Males with anorexia nervosa: a controlled study of eating disorders in first-degree relatives

OBJECTIVE: To compare lifetime rates of full and partial anorexia nervosa and bulimia nervosa in first-degree relatives of males with anorexia nervosa and in relatives of never-ill comparison subjects. METHODS: Rates of eating disorders were obtained for 747 relatives of 210 probands from personal structured clinical interviews and family history. Best-estimate diagnoses were determined blind to proband diagnosis and pedigree status. RESULTS: Full and partial syndromes of anorexia nervosa aggregated in female relatives of ill probands. For the full syndrome of anorexia nervosa, the crude relative risk was 20.3 among female relatives and for partial syndrome anorexia nervosa, the crude relative risk was 3.3. In contrast, bulimia nervosa was relatively uncommon among relatives of ill probands. CONCLUSION: Although anorexia nervosa in males is exceedingly rare, there is a pattern of familial aggregation that is highly similar to that observed in recent family studies of affected females. On the basis of these findings, there is no evidence that familial-genetic factors distinguish the occurrence of anorexia nervosa in the two sexes.     

Features associated with excessive exercise in women with eating disorders

OBJECTIVE: Excessive exercise and motor restlessness are observed in a substantial number of patients with eating disorders. This trait has been studied extensively among animal models of activity anorexia nervosa (AN) and may hold particular interest as an endophenotype for AN. We explored features associated with excessive exercise across subtypes of eating disorders. METHOD: Participants were female probands and affected female relatives from the multi-site international Price Foundation Genetic Studies with diagnoses of AN, bulimia nervosa (BN), and both AN and BN or eating disorder not otherwise specified (ED-NOS) (N=1,857). Excessive exercise was defined based on responses to the Structured Interview for Anorexic and Bulimic Disorders (SIAB). RESULTS: Among the eating disorder diagnostic groups, excessive exercise was most common among the purging subtype of AN. Individuals who reported excessive exercise also reported lower minimum BMI, younger age at interview, higher scores on anxiety, perfectionism, and eating disorder symptom measures, more obsessions and compulsions, and greater persistence. CONCLUSION: Excessive exercise may be associated particularly with the purging subtype of AN as well as with a constellation of anxious/obsessional temperament and personality characteristics among women with eating disorders.     

Dissimilarities in eating attitudes,body image distortion,depression, and self-esteem between high-intensity male runners and women with bulimia nervosa

It has been suggested that high-intensity exercise regimens in males bear a resemblance to the features of eating disorders and that male runners may resemble women with anorexia nervosa and bulimia nervosa with regard to eating and weight attitudes, negative body image, and negative psychological adjustment. Twenty high-intensity male runners were compared with 20 sedentary-moderate exercising male controls and 20 women with bulimia nervosa. Compared with the bulimia nervosa subjects, the male runners were not anxious about eating, overly preoccupied with food, excessive in binge-eating or purging behavior, negatively preoccupied with their weight, intent on losing weight, high on personality traits presumed to underlie eating disorders, nor depressed or low in self-esteem. The male groups of high-intensity runners and controls were not significantly different on any measure. These results suggest that high-intensity exercising in males is not analogous to anorexia nervosa and bulimia nervosa.     

The psychiatric history of anorexia nervosa and bulimia nervosa: Weight concerns and bulimic symptoms in early case reports

British, French, American, German, and Italian historical medical reports on possible cases of anorexia nervosa and bulimia nervosa were critically reevaluated in order to trace the history of weight concerns, binge eating, and methods of food reversal like self-induced vomiting in these texts. It is argued that weight concerns are a new phenomenon in prolonged extreme fasting and has superseded traditional ascetic motivations for fasting from the first use of the term anorexia nervosa on. Binge eating, or bulimia as a symptom, on the other hand, has been known ever since ancient times; what is new here is its combination with methods of food reversal, which are motivated by concerns about weighing too much. This combination, bulimia nervosa (DSM-III-R), was first described in cases of primary anorexia and started becoming more frequent only in the 1940s. First accounts of possible cases of bulimia nervosa at normal body weight were published in the 1930s. Methodological problems of retrospective diagnosing and factors inherent to the history of medicine which might have influenced the history of medical writing about eating disorders are discussed.     

