Stomaching uncertainty: Relationships among intolerance of uncertainty,eating disorder pathology,and comorbid emotional symptoms

Intolerance of uncertainty (IU) is proposed to be a transdiagnostic vulnerability factor for various emotional disorders. There is robust evidence for the role of IU in anxiety and depressive disorders, but a paucity of evidence in eating disorders (ED). This study evaluated the factorial validity, internal consistency, and convergent validity of the Intolerance of Uncertainty Scale—Short Form (IUS-12; Carleton, Norton, & Asmundson, 2007), and examined whether IU is associated with ED pathology and comorbid emotional symptoms, in a clinical sample with EDs (N = 134). A unitary factor solution provided the best fit. The IUS-12 showed excellent internal consistency, and good convergent validity. IU had an indirect effect on dietary restraint, purging, and emotional symptoms via overvaluation of eating, weight, and shape. The indirect effect was not significant for bingeing. Findings provide partial support for the notion that IU is a vulnerability factor for ED pathology and support the notion that IU is a transdiagnostic vulnerability factor for emotional symptoms. Limitations, research implications, and future directions for research are discussed.     

Marital status and eating disorders: An analysis of its relevance

Objectives: This study attempts to understand the clinical impact of marital status on the psychopathology and symptomatology of anorexia (AN) and bulimia nervosa (BN) patients. Method: Eating disorder (ED) patients (n=332, 198 BN and 134 AN) consecutively admitted to our unit participated in the study. All subjects met DSM-IV criteria for those pathologies and were female. Our sample was divided retrospectively into three subgroups based on their marital status. For the assessment, commonly applied questionnaires in the field of ED were used [Eating Attitudes Test (EAT-40), Eating Disorder Inventory (EDI), Bulimic Investigatory Test Edinburgh (BITE), Body Shape Questionnaire (BSQ), Beck Depression Inventory (BDI) and Social Avoidance and Distress Scale (SAD)]. Results: 2×3 (Diagnostic×Marital status) ANOVA and ANCOVA (with age as covariance) designs were applied in the current study. Our results suggested that ED patients who lived with a partner were significantly different with respect to the other ED patients in the following variables: higher age (P<.0001), higher motivation for change (P<.004), perfectionism (P<.03) and purging behavior (P<.04). Discussion: The main finding in this study is that ED patients who live with a partner are those who presented greater eating symptomatology and psychopathology but even higher motivation for change. Interpersonal functionality has to be considered in the development and maintenance of ED.     

Exploring eating disorder quality of life and functional gastrointestinal disorders among eating disorder patients

Background

Functional gastrointestinal-like disorders (FGIDs) are prevalent among eating disorder (ED) patients. The aims are to explore the relationship between quality of life related to eating disorders (QOL ED) and FGIDs.

Methods

Consecutive ED patients, 18-45 years old, completed the Rome II, QOL ED, Irritable Bowel Syndrome QOL (IBS-QOL) and Bowel Symptom Severity Index (BSSI) questionnaires on admission to hospital for treatment of their ED.

Results

Despite the high prevalence of FGIDs (93%), only IBS is clearly correlated with QOL ED scores. The QOL ED subscores significantly related are ED feelings, psychological feelings and effect on daily living. These subscores contain items such as fearing loss of control over your body and feelings, being preoccupied with thoughts of body weight and shape, feeling confused and that eating and exercise have a negative effect on work/study. There were no relationships between QOL ED behavior and individual FGIDs or categories of FGIDs. The QOL ED and IBS-QOL are highly correlated, and there is a positive linear relationship between the QOL ED global and IBS-QOL total and BSSI scores.

Conclusion

The presence of IBS (but not other FGIDs) in ED patients is strongly related to eating disordered and psychological feelings. The poorer the QOL ED is, the poorer the IBS-QOL is and the more severe the IBS symptoms are.     

