Subjective binge eating with compensatory behaviors: A variant presentation of bulimia nervosa

Objectives:

To determine whether a variant bulimic‐type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., “subjective bulimia nervosa,” SBN), has comparable clinical severity to established eating disorders, particularly BN.

Method:

Treatment‐seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN‐R) (N = 45), and AN‐binge/purge type (AN‐B/P) (N = 24) were compared.

Results:

Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN‐R and AN‐B/P.

Discussion:

Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment‐seeking, and outcomes. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

Eating disorder symptomatology and substance use disorders: Prevalence and shared risk in a population based twin sample

Objective:

Research shows a significant association between eating disorders (ED) and substance use disorders (SUD). The objective of this study is to examine the prevalence, chronology, and possibility of shared familial risk between SUD and ED symptomatology.

Method:

Subjects included 1,206 monozygotic and 877 dizygotic adult female twins. ED symptomatology included anorexia (AN) and bulimia nervosa (BN) diagnosis, symptoms associated with diagnostic criteria, and BN symptom count. SUD included alcohol, illicit drug, and caffeine abuse/dependence. Generalized estimated equation modeling was used to examine phenotypic associations, and Choleksy decompositions were used to delineate the contribution of genes and environment to comorbidity.

Results:

There were no significant differences between SUD prevalence in women with AN and BN. Women with BN reported BN preceded SUD development while the reverse was true for AN. Twin analyses showed possible familial overlap between BN symptomatology and all SUD examined.

Discussion:

Results suggest an important difference in the chronology of EDs and SUDs. Women with BN may be turning to substances to dampen bulimic urges. Women with AN may be engaging in substance use initially in an effort to lose weight. Results also suggest familial factors contribute to the comorbidity between BN and SUD. © 2010 by Wiley Periodicals, Inc. (Int J Eat Disord 2010;)     

Course and predictors of maternal eating disorders in the postpartum period

Objective:

To investigate course and predictors of eating disorders in the postpartum period.

Method:

A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM‐IV criteria for prepregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS‐P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum.

Results:

Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS‐P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED.

Discussion:

This is the first large‐scale population‐based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

Personality pathology in purging disorder and bulimia nervosa

Objective:

To compare levels of personality pathology in women with purging disorder (PD), bulimia nervosa (BN), and controls and to compare women with PD and BN on associations between personality pathology and shared eating disorder features.

Method:

Women with BN (n = 73), PD (n = 48), and controls (n = 64) completed interviews and self‐report questionnaires.

Results:

BN and PD were associated with significantly greater personality pathology compared to controls. Cluster C symptoms and trait anxiety were greater in BN compared to PD, but groups did not differ on Cluster B symptoms or impulsivity. Subjective binge episodes were associated with anxious and impulsive personality traits in PD but not BN. Purging in PD was associated with trait anxiety, while purging in BN was associated with impulsivity.

Discussion:

Although BN and PD share eating disorder features and personality disturbance, some of the underlying associations between these eating disorder and personality features differ between groups. © 2011 by Wiley Periodicals, Inc.     

The Course of Eating Disorders Involving Bingeing and Purging Among Adolescent Girls: Prevalence,Stability, and Transitions

Purpose

To quantify eating disorder (ED) stability and diagnostic transition among a community-based sample of adolescents and young adult females in the United States.

Association of Serum Vitamin D Concentration With Clinical Symptoms and Quality of Life in Patients With Irritable Bowel Syndrome

Objective: A high prevalence of vitamin D deficiency (VDD) in gastrointestinal (GI) disorders and the role of vitamin D in the function of the gut have been shown previously. Therefore, we aimed to evaluated the VDD and the possible association of the GI symptoms severity and quality of life (QoL) score with the serum levels of vitamin D in irritable bowel syndrome (IBS).

