Self-oriented perfectionism in eating disorders

OBJECTIVE: To assess perfectionism dimensions in eating disorders in comparison with other psychiatric disorders and subjects from the general population. METHOD: The Child and Adolescent Perfectionism Scale (CAPS), the Eating Disorders Inventory (EDI-2), and the Eating Attitudes Test (EAT) were administered to a group of 108 female eating-disordered patients (75 anorexia nervosa and 33 bulimia nervosa), to a group of 86 female psychiatric patients with anxiety (N = 32), depressive (N = 38), or adaptive disorders (N = 16), and to 213 healthy female participants. RESULTS: Both bulimic and anorexic patients scored higher on Self-Oriented Perfectionism (p < 0.001) than the other two groups but not on Socially-Prescribed Perfectionism (p = 0.054). Among patients with eating disorder, 17.6% obtained a score two standard deviations higher than the mean in the healthy comparison group on self-oriented perfectionism; this percentage was significantly higher than in the other two groups. The percentage of eating disorder patients with high socially-prescribed perfectionism was similar to that found in other psychiatric disorders. Moreover, self-oriented perfectionism was a predictor of an eating disorder. CONCLUSION: Self-oriented perfectionism is more specific to eating disorders than to depressive or anxiety disorders.     

Purging disorder: An ominous variant of bulimia nervosa?

OBJECTIVE: The current study evaluates the clinical significance and distinctiveness of purging disorder (PD), an eating disorder characterized by recurrent purging in the absence of objective binge episodes (OBE) among normal-weight individuals. METHOD: Women with PD (n = 37), bulimia nervosa (BN; n = 39), or no eating disorder (n = 35) completed clinical assessments. Women with PD (n = 23) and BN (n = 25) completed 6-month follow-up assessments. RESULTS: Compared with controls, both eating-disordered groups reported significantly higher eating, Axis I, and Axis II pathology. Compared with BN, PD was associated with significantly lower eating concerns, disinhibition, and hunger. At 6-month follow-up, rates of remission did not differ significantly between PD and BN, and crossover between disorders was rare. CONCLUSION: PD appears to be a clinically significant and potentially distinctive eating disorder.     

Maladaptive core beliefs and eating disorder symptoms

This study compared maladaptive core beliefs of eating-disordered groups (full and subthreshold syndrome) and healthy controls and investigated the association between eating disorder symptoms and core beliefs. Participants were compared on self-report measures of core beliefs (YSQ) and eating disorder psychopathology (BITE). Anorexia nervosa (AN; both subtypes) and bulimia nervosa (BN) patients had significantly more core beliefs than healthy controls. Binge eating disorder (BED) patients had intermediate scores between AN and BN on the one hand and healthy controls on the other hand. No correlation was found between core beliefs and frequency of binge eating. Frequency of vomiting, laxative misuse and fasting was positively associated with all domains of core beliefs. Patients with eating disorders have some core beliefs which are not directly related to eating, weight or shape. Frequency of purging and fasting behaviors is associated with more severe maladaptive core beliefs. Our data demonstrate the importance of identifying purging and fasting as significant clinical markers.     

Description of eating-disordered,psychiatric, and normal women along cognitive and psychodynamic dimensions

To evaluate various psychological constructs used in formulations of anorexia and bulimia nervosa, we compared 76 eating-disordered, 20 psychiatric, and 24 normal women on measures of irrational cognitions, object-relations disturbances, and defense styles. The eating-disordered groups exhibited more disturbance on all measures than normals and many pathological elevations relative to psychiatric controls. Despite these differences, common qualitative features were identified in all patient groups, suggesting that formulations based on the factors examined alone, while useful in providing an understanding of patients' issues, will be inadequate to account for eating-disorder development.     

Cognitive impairment in anorexia nervosa is not due to depressed mood

OBJECTIVE: Previous research has revealed cognitive deficits in patients with anorexia nervosa. It is unclear whether these deficits are linked to co-morbid depression in this population. We examined the relationship between depressive symptoms and cognitive functioning. METHOD: A large sample of subjects (N = 98) was examined using a common measure of cognitive ability and two measures of depression. RESULTS: We confirmed that there is no relationship between depression and cognitive ability in this group. DISCUSSION: This suggests that alternative explanations be explored for cognitive deficits in patients with anorexia nervosa.     

Structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10: Updated (third) revision

Objectives: Earlier versions of the Structured Interview for Anorexic and Bulimic Disorders (SIAB) were modified in order to include new research findings and to update the expert rating interview to the diagnostic criteria of DSM-IV and ICD-10. The semistandardized interview was developed for reliable and valid assessment of the specific as well as the general psychopathology of eating disorders. Method: Data from SIAB-EX interviews (current and past/lifetime symptom expression) were available from three samples: (a) 330 eating-disordered patients assessed at the start of treatment, (b) 148 former eating-disordered patients with anorexia nervosa (AN) or bulimia nervosa (BN) assessed at follow-up, and (c) 111 community controls. Sixty-one of the 87 items of the SIAB-EX with a 5-point scale were factor analyzed. Results: Principal components analyses with varimax rotation produced the following six components of the SIAB-EX (lifetime): (I) Body Image and Slimness Ideal; (II) General Psychopathology; (III) Sexuality and Social Integration; (IV) Bulimic Symptoms; (V) Measures to Counteract Weight Gain, Fasting, and Substance Abuse; and (VI) Atypical Binges. The factor solution for the current symptom expression was very similar to that based on lifetime symptom expression. Average item and factor scores are given for six groups of eating-disordered patients and controls. High interrater reliability was established for both current and the past symptom expression. Cronbach's alpha coefficients indicated good internal consistency for five of the six components of the SIAB-EX. DSM-IV and ICD-10 diagnoses for eating disorders can be derived directly or by using a computer algorithm from the SIAB-EX. A detailed 90-page manual facilitates the training of interviewers. Conclusion: The 87-item SIAB-EX was originally developed for detailed assessment of eating disorders cross-sectionally and longitudinally. The updated version which allows for diagnosis according to DSM-IV and ICD-10 is described here. © 1998 by John Wiley & Sons, Inc. Int J Eat Disord 24: 227–249, 1998.     

Shape- and weight-based self-esteem and the eating disorders

Objectives: To determine the psychometric properties of the Shape- and Weight-Based Self-Esteem (SAWBS) Inventory in women with eating disorders, and to compare SAWBS scores in women who have eating disorders with women from psychiatric and normal control groups. Method: Women with eating disorders (n = 48), women with other psychiatric disorders (n = 44), and undergraduate control women (n = 82) completed the SAWBS Inventory and measures of depression, self-esteem, and eating disorder symptomatology. Twenty women from the eating disorder group completed the SAWBS Inventory a second time 1 week later. Results: Similar to previous work in undergraduate samples, SAWBS scores were stable over 1 week, and demonstrated concurrent and discriminant validity in women with eating disorders. In between-group comparisons, SAWBS scores were higher among women with eating disorders than in either control group, even after controlling for age, socioeconomic status, body mass index, and self-esteem. A differing relationship between depression and SAWBS emerged as a function of group; SAWBS scores differed significantly among depressed, but not nondepressed women from the three groups. Conclusion: The psychometric properties of the SAWBS Inventory were established in women with eating disorders. As expected, SAWBS scores were higher in women with eating disorders than in the control groups. Clinical implications of these findings are discussed. © 1998 by John Wiley & Sons, Inc. Int J Eat Disord 24: 285–298, 1998.     

Differences between women with anorexia nervosa and restrained eaters on shape and weight concerns, self-esteem, and depression

OBJECTIVE: The current study examined the relation among shape and weight concerns, domain-specific self-esteem, dietary restraint, and depression. METHOD: Women with anorexia nervosa (AN; n = 19), restrained eaters (n = 20), and unrestrained eaters (n = 21) completed measures of shape and weight concerns, depression, and self-esteem. RESULTS: Women with AN had significantly higher shape and weight concerns and lower self-esteem than restrained eaters. However, once depression was controlled, these significant differences disappeared on all but the morality self-esteem subscale. Unrestrained eaters had significantly lower shape and weight concerns and higher self-esteem than restrained participants both before and after depression was controlled. DISCUSSION: Shape and weight concerns and low self-esteem are associated with dietary restriction. However, results from the current study suggest these two variables may not be the primary driving forces behind extreme dietary restriction.     