Factors associated with suicidal behaviors in a large French sample of inpatients with eating disorders

OBJECTIVE: The objective of the present study was to identify factors associated with suicidal behaviors among patients with eating disorders. METHOD: A large database including sociodemographic and clinical characteristics of 1,009 consecutive patients hospitalized for an eating disorder in Paris, France, was examined. Data gathered upon admission to hospital were analyzed to identify factors associated with a history of suicide attempt or current suicidal ideation, among the whole sample as well as among each subtype of eating disorder. RESULTS: Among the whole sample, the factor most strongly associated with suicide attempt or suicidal ideation was the diagnostic category, with the highest odds ratio for bulimia nervosa followed by anorexia nervosa of the binging/purging subtype. Among diagnostic subgroups, the strongest factors were drug use, alcohol use, and tobacco use. CONCLUSION: Suicide risk should be monitored carefully among patients with eating disorders, paying particular attention to combinations of risk factors.     

Season of birth and bulimia nervosa

OBJECTIVE: Previous studies suggest season of birth variation in eating disorders akin to those of psychoses. We studied season of birth variation in bulimia nervosa. METHOD: Season of birth variation in 935 patients was examined after adjustment for population trends. Variation was also examined for subgroups by age and previous anorexia nervosa. RESULTS: Season of birth did not differ significantly from population norms among bulimics (p >.30), contrasting with studies of other eating disorders. With a history of anorexia nervosa (n = 227), peak season of birth was in March (p <.05). This is consistent with previous studies and also with seasonal birth variation for psychoses. DISCUSSION: Overall, we find no evidence of season of birth variation in bulimia nervosa, and suggest any positive findings be treated with caution. We discuss a number of confounding influences and argue that one explanation remains shared trait vulnerability between anorexia nervosa and psychoses.     

Taste function in patients with anorexia nervosa and bulimia nervosa

The sensitivity to sucrose, sodium hydrochloride, tartrate, and quinine was examined by a filter paper disc method in patients with anorexia nervosa and with bulimia nervosa. There were 20 of the 23 anorexia patients and 11 of the 13 bulimic patients who showed hypogeusia. There were 12 of the 23 anorexia patients and 8 of the 13 bulimia patients who showed dysgeusia. Seven anorexia patients were restudied when the treatments produced a weight gain to more than 85% of normal body weight. Taste function had improved substantially in all but still was subnormal. Serum zinc, iron, and triiodothyronine levels in these patients were depressed; however, none of these levels correlated with the taste recognition scores or dysgeusia scores. In conclusion, patients with anorexia nervosa and bulimia nervosa showed hypogeusia and/or dysgeusia, although the etiology of the taste dysfunction in these patients remains to be determined. These findings should be considered in the implications for treating these patients.     

The diagnosis of bulimia nervosa

The interpretation of research into the eating disorder bulimia nervosa is complicated by the use of two different sets of diagnostic criteria. In North America the DSM III criteria are usually employed (American Psychiatric Association, 1980), whereas in Britain Russell's criteria (Russell, 1979) are preferred. While the two sets of criteria appear to be designed to identify people with essentially the same disorder, they embrace different, but over-lapping, populations. Discrepancies between the findings of various investigations may therefore be attributed in part to the fact that different patient groups have been studied. In this paper both these sets of diagnostic criteria and the proposed DSM III R criteria (American Psychiatric Association, 1985) are reviewed in the light of current knowledge. In addition, the relationship between bulimia nervosa and anorexia nervosa is examined. Certain revisions to the diagnostic criteria for both disorders are suggested reflecting the view that extreme concerns about shape and weight are a central psychopathological feature uniting anorexia nervosa and bulimia nervosa.     

The current status of treatment for anorexia nervosa and bulimia nervosa

A survey investigating the current status of treatment for anorexia nervosa and bulimia nervosa was distributed at the International Conference on Eating Disorders in 7988 and again in 1990. Respondents answered questions regarding treatments they had endorsed for their last patient with anorexia nervosa and for bulimia nervosa. One hundred and seven medical doctors and psychologists completed the survey in 1988 and 115 in 1990. The results indicate that: (1) less than 50% of the respondents believe there is a consensus regarding the treatment of eating disorders; (2) talking therapy is overwhelmingly endorsed for the treatment of both anorexia and bulimia nervosa; (3)there is a trend in clinical practice towards using drug therapy more frequently in treating patients with bulimia nervosa than in treating patients with anorexia nervosa; (4)physicians are more likely than psychologists to endorse drug therapy when treating patients with anorexia and for bulimia nervosa; and (5) about one third of the respondents endorse drug therapy for treating anorexia nervosa. © 1992 John Wiley & Sons, Inc.     