Methods: A total of 90 patients with IBS based on Rome III criteria enrolled in the study from the tertiary referral university hospital. In addition, 90 sex- and age-matched healthy controls (HCs) were recruited. To measure the serum levels of 25(OH)D₃, blood samples were taken from all the participants. Severity of clinical symptoms, IBS quality of life (IBS-QoL), and IBS symptom severity score (IBSSS) were assessed.

Results: In 66.7% of IBS patients, serum 25(OH)D₃ concentrations were <20?ng/mL. The mean serum 25(OH)D₃ of IBS patients was statistically (p?<?0.05) lower vs. HCs. When different subtypes were analyzed, the serum 25(OH)D₃ concentrations in diarrhea-predominant IBS were statistically (p?<?0.05) lower as compared to HCs. Furthermore, the lower serum concentrations of 25(OH)D₃ were associated (p?<?0.05) with higher severity of abdominal pain and distention, flatulence, overall GI symptoms, and IBSSS. However, a direct significant association was seen between IBS-QoL and serum 25(OH)D₃.

Conclusion: Results of this study showed a high prevalence of VDD in patients with IBS. In addition, VDD was associated with a higher severity of clinical symptoms and lower QoL in IBS.     

Effects of reducing the frequency and duration criteria for binge eating on lifetime prevalence of bulimia nervosa and binge eating disorder: implications for DSM-5

Objective:

We assessed the impact of reducing the binge eating frequency and duration thresholds on the diagnostic criteria for bulimia nervosa (BN) and binge eating disorder (BED).

Method:

We estimated the lifetime population prevalence of BN and BED in 13,295 female twins from the Swedish Twin study of Adults: Genes and Environment employing a range of frequency and duration thresholds. External validation (risk to cotwin) was used to investigate empirical evidence for an optimal binge eating frequency threshold.

Results:

The lifetime prevalence estimates of BN and BED increased linearly as the frequency criterion decreased. As the required duration increased, the prevalence of BED decreased slightly. Discontinuity in cotwin risk was observed in BN between at least four times per month and at least five times per month. This model could not be fit for BED.

Discussion:

The proposed changes to the DSM‐5 binge eating frequency and duration criteria would allow for better detection of binge eating pathology without resulting in a markedly higher lifetime prevalence of BN or BED. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)     

Objective and subjective binge eating in underweight eating disorders: associated features and treatment outcome

Objective:

To define the utility of the DSM‐IV‐TR definition of binge eating, as it applies to anorexia nervosa (AN) and underweight eating disorder not otherwise specified (ED‐NOS).

Method:

We investigated the psychopathological features associated with bulimic episodes in 105 underweight individuals with eating disorders who reported regular objective bulimic episodes with or without subjective bulimic episodes (OBE group, n = 33), regular subjective bulimic episodes only (SBE group, n = 36) and neither objective nor subjective bulimic episodes (n = 36, no‐RBE group). The Eating Disorder Examination (EDE), anxiety, depression, and personality tests were administered before and upon completion of inpatient cognitive behavior therapy (CBT) treatment 6 months later.

Results:

Compared with the SBE group, OBE subjects had higher body mass index, and more frequent self‐induced vomiting, while both OBE and SBE groups had more severe eating disorder psychopathology and lower self‐directness than the no‐RBE group. Dropout rates and outcomes in response to inpatient CBT were similar in the three groups.

Discussion:

Despite a few significant differences at baseline, the similar outcome in response to CBT indicates that categorizing patients with underweight eating disorder on the basis of the type or frequency of bulimic episodes is of limited clinical utility. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012;)     

An epidemiologic study of irritable bowel syndrome in adolescents and children in South China: a school‐based study

