Fractures in patients with anorexia nervosa,bulimia nervosa,and other eating disorders--a nationwide register study

OBJECTIVE: To study fracture risk in patients with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorders not otherwise specified (EDNOS). METHOD: Cohort study including all Danes diagnosed with AN (n = 2,149), BN (n = 1,294), or EDNOS (n = 942) between 1977 and 1998. Each patient was compared with three randomly drawn age- and gender-matched control subjects. RESULTS: Fracture risk was increased in AN after diagnosis compared to controls (incidence rate ratio: 1.98, 95% CI: 1.60-2.44), but not before. The increased fracture risk persisted more than 10 years after diagnosis. A significant increase in fracture risk was found before diagnosis in BN (1.31, 95% CI: 1.04-1.64), with a trend towards an increase after diagnosis (1.44, 95% CI: 0.93-2.22). EDNOS patients had a significant increase in fracture risk before (1.39, 95% CI: 1.06-1.81) and after diagnosis (1.77, 95% CI: 1.25-2.51). DISCUSSION: The increased fracture risk many years after diagnosis indicates permanent skeletal damage.     

A comparison of early family life events amongst monozygotic twin women with lifetime anorexia nervosa, bulimia nervosa, or major depression

OBJECTIVES: To investigate the differential profile of early family life events associated with lifetime anorexia nervosa (AN), bulimia nervosa (BN), and major depression (MD). METHOD: Only data from the monozygotic twins (n = 622) were examined from a community sample of female twins who had participated in three waves of data collection. Eating disorder and MD diagnoses were ascertained from the Eating Disorder Examination at Wave 3 and interview at Wave 2 respectively. Early family events were ascertained from self-report measures at Waves 1 and 3. Two case control designs were used, including a comparison of women: (1) who had lifetime AN, BN, MD, and controls, and (2) twin pairs discordant for either AN, BN, or MD (where the unaffected cotwin formed the control group). RESULTS: Across the two types of designs, compared to controls, both AN and BN were associated with more comments from the family about weight and shape when growing up. AN was uniquely associated with higher levels of paternal protection while BN was associated with higher levels of parental expectations. CONCLUSION: While some overlap among early life events was indicated, especially related to parental conflict and criticism, there was evidence to support some degree of nonoverlap among life events associated with AN, BN, and MD.     

Prevalence of anorexia nervosa and bulimia nervosa in a geographically defined area in Japan

OBJECTIVE: Little has been understood regarding the frequency of eating disorders in Japan. This study was designed to identify the prevalence of anorexia nervosa (AN) and bulimia nervosa (BN) in Japan. METHOD: We asked doctors in all of the relevant medical facilities (130 hospitals and 1,326 clinics) in Niigata Prefecture to report patients with DSM-IV-diagnosed eating disorders who appeared or were admitted between 20-24 October 1997. The response rate was 94.4%. RESULTS: The estimated point prevalences of AN and BN were 4.79 and 1.02, respectively, per 100,000 females. Specifically for the age group of 15-29 years, the prevalence of AN was 17.10 and that of BN 5.79. DISCUSSION: The prevalence of AN and BN in Japan is lower than that for European Caucasian populations. This result may be due to cultural and ethnic differences and/or it may be a transient phenomenon.     

Features associated with excessive exercise in women with eating disorders

OBJECTIVE: Excessive exercise and motor restlessness are observed in a substantial number of patients with eating disorders. This trait has been studied extensively among animal models of activity anorexia nervosa (AN) and may hold particular interest as an endophenotype for AN. We explored features associated with excessive exercise across subtypes of eating disorders. METHOD: Participants were female probands and affected female relatives from the multi-site international Price Foundation Genetic Studies with diagnoses of AN, bulimia nervosa (BN), and both AN and BN or eating disorder not otherwise specified (ED-NOS) (N=1,857). Excessive exercise was defined based on responses to the Structured Interview for Anorexic and Bulimic Disorders (SIAB). RESULTS: Among the eating disorder diagnostic groups, excessive exercise was most common among the purging subtype of AN. Individuals who reported excessive exercise also reported lower minimum BMI, younger age at interview, higher scores on anxiety, perfectionism, and eating disorder symptom measures, more obsessions and compulsions, and greater persistence. CONCLUSION: Excessive exercise may be associated particularly with the purging subtype of AN as well as with a constellation of anxious/obsessional temperament and personality characteristics among women with eating disorders.     

