Suicidality in eating disorders: clinical and psychological correlates

Although many authors have described eating disorders as often being associated with suicidal feelings and behaviour, few studies to date have evaluated the prevalence and characteristics of suicidal behaviour in eating disordered patients. In the present study, in which a consecutive series of 495 out-patients was studied, 13% of the patients reported at least one suicide attempt and 29% reported current suicidal ideation; 26% of attempters reported multiple attempts. A history of suicide attempt was more prevalent among binge-eating/purging anorexics and among purging bulimics than in the other subgroups. In cases with anorexia nervosa, suicide attempters were older, had a longer illness duration, weighed less, had more often used drugs and/or alcohol and tended to be more obsessive than non-attempters. In cases with bulimia nervosa, attempters presented with more psychiatric symptoms and had more frequently been sexually abused.     

Development and preliminary validation of a Finnish version of the Eating Disorder Examination Questionnaire (EDE-Q)

Background: Eating behaviour can be viewed as a continuum, ranging from extremely restrictive to extremely disinhibited eating. Valid and reliable instruments are needed to ensure detection of individuals with risk for eating disorders (ED). Self-report methods are the most feasible, cost, and time efficient. One of the most widely used self-reports is the Eating Disorder Examination Questionnaire (EDE-Q).

Aim: The aim of this study was to develop a Finnish version of the EDE-Q version 6.0 and to assess its psychometric properties in adolescents, adults, and ED patients.

Methods: The present study utilized data from three different samples: adolescents (n?=?242), adults (n?=?133), and ED patients (n?=?52). The patient group comprised different EDs, but individual ED diagnoses were not studied separately. Data was collected January 2014 through June 2015.

Results: The Finnish version of the EDE-Q showed acceptable-to-excellent internal consistency on all sub-scales in all three samples and discriminated patients from healthy individuals. Female participants generally scored higher than male and sex differences were more pronounced among the younger age group.

Conclusions: The Finnish version of the EDE-Q can, based on this study, be regarded as reliable, valid, and functional. Further studies are needed to evaluate the population norms and to test the validity in individual ED diagnoses.     

Eating Disorder Inventory in Sweden: description, cross-cultural comparison, and clinical utility

The Eating Disorder Inventory is one of very few tests for anorexia nervosa and bulimia nervosa that measures not only symptoms but also psychological characteristics believed to be central in these disorders. This study of 425 patients and control subjects showed that patients had markedly higher scores than controls and recovered patients on all eight scales. Individuals with bulimia nervosa scored higher on a few of the scales than those with anorexia nervosa, as did binge eaters at all weights compared with those who only restricted eating. Comparison with Canadian subjects showed several differences in normal controls. Since the technical properties of our Swedish version of the EDI were excellent, these differences may be meaningful rather than artifacts of the translation. Finally, the analyses indicated that the EDI may be useful for purposes of screening for eating disorders, and possibly for differential diagnosis.     

Full-syndrome,partial-syndrome and subclinical eating disorders: an epidemiological study of female students in Southern Italy

We screened a sample of 919 female students, aged 13–19 years, by means of the EDI 2 and GHQ-28 questionnaires. Those students identified as being at risk for an eating disorder (281 subjects) underwent a psychiatric interview. We found 2 cases of full-syndrome anorexia nervosa (0.2%), 21 cases of full-syndrome bulimia nervosa (2.3%) and 2 cases of full-syndrome binge-eating disorder (0.2%). Moreover, 35 girls (3.8%) met the criteria for partial-syndrome and 98 girls (10.7%) fulfilled the criteria for subclinical eating disorders. Subjects with partial-syndrome and subclinical eating disorders had higher scores than those with no diagnosis, but lower scores than students with full-syndrome eating disorders, on both the EDI 2 and GHQ-28 questionnaires. A follow-up of subjects with partial-syndrome and subclinical eating disorders is now in progress.     

Serotonin transporter gene polymorphism in eating disorders: Data from a new biobank and META-analysis of previous studies

Objectives Growing interest focuses on the association between 5-HTTLPR polymorphism and eating disorders (ED), but published findings have been conflicting. Methods The Italian BIO.VE.D.A. biobank provided 976 samples (735 ED patients and 241 controls) for genotyping. We conducted a literature search of studies published up to 1 April 2015, including studies reporting on 5HTTLPR genotype and allele frequencies in obesity and/or ED. We ran a meta-analysis, including data from BIO.VE.D.A. – comparing low and high-functioning genotype and allele frequencies in ED vs. controls. Results Data from 21 studies, plus BIO.VE.D.A., were extracted providing information from 3,736 patients and 2,707 controls. Neither low- nor high-functioning genotype frequencies in ED patients, with both bi- and tri-allelic models, differed from controls. Furthermore, neither low- nor high-functioning allele frequencies in ED or in BN, in both bi- and triallelic models, differed from control groups. After sensitivity analysis, results were the same in AN vs. controls. Results remained unaltered when investigating recessive and dominant models. Conclusions 5HTTLPR does not seem to be associated with ED in general, or with AN or BN in particular. Future studies in ED should explore the role of ethnicity and psychiatric comorbidity as a possible source of bias.     