Background To explore the prevalence of irritable bowel syndrome (IBS) among school‐aged children in South China, and identify distribution characteristics and contributing factors. Methods Primary, middle and high school students (n= 2013) were recruited from schools in Shanghai. Students completed two questionnaires, one for IBS in adolescents and children and the Screen for Child Anxiety Related Emotional Disorders (SCARED). Results (1) The prevalence of IBS among students was 20.72% and the incidence increased with age. (2) Several physical factors and overuse of analgesics were significantly associated with IBS. (3) The prevalence of anxiety disorder was higher in older students, and in females vs. males. Students with IBS tended towards anxiety‐related emotional disorders (38.14% vs. 18.96%). (4) IBS students scored higher in all SCARED categories. Within IBS students, those who frequently sought medical care reported higher scores in the somatization/panic category. Conclusion (1) Irritable bowel syndrome is a common disorder among adolescents in South China and prevalence increases with age. (2) Gastrointestinal infection, abuse of analgesics and psychological factors might be related to the incidence of IBS. (3) The tendency towards anxiety‐related emotional disorders also increases with age, suggesting a possible correlation with IBS and underlining the importance of positive family and school environments. Although the prevalence of anxiety‐related emotional disorders was higher in females than males, this trend was not correlated with the occurrence of IBS.     

Serotonin transporter binding after recovery from bulimia nervosa

Objective:

Physiological and pharmacological studies indicate that altered brain serotonin (5‐HT) activity could contribute to a susceptibility to develop appetitive and behavioral alterations that are characteristic of bulimia nervosa (BN).

Method:

Eight individuals recovered from BN (REC BN) and eight healthy control women were scanned with [11C]DASB and positron emission tomography imaging of the 5‐HT transporter (5‐HTT). Logan graphical analysis was applied, and parametric binding potential (BP_{nondisplaceable (ND)}) images were generated. Voxel‐by‐voxel t‐tests and a region of interest (ROI) analysis were conducted.

Results:

REC BN had significantly lower [11C]DASB BP_ND in midbrain, superior and inferior cingulate and significantly higher [11C]DASB BP_ND in anterior cingulate and superior temporal gyrus in the voxel‐based analysis. ROI analysis indicated lower [11C]DASB BP_ND in midbrain (p = .07), containing the dorsal raphe, in REC BN, consistent with our earlier studies.

Discussion:

These preliminary findings of a small‐scale study confirm and extend previous data suggesting that ill and recovered BN have altered 5‐HTT measures, which potentially contribute to BN symptomatology and/or differential responses to medication. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012;)     

A cost effectiveness analysis of stepped care treatment for bulimia nervosa

Background:

The cost effectiveness of various treatment strategies for bulimia nervosa (BN) is unknown.

Aims:

To examine the cost effectiveness of stepped care treatment for BN.

Method:

Randomized trial conducted at four clinical centers with intensive measurement of direct medical costs and repeated measurement of subject quality of life and family/significant other time involvement. Two hundred ninety‐three women who met DSM‐IV criteria for BN received stepped care treatment or cognitive behavioral therapy. Cost effectiveness ratios were compared.

Results:

The cost per abstinent subject was $12,146 for stepped care, and $20,317 for cognitive behavioral therapy. Quality of life ratings improved significantly with treatment, and family/significant other time burden diminished substantially.

Discussion:

In this trial, stepped care for BN appeared cost effective in comparison to cognitive behavioral therapy. Treatment was associated with improved quality of life and diminished time costs of illness. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: reduction of eating disorder not otherwise specified and validity

Objective:

Revised Eating Disorder (ED) diagnostic criteria have been proposed for the Diagnostic and Statistical Manual (DSM)‐5 to reduce the preponderance of eating disorder not otherwise specified (EDNOS) and increase the validity of diagnostic groups. This article compares DSM‐IV and proposed DSM‐5 diagnostic criteria on number of EDNOS cases and validity.

Method:

Participants (N = 397; 91% female) completed structured clinical interviews in a two‐stage epidemiological study of EDs. Interviewers did not follow standard skip rules, making it possible to evaluate alternative ED diagnostic criteria.