Secular trends in the incidence of anorexia nervosa: Integrative review of population-based studies

Objective and Method: Aggregating across retrospective cohort samples, this integrative review synthesizes the findings of 12 cumulative incidence studies (45 hypotheses) on anorexia nervosa secular trends. Results: (1) The female/male anorexia incidence rate ratio was estimated to be 8.20, 18.46 versus 2.25 cases per 100,000 per year, p < .05; (2) female teenagers experienced anorexia at a rate fivefold greater than other women, 50.82 versus 10.37 incident cases per 100,000 per year, p < .001; (3) no secular trend or change in the incidence of anorexia was observed among teenagers, while a near threefold increase was observed over the past 40 years among women in their 20s and 30s, 6.28 (1950–1964) versus 17.70 (1980–1992) cases per 100,000 per year, p < .05; and (4) the two cohort characteristics of age, and the age by year interaction accounted for nearly two thirds of the variability among anorexia incidence estimates, R² = .614, F(2,27) = 21.49, p < .001. After the two factors of age and the Age × Year interaction were accounted for, none of the other study characteristics, including study year(s), were found to be significantly associated with anorexia incidence, that is, a main effect of time was not observed. Discussion: The integrative evidence across the population-based epidemiologic studies covering 40 years in this field suggests strongly that, overall, the incidence of anorexia nervosa, particularly among those very young women at greatest risk of experiencing it, has not increased significantly. However, the risk does seem to have increased significantly among women in their 20s and 30s. © 1998 John Wiley & Sons, Inc. Int J Eat Disord 23: 347–352, 1998.     

Regional cerebral blood flow after recovery from anorexia or bulimia nervosa

OBJECTIVE: Abnormalities of regional cerebral blood flow (rCBF) have been found in individuals who are ill with anorexia (AN) or bulimia nervosa (BN). Little is known about whether rCBF normalizes after recovery from AN and BN. METHOD: Eighteen control women (CW), 10 recovered restricting type AN, 8 recovered AN with a binging history, and 9 recovered BN participants without a history of AN were studied using positron emission tomography and [(15)O]water in order to assess rCBF. RESULTS: Partial volume corrected rCBF values in cortical and subcortical brain regions were similar between groups. Neither current body mass index nor age correlated with rCBF values. CONCLUSION: The results from this study indicate that rCBF normalizes with long-term recovery. Thus, altered rCBF is unlikely to confound functional imaging studies in AN or BN after recovery.     

Bulimia nervosa: Friend or foe? The pros and cons of bulimia nervosa

OBJECTIVE: The aim of the current study was to use a qualitative approach to investigate the attitude of people with bulimia nervosa (BN) to their illness. METHOD: Patients with BN were asked to write two letters to their bulimia, one addressing it as a friend and the other addressing it as an enemy. We used a coding scheme to classify themes in letters of people with anorexia nervosa (AN) to group together themes expressed by those with BN. We revised the coding scheme to include themes that were not present in the letters of people with AN. RESULTS: There were both similarities and differences in the themes described by AN and BN patients. Two positive themes (BN allowing the individuals to eat and not get fat and BN as a way of dealing with boredom) and two negative themes (shame or low self-esteem resulting from BN and obsessive thoughts of weight and shape) were added to the coding scheme to account for these differences. DISCUSSION: The positive and negative aspects of BN differ in some important ways from those expressed by patients with AN. The meaning of these differences is discussed with reference to the wider symptom pattern of BN compared with AN and their importance with reference to motivation for change is outlined.     

Eating Disorders Examination versus Eating Disorders Examination-Questionnaire in adolescents with full and partial-syndrome bulimia nervosa and anorexia nervosa

OBJECTIVE: The current study compared the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in adolescents with eating disorders. METHOD: Adolescents (N = 70) with bulimia nervosa (BN; n = 21), partial-syndrome BN (PBN; n = 25), and anorexia nervosa (AN; n = 24) were assessed with the EDE and EDE-Q. RESULTS: Moderate to high correlations were found on all four subscales within and between diagnostic groups. The discrepancy between the EDE and EDE-Q was significantly greater in BN relative to PBN and AN for the Eating Concern subscale. Objective binge episode (OBE) frequency in BN and subjective binge episode (SBE) frequency in BN and PBN were higher with the EDE compared with the EDE-Q. Self-induced vomiting was highly correlated between the two measures. DISCUSSION: Adolescents with BN, PBN, and AN exhibited strong correspondence between the EDE interview and questionnaire formats. However, this consistency was not as pronounced for BN as it was for PBN and AN. The current study lends preliminary credibility to the use of the EDE-Q in adolescent eating disorder samples.     

