Suicide and attempted suicide in eating disorders, obesity and weight-image concern

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Meta-analyses have shown that individuals suffering from anorexia nervosa and bulimia nervosa commit suicide more often than their counterparts in the general population; also a few studies have suggested that suicide is the major cause of death among patients with anorexia nervosa, refuting the assumption that inanition generally threatens the life of these patients. Data concerning suicide in bulimia nervosa, on the other hand, are still scarce but suicide attempts are easily found among cohorts of patients with bulimia nervosa, which constitutes a risk factor for completed suicide. Suicidality in obesity and individuals with disturbed weight status has been reported. Both in the case of bulimia nervosa and obesity more long-term follow-up studies need to be completed before the risk of suicide for such disorders may be compared with that for anorexia nervosa.     

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.     

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.     

Prospective predictors of the onset of anorexic and bulimic syndromes

OBJECTIVE: This study investigated prospective predictors of lifetime history diagnoses of partial- and full-syndrome anorexia nervosa and bulimia nervosa (referred to as anorexic syndrome and bulimic syndrome.) METHOD: Participants were 157 females who were studied initially in the 7th-10th grades (ages 12-16) and followed-up 2 and 8 years later in middle adolescence (ages 14-18) and young adulthood (ages 20-24), respectively. A telephone interview to determine lifetime history of anorexic and bulimic syndromes was conducted in young adulthood. RESULTS: In multivariate analyses controlling for initial eating symptoms, initial perfectionism and low body weight predicted young adult onset of anorexic syndrome, and initial negative emotion predicted young adult onset of bulimic syndrome. DISCUSSION: Our findings suggest that adolescent girls who are initially thin and also adhere to perfectionistic standards may be at risk for developing anorexic syndrome. For bulimia, negative affect may contribute to the development of the binge-purge cycle.     

Body images in anorexia nervosa and bulimia nervosa

This study extends earlier research on body image disturbance in anorexia nervosa to the reactions of patients with bulimia nervosa. “Natural” procedures were employed, and normal comparison groups as well as those with anorexia nervosa or bulimia nervosa used adjective scales to rate “the self,” mirror images of themselves that were veridical, exaggerated for fatness or for thinness and adjusted to their ideal, and a television image they had adjusted to show how they feel and then how they think their body is. The different adjustments and ratings that were made in each condition question the validity of any single estimates of body size. Nevertheless, this multimethod approach to the cognitive and affective components of body image shows that those with anorexia nervosa and bulimia nervosa consistently emphasize their feelings of fatness.     

Dating People with Anorexia Nervosa and Bulimia Nervosa: Attitudes and Beliefs of University Students

ABSTRACT

Attitudes and beliefs about dating people with eating disorders were investigated in men and women using a questionnaire administered to 752 university students. Students believed that people with anorexia nervosa and bulimia nervosa had a difficult time dating, dates would involve conflict, and dating would be a negative experience. Students were more comfortable in casual interactions than more serious dating activities with people with anorexia nervosa and bulimia nervosa. Men were somewhat comfortable dating people with anorexia nervosa or bulimia nervosa, but less so for obesity. Most students believed dating people with anorexia nervosa and bulimia nervosa would not be a positive experience, and men Stigmatized people with eating disorders differently, than did women.     

Sociocultural influences on eating disorders in professional female ballet dancers

Fifty-five white and eleven black female dancers in nine regional and national ballet companies in America and Europe (mean age 24.9) were surveyed for eating disorders. The dancers, as a whole, weighed 12% below their ideal weight for height. None of the black American dancers reported anorexia nervosa or bulimia, while 15% of the white American dancers reported anorexia nervosa and 19% reported bulimia. All instances of anorexia nervosa were in national rather than regional companies, making the incidence among whites in the former 22%. Self-reported anorectics scored higher on the EAT-26, had lower weights, exhibited more psychopathology, and a poorer body image than the nonanorectics. In addition, all but one of the self-reported anorectics weighed, or had weighed, less than 20% of ideal weight for height. The bulimics valued their careers less, dieted more, and exercised less frequently than the nonbulimics. Weight did not differ for these two groups. The data suggest that the anorectic dancers differ from dancers with no eating disorders and that sociocultural factors are related to the report of eating disorders. Specifically, level of competition is related to reported anorexia nervosa and ethnicity to anorexia nervosa and bulimia.     

Endocrine aspects of eating disorders in adolescents

Eating disorders are an important health concern among adolescents. Young women frequently present with signs and symptoms of anorexia nervosa and bulimia nervosa. These disorders represent clinically significant illnesses with serious and sometimes permanent medical complications, including a number of endocrine conditions, that, in general, result from the body s adaptive response to malnutrition. Examples include disorders of metabolism, cortisol and leptin regulation, fluid and electrolyte homeostasis, thyroid function, glucose regulation, growth and development, and reproductive function with the development of amenorrhea as well as the risk of osteoporosis.     