Results:

Using DSM‐IV versus DSM‐5 criteria, 34 (14%) versus 48 (20%) had anorexia nervosa, 43 (18%) versus 44 (18%) had bulimia nervosa, and 163 (68%) had EDNOS versus 20 (8%) had binge eating disorder (BED), and 128 (53%) had EDNOS, respectively, reflecting a significant decrease in EDNOS. Validation analyses supported significant differences among groups with some improvement associated with delineation of BED.

Discussion:

Proposed revisions to EDs in the DSM‐5 significantly reduced reliance on EDNOS without loss of information. © 2011 by Wiley Periodicals, Inc.     

Use of Complementary and Alternative Medicine for Work Related Musculoskeletal Disorders Associated With Job Contentment in Dental Professionals: Indian Outlook

Background

High prevalence rates of work-related musculoskeletal disorders (WRMSD) among dentists have been reported. Complementary and alternative medicine (CAM) therapies can be helpful in managing and preventing work-related musculoskeletal disorders. The purpose of this study was to determine if dental professionals are using CAM for work-related musculoskeletal disorders. Who have greater job satisfaction: dentist who uses Complementary and alternative medicine (CAM) or conventional therapy (CT) as a treatment modality for WRMSD

Method

Dentists who registered in Uttar Pradesh state, India under Indian Dental Council, Uttar Pradesh branch (n=1134) were surveyed. Data were analyzed using univariate and bivariate analyses and logistic regression.

Result

A response rate of 53% (n=601) was obtained, revealing that 82% (n=487) of the respondents suffered from work-related musculoskeletal disorders. The use of complementary and alternative medicine or conventional therapy was reported among 80% (n=390) of the dentists with work-related musculoskeletal disorders. Complementary and alternative medicine users reported greater overall health compared to conventional therapy users (P<0.001). Of those with work-related musculoskeletal disorders, 35.5% (n=172) considered a career change for once, and 4.0% (n=19) reported having left dentistry.

Conclusion

Complementary and alternative medicine therapies may improve quality of life, reduce work disruptions and enhance job satisfaction for dentists who suffer from work-related musculoskeletal disorders. It is important that dentists incorporate complementary and alternative medicine strategies into practice to facilitate musculoskeletal health that will enable longer and healthier careers, increase productivity, provide safer workplace and prevent musculoskeletal disorders.     

The impact of a change in work posture from seated to stand‐up on work‐related musculoskeletal disorders among sewing‐machine operators

Background

Work‐related postural change could lead to improved musculoskeletal health.

Method(s)

In a quantitative, retrospective, longitudinal study, data of work‐related musculoskeletal disorders of 123 sewing‐machine operators were captured for 4.5 years, and analysed using Poisson regression.

Results

Stand‐up work posture (SUWP) reduced the incidence for spinal disorders (SD) to 0.29 fold the incidence for sitting work posture (SWP) (P < 0.001). Morbid obesity had significantly increased (P = 0.04) incidence of upper limb disorders (ULD), 3.35 times that of normal body mass index (BMI) (regardless of work posture). SUWP was associated with increased IRR (1.49) for lower limb disorders (LLD). LLDs were associated with obesity (overweight (IRR = 2.58; P = 0.08), obese (IRR = 2.45; P = 0.09), and morbidly obese (IRR = 6.24; P = 0.001)).

Conclusions

The protective benefit of the SUWP was statistically significant for SD incidence. Owing to high mean BMI, SUWP had a negative impact on the incidence of LLDs for the first 2 months.

     

Comparative prevalence,correlates of impairment,and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders

Objective:

The study compared the prevalence, correlates of functional impairment, and service utilization for eating disorders across Latinos, Asians, and African Americans living in the United States to non‐Latino Whites.

Method:

Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES;NIMH, 2007) were used.