Specific and nonspecific comorbidity in anorexia nervosa

OBJECTIVE: This article reports lifetime Axis I and II comorbidity in women with anorexia nervosa (AN), and ascertains specific and nonspecific comorbidity in AN compared to clinical samples of women with bulimia nervosa (BN) or major depression (DEP). METHOD: Outpatient AN (n = 56), BN (n = 132), and DEP (n = 100) samples were assessed using Structured Clinical Interviews I and II for DSM-III-R. Baseline data were compared using univariate statistics and logistic regression. RESULTS: In the AN sample as a whole, specific elevations were found for prevalences of obsessive compulsive disorder. The AN-binge eating purging subtype (AN-BP) and the BN sample had elevated prevalences of Cluster B personality disorders. Cluster C prevalences were elevated across samples. CONCLUSION: Evidence of AN-specific, eating disorder-specific, and nonspecific comorbidity illustrates the heterogeneity in AN. Further research is need to examine the relative impact of specific and nonspecific comorbidity in AN subtypes and AN as a whole.     

Outcomes of eating disorders: a systematic review of the literature

OBJECTIVE: The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center systematically reviewed evidence on factors associated with outcomes among individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) and whether outcomes differed by sociodemographic characteristics. METHOD: We searched electronic databases including MEDLINE and reviewed studies published from 1980 to September, 2005, in all languages against a priori inclusion/exclusion criteria and focused on eating, psychiatric or psychological, or biomarker outcomes. RESULTS: At followup, individuals with AN were more likely than comparisons to be depressed, have Asperger's syndrome and autism spectrum disorders, and suffer from anxiety disorders including obsessive-compulsive disorders. Mortality risk was significantly higher than what would be expected in the population and the risk of suicide was particularly pronounced. The only consistent factor across studies relating to worse BN outcomes was depression. A substantial proportion of individuals continue to suffer from eating disorders over time but BN was not associated with increased mortality risk. Data were insufficient to draw conclusions concerning factors associated with BED outcomes. Across disorders, little to no data were available to compare results based on sociodemographic characteristics. CONCLUSION: The strength of the bodies of literature was moderate for factors associated with AN and BN outcomes and weak for BED.     

Review of the prevalence and incidence of eating disorders

OBJECTIVE: To review the literature on the incidence and prevalence of eating disorders. METHODS: We searched Medline using several key terms relating to epidemiology and eating disorders and we checked the reference lists of the articles that we found. Special attention has been paid to methodologic problems affecting the selection of populations under study and the identification of cases. RESULTS: An average prevalence rate for anorexia nervosa of 0.3% was found for young females. The prevalence rates for bulimia nervosa were 1% and 0.1% for young women and young men, respectively. The estimated prevalence of binge eating disorder is at least 1%. The incidence of anorexia nervosa is 8 cases per 100,000 population per year and the incidence of bulimia nervosa is 12 cases per 100,000 population per year. The incidence of anorexia nervosa increased over the past century, until the 1970s. DISCUSSION: Only a minority of people who meet stringent diagnostic criteria for eating disorders are seen in mental health care.     

Changes in weight and body image over time in women with eating disorders

BACKGROUND: This study examined the changes in body image and weight in young women with an adolescent eating disorder, relative to women without an eating disorder (noED). METHOD: Three diagnostic groups, anorexia nervosa (AN; n = 10), bulimia nervosa (BN; n = 27), and binge eating disorder (BED; n = 42) and three comparison groups (noED; n = 659 each) were compared on body mass index (BMI) and self-reported current body size, ideal body size, and weight dissatisfaction. Dependent variables were examined 2 and 1 year before the onset, the onset year, and 1 and 2 years after the onset of the eating disorder in a model that was adjusted for ethnicity and BMI. RESULTS: BMI was lower in the AN group at all time points except 2 years before onset. AN girls evidenced a significantly stronger relation between BMI and current self-ratings and weight dissatisfaction than noED girls. BMI did not differ between the BN group and the noED group. Girls with BN reported larger current body sizes and greater weight dissatisfaction across all time points. The BED group had higher BMI than the noED group across time. BED girls reported greater current body size ratings and weight dissatisfaction than the noED girls. Girls with AN, BN, or BED did not differ from the noED girls on body ideal ratings. DISCUSSION: Body weight seems to influence perception of body size more so for girls with AN than for noED girls. No support was found for an accelerated weight gain over time for BN. Weight may increase over time for the BED group relative to the noED group, but larger studies are needed. Across all three groups, ideal body size appears to be unrelated to diagnostic status. Rather, the risk for developing an eating disorder appears to arise from size overestimation and related weight dissatisfaction.     