The development and validation of the body shape questionnaire

Concerns about body shape are common among young women in Western cultures, and, in an extreme form, they constitute a central feature of the eating disorders anorexia nervosa and bulimia nervosa. To date there has been no satisfactory measure of such concerns. A self-report instrument, the Body Shape Questionnaire (BSQ) has therefore been developed. The items that constitute this measure were derived by conducting semistructured interviews with various groups of women including patients with anorexia nervosa and bulimia nervosa. The BSQ has been administered to three samples of young women in the community as well as to a group of patients with bulimia nervosa. The concurrent and discriminant validity of the measure have been shown to be good. The BSQ provides a means of investigating the role of concerns about body shape in the development, maintenance, and treatment of anorexia nervosa and bulimia nervosa.     

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 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.     

Age of onset in eating disorders

This paper presents age of onset data for anorexia nervosa and bulimia nervosa, derived from a sample of 323 patients referred to a tertiary referral center. Patients had anorexia nervosa (n = 39), bulimia nervosa (n = 173), or bulimia nervosa with a history of anorexia nervosa (n = 173). While the pattern of onset of anorexia nervosa and bulimia nervosa is similar up to age 25, there is a significant excess of new cases of anorexia nervosa beyond this point. Significantly, age of onset was constant for both anorexia nervosa and bulimia regardless of whether they occurred in isolation (anorexia or bulimia alone) or in concert in the same individual (bulimia with a history of anorexia nervosa).     

Bulimia and anorexia nervosa alternating with the seasons: A case report

A case of seasonal bulimia nervosa developing in a 26 year old woman with preexisting anorexia nervosa is described. The relationship between seasonal affective disorder, anorexia, and bulimia is discussed.     

Clinical and personality correlates of body size overestimation in anorexia nervosa and bulimia nervosa

A video camera technique was used to assess perceived actual and ideal size in patients with a restricting type of anorexia nervosa (n = 17), bulimia nervosa patients with previous anorexia (n = 23), bulimia nervosa patients with no previous anorexia (n = 24), phobic controls (n = 18), and normals (n = 33). Bulimic patients with previous anorexia demonstrated a significantly greater tendency to overestimate their actual body size (p <.05) than subjects in the restricting anorexic or control groups. Previously anorexic bulimics also demonstrated more overall clinical and personality disturbance than any of the other groups (p <.01). Body size overestimation and dissatisfaction were strongly associated with the duration and severity of the eating disturbance in previously anorexic bulimics but there were no clear relationships between clinical or personality disturbances and body size distortions in the restricting anorexic or never-anorexic bulimic groups. Results are discussed with respect to the importance of refining diagnostic criteria for subtypes of anorexia and bulimia nervosa. Multitrait-multimethod methodologies are recommended for purposes of elucidating “body image disturbance” and its importance in the etiology and maintenance of eating disorders.     

Suicide and attempted suicide in anorexia nervosa and bulimia nervosa

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Risk factors for suicide and attempted suicide (which in many cases results in successful suicide) in anorexia nervosa include: purging type, chronic disease, and during treatment, obsessive symptoms and drug abuse, major depression, and for anorexia nervosa low body mass index (BMI) at presentation. In anorexia nervosa suicide has been considered the first cause of death and attempted suicide is a serious threat to these individuals. Data concerning suicide in bulimia nervosa has still scarce whereas attempted suicides are easily found in clinical histories of patients. No doubt suicidal behavior is underestimated amongst patients with anorexia nervosa and bulimia nervosa. An effort to reconcile with subject of suicide and a better evaluation of these patients' psychopathology should improve suicide prevention strategies amongst these individuals.     

Survey of eating disorders in English-medium schools in Lahore,Pakistan

A survey of 369 schoolgirls was conducted in Lahore, Pakistan, using the Eating Attitudes Test (EAT-26) and Body Shape Questionnaire (BSQ) in English. Factor analyses of the EAT and BSQ supported their cross-cultural validity in these English medium schools. Girls who scored highly on either questionnaire were invited for interview. One girl met DSM-/I/-R criteria for bulimia nervosa and there were five subjects with partial syndrome bulimia nervosa. No girls suffered from anorexia nervosa. There was some evidence that the most ‘Westernized’ girls were at greatest risk of developing an eating disorder. Comparison is made with a survey con- ducted by the authors among Asian schoolgirls in Bradford, UK. The results are discussed in the light of previous claims that eating disorders should be regarded as ‘culture-bound syndromes’.     

Lay beliefs about disordered eating

Although “disordered eating,” as a set of psychiatric conditions, implicitly evaluates components of a social phenomenon, little attention has been paid to the boundaries between socially accepted and abnormal eating. Lay knowledge and evaluations of the formal criteria for a diagnosis of anorexia nervosa or bulimia were therefore examined. The results show that although males and females know more about anorexia nervosa than bulimia, the DSM-III criteria for anorexia nervosa, which involve the determined pursuit of slimness and a body image disturbance, were judged by very few people to be both uncommon and abnormal. Bulimia, however, seems to be much closer to what is commonly judged to involve unusual behavior.     

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.     

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.