Results:

The prevalence of anorexia nervosa (AN) and binge‐eating disorder (BED) were similar across all groups examined, but bulimia nervosa (BN) was more prevalent among Latinos and African Americans than non‐Latino Whites. Despite similar prevalence of BED among ethnic groups examined, lifetime prevalence of any binge eating (ABE) was greater among each of the ethnic minority groups in comparison to non‐Latino Whites. Lifetime prevalence of mental health service utilization was lower among ethnic minority groups studied than for non‐Latino Whites for respondents with a lifetime history of any eating disorder.

Discussion:

These findings suggest the need for clinician training and health policy interventions to achieve optimal and equitable care for eating disorders across all ethnic groups in the United States. © 2010 by Wiley Periodicals, Inc. (Int J Eat Disord 2011)

     

Effects of linseeds on the symptoms of irritable bowel syndrome: a pilot randomised controlled trial

Background: Manipulation of dietary fibre intake represents a longstanding treatment for patients with irritable bowel syndrome (IBS), particularly for those with constipation. Linseeds are often recommended by both clinicians and dietitians as a source of dietary fibre to alleviate symptoms. Recent guidance on the management of irritable bowel syndrome (IBS) advises that linseeds may reduce wind and bloating, although there is limited clinical evidence to support this recommendation. The present pilot study aimed to compare the clinical effectiveness of: (i) whole linseeds versus ground linseeds; (ii) whole linseeds versus no linseeds; and (iii) ground linseeds versus no linseeds in the management of IBS symptoms. Methods: In an open randomised controlled trial, subjects with IBS (n = 40) were allocated to one of three intervention groups: two tablespoons of whole linseeds per day (n = 14), two tablespoons of ground linseeds per day (n = 13) and no linseeds as controls (n = 13). Symptom severity (primary outcome) and bowel habit were assessed before and after a 4‐week intervention and statistical differences between the groups were compared. Results: Thirty‐one subjects completed the present study. Between‐group analysis comparing the improvement in symptom severity did not reach statistical significance for whole linseeds (n = 11) versus ground linseeds (n = 11; P = 0.62), whole linseeds versus controls (n = 9; P = 0.12) and ground linseeds versus controls (P = 0.10). There were no significant changes in stool frequency or stool consistency for any of the groups. Conclusions: Linseeds may be useful in relief of IBS symptoms. Further research is needed to detect clear differences between the effects of whole and ground linseeds.     

High nutrition risk is associated with higher risk of dysphagia in advanced age adults newly admitted to hospital

Aim

To establish the prevalence of nutrition risk and associated risk factors among adults of advanced age newly admitted to hospital.

Methods

A cross‐sectional study was undertaken in adults aged over 85 years admitted to one of two hospital wards in Auckland within the previous 5 days. An interviewer‐administered questionnaire was used to establish participant's socio‐demographic and health characteristics. Markers of body composition and muscle strength were collected. Nutrition risk was assessed using the Mini Nutritional Assessment‐Short Form (MNA‐SF), dysphagia risk using the 10‐Item Eating Assessment Tool (EAT‐10) and level of cognition using the Montreal Cognitive Assessment.

Results

A total of 88 participants with a mean age of 90.0 ± 3.7 years completed the assessments. A third (28.4%) of the participants were categorised by the MNA‐SF as malnourished and 43.2% were classified at risk of malnutrition. A third (29.5%) were at risk of dysphagia as assessed by EAT‐10. Malnourished participants were more likely to be at risk of dysphagia (P = 0.015). The MNA‐SF score was positively correlated with body mass index (r = 0.484, P < 0.001) and grip strength (r = 0.250, P = 0.026) and negatively correlated with risk of dysphagia (r = ?0.383, P < 0.001).

Conclusions

Among newly hospitalised adults of advanced age, over two thirds were malnourished or at risk of malnutrition, and a third were at risk of dysphagia. Nutrition risk was positively correlated with low BMI and grip strength and negatively correlated with dysphagia risk. Findings highlight the importance of screening for dysphagia risk, especially in those identified to be malnourished or at nutrition risk.     

