Assessing rumination in eating disorders: principal component analysis of a minimally modified ruminative response scale

A process account of eating disorders (EDs) (Park et al., in press-a) proposes that preoccupation with ruminative themes of eating, weight and shape may be important in ED maintenance. No self-report measure exists to capture disorder-specific rumination in EDs. 275 healthy participants rated rumination items and completed self-report measures of ED symptoms, depression and anxiety. Principal component analysis revealed two factors, reflection and brooding. The final nine-item Ruminative Response Scale for Eating Disorders (RRS-ED) demonstrated good convergent and discriminant validity and test–retest reliability. The psychometric properties were replicated in an anorexia nervosa sample. The findings support the notion that rumination in EDs is distinct from rumination in depression and is not adequately captured by existing measures.     

Signs of anorexia and bulimia nervosa in high school girls reporting combinations of eating and mood symptoms: Relevance of self-report to interview-based findings

Scores from structured clinical interviews for DSM-III-R eating and mood disorders were compared across groups of high school girls who, on self-report, had indicated: (a) eating/ weight concerns and depression (n = 31), (b) eating/weight concerns without depression (n = 54), and (c) neither set of concerns (n = 75). Few girls had full eating disorders, however, clinical signs of anorexia and bulimia nervosa were often detected upon interview, largely in the group reporting concurrent eating and mood problems. Girls reporting eating concerns alone showed no larger number of clinical symptoms than did girls reporting low eating concerns. Results suggested that the isolation of cases at-risk of clinical-spectrum eating disturbances can be parsimoniously enhanced by complementing self-report measures of eating attitudes and behaviors with a measure of concurrent depression. © 1992 John Wiley & Sons, Inc.     

The anxiety symptoms of bulimia nervosa: A comparative study

The mental state profile of a sample of 42 patients with bulimia nervosa (BN) was compared with that of a sample of patients with Generalized Anxiety Disorder (GAD) on whom the same assessments had been conducted. The two samples were similar in the severity of their overall mental state disturbance, but were clearly distinguishable in terms of symptom profile. Despite considerable similarities between the two patient groups, patients with Generalized Anxiety Disorder more commonly reported clear symptoms of anxiety, while patients with bulimia nervosa more frequently reported symptoms associated with depression. Indeed, it was possible to differentiate the two groups, by means of a discriminant function analysis, using only six symptom items. The mood disturbance associated with bulimia nervosa is considerable and may contribute to the maintenance of the disorder, but it is largely secondary to the eating problems and concerns about weight and shape, which characterize this disorder.     

Criterion validity of the multiaxial assessment of eating disorders symptoms

OBJECTIVE: The purpose of this investigation was to establish the criterion validity of the Multiaxial Assessment of Eating Disorders Symptoms (MAEDS). The MAEDS is a brief, comprehensive, self-report measure for the evaluation of eating disorders treatment outcome. It assesses six symptoms associated with eating disorders with subscales for binge eating, purgative behavior, avoidance of forbidden foods, restrictive eating, fear of fatness, and depression. METHOD: To establish criterion validity, we compared the subscale scores of the MAEDS across four eating disorder diagnoses, specified by subtype (bulimia nervosa, purging type; anorexia nervosa, binge-eating/purging type; anorexia nervosa, restricting type; and binge eating disorder). Participants who did not meet the full diagnostic criteria for an eating disorder, but who did meet criteria for a partial syndrome eating disorder, were grouped with the full eating disorder diagnostic subtypes. RESULTS: The criterion validity of the MAEDS was supported by the pattern of subscale scores for the different eating disorder diagnostic groups. Also, with few exceptions, persons diagnosed with anorexia nervosa, bulimia nervosa, and binge eating disorder, in comparison to subthreshold cases of anorexia nervosa, bulimia nervosa, and binge eating disorder, had equivalent scores on the subscales of the MAEDS. DISCUSSION: These findings support the criterion validity of the MAEDS and add to a growing literature that questions differences in severity of eating disorder symptoms in full syndrome versus partial syndrome cases.     