Prevalence of eating disorders among adolescent and young adult scholastic population in the region of Madrid (Spain)

OBJECTIVE: The prevalence of eating disorders (EDs) in a representative scholastic sample was evaluated, and the demographic factors associated with ED were assessed. METHOD: The study used a two-stage epidemiological design. The study population was a randomly selected sample of 1545 students (12- to 21-year-old males and females) in the region of Madrid (Spain). RESULTS: ED prevalence was 3.43%. Prevalence estimations were as follows: 5.34% for females: 2.72% for eating disorders not otherwise specified (EDNOS), 2.29% for bulimia nervosa (BN), and 0.33% for anorexia nervosa (AN); and 0.64% for males: 0.48% for EDNOS, 0.16% for BN, and 0.00% for AN. Some demographic factors that were shown to be associated with ED included the following: sex, age, single child, single-parent families, and father or mother's death. DISCUSSION: Despite the methodological improvements over previous epidemiological studies developed in Spain, there were no significant differences in the prevalence estimations.     

Marital status and eating disorders: an analysis of its relevance

Objectives: This study attempts to understand the clinical impact of marital status on the psychopathology and symptomatology of anorexia (AN) and bulimia nervosa (BN) patients. Method: Eating disorder (ED) patients (n=332, 198 BN and 134 AN) consecutively admitted to our unit participated in the study. All subjects met DSM-IV criteria for those pathologies and were female. Our sample was divided retrospectively into three subgroups based on their marital status. For the assessment, commonly applied questionnaires in the field of ED were used [Eating Attitudes Test (EAT-40), Eating Disorder Inventory (EDI), Bulimic Investigatory Test Edinburgh (BITE), Body Shape Questionnaire (BSQ), Beck Depression Inventory (BDI) and Social Avoidance and Distress Scale (SAD)]. Results: 2×3 (Diagnostic×Marital status) ANOVA and ANCOVA (with age as covariance) designs were applied in the current study. Our results suggested that ED patients who lived with a partner were significantly different with respect to the other ED patients in the following variables: higher age (P<.0001), higher motivation for change (P<.004), perfectionism (P<.03) and purging behavior (P<.04). Discussion: The main finding in this study is that ED patients who live with a partner are those who presented greater eating symptomatology and psychopathology but even higher motivation for change. Interpersonal functionality has to be considered in the development and maintenance of ED.     

Eating disorder symptoms among Japanese female students in 1982, 1992 and 2002

To study transcultural differences in eating disorders, we examined eating disorder symptoms and point prevalence of eating disorders among Japanese female students in 1982, 1992 and 2002. In 1982, 1992 and 2002, a total of 10,499 Japanese female students, aged 16–23 years, were asked to complete a self-administered questionnaire. Diagnosis of an eating disorder was made on the basis of DSM-IV criteria. On almost all measures, there were significant increases of a disordered attitude about fear of gaining weight, body perception disturbance and problematic eating behaviors over time. The point prevalence of anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified significantly increased over time. These results suggest that the prevalence of eating disorder symptoms and the point prevalence of eating disorders were increasing among Japanese female students in 2002. Changing socio-cultural factors in Japan may explain the dramatic increase of eating disorders over time.     

Health-related quality of life among adolescents with eating disorders

Objective

Health-related quality of life (HRQoL) is an emerging area of research in eating disorders (EDs) that has not been examined in adolescents in detail. The aim of the current study is to investigate HRQoL in an adolescent ED sample, examining the impact of ED symptoms on HRQoL.

Methods

Sixty-seven treatment-seeking adolescents (57 females) with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) completed self-report measures of HRQoL and ED symptoms.

Results

Participants reported poorer HRQoL in mental health domains than in physical health domains. Disordered attitudes, binge eating, and compensatory behaviors were associated with poorer mental health HRQoL, and body dissatisfaction was associated with poorer physical health HRQoL.

Conclusion

The current study assessed HRQoL among adolescents with EDs, finding several consistencies with the literature on adults with EDs. Future research should compare adolescents and adults with EDs on HRQoL.     