A retrospective analysis of cardiometabolic health in a large cohort of truck drivers compared to the American working population

Background

Truck drivers face many health challenges, including lifestyle, diet, inactivity, stressors, and social support.

Methods

A repeated cross‐sectional analysis compared 88,246 truck drivers with data from (n = 11 918) the National Health and Nutrition Examination Survey (NHANES). Trends over time for body mass index (BMI), high blood pressure, diabetes mellitus, heart disease, and sleep disorders were analyzed, adjusting for potential confounders.

Results

Truck drivers had significantly worsening health metrics between 2005 and 2012 compared to NHANES participants. Truck drivers were significantly more likely to be obese and morbidly obese with prevalence odds ratios (POR) and 95% confidence intervals (95%CI) of 1.99 (1.87, 2.13) and 2.34 (2.16, 2.54), respectively. Measured blood pressure, self‐reported high blood pressure, diabetes mellitus, and heart disease all significantly increased. Also, sleep disorders increased among truck drivers from 2005 to 2012 (POR = 6.55, 95%CI 5.68, 7.55).

Conclusion

These data suggest disproportionate increases in poor health among truck drivers from 2005 to 2012.

     

Distance saturation product predicts health–related quality of life among sarcoidosis patients

Background

Quality of life (QOL) is an important measure in the management of Irritable Bowel Syndrome (IBS). Controversy exists in the findings of studies evaluating QOL in IBS subtypes, and little is known about this issue in Iranian patients. Determination of the factors affecting QOL in IBS patients may influence treatment outcomes. The aims of this study are to: 1) compare QOL between subtypes in a sample of Iranian IBS patients, 2) determine the factors associated with QOL in IBS.

Methods

This cross sectional study included two hundred and fifty IBS patients with the mean age (± standard deviation) of 31.62 (± 11.93) years that were referred to outpatient gastroenterology clinic. IBS patients were diagnosed based on Rome-3 criteria by a gastroenterologist, and then they were categorized into three subtypes according to the predominant type of bowel habit. The "QOL specific for IBS", "Stait-trait anxiety inventory", and "Beck depression inventory-2" questioners were used to evaluate QOL, anxiety, and depression symptoms, respectively.

Results

The mean QOL scores in IBS mixed subtype (71.7 ± 25.57), constipation predominant subtype (80.28 ± 25.57), and diarrhea predominant subtype (76.43 ± 19.13) were not different. (P value: 0.05) In multivariate linear regression analysis, anxiety symptom scores were inversely correlated with QOL scores. [Standardized beta: -0.43, (95% confidence interval: -0.70, -0.39), P value: < 0.01]

Conclusion

It seems reasonable to manage anxiety symptoms properly in IBS patients since this might increase their QOL.     

The therapeutic alliance in the early part of cognitive-behavioral therapy for the eating disorders

Objective:

This study examined the strength of the therapeutic alliance in the early stages of cognitive‐behavioral therapy (CBT) for the eating disorders, and whether the strength of that allianceis associated with early eating characteristics, comorbid Axis 1 and 2 features.

Method:

Forty‐four eating‐disordered patients completed measures of eating and Axis 1 and 2 characteristics at the start of therapy, and measures of the therapeutic alliance and eating characteristics at the sixth session of CBT.

Results:

The therapeutic alliance was strong, including in the domain of attachment. It was unrelated to initial eating pathology and early changes in eating cognitions and behaviors. However, there were links between initial emotional and interpersonal features and therapeutic alliance by the sixth session.

Discussion:

The findings counter suggestions that CBT for eating disorders is characterized by a poor therapeutic relationship. The therapeutic alliance is likely to be enhanced by addressing high levels of emotional distress and difficulties in interpersonal function where appropriate. This research needs to be extended to other therapies, other domains of function and different time points in therapy, to build a fuller picture of the role of the therapeutic relationship in working with the eating disorders. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)