Bulimic symptoms, cognitions, and body dissatisfaction in women with major depressive disorder

OBJECTIVE: The goals of this study were to assess eating disorder symptoms in depressed women with no history of eating disturbance and to evaluate the clinical significance of these symptoms relative to those reported by women with bulimia spectrum disorder. METHOD: Participants were 63 women with major depressive disorder (MDD) (n = 19), bulimia spectrum disorder (n = 20), or no history of MDD or eating disorder (n = 24). Measures included diagnostic interviews and self-report questionnaires designed to assess diagnostic criteria for bulimia nervosa, subthreshold eating disorder symptoms, dysfunctional attitudes about appearance, and body dissatisfaction. RESULTS: There were no significant differences between depressed and bulimic women on shape concerns, appearance overvaluation, or body dissatisfaction. Depressed women endorsed significantly more subthreshold eating disorder symptoms, dysfunctional attitudes about appearance, and body dissatisfaction than did control subjects. DISCUSSION: Eating disorder symptoms may be associated with depression in women in the absence of comorbid eating disorder diagnoses.     

The addition of a parent and clinician component to the eating disorder examination for children and adolescents

OBJECTIVE: Our goal was to evaluate the addition of parent and clinician reports to the eating disorder examination (EDE) when used with children and adolescents. METHOD: The EDE was completed with 117 children and adolescents with eating disorders (mean age 14.95 +/- 1.91 years). A slightly modified version of the EDE was completed with parents, and clinician summary scores were assigned. Repeated measures analysis was used to compare child, parent, and clinician scores. RESULTS: In those 70 participants with anorexia nervosa (AN) or eating disorder not otherwise specified with a restrictive pattern (EDNOS-R), child scores were significantly lower than parent scores and clinician scores on restraint and weight concerns. On eating concerns and shape concerns, child scores were lower than clinician scores. Participants with bulimia nervosa (BN) or eating disorder not otherwise specified with binge eating or purging (EDNOS-BP), reported more restraint and shape concerns than parents (n = 47), but their scores did not differ from clinician ratings. No differences were seen in this group on weight concerns or eating concerns. CONCLUSION: Parent and clinician reports are particularly important when assessing children and adolescents with AN or EDNOS-R, but may be less critical for those with BN or EDNOS-BP.     

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.     

Mitral valve prolapse in eating and panic disorder: A pilot study

The prevalence of echocardiographic mitral valve prolapse (MVP) and arrhythmias was studied in controls (n = 23) and patients with panic disorder (n = 14), bulimia nervosa (n = 14), and anorexia nervosa (n = 21). There was approximately twice the rate of MVP in patient groups compared to controls, a statistically insignificant difference. Importantly, the presence of prolapse was not associated with measures of weight or depression but there was a trend for MVP to be associated with anxiety disorder in bulimic patients. There were no significant arrhythmias found. These results raise the possibility that MVP may not be a state weight-related phenomenon as has been proported, but rather a trait phenomenon reflecting comorbidity with anxiety disorder.     

Eating disorders, dieting, and the accuracy of self-reported weight

OBJECTIVE: This study investigated the accuracy of self-reported weight and height in individuals with an eating disorder (i.e., anorexia nervosa [AN] and bulimia nervosa [BN]) and in individuals without an eating disorder (i.e., dieters and nondieters). METHOD: Self-reported and measured weights and heights were obtained from the eating disorder sample (n = 81) and the college student sample (n = 163) and were compared within and between the groups. RESULTS: Eating disorder patients were extremely accurate at self-reporting their weight. However, there was a significant difference in accuracy between AN and BN patients. AN patients slightly overreported their weight, whereas BN patients slightly underreported their weight. Both dieters and nondieters significantly underreported their weight. However, dieters significantly underreported their weight to a greater degree than did the nondieters. DISCUSSION: The implications of these subgroup differences and their specificity to weight reporting are discussed with reference to the accuracy of self-reported height.     

Anorexia nervosa with bipolar disorder: A case report

Whether eating disorders cause or are the result of affective disorders is an unsettled question. The association between manic syndromes and eating disorders has been reported rarely. We describe a patient in whom anorexia nervosa developed shortly after the onset of rapid cycling manic—depressive disorder, and whose eating disorder and manic—depressive symptoms twice resolved simultaneously with lithium treatment. This case demonstrates that anorexia nervosa can occur in the context of manic—depressive disorder. This patient first developed depressive, then anorexic, and finally manic symptoms, rapidly alternating with depression. It is uncertain whether this patient's anorexia nervosa had a biological or a psychological basis. Response to lithium carbonate argues for the mobilization of an anorexic diathesis during a mood disorder. Appearance of the anorexia nervosa after initial depression could be seen also as an unsuccessful way to defend against major mood problems.     

