring Trustworthiness in Qualitative Research Projects’. 1 Jan. 2004 : 63 – 75.

  

Comments on the Quality of English Language

The language is fine, there are minor spelling mistakes that a thorough edit can fix.

Author Response

Reviewer 2:

- Section 2.1.: How did you select the 18 detailed interviews from the whole sample? And how did you assess whether saturation was achieved?

Thank you for your suggestion:

18 detailed interviews were selected for this specific study (that included wealth of information describing the patients’ experience of the illness and its consequences), (see page 5-6).

- With which theoretic approach did you analyse the interviews? You mention a phenomenological approach in section 5, but it would be good to mention it earlier in the paper, in the method section.

Thank you very much, we described in more details the phenomenological approach:

The current study used a phenomenology approach derived from the phenomenological-hermeneutic perspective, which observes the human world as composed of multiple subjective realities (Patton, 2014; see page 8). 

- Section 2.3.: Can you add a brief description of the specific steps in the analysis: which author did what, and how did you perform the analysis? Did you analyze data together, or separately?

Thank you very much, we described in more details:

All interviews were conducted and transcribed by the first and second authors, who read all the transcripts at list 3 times to become familiar with the data. The data was coded, and all codes were reviewed and discussed with the co-authors. A collaborative decision made ensuring consensus and support of each theme (see page 8).

 

- Were the exclusion criteria related to the ED treatment assessment, or to your study specifically? Why were men excluded?

Thank you very much for you comment:

Exclusion criteria included men (only few men referrals,), a diagnosis of AN (only few patients with AN presented night eating), severe psychiatric comorbidity (ie. Psychosis, night eating may manifest as part of the psychiatric illness), and diagnosis of sleep-related eating disorders (which according to the DSM not included; see page7).

- Data collection: Were the transcriptions entries for the patient´s charts, or verbatim? How might this affect the results`?

 Unfortunately, WE didn't understand this comment.

 

- I would recommend you to use other pseudonyms for the patients than Patient no. It seems unnecessarily alienating.

If it is OK with the reviewer, we would prefer to keep it as is, in order to avoid

any confidential reasons. 

 

- Lines 161 ff: There is something with the font size in the quotes - they are bigger than the actual text.

We got through all the quotes and change to the same size to be consisted.

- Section 3.1.: In this section, it would be good if you introduced the sub-themes.

Same goes for section 3.2.

We changed as the reviewer suggested:

For section 3.1:

Two main sub themes emerged from them 1, the first described feelings of disgust and shame related to eating and the second described memories of physical and emotional neglect (see page 10).

For section 3.2

Four main sub themes emerged from them 2, the first described Food as relaxing and calming, the second described Food as a tool for filling the emptiness, the third described food as a way of having some control over life, and the fourth described food as a way of dissociating from reality (see page 15).

 

- Lines 361 ff: The conclusion doesn´t quite concur with the heading that explains food as a way of dissociating from reality.

Thank you,

Night eating was also portrayed as a dissociating experience from reality, reminiscent of coping mechanisms for dealing with bad memories of traumatic life events and enabling daily functioning (see page 19).

 

- Lines 483-484: I don´t think quantitative studies can or should validate or generalize your findings, as it is a different approach. The qualitative data can stand in their own right. It would be good, however, if you in this section included reflections on the trustworthiness of your study, for example based on this paper: Shenton, Andrew K. ‘Strategies for Ensuring Trustworthiness in Qualitative Research Projects’. 1 Jan. 2004 : 63 – 75.

 

However, qualitative studies emphasized reflection rather than generalization, as a strategy for ensuring trustworthiness. (Shenton-Andrew, 2004; see page 23).

We added this reference:

Shenton, Andrew K. ‘Strategies for Ensuring Trustworthiness in Qualitative Research Projects’. 1 Jan. 2004: 63 – 75.  

 

 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors

Thank you for revising and resubmitting your manuscript, which has improved the paper. I, however, still have some comments about the method section. 

I still miss information about how the interviews were selected – for the cause of transparency. Were they randomly selected, or selected based on specific criteria, and by whom?

Did you select 18 beforehand, or did you achieve saturation along the way?

 

You write that “all interviews were conducted and transcribed by...” (lines 137-140). At the same time, you write that “the article is a retrospective qualitative study” (line 114). I get the impression, that the study is retrospective, because it´s based on semi-structured diagnostic interviews - but it is unclear in the text and should be more precise. 