Invalidating childhood environments in anorexia and bulimia nervosa

OBJECTIVE: This study examined the relationship between an invalidating childhood environment and eating pathology, including diagnoses, eating attitudes and eating behaviours. METHOD: Fifty-eight eating-disordered patients completed a measure of invalidating childhood environments, and a standardised measure of eating pathology. RESULTS: Patients with bulimia nervosa scored higher on levels of paternal invalidation than those with anorexia nervosa. There were no associations at the attitudinal level, but some behaviours were related to perceived parental style. Self-induced vomiting was associated with paternal invalidation, while those who experienced an invalidating mother were less likely to report binge-eating. Those who exercised excessively were more likely to have experienced a family style in which the focus is on remaining in control of one's emotions, success and achievement. DISCUSSION: Invalidating childhood environment was related to eating psychopathology in a clinical population - particularly the presence or absence of some behaviours. Implications for treatment are considered.     

Chewing and spitting out food among eating-disordered patients

OBJECTIVE: The symptom of chewing and spitting out food (CHSP) is fairly common among patients with eating disorders. The purpose of this study is to examine the associations of the symptom in patients with eating disorders. METHOD: Patients who reported CHSP were compared with those who did not. The relationship between CHSP and other symptoms was assessed by logistic regression analysis. RESULTS: CHSP was found in 22% of patients. Patients with anorexia nervosa and eating disorder not otherwise specified who reported CHSP showed more severe eating-related pathology. This was not so for bulimia nervosa patients with CHSP who differed only in reporting greater distortion of body image. Binging was not related to CHSP in any of the diagnostic groups. DISCUSSION: CHSP is a common symptom in all groups of patients with eating disorders. The symptom may serve different functions for different patients, depending on diagnosis.     

Relationship between EDNOS and its subtypes and borderline personality disorder

OBJECTIVE: The purpose of this study was to assess the prevalence of eating disorder not otherwise specified (EDNOS) and four well-defined subtypes of this disorder found in a sample of female borderline patients. METHOD: The lifetime prevalence of EDNOS and its various subtypes among 233 female borderline patients and 46 female Axis II comparison subjects was assessed using the Structured Clinical Interview for DSM-III-R Axis I disorders. RESULTS: Thirty-three percent of female borderline patients met DSM-III-R criteria for EDNOS at some point in their lives. Of these 76 women, 20% reported a pattern of restricting without low weight, 37% reported a pattern of binging without purging, 37% reported a pattern of purging without binging, and 33% reported a pattern of low weight without loss of menses. However, less than 25% of these 76 borderline women had ever met criteria for anorexia nervosa or bulimia nervosa. CONCLUSIONS: The results of this study suggest that EDNOS is a separate cluster of eating disorders among borderline women, rather than a prodromal or residual form of a more clear-cut case of anorexia or bulimia nervosa.     

Review of the prevalence and incidence of eating disorders

OBJECTIVE: To review the literature on the incidence and prevalence of eating disorders. METHODS: We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found. Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases. RESULTS: An average prevalence rate for anorexia nervosa of 0.3% was found for young females. The prevalence rates for bulimia nervosa were 1% and 0.1% for young women and young men, respectively. The estimated prevalence of binge eating disorder is at least 1%. The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year. The incidence of anorexia nervosa increased over the past century, until the 1970s. DISCUSSION: Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care.     

Changes in creatinine clearance during treatment of anorexia nervosa and bulimia nervosa

The improvement in renal clearance of creatinine in anorexia nervosa patients during treatment has been attributed to the increase in body weight. The body weight and creatinine clearance of 72 anorexia nervosa and 10 bulimia nervosa patients were studied during inpatient treatment. The anorexia nervosa patients gained an average of 4.5 kg, while the body weight of the bulimia nervosa patients was unchanged. Both groups showed a similar increase in weight-corrected creatinine clearance. The increase in creatinine clearance of eating disorder patients is associated with the cessation of the abnormal weight-controlling behaviors rather than weight gain.     