Eating disorders and substance use. An examination of behavioral associations

The association between the eating disorders of anorexia nervosa (AN) and bulimia nervosa (BN) and substance use disorder (SUD) has been widely investigated, however, our understanding of the relationship between the disorders remains unclear. Explanatory models have tended to focus on behaviors, yet, little is currently known about the patterns of association among disordered eating and substance use behaviors. In this exploratory study, a behavioral approach was used to investigate the cooccurrence of seven disordered eating and three substance use behaviors in women meeting current DSM-III-R criteria for AN (n=12), subthreshold AN (n=14), BN (n=29), and subthreshold BN (n=24). Results suggest that disordered eating behaviors are differentially associated with substance use behaviors. The most robust finding was that diuretic use positively predicted the current level of alcohol use regardless of diagnostic group. The findings for marijuana and tobacco use were less consistent. Results suggest that rather than being pervasive in all eating disordered women, higher levels of alcohol use may be found in those women who use diuretics.     

The clinical presentation of Japanese women with anorexia nervosa and bulimia nervosa: a study of the Eating Disorders Inventory-2

OBJECTIVE: The current study described the clinical presentation of anorexia nervosa (AN) and bulimia nervosa (BN) in Japan utilizing the Eating Disorders Inventory-2 (EDI-2) and assessed whether the clinical profile of eating disorder cases in Japan differs significantly from North American data. METHOD: Statistical comparisons of Japanese AN, BN, and non-eating-disordered (NonED) EDI-2 data were conducted across diagnostic groups and with the North American standardization sample. RESULTS: The Japanese diagnostic groups reported significant between-group differences on all eight EDI-2 subscales. Compared with the standardization sample, all the Japanese groups reported significantly greater maturity fears, the Japanese AN-restricting subtype group (AN-R) reported lower levels of drive for thinness and perfectionism, the Japanese BN group reported lower levels of drive for thinness, and the Japanese NonED Group reported lower levels of drive for thinness and perfectionism but higher rates of ineffectiveness. DISCUSSION: Differences between the Japanese and North American groups suggest that certain cultural differences exist in eating disorder profiles.     

College students' mental models for recognizing anorexia and bulimia nervosa

Knowledge about eating disorders influences lay people's ability to recognize individuals with anorexia nervosa (AN) and bulimia nervosa (BN) and refer them to professional treatment. We assessed mental models (stored knowledge) of AN and BN in 106 college students. Results indicated that most students have general, but not specific, information about AN and BN's symptoms, consequences, causes, duration, and cures. They also believe that people with eating disorders tend to be young, White women. These findings suggest that lay recognition of eating disorders may be based primarily on observations of dysfunctional eating behaviors and therefore facilitated by additional knowledge.     

Eating disorder symptomatology and substance use disorders: Prevalence and shared risk in a population based twin sample

Objective:

Research shows a significant association between eating disorders (ED) and substance use disorders (SUD). The objective of this study is to examine the prevalence, chronology, and possibility of shared familial risk between SUD and ED symptomatology.

Method:

Subjects included 1,206 monozygotic and 877 dizygotic adult female twins. ED symptomatology included anorexia (AN) and bulimia nervosa (BN) diagnosis, symptoms associated with diagnostic criteria, and BN symptom count. SUD included alcohol, illicit drug, and caffeine abuse/dependence. Generalized estimated equation modeling was used to examine phenotypic associations, and Choleksy decompositions were used to delineate the contribution of genes and environment to comorbidity.

Results:

There were no significant differences between SUD prevalence in women with AN and BN. Women with BN reported BN preceded SUD development while the reverse was true for AN. Twin analyses showed possible familial overlap between BN symptomatology and all SUD examined.