Comparison of the yale-brown-cornell eating disorders scale in recovered eating disorder patients, restrained dieters, and nondieting controls

OBJECTIVE: Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) scores were assessed in recovered eating disorder patients, restrained dieters, and unrestrained nondieters. METHOD: YBC-EDS interviews were conducted with 53 recovered eating disorder patients who had no symptoms within at least 6 months, 29 restrained dieters, and 36 unrestrained controls. RESULTS: Unrestrained control subjects had no typical eating-disordered preoccupations or rituals. The majority (62%) of restrained dieters did have current eating-disordered preoccupations but only 5 had current eating-disordered rituals. Most recovered eating disorder subjects had no current eating-disordered preoccupations (66%) and 76% had no current eating-disordered rituals. Unrestrained eating controls had significantly lower Preoccupation, Total, and Motivation to Change scores on the YBC-EDS than the other groups and significantly lower Ritual scores than the recovered eating disorder group. There were no significant differences between the restrained dieters and the recovered eating disorder group. DISCUSSION: Recovered eating disorder patients who no longer meet any of the DSM-IV criteria for an eating disorder are similar in severity of eating concern to normal weight restrained eating dieters. Both of these groups have more eating and weight concerns as compared with the unrestrained eating, nondieting controls. The YBC-EDS effectively distinguishes the healthy eating controls from restrained eating dieters and recovered eating disorder patients.     

Menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a nonpsychiatric control group

OBJECTIVE: To examine chronology and experience of menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a nonpsychiatric control group. METHOD: We interviewed 150 females, namely 50 patients with anorexia or bulimia nervosa (ED), 50 patients with polysubstance dependence (PSD-CO), and 50 healthy controls (HE-CO) (defined by DSM-IV) on chronology and their experience of menarche, puberty, and first sexual activities adjusted for childhood sexual abuse. RESULTS: ED women were similar to HE-CO in age at menarche and most sexual milestones, but differed significantly from PSD-CO women, who were "early starters." Regarding their experience of menarche, pubertal body changes, and first sexual activities, however, ED women rated these variables significantly more negatively than did either of the comparison groups. These significant differences remained after adjusting for sexual abuse. CONCLUSION: These findings suggest a negative body attitude in ED patients already at pubertal age, namely years before onset of the disorder. Prospective data are needed.     

Weight-related and shape-related self-evaluation in eating-disordered and non-eating-disordered women

OBJECTIVE: Weight- and shape-related self-evaluation refers to the process whereby an individual determines her self-worth based on an evaluation of her body weight and shape. This is a hallmark feature of both anorexia and bulimia nervosa, as specified in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. The purpose of this study was to further our understanding of weight-related self-evaluation in eating-disordered women. METHOD: Eating-disordered patients, restrained eaters, and unrestrained eaters completed an experimenter-designed questionnaire that examines different dimensions of weight-related self-evaluation (i.e., the Multidimensional Weight-Related Self-Evaluation Inventory). RESULTS: Results revealed that weight-related self-evaluation is a feature shared, to some extent, by both eating-disordered patients and restrained eaters. However, eating-disordered patients extend weight-related self-evaluation to include more domains of self-esteem than did restrained eaters. DISCUSSION: These findings support a multidimensional approach to weight-related self-evaluation and further our understanding of the process of weight-related self-evaluation in eating-disordered patients.     

Bulimia nervosa following psychological and multiple child abuse: support for the self-medication hypothesis in a population-based cohort study

OBJECTIVE: To unravel the complex role of child abuse as a risk factor for bulima nervosa (BN), from the perspective of the self-medication hypothesis which asserts that in abused BN cases binge eating is primarily a way of coping with the anxiety or mood disorders that stem from the abuse. METHOD: In a population-based study (N = 1,987) DSM-III-R diagnoses were assessed with the CIDI. Differences in exposure rates to child abuse between BN cases versus healthy, psychiatric, substance use, and dual diagnosis controls were employed to test the self-medication hypothesis. RESULTS: A history of psychological or multiple abuse was found to be a specific risk factor for dual diagnosis disorder (cases with psychiatric and substance use disorders) and for BN. Nearly all BN cases that experienced multiple or psychological child abuse, showed such comorbid anxiety or mood disorders. DISCUSSION: We found tentative support for the self-medication hypothesis.     