The impact of pregnancy on anorexia nervosa and bulimia

The present study examines the impact of pregnancy on anorexia nervosa and bulimia. A survey of women with an active eating disorder involving anorexia nervosa, bulimia, or mixed symptoms 6 months prior to their first pregnancy was undertaken to gain information on attitudes toward becoming pregnancy, fears and concerns related to the unborn child, the impact on eating disorder behaviors prenatal and postnatal, weight gain and weight gain of the baby as an indicator of its health, and the obstetricians view of the pregnancy and health status of the infant upon delivery. The results indicate that pregnancy had a pronounced beneficial impact on anorexic and bulimic symptoms during pregnancy. However, lasting psychological benefit was limited to a minority of the sample in the first year after childbirth. In contrast to previous research, infants had normal birth weights and deliveries with an absence of congenital defects. The implications of these results and suggestions for future research are discussed.     

Correlates of problematic eating behaviors in less acculturated Latinas

We examined whether body weight, depression, and body dissatisfaction could predict problematic eating behaviors in a community sample of less acculturated adult Latina women. Three hundred and forty-nine Latina women ages 20-40 were classified as non-overeater (n=244), eating disorder not otherwise specified-binge eating disorder features (EDNOS-BED) (n=65), or eating disorder not otherwise specified-bulimia nervosa features (EDNOS-BN) (n=40). Participants completed measures of problematic eating behaviors, depression, and body image. Results revealed that normal weight and overweight women were at a higher risk only for EDNOS-BN, while obese women were at a higher risk for either EDNOS-BN or EDNOS-BED. Women with high depression scores were 16 times more likely to be assigned to the EDNOS-BN group than women with lower depression scores. Results illustrate the important role of depression and body weight in predicting problematic eating in less acculturated Latinas.     

Anxiety and psychoactive substance use disorder comorbidity in anorexia nervosa or depression

OBJECTIVE: This study considered whether the prevalence and type of anxiety and psychoactive substance use disorder (PSUD) diagnoses differ between women with spectrum anorexia nervosa (AN) (N=40) and women with major depressive disorder (N = 58) participating in outpatient clinical trials. METHOD: Anxiety and PSUD diagnoses (according to criteria in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders) were assessed using structured clinical interviews. Comparisons were made between AN subtypes (restricting or binge eating/purging) and by history of depression within the AN sample. RESULTS: A high prevalence of obsessive-compulsive disorder (OCD) was found in women with AN. However, social phobia, simple phobia, and PSUD were significantly elevated in both women with depression and women with AN. Prevalences were similar for anxiety and PSUD diagnoses between AN subtypes. DISCUSSION: Women with anorexia or depression were comparable in all respects, except for the elevated OCD prevalence in AN, emphasizing the need to use clinical comparison groups to avoid inadvertently attributing elevated prevalences of comorbid conditions to specific disorders.     

Rumination in adults: Two case histories

Rumination has been reported to be a relatively rare disorder of eating during infancy. Over the past decade, there appears to be a renewed interest in and recognition of adult rumination. Although some authors believe adult rumination is benign, others have begun to link it with both eating disorders and depressive symptoms. This paper presents two adult cases whose rumination was associated with anorexia and bulimia nervosa. More identification and study of adult rumination is needed to clarify its course and medical significance. © 1995 by John Wiley & Sons, Inc.     

Acquired pseudo eating disorder: An imitation or fabrication of anorexia nervosa

Acquired pseudo eating disorder is a condition characterized by the development or fabrication of symptoms corresponding to an eating disorder in a patient hospitalized for an unrelated medical illness, who has previously been exposed to a patient(s) with anorexia nervosa. Two adolescent patients developed an eating disorder during medical hospitalisation. Both acquired the condition while hospitalized for another reason (myelomeningocele and multiple sclerosis, respectively). The potential psychodynamics suggested the selection of an “eating disorder,” amenable to control, over the reality of a threatening illness that was experienced as being out of control. Thus, the new and dramatic symptoms appeared to serve as a defense against a pervasive underlying depression. The patient's loudly proclaimed “eating disorder” seemed to originate from the imitation of anorexia nervosa patients. Recognition of this hospital-acquired pseudo eating disorder and appropriate counseling resulted in rapid resolution of the symptoms. It is possible to identify a pseudo eating disorder developing during a hospitalization and differentiate it from “true” anorexia nervosa.     

Self-reported history of anorexia nervosa and current quality of life: findings from a community-based study

Purpose

To evaluate the impact of a lifetime history of anorexia nervosa (AN) on current quality of life (QoL) and eating disorder (ED) symptomatology.

Method

3,034 participants from a randomly selected sample of households in the Australian population were interviewed for current ED symptoms and QoL (SF-36).