Participant recruitment for an anorexia nervosa treatment study

OBJECTIVE: To investigate the nature of differing recruitment rates for clinical treatment trials for anorexia nervosa and bulimia nervosa. METHODS: Recruitment rates from a study recruiting women partially recovered from anorexia nervosa were compared with the rates from two studies conducted at the same sites recruiting women with bulimia nervosa. RESULTS: At all sites in the anorexia study, the total number of contacts per month rose steadily over the first 2 years of the recruitment phase then decreased to near zero with the number of participants randomized to the study practically evaporating. In contrast, the bulimia studies screened a larger group of contacts and met monthly randomization goals in the time allotted for recruitment. Participants eligible for a study but with a barrier to participation occurred at a much higher rate in the anorexia study than in the bulimia studies. DISCUSSION: These results reveal a difficulty in planning recruitment from a small population such as partially recovered anorexics. A small population's total pool size diminishes faster than it is replenished, suggesting that future studies of anorexia nervosa may recruit more successfully from many sites in a short period rather than at a few sites over a long period.     

Effect of inositol on bulimia nervosa and binge eating

OBJECTIVES: This study aimed to determine whether inositol has therapeutic value in patients with bulimia nervosa and binge eating. METHOD: A double-blind crossover trial using 18 g inositol versus placebo was performed in 12 patients for 6 weeks in each arm. RESULTS: Inositol was significantly better than placebo on the Global Clinical Impression, the Visual Analogue Scale, and the Eating Disorders Inventory. DISCUSSION: Inositol is as therapeutic in patients with bulimia nervosa and binge eating as it is in patients with depression and panic and obsessive-compulsive disorders. This increases its parallelism with serotonin selective reuptake inhibitors.     

Racial and socioeconomic: Influences in anorexia nervosa and bulimia

Eight black and 120 white patients with anorexia nervosa or bulimia were compared with each other and with 21 black control patients. Biack and white patients with eating disorders were similar in demographic features (except for later age of onset in blacks), in clinical characteristics, and in course of illness. Both racial groups with eating disorders had a significantly higher socioeconomic status than control patients. A diagnosis of anorexia nervosa or bulimia can be confidently made independent of racial designation. Socioeconomic status appears to be a risk factor for development of anorexia nervosa or bulimia in both black and white populations.     

Season of birth and eating disorders: patterns across diagnoses in a specialized eating disorders service

OBJECTIVE: In view of inconsistent findings from previous studies, the aim was to investigate possible seasonal variation in month of birth in patients with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. METHOD: We examined the month of birth in a cohort of 1,305 adult patients with a DSM-IV eating disorder diagnosis at first presentation to a specialized eating disorders service. RESULTS: When compared to general population data, we found no evidence of significant variation in month or season of birth in anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified. CONCLUSION: The authors question whether people who develop eating disorders differ from the general population in their season of birth. Caution is expressed about further speculation regarding the etiological significance of season of birth in eating disorders.     

The clinical presentation of Japanese women with anorexia nervosa and bulimia nervosa: a study of the Eating Disorders Inventory-2

OBJECTIVE: The current study described the clinical presentation of anorexia nervosa (AN) and bulimia nervosa (BN) in Japan utilizing the Eating Disorders Inventory-2 (EDI-2) and assessed whether the clinical profile of eating disorder cases in Japan differs significantly from North American data. METHOD: Statistical comparisons of Japanese AN, BN, and non-eating-disordered (NonED) EDI-2 data were conducted across diagnostic groups and with the North American standardization sample. RESULTS: The Japanese diagnostic groups reported significant between-group differences on all eight EDI-2 subscales. Compared with the standardization sample, all the Japanese groups reported significantly greater maturity fears, the Japanese AN-restricting subtype group (AN-R) reported lower levels of drive for thinness and perfectionism, the Japanese BN group reported lower levels of drive for thinness, and the Japanese NonED Group reported lower levels of drive for thinness and perfectionism but higher rates of ineffectiveness. DISCUSSION: Differences between the Japanese and North American groups suggest that certain cultural differences exist in eating disorder profiles.     

Drug use in women with anorexia and bulimia nervosa

Forty-two inpatient women with bulimia nervosa and 29 women with anorexia nervosa were surveyed regarding eating behavior, patterns of licit and illicit substance use, and relation between drug use and appetite. Substantial use of licit substances such as laxatives, diuretics, and emetics were reported in women with bulimia nervosa. In addition, alcohol and cigarette use were significantly more common in women with bulimia nervosa than anorexia nervosa. The majority of bulimic subjects reported that smoking decreased appetite, alcohol increased appetite, and laxatives had no effect on appetite. Analysis of temporal patterns of drug intake suggested that binging and purging as well as alcohol, cigarette, and laxative use were considerably more prevalent in the evening hours. We suggest that the high rates of drug use in women with bulimia nervosa may be related to effects of food deprivation associated with the disorder.