Correspondence between the clinical assessment of eating-disordered patients and findings derived from questionnaires at follow-up

Questionnaire scores were compared across three outcome groups in a follow-up of eating-disordered patients with onset of the disease during adolescence. Among a total of 40 patients, 7 continued to suffer from either anorexia or bulimia nervosa. Seven additional patients displayed partial syndromes and 26 had recovered. Both a semantic differential measuring body image and the Eating Attitudes Test (EAT) demonstrated limited evidence of clinical sensitivity by differentiating the three outcome groups. The Eating Disorders Inventory (EDI) did not discriminate the three outcome groups. Obviously, clinical interviews and self-report questionnaires tackle different facets of the eating disorders and, therefore, both should be used in outcome studies. © 1993 by John Wiley & Sons, Inc.     

An empirically validated,short-term psychoeducational group treatment program for bulimia

The present study examined the effectiveness of an empirically based, psychoeducational, group treatment program for bulimia. The seven-week program focused primarily on decreasing depression, enhancing self-esteem, increasing assertion and improving body image. In addition, women monitored their own bingeing and purging. Relative to no treatment controls (N = 7), women who received treatment (N = 11) showed significant improvements in their number of binges per month, self-esteem, and depression. Also, the number of purges per month tended to decrease. Women in both groups showed significant improvements in body image. The treatment gains were maintained at a ten-week follow-up. These results suggest that a short-term group treatment approach that focuses on personality and behavioral deficits as well as the maladaptive eating pattern is an effective treatment strategy for bulimia.     

Elevated plasma lipids in patients with binge eating disorders are found only in those who are anorexic

OBJECTIVE: We have previously shown that patients with restricting type anorexia nervosa (AN-R) have low plasma lipid levels, which increase with refeeding. In this study, we investigated plasma lipid levels in patients with eating disorders, distinguishing between individuals with bulimia nervosa (BN) and anorexia nervosa of the binge eating/purging type (AN-B). METHODS: We examined the fasting lipid levels in individuals with BN (n = 10) and AN-B (n = 9), and compared these findings with a group of age-matched normal weight healthy controls (C) (n = 10). RESULTS: The AN-B group had significantly higher concentrations of total plasma cholesterol, apolipoprotein (apo) B, apoA1, and low-density lipoprotein (LDL)-cholesterol than both control and BN groups (p < .05). The AN-B group also had higher plasma triglycerides and intermediate-density lipoprotein (IDL)-apo B levels (p < .05) than controls. DISCUSSION: In conclusion, the issue of hyperlipidemia in patients with eating disorders is a complex one and this study, taken together with the findings of our previous study, demonstrates the importance of carefully distinguishing between the major types of eating disorders (AN-R, BN, and AN-B) when examining plasma lipid levels.     

Neuropsychological correlates of dieting disorders

Various studies have suggested that patients with anorexia nervosa may have cognitive deficits on neuropsychological examination. A battery of tests was administered to 35 patients (34 female, 1 male), diagnosed as suffering from anorexia nervosa (n = 20) or bulimia nervosa (n = 15) during the early stages of admission to a specialized eating disorders unit. Results revealed no significant differences between the anorexia nervosa and bulimia nervosa patients on any of the intellectual, neuropsychological, or academic-related tasks that were administered. There was no evidence of cognitive deficits in certain patient groups when compared with theoretical norms.     

Depression,self-esteem,and life events in adolescents with chronic diseases

This study assesses whether nonhospitalized adolescents with chronic diseases differ from their healthy peers on standardized measurements of depression, self-esteem, and life events. The study group consisted of 80 patients (20 with sickle cell disease, 40 with asthma, and 20 with diabetes). All patients had been admitted at least twice in the preceding year, had their disease for at least 2 years, and were between the ages of 12 and 18. The control group consisted of 100 adolescents, matched for age and socioeconomic status, from local schools. All subjects completed a questionnaire compiled from the Beck Depression Inventory (BDI), the Rosenberg Scale of SelfEsteem, and the McCutcheon Life Events Checklist. Adolescents with chronic disease had higher depression scores (p < 0.001) and lower self-esteem (p < 0.001) than their healthy age-matched controls. There was no statistically significant difference in life events between the chronic disease and control groups. Depression, selfesteem, and life events did not differ significantly among the three disease groups. These findings suggest a need for intervention strategies to address depression and low self-esteem in adolescents with chronic disease.     