Results

89 participants (2.9 %) reported a history of AN, 73 of whom were female. These participants scored lower on six of the eight subscales on the SF-36, including all of the mental health subscales, and were more likely to report binge eating and extreme weight or shape concerns than participants who did not report a history of AN. On the other hand, participants who reported a history of AN were less likely to be overweight. None of the participants who reported a history of AN met current criteria for AN; however, one met criteria for bulimia nervosa non-purging subtype and four met criteria for binge eating disorder. The endorsement of current ED symptoms was found to moderate the impact of a history of AN on scores of the social functioning and role limitations due to emotional health SF-36 subscales, such that participants who reported a history of AN scored lower on these subscales if they also reported current ED symptoms.

Conclusions

A history of AN has a deleterious impact on current QoL, despite remittance from the disorder. This may be explained in part by the presence of certain ED symptoms, including objective binge eating and the persistence of extreme weight and shape concerns.     

Cross-Cultural Research on Anorexia Nervosa: Assumptions Regarding the Role of Body Weight.

OBJECTIVE: To critically examine two assumptions guiding cross-cultural research on the weight concerns of anorexia nervosa: (1) that weight concerns are specific to contemporary, Western manifestations of the disorder and (2) that the dissemination of Western values regarding thinness is primarily responsible for the development of anorexia nervosa in non-Western contexts. METHOD: A review of theoretical and empirical literature on cross-cultural aspects of anorexia nervosa and the medical records of 14 Asian patients treated for eating disorders in Sydney, Australia. RESULTS AND DISCUSSION: Regarding the first assumption: It is argued that weight concerns when defined as weight loss that is positively valued (rather than a fat phobia) is a defining characteristic of anorexia nervosa and is not limited to contemporary, Western cases of the disorder. Regarding the second assumption: It is argued that the occurrence of anorexia nervosa in non-Western contexts cannot be solely attributed to the acceptance of Western thinness ideals because values and practices intrinsic to non-Western cultures are also likely to be etiologically relevant.     

Comparison of binge eating disorder and bulimia nervosa in a community sample.

OBJECTIVE: This study examined the relationship between binge eating disorder (BED), a newly proposed eating disorder, and bulimia nervosa (BN). METHOD: Three groups recruited from the community were compared: women with BED (n = 150), women with purging BN (n = 48), and women with nonpurging BN (n = 14). RESULTS: The three groups did not differ significantly in education, weight or shape concern, and current or lifetime prevalence of nine major mental disorders. Women with BED, compared with women with purging BN, were older, less likely to have a history of anorexia nervosa, and less likely to have been treated for an eating disorder. Obesity was more commonly associated with BED than with either subtype of BN. DISCUSSION: Our results lend some support to BED as an eating disorder distinct from purging BN. More research is needed to clarify the position of nonpurging BN relative to BED and purging BN.     

Executive function in eating disorders: The role of state anxiety

Objective:

We examined the influence of depression and anxiety on executive function in individuals with a DSM‐IV diagnosis of anorexia nervosa‐restricting type, anorexia nervosa‐binge‐eating/purging type, bulimia nervosa, or eating disorder not otherwise specified.

Method:

We assessed 106 women after their inpatient treatment in an eating disorders program. All participants were nutritionally stable at the time of testing.

Results:

Thirty percent of the total sample showed impaired performance on one or more tests of executive function. No differences in executive function were observed among diagnostic groups. Anxiety scores accounted for significant variance in performance for all groups.

Discussion:

Executive function deficits were found in a minority of our sample, with significant variance in performance accounted for by self‐reported anxiety. State anxiety appears to contribute to diminished executive function in women with eating disorders. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

Temperament in eating disorders

This study examined dimensional personality and temperamental characteristics in women with eating disorders. Clinical symptoms, personality, and temperament were examined in 30 women with anorexia nervosa (AN), 32 women with bulimia nervosa with no history of anorexia nervosa (BN), and 20 women with comorbid anorexia and bulimia nervosa (AB). Temperament differed markedly across the groups on the Tridimensional Personality Questionnaire (TPQ) with AN women showing greater reward dependence, BN women scoring higher on novelty seeking subscales, and AB women showing high harm avoidance. The TPQ subscales also displayed higher classification accuracy than other personality and symptom measures. Temperamental features are distinct across eating disorder subtypes. Temperament could reflect differential vulnerabilities for the development of specific eating disorder symptom clusters. © 1995 by John Wiley & Sons, Inc.