Social perception in people with eating disorders

ObjectiveSocial perception is a key aspect of social cognition which has so far not been investigated in eating disorders (ED). This study aimed to investigate social perception in individuals with anorexia nervosa (AN) and bulimia nervosa (BN).MethodsOutpatients with AN (restricting subtype [AN-R]: n = 51; binge-purge subtype [AN-BP]: n = 26) or BN (n = 57) and 50 healthy control (HC) participants completed the Interpersonal Perception Task (IPT-15). This is an ecologically valid task, which consists of 15 video clips, depicting complex social situations relating to intimacy, status, kinship, competition and deception. The participants have to assess relationships between protagonists’ based on non-verbal cues.ResultsOverall, there was no difference between groups on the IPT total score and subscale scores. Group differences on the Intimacy subscale approached significance so post hoc comparisons were carried out. HCs performed significantly better than AN-R participants in determining the degree of intimacy between others.ConclusionsSocial perception is largely preserved in ED patients. Individuals with AN-R show impairments in identifying intimacy in social situations, this may be due to the lack of relationship experience. Further research into different aspects of social cognition is required to establish the link between interpersonal difficulties and ED psychopathology.     

The epidemiology of eating disorders in six European countries: Results of the ESEMeD-WMH project

Few data are available to estimate the prevalence of eating disorders (EDs) and their correlates in the community. This paper reports data on EDs obtained in the framework of the ESEMeD project, aimed at investigating the prevalence of non-psychotic mental disorders in six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain), using a new version of the Composite International Diagnostic Interview. The ESEMeD study was a general population cross-sectional household survey. In total, 21,425 respondents aged 18 or older provided data for the project between January 2001 and August 2003. A subsample (N = 4139) underwent a detailed investigation on EDs. Lifetime estimated prevalence of anorexia nervosa, bulimia nervosa, binge eating disorder, sub-threshold binge eating disorder, and any binge eating were 0.48%, 0.51%, 1.12%, 0.72%, and 2.15%, respectively, and they were 3-8 times higher among women for all EDs. However, since people under 18 were excluded from this study, our prevalence should be taken as lower-bound estimate of real frequencies. Indeed, cumulative lifetime prevalence analysis showed that the majority of eating disorders had their initial onset between 10 and 20 years of age. Role impairment and comorbidity with other mental disorders were highly common, yet only small proportions of patients with a lifetime diagnosis of EDs requested medical treatment. It still has to be proven whether early diagnostic identification and access to specialized care can reduce the burden caused by these disorders.     

The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality

Our aim was to characterize the incidence rates and cumulative incidence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and examine associations among eating disorder diagnoses, suicide attempts, and mortality. Individuals born in Denmark between 1989 and 2006 were included (N = 966,141, 51.3% male). Eating disorders diagnoses (AN, broad AN, BN, EDNOS) were drawn from the Danish Psychiatric Central Research Register (PCRR) and Danish National Patient Register (NPR). Suicide attempts and deaths were captured in the NPR, the PCRR, and the Danish Civil Registration System (CRS). In females, AN had a peak hazard at approximately age 15 years, BN at 22 years, and EDNOS had an extended peak that spanned 18 years–22 years. Eating disorder diagnoses predicted a significantly higher hazard for death and suicide attempt compared with the referent of individuals with no eating disorders. In males, peak hazard for diagnosis was earlier than in females. The present study represents one of the largest and longest studies of eating disorder incidence and suicide attempts and death in both females and males. Eating disorders are accompanied by increased hazard of suicide attempts and death even in young adults.     

The body asks and the mind judges: Food cravings in eating disorders

BackgroundFood Craving (FC) is a construct influenced by cognitive, emotional, physiological and external components, severely altered in Eating Disorders (EDs).ObjectivesTo investigate how FC was measured in EDs.MethodsA search was conducted (PubMed, Scopus and PsycINFO databases) for studies that have investigated FC in EDs published in the last thirty years.ResultsThe studies found (n= 37) demonstrated that FC is a predictor of binge eating in individuals with Bulimia Nervosa and Binge Eating Disorder, which are more sensitive to the environment and emotional factors, whereas, in individuals with Anorexia Nervosa, FC levels are lower.DiscussionFC is a physiological component of eating behavior, as well as the craving/urge that arises associated with thirst during dehydration, and food restriction is a crucial mechanism for the restriction-binge cycle to hold. Further studies are needed to see if FC increases in response to treatment for Anorexia Nervosa, recognizing that individuals without Anorexia Nervosa have higher FC levels and greater motivational orientation towards food.ConclusionsIt is necessary to understand the physiological role of FC and also consider the significance of each food in an individual eating context (eating attitudes) and whether it is treated like a “drug” or just as a desired tasty food and future studies should verify possible neural changes involved in FC after nutritional treatment.     

Understanding catastrophic worry in eating disorders: process and content characteristics

Background and objectives

The majority of people with eating disorders (ED) experience high levels of comorbid anxiety and depression, yet the maintenance processes of these in ED remain largely unknown. Worry, a defining cognitive feature and important maintenance factor of anxiety, has not been well-studied amongst people with ED. This is the first study to explore both the process and content characteristics of catastrophic worry in ED.

Methods

Twenty-nine patients with anorexia nervosa (AN), 15 patients with bulimia nervosa (BN) and 37 healthy controls (HC) completed measures assessing anxiety, depression, worry and eating disorder pathology. Catastrophic worry was assessed using the Catastrophizing Interview and catastrophic worry content was explored using qualitative Thematic Analysis.

Results

Compared to HCs, ED groups had higher levels of anxiety, depression and worry and they generated a greater number of catastrophic worry steps. Worry was further found associated with depressive symptomatology in those with ED. Worry content for the ED groups included ED themes, but also themes reflecting broader inter and intrapersonal concerns.

Limitations

The degree to which worry is driven by depressive versus anxious symptomatology remains unclear. The current study does not include an anxious or depressed control group, and results should be considered in the light of relatively small samples sizes.

Conclusion

Findings indicate that interventions that target worry processes may be a useful adjunct to treatment for those ED patients with clinical worry levels.     

Assessment of somatosensory indicators of polyneuropathy in patients with eating disorders

Summary The somatosensor functions of small-diameter nerve fibres were tested on the lower and upper extremities in nine patients with anorexia nervosa, ten patients with bulimia nervosa and ten control subjects, by analysing warmth, cold, and pain thresholds. To test large-diaeter nerve fibres, the vibration threshold was also measured, Both patient groups had markedly elevated pain thresholds compared with the control subjects. In contrast, warmth and cold thresholds were only suggestively elevated while vibration thresholds were not at all increased in the patients. A distal-proximal pattern of somatosensory deficients, suggestive of peripheral polyneuropathy, was not observed. Hence, a peripheral polyneuropathy affecting small or large afferent fibres as a consequence of an eating disorder seems to be a rare event.     

Control over interfering memories in eating disorders

Introduction: Recent studies have suggested that patients suffering from either anorexia nervosa (AN) or bulimia nervosa (BN) exhibit abnormal performance in the ability to control cognitive interference in response selection. Method: We assessed the status of cognitive control in episodic memory by addressing the ability to inhibit interfering memories. To this end, we used the retrieval-practice paradigm, which allows for measuring both the beneficial and the detrimental effects of memory practice. The latter phenomenon, known as retrieval-induced forgetting (RIF), is thought to reflect an adaptive inhibitory mechanism aimed at reducing competition in memory retrieval. Twenty-seven healthy controls and 27 patients suffering from eating disorders (either AN or BN) performed a retrieval-practice paradigm and a control task addressing general reactivity and filled a self-report questionnaire on impulsivity. Results: No differences between patients and healthy controls were observed for the beneficial effects of practice. The same pattern also emerged for RIF. However, when patients with AN and BN were analyzed separately, a clear dissociation emerged: patients with AN displayed no hint of RIF, whereas patients with BN showed an intact memory suppression performance. No group differences emerged in the control task. Conclusions: Our findings suggest a specific impairment in the ability to suppress interfering memories in patients with AN, thus extending current evidence of cognitive control deficits in AN to episodic memory.     

Testing a cognitive model of generalized anxiety disorder in the eating disorders

Generalized anxiety disorder (GAD) is one of the most common comorbid disorders found in individuals with eating disorders. Despite this, little is known of shared vulnerability factors between the two disorders. The aim of the present study was to examine the four main components of a cognitive model for GAD in the eating disorders. One hundred and sixty-two females took part. Three groups were formed comprising of 19 participants with an eating disorder and GAD, 70 with an eating disorder without GAD and 73 healthy controls. All completed self-report questionnaires that measured eating attitudes, levels of GAD, intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Participants with an eating disorder and GAD scored the highest on all four components when compared to healthy individuals and on most components when compared to those with an eating disorder. Participants with an eating disorder without GAD scored higher on all components compared to healthy controls. Findings extend our understanding of shared vulnerability factors between the eating disorders and GAD.     

Regional cerebral blood flow patterns of change following the own body image exposure in eating disorders: A longitudinal study

ObjectiveThe aim of the present study is to see if the changes in the regional cerebral blood flow (rCBF) experienced by restrictive anorexia nervosa (AR) and bulimia nervosa (BN) patients, following the exposure to their own body image, persist at follow-up.MethodsThree single photon emission computed tomography (SPECT) were performed on nine patients with a DSM-IV diagnosis of AR, 13 with BP, and 12 controls: at rest, following a neutral stimulus, and after exposure to their previously filmed whole body image. Body dissatisfaction was measured by means of the Body Dissatisfaction Questionnaire (BSQ). One year later the same assessment was repeated.ResultsFollowing the exposure to their own body image, BN showed an increase in body dissatisfaction, which was associated with the increase in the rCBF of the Right Temporal Area. Those changes persisted at follow-up.DiscussionMore specific long term therapies are needed for the treatment of the averse response showed by ED patients to their own body image exposure that is associated with the hyperactivation of the right temporal area when they are confronted with their whole body image.     

Approach and avoidance motivation in eating disorders

It has been proposed that approach and avoidance processes may be critically involved in the development and maintenance of eating disorders (EDs), including anorexia nervosa (AN) and bulimia nervosa (BN). The Behavioural Inhibition System and Behavioural Activation System Scales (BIS/BAS) and Appetitive Motivation Scale (AMS) questionnaires were administered to 286 participants: 91 healthy controls (HCs), 121 participants with a current ED, either AN (restrictive and binge purge subtypes), or BN and 74 participants recovered from an ED. Individuals with EDs had higher levels of sensitivity to punishment and lower levels of reward reactivity than controls. Individuals in recovery from an ED scored the same as those in the acute group, with the exception of BAS fun seeking, for which they scored significantly higher than those with restricting AN. Discriminant analysis revealed that HCs were maximally separated from those in the acute and recovered ED groups along a dimension reflecting high punishment sensitivity and low reward sensitivity. Classification analysis demonstrated that ED and HC group membership was predicted from reward and punishment sensitivity measures; however recovered participants tended to be misclassified as ED. This study suggests high punishment sensitivity and low reward reactivity/sensitivity might form a personality cluster associated with the risk of developing an ED.     

Assessment methods for eating disorders and body image disorders

The growing interest in the treatment and research of eating disorders has stimulated the development of assessment methods, and there are now many questionnaires for evaluating behavioral and attitudinal characteristics of eating pathology. The present article sets out to review the assessment tools that are widely used in clinical practice and research. In particular, it covers self-report measures with summaries of their psychometric properties. It also presents diagnostic questionnaires based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria. The instruments described include screening questionnaires, measurement tools for specific eating disorder symptoms, measurement of quality of life in eating disorders, and some tools for the measurement of body image disorder, a common feature of eating disorders. There is also a discussion of distorting factors that decrease the authenticity of assessment tools. These problems arise from the definition of some constructs and from the phenomena of denial and concealment, which are frequent among eating-disordered individuals. The frequent co-occurrence of other psychopathological features (e.g., multiimpulsive symptoms) shows that other psychological phenomena should also be evaluated in line with the assessment of eating disorders.