A retrospective comparison of purging type disorders: eating disorder not otherwise specified and bulimia nervosa

OBJECTIVE: In light of recent research indicating the clinical significance of eating disorder not otherwise specified-purging only (EDNOS-P), differences between women with lifetime bulimia nervosa purging subtype (BN-P) and EDNOS-P were examined. METHOD: Three groups of women were examined, a control group (n = 684) and two groups with lifetime eating disorders: BN-P (n = 22), and EDNOS-P (n = 53). RESULTS: Women with lifetime BN-P were significantly more likely to use vomiting than women with EDNOS-P but the latter group relied more on laxative abuse. Compared with controls, women with both eating disorders had higher weight and shape concern, dietary restraint, lifetime major depression, and suicidality. The BN-P group had significantly higher eating concern, dietary restraint, and suicidality than the EDNOS-P group. CONCLUSION: In accordance with previous research examining women with current eating disorders, EDNOS-P is indicated to be clinically significant. On the whole, the pattern of results indicated that EDNOS-P lies somewhere between BN-P and healthy controls in its clinical significance.     

Comparison of a high-carbohydrate and highprotein breakfast effect on plasma ghrelin, obestatin, NPY and PYY levels in women with anorexia and bulimia nervosa

ABSTRACT: BACKGROUND: The present study investigated plasma levels of gut-brain axis peptides ghrelin, obestatin, NPY and PYY after consumption of a high-carbohydrate (HC) and high-protein (HP) breakfast in patients with anorexia nervosa, bulimia nervosa and in healthy controls. These peptides play an important role in regulation of energy homeostasis and their secretion is disturbed under condition of eating disorders. As various types of consumed macronutrients may induce different plasma hormone responses, so we examined these responses in women patients with eating disorders and compared them with those of healthy controls. METHODS: We examined plasma hormone responses to HC and HP breakfast in patients with AN (n = 14; age: 24.6 +/- 1.8 years, BMI: 15.3 +/- 0.7), BN (n = 15; age: 23.2 +/- 1.7 years, BMI: 20.5 +/- 0.9) and healthy controls (n = 14; age: 24.9 +/- 1.4 years, BMI: 21.1 +/- 0.8). Blood samples were drawn from the cubital vein, the first blood drawn was collected before meal, and then 30, 60, 90, 120 and 150 min after breakfast consumption. Plasma hormone levels were determined by commercially available RIA kits. RESULTS: Fasting and postprandial plasma obestatin levels were significantly increased in both AN and BN patients, while plasma ghrelin levels were significantly increased in AN patients only. After breakfast consumption, plasma levels of ghrelin and obestatin decreased, although they were still above the range of values of healthy controls. Fasting NPY plasma levels were significantly increased in AN and BN patients and did not change postprandially. Fasting PYY levels were comparable in AN, BN and healthy controls, but postprandially significantly increased after HP breakfast in AN and BN patients. Different reactions to breakfast consumption was found for ghrelin and PYY among investigated groups, while for obestatin and NPY these reactions were similar in all groups CONCLUSIONS: Significant increase of obestatin and NPY in AN and BN patients may indicate their important role as the markers of eating disorders. Different reactions of ghrelin and PYY to breakfast consumption among groups suggest that role of these hormones in regulation of energy homeostasis can be adjusted in dependence to acute status of eating disorder.     

A controlled family study of anorexia nervosa: Evidence of familial aggregation and lack of shared transmission with affective disorders

Lifetime prevalence rates of eating disorders and affective disorder were determined in biological relatives of probands with anorexia nervosa, affective disorder, and other types of psychiatric disturbance. Anorexia nervosa was found to cluster in families with intergenerational transmission, and was absent among relatives of controls. Significantly higher rates of affective disorder were found among relatives of anorexics with coexisting depression, suggesting that these probands transmit two disorders to relatives. The results indicate there is familial resemblance for anorexia nervosa, and that the liability is different from that operating in the transmission of affective disorders.