 

My comment about the data collection, that the authors didn´t understand: Sorry about an unclear formulation. My comment is connected to the comment above about the transcriptions: It´s unclear if your transcripts are your own semi-structured interviews, or if you reviewed transcripts that were part of a semi-structured diagnostic interview, conducted in clinical practice. You should include some reflections about this. If you conducted your own interviews, you would, e.g., have your own interview guide based on a theoretical/practical rationale. If the interviews are already made, you will have second hand information, and this affects the results. Make sure to be concise about this.  

I´m not sure that I agree with you in lines 501-502. Shenton writes about how trustworthiness is assessed in qualitative reseach, and I think you should include your own thoughts about your study´s trustworthiness according to Shenton.   

Author Response

 

07-11-23

To:

Editor-in-Chief  

Ms.Winnie.Cheng
MDPI Branch Office, Beijing
E-mail: winnie.cheng@mdpi.com

Psychiatry International (ISSN 2673-5318)

 

 

Re: Resubmission revised manuscript:  psychiatryint-2554535

 

Dear Editor in Chief,

 

Thank you for considering our paper to be of interest and important for presentation in
Psychiatry International. 

 

We are pleased to have the opportunity to revise our manuscript.

Enclosed please find a file of our revised manuscript, the comments, as described in the detailed, itemized letter regarding each of the comments of the referees and a cover letter.

We hope you will find it now suitable for the journal and look forward to hearing from you.

 

Best wishes,

Orna Tzischinsky

With hope for better days and peace

 

Corresponding Author

Prof. Orna Tzischinsky, DSc

Emek Yezreel Academic College

orna@yvc.ac.il

 

Reviewer 2:

 

Thank you for revising and resubmitting your manuscript, which has improved the paper. I, however, still have some comments about the method section. 

I still miss information about how the interviews were selected – for the cause of transparency. Were they randomly selected, or selected based on specific criteria, and by whom?

Did you select 18 beforehand, or did you achieve saturation along the way?

 Thank you, we added more information about the selected research patients:

All assessment interviews were designed as semi-structured interviews, with standardized questions posed to all patients. These interviews formed an integral part of a semi-structured diagnostic interview process conducted in the clinical practice of the Eating Disorders (ED) institution. The research team meticulously reviewed all 82 interviews, some of them offered more extensive, informative and expressive responses. From this pool, 18 interviews were selected for this study due to their inclusion of the most detailed and expressive information. (See line 75-82).

 

You write that “all interviews were conducted and transcribed by...” (lines 137-140). At the same time, you write that “the article is a retrospective qualitative study” (line 114). I get the impression, that the study is retrospective, because it´s based on semi-structured diagnostic interviews - but it is unclear in the text and should be more precise. 

 My comment about the data collection, that the authors didn´t understand: Sorry about an unclear formulation. My comment is connected to the comment above about the transcriptions: It´s unclear if your transcripts are your own semi-structured interviews, or if you reviewed transcripts that were part of a semi-structured diagnostic interview, conducted in clinical practice. You should include some reflections about this. If you conducted your own interviews, you would, e.g., have your own interview guide based on a theoretical/practical rationale. If the interviews are already made, you will have second hand information, and this affects the results. Make sure to be concise about this.  

Thank you for your explanation, we included more information:

The 18 interviews conducted during the assessment period and selected for this research were transcribed by the first and second authors. They meticulously reviewed each transcript at least three times to gain a thorough understanding of the data. Subsequently, the data underwent a rigorous coding process, with all codes subject to review and discussion with the co-authors. Collaborative decisions were made to ensure consensus and support for each identified theme (see line 137-142).

 

 

I´m not sure that I agree with you in lines 501-502. Shenton writes about how trustworthiness is assessed in qualitative reseach, and I think you should include your own thoughts about your study´s trustworthiness according to Shenton. 

In regard to trustworthiness according to Shenton, we added our thoughts about our research:

Qualitative studies prioritize reflection over generalization as a means to ensure trustworthiness (Shenton-Andrew, 2004). According to the initial criterion outlined by Guba (1981), the credibility of the current findings is considered very high since they authentically represent the perspectives of NES (Night Eating Syndrome) patients. However, it is important to note that these findings may not be readily generalizable to the entire NES population. Instead, they offer valuable insights into the individual experiences of NES patients and their relationship with trauma (see line 478-482).    

Top of Form

 

WE hope now it's clearer.

WE added the GUBA reference.

Author Response File: Author Response.pdf