Discussion:

Results suggest an important difference in the chronology of EDs and SUDs. Women with BN may be turning to substances to dampen bulimic urges. Women with AN may be engaging in substance use initially in an effort to lose weight. Results also suggest familial factors contribute to the comorbidity between BN and SUD. © 2010 by Wiley Periodicals, Inc. (Int J Eat Disord 2010;)     

Subjective binge eating with compensatory behaviors: A variant presentation of bulimia nervosa

Objectives:

To determine whether a variant bulimic‐type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., “subjective bulimia nervosa,” SBN), has comparable clinical severity to established eating disorders, particularly BN.

Method:

Treatment‐seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN‐R) (N = 45), and AN‐binge/purge type (AN‐B/P) (N = 24) were compared.

Results:

Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN‐R and AN‐B/P.

Discussion:

Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment‐seeking, and outcomes. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

Nutrition entérale à domicile en cas de troubles du comportement alimentaire

Weight restoration is crucial for successful treatment of anorexia nervosa (AN). Without it, patients may face serious or even fatal complications of severe starvation. Renutrition should take into account clinical characteristics unique to these patients, such as gastroparesis and fear of gaining body weight. The efficacy of tube feeding and home-tube feeding (Home-TF) has been suggested in AN and proven in bulimia nervosa (BN). TF and home-TF allow a better body weight gain (mainly fat-free mass) in AN patients and a strong decrease in the frequency and the intensity of binge-eating/purging episodes at relatively short-term (1 year) in BN patients. In AN, home-TF does not increase anxiety, depression, or worsen the eating behavior. In BN patients, home-TF decreases anxiety and depressive state and improves the quality of life. The goal of home-TF is not to cure the patients, but only to avoid serious malnutrition and its complications and to insure a better investment of the patients for their psychotherapy. Home-TF must be associated with psychotherapy, namely cognitive behavioural therapy and family therapy in adolescents. If the fear of gaining body weight is too high, the risk of failure of home-TF, because of poor compliance, is increasing. In any case, the aims and the goals of home-TF should be extensively explained.     

Invasive cervical cancer among American Indian women in the Northern Plains, 1994-1998: incidence, mortality, and missed opportunities

OBJECTIVES: Cervical cancer mortality rates among the American Indian and Alaska Native (AI/AN) population in North and South Dakota were five times the national average (15.6 per 100,000 vs. 3.1 per 100,000, age adjusted) when last evaluated (from 1989 through 1993). Our goals were to update the AI/AN population cervical cancer mortality rates and to present incidence rates for AI/AN women in the region. METHODS: We reviewed charts for women diagnosed with invasive cervical cancer at Indian Health Service (IHS) facilities in North and South Dakota from 1994 through 1998 and collected information about cervical cancer screening and treatment history. Incidence and mortality rates were standardized to the 1970 U.S. population. RESULTS: Twenty-one cases of invasive cervical cancer and eight deaths were identified. Annualized incidence and mortality rates were 11.5 per 100,000 and 4.5 per 100,000. These compare with national all-race/ethnicity rates of 8.5 per 100,000 and 2.7 per 100,000 for incidence and mortality. Fifteen (71%) of 21 cases were diagnosed due to symptoms. CONCLUSIONS: While cervical cancer mortality rates have declined, incidence and mortality rates among AI/AN women remain higher than in the general U.S. population. Increased use of pap tests and careful follow-up of abnormal results should be aggressively promoted among AI/AN women in North and South Dakota.     

Artificial sweetener use among individuals with eating disorders

Women with eating disorders report using large quantities of artificially sweetened products, but this has not been quantified. OBJECTIVE: The authors assessed the use of selected artificially sweetened low-calorie products among women with eating disorders compared with controls. METHOD: Thirty women with anorexia nervosa (18 with the restricting subtype [AN-R] and 12 with the binge/purge subtype [AN-B/P]), 48 women with bulimia nervosa (BN), and 32 healthy control women completed a survey of frequency and amount of consumption of chewing gum, artificially sweetened low-calorie beverages, and packets of artificial sweetener in the previous month. RESULTS: A greater proportion of women with AN-B/P and BN reported use of each product, compared with women with AN-R and control participants. Among product users, patients with eating disorders reported using greater amounts than controls. Among patients who reported binge eating and/or purging, the quantity of each product used was inversely correlated with body mass index (BMI). CONCLUSION: These data suggest an increased drive for sweet orosensory stimulation in women with AN and BN.