Outcome,recovery, relapse and mortality across six years in patients with clinical eating disorders

The study describes course and outcome over 6 years for adults with eating disorders. Special interest is paid to clinically critical events such as relapse and premature death. Seventy-seven per cent of the 30 prospectively studied patients had no eating disorder diagnosis after 6 years. Among the recovered patients, the total risk of relapse was 48%. The mortality was 17.8 times higher than expected. The overall pattern of results confirm earlier ones for anorexia nervosa and extend the limited database for bulimia nervosa. Of particular importance may be 1) that no patient in this sample suffered more than one major relapse and 2) that the risk for premature death may be twice as high among bulimic as among restricting patients.     

Decreased levels of serum brain-derived neurotrophic factor in female patients with eating disorders.

BACKGROUND: Several lines of evidence suggest that brain-derived neurotrophic factor (BDNF) plays a role in the regulation of eating behavior. Because of its role in eating behavior, which is especially relevant to eating disorders, BDNF is an attractive candidate for investigation of potential biological markers of eating disorders such as bulimia nervosa (BN) and anorexia nervosa (AN). METHODS: We enrolled 18 female patients with BN, 12 female patients with AN, and 21 age-matched female normal control subjects in this study. Eating-related psychopathology and depressive symptoms were evaluated using the Bulimic Investigatory Test, Edinburgh (BITE) and the Hamilton Depression Rating Scale (HDRS). Serum BDNF levels were measured by a sandwich enzyme-linked immunosorbent assay. RESULTS: Serum levels of BDNF in the patients with AN or BN were significantly (p<.0001) decreased compared with those of normal control subjects, and serum BDNF levels in the patients with AN were significantly (p=.027) lower than those in patients with BN. A significant positive correlation (r=.378, p=.006) between serum BDNF levels and body mass index in all of the subjects was detected. Furthermore, there was a significant positive correlation (r=.435, p=.015) between the BITE symptom scale score and HDRS in these patients. CONCLUSIONS: The present study suggests that BDNF may play a role in the pathophysiology of eating disorders.     

Central coherence in eating disorders: An updated systematic review and meta-analysis

Objectives. A bias towards local information over the global “gist” (weak central coherence, WCC), has been identified as a possible contributing and maintaining factor in eating disorders (ED). The present study aimed to provide an updated review of the WCC literature and examine the hypothesis that individuals with ED have WCC. Methods. The new search found 12 eligible studies. Meta-analyses were performed on nine of these 12 studies, the remaining three were commented on individually. Data were combined with data from the previous 2008 review, and meta- analyses were performed on 16 studies (nine studies from the new search and seven studies from 2008 review). Results. Meta-analysis of the Group Embedded Figures Task provided evidence of superior local processing across all ED subtypes (pooled effect size of d = ?0.62 (95% CI = ?0.94, ?0.31), P < 0.001). Evidence of poorer global processing in ED groups was found from meta-analyses of the Rey-Osterrieth Complex Figures task (d = ?0.63 (95% CI = ?0.77, ?0.49, P < 0.001), and the Object Assembly Task (d = ?0.65 (95% CI = ?0.94, ?0.37), P < 0.0001). Conclusions. As well as supporting the results of previous studies by providing evidence of inefficient global processing, this review has provided evidence of superior local processing, which supports the WCC hypothesis in ED.     

Lifetime substance abuse, family history of alcohol abuse/dependence and novelty seeking in eating disorders: Comparison study of eating disorder subgroups

Aim:  To assess lifetime substance abuse, family history of alcohol abuse/dependence, and novelty seeking in three different eating disorder groups (anorexia nervosa–restrictive; anorexia nervosa–binge eating/purging; anorexia nervosa to bulimia nervosa).
Method:  A total sample of 371 eating disorder patients participated in the current study. Assessment measures included the prevalence of substance abuse and family history of alcohol abuse/dependence as well as the novelty-seeking subscale of the Temperament and Character Inventory–Revised.
Results:  Significant differences across groups were detected for lifetime substance abuse, with anorexia nervosa–restrictive individuals exhibiting a significant lower prevalence than the anorexia nervosa to bulimia nervosa and anorexia nervosa–binge eating/ purging patients ( P  < 0.01). For family history of alcohol abuse/dependence the same pattern was observed ( P  = 0.04). Novelty seeking was associated with substance abuse ( P  = 0.002), with the anorexia nervosa to bulimia nervosa group exhibiting significantly higher scores on the novelty-seeking scale than the other two groups ( P  < 0.001). But family history of alcohol abuse/dependence was not related to novelty seeking ( P  = 0.092).
Conclusion:  Lifetime substance abuse appears to be more prevalent in anorexia nervosa patients with bulimic features. Higher novelty-seeking scores may be associated with diagnosis cross-over.     

A nonsynonymous polymorphism in cannabinoid CB2 receptor gene is associated with eating disorders in humans and food intake is modified in mice by its ligands

Marijuana use activates cannabinoid receptors (CB‐Rs) producing several behavioral effects related to addiction, mood, and appetite. We investigated the association between CNR2 gene, which encodes cannabinoid CB2 receptor (CB2‐R) and eating disorders in 204 subjects with eating disorders and 1876 healthy volunteers in Japanese population. The effect of treatment with CB2‐R ligands on mouse food consumption was also determined. The CB2‐R ligands used suppressed food intake in a time‐ and strain‐dependent manner when food was available ad libitum and during the 12‐h fast except, AM 630—the CB2‐R antagonist that stimulated food consumption in food‐deprived mice. There is an association between the R63Q polymorphism of the CNR2 gene and eating disorders (P = 0.04; Odds ratio 1.24, 95% CI, (1.01–1.53). These results suggest that cannabinoid CB2‐R is involved in the endocannabinoid signaling mechanisms associated with the regulation of food intake and in eating disorders. Synapse 64:92–96, 2010. © 2009 Wiley‐Liss, Inc.     

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.     

Core pathology of eating disorders as measured by the Eating Disorder Examination Questionnaire (EDE‐Q): the predictive role of a nested general (g) and primary factors

The present study examined several factor models of the Eating Disorder Examination Questionnaire (EDE‐Q), and in particular, whether a nested general factor (‘g’) was present, hence supporting a common pathology factor. A total of 1094 women were randomly selected by Statistics Norway and mailed a questionnaire packet. The sample was randomly split, using the first half for exploratory analyses and the second for confirmatory validation purposes. A four‐factor solution received the best support, but the structure deviated from the original model of Fairburn. The internal consistency was high for the first three factors (.93, .82 and .86) and satisfactory for the fourth (.78). The additional specification of a general (g) factor improved model fit significantly, implying that the EDE‐Q scores are indicators of both a general core and four primary symptom patterns. Furthermore, the g was more strongly related to predictors like age and body mass index (BMI) than the four primary factors in a full structural equation model. The validity of interpreting the global EDE‐Q score as indicative of g was supported. A brief Shape and Weight Concern subscale of 11 items was strongly related to the g‐factor, and may provide an abbreviated measure of overall eating disorder pathology. Copyright © 2013 John Wiley & Sons, Ltd.     

Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome

Objective

The study was aimed at assessing the prevalence of compulsive exercising to control shape and weight in eating disorders (EDs) and its relationship with treatment outcome.

Method

Compulsive exercising to control shape and weight, defined according to a modified version of the Intense Exercising to Control Shape or Weight section of the Eating Disorder Examination (EDE), was assessed in 165 consecutive ED inpatients entering a protocol based on the transdiagnostic cognitive behavior theory and treatment of EDs. Baseline assessment also included anthropometry, the global EDE interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI), the Eating Disorders Inventory-Perfectionism Scale, and the Temperament and Character Inventory.

Results

Of the patients, 45.5% were classified as compulsive exercisers, the prevalence being highest (80%) in restricting-type anorexia nervosa (AN), lowest in EDs not otherwise specified (31.9%), and intermediate in binge/purging AN (43.3%) and in purging-type bulimia nervosa (39.3%). Compulsive exercising to control shape and weight was independently predicted by the EDE restraint score (odds ratio, 1.32; 95% confidence interval, 1.06-1.64; P = .014) after adjustment for ED; the total amount of exercise was associated with EDE restraint, as well as with the Temperament and Character Inventory reward dependence. At follow-up, an improved EDE global score was predicted by lower baseline values, higher baseline STAI and STAI improvement, and lower amount of exercise in the last 4 weeks. Voluntary treatment discontinuation was not predicted by baseline exercise.

Discussion

Compulsive exercising to control shape and weight is a behavioral feature of restricting-type AN, associated with restraint and temperament dimensions, with influence on treatment outcome.     

Diagnosis and classification of eating disorders in adults with intellectual disability: the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) approach

Background Previous classifications of eating disorders [EDs] employed a narrower concept of EDs. They did not include the wide range of abnormal eating behaviours [AEBs], persistent feeding disorders and EDs psychopathology, aetiological and comorbidity factors seen in adults with intellectual disability [ID]. Methods The International Classification of Diseases − 10 [ICD-10], ICD-10-MR, Diagnostic and Statistical Manual − IV [DSM-IV] and Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation[DC-LD] diagnostic approaches to EDs in adults with ID are compared. Results The DC-LD encourages conceptually clearer and systematic hierarchical differential diagnostic classification of AEBs and EDs. The DC-LD also allows consideration of relevant aetiological and comorbidity issues. DC-LD-based multi-axial case formulation supports the multimodal clinical assessment of AEBs and EDs. Conclusions Further research should develop similar systematic and evidence-based multicomponent clinical diagnostic, management and service models for adults